Apr 28, 2020 | TPC Outstanding Scholar
Jennifer L. Rogers, Jamie E. Crockett, and Esther Suess
Jennifer L. Rogers, Jamie E. Crockett, and Esther Suess received the 2019 Outstanding Scholar Award for Concept/Theory for their article, “Miscarriage: An Ecological Examination.”
Jennifer L. Rogers, PhD, NCC, is an assistant professor in the Wake Forest University Department of Counseling. She received her PhD in counseling and counselor education from Syracuse University. Her clinical and research interests are centered around relational approaches to counseling, supervision, and counselor preparation across ecologically diverse practice contexts. Her current research focuses upon how attachment and cognitive patterns among beginning counselors influence their experiences during clinical supervision.
Jamie E. Crockett, PhD, NCC, LCMHCA, is an assistant professor in the Wake Forest University Department of Counseling and a clinical mental health counselor at Triad Counseling and Clinical Services. Her clinical and research interests include human development, attachment, gender and sexuality, reproductive health, grief and loss, contemplative and breath-based approaches, emotion, wellness, religion and spirituality, ethics, feminism, and diversity and culture.
Esther Suess, MA, NCC, LPC-A, LCMHCA, is a mental health counselor at the Mood Treatment Center in Winston-Salem, North Carolina, with a specialty in the treatment of eating disorders and obsessive-compulsive disorder. She graduated with an undergraduate degree in psychology from University College Dublin in 2016 and received her master’s degree in clinical mental health counseling from Wake Forest University in 2018. Her research interests include cultural diversity and biopsychosocial factors in counseling and eating disorders.
Read more about the TPC scholarship awards here.
Mar 9, 2020 | Volume 10 - Issue 1
Michael T. Kalkbrenner
College counselors work collaboratively with professionals in a variety of disciplines in higher education to coordinate gatekeeper training to prepare university community members to recognize and refer students in mental distress to support services. This article describes the cross-validation of scores on the Mental Distress Response Scale (MDRS), a questionnaire for appraising university community members’ responses to encountering a student in mental distress, with a sample of faculty members. A confirmatory factor analysis revealed the dimensions of the MDRS were estimated adequately. Results also revealed demographic differences in faculty members’ responses to encountering a student in mental distress. The MDRS has implications for augmenting the outreach efforts of college counselors. For example, the MDRS has potential utility for enhancing campus-wide mental health screening efforts. The MDRS also has implications for supporting psychoeducation efforts, including gatekeeper training workshops, for professional counselors practicing in college settings.
Keywords: Mental Distress Response Scale, mental health, college counselors, gatekeeper, outreach
College counselors play crucial roles in supporting students’ personal, social, and academic growth, as well as students’ success (Golightly et al., 2017). Outreach and prevention programming, including campus violence prevention and supporting college student mental health, are two key elements in the practice of college counselors (Brunner et al., 2014; Golightly et al., 2017). Addressing these two key areas has become increasingly challenging in recent years because of the prevalence of campus violence incidents, including mass shootings in the most severe cases, and the frequency of mental health distress among college students, which has increased substantially since the new millennium (Auerbach et al., 2016; Barrett, 2014; Vieselmeyer et al., 2017). In fact, supporting college student mental health has become one of the greatest challenges that institutions of higher education are facing (Reynolds, 2013).
Most college students suffering from mental health issues do not seek treatment (Downs & Eisenberg, 2012). In response, college counselors, student affairs professionals, and higher education administrators are working collaboratively to develop and implement mental health awareness initiatives and gatekeeper training workshops, which include training university community members (e.g., students, faculty, and staff) as referral agents to recognize and refer students who are showing warning signs for suicide or other mental health issues to support services (Albright & Schwartz, 2017; Hodges et al., 2017). Faculty members are particularly valuable referral agents, as they tend to interact with large groups of students on frequent occasions, and they generally report positive attitudes about supporting college student mental health (Albright & Schwartz, 2017; Kalkbrenner, 2016).
Despite the utility of faculty members as gatekeepers for recognizing and referring students to the university counseling center and to other resources, the results of a recent national survey indicated that a significant proportion of faculty members (63%) do not refer a student in mental distress to support services (Albright & Schwartz, 2017). The literature is lacking research on how faculty members are likely to respond to encountering a student in mental distress, including but not limited to making a faculty-to-student referral to mental health support services. The primary aim of this investigation was to confirm the psychometric properties of the Mental Distress Response Scale (MDRS), a screening tool for measuring university community members’ responses to encountering a student in mental distress. Past investigators validated the MDRS for use with 4-year university students (Kalkbrenner & Flinn, 2020) and community college students (Kalkbrenner, 2019). If found valid for use with faculty members, college counselors could find the MDRS useful for screening and promoting faculty-to-student mental health support. A review of the extant literature is provided in the following section.
Mental Health and the State of Higher Education
Active shooter incidents on college campuses are some of the most tragic events in American history (Kalkbrenner, 2016). The 2015 massacre that occurred on a college campus in Oregon received attention at the highest level of government; former President Barack Obama urged the nation to decide when voting “whether this cause of continuing death for innocent people should be a relevant factor.” (Vanderhart et al., 2015, section A, p. 1). Seung-Hui Cho was a perpetrator of another one of these tragedies at Virginia Polytechnic Institute in 2007. According to Cho’s mother, he had a history of social isolation and unresolved mental health issues (Klienfield, 2007). Without treatment, the effects of mental health disorders can be debilitating and widespread for students, including impairments in academic functioning, attrition, self-harm, social isolation, and suicide or homicide in the most serious cases (Kalkbrenner, 2016; Shuchman, 2007). The early detection and treatment of students who are at risk for mental health disorders is a harm-prevention strategy for reducing campus violence incidents and promoting college student mental health (Futo, 2011; Kalkbrenner, 2016). Consequently, the practice of college counselors involves deploying outreach and systems-level mental health support interventions (Albright & Schwartz, 2017; Brunner et al., 2014; Golightly et al., 2017).
The Role of College Counselors in Providing Systems-Level Interventions
Providing individual counseling is a key role of college counselors (Golightly et al., 2017). In recent years, however, the practice of college counselors has been extended to providing systems-level and preventative mental health interventions to meet the growing mental health needs of college student populations (Brunner et al., 2014; Golightly et al., 2017). In particular, college counselors and their constituents engage in both campus-wide and targeted prevention and outreach programs (Golightly et al., 2017; Lynch & Glass, 2019), including gatekeeper training workshops to prepare university community members as referral agents or train them to recognize and refer students at risk for suicide and other mental health issues to the university counseling center (Albright & Schwartz, 2017; Brunner et al., 2014). These collaborative, educative, and preventative efforts are particularly crucial given the increase in both the severity and complexity of mental health disorders among college students (Gallagher, 2015; Reetz et al., 2016). The findings of past investigators suggest that faculty members are particularly viable referral agents for recognizing and referring students in mental distress to the counseling center (Kalkbrenner, 2016; Margrove et al., 2014).
Faculty Members as Referral Agents
Faculty members have a propensity to serve as referral agents (i.e., recognize and refer students in mental distress to resources) because of their frequent contact with students and their generally positive attitudes and willingness to support their students’ mental and physical wellness (Albright & Schwartz, 2017). Albright and Schwartz (2017) found that approximately 95% of faculty members and staff considered connecting students in mental distress to resources as one of their roles and responsibilities. Similarly, Margrove et al. (2014) found that 64% of untrained university staff members expressed a desire to receive training to recognize warning signs of mental health disorders in students.
Past investigators extended the line of research on the utility of faculty members as gatekeepers by identifying demographic differences by gender and help-seeking history (previous attendance in counseling) in faculty members’ tendency to support college student mental health (Kalkbrenner & Carlisle, 2019; Kalkbrenner & Sink, 2018). In particular, Kalkbrenner and Sink (2018) identified gender as a significant predictor of faculty-to-student counseling referrals, with faculty who identified as female more likely to make faculty-to-student referrals to the counseling center compared to their male counterparts. Similarly, Kalkbrenner and Carlisle (2019) found that faculty members’ awareness of warning signs for mental distress in students was a significant positive predictor of faculty-to-student referrals to the counseling center. In addition, faculty members with a help-seeking history (previous attendance in counseling) were significantly more aware of warning signs for mental distress in their students compared to faculty without a help-seeking history (Kalkbrenner & Carlisle, 2019).
Faculty Members’ Responses to Encountering a Student in Mental Distress
Despite the growing body of literature on institutional agents’ participation in gatekeeper training (i.e., recognize and refer), research on the measurement and appraisal of how faculty members are likely to respond when encountering a student in mental distress is in its infancy. The results of a recent national survey of college students (N = 51,294) and faculty members (N = 14,548) were troubling, as 63% of faculty members did not refer a student in psychological distress to mental health support services (Albright & Schwartz, 2017). Making a referral to the university counseling center is one possible response of students and faculty members to encountering a peer or student in mental distress (Kalkbrenner & Sink, 2018). However, the findings of Albright and Schwartz (2017) highlight a gap in the literature regarding how university community members are likely to respond when encountering a student in mental distress, including but not limited to making a faculty-to-student referral to the college counseling center.
To begin filling this gap in the literature, Kalkbrenner and Flinn (2020) developed, validated, and cross-validated scores on the MDRS to assess 4-year university students’ responses to encountering a student in mental distress, including but not limited to making a referral to mental health support services. In a series of two major phases of psychometric analyses, Kalkbrenner and Flinn identified and confirmed two dimensions or subscales of the MDRS, including Diminish/Avoid and Approach/Encourage, with two large samples of undergraduate students. The Diminish/Avoid subscale measures adverse or inactive responses of university community members to encountering a student in mental distress (e.g., stay away from the person or warn the person that mental issues are perceived as a weakness). The Approach/Encourage subscale appraises facilitative or helpful responses of university community members when encountering a student in mental distress that are likely to help connect the person to resources (e.g., talking to a college counselor or suggesting that the person go to the campus counseling or health center). However, the psychometric properties of the MDRS have not been tested with faculty members. If found valid for such purposes, the MDRS could be a useful tool that college counselors and their constituents can use to screen and promote faculty-to-student referrals to mental health support services. In particular, the following research questions were posed: (1) Does the two-dimensional hypothesized MDRS model fit with a sample of faculty members? and (2) To what extent are there demographic differences in faculty members’ responses to encountering a student in mental distress?
Method
Participants and Procedures
Data were collected electronically from faculty members using Qualtrics, a secure e-survey platform. A nonprobability sampling procedure was used by sending a recruitment email message with an electronic link to the survey to 1,000 faculty members who were teaching at least one course at a research-intensive, mid-Atlantic public university at the time of data collection. A total of 221 faculty members clicked on the electronic link to the survey and 11 responses were omitted from the data set because of 100% missing data, resulting in a useable sample size of 210, yielding a response rate of 21%. This response rate is consistent with the response rates of other investigators (e.g., Brockelman & Scheyett, 2015; Kalkbrenner & Carlisle, 2019) who conducted survey research with faculty members. For gender, 58% (n = 122) identified as female, 41% (n = 86) as male, and 0.5% (n = 1) as non-binary or third gender, and 0.5% (n = 1) did not specify their gender. For ethnicity, 79.0% (n = 166) identified as Caucasian, 6.2% (n = 11) as African American, 3.8% (n = 8) as Hispanic or Latinx, 2.9% (n = 6) as Asian, 2.9% (n = 6) as multiethnic, 0.5% (n = 1) as Hindu, and 0.5% (n = 1) as Irish, and 5.2% (n = 11) did not specify their ethnic identity. Participants ranged in age from 31 to 78 (M = 50; SD = 11). Participants represented all of the academic colleges in the university, including 28.6% (n = 60) Arts and Letters, 22.9% (n = 48) Education, 18.1% (n = 38) Sciences, 12.9% (n = 27) Health Sciences, 9% (n = 19) Engineering and Technology, and 7.6% (n = 16) Business, while 1% (n = 2) of participants did not specify their college.
Instrumentation
Demographic questionnaire
Following informed consent, participants were asked to indicate that they met the inclusion criteria for participation, including (1) employment as a faculty member, and (2) teaching at least one course at the time of data collection. Participants then responded to a succession of demographic items about their gender, ethnicity, age, academic college, and highest level of education completed. Lastly, respondents indicated their rank and help-seeking history (previous attendance in counseling or no previous attendance in counseling) and if they had referred at least one student to mental health support services.
Mental Distress Response Scale (MDRS)
The MDRS is a screening tool comprised of two subscales (Approach/Encourage and Diminish/Avoid) for measuring university community members’ responses to encountering a student in mental distress (Kalkbrenner & Flinn, 2020). The items that mark the Approach/Encourage subscale appraise responses to mental distress that are consistent with providing support and encouragement to a student in mental distress (e.g., “suggest that they go to the health center on campus”). The Diminish/Avoid subscale measures adverse or inactive responses to encountering a student in mental distress (e.g., “try to ignore your concern”). Kalkbrenner and Flinn (2020) found adequate reliability evidence for an attitudinal measure (α > 0.70) and initial validity evidence for the MDRS in two major phases of analyses (exploratory and confirmatory factor analysis [CFA]) with two samples of college students. Kalkbrenner (2019) extended the line of research on the utility of the MDRS for use with community college students and found adequate reliability (α > 0.80) and validity evidence (single and multiple-group confirmatory analysis).
Data Analysis
A CFA based on structural equation modeling was computed using IBM SPSS Amos version 25 to cross-validate scores on the MDRS with a sample of faculty members (research question #1). Using a maximum likelihood estimation method, the following goodness-of-fit indices and thresholds for defining model fit were investigated based on the recommendations of Byrne (2016) and Hooper et al. (2008): Chi square absolute fit index (CMIN, non-significant p-value with an x2/df ratio < 3), comparative fit index (CFI > 0.95), incremental fit index (IFI > 0.95), Tucker-Lewis index (TLI > 0.95), goodness-of-fit index (GFI > 0.95), root mean square error of approximation (RMSEA < 0.07), and standardized root mean square residual (SRMR < 0.08). Based on the findings of past investigators (e.g., Kalkbrenner & Sink, 2018) regarding demographic differences in faculty members’ propensity to support college student mental health, a 2 X 2 (gender X help-seeking history) MANOVA was computed to investigate demographic differences in faculty members’ responses to encountering a student in mental distress (research question #2). The independent variables included gender (male or female) and help-seeking history (previous attendance in counseling or no previous attendance in counseling). Discriminant analysis was used as the post hoc procedure for significant findings in the MANOVA (Warne, 2014). The researcher examined both main effects and interaction effects and applied Bonferroni adjustments to control for the familywise error rate.
Results
CFA
The researcher ensured that the data set met the necessary assumptions for CFA (Byrne, 2016; Field, 2018). A missing values analysis revealed that less than 5% of data was missing for all MDRS items. Little’s Missing Completely at Random (MCAR) test revealed that the data was missing at random: χ2 (387) = 407.98, p = 0.22. Expectation maximization was used to impute missing values. Outliers were winsorized (Field, 2018) and skewness and kurtosis values for the MDRS items (see Table 1) were largely consistent with a normal distribution (+ 1; Mvududu & Sink, 2013). Inter-item correlations between the 10 items were favorable for CFA, and Mahalanobis d2 indices revealed no extreme multivariate outliers. The researcher ensured that the sample size was sufficient for CFA by following the guidelines provided by Mvududu and Sink (2013), including at least 10 participants per estimated parameter with a sample > 200.
Table 1
Descriptive Statistics for MDRS Items
| Item Content |
M |
SD |
Skew |
Kurtosis |
| 1. I would stay away from this person |
49.83 |
9.46 |
1.11 |
0.22 |
| 2. Suggest that they go to the health center on campus |
50.15 |
9.48 |
-0.60 |
-0.08 |
| 3. Try to ignore your concern |
49.74 |
9.08 |
1.07 |
1.08 |
| 4. Take them to a party |
49.21 |
3.11 |
0.70 |
0.81 |
| 5. Tell them to “tough it out” because they will feel better over time |
49.73 |
8.94 |
1.32 |
1.26 |
| 6. Suggest that they see a medical doctor on campus |
50.00 |
9.98 |
-0.24 |
-0.06 |
| 7. Avoid this person |
49.70 |
9.02 |
1.80 |
1.33 |
| 8. Suggest that they see a medical doctor in the community |
50.00 |
9.98 |
-0.49 |
-0.10 |
| 9. Warn the person that others are likely to see their mental health issues as a weakness |
49.31 |
7.14 |
1.90 |
1.59 |
| 10. Talk to a counselor about your concern |
50.00 |
9.97 |
-0.83 |
0.15 |
SEKurtosis = 0.15, SESkewness = 0.17.
Note. Values were winsorized and reported as standardized t-scores (M = 50; SD = 10).
The 10 MDRS items (see Table 1) were entered in the CFA. A strong model fit emerged based on the GFI recommended by Byrne (2016) and Hooper et al. (2008). The CMIN absolute fit index demonstrated no significant differences between the hypothesized model and the data: χ2 (34) = 42.41, p = 0.15, CMIN/df = 1.25. In addition, the CFI = 0.98, GFI = 0.96, IFI = 0.98, TLI = 0.98, RMSEA = 0.03, 90% confidence interval [<.00, .06], and SRMR = 0.05 also demonstrated a strong model fit. Internal consistency reliability analyses (Cronbach’s coefficient alpha) revealed satisfactory reliability coefficients for an attitudinal measure, Diminish/Avoid (α = 0.73) and Approach/Encourage (α = 0.70). In addition, the path model coefficient (-0.04) between factors supported the structural validity of the scales (see Figure 1).
Figure 1
Confirmatory Factor Analysis Path Diagram for the Mental Distress Response Scale
Note. CFA = confirmatory factor analysis, MDRS = Mental Distress Response Scale.
Multivariate Analysis
A 2 X 2 (gender X help-seeking history) MANOVA was computed to investigate demographic differences in faculty members’ responses to encountering a student in mental distress (research question #2). G*Power was used to conduct an a priori power analysis (Faul et al., 2007) and revealed that a minimum sample size of 151 would provide a 95% power estimate, α = .05, with a moderate effect size, F2(v) = 0.063. A significant main effect emerged for gender: F(3, 196) = 8.27, p < 0.001, Wilks’ λ = 0.92, = 0.08. The MANOVA was followed up with a post hoc discriminant analysis based on the recommendations of Warne (2014). The discriminant function significantly discriminated between groups: Wilks’ λ = 0.91, X2 = 18.85, df = 2, p < 0.001. The correlations between the latent factors and discriminant function showed that Diminish/Avoid loaded more strongly on the function (r = 0.98) than Approach/Encourage (r = 0.29), suggesting that Diminish/Avoid contributed the most to group separation in gender. The mean discriminant score on the function was -0.27 for participants who identified as female and 0.37 for participants who identified as male.
Discussion
The results of tests of internal consistency reliability (Cronbach’s coefficient alpha), CFA, and correlations between factors supported the psychometric properties of the MDRS with a sample of faculty members. The results of the CFA were promising as GFI demonstrated a strong model fit between the two-dimensional hypothesized MDRS model and a sample of faculty members (research question #1). In particular, based on one of the most conservative and rigorous absolute fit indices, the CMIN (Byrne, 2016; Credé & Harms, 2015), the researchers retained the null hypothesis—there were no significant differences between the hypothesized factor structure of the MDRS and a sample of faculty members. The strong model fit suggests that Approach/Encourage and Diminish/Avoid are two latent variables that comprise faculty members’ responses to encountering a student in mental distress. The findings of the CFA add to the extant literature about the utility of the MDRS for use with 4-year university students (Kalkbrenner & Flinn, 2020), community college students (Kalkbrenner, 2019), and now with faculty members.
An investigation of the path model coefficient between subscales (see Figure 1) revealed a small and negative association between factors, which supports the structural validity of the MDRS. In particular, the low and negative relationship between the Approach/Encourage and Diminish/Avoid subscales indicates that the dimensions of the MDRS are measuring discrete dimensions of a related construct. As expected, faculty members who scored higher on the Approach/Encourage subscale tended to score lower on the Diminish/Avoid subscale. However, the low strength of the association between factors suggests that faculty members’ responses to encountering a student in mental distress might not always be linear (e.g., a strong positive approach/encourage response might not always be associated with a strong negative diminish/avoid response). Haines et al. (2017) demonstrated that factors in the environment and temperament of a person showing signs of mental distress were significant predictors of mental health support staff’s perceptions of work safety. It is possible that under one set of circumstances faculty members might have an approach/encourage response to mental distress. However, under a difference set of circumstances, a faculty member might have a diminish/avoid response. For example, the extent to which a faculty member feels threatened or unsafe might mediate their propensity of having diminish/avoid or approach/encourage responses. Future research is needed to evaluate this possibility.
Consistent with the findings of previous researchers (Kalkbrenner & Carlisle, 2019; Kalkbrenner & Sink, 2018), the present investigators found that faculty members who identified as male were more likely to report a diminish/avoid response to encountering a student in mental distress compared to female faculty members. Similarly, Kalkbrenner and Sink (2018) found that male faculty members were less likely to make faculty-to-student referrals to the counseling center, and Kalkbrenner and Carlisle (2019) found that male faculty members were less likely to recognize warning signs of mental distress in college students. Similarly, the multivariate results of the present investigation revealed that male faculty members were more likely to report a diminish/avoid response to encountering a student in mental distress when compared to female faculty members. The synthesized findings of Kalkbrenner and Carlisle (2019), Kalkbrenner and Sink (2018), and the present investigation suggest that faculty members who identify as male might be less likely to recognize and refer a student in mental distress to mental health support services. The MDRS has valuable implications for enhancing the practice of professional counselors in college settings.
Implications for Counseling Practice
Outreach, consultation, and psychoeducation are essential components in the practice of college counselors (Brunner et al., 2014; Golightly et al., 2017). The findings of the present investigation have a number of practical implications for enhancing college counselors’ outreach and psychoeducation work—for example, gatekeeper workshops geared toward promoting faculty-to-student referrals to mental health support resources. The complex and multidimensional nature of college student mental health issues calls for interdisciplinary collaboration between college counselors and professionals in a variety of disciplinary orientations in higher education (Eells & Rockland-Miller, 2011; Hodges et al., 2017). College counselors can take leadership roles in coordinating these collaborative efforts to support college student mental health. In particular, college counselors can work with student affairs officials, higher education administrators, and their constituents, and attend new faculty orientations as well as department meetings to administer the MDRS, establish relationships with faculty, and discuss the benefits of gatekeeper training as well as supporting college student mental health. The results of the MDRS can be used to gain insight into the types of responses that faculty members are likely to have when encountering a student in mental distress. This information can be used to structure the content of gatekeeper training workshops aimed at promoting faculty-to-student referrals to mental health support services. Specifically, college counselors might consider the utility of integrating brief interventions and skills training components into gatekeeper training workshops. Motivational interviewing, for example, is an evidence-based, brief approach to counseling that includes both person-centered and directive underpinnings with utility for increasing clients’ intrinsic motivation to make positive changes in their lives (Iarussi, 2013; Resnicow & McMaster, 2012). Professional counselors who practice in higher education are already using motivational interviewing to promote college student development and mental health (Iarussi, 2013). Although future research is needed, integrating motivational interviewing principles (e.g., expressing empathy, rolling with resistance, developing discrepancies, and supporting self-efficacy; Iarussi, 2013) into gatekeeper training workshops might increase faculty members’ commitment to supporting college student mental health.
The MDRS has the potential to enhance college counselors’ outreach and mental health screening efforts (Golightly et al., 2017). College counselors can incorporate the MDRS into batteries of pretest/posttest measures (e.g., the MDRS with a referral self-efficacy measure) for evaluating the effectiveness of mental health awareness initiatives and gatekeeper training programs for faculty and other members of the campus community. If administered widely, the MDRS might have utility for assessing faculty members’ responses to students in mental distress across time and among various campus ecological systems, providing data to drive the prioritization and allocation of outreach efforts aimed at facilitating and maintaining referral networks for connecting students in mental distress to support services.
The results of the present study have policy implications related to campus violence prevention programming. The sharp increase in campus violence incidents has resulted in several universities implementing threat assessment teams as a harm-prevention measure (Eells & Rockland-Miller, 2011). Threat assessment teams involve an interdisciplinary collaboration of university faculty and staff for the purposes of recognizing and responding to students who are at risk of posing a threat to themselves or to others. College counselors can take leadership roles in establishing and supporting threat assessment teams at their universities. College counselors can administer the MDRS to faculty and staff and use the results as one way to identify potential threat assessment team members. University community members who score higher on the Approach/Encourage scale might be inclined to serve on threat assessment teams because of their propensity to support college student mental health. The brevity (10 questions) and versatility of administration (paper copy or electronically via laptop, smartphone, or tablet) of the MDRS adds to the practicality of the measure. Specifically, it might be practical for college counselors and their constituents to administer the MDRS during new faculty orientations, annual opening programs, or department meetings, or via email to faculty and staff. Results can potentially be used to recruit threat assessment team members.
Our findings indicate that when compared to their female counterparts, male faculty members might be more likely to have a diminish/avoid response when encountering a student in mental distress. College counselors might consider working collaboratively with student affairs professionals to implement gatekeeper training and mental health awareness workshops in academic departments that are comprised of high proportions of male faculty members. It is possible that male faculty members are unaware of how to identify warning signs of mental distress in their students (Kalkbrenner & Carlisle, 2019). College counselors might consider the utility of distributing psychoeducation resources for recognizing students in mental distress to faculty and staff. As just one example, the REDFLAGS model is an acronym of eight red flags or warning signs for identifying students who might be struggling with mental health issues (Kalkbrenner, 2016). Kalkbrenner and Carlisle (2019) demonstrated that the REDFLAGS model is a promising psychoeducational tool, as faculty members’ awareness of the red flags was a significant positive predictor of faculty-to-student referrals to the counseling center. The REDFLAGS model appears to be a practical resource for college counselors that can be distributed to faculty electronically or by paper copy, or posted as a flyer (Kalkbrenner, 2016; Kalkbrenner & Carlisle, 2019).
Limitations and Future Research
The findings of the present study should be considered within the context of the limitations. A number of methodological limitations (e.g., self-report bias and social desirability) can influence the validity of psychometric designs. In addition, the dichotomous nature of the faculty-to-student counseling referral variable (referred or not referred) did not provide data on the frequency of referrals. Future researchers should use a continuous variable (e.g., the number of student referrals to the counseling center in the past 2 years) to appraise faculty-to-student referrals. Future researchers can further test the psychometric properties of the MDRS through cross-validating scores on the measure with additional, unique populations of faculty members from a variety of different geographic and social locations. Invariance testing can be computed to examine the degree to which the MDRS and its dimensions maintain psychometric equivalence across different populations of faculty members. In addition, the criterion validity of the MDRS can be examined by testing the extent to which respondents’ MDRS scores are predictors of their frequency of student referrals to the counseling center and to other resources. Furthermore, future qualitative research is needed to investigate faculty members’ unique experiences around supporting college student mental health.
The low and negative association between the Approach/Encourage and Diminish/Avoid subscales suggests that faculty members might have an approach/encourage response to encountering a student in mental distress under one set of circumstances; however, they might have a diminish/avoid response under a difference set of circumstances. Future investigators might test the extent to which attitudinal variables mediate respondents’ MDRS scores—for example, the extent to which faculty members’ sense of safety predicts their MDRS scores. In addition, given the widespread public perception of individuals living with mental illness as violent and dangerous (Varshney et al., 2016), future researchers might identify demographic and background differences (particularly mental health stigma) among participants’ MDRS scores.
Summary and Conclusion
Mental health outreach and screening are essential components in the practice of college counselors, including training referral agents to recognize and refer students who might be struggling with mental health distress to support services (Golightly et al., 2017). Taken together, the results of the present study indicate that the MDRS and its dimensions were estimated sufficiently with a sample of faculty members. Our findings confirmed the two-dimensional hypothesized model for the types of responses that faculty might have when encountering a student showing signs of mental distress. In particular, the results of a CFA provided support for the MDRS and its dimensions, confirming a two-dimensional construct for the types of responses (approach/encourage and diminish/avoid) that faculty members might have when encountering a student in mental distress. Considering the utility of faculty members as gatekeepers and referral agents (Hodges et al., 2017; Kalkbrenner, 2016), researchers, practitioners, and policymakers may find the MDRS a useful screening tool for identifying the ways in which faculty members are likely to respond when encountering a student in mental distress. Results can be used to inform the content of mental health awareness initiatives and gatekeeper training programs aimed at promoting approach/encourage responses to connect students who need mental health support to the appropriate resources.
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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Michael T. Kalkbrenner, PhD, NCC, is an assistant professor at New Mexico State University. Correspondence can be addressed to Michael Kalkbrenner, 1220 Stewart St., OH202B, NMSU, Las Cruces, NM 88001, mkalk001@nmsu.edu.
Mar 9, 2020 | Volume 10 - Issue 1
Kathryn Marburger, Sheri Pickover
Providing treatment to survivors of human trafficking requires mental health professionals to understand complex layers of multiple traumas. These layers include an understanding of how trafficking occurs; what gender, ages, sexual orientations, life circumstances, and ethnicities are most at risk to be trafficked; the lasting impact of trafficking on human development, mental health, and family relationships; and the stigma victims face from their own families, communities, and mental health providers. These survivors suffer from physical ailments and post-traumatic stress disorder, and they are at high risk for developing comorbid disorders such as depression and addiction disorders. Integrated treatment options to alleviate these concerns, including cognitive behavioral therapy, trauma-focused therapy, ecologically focused therapy, and family therapy, are presented.
Keywords: human trafficking, trauma, post-traumatic stress disorder, addiction disorder, sexual orientation
Human trafficking is often referred to as modern-day slavery and is found in every corner of the globe (Cecchet & Thoburn, 2014; Department of Homeland Security [DHS], n.d.; Gerassi, 2015; Hardy et al., 2013; Hodge, 2014; Litam, 2017; Polaris, n.d.-b; Sanchez & Stark, 2014; Zimmerman & Kiss, 2017). The United Nations defines trafficking as:
the recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or
use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or
of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the
consent of a person having control over another person, for the purpose of exploitation. (Office of the
High Commissioner for Human Rights, 2000, article 3, para. 1)
The International Labour Office (2017) has estimated that 40.3 million people are victims of modern-day slavery throughout the world. This means that one person in every 1,000 is being victimized through modern-day slavery. Offering high rewards with minimal risk, human trafficking is a profitable and fast-growing criminal enterprise. Human trafficking profits surpass illegal arms trafficking and are second only to drug trafficking (Busch-Armendariz et al., 2014; Greer & Davidson Dyle, 2014; UNICEF USA, 2017). The International Labour Office (2014) has estimated that the profits from human trafficking are $150 billion a year, of which $99 billion comes from sexual exploitation.
The DHS reported that the crime of human trafficking is often hidden in plain sight in both legal and illegal industries; victims can be any gender, sexual orientation, age, and nationality, including documented or undocumented immigrants (DHS, n.d.; Rothman et al., 2017). However, statistics on human trafficking within the United States are lacking (DHS, n.d.; Gerassi, 2015; Miller-Perrin & Wurtele, 2017; Varma et al., 2015), and a uniform system of collecting data to identify victims currently does not exist, which increases the difficulty of obtaining accurate data (Gerassi, 2015; Miller-Perrin & Wurtele, 2017). Additional factors that contribute to the underreporting of human trafficking include legal and social services that are not readily accessible to victims, fear of punishment from traffickers, and fear or distrust of law enforcement. Moreover, some victims may not even recognize themselves as being the victims of human trafficking (De Chesnay, 2013; Miller-Perrin & Wurtele, 2017).
Human trafficking is a crime that inflicts complex layers of trauma on victims and survivors. The goal of this article is to provide mental health professionals with a systemic view of this crime from various perspectives so that they can implement wraparound-focused treatment plans. The perspectives adopted include how individuals become trafficked, sociocultural factors, the impact on the victims’ development and mental health, family relationships, and the stigma victims face from communities and their families. Having knowledge of these complex factors will allow mental health professionals to devise trauma-sensitive approaches to treat survivors of human trafficking. For the purpose of this paper, the term victims refers to individuals who are actively under the control of the trafficker, and the term survivors refers to individuals who are no longer being exploited.
Sexual exploitation and forced labor are two of the most common forms of human trafficking (Busch-Armendariz et al., 2014; De Chesnay, 2013; Greer & Davidson Dyle, 2014; Hodge, 2014; Martinez & Kelle, 2013; Miller-Perrin & Wurtele, 2017; U.S. Department of State, 2017). Human Rights First (2017) reported that 19% of human trafficking victims are trafficked for sex, and yet sex trafficking accounts for 66% of trafficking profits worldwide. Sex trafficking includes a wide variety of traditionally accepted forms of labor, including commercial sex, exotic dancing, and pornography. It is a form of oppression placing men, women, and children throughout the world at risk of sexual exploitation (Litam, 2017; Polaris, n.d.-a; Zimmerman & Kiss, 2017).
Traffickers treat victims’ bodies as resources to be used and repeatedly sold for money or goods such as pornography, cigarettes, drugs, clothing, and shelter (Busch-Armendariz et al., 2014; Greer & Davidson Dyle, 2014; Litam, 2017; Miller-Perrin & Wurtele, 2017; Sanchez & Stark, 2014). International trafficking often receives more attention; however, most trafficking occurs domestically within the same country (Martinez & Kelle, 2013; Zimmerman & Kiss, 2017). Furthermore, trafficking does not have to include crossing a state line, nor does it necessarily involve moving locations (Busch-Armendariz et al., 2014). Domestic minor sex trafficking is flourishing in every region, state, and community in the United States (Countryman-Roswurm & Bolin, 2014), with Midwestern cities showing increased rates of recruitment; such cities have access to several highways to transport victims to destination cities, including Detroit, Chicago, and Las Vegas, where demand for sexual exploitation is highest (Litam, 2017).
Sex trafficking has been linked not only to escort and massage services, strip clubs, and pornography, but also to major sporting events, entertainment venues, truck stops, business meetings, and conventions (Busch-Armendariz et al., 2014; Hardy et al., 2013; Litam, 2017). As long as demand exists, the opportunity for traffickers to sell victims is limitless. The internet increases the convenience and reduces the risk for traffickers and consumers. For instance, although Backpage.com was shut down by the U.S. government in 2017 for participating in and profiting from sex trafficking advertisements, and other websites like Craigslist began to censor and remove sex advertisements (Anthony et al., 2017; Leary, 2018; Peterson et al., 2019), numerous websites are used by traffickers not only to lure victims but also to advertise and sell to consumers. These websites include Eros.com, Bedpage.com, and social media platforms such as Instagram, Facebook, Twitter, Tinder, and Grindr (Jordan et al., 2013; Litam, 2017; Moore et al., 2017; O’Brien, 2018). The physical and psychological abuse victims experience from both traffickers and consumers leaves victims traumatized (Graham et al., 2019; Greer & Davidson Dyle, 2014; Litam, 2017; Moore et al., 2017; Zimmerman & Kiss, 2017).
The Victims of Trafficking
One out of every four victims of human trafficking is a child (International Labour Office, 2017), and these children are often found in the child welfare and juvenile justice systems, and runaway and homeless youth shelters (Moore et al., 2017; U.S. Department of State, 2017). In 2016, it was estimated that one out of six runaways was a victim of sex trafficking and 86% had been in foster care or social services when they ran away (Polaris, n.d.-a). Runaway youth are usually approached by traffickers within 48 hours of living on the street (Jordan et al., 2013). Traffickers recruit runaway or homeless children into trafficking rings, exposing them to extreme forms of abuse that result in many being killed from the violence inflicted or from diseases acquired through sexual abuse (Litam, 2017).
Sex trafficking is prevalent throughout the world, affecting men, women, children, families, and communities. Individuals also are trafficked for various other purposes, including domestic service, agricultural work, commercial fishing, the textile industry, construction, mining, factory work, and petty crime (U.S. Department of State, 2017; Zimmerman & Kiss, 2017). Although men have been confirmed to be victims in all areas of trafficking, they are disproportionately subjected to forced labor, whereas women and children account for the majority of sexually exploited victims (International Labour Office, 2017). Although trafficking occurs in all parts of the world and can affect anyone, several factors increase the risk of trafficking, including gang activity, a history of childhood abuse, and poverty. Substance abuse also plays a key role (De Chesnay, 2013; Moore et al., 2017; O’Brien, 2018).
Addiction
Substance abuse within families is a risk factor for children becoming the victims of trafficking (Hardy et al., 2013; Miller-Perrin & Wurtele, 2017). Parents or other family members with an addiction can force youth into sexual exploitation, selling or trading them to support their drug addiction (De Chesnay, 2013; Litam, 2017). Traffickers often force substance use on victims in order to control and sexually exploit them (De Chesnay, 2013; Gerassi, 2015; Hodge, 2014; Hom & Woods, 2013; Litam, 2017; Moore et al., 2017). Substance abuse also may be a way for trafficking victims to cope with the abuse they endure (Miller-Perrin & Wurtele, 2017).
Trafficking victims who engage in substance abuse usually experience detrimental personal outcomes, including an increased likelihood of engaging in high-risk behaviors (i.e., unprotected sex), infection from needles, and overdosing (Gerassi, 2015; Zimmerman et al., 2011). They often commit drug-related crimes for their trafficker and are therefore at risk of arrest and conviction for prostitution and drug offenses (Litam, 2017; Miller-Perrin & Wurtele, 2017; Zimmerman et al., 2011). Arrests, drug charges, substance abuse, and violent clients can trap trafficking victims in a vicious circle of re-traumatization by their traffickers, their potentially abusive consumers, and the criminal justice system (Gerassi, 2015; Zimmerman et al., 2011).
Impact on Physical and Mental Health
A concern for children who fall prey to sex trafficking is the impact these experiences have on their development. Not only are victims affected by educational deprivation, but trafficking also causes serious harm to their psychological, spiritual, and emotional development (Miller-Perrin & Wurtele, 2017; Rafferty, 2008; Sanchez & Stark, 2014). Child victims suffer from an increased risk of several emotional problems such as guilt, shame, anxiety, hopelessness, and loss of self-esteem (Miller-Perrin & Wurtele, 2017; Rafferty, 2008). Some of the mental health consequences for child victims include depression, dissociation, post-traumatic stress disorder (PTSD), eating disorders, somatization, poor attachment, antisocial behaviors, substance use disorders, self-harm, and suicidality (Kiss et al., 2015; Miller-Perrin & Wurtele, 2017; Rafferty, 2008). Furthermore, because of the exposure to the violence and sexual assault linked to trafficking, child victims have been found to be at higher risk of sexually transmitted infections, reproductive health problems from unsafe abortions, fractures, genital lacerations, malnutrition, and dental problems (Miller-Perrin & Wurtele, 2017).
Trafficking poses significant risk to child victims’ long-term mental health. Survivors trafficked in childhood report a high prevalence of mental health problems such as depression, anxiety, and PTSD. These mental health problems also affect adult victims (Hom & Woods, 2013; Oram et al., 2016). Among women who have survived trafficking, there are increased rates of anxiety and stress disorders, disassociation, depression, personality disorders, low self-esteem, suicidal ideation, and poor interpersonal relationships (Sanchez & Stark, 2014). Additionally, somatic symptoms such as headaches, fainting, and memory problems are commonly reported among women who are victims of trafficking (Oram et al., 2016). A high prevalence of sexually transmitted infections has been reported in both men and women (Hom & Woods, 2013; Oram et al., 2016; Sanchez & Stark, 2014). Borschmann et al. (2017) found high rates of self-harm among adult victims of human trafficking.
Pregnancy is a common occurrence for trafficked women (Bick et al., 2017; Gerassi, 2015; Hom & Woods, 2013; Oram et al., 2016; Sanchez & Stark, 2014). Several barriers to maternity services have been identified for pregnant victims, including traffickers preventing women from seeking care and the victims feeling reluctant because they might not have valid documents (Bick et al., 2017). Additionally, children and family members are often used by traffickers to threaten and coerce victims, which further isolates victims and distances them from their families (Hardy et al., 2013; Hodge, 2014; Juabsamai & Taylor, 2018; Sanchez & Stark, 2014).
Sex trafficking often involves the exploitation of victims by force, and the brutal nature of the crime can cause complex mental health problems for victims (Gerassi, 2015; Greer & Davidson Dyle, 2014; Hodge, 2014; Hom & Woods, 2013; Litam, 2017). Victims endure high levels of trauma, and survivors show increased rates of depression, anxiety, PTSD, and substance use disorders (Gerassi, 2015). The goal of traffickers is to physically and psychologically break victims down into subservience (Hodge, 2014). Not only are victims forced to engage in humiliating sexual acts and use substances, but traffickers also use recurrent beatings, rape, and even murder as tactics to control their victims (De Chesnay, 2013; Gerassi, 2015; Hodge, 2014; Hom & Woods, 2013; Litam, 2017). Victims may believe that the traffickers have their best interests in mind and develop significant bonds with their traffickers, similar to Stockholm syndrome, and may be reluctant to escape (De Chesnay, 2013; Hodge, 2014; Hom & Woods, 2013; Litam, 2017). In addition, victims of sexual exploitation have not only endured physical and emotional abuse from their traffickers, but there also is a strong correlation with childhood abuse (Gerassi, 2015; Miller-Perrin & Wurtele, 2017). However, issues of physical and mental health tend to be exacerbated by issues of economic deprivation and racial inequality. These factors may act as a catalyst for putting individuals more at risk of human trafficking (Greer, 2013).
Multicultural Considerations
Sex traffickers often target vulnerable individuals, including runaway and homeless youth; victims of domestic abuse or sexual assault; victims of war; and individuals who experience social discrimination, including gender, racial, ethnic, and socioeconomic inequality (Anthony et al., 2017; Miller-Perrin & Wurtele, 2017). For example, LGBTQ homeless youth account for 20% of the homeless youth population in the United States, yet 58.7% of homeless LGBTQ youth are victims of sex trafficking (Martinez & Kelle, 2013). Martinez and Kelle (2013) further noted that this figure is significantly higher than the 33.4% of the heterosexual homeless youth. Furthermore, LGBTQ youth are more than seven times more likely to experience acts of violence than their cisgender peers (Anthony et al., 2017). Trafficking often affects victims of poverty. Studies of sexual exploitation and domestic sex trafficking also have reported higher rates of violence against women of color, especially African American women, and undocumented immigrants (Gerassi, 2015; Zimmerman & Kiss, 2017).
Finally, individuals with intellectual disabilities are at risk because of an unfamiliarity with sexual activities and an inability to understand the nature of sexual abuse and exploitation (Reid, 2018). As a result, such individuals are at a higher risk of becoming victims of trafficking (Greer & Davidson Dyle, 2014; Hodge, 2014; Miller-Perrin & Wurtele, 2017; Reid, 2018).
Returning Home
Women who have been victims of trafficking have often been found to come from abusive households (Gerassi, 2015; Hom & Woods, 2013; O’Brien, 2018; Oram et al., 2016). As a result, once victims are free from their traffickers, they have often been found to not only lack social support but also lack basic needs such as shelter and financial support (Hom & Woods, 2013; Le, 2017; Oram et al., 2016). Reconciliation with supportive family often plays a key role for trafficking survivors; however, because of stigma, some victims are met with shame and judgment from their families and are not welcomed (Hom & Woods, 2013; Juabsamai & Taylor, 2018; McCarthy, 2018; Zimmerman & Kiss, 2017).
Unfortunately, it is not uncommon for victims to be exploited by someone they know and love. Oftentimes a trafficker is a family member, intimate partner, friend, or acquaintance (Gerassi, 2015; Hardy et al., 2013; Hom & Woods, 2013; Le, 2017; Miller-Perrin & Wurtele, 2017; Moore et al., 2017), which further complicates survivors’ ability to establish trusting relationships. Moreover, law enforcement may charge adult victims with prostitution. Not only is the victim caught in legal limbo, but they are re-victimized by law enforcement (Sanchez & Stark, 2014). Finally, female survivors who socialize with men after being freed from their traffickers have reported being triggered with memories of their abusive experiences, further affecting their ability to develop healthy, stable relationships and social support (Hom & Woods, 2013).
Victims of human trafficking have often been robbed of their identities, had their self-esteem demolished, and already experienced physical and psychological abuse before they became victims of human traffickers. Once they leave their traffickers, survivors have a variety of immediate, short-, and long-term needs that must be addressed to help promote resiliency while they are reintegrating into the community (Busch-Armendariz et al., 2014; Graham et al., 2019; Hom & Woods, 2013; Le, 2017; McCarthy, 2018; O’Brien, 2018; Twigg, 2017). Immediate needs include ensuring safety; finding medical care, food, shelter, clothing, and counseling; and acquiring identification, language interpretation services, and legal and immigration assistance (Busch-Armendariz et al., 2014; Graham et al., 2019; Hom & Woods, 2013; McCarthy, 2018; Polaris, n.d.-a; Twigg, 2017). Education, employment, and establishing friendships have been identified as vital ongoing needs to successfully alleviate stress while reintegrating into the community (Hom & Woods, 2013; McCarthy, 2018; O’Brien, 2018; Polaris, n.d.-a; Twigg, 2017). However, it is important to note that survivors are often met with substantial challenges while seeking basic services. For instance, many programs may be underfunded or ill-equipped to handle the high demand for services (Polaris, n.d.-a). This reaffirms the crucial need to meet survivors with empathetic and nonjudgmental attitudes to help prevent re-victimization and a return to traffickers (Anthony et al., 2018; Hodge, 2014; Hom & Woods, 2013; McCarthy, 2018).
Family support can provide survivors with significant protection while reintegrating into the community. Reconnecting with family typically increases the likelihood of a sustainable return process (McCarthy, 2018; Twigg, 2017). However, reconciliation might require a careful approach, as the process can be met with difficulties, including stigma, dysfunctional family environments, or the family’s direct involvement with the victim’s trafficking (Le, 2017; McCarthy, 2018; Twigg, 2017; Zimmerman & Kiss, 2017). In some cases, shame within a cultural context is a prohibitive factor for many to return to their families because of the association with prostitution or having been trafficked (Hom & Woods, 2013). As a result, it is necessary to provide comprehensive, culturally sensitive interventions for trafficking survivors (Hodge, 2014; Hom & Woods, 2013; Le, 2017; McCarthy, 2018). Family continues to be essential to survivors’ sense of identity, and, upon return, cultural beliefs and values that previously formed their self-concept remain influential to survivors (Le, 2017). Many women have noted that marriage and children play an integral role in successfully reintegrating into their community and gaining acceptance from family members (McCarthy, 2018). However, issues of economic deprivation and racial inequality act as a barrier to successful community reintegration and put an individual at higher risk for trafficking (Greer, 2013).
This brief literature review has confirmed that victims of human trafficking suffer from a wide array of mental health concerns, including PTSD, depression, anxiety, and substance abuse, and from stigma associated with being victims of human trafficking. Mental health treatment should address these complex concerns and provide for comprehensive assessment and treatment planning.
Treatment Challenges
Working with trafficked clients poses a series of challenges for counselors because an intervention modality specific to sex-trafficked survivors has yet to be developed (Hopper et al., 2018; Jordan et al., 2013). Treatments are borrowed from evidence-based interventions initially developed for PTSD, domestic violence, and captivity, and a holistic approach is essential (De Chesnay, 2013; Hom & Woods, 2013; Jordan et al., 2013). Four essential practices for providers include ensuring safety and confidentiality, engagement of trauma-informed care, performing a comprehensive needs assessment, and delivery of comprehensive case management that coordinates physical and mental health and legal services. As a result of the multiple traumas trafficking victims endure, the path to restoring wellness is often long and complex, requiring additional time and patience from mental health counselors (Hodge, 2014; Hom & Woods, 2013).
Mental health counselors should conduct a needs assessment to identify the physical, emotional, and spiritual needs of trafficking survivors (Hodge, 2014; Hom & Woods, 2013). Survivors are often in need of medical treatment, as traffickers do not bother with preventative care or what they may consider minor treatment and only allow victims to seek treatment when a condition interferes with earning money (De Chesnay, 2013). Similarly, survivors are often resistant to seek help from mental health providers because of fear of physical violence or threats of retaliation from their traffickers if they disclose their circumstances (De Chesnay, 2013; Hodge, 2014; Litam, 2017). Survivor-centered approaches are recommended initially to acknowledge and validate the survivor’s experience, give the survivor control, and build a sense of safety and trust (Hodge, 2014; Hom & Woods, 2013; Twigg, 2017).
However, after months or years of abuse, trafficking survivors often need a wide array of services to meet their distinctive needs (Hodge, 2014; Hom & Woods, 2013; McCarthy, 2018; Polaris, n.d.-a). The U.S. government has enacted several policies to help victims of trafficking, including the Victims of Trafficking and Violence Protection Act of 2000, which allows victims who have been trafficked from abroad to be issued visas, enabling them to reside in the United States (Davy, 2016; Hodge, 2014). Survivors need to be met with nonjudgmental attitudes, acceptance, understanding, and genuine concern, and they should be slowly encouraged to take on risks associated with leaving their traffickers (Hodge, 2014; Hom & Woods, 2013; McCarthy, 2018). Providing survivors with emotional support and encouragement opposes the isolated world created by their trafficker. Survivors have explained that street outreach programs can play an essential role in establishing contact, allowing victims to become aware of the resources available and begin breaking down the sense of isolation (Hom & Woods, 2013). Additionally, it is vital to empower survivors so that they can understand they are in control (Anthony et al., 2018; Hodge, 2014; Hom & Woods, 2013; Twigg, 2017). Research on resiliency has found creativity, humor, flexibility, and movement are important factors in improving self-esteem, prosocial behaviors, and hope among traumatized individuals (Litam, 2017).
Evidence-Based Treatment
Counselors working with trafficking survivors should be equipped to use several trauma-sensitive interventions to assist with the individual needs of each survivor (Busch-Armendariz et al., 2014; De Chesnay, 2013; Hardy et al., 2013; Hodge, 2014; Hom & Woods, 2013; Litam, 2017; Miller-Perrin & Wurtele, 2017; Twigg, 2017). Trauma-sensitive interventions recognize safety as the foundation for working with individuals to end self-harm, develop trusting relationships, overcome obstacles, leave dangerous situations, and promote wellness (Hopper et al., 2018). Although it may be painful for trafficking survivors to verbalize their traumatic experiences, creative therapies offer alternative methods of communication and expression (De Chesnay, 2013; Litam, 2017).
Although evidence-based practices for treating sex-trafficking survivors are not widespread, counseling techniques exist that have been shown to be effective with child sex abuse victims, including trauma-focused cognitive behavioral therapy and dialectical trauma-focused cognitive behavior therapy (De Chesnay, 2013; Twigg, 2017). Similarly, participating in group counseling can empower survivors of sex trafficking and provide them with an opportunity to share their experiences, generating a sense of community and support (Hopper et al., 2018). Peer support has been noted to be a vital component of intervention, both as a motivating factor to remain in treatment and as help in the prevention of survivors returning to their traffickers (De Chesnay, 2013; Litam, 2017; Twigg, 2017). Furthermore, discussing stigmatized topics within group settings can help reduce shame, as it is common for trafficked survivors to feel that no one else has gone through similar situations (Hickle & Roe-Sepowitz, 2014; Litam, 2017). Having a setting to address the shame can help survivors recognize the commonality of their experiences and build support (Countryman-Roswurm & Bolin, 2014; Litam, 2017).
Family Therapy
As human trafficking affects individuals, families, and communities, it is necessary to adopt treatment models that engage families and communities as well as individual-based treatment models. Twigg (2017) found that survivors require and benefit from therapeutic support in order to achieve successful family and community reunification. However, like individual treatment, family therapy models specific to human trafficking survivors do not exist, but current family therapy models developed around trauma could be adapted for use with human trafficking survivors. Apsche et al. (2008) developed Family Mode Deactivation Therapy, a cognitive behavior family therapy model for use with youth and families in residential treatment that uses ongoing assessment and community skill development to reduce the behavioral symptoms associated with trauma. The researchers found this model reduced recidivism more effectively than a non–family-based approach. Hughes (2017) developed an attachment-focused family treatment for children who have experienced developmental trauma. This two-phase treatment provides therapy to a caregiver first, then transitions to joint sessions to reframe the trauma experience.
Similarly, using ecologically based family therapy with individuals involved in sex trafficking has been found to improve outcomes for sobriety and depression (Murnan et al., 2018). Agani et al. (2010) recommended the use of the linking human systems community resilience model, which is based on transgenerational and ecosystemic structural family therapies. This model focuses on identifying the strengths of community and family members, bringing them together to encourage their competency and using community leaders to solve problems. Other novel approaches to working with survivors of crime include the Family Group Project, which involves group therapy aimed at recreating a family environment to re-integrate survivors into the community (Allen et al., 2015).
A Survivor’s Story
Research provides one perspective on the plight of human trafficking victims and survivors, but a first-person account provides insight to the worldview of an actual survivor. One of the authors met with a human trafficking advocate in order to gain further perspective on the needs of survivors. The advocate, who requested that the author provide no identifying information beyond her gender, disclosed during the interview that she was a survivor who had been trafficked by her husband. Her trafficker had been blackmailing a John, a term commonly used for an exploitive consumer. She was arrested during a raid and remained in jail for 3 months because she refused to say anything. She explained that it took her a year to build up the strength and courage to testify in court because her trafficker blackmailed her. He threatened to tell her family about the exploitative acts and substance use, which he forced her to engage in. He would say, “Do you really want your family to know what you have been up to?” However, once her family was notified of her predicament, she reported that her family members provided emotional support. She explained that it was through their support she was able to come forward and testify.
Although she came forward and testified against her trafficker, she was not viewed as a victim, and she was charged with prostitution. As she explained, advocates are trying to change the legislation and work with police in her local area so that human trafficking victims are not charged with crimes. For instance, not only was she charged with prostitution, but she also had to pay the John $3,000, the money her trafficker had stolen from him. Despite never having seen the money, she was ordered to repay it and was placed on a repayment schedule. Even more disheartening, her trafficker made a plea deal and did not have to repay any money and the charges of trafficking were dropped. All these events provide an example of how the legal system can re-victimize a survivor. Although she had been the victim of trafficking, which stigmatized her, she also was told that she owed money to someone her trafficker had stolen from, thus re-victimizing her.
The charge of prostitution remained on her record and became something she had to explain to potential employers. With the support of her family and by attending therapy, she was able to rebuild her life. She had a bachelor’s degree in social work when she met her ex-husband and was able to obtain her limited license. She decided to pursue a master’s degree and was once again faced with the challenge of disclosing the charge on her record and reliving the trauma of explaining what happened. The first university she applied to denied her application, and this placed her in a deep depression; however, she was accepted at another university and after graduating became an advocate for survivors of human trafficking. She also shared that although it took time to be able to trust someone again, she has established an intimate relationship and will soon be married.
Conclusion
Counselors treating a human trafficking survivor need to develop a wide-ranging view of assessment, treatment, case management, support, advocacy, and termination from counseling. Human trafficking survivors suffer from a complex variety of developmental, mental health, and social issues that require counselors to not only engage the individual in treatment, but also to act as an advocate against stigma within their family and the community.
The myriad of issues faced by these individuals, from navigating the criminal justice system, coping with multiple layers of physical and emotional trauma, overcoming substance abuse, overcoming family and community alienation, coping with dual stigmas of human trafficking and mental health diagnoses, to finally reintegrating into daily work and life, require counselors to be vigilant in the assessment process. Counselors need to consider assessment an ongoing extensive process that should occur throughout every session and focus not just on mental health needs, but also on physical health and basic needs, and career support. Counselors will need to assess risk of the individual returning to the trafficker and have referrals ready to help the client stay safe. Human trafficking survivors will need a counselor able to quickly identify short-term crisis needs during long-term treatment.
When entering the treatment phase, counselors need to research multiple treatment modalities that may not directly relate to human trafficking but may support the client. For example, a counselor will need to navigate working with substance use, trauma, family issues, and career concerns. Counselors will need to widen their view of their role within the therapeutic relationship. Human trafficking survivors may require case management services more than long-term counseling when first entering care, yet the need to build a strong therapeutic relationship is paramount for ongoing treatment. The counselor should consider taking on the case management role as needed to promote consistency in the treatment process. As an advocate, the counselor will need to engage multiple individuals and systems into the treatment process to ensure comprehensive care. Counseling skills aimed at engaging families, law enforcement personnel, legal personnel, and medical professionals in treatment are essential for treating survivors. Counselors would also benefit from strength-based approaches with this population, as research indicates survivors most benefit from being able to identify their own qualities of self-protection and resiliency, which empowers their recovery process. This empowerment also allows for a supportive termination process, ensuring that the survivor has ongoing access to a support network in order to facilitate long-term recovery.
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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Kathryn Marburger is a graduate student at the University of Detroit Mercy. Sheri Pickover, PhD, LPC, is an associate professor at Central Michigan University. Correspondence can be addressed to Sheri Pickover, 195 Ojibway Court, Mt. Pleasant, MI 48859, picko1s@cmich.edu.
Mar 9, 2020 | Volume 10 - Issue 1
Ryan M. Cook, Laura E. Welfare, Connie T. Jones
This study examined the incidence of intentional nondisclosure by postgraduate, prelicensed counselors receiving supervision as they pursue licensure, which has not been previously examined. Examining the responses of 107 prelicensed counselors, we found that 95.3% reported withholding some degree of information from their supervisors, and 53.3% completely withheld a concern from their supervisors. Participants completely withheld supervision-related incidents (e.g., negative reactions to supervisor, questioning supervisor’s competency) more frequently than they withheld client-related incidents (e.g., clinical mistakes, personal issues). We offer strategies for prelicensed counselors, supervisors, counselor educators, and counselor credentialing bodies to reduce intentional nondisclosure. These strategies include creating a collaborative environment, developing supervision contracts, and attending to power differentials in supervision.
Keywords: intentional nondisclosure, clinical supervision, prelicensed counselors, supervisors, counselor educators
Counselors who desire licensure as full, independent professional counselors must complete a postgraduate supervised field experience (Henriksen et al., 2019). The primary purpose of postgraduate supervision is to ensure that prelicensed counselors provide counseling services that are in accordance with legal, ethical, and professional standards as they begin their professional careers (Borders et al., 2011; Magnuson et al., 2000). Unlike university-based supervision, to which prelicensed counselors are more accustomed (Magnuson et al., 2000), postgraduate supervision requires prelicensed counselors to regularly self-direct their supervision experience. That is, in postgraduate supervision, prelicensed counselors are called to more autonomously self-identify their clinical concerns and developmental needs, and to convey this information to their supervisors (Cook & Sackett, 2018).
Although supervisees’ self-reports can enrich the supervision process (Noelle, 2002), relying on prelicensed counselors to self-select information to share with their supervisor may be problematic (Ladany et al., 1996). While supervision is intended to facilitate supervisees’ professional development, there also is an evaluative component inherent in the supervisory relationship (Borders et al., 2011). The supervisor’s evaluations of the supervisee’s clinical performance are tied to their professional progress (i.e., obtaining full, independent licensure; Magnuson et al., 2000). As such, it benefits supervisees to present themselves in a manner that will yield positive evaluations from their supervisors and to withhold information that could result in their supervisors developing a negative perception of their clinical competencies (Cook, Welfare, & Romero, 2018; Ladany et al., 1996).
Supervisees withholding information from their supervisors is a well-established phenomenon in supervision literature (Cook, Welfare, & Romero, 2018; Gibson, et al., 2019; Hess et al., 2008; Ladany et al., 1996). Termed supervisee nondisclosure, researchers have shown that the frequency of supervisee nondisclosure in clinical supervision is high—ranging from 60% to 97.2% (Cook, Welfare, & Romero, 2018; Ladany et al., 1996; Mehr et al., 2010). But these studies were based on samples of counselors-in-training (CITs) or trainees in allied professions such as psychology. To date, only one qualitative study has examined the phenomenon of nondisclosure in a sample of postgraduate supervisees. Sweeney and Creaner (2014) found that counseling psychology graduates in Ireland (N = 6), like supervisees in mental health training programs (Cook, Welfare, & Romero, 2018; Ladany et al., 1996), commonly withhold information from their supervisors.
What seems most problematic are the instances in which a supervisee identifies a concern or perceives an issue and decides to withhold it from their supervisors anyway (Cook & Welfare, 2018; Yourman & Farber, 1996). These instances are known as supervisee intentional nondisclosure. Ladany and colleagues (1996) suggested that the information being intentionally withheld by supervisees is likely to be the most important information to their clinical and professional development. As such, supervisees who withhold information may inadvertently undermine their own professional growth.
Supervision scholars (Cook, Welfare, & Romero, 2018; Gibson et al., 2019; Hess et al., 2008; Ladany et al., 1996) have found that the types of information withheld by supervisees can be broadly categorized into supervision-related incidents (e.g., negative reactions to a supervisor, evaluation concerns, fears of correcting a supervisor, concerns about the process of supervision) and client-related incidents (e.g., clinical mistakes, general reactions to clients, concerns about lack of professional competencies). The reasons for these intentional nondisclosures most often point to issues in the supervisory relationship (e.g., supervisory working alliance; Cook & Welfare, 2018; Hess et al., 2008), supervisee personality traits (e.g., attachment styles; Cook & Welfare, 2018), and supervisor–supervisee power differentials (e.g., fear of negative evaluation concerns, desire to present oneself favorably to the supervisor; Hess et al., 2008; Ladany et al., 1996). In total, the types of information being intentionally withheld by supervisees, as well as the reasons for their nondisclosures, reflect issues that are inherent in a hierarchal and evaluative relationship such as the supervisory relationship (Hess et al., 2008; Mehr et al., 2010; Sweeney & Creaner, 2014).
Prelicensed counselors, like CITs and supervisees from allied professions, experience similarly high stakes in clinical supervision. However, as described in detail below, postgraduate supervision differs from university-based supervision (Magnuson et al., 2000), and prelicensed counselors are more advanced in their professional development as compared to CITs (Rønnestad & Skovholt, 2003). For these reasons, the salient issues that prelicensed counselors are hesitant or unwilling to discuss with their supervisors might differ from those of CITs. Relatedly, the degree to which they fail to disclose information might also differ. Thus, in our investigation we examined the types of information being withheld in postgraduate supervision by 107 prelicensed counselors and the degree to which they were unwilling to discuss their concerns with their supervisors.
Postgraduate Supervision for Licensure
Postgraduate supervision is required for counselors who desire licensure as full and independent professional counselors in all 50 states in the United States as well as Guam, Puerto Rico, and the District of Columbia. The specific requirements of postgraduate supervision differ in each licensing jurisdiction (e.g., frequency of supervision, hours of required supervision; Henriksen et al., 2019). Although prelicensed counselors often are more self-aware of their client needs and developmental concerns than CITs (Loganbill et al., 1982; Rønnestad & Skovholt, 2003; Stoltenberg & McNeill, 2010), prelicensed counselors also are facing new challenges as counselors such as managing more complex caseloads (Freadling & Foss-Kelly, 2014) and possibly questioning their own clinical competencies (Rønnestad & Skovholt, 2003). Thus, a supervised field experience is critical to helping prelicensed counselors transition from CITs to professional counselors (Henriksen et al., 2019).
As compared to university-based supervision, there are unique features of postgraduate supervision for prelicensed counselors (Magnuson et al., 2000). Namely, prelicensed counselors engaged in postgraduate supervision are tasked to self-direct their supervision experience (Cook & Sackett, 2018) more than they were during university-based supervision. For example, prelicensed counselors may have less access to their supervisors than they did during their graduate training. Henriksen et al. (2019) conducted a content analysis of supervision requirements for postgraduate supervision. Based on their findings, no jurisdiction required supervisors and supervisees engaging in postgraduate supervision to meet at a frequency that equaled the Council for Accreditation of Counseling and Related Educational Programs’ (CACREP) required averages of an hour of individual supervision or 1.5 hours of group supervision per week. It is important to note that it is certainly possible for prelicensed counselors to meet with their supervisors more than is required, but these standards provide a useful benchmark. Prelicensed counselors also may have fewer opportunities than CITs for their clinical work to be directly observed by their supervisors (Magnuson et al., 2000), which could perpetuate the supervisors’ reliance on supervisees’ self-report in supervision (Cook & Sackett, 2018) and unintentionally encourage supervisee nondisclosure (Ladany et al., 1996). For example, Fall and Sutton (2004) found that prelicensed counselors used self-report in their supervision sessions 80% of the time. Comparatively, other methods to monitor supervisees’ work, such as direct observation of a counseling session, audio and video recording, or live supervision, were used far less often (each used 10% of the time).
In addition, the interpersonal dynamics between supervisor and supervisee in postgraduate supervision may differ from those experienced during university-based supervision. Unlike the development-oriented process of university-based supervision, Magnuson et al. (2000) poignantly described postgraduate supervision as a “business relationship” (p. 177). Some prelicensed counselors pay for supervision from someone who does not work at their place of employment, while other prelicensed counselors work with a supervisor at their place of employment (Magnuson et al., 2000). In the latter situation, the supervisors providing clinical supervision also can be evaluating the prelicensed counselor as an administrative supervisor. Although the dual roles may be logistically advantageous for agencies, having combined clinical and administrative supervision could be problematic (Borders et al., 2011; Magnuson et al., 2000). In sum, as compared to university-based supervision, the businesslike nature of postgraduate supervision as well as the heavy reliance on prelicensed counselors to self-direct their supervision experience can change how these counselors utilize intentional nondisclosure in postgraduate supervision.
The degree to which prelicensed counselors are willing to disclose information to their supervisors has implications for clinical supervisors as well. Clinical supervisors assume legal responsibility for the quality of services rendered to their supervisees’ clients (Magnuson et al. 2000). With the dependence on prelicensed counselors to self-report information in clinical supervision (Fall & Sutton, 2004) and the potential absence of regular direct observation (Gray & Erickson, 2013; Magnuson et al., 2000), supervisors are reliant on prelicensed counselors to accurately recall details of their counseling work and to honestly discuss their developmental needs. If prelicensed counselors, like CITs, were to feel unsure about presenting themselves honestly to their supervisors, their decision could unintentionally undermine the work of their clinical supervisors, who have a legal duty to their supervisees and the supervisees’ clients (Magnuson et al., 2000).
No study has examined what prelicensed counselors perceive as salient in their clinical supervision experience and the degree to which they are willing to discuss concerns with their supervisors. Postgraduate supervision is critically important to a counselor’s developmental growth (Henriksen et al., 2019). Prelicensed counselors are mandated to receive clinical supervision (Henriksen et al., 2019), which means that supervisee intentional nondisclosure is a relevant issue. As such, an investigation of supervisee intentional nondisclosure in a sample of postgraduate, prelicensed counselors is needed. Therefore, the aim of our study was to examine prelicensed counselors’ self-reported incidents of intentional nondisclosure in clinical supervision. Specifically, our investigation was guided by two research questions: (a) What is the frequency of intentional nondisclosure in clinical supervision as reported by prelicensed counselors, and (b) Which concerns do prelicensed counselors find most difficult to discuss with clinical supervisors?
Method
Participants and Procedures
Participants in the current study were prelicensed counselors pursuing full, independent licensure as professional counselors. We aimed to recruit a nationally representative sample, so we obtained mailing addresses for persons pursuing licensure in two states in each of the five Association for Counselor Education and Supervision (ACES) regions. Specifically, we solicited participation from prelicensed counselors in Arkansas, Colorado, Idaho, Iowa, Oklahoma, Oregon, Rhode Island, Texas, Vermont, and Washington. We randomly selected up to 150 names from each state. After eliminating and replacing unverifiable mailing addresses, we identified 1,347 potential participants. We first received IRB approval and then solicited participation by mailing paper-and-pencil survey packets to the potential participants. We asked participants to anonymously respond about their current, licensed clinical supervisor. Participants returned the surveys to the authors using a prepaid envelope. Of the 1,347 mailed packets, 330 packets (24.5%) were “returned to sender” and never received by the potential participants. Of the remaining 1,017 packets distributed to potential participants, 109 survey packets were returned. However, two participants’ responses were incomplete and subsequently removed. The number of usable packets was 107, resulting in a response rate of 10.5%. This response rate, although low, is consistent with previous survey research employing a mailing recruitment strategy (Barden et al., 2017). Because data collection was anonymous, we are unable to identify the state of origin for participants included in our sample.
The age of participants ranged from 24 to 67 (M = 38.79, SD = 11.20). The majority of participants identified as White (83.2%), while eight participants identified as Hispanic (7.5%), five participants identified as African American/Black (4.7%), two participants identified as Asian (1.9%), two participants identified as Multiracial (1.9%), and one participant did not respond to this item (0.9%). Eighty-five participants identified as female (79.4%), 21 participants identified as male (19.6%), and one participant identified as non-binary (0.9%). The demographic characteristics of the participants in the current study are comparable to counseling professionals in general (CACREP, 2018). On average, the participants received 64.73 (SD = 29.79) minutes of clinical supervision per week. Finally, 56 participants were assigned a supervisor at their job (51.4%), 28 paid for supervision from someone who did not work at their employment site (26.4%), 17 chose a supervisor at their place of employment (15.9%), and six participants indicated other (5.6%; e.g., free supervision from someone outside their job).
Measures
Supervisee Nondisclosure Scale (SNDS)
The SNDS is an instrument designed to capture the degree to which participants disclosed or withheld information to their supervisors (Ellis & Colvin, 2016; Siembor, 2012). Siembor (2012) developed a pool of 30 items, informed by prior research on nondisclosure (Hess et al., 2008; Ladany et al., 1996). Participants indicate their level of disclosure using a 7-point Likert scale with three defined levels: (1 = fully disclosed, 4 = sometimes disclosed, 7 = decided not to disclose). Higher scores indicate higher levels of nondisclosure. Participants are given the option to select not applicable for items describing incidents that have not occurred during their supervision experiences. The items include information related to the supervision experience (e.g., “Negative reactions that I had about my supervisor’s behavior or attitudes”) and items related to the supervisee’s clinical work (e.g., “Clinical mistakes that I did make”). Abbreviated item stems for all 30 SNDS items are presented in Table 1. The internal reliability of all 30 items was strong (α = .88, n = 107) and consistent with prior research (α = .84; McKibben et al., 2018).
Demographic Survey
We created a survey to collect self-report demographic data for both the supervisee and supervisor (e.g., gender, race). We also asked participants to share about the details of their supervision experience (e.g., time in supervision, administrative versus clinical supervision, selecting a supervisor).
Results
Across all 30 SNDS items, 95.3% of the participants reported some degree of intentional nondisclosure (i.e., partially or fully withheld) for at least one item. The number of incidents of intentional nondisclosure endorsed by participants ranged from 0 to 26 (M = 10.68; SD = 6.62). Also, 53.3% indicated that they fully withheld information from their clinical supervisor for at least one item. The range of incidents completely withheld by participants was 0 to 14 (M = 1.73, SD = 2.6). This finding suggests that intentional nondisclosure by prelicensed counselors in clinical supervision is quite common.
The Frequency of Intentional Nondisclosure in Clinical Supervision
To address the first research question, we examined the frequency of participants who responded that they utilized intentional nondisclosure on each item (i.e., what percent withheld information?). To do so, we analyzed the self-reported responses on each item using the four groups: not applicable, fully disclosed, sometimes disclosed, and decided not to disclose (see Table 1). For each item, participant responses of not applicable were categorized in the not applicable group, responses of 1 were categorized in the fully disclosed group, responses of 2 to 6 were categorized in the sometimes disclosed group, and responses of 7 were categorized in the decided not to disclose group. The incidence of partial or complete nondisclosure per item ranged from 69.2% (“disagreement with one’s supervisor”) to 1.9% (“supervisor attraction issue”), and the average incidence across the items was 35.6% (SD = 15.8%). After “disagreement with one’s supervisor,” the items with the highest incidence rates were “negative reaction to supervisors’ behavior or attitudes” (66.3%), “perceived that my supervisor is wrong” (60.7%), “personal issue” (49.6%), and “personally identifying with a client” (e.g., countertransference; 48.6%). In addition to revealing what supervisees chose to withhold, the results indicated issues that did not emerge in supervision and those that emerged but were fully disclosed. For example, items frequently marked not applicable were “supervisor attraction issue” (97.2%), “client attraction issue” (86.9%), “unsafe in supervision” (86.0%), and “supervisors’ attire and/or appearance” (84.1%). In contrast, “client information” and “clinical mistake” came up often and were fully disclosed.
Table 1
Incidence of Intentional Nondisclosure by Prelicensed Counselors in Clinical Supervision for State Licensure as Professional Counselors
| Incident of Potential Intentional Nondisclosure |
N |
M (SD) |
Not Applicable
n (%) |
Fully Disclosed
n (%) |
Sometimes Disclosed
n (%) |
Decided Not to Disclose
n (%)a |
| Negative reaction to supervisors’ behavior or attitudes SRI |
106 |
3.49 (2.71) |
29 (27.1%) |
6 (5.6%) |
47 (43.9%) |
24 (22.4%) |
| Supervisors’ competence SRI |
107 |
2.16 (2.87) |
63 (58.9%) |
2 (1.9%) |
24 (22.4%) |
18 (16.8%) |
| Needs not being met in supervision SRI |
107 |
2.22 (2.83) |
60 (56.1%) |
4 (3.7%) |
27 (25.2%) |
16 (15.0%) |
| Supervisors’ display of stereotypes or bias SRI |
106 |
1.85 (2.54) |
63 (58.0%) |
2 (1.9%) |
30 (28.0%) |
11 (10.3%) |
| Supervisors’ attire and/or appearance SRI |
106 |
0.99 (2.37) |
90 (84.1%) |
0 (0.0%) |
6 (5.6%) |
10 (9.3%) |
| Consult with peer and/or another supervisor SRI |
105 |
1.62 (2.19) |
45 (42.1%) |
26 (24.3%) |
24 (22.4%) |
10 (9.3%) |
| Supervision process concerns SRI |
107 |
1.85 (2.42) |
56 (52.3%) |
9 (8.4%) |
33 (30.8%) |
9 (8.4%) |
| Power differentials SRI |
106 |
1.25 (2.35) |
76 (71.0%) |
6 (5.6%) |
15 (14.0%) |
9 (8.4%) |
| Focus of supervision SRI |
107 |
1.86 (2.50) |
58 (54.2%) |
9 (8.4%) |
32 (29.9%) |
8 (7.5%) |
| Unsafe in supervision SRI |
106 |
0.78 (2.09) |
92 (86.0%) |
0 (0.0%) |
6 (5.6%) |
8 (7.5%) |
Perceived that my supervisor
is wrong SRI |
106 |
2.78 (2.42) |
30 (28.0%) |
11 (10.3%) |
58 (54.2%) |
7 (6.5%) |
| Disagreement with one’s supervisor SRI |
106 |
2.92 (2.01) |
13 (12.1%) |
19 (17.8%) |
68 (63.6%) |
6 (5.6%) |
| Supervision format issues SRI |
106 |
1.79 (2.36) |
56 (52.3%) |
10 (9.3%) |
34 (31.8%) |
6 (5.6%) |
| Personal issue CRI |
107 |
2.22 (1.82) |
9 (8.4%) |
45 (42.1%) |
48 (44.9%) |
5 (4.7%) |
| Personally identify with client (e.g., countertransference) CRI |
106 |
2.08 (1.74) |
9 (8.4%) |
45 (42.1%) |
47 (43.9%) |
5 (4.7%) |
| Evaluation concern SRI |
106 |
1.75 (2.03) |
38 (35.5%) |
29 (27.1%) |
35 (32.7%) |
4 (3.7%) |
| Client attraction issue CRI |
106 |
0.43 (1.48) |
93 (86.9%) |
5 (4.7%) |
4 (3.7%) |
4 (3.7%) |
| Client attracted to counselor CRI |
107 |
0.70 (1.49) |
74 (69.2%) |
17 (15.9%) |
13 (12.1%) |
3 (2.8%) |
| Positive reaction to supervisor SRI |
107 |
1.87 (1.50) |
3 (2.8%) |
63 (58.9%) |
38 (35.5%) |
3 (2.8%) |
| Issues with colleague SRI |
107 |
1.68 (1.75) |
27 (25.2%) |
40 (37.4%) |
37 (34.6%) |
3 (2.8%) |
| Positive reaction to client CRI |
106 |
1.62 (1.47) |
11 (10.3%) |
59 (55.1%) |
33 (30.8%) |
3 (2.8%) |
| Feeling inadequate CRI |
105 |
2.09 (1.59) |
6 (5.6%) |
50 (46.7%) |
47 (43.9%) |
2 (1.9%) |
| Clinic setting concerns CRI |
107 |
1.88 (1.62) |
12 (11.2%) |
51 (47.7%) |
42 (39.3%) |
2 (1.9%) |
| Supervisor attraction issue SRI |
106 |
0.13 (0.96) |
104 (97.2%) |
0 (0.0%) |
0 (0.0%) |
2 (1.9%) |
| Unprofessional behavior with client CRI |
107 |
1.13 (1.75) |
62 (57.9%) |
15 (14.0%) |
27 (25.2%) |
2 (1.9%) |
| Future clinical mistake CRI |
107 |
1.89 (1.37) |
63 (58.9%) |
20 (18.7%) |
43 (40.2%) |
1 (0.9%) |
| Clinical mistake CRI |
106 |
1.65 (1.31) |
3 (2.8%) |
71 (66.4%) |
31 (29.0%) |
1 (0.9%) |
Unfavorable client–counselor
interaction CRI |
107 |
1.78 (1.88) |
41 (38.2%) |
17 (15.9%) |
48 (44.9%) |
1 (0.9%) |
| Client information CRI |
106 |
1.36 (1.15) |
8 (7.5%) |
77 (72.0%) |
20 (18.7%) |
1 (0.9%) |
| Negative reaction to client CRI |
107 |
1.79 (1.35) |
6 (5.6%) |
58 (54.2%) |
42 (39.3%) |
1 (0.9%) |
Note. Percentages may not equal 100% for each item because of rounding.
SRI = Supervision-Related Incident
CRI = Client-Related Incident
a = Items are ranked based on incidence of total nondisclosure (i.e., score of 7).
The Most Difficult to Discuss Items
In addition to the per-item incidence rates, we also calculated which concerns were most often totally withheld from supervisors. We hoped to understand what items participants might be completely unwilling to discuss in supervision. Interestingly, we ranked all 30 SNDS items by the number of participants who reported using total nondisclosure, and this revealed that the 13 items with the highest endorsement were all supervision-related incidents. There were 24 participants (22.4%) who reported completely withholding their negative reaction to their supervisors’ behavior or attitudes. Relatedly, 18 participants (16.8%) did not discuss their concerns about their supervisors’ competence, and 16 participants (15.0%) did not tell their supervisors that they believed they were not getting enough out of supervision. Regarding client-related incidents, the highest-rated total nondisclosure was personal issues related to work with clients, which was reported by five participants (4.7%). The full results regarding the most difficult to discuss items are presented in Table 1.
Discussion
Our study examined the incidence of intentional nondisclosure by prelicensed counselors receiving postgraduate supervision for licensure as professional counselors. We found that 95.3% of prelicensed counselors in this study reported they withheld some degree of information from their clinical supervisors. This was comparable to the rates of intentional nondisclosure by trainees from allied professions (Ladany et al., 1996; Mehr et al., 2010). On average, participants reported 10.68 of 30 (SD = 6.62) intentional nondisclosures in clinical supervision, which also is comparable to the 8.06 nondisclosures reported by psychology trainees in the study by Ladany et al. (1996), although we should acknowledge that Ladany et al. used a different measure to capture incidents of nondisclosure in their study. Like allied professions, intentional nondisclosure by postgraduate, prelicensed counselors appears to be routine in clinical supervision. Further, we surmise that even though postgraduate, prelicensed counselors are more developmentally advanced than CITs (e.g., self-aware, motivated; Stoltenberg & McNeill, 2010), in a hierarchical and evaluative relationship such as clinical supervision, they too will withhold information. This suggests that prelicensed counselors, who are empowered to self-direct their postgraduate supervision experience, are doing just that—they are self-directing their supervision experience, including editing or concealing concerns about their clients and supervision experience from their supervisors. As such, supervisors who are reliant on supervisee self-report may not be getting a full picture of supervisee concerns or needs. This finding reveals implications for prelicensed counselors and supervisors alike. Delving further into the types of incidents being withheld in postgraduate supervision, as well as the frequency of these incidents, can help tell a more complete story of supervisee intentional nondisclosure by prelicensed counselors.
Overall, we found that participants were more willing to discuss commonly occurring client-related incidents than they were to disclose supervision-related incidents. However, the participants still reported hesitancy in disclosing many of their client-related concerns. This is evidenced by participants identifying client-related issues as salient issues to their supervision experience, and although they withheld some degree of this information from their clinical supervisors, they did not completely withhold the information. Although prior research has found that supervisees are less apprehensive to discuss client-related issues with their clinical supervisors (Ladany et al., 1996; Mehr et al., 2010; Yourman & Farber, 1996), there may be unique differences for prelicensed counselors that help to explain the findings from the current study. Notably, it is possible that as theorized (Loganbill et al., 1982; Stoltenberg & McNeill, 2010), prelicensed counselors are better able to self-monitor their own needs. As prelicensed counselors gain more clinical experience, they are able to autonomously address their client-related concerns (Rønnestad & Skovholt, 2003) and do not need to fully elaborate on their client-related concerns to their supervisors. However, when prompted by a survey such as this one, they recognize that there is more information to share about the incident (i.e., some degree of nondisclosure). Also, given the limited time in supervision for licensure, prelicensed counselors appear to need to prioritize specific information about their clinical work and seek guidance about their most pressing clinical needs (Cook & Sackett, 2018). Thus, at times they are unable to fully discuss the intricacies of their client caseloads.
We also found that prelicensed counselors are most hesitant and sometimes unwilling to discuss supervision-related concerns with their clinical supervisors. In the current study, the most common nondisclosures included disagreements with one’s supervisor, negative perceptions of one’s supervisor, and believing one’s supervisor was wrong, all directly pertaining to the supervisor. High levels of nondisclosure in relation to these types of incidents have been reported in prior research with psychology trainees (Mehr et al., 2010). Prelicensed counselors are likely to have started to develop their own counseling style (Rønnestad & Skovholt, 2003), which may or may not align with their supervisors’ approach to counseling. As such, it is likely that supervisees sometimes disagree with their supervisors or believe that their supervisor handled a situation poorly (Magnuson et al., 2002). It is possible that supervisees’ concerns about voicing dissent to their supervisors could reflect a weak or insecure supervisory relationship, which has been found to be a significant predictor of nondisclosure (Cook & Welfare, 2018; Mehr et al., 2010).
A little more than half of the participants (53.3%) reported that they completely withheld information from their supervisors. That is, these participants recognized something as being salient in their clinical supervision but refrained from disclosing any information about their concern with their supervisor. Perhaps most startling, the top 13 items (out of 30 items total) were all supervision-related incidents and some of these incidents occurred with staggering frequency. For example, a number of participants completely withheld their negative reactions to their supervisor’s behavior or attitudes (22.4%), never disclosed that they questioned their supervisor’s competence (16.8%), and declined to discuss that their needs were not being met in supervision (15.0%). These findings underscore the inherent power imbalance between supervisees and supervisors (Cook, McKibben, & Wind, 2018; De Stefano et al., 2017; Ladany et al., 1996). Although prelicensed counselors perceive concerns about their supervisor or their supervision experience, they are unwilling to broach these topics with their evaluative supervisors (Gibson et al., 2019).
It is difficult to say why the participants in the current study felt unfulfilled by their supervision experience or wondered about their supervisors’ competencies. We must exercise judgment before assuming that the supervisors of the participants in the current study were providing substandard supervision (Ellis et al., 2014). However, it also seems important that supervisees perceive their postgraduate supervision experience as a meaningful one, given the stakes associated with clinical supervision (Magnuson et al., 2000). For example, many prelicensed counselors pay for supervision, which can be a substantial financial investment for new prelicensed counselors. Relatedly, in situations in which prelicensed counselors’ clinical supervisors also are their administrative supervisors, sustained employment may depend on the supervisor’s favorable review. Regardless, these findings highlight the importance of outlining clear expectations of clinical supervision for supervisees (Magnuson et al., 2002) and developing a quality supervisory relationship in order to mitigate supervisee nondisclosure (Cook & Welfare, 2018; Mehr et al., 2010). In sum, these findings offer insight into the experiences of prelicensed counselors in postgraduate supervision, which can yield lessons for prelicensed counselors, supervisors, counselor educators, and counselor credentialing bodies in order to mitigate the occurrence of intentional nondisclosure in the future.
Implications for Prelicensed Counselors
Prelicensed counselors need to take an active role in their postgraduate supervision experience. Learning to navigate the nuances of supervision in addition to learning to be a practicing counselor early in one’s career is a daunting task (Freadling & Foss-Kelly, 2014). Prelicensed counselors who are contemplating withholding information from their clinical supervisors should consider their ethical and professional responsibilities to clients (American Counseling Association, 2014). Counselors who are starting postgraduate supervision may find it helpful to consult resources to help acculturate them to the specifics of postgraduate supervision and to explore strategies other than nondisclosure for addressing their concerns in supervision (Cook & Sackett, 2018; Magnuson et al., 2000; Pearson 2001, 2004).
Also, prelicensed counselors should consider which of the incidents described herein could be most relevant to their postgraduate supervision experience. Specifically, our prelicensed counselor participants were most apprehensive to discuss supervision-related concerns with their clinical supervisors. Unlike clients, who have the freedom to choose a different counselor if they are dissatisfied with their counseling services, supervisees likely have limited options when it comes to changing supervisors (De Stefano et al., 2017). Many of the concerns expressed by our participants reflect the inherent power differential between supervisors and supervisees. As such, prelicensed counselors who are dissatisfied with their supervision experience can find it helpful to broach some of these commonly reported issues with their clinical supervisors (Cook, McKibben, & Wind, 2018). The Power Dynamics in Supervision Scale was designed to operationalize supervisees’ perceptions of power and to aid in the discussion of power dynamics in clinical supervision (Cook, McKibben, & Wind, 2018). Prelicensed counselors may find such an instrument a helpful way to invite these discussions in an objective and nonthreatening manner with their supervisors. Such discussion between supervisors and supervisees can make it easier for supervisees to disclose more honestly if that issue arises (Knox, 2015).
Finally, some participants perceived their supervision experience as substandard, while a few more participants reported feeling unsafe in supervision or recognized power differentials between themselves and their supervisors. Although uncommon, our study is not the first one in which supervisees in the counseling profession report substandard or harmful experiences (Cook, Welfare, & Romero, 2018). Furthermore, no one should endure supervision that they perceive to be inadequate or harmful (Ellis et al., 2014). Supervisees can find it helpful to consult with a trusted colleague or another supervisor. For more egregious issues, prelicensed counselors may seek help from a professional association ethics consultant or a representative from their state licensing board (Cook, Welfare, & Romero, 2018). For those supervisees who are paying for supervision (26.4% in the current study), finding another supervisor may be the most viable solution.
Implications for Supervisors, Counselor Educators, and Counselor Credentialing Bodies
Addressing supervisee intentional nondisclosure must be a priority for clinical supervisors who are providing postgraduate supervision. If supervisors are to rely on supervisee self-report (Fall & Sutton, 2004), it will benefit supervisors to create a safe and open supervision environment that invites supervisee disclosure (Cook & Welfare, 2018; Gibson et al., 2019; Mehr et al., 2010). Encouragingly, prelicensed counselors appear more apt to discuss client-related incidents than supervision-related incidents; however, it also seems that clinical supervisors are not getting the full picture of their supervisees’ clinical work because there is some degree of nondisclosure. Notably, prelicensed counselors reported hesitancy in fully discussing their personal issues related to their work with clients, clinical mistakes, and reactions to clients. As prelicensed counselors continue their professional development, they can desire to try new interventions in their counseling work or have novel insights into how their personal experiences are impacting their clinical work (Rønnestad & Skovholt, 2003). Understandably, they might be apprehensive about discussing these issues with their evaluative supervisors. Supervisors will find it helpful to facilitate a discussion with their supervisees about the lifelong journey of being a professional counselor (Rønnestad & Skovholt, 2003) and the normality of sometimes feeling stuck in one’s clinical work with clients (Cook & Sackett, 2018) or going through stages of feeling stagnation, confusion, and integration, as discussed in the foundational model of Loganbill et al. (1982).
Prelicensed counselors’ unwillingness to discuss their supervision-related concerns, particularly those incidents that are commonly occurring such as negative impressions of one’s supervisor, negative reactions to a supervisor’s competence, and the belief that one’s needs are not being met in clinical supervision, seems to be most problematic. There are infrequently occurring issues that supervisees are completely unwilling to discuss (e.g., romantic attraction to one’s supervisor) that can lead to ruptures in the supervisory relationship (Nelson et al., 2008). Prior research suggests that supervisees who possess a favorable impression of their supervisory relationship are less likely to withhold information from their supervisors (Cook & Welfare, 2018; Gibson et al., 2019; Mehr et al., 2010). As such, supervisors need to take steps during formation of the supervisory relationship and throughout the supervision experience to create a safe and open environment that invites supervisee disclosure. Supervisors will find it helpful to specifically attend to the issues identified in our study such as how to professionally address disagreements between supervisors and supervisees, and to discuss supervisees’ personal expectations of clinical supervision.
Counselor educators can play a critical role in helping CITs learn strategies to navigate postgraduate supervision and understand the concept of intentional nondisclosure. For example, counselor educators can better prepare CITs for some of the nuanced differences of postgraduate supervision (Magnuson et al., 2002) versus the supervision they receive in their training programs. Counselor education programs can share resources (Cook & Sackett, 2018; Magnuson et al., 2002; Pearson, 2001, 2004) with CITs before they graduate to teach them about postgraduate supervision and help them learn about the experiences of prelicensed counselors. Further, counselor educators can teach CITs to be their own advocates in postgraduate supervision because they will be expected to self-direct their supervision experience (Magnuson et al., 2000). Advocacy in this context can include teaching soon-to-be graduates the importance of utilizing supervision contracts and training them to prepare their own supervision contracts to use with their postgraduate supervisors. These supervision contracts should outline key information to conducting adequate supervision (Ellis et al., 2014), including but not limited to (a) the frequency of clinical supervision (e.g., weekly individual or triadic supervision sessions), (b) the modalities to be utilized in supervision (e.g., self-report, audio or video recording), (c) the relevant ethical and professional guidelines that will guide the supervision experience, and (d) the roles and responsibilities for both the supervisor and supervisee. Preparing these documents prior to graduation can ensure that supervisees are well-informed of their rights as supervisees (Munson, 2002) and help easily identify signs of substandard postgraduate supervision (Ellis et al., 2014).
Counselor educators might also share the findings from this study with their CITs and facilitate a discussion about the concerns identified by the participants. Educating CITs on the concept of intentional nondisclosure is important, as it can aid CITs in identifying what influences their own intentional nondisclosure. With greater self-awareness, they may be able to identify the temptation if it ever presents itself. Counselor educators also can teach CITs about the potential harm to clients when supervisees choose to engage in intentional nondisclosure. For example, if supervisees purposefully withhold about the triggers they experience when working with a client, they run the risk of not providing effective counseling services and, even worse, harming the client (Hess et al., 2008; Ladany et al., 1996).
Finally, given that our study was the first study to examine supervisee intentional nondisclosure in a sample of prelicensed counselors, it is important to offer recommendations for state licensure boards and nationwide credentialing bodies that may improve the supervision experience for supervisees and supervisors. These prelicensed counselors withheld specific supervision-related concerns, including the belief that their expectations of clinical supervision were not being met and that they disapproved of their supervisors’ behaviors. Unlike university-based supervision in which supervision requirements and supervisors’ training and credentials (e.g., time in supervision, required supervision training, direct observation) are clearly outlined by accreditation bodies (CACREP, 2015), the supervision requirements for those pursuing state licensure vary from state to state (Field et al., 2019; Gray & Erickson, 2013; Henriksen et al., 2019). Some scholars have questioned if the supervision being provided is minimally adequate, or if supervisors are aware that they are providing inadequate or harmful supervision (Ellis et al., 2014). It is unclear how many supervisors in our study had received clinical supervision training or were providing supervision in accordance with professional standards (i.e., Borders et al., 2011). For example, only six of the 10 states that we sampled had licensure board requirements for clinical supervisors to have completed supervision training (Field et al., 2019), and none required a supervision credential such as the Approved Clinical Supervisor (issued by the National Board for Certified Counselors). It is important for all state licensure boards to require supervision training in order to best position supervisors to provide quality supervision. Relatedly, Field et al. (2019) found that only 47.1% of states require supervisors to complete a supervision contract or supervision philosophy prior to conducting postgraduate supervision. At a minimum, all licensure jurisdictions should require these documents as a part of the application packet for prelicensed counselors when they register their supervisor with their licensing board. By requiring these documents, state licensure boards and credentialing bodies can encourage a dialogue between supervisors and supervisees about some of the concerns identified in our study.
Limitations and Opportunities for Future Research
Like in all studies, there are limitations that need discussion. We aimed to collect data from a nationally representative sample; however, our findings could have been impacted by the varying licensure regulations in each state. As such, future research could benefit from a retest of the incidence of nondisclosure by prelicensed counselors in other states. Relatedly, although our response rate was consistent with prior counseling research that collected data via mailings (Barden et al., 2017), future researchers could explore other data collection methods (e.g., electronic survey) to increase participants’ responsiveness. Also, it is possible that the topic of nondisclosure was acutely salient to the persons who chose to participate in the current study, which could have influenced our findings. Future scholars are urged to examine more demonstrable factors of the supervisory relationship that may help to explain intentional nondisclosure by prelicensed counselors such as the incidents of inadequate and harmful supervision, which appear to influence supervisees’ willingness to disclose in supervision. Finally, future researchers should explore if nondisclosure occurs less frequently in supervision dyads that regularly use one of a number of supervisory relationship inventories (Tangen & Borders, 2016) to assess the perceived quality of their supervisory relationship.
Conclusion
In sum, postgraduate supervision has important implications for prelicensed counselors and supervisors alike. Thus, it behooves both prelicensed counselors and clinical supervisors to mitigate supervisee intentional nondisclosure. The findings presented in this study provide insight into the type of information being withheld by supervisees and the degree to which they are hesitant to discuss certain concerns. Clinical supervisors who hope to create an environment that promotes supervisee disclosure will benefit from specifically targeting some of the issues identified herein.
Conflict of Interest and Funding Disclosure
This research was funded by the Southern
Association for Counselor Education and Supervision.
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Ryan M. Cook, PhD, ACS, LPC, is an assistant professor at the University of Alabama. Laura E. Welfare, PhD, NCC, ACS, LPC, is an associate professor at Virginia Tech. Connie T. Jones, PhD, NCC, ACS, LPCA, LCAS, is an assistant professor at the University of North Carolina at Greensboro. Correspondence can be addressed to Ryan Cook, 310 Graves Hall, Box 870231, Tuscaloosa, AL 35487, rmcook@ua.edu.
Mar 9, 2020 | Volume 10 - Issue 1
William H. Snow, J. Kelly Coker
Distance education has become a mainstay in higher education, in general, and in counselor education, specifically. Although the concept sometimes still feels new, universities have been engaged in some form of distance learning for over 20 years. In the field of distance counselor education, it is imperative to understand where we have been, where we are now, and where we are going. This article will lay the foundation for the special section of The Professional Counselor on distance counselor education and will explore the history of using technology in education, recent research about distance education in counseling and counselor education, and topic areas discussed throughout this special section. This special section will bring clarity to current and emerging best practices in the use of technology in the distance education of professional counselors, clinical supervisors, and counselor educators.
Keywords: online, distance education, counselor education, technology, best practices
Counselor educators have become comfortable and adept over the years at fostering students’ development in clinical skills in traditional residential formats. For many counseling faculty, in-class, face-to-face (F2F), personal encounters are foundational and irreplaceable. For educators with this mindset, distance learning is not an opportunity but a threat to what they consider the best teaching and learning practice (Layne & Hohenshil, 2005). No matter one’s personal preference or belief, the advent of distance learning is challenging the sovereignty of the purely residential experience.
For the purposes of this discussion, we are using the term distance education versus the more prolific term online education. The U.S. Department of Education’s Office of Postsecondary Education (OPE) has officially adopted the broader term of distance education, which focuses on the physical separation in the teacher–student relationship (OPE, 2012). This is in contrast to the term online education, which emphasizes the internet-facilitated communication that supports the teaching relationship at a distance.
The number of students in distance education programs has been increasing each year (Friedman, 2018). By 2016, over 6 million students in the United States were engaged in distance education, and nearly half were exclusively taking online classes (Seaman et al., 2018). Over two-thirds of the students were enrolled in distance learning courses at public universities (Lederman, 2018). In contrast, the total number of residential students dropped by over 1.1 million (6.4%) between 2012 and 2016 (Seaman et al., 2018). The growth in enrollment and the future of higher education continues to move toward distance education.
The same trends have impacted counselor education. At the time of this writing, the Council for the Accreditation of Counseling and Related Educational Programs (CACREP) reported that there are 69 CACREP-accredited master’s programs that are considered distance education, 34 of which are clinical mental health counseling programs (CACREP, n.d.). Over 25% of counseling students are now enrolled in academic programs defined as distance education (Snow et al., 2018). Because an increasing number of programs are including distance education opportunities, the need for an exploration of efficacious deliveries of distance education content is imperative (Cicco, 2012).
The growth in distance education programs is often based on mixed motivations. One motivation is the desire to provide greater access for traditionally underserved populations (Bennett-Levy et al., 2012). For example, distance education can benefit students in rural areas as well as those living abroad (Sells et al., 2012). Remotely located service providers can benefit as well. Agencies that lack immediate physical access to counselor education programs now have the online tools to train members of their community locally in advanced mental health skills through distance education so they can continue serving their communities while in school. Distance education programs also can better support working adults and caregivers who in theory are within geographic proximity of a campus but are constrained by complex schedules, responsibilities, and mobility-related issues (e.g., disabilities, difficult travel). The ability to engage in academic studies from any location around the globe, within a more flexible scheduling model, is a game-changer (Bennett-Levy et al., 2012). Additionally, adult learners increasingly prefer the autonomy and self-direction found in these distance education formats (Ausburn, 2004).
Distance education programs allow access to a greater pool of qualified, diverse faculty. Qualified counselor educators anywhere in the world with access to a computer and an internet connection are prospective instructors. Most importantly, distance education programs eliminate the constraints of geographic proximity, worsening traffic commutes, and parking concerns. For the distance education program, it is all about access for any faculty member or student in the world (Reicherzer et al., 2009).
A more pragmatic motivation for universities is to view distance education programming as a source of revenue, growth, and efficiency (Jones, 2015). For example, distance education courses eliminate the costs and limitations of brick-and-mortar classrooms. Unfortunately, students may not benefit when universities increase online class sizes and hire less expensive adjuncts to increase the bottom line (Newton, 2018). Some universities might even tack on special technology or distance education fees.
It is our belief that the counseling profession should take the lead in proactively investigating the promise of the distance education experience, including the technologies, pedagogies, and methods. We must determine which best practices create excellent educational experiences for the ultimate benefit of our counseling students and the clients they will serve. This special section of The Professional Counselor is an essential step in that direction.
A History of Learning Technologies and Their Impact on Distance Counselor Education
If we take a step back, we can see that there has been a continual movement toward infusing technology into the general educational process and, more recently, specifically in counseling and counselor education. We have moved from a strictly oral tradition in which vital knowledge and skills were passed on in F2F interactions to a present-day, technologically mediated set of interactions in which teacher and student may never meet in person and where dialogues are reduced to bits and bytes of information transmitted across the internet.
In ancient times, essential knowledge, skills, histories, and traditions were only preserved in the memories of those able to experience events directly or to receive critical information from others. People were living repositories of essential skills of survival, cultural insight, and wisdom. If they failed to pass it on orally or through example, what they knew and embodied was lost forever. It is a surprise to many that Socrates did not pen a single word. His choice of influence was through discussions with his followers and came to be known as the Socratic method. Socratic concepts would have been lost forever, but fortunately, followers such as Plato put them in writing.
The Written Word
Socrates’s ideas on teaching and learning lived through an early technology: the written word. The technological advancement of written language, writing devices, and the availability of parchment and paper as a set of communication tools was revolutionary in furthering information sharing and learning. Scholarship became associated with the ability not only to think critically, but also to read about the thoughts of others and respond in writing to contribute to the public discourse. Written documents were copied and distributed in what was the earliest form of distance education. During the medieval period, the copying of important texts often fell to those within monastic religious life, usually as a compulsory duty. Copying books for six or more hours per day for years was a noted source of drudgery (Greenblatt, 2011), but the printing press removed the need for such anguish.
The Printing Press
The limitation of scribes hand-copying documents meant that access to readable material was for society’s select few. Gutenberg’s invention of the printing press in approximately 1438 increased access to print (Szabo, 2015). For the first time in history, the works of scholars, philosophers, and artists could be printed in books and made available to a wider public. With written materials available, the literacy rates in Europe rose from approximately 10% in the 1400s to over 90% by the middle of the 20th century (Roser & Ortiz-Ospina, 2018). The printing press laid the groundwork for innovation in education as well. In the 1720s, the printing press allowed for the first distance education correspondence courses in Boston, representing the “written era” of technology-enhanced education (Drumbauld, 2014). More technologies would eventually revolutionize progress in educational methods.
Sound Recordings and Film
The phonograph was invented by Thomas Edison in 1877 as a device to both record and play back sound (Thompson, 2016). It did not replace writing and books but could record and preserve the sounds of music, events, and the words of famous people and other languages. For example, when people could hear what foreign dialects sounded like from the lips of native speakers, language instruction was transformed.
The development of celluloid film recording and motion pictures in 1895 led to newsreels and documentaries in the early 1900s that provided the public with information about current affairs and historical and cultural events. For the first time in history, people could experience significant events in recorded sight and sound versus only reading about them. Moreover, they could now learn by seeing (O’Shea, 2003).
Radio, Television, and the Telephone
Relatedly, the advent of commercial radio broadcasting in the 1920s provided the first live reporting of events (University of Minnesota, n.d.). For example, radio audiences heard powerful first-hand emotions in the reporter’s voice as he watched the Hindenburg disaster unfolding before his eyes. In the 1920s, colleges and universities began to take advantage of this new, powerful medium. For example, Pennsylvania State University was the first university to be granted a broadcast license to begin offering college courses over the radio (Dawson, 2018).
The “radio era” quickly transitioned to the “TV Era” in the late 1960s when televisions were in most homes in the United States. People could both see and hear world events at a distance. Stanford University was one of the first institutions to capitalize on this burgeoning technology for educational purposes. The Stanford Instructional Television Network was started in 1968 and offered instruction for part-time engineering students (LeDesma, 1987).
Radio and television broadcasts were significant innovations. Their drawback from an educational perspective was that they were primarily one-way mediums and the audience was merely a passive recipient of sights and sounds. It was the telephone that provided the masses with the first means to engage in two-way conversations at a distance. For the first time in history, the average person could not just listen at a distance, but also could talk back. An early telephone-based education using this two-way communication medium was offered by the University of Wisconsin in 1965 (Drumbauld, 2014). Computers and the internet would soon become the next revolutionary communications medium.
Computers and the Internet
Computers were useful as standalone information processors, but it was the unifying ability for computers to communicate that set the stage for the next revolution in information dissemination since Gutenberg’s printing press—the internet. The internet is in actuality a shortened version of the term internetworking, which was born in 1969 when the Advanced Research Projects Agency Network (ARPANET) successfully sent the first message between computers (Leiner et al., 1997). That was followed by the standardization of the Transmission Control Protocol/Internet Protocol (TCP/IP) to give all researchers a standard computer language in order to talk together on this small but growing assemblage of internetworked computers (Leiner et al., 1997). Technical advances continued to follow, but the fledgling internet was not accessible to the average person. Defense researchers, academics, and early computer buffs with the drive and savvy to understand and write in computer languages like Unix to execute functions like domain name system lookup, file transfer protocol, and simple message transfer protocol dominated the internet (Leiner et al., 1997). The basic networking foundations were developed, but the average person was waiting for the time when the internet would move from the researchers’ lab to broader computing access.
Personal Computing
For decades, computers were costly in price, massive in size, and difficult to maintain, and required a dedicated, specialized operating staff. This meant computer access was only for select university personnel, government employees, larger businesses, and electronic hobbyists. Access changed with the advent of the Apple II in 1977, the IBM PC in 1981, the Apple Macintosh in 1984, and the Windows operating system in 1990 (Allan, 2001). The era of the personal computer (PC) was born and it soon became a must-have technology and home appliance for an increasing number of individuals in society. Functional, affordable, and easy to operate, computers were now available to the general consumer, opening up a worldwide network of information sharing.
The World Wide Web
Early PCs were standalone machines, and few connected to the government-dominated internet. In the 1980s, there began a movement for PCs to connect to proprietary, fledgling dial-up modem-driven services like America Online (AOL; Rothman, 2015). These computer connection services allowed dial-up modem access, information sharing, and file uploading and downloading for a monthly subscription (Haigh et al., 2015). Email communications could be sent but only for those on closed, proprietary networks.
Some universities began their own networks or used services like AOL in order to connect faculty, staff, and students. These online services were far more comfortable to use than the more complex internet, which still required a level of technical sophistication. Although these services were accessible, they were somewhat isolated as each service provider had an exclusive dial-up modem for access and an entity unto itself.
In 1990, only 2.6 million people worldwide had access to the fledgling internet (Roser et al., 2020). A significant breakthrough occurred with the development of hypertext language in 1991 and the first integrated web browser, called Mosaic, in 1993 (Hoffman, n.d.). Access to the internet and its wealth of resources suddenly became available with a point and click of a computer mouse. The term World Wide Web accurately described internet connectivity that spanned the world and connected smart devices to include computers, tablets, gaming consoles, and phones. If a device had a central processing unit, it could connect. By 2018, 4.2 billion people, or 55.1% of the world population, had internet access (Internet World Stats, 2019). In response, the number of digital websites grew from 130 in 1993 to over 1.9 billion today (InternetLiveStats.com, n.d.).
The Digital Age
Digitization has created a world library and communication platform where text, audio, and video recordings are available to anyone with a computer, tablet, gaming console, or smartphone connected to the internet. Anything that can be digitized can be stored and transmitted in real time. The internet merely has taken our previous modes of physical and analog forms of communication and moved them into the digital stream. Internet publishing is a simple extension of Gutenberg’s printing press. The local library is now a part of the World Wide Web library. Text messaging is the modern-day telegraph, and cellular phone services have cut out the need for copper wiring. Streaming audio and video are what radio and television were. Cutting edge videoconferencing platforms are the new F2F communication mode. Reality has now become a virtual reality. For the counselor educator, all of the world’s accumulated technological advances and resources can rest in the palm of your hand. All of the technologies have come together to support progress toward what we call the distance learning era.
Distance Education
Even though we tend to think of distance education as a recent development, Pennsylvania State University offered correspondence education to rural farmers using U.S. mail in 1892, over 125 years ago (Dawson, 2018). Correspondence courses were the precursors to the more sophisticated distance education approach offered by the University of Phoenix in 1976. The 1990s brought about the most significant changes regarding online educational delivery, with the University of California-Berkeley offering the first completely online curriculum in 1994, and Western Governor’s University, established in 1997, helping Western states maximize educational resources through distance education (Drumbauld, 2014). Today, the distance education student population has grown to over 6 million students in the United States (Seaman et al., 2018). Counselor education programs have developed along with this national trend. Today, 69 counseling programs are offering CACREP-accredited distance education degrees (CACREP, n.d.).
Web-Facilitated Faculty–Student and Student–Student Interactions
In the early 1990s, Moore and Thompson (1990) and Verduin and Clark (1991) defined the core conditions that distance education should achieve to become as effective as F2F instruction. These conditions were timely instructor feedback to students and regular student-to-student interactions. Almost 30 years later, those conditions have been fulfilled. Secure audio- and videoconferencing platforms, such as Zoom and Adobe Connect, now allow faculty and students to connect F2F in real time, synchronously (Benshoff & Gibbons, 2011).
E-learning platforms, such as Blackboard, Canvas, and Moodle, now provide an integrated solution for faculty to asynchronously post syllabi, assignments, and instructional resources for instant download by students. Students can then respond to faculty questions via threaded discussions, upload papers, and take online assessments. Faculty, in turn, can review student work and provide feedback as fast as they can type.
It is now clear that with the combined power of the PC and facilitated technologies, timely instructor feedback and regular student-to-student interactions are possible. The future is here, and all that remains is for counselor education instructional pedagogy to catch up, as well as keep up, with the technological advances that are driving changes in education.
Clarity of Focus: What Is Distance Counselor Education?
Terms like online education, distance learning, and hybrid program, without a clear understanding of their proper use, are problematic. The determination of an academic program as distance education, online, hybrid, or residential has implications for federal financial aid, regional accreditors, and CACREP. So, what is distance education, how is it linked to advances in educational technology, and how does it relate to counselor education?
In practice, various terms, such as distance learning, online learning, and online education, are used. The OPE (2012) has officially adopted the term distance education and further defines distance education as instructional delivery that uses technology in courses for students separated from their instructor to support “regular and substantive interaction between the students and the instructor, either synchronously or asynchronously” (p. 5). The technologies referred to by the OPE are generally internet-based and may include the use of email, audioconferencing, videoconferencing, streaming videos, DVDs, and learning management systems.
Januszewski and Molenda (2013) defined educational technology as “the study and ethical practice of facilitating learning and improving performance by creating, using and managing appropriate technological processes and resources” (p. 1). Simply put, educational technology is about the physical tools we use in education and the processes that we implement to intentionally shape the relationship of the tools to the subject matter, teacher, student, and social learning environment. These tools and processes combine to form the educational pedagogy to support learning and the OPE (2012) mandate for “regular and substantive interaction between student and instructor” (p. 5).
The OPE (2012) categorizes programs as distance education if at least 50% or more of their instruction is via distance learning technologies. In contrast, residential programs, as categorized by the OPE, CACREP, and federal financial aid regulations, are allowed to infuse significant distance education elements into their instructional coursework as long as they do not exceed the 49% threshold. As an example, a 60 semester unit (90 quarter units) residential program could still offer 29 semester units (44.5 quarter units) of distance education coursework and technically remain residential by OPE standards.
The Continuum of Residential to Distance Education Programming
At one end of the spectrum are purely residential programs, offering 100% of courses in person. The next step along the spectrum is residential hybrid programs. These are still considered residential in providing the preponderance of courses in residence, but they can contain up to 49% of their credit units online and technically maintain their residential classification. Next along the spectrum are limited residency distance learning programs. These provide 50% or more of courses online but require some level of on-campus participation. A 2018 study by Snow et al. found that 90% of CACREP-accredited distance education programs were considered limited residency. They required students to attend a campus residency at least once and up to four times during their degree program. Finally, at the opposite end of the spectrum is a small but growing number of programs offering entirely distance education formats. These offer 100% of their coursework at a distance with no campus residency requirement.
The Infusion of Distance Education Technology in All Education
It is difficult to imagine any counselor education in 2020 to be technology-free and without some integration of distance education elements into individual class sessions, full courses, or programs. In concept, one could argue that there is a bit of online educator in the majority of faculty members today, whether they realize it or not. Most universities now require faculty, even the most technophobic, to have access to a computer and read and respond to email communications. Critical information is commonly only accessible on institutional web pages. Confidential information, such as student advising information, is often available online via secure portals—no more hard copy student files. Grades are now commonly put online. All of these widely used technologies support students learning at a distance.
The advent of the modern learning management system in the form of web-based platforms, such as Blackboard, Canvas, and Moodle, has added a level of access and interactivity to all programs in the teaching spectrum, from entirely residential to entirely online. Faculty engaged in all formats can use these educational platforms to post text, audio, video, and recorded lectures. Students can view materials, upload their papers, and post responses for review and grading. Discussion groups can interact using asynchronous, threaded discussions within these portals. Embedded grade books keep students informed of their progress at all times. These learning platforms, along with other educational technologies, are now commonly employed in both residential and distance education courses, making the programs look increasingly more similar than different.
Reducing the Distance in Distance Education
Assuming the presence of residential courses with as much technology infused into them as many distance education courses, what is the difference? Both formats require “regular and substantive interaction between the students and the instructor” (OPE, 2012, p. 5). The key word in distance education is distance. The OPE (2012) refers to distance education where students are physically separated from their instructor. Academic programs are required to support, facilitate, and ultimately ensure that regular and substantive interactions occur between students and instructors. The implicit assumption is that residential faculty in close physical proximity to their students have adequate if not superior amounts of regular and substantive interactions with students and thus greater connection and engagement. But, is that necessarily true?
We suggest that rather than focus on whether a class is considered residential or distance education, the concern should be about the amount of regular and substantive interactions, which decrease the social distance between students and faculty and thus help foster community and quality student engagement. Reducing social distance, a measure of relationship and connection, is a significant factor in promoting student engagement. The Great Schools Partnership (2016) defined student engagement as “the degree of attention, curiosity, interest, optimism, and passion that students show when they are learning or being taught, which extends to the level of motivation they have to learn and progress in their education” (para. 1). There is ample evidence that students who feel a sense of community and connection, no matter what the delivery model, demonstrate better academic performance and higher levels of satisfaction and retention (Benshoff & Gibbons, 2011; Chapman et al., 2011; Rovai & Wighting, 2005). The decreased social distance between faculty and students is a good indicator of “regular and substantive interactions” and thus greater student engagement in the learning process. The physical proximity of faculty and students within residential learning programs can certainly provide opportunities for direct interaction and decreased social distance, but without appropriate faculty desire to connect and engaging pedagogy, there is no guarantee. Numerous studies involving residential programs document cases of student disconnect, alienation, and reduced graduation rates on college campuses (e.g., Feldman et al., 2016; O’Keefe, 2013; Redden, 2002; Rovai & Wighting, 2005; Tinto, 1997). Helping students feel connected to their faculty, fellow students, and campuses is an important task for those operating in both residential and distance learning arenas. Distance education faculty using the appropriate technological tools and pedagogy can overcome the obstacles of physical separation and facilitate meaningful, regular, and substantive interactions.
As we reflect on our educational careers, the authors remember auditorium-style classes in large lecture halls. The physical distance to the instructor might have been 50 feet, but it might as well have been 50 miles as it was difficult to connect with an instructor when competing with 99 other students for attention. Conversely, we have experienced an online class where faculty and students were geographically scattered, but small class sizes allowed us all to make stronger connections. We have come to believe that online education done right can take the distance out of distance education.
The ability of students and faculty to connect at a distance is ever increasing. What was once almost purely an asynchronous model of instruction (i.e., threaded discussion posts and emailed assignments) now has evolved with the addition of interactive videos and training modules, recorded lectures, “real-time” synchronous classes, and live videoconferencing for classroom experiences, advising, and clinical supervision. These tools are allowing students to watch expert counseling role models demonstrate and practice clinical skills themselves while getting real-time feedback from instructors and fellow students. For many counselor education programs, distance education and online learning experiences are now better characterized as virtual remote classrooms.
The Special Section: Distance Counselor Education
This special section reviews the historical context of distance education, seeks to understand the critical elements and best practices for effective distance education, and makes modest projections about future trends. Six additional articles can be found in this issue that provide greater focus on the following areas of consideration: (a) student selection, development, and retention; (b) challenges and solutions of clinical training in the distance environment; (c) distance education pedagogy similarities and differences compared to residential instruction; (d) legal and ethical considerations for distance counselor education; (e) opportunities and challenges of multicultural and international distance education; and (f) student perceptions and experiences in distance education.
Student Selection, Development, and Retention: Who Can Best Succeed?
There are several measures of student success, including retention, academic performance, and graduation rates. Researchers have examined the success of students enrolled in online programs or classes to better understand those factors that lead to or impede student success. Sorenson and Donovan (2017) sought to explore why undergraduate students at an online, for-profit university were dropping out. The authors determined that attrition could be attributed to several factors, including a perceived lack of support by the university and faculty, difficulty balancing multiple priorities, a lack of awareness of how much time is required, and academic issues (Sorenson & Donovan, 2017).
How do we determine the best “fit” through our student selection process? A student’s undergraduate college grade point average does seem to serve as a significant predictor of success in graduate distance learning programs (Cochran et al., 2014). Graduate Record Exam scores, previous work experience, and application essays also are commonly used to select students, but Overholt (2017) did not find them useful in predicting student success among non-traditional graduate student populations. Gering et al. (2018) determined that more salient factors for predicting success included initiative, the ability to take responsibility for one’s education, and time management. Yukselturk and Bulut (2007) have described these factors as representing self-regulated learners.
Gering et al. (2018) also found some external student success factors to be crucial, including a supportive family, strong social connections with other students, strong teaching presence, and receiving prompt and regular feedback and guidance. It is clear then that student success in distance learning courses is partially dependent upon student attributes but also on their level of external support, the actions of the instructor, and a supportive institution.
Clinical Training in the Virtual Remote Environment: What Are the Challenges and Solutions?
It is one thing to offer didactic learning at a distance but quite another when we think about how to conduct engaging clinical skills development in the distance education environment. How do we support the development of appropriate knowledge, skills, and dispositions to help counseling students succeed? The virtual remote classroom allows students to observe faculty experts and student volunteers engaged in clinical role-play simulations. Students can team up with other students in virtual breakout rooms to practice skills they have just watched remotely. Videoconference tools with embedded recording features can capture verbal and non-verbal interactions. Faculty can subsequently observe student role plays live or via recorded sessions.
According to Reicherzer et al. (2012), online and hybrid counselor training programs using a blend of asynchronous, synchronous, and in-person training can produce counselors capable of meeting site supervisors’ expectations of clinical skill preparation before entering practicum and internship. Other researchers found that student learning outcomes are higher for hybrid or blended programs than for fully online or fully residential programs (Means et al., 2010).
Graduates of such programs have an advantage over residential students in their experience with the technologies required for implementing telemedicine and online counseling in their practices—a necessary competency for future practice in the 21st century. With their background in distance learning, these students will have firsthand knowledge of what it takes to properly implement online tools for facilitating strong therapeutic connections. Their remote experiences will provide valuable insights to mental health agency leaders who eventually need to integrate telemedicine into their work to keep pace with future trends and demands (Zimmerman & Magnavita, 2018). This will set these students apart from other clinicians graduating today who lack the training outcomes to participate competently with the proper ethical safeguards in the online world (Barnett, 2018).
Virtual Remote Educational Pedagogy: Similar or Different From Residential Instruction?
In education, the preferred relationship of balancing course content, pedagogy, and technology will vary by institution and instructor. One example is the philosophy of José Bowen (2012). He prefers the live classroom experience, creating more value within the live classroom experience and using technology outside the classroom (Bowen, 2012). He is not against technology, but he believes it is best used outside the classroom to free up more time for richer in-class dialogue. Other programs may adopt a model with more reliance on technology for primary content delivery with the instructor taking a backseat to the online delivery systems. In the context of online and technology-enhanced counselor education, how do those of us who work and teach virtually maximize the available technology to create a vibrant, interactive experience? Can we leverage technological tools to provide the resources needed for success while still creating an impactful and compelling experience? What is the appropriate balance?
In a study of online courses with demonstrated effectiveness, Koehler et al. (2004) determined that three components must dynamically constrain and interact with each other: content, pedagogy, and technology. Faculty must demonstrate expertise in their subject matter, skill teaching in an online environment, and an understanding of as well as effectiveness in utilizing technology in dynamic ways. If all three are present in a course, students report having a better learning experience.
Total distance learning, blended learning, and fully residential learning approaches share another common success—the importance of a positive, supportive learning community. In a study by Murdock and Williams (2011), distance learning students who felt connected and a part of the university community reported more satisfying learning experiences. At least in these cases, successful connection was more important than any particular teaching pedagogy or technology.
Legal and Ethical Considerations in Online Delivery
Online educators are subject to the same statutory and regulatory compliance concerns as their residential counterparts. Online educators have additional complications, challenges, and risks because of their reliance on web-based technologies and online communication. Security, privacy, and access are some of the considerations faced by educators teaching at a distance.
Cybersecurity is now an overarching concern in higher education (White, 2015). Most, if not all, of the student’s personal information, academic record, and submitted course materials are stored in computer files in cloud-based storage. Increasingly, physical student records do not exist as backups. We are moving toward total dependence on reliable, secure access to internet-based storage and retrieval solutions. Distance educators face a level of risk each time student and institutional information is stored, accessed, and shared across cyberspace. There are plenty of bad actors in society focused on disrupting and exploiting these kinds of private information.
The Family Education Rights and Privacy Act (U.S. Department of Education, 2018) requires the protection of the student’s personally identifiable information and education records from unauthorized disclosure. Protection requirements apply to the institution in general; educational service providers providing outsourced services; and every administrator, staff member, and faculty member with access to student records. Although cybersecurity is an important security component, there are other simple, practical questions for the individual educator to ponder. For example, when involved in asynchronous communications via email, how do you know it is the actual student? When a distance learning faculty member gets a phone call from an online student they do not know well, how do they verify identity? In 2007, a residential student impostor lived on Stanford’s campus for 6 months, ate in the cafeteria, and lived the campus experience until finally caught (Novinson, 2007). If it can happen in a residential setting where we interact with students directly, it can surely happen in an online environment.
Compliance regulations for the Health Insurance Portability and Accountability Act of 1996 (HIPAA) govern the security of communications that clinical site supervisors, clinicians in training, and faculty supervisors maintain about client cases (HIPAA, 2015). Clinical faculty conducting individual, triadic, or group supervision via telecommunication must verify that technologies meet HIPAA compliance. There also is the requirement that student clinicians must not be discussing confidential issues within earshot of friends, families, and roommates—and not doing so via the local coffee shop’s wireless hotspot.
Online education provides access to students at a distance, and in many respects, it provides access and opportunities for those who previously had few options to extend their learning. Online courses may not prove accessible to people with disabilities as the reliance on embedded web technologies may present challenges (Edmonds, 2004). The Americans with Disabilities Act (ADA) requires educational institutions to make their physical campuses accessible to people with disabilities and the virtual campuses as well. The ADA government website provides guidelines of what is required to make web-based information accessible to those with various disabilities (United States Department of Justice, n.d.).
Issues of student sexual harassment can occur, necessitating Title IX investigations and interventions (Office for Civil Rights, 2018). University administrators must learn how to handle these and other related issues at a distance with students who may be physically separated.
Online educators must comply with federal statutes and regulations, those in their institution’s home state, and those in the state in which the student resides. State-by-state approval is possible but cumbersome. There are initiatives, such as the National Council for State Authorization Reciprocity Agreements, to establish a state-level reciprocity process (National Council for State Authorization Reciprocity Agreements, n.d.).
Multicultural and International Distance Education: What Are the Opportunities and Challenges?
Another important consideration is how well distance counseling programs effectively attract, retain, and support students from diverse backgrounds. Since its rise in availability, distance education has been a strong draw for people from diverse backgrounds, particularly women of color (Columbaro, 2009). Walden University, one of the largest online universities in the country, reported in 2015 that of its almost 42,000 graduate students, 76.7% were women and 38.7% were African American (Walden University’s Office of Institutional Research and Assessment, 2015).
In addition to the strong representation of students of color in online education, there is a growing number of international students who also are taking advantage of opportunities to learn at a distance (Kung, 2017). Kung (2017) reported data from the Institute of International Education that showed a 7.1% increase in the number of international students studying in U.S. colleges and universities. Distance learning can accelerate this increase as online students do not require an F-1 visa to participate at a distance. With this rise, Kung calls for an increase in cultural awareness, sensitivity, and preparation for working with international students in online settings.
Counselor Education at a Distance: Student Perspectives
Given the rise in the number of distance counselor education programs, it seems that there would be a wealth of literature to help us understand the real experiences of students training to be professional counselors in online formats. Although there have been studies examining general student perceptions of engagement, social presence, and outcomes in online learning environments (Bolinger & Halupa, 2018; Lowenthal & Dunlap, 2018; Murdock & Williams, 2011), specific experiences of online counseling students across the wide variety of delivery methods has not, to these authors’ knowledge, been conducted. As technology improves and options for learning management, videoconferencing, and student assessment platforms increase, programs training counselors at a distance have a widening variety of ways in which this learning can occur.
Asynchronous, synchronous, blended, hybrid, and fully online are just a few modalities that counseling students use to experience their education. A glimpse into the experiences of students will shed light on how our most important players in this ever-changing game of distance counselor education view the efficacy of their respective training, now and in the future.
The Future of Distance Counselor Education
As we examine emerging technologies and near-future possibilities, it can seem like science fiction. The use of avatars and other simulation and gaming technologies in counselor training, for example, have been examined for potential substitutions for counseling practice with peers and real people. Walker (2009) studied the use of avatars in one virtual platform, Second Life, for skills training among master’s-level counseling students. Counseling students’ attitudes regarding the effectiveness of this medium to enhance skills development were measured, and findings suggested that this technological enhancement was efficacious to student learning, engagement, and overall skill development.
Virtual reality (VR) is already used in counseling and is being explored as a way to create environments that can help address trauma and phobias and enhance mindfulness training and techniques. Riva and Vincelli (2001) contend that the use of VR in clinical settings can serve as a “sheltered setting” (p. 52) where clients can explore distress-producing stimuli in a safe and controlled environment.
What potential does this technology have in the training of the next counselors? Might we have “virtual” clients that counselors interact with, in real time, in a VR environment? Buttitta et al. (2018) of California State University, Northridge’s counselor education program are already doing so in training their counseling students. They recently presented initial findings at the 2018 Western Association for Counselor Education and Supervision (WACES) Conference where they demonstrated how they could change the avatar’s voice and physical look to become a person of any age, gender, or ethnicity. Their initial impressions are that student learning is as good with avatars as with role-playing students.
We see this idea tested in training programs in other fields. Plessas (2017) conducted a study of the effectiveness of using VR “phantom heads” for dental students to practice their skills on. Findings suggested that along with concurrent, augmented feedback from supervisors, this training method creates a level of efficiency and safety. Additional platforms for virtual counseling are being developed, necessitating enhanced training of counselors who are equipped to work with new technologies and environments.
Conclusion
As counselor training programs become more technologically savvy, different models and methods of online pedagogy are available to them. What once was almost purely an asynchronous model of instruction (i.e., discussion posts and assignments in a learning management system like Blackboard or Canvas) now has the ability to add interactive videos and training modules, recorded lectures and discussions, and “real-time” synchronous classes and supervision groups using platforms such as Zoom, Skype, or GoToMeeting. The opportunity–capability gap between distance education and residential classrooms is shrinking. According to Cicco (2011), there is greater efficacy of training when online learning includes opportunities for counseling modeling by experts using videos and podcasts as well as opportunities for students to engage in the practice and demonstration of clinical skills. Today’s distance education classroom can do all that and more.
Students in online core counseling skills courses have reported higher self-efficacy (using the Counseling Self-Estimate Inventory) than their counterparts in traditional F2F classrooms (Watson, 2012). Repeated studies draw similar conclusions regarding gains in self-efficacy using online instruction (Smith et al., 2015). Higher levels of internal motivation, student confidence, and self-efficacy are due in part to the structure of online courses and the requirement for students to engage in independent, autonomous learning exercises (Wadsworth et al., 2007).
The evidence we have examined leads us to the conclusion that not only is online and distance education here to stay, but there also are excellent reasons and justifications for its current use and future expansion. We trust that this special section will help to shed light on those aspects of distance counselor education programs proven effective and provide information to the benefit of all counselor training programs—no matter what delivery methods are utilized.
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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William H. Snow, PhD, is an associate professor at Palo Alto University. J. Kelly Coker, PhD, NCC, LPC, is an associate professor at Palo Alto University. Correspondence can be addressed to William Snow, 1791 Arastradero Road, Palo Alto, CA 94304, wsnow@paloaltou.edu.
