Mar 9, 2020 | Volume 10 - Issue 1
Donna S. Sheperis, J. Kelly Coker, Elizabeth Haag, Fatma Salem-Pease
Online counselor education has been studied extensively since its inception, but the experiences of students within these programs have received limited attention. This collaborative view from faculty and students of online counselor education was developed to share the stories of students who have engaged in both synchronous and asynchronous distance counselor education programs at the master’s and doctoral level. Students talked about finding online programs to be viable options to work flexibly within their adult lives. In addition, they shared that they were more satisfied when there were efforts to foster connection through synchronous or other means found in a community of inquiry. Finally, their reports illuminate potential directions for research in exploring the experience of students in online counselor education programs.
Keywords: online programs, counselor education, synchronous, community of inquiry, students
Online counselor education has been a reality since the late 1990s, yet little is known about the training experiences of students in these programs. At the time of this writing, there are approximately 79 master’s and doctoral online counseling programs accredited by the Council for the Accreditation of Counseling and Related Educational Programs (CACREP; n.d.) and several other distance counseling programs without CACREP accreditation. Potential students have many options to consider in the online counselor education environment, and distance programs continue to strive to differentiate themselves from an ever-growing landscape of educational offerings. What is it that students and recent graduates of different online programs reported were the experiences that fostered their growth as professional counselors and counselor educators? Who supported them and their growth (e.g., peers, faculty, supervisors)? How did they stay engaged, motivated, and focused on their goals in a distance environment?
The aim of this article was to explore these questions with students and graduates of distance counseling and counselor education programs. Current students and recent graduates of distance counseling and counselor education programs were invited to bring voice to their experiences through informal interviews and this collaborative account. Program faculty contacted the students and graduates who volunteered to share their perspectives about the programs and agreed to have their responses used in this article. Two of the students who provided their opinion also served as coauthors. This effort was not designed to create generalizable or transferable knowledge; thus, there was no formal sampling strategy in place. It should also be noted that because the goal was not to generate generalizable or transferable knowledge, these interviews did not fall under the purview of IRB review. Thus, student responses are not anonymized and are cited as personal communications, with the students’ permission.
To gather a broad range of information, we reached out to students from programs with a variety of characteristics, including both CACREP- and non–CACREP-accredited counselor education programs; private for-profit and private nonprofit programs; faith-based and secular programs; and programs employing a continuum of distance delivery methods ranging from asynchronous, to hybrid, to synchronous. However, the information provided is not exhaustive in terms of the types of programs available. Instead, we were interested in the views of students across diverse online counselor education programs. Throughout the article, we include direct quotes from students as well as references from the literature that relate to those experiences.
For our small group of students and graduates who shared their perspectives for this article, the average age was 41.4, with all contributors in their 40s except one. Given that distance education learners tend to fall into the category of “adult learner,” an exploration of motivators for choosing online education among this group was germane. In a survey of adult learners, the Education Activities Board (2019) indicated that today’s adult learners are “savvy, digital consumers who approach their education with a consumer-like mindset” (p. 2).
As indicated by Snow and Coker (2020), one might expect there would be a plethora of literature to assist in understanding experiences of students in distance education programs. Studies examining student perceptions of social presence, engagement, outcomes, and teaching strategies in online distance education have been conducted, but specific inclusion of student perceptions of distance counselor education is lacking (Bolliger & Halupa, 2018; Gering et al., 2018; Lowenthal & Dunlap, 2018; Murdock & Williams, 2011). This glimpse into the experiences of students and graduates from distance counselor education programs informs our understanding of how direct consumers view their counseling training and preparation experiences.
Choosing Online Counselor Education
It is a major decision to become a professional counselor or counselor educator. Another important decision is deciding where to train and by what learning method to receive training. To understand why a prospective student might choose a distance education program, we must first understand the characteristics of the online learner. Distance education students tend to skew older than their on-campus counterparts, and the average age of an online learner is 34 (Education and Careers, 2019).
With this fact in mind, we asked our five students to respond to the following prompt: “Provide us with a brief statement as to why you chose counseling and then online education.” Among our small group, reasons for choosing online counselor education clustered around family, work, and lifestyle. Two of our five students shared that being a single parent of one or more children with special needs was a driving factor. Another, also the parent of a child with special needs, needed the flexibility afforded by distance learning to be able to live overseas to accommodate her husband’s job. Keeping a particular job and work schedule were reasons for other students.
According to an Education Activities Board survey (2019), the number of graduate students taking online courses rose 47% between 2012 and 2017, suggesting that the appeal of flexible options for adult learners is a salient factor in their decision to pursue an online education. Amy Campos, a graduate of a large for-profit university with a CACREP-accredited program, summed it up well:
I was in my late 30s when I decided it was time to level up and begin the journey to a graduate degree. I was raising two neurodiverse children and had just entered the unfamiliar territory of single parenting! I knew I would need to find a program that not only supported my career and educational goals but blended with my personal and family needs as well. (personal communication, May 3, 2019)
Overall, students indicated that an online program offered the flexibility they needed to successfully navigate graduate training at the current stage of their lives.
Structure and Process of Online Counselor Education Programs
When we started training in online counselor education programs, there were limited options in terms of program structure and student experiences. In the early 2000s, the delivery of curriculum in counseling programs was an either–or proposition: students either enrolled in a traditional face-to-face (F2F) program or in an online program that was solely asynchronous except for an on-campus skills training component (i.e., residency). Asynchronous learning simply means that students do not attend required meetings of the class during a given week, although they likely have assignments with required dates. The early adopters of online counselor education were able to meet and achieve CACREP accreditation through a blend of asynchronous learning experiences in learning management systems such as Blackboard with asynchronous assignments, readings, and discussion posts, and F2F, on-campus training residencies to practice and demonstrate clinical skills.
Given that most early online counselor education training programs followed this same format, much of the early literature regarding the efficacy of online learning focused on the comparisons between two instructional modalities: F2F or on-campus vs. online, asynchronous instruction. In a comparison of levels of learning and perceived learning efficiency of on-campus and online learning environments, Smith et al. (2015) found that levels of learning (i.e., student participants’ perceptions of learning) between online and on-campus students were essentially the same, while the efficiency of learning outcome (i.e., student participants’ perceptions of time devoted to learning activities and achieving learning outcomes) favored the online modality.
Other studies have shown little difference in academic outcomes between on-campus and online delivery methods in psychology programs (Hickey et al., 2015) and counseling programs in Australia (Furlonger & Gencic, 2014). Examinations of blended learning models similarly have shown that students can benefit from both on-campus and distance modalities (Karam et al., 2014). More and more, teasing out the different kinds of learning opportunities across the ever-widening spectrum of distance education is becoming the focus. The use of videoconferencing, interactive media, and a blend of synchronous and asynchronous deliveries is increasingly common in counselor education (Snow et al., 2018).
Our students discussed a variety of delivery methods and structures from their online learning experiences. According to Fatma Salem-Pease, a coauthor who was also interviewed as a student at a private nonprofit university with a non–CACREP-accredited program,
some courses are lighter than others, with more focus on practicing counseling skills, and will therefore have more synchronous activities. Other courses focus on psychology and counseling fundamentals and therefore require more reading, research, and involve writing more papers. A big majority of the learning is done individually. (personal communication, April 25, 2019)
Two of the students’ programs were structured with required weekly, synchronous class meetings, and the students indicated that these components positively impacted their sense of engagement and learning. According to Michelle Fowler, a graduate of a private nonprofit university with a CACREP-accredited program, “group projects and small group breakouts through Zoom were a good way to get to know people. The best way to really get to know people was through assigned weekly meeting groups” (personal communication, April 10, 2019). Similarly, Libby Haag, a student at a private nonprofit religious university with a CACREP-accredited program, shared that the synchronous nature of her program was her favorite part (personal communication, April 16, 2019). She felt that being connected in that fashion to faculty and peers allowed her to practice the relational elements essential to becoming a competent counselor. There was a definite enthusiasm for these relationships from students whose programs offered the synchronous environment online.
Two other students interviewed for this article were in programs that followed the more traditional online format of asynchronous classes with F2F residency experiences. Interestingly, comments from one of our students who attended a program with an asynchronous learning model identified a potential need to include other modes of training and delivery in addition to asynchronous learning. Shawn Clark, a graduate of a public university with a large CACREP-accredited program, wrote:
We have to meet once a week at night as a class during the internship processes but not during any other classes. I enjoyed the interaction during these meetings because we were able to critique each other’s skills, which helped me develop professionally. If we could have met as a class online during all my classes, I believe I would be more prepared as a counselor. (personal communication, April 22, 2019)
From all of our students’ observations, a blend of formats, deliveries, and experiences seemed to benefit them most. These observations support the emerging literature concerning different deliveries of distance education. According to Harris (2018), a combination of modalities, including F2F, online, asynchronous, and synchronous, tap into a variety of learning styles and together can create a learning experience that positions students for success.
Community of Inquiry
Allen et al. (2016) suggested that about 77% of institutions with distance offerings find them critical to their long-term strategy and the future growth of their institutions. An important element in online education is the community of inquiry, which is a framework for teaching and learning that is built on aspects of constructivist pedagogy. Specifically, the community of inquiry is comprised of social presence, cognitive presence, and teaching presence (Richardson & Ice, 2010). Akyol and Garrison (2008) defined these types of presence as follows: social presence is the experience of connection in online learning, cognitive presence is the exchange of information and ideas, and teaching presence is the facilitation and shaping of the discourse. For the purpose of this article, we asked students to talk with us about how they experienced these in their interactions with peers and faculty.
Interactions With Peers
Researchers who have studied the community of inquiry model have found that a lack of interaction between online students results in an experience of loneliness and an increase in students dropping courses (Ozaydın Ozkara & Cakir, 2018). All of the students we spoke with talked about developing deeper connections during the residency component of their curriculum and how meaningful those relationships were. But there were other areas for connection provided as well. Students who were in programs with a synchronous online component commented on the use of breakout rooms in virtual platforms such as Zoom and how helpful they were to developing community. Additionally, the use of virtual groups during the group counseling course increased opportunities to interact with peers. None of the students participating in our discussion cited online discussion boards as a way to increase or improve interactions with peers, but some did share that simply seeing the same students’ names in multiple classes was helpful.
Interactions With Faculty
Within the community of inquiry, teaching presence is comprised of both the way the faculty member sets the stage for learning and the way they generate a focus for the online discourse (Walsh, 2019). Unfortunately, faculty tend to view their teaching presence more favorably than students (Blaine, 2019). As such, it was important to get the student perspective on interactions with faculty.
Students’ interaction ranged from being in the classroom to taking advantage of opportunities to connect out of class. Within the class, students found instructor videos to be helpful, sharing that in some fully asynchronous programs, students may never see their faculty members’ faces or hear their voices as lectures are developed at the institutional level and prepopulated in each course shell. Faculty members who took the use of video even further, such as using the video feedback options in the learning management system, were appreciated even more. But it was the interactions outside of the classroom that seemed to be the most impactful to students.
Students discussed having email, phone, and video chat communication with faculty and how important that was to their experience. These interactions felt personal and “helped me rebuild my self-esteem and acknowledge my self-worth” as well as student self-efficacy while serving as a professional model (F. Salem-Pease, personal communication, April 25, 2019). Students who did not have more personal interactions outside of class reported less satisfaction in this area. A clear takeaway is that the more students can interact with each other and with their faculty both in and out of the classroom, the more fulfilling their experience is with online education.
Practicum and Internship
Having taught in counselor education programs for a combined 40 years, we recognize that whether on-campus or online, the experience of practicum and internship is one of the most anxiety-provoking elements of counselor training. Whether the anxiety is about finding an appropriate site, securing sufficient direct client hours, or struggling with insecurity around skills and abilities, students entering field experience need additional support (Nease, 2013). The experience of online students is no different. Those who live in towns with a large, campus-based program reported some challenges helping sites understand their status. One student talked about needing to make a case for her program when the site was primarily accustomed to dealing with the hometown university. However, students who had lived in their hometown for a while and had good connections, or who lived in areas that are highly populated and have multiple agency opportunities, reported less stress.
Faculty connections were also found to be helpful. Just as students may come from all areas of the country or the world, so may faculty. Having faculty familiar with state requirements and who have peers in the towns where students are trying to gain a site can be helpful. All students reported a willingness to be persistent, make the necessary calls, know their program and training, and take on the hurdles of a human resource department as necessary qualities for success in finding practicum and internship sites.
Counselor Licensure
Counselor educators are well aware that state licensure requirements are not uniform, can be tricky, and are challenging to even the most seasoned licensure candidate. But students often enter counseling programs assuming that licensure is similar across states and territories (Buckley & Henning, 2016). To this end, most of the students we spoke to talked about having discussions about state licensure requirements early in their training. Students were advised to look for any challenges or deficiencies posed by their program of study:
The only concern I had with my license was from not having a human sexuality course from my university. The state of Florida requires this class. However, when I reached out to my university and told them of my dilemma, they found the course in another program and offered it to me. I will be taking it this summer. (S. Clark, personal communication, April 22, 2019)
In addition, many students reported having early assignments that required them to review their state board requirements.
We are required to research the state requirements and write several papers about them during the very first term. After that, we are constantly reminded of our state requirements, especially as we head into practicum and internship, and also when selecting elective courses. (F. Salem-Pease, personal communication, April 25, 2019).
Students seemed to benefit from programs that began the licensure discussion during admissions and kept it at the forefront throughout their training.
Motivation in Online Training
We started this paper with a premise that many learners in distance education programs need to be self-motivated to be successful. Even programs that have synchronous and on-campus portions still generally require students to engage in some amount of self-paced and self-guided learning. As early as 1986, Moore was writing about the importance of self-directed learning in distance education environments. He suggested that the self-directed or autonomous learner is motivated to “set their goals and define criteria for achievement” (Moore, 1986, p. 13).
Our students were asked to consider any strategies that have helped them remain motivated through their training program. All of the students mentioned some combination of the need to stay organized, make and keep a schedule, and set realistic goals for success. Fatma Salem-Pease offered that it is a combination of having an organized weekly schedule and self-care routines that helps to maintain motivation: “One significant aspect of my self-care has become planning ahead and giving myself the appropriate amount of time to complete an assignment well before the deadline.” She went on to say, “Self-care is an important component of any journey and is absolutely necessary to maintain stamina until the end” (personal communication, April 25, 2019). Two students discussed the roles their professors played in their ability to stay motivated. Michelle Fowler shared that “[a] big challenge was dealing with the different formats teachers used” (personal communication, April 10, 2019). Libby Haag discussed how being an independent thinker and problem solver goes hand-in-hand with being mindful and respectful of professors’ time: “I make sure my email communications are respectful, clear, and concise. I believe these relationship-focused skills have helped me to have better connections with my professors and peers in an environment that often feels isolating” (personal communication, April 16, 2019).
Other ways our students described their ability to be self-motivated in a distance learning environment included being disciplined, intrinsically driven, resourceful, dedicated, and having a sense of self-efficacy. As one student stated, “self-efficacy is an important factor that determines the student’s perception of her ability to achieve certain tasks” (F. Salem-Pease, personal communication, April 25, 2019). This observation is supported by inquiries that have examined the relationships between self-efficacy, confidence, and attainment in online formats. Watson (2012) found that students in online learning environments have higher self-efficacy beliefs than students in traditional, on-campus programs and that online learning environments may in fact increase personal motivation and self-efficacy.
A framework for understanding motivation in educational environments is self-determination theory, which makes a distinction between autonomous (self-determined) motivation and controlled (externally pressured) motivation (Ryan & Deci, 2008). Ryan and Deci (2008) posited that individuals are more likely to engage in positive change, whether in therapeutic, educational, or family settings, when there are external supports in place that promote autonomy. Autonomous motivation is achieved when the needs for autonomy, competence, and relatedness are met (Baeten et al., 2012). Learning environments that strive to create conditions where students can feel they have some level of autonomy balanced with a clearly formulated structure, as well as opportunities for involvement and engagement with faculty and peers, have a combination of factors that are conducive to student motivation (Baeten et al., 2012).
Watson (2012) explained that “one of the common concerns often voiced has been whether or not ‘skills-based’ or ‘techniques’ courses could be offered sufficiently online” (p. 143). This aspect is often addressed in CACREP-accredited programs through the F2F residency experience and synchronous video activities that allow students to practice counseling skills and get helpful feedback and guidance from professors (Snow et al., 2018). Online students report that course materials generally make use of a variety of videos, including full counseling session videos and those incorporating certain techniques, which fosters vicarious learning. Fatma Salem-Pease indicated that the level of attention she received while pursuing her online degree was higher and more personalized than when she was pursuing an on-campus degree. She attributed this distinction to the fact that group sizes were small and her belief that there may be a benefit to professors reviewing video recordings in the comfort of their own office or home space where they are not pressured to assess the skills of multiple individuals in one sitting.
“What I Wish I Had Known Before Starting an Online Program”
The students who shared their perspectives were asked to talk about what they wish they had known coming into an online program. Many wished they had truly understood the importance of developing relationships with faculty and fellow students. Generating groups using Facebook or other social media was suggested as a way to facilitate this. In addition, some wished they had known that developing teams to practice skills would have been helpful to the online counselor-in-training.
A primary area of consideration on this topic was the financial cost of online education. Because many online programs are housed in private institutions, it was suggested that students
look long and hard at the expense associated with the program and the entry-level jobs they will get with their degree. The amount of debt in relation to that salary can be overwhelming, and while it may prove to work out in the long run, [online private institutions] may not be the wisest choice. (S. Clark, personal communication, April 22, 2019)
Whether in private or public universities, students were pleased that the online programs allowed them to pursue the education they wanted and needed while still maintaining a full-time job.
Student Perspectives of the Literature
We offered our two student coauthors and graduate interviewees the opportunity to each identify a relevant article from the literature that resonated, in some way, with their experiences as online learners and to contribute to this article by outlining the impact of that article on their learning experience. The student authors of this manuscript found that building relationships was reflected in the literature as an essential element, just as it was in their own experiences.
Building Relationships in Online Counselor Education Programs—Libby Haag
At the essence of counseling is relationships (Hall et al., 2010). Online education can often remove the humanistic quality by an absence of F2F instruction, resulting in a lost opportunity to connect with peers, professors, and future counselors and thus lacking an essential component in personal growth. Relationship-building skills are imperative for developing effective counselors, maintaining professional integrity, and implementing gatekeeping, and online learners often can feel detached from their professors and peers. Although on-site schooling offers the humanistic relationship-building aspect, online formats have the ability to educate underserved and diverse individuals to give them the opportunity to become professional counselors (Hall et al., 2010). Online counselor education combines the best aspects of technology with traditional campus education, which may create a more accessible, relational, and humanistic approach to the development and training of counselors.
Humanistic Framework
According to Hall et al. (2010), a more effective online education for counselors is a humanistic framework that includes both technology and consistent F2F video interaction while maintaining a student-centered focus. This interactive model can effectively solve the problem of how to reach many underserved students to promote diversity in growing our profession while still teaching effective counseling skills to nurture the important humanistic, personal relationship aspect that is paramount to our profession. This humanistic framework to create a more effective and personal online experience has four principles: “the importance of viewing and valuing students holistically, the importance of maintaining meaningful relationships, an emphasis on valuing intentionality, and the recognition that people are goal oriented and creative beings” (Hall et al., 2010, p. 47).
Viewing and Valuing Students Holistically. Online educators need to view each student holistically as a distinctive individual and not use a reductionist approach (Hall et al., 2010). It is essential that the student feel important and valued while being viewed phenomenologically. A suggestion for viewing and valuing students in a more holistic manner would be to do video interviews as part of the application process. This would help establish a relationship with a professor before school even begins to create a meaningful, intentional, and relationship-driven curriculum.
Maintaining Meaningful Relationships. According to Hall et al., “a good relationship is the basis of counseling and education” (2010, p. 48). Therefore, personal relationships need to be developed in an online program for both teachers and peers. Some suggestions to foster a positive relationship begin with sending emails before class starts and encouraging an open-door policy for communication. In addition, professors can approach an online class with group counseling techniques. For example, when beginning class, the professor could have all the students introduce themselves in the video forum using an icebreaker. At the next class, they can have the students reintroduce one another. Small group projects are also encouraged with some group counseling techniques (Hall et al., 2010).
Valuing Intentionality. Intentionality, as defined by Hall et al., is “a sense of purpose in guiding and choosing one’s behavior” and “our capacity to reach out, take care of, and tend to others in purposeful ways” (2010, p. 48). Online professors could begin to guide students into becoming intentional learners, with an emphasis on self-awareness and deliberate reflection of their considerate interactions with others. This will help foster and model the connection online counseling students need for effective relationship skills in the future.
People Are Goal-Directed and Creative Beings. Personal growth is a primary characteristic of a holistic, humanistic online education. Professors need to be willing to nurture creativity, drive, and resourcefulness within the classroom. Having a personal growth-based curriculum will only increase the student’s online experience. Hall et al. (2010) asserted that opportunities for growth and intrinsic motivation exist in creating an environment that promotes self-actualization, self-realization, and self-enhancement. It is suggested that teachers use a variety of techniques to match unique learning styles of a diverse student body for fostering creativity in online counselor education.
From a Personal Perspective
In examining and analyzing Hall et al. (2010) above, Libby Haag shared that her personal experience with a humanistic online framework has helped her to become a more rounded counselor. She feels as if she thrived in this environment, which was rooted in a very CACREP-driven curriculum with an emphasis on personal and professional growth. The relationships she created with teachers, peers, and supervisors were invaluable, and the F2F interaction helped to develop better social skills and a sense of community. She indicated that she made sure to reach out and let peers and professors get to know her personally. These actions helped her to feel connected and valued in a system that can sometimes lack a human element. She found that her most influential professors were those who were very personable and patient and who used humor and modeled authenticity with a focus on fostering relationships. They were available for personal consultation and they always offered a good deal of feedback. Overall, concurrent with the literature, Libby Haag’s experience was that a relationship-focused online program was essential in creating competent counselors.
Self-Efficacy and the Online Learner—Fatma Salem-Pease
Fatma Salem-Pease discovered that the 2012 article by Watson, “Online Learning and the Development of Counseling Self-Efficacy Beliefs,” supports a lot of the viewpoints she had previously shared in her personal communications. First, the article discussed the importance of practicing learned skills in real-life F2F situations and expressed the concerns voiced by many counselor educators about the efficacy of an online program that does not incorporate F2F learning components. As discussed earlier in this article, Watson (2012) explained that “One of the common concerns often voiced has been whether or not ‘skills-based’ or ‘techniques’ courses could be offered sufficiently online” (p. 143). This aspect is often addressed through residency experiences and through synchronous video activities that allow students to practice counseling skills and receive helpful feedback and guidance from professors. Course materials also have a variety of videos, including counseling sessions and how certain techniques are used, which foster vicarious learning.
Watson (2012) noted that “academic coursework, assigned readings, classroom discussions, self-reflection, modeling, supervision and hands on experiences associated with practica and internships” are required elements to enhancing competency and perception of self-efficacy (p. 145). The study hypothesized that F2F students have higher levels of perceived counseling self-efficacy than online students. The researcher administered the Counseling Self Estimate Inventory to 373 graduate students, 207 of which were F2F students, while 166 reported having taken the core skill development courses online. The results of the study disproved the hypothesis and showed that online counseling students have stronger counseling self-efficacy than F2F students.
These results support Fatma Salem-Pease’s and other students’ thoughts that online students have the opportunity to individualize their learning to their specific needs, helping them feel more confident in what they know and more aware of what they need to work on further. Structured F2F educational programs, she believes, burden students with an extensive and specific schedule to follow daily, which leaves minimal time for students to reflect on what is being learned and how to maximize the learning experience. Online students can be more actively engaged in their learning and have more freedom to choose what to accomplish and learn with their time.
Conclusion
Although much has been written about the online learning experience in counselor education, it is rare to hear faculty and students work together to share their experiences in online education and training settings. What we have captured here first and foremost is that online counselor education provides a positive option for many students and faculty. Online counselor education allows students to blend academic pursuits into their current family and career lives in a way that is more accessible than traditional on-campus programs. When embarking on this journey, students value the connections they are able to foster with faculty and with peers, many of which occur through the synchronous parts of a program. Given that many programs are fully asynchronous, further research into the use of synchronous components would benefit the field of online counselor education.
Additionally, students strongly supported the fact that the path to success is smoother when programs attend to the various field experience and licensure requirements of their students across states. It is clear that an online counselor education program requires skills in both self-motivation and self-care to provide the maximum benefit to the student. Although this paper addressed the student experience in a non-empirical manner, a more research-driven approach to understanding student experience in distance counselor education programs is needed. Overall, online counselor education is functional, effective, and preferred by many students who are now pursuing their own careers in the profession of counseling.
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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Donna S. Sheperis, PhD, NCC, ACS, CCMHC, LPC, is an associate professor at Palo Alto University. J. Kelly Coker, PhD, NCC, LPC, is an associate professor at Palo Alto University. Elizabeth Haag was a graduate student at the University of the Cumberlands. Fatma Salem-Pease was a graduate student at Southern New Hampshire University. Correspondence can be addressed to Donna Sheperis, 5150 El Camino Real, Los Altos, CA 94022, dsheperis@paloaltou.edu.
Jan 6, 2020 | Book Reviews
by Robert C. Reardon, Janet G. Lenz, Gary W. Peterson, & James P. Sampson, Jr.
The sixth edition of Career Development and Planning was authored in 2019 by notable career researchers, Drs. Robert Reardon, Janet Lenz, Gary Peterson, and James Sampson. This book describes the processes behind theory-based career decision-making strategies and is written for a college-level audience as a guide for clients and students when formulating and implementing career decisions. In this review, an overview of the content included in the text and a description of the strengths and limitations will be provided for prospective readers to consider.
The text is organized into three sections of five chapters, each section covering a different aspect of career decision-making and planning. The first section describes the components of cognitive information processing (CIP) theory, including metacognitions, decision-making, self-knowledge, and options knowledge. Strategies for addressing each CIP theory component are provided. Some strategies are based within the theory such as the CASVE cycle for decision-making or the exploration of positive and negative self-talk to address meta-cognitions. Other strategies incorporate key tenets from other theories, including Holland’s RIASEC hexagon for self-knowledge clarification. Section two focuses on the sociological aspects of career decision-making, including organizational culture, work and family roles, the implementation of technology, and the different ways in which people conduct their work (e.g., job sharing, flex time, telecommuting). The final section of the text discusses strategies for launching a successful career search campaign, including resumé writing, networking, and salary and benefit negotiation. Tips for a successful college-to-employment transition are also included. Updated online resources for many of the topics covered in the text can be found throughout the chapters. Additionally, activities and worksheets related to the content can be found in the appendices of the text. Instructors can request the Instructor’s Manual as a text companion, but this resource was not available to this reviewer.
The organization of the information is an aspect that improves the reader’s experience. The semi-chronological structure provides an opportunity for readers to return to the text for guidance at any point in their career path. A primary strength of this text can be found in the appendices, which provide activities that enhance the learning experience by presenting an opportunity for personal reflection on text concepts. Additionally, resources are provided for readers who wish to learn more about the more specific topics covered in each chapter. Visual aids are included to assist readers in understanding abstract concepts and illustrate theories that may be otherwise difficult to comprehend.
By providing basic information on CIP theory, readers can reflect on these concepts as more information is presented while moving toward a career path. The detailed discussion of CIP theory included within the first section is unique to this book. Whereas most texts focus on the information provided in the second and third sections of this text, the inclusion of the theory is an effective way to assist students and clients with the basic skills needed for making major decisions.
Despite providing crucial information regarding career concerns, clients and students may find the text dense and difficult to navigate on their own. Because of this, career course instructors, counselors, and career professionals may find it beneficial to guide clients and students through the content and assist with connecting the information provided to personal experiences and goals. As previously discussed, the text provides activities that personalize these concepts; however, because these activities are located in the appendices, clients may have difficulty connecting the appropriate appendix item to the relevant topic. Future editions of this book may benefit from including more activities and making more obvious connections between topics and appropriate activities in relevant chapters.
Overall, Career Development and Planning is a worthy edition to any career course or career practitioner’s professional toolbelt, specifically for the resources, activities, and worksheets provided throughout the text. Additionally, the inclusion of CIP theory as the framework for the additional information provided sets this text apart from other career course texts and enables readers to use this framework while thinking through not only current career decisions, but other major decisions made throughout the life span. However, this book is meant to be a guide rather than a self-help solution to all career concerns. Career professionals will find this text to be a useful resource for clients and students with concerns ranging from deciding on the right career trajectory to preparing for their first job.
Reardon, R. C., Lenz, J. G., Peterson, G. W., & Sampson, J. P. (2019). Career development and planning: A comprehensive approach (6th ed.). Kendall Hunt Publishing.
Reviewed by: Jessica N. Schultz, University of Southern Mississippi
The Professional Counselor
tpcjournal.nbcc.org
Nov 30, 2019 | Volume 9 - Issue 4
Joshua D. Smith, Neal D. Gray
This interview is the fourth in the Lifetime Achievement in Counseling Series at TPC that presents an annual interview with a seminal figure who has attained outstanding achievement in counseling over a career. I am honored to present the interview of Liliana Sznaidman, a professional counselor in North Carolina. Ms. Sznaidman is the second practitioner to be interviewed for this annual series. Ms. Sznaidman is a licensed professional counselor and licensed professional counselor supervisor with over 20 years of clinical experience. She is currently the principal owner of a private practice where she provides counseling, clinical supervision, and consultation services. Joshua Smith and Dr. Neal Gray graciously accepted the assignment to interview Ms. Sznaidman. What follows are Ms. Sznaidman’s reflections on her counseling career and its impact on her clients. —J. Scott Hinkle, Editor
Liliana Sznaidman has over 20 years of experience as a licensed professional counselor (LPC) and licensed professional counselor supervisor (LPCS) in North Carolina. She currently owns a private practice where she provides counseling and psychotherapy to adults, couples, and young adult clients. She also provides clinical supervision and consultation services to pre-licensed counselors and other mental health professionals.
Ms. Sznaidman received her master’s degree in counseling at the University of North Carolina at Greensboro. Prior to her master’s training, she completed a degree in early childhood education in Buenos Aires, Argentina. In addition to her LPC and LPCS, Ms. Sznaidman holds the credentials of National Certified Counselor and Approved Clinical Supervisor. She also has completed post-master’s training in clinical supervision and has received extensive training in psychoanalytic theory and practice.
Before going into private practice, Ms. Sznaidman worked as an outpatient psychotherapist providing family counseling services, and as a bilingual therapist. Ms. Sznaidman has been an advocate and asset to her community. She has conducted and co-facilitated psychoeducational groups in Spanish for Latinx adolescents and assisted in providing case management and referrals. Ms. Sznaidman has demonstrated service to the profession by serving as a field placement supervisor for master’s-level student interns and provided professional presentations to community agencies.
Ms. Sznaidman is a member of several professional organizations, including the Licensed Professional Counselors Association of North Carolina (LPCANC), where she was the president of the board of directors and helped to advocate for the inclusion of LPCs in continuing education opportunities. She also created the first mentoring program in the association. Ms. Sznaidman is an active member of the American Mental Health Counselors Association (AMHCA); the Pro Bono Counseling Network for Durham, Orange, Person, and Chatham Counties; and the Psychoanalytic Center of the Carolinas. Ms. Sznaidman received both the 2009 Distinguished Practitioner Award and the 2013 Alumni Distinguished Service Award from the University of North Carolina at Greensboro, and was named 2014 Mental Health Counselor of the Year by AMHCA.
In this interview, Ms. Sznaidman shares beneficial insights into her career, her approach to counseling, growth and changes within the counseling profession, her involvement in professional organizations, and the future development of the profession.
- As an LPC and LPCS in North Carolina, what led you to pursue a degree in
counseling compared to other helping professions?
It was in my late high school years when I began to think about engaging in a helping profession due to personal experiences receiving such help and becoming increasingly curious about the human mind.
However, political unrest in my country of origin, Argentina, followed by a couple of moves back and forth to the United States, veered my career in a different direction and affected a delay of my initial plans. It was after I settled more permanently in the United States that a counseling career became a reality.
After examining other specialties within the mental health profession, I decided to pursue professional counseling due to its predominant academic and practice emphasis on the provision of services to clients. Other disciplines seemed to divide their focus between this and macro work in communities, or psychological testing, which was not appealing to me in either the academic or practice realms.
- As a bilingual counselor with clinical interests in diversity and cross-cultural
counseling, what have been your perceptions and observations regarding
multicultural competency in counseling?
I recall taking a multicultural course in graduate school and truly appreciating it, based on how it set the tone for challenging the notion of mainstream cultural values being the guiding principle for helping clients, and erroneous, stereotypical assumptions about other cultures. Yet, it was quite surprising to witness thereafter that more emphasis was not placed on postgraduate continuing education opportunities in multicultural competency.
It seems to me that multiculturalism may be erroneously considered a specialty, particularly in today’s society where cultural differences are embedded in many client–therapist dyads. If we conceptualize multicultural nuances in a more expansive manner, even aspects as subtle as having had an urban upbringing compared to being raised on a farm, it might lead to richer exploration and meaning making in the context of working with clients.
Our profession and the counseling field overall would benefit from incorporating multicultural aspects into virtually every realm of training, rather than considering it a separate and unique body of knowledge. By not doing so, we might shortchange the overall growth of our profession in this area and limit how we serve our clients.
3. As a licensed counselor for over 20 years, what in your opinion are the biggest
changes within the profession? How have these changes impacted your work as a
clinician? Conversely, what are the biggest barriers facing counselors right now?
This is a very good topic to explore because it is easy for professional counselors to forget when there used to be little respect for our profession, despite our graduate training being comparable to that of others in the mental health field. The mental health professional world and the public at large knew very little about our training and our professional license. As a result, employers were quite wary about considering us in their hiring opportunities overall, and particularly while candidates were still accruing full licensure status. Health insurance companies, including those federally or state funded, were not accepting our licensed clinicians on their provider panels.
Being fully aware that the nature of our profession’s historical presence may vary from state to state, I can only speak of it based on my experience practicing in North Carolina. Thanks to the work of a handful of dedicated colleagues, professional counselors gradually but steadily gained acknowledgment by prospective employers and attained full third-party reimbursement status from insurance companies that operate within the state. In North Carolina, we were among the first in the field to institute distinct formal licensing tiers for associate, fully licensed, and supervisory levels. This offers a way to clearly reflect differential levels of training within our profession. However, it is evident that more work needs to be done by our professional associations in educating the public at large about who we are, how we are trained, and what exactly each of these tiered licensure levels means.
Nationally, of course we know that Medicare recognition is the next desired achievement, but we have certainly come a long way as a profession. It behooves us all to look back in gratitude in order to look forward to new horizons. Lastly, I want to say how encouraging it is to see the impetus of several national organizations working together toward a more cohesive licensing nomenclature and criteria, as well as reciprocity across states. Implementing uniformity in licensing standards can only benefit all of us in attaining increased professional recognition throughout the United States.
Witnessing the profession evolve and change throughout the years has been both encouraging and at times concerning. Particularly in private practice, the salient point is the impact of increasing administrative requirements and treatment barriers placed by insurance companies, while compensation for counseling services has remaining unchanged or lowered for over 15 years. Over time, insurers established a fee-for-service model that has resulted in a decline in previously available salaried employment opportunities, giving way to contract-based type arrangements. This model may pose many challenges to new graduates who may not feel fully ready to venture on their own into private practice, while also finding percentage fee-for-service remuneration positions financially unsustainable. At the state level, we also have seen a significant transformation involving the transition of publicly funded county mental health clinics to outsourcing management and provision of all services to large private sector companies. This, too, has impacted the nature of the job market for counselors.
Overall, we have seen an increase in new graduates starting out in private practice immediately after graduation, but for some this might be too soon or too daunting. I think that graduate programs can help pave the way by a two-fold approach: providing students with at least the basics of practice management skills and impressing upon them the importance of ongoing supervision and consultation with peers. It is no secret that private practice can at times feel isolating; thus establishing regular contact with colleagues for support and consultation can make a significant and positive impact.
- I see that you operate from a psychodynamic approach, both as a clinician and as a
supervisor. What does that approach mean to you in each of these roles?
Psychoanalytic psychotherapy operates under the premise that through exploration of the unconscious, conflicts take place. It also works by utilizing transference and countertransference in the client–counselor relationship to identify common threads in people’s lives. Analytic therapy is often criticized in part due to the length of treatment intrinsic to this orientation, misconceptions about it being solely rooted on antiquated and outdated theory and practice, as well as the therapist’s role being perceived as less active. However, contrary to many beliefs, there is a significant body of research in its efficacy and long-term sustained gains, in addition to its well-known years of historical practice and evolving theoretical contributions.
In my work with clients, I try to guide them to identify common themes, which when brought to the conscious level, begin to form a cohesive narrative of the person’s life that they may not have previously realized. In supervision, I attempt to help my supervisees identify themes in their clients, while also remaining attentive to what emerges within them in the context of that dyadic relationship. It is meaningful, transforming work that does not focus on presenting symptoms alone, but rather on the underlying roots most often unbeknownst to the client and on affecting long-lasting change for self-fulfilling lives.
- What has been your experience when interacting with national and local counseling
organizations? Do you feel supported by professional organizations and leaders?
Has support changed in the last 20 years?
I was active for many years within professional organizations, including serving on a state chapter association’s board of directors, LPCANC, for approximately five years. The work of these organizations is remarkable, as are their attainments. I think it was fortunate that my graduate program placed so much emphasis on involvement in these organizations. It was discussed in classes, in workshops, and certainly modeled by faculty in the program. I met our regional association leaders for the first time in one such workshop, and that experience truly made an impression on me as a student. The learning, networking, and growth opportunities that this involvement affords us is likely not available in any other aspect of our professional careers and is invaluable.
- Throughout your years of practice, what has been the role of counselor identity,
and has that changed over time?
It has been interesting to me to witness my own journey within the profession throughout the years. Certainly, most of us work on getting better at and more experienced in what we are trained to do. It was interesting to me to see this focus and role expand and morph, venturing in different directions, such as advocacy and involvement in professional associations, more intensive clinical training, mentoring and training others via clinical supervision, and combining all of these in my professional life.
- For future counselors, what advice would you have regarding their involvement in
advancement and future development of the profession?
As I mentioned earlier, it was through the work of our dedicated colleagues that we attained the recognitions we now have, and yet more work always needs to be done. It is important that we as a profession make inroads in increasing salaried employment opportunities for our new graduates, as we still witness some hospitals, specific departments, university counseling centers, and the like that do not include professional counselors in their hiring practices. Counselors can certainly enter private practice at any juncture in their career, even while under supervision. Yet, based from my own experience, there is not much better learning than that which takes place when you witness the day-to-day practice of professionals more senior to you. This in my mind translates into full-time employment where excellent role models are available.
Another important aspect of advancing in the profession stems from engaging in lifelong learning and some of the best ways to do so are through continuing education and ongoing supervision. It is not uncommon for new counselors to experience supervision as such a financially burdensome mandate throughout their restricted license period that they tend to discontinue it immediately after full licensure is attained. I see this as depriving themselves of ongoing growth. Clinical supervision can take many different forms and frequency levels after graduation, but it remains an invaluable source of ongoing learning. It has been my own personal choice to remain in some form of clinical supervision throughout the entirety of my 20+ year career thus far, and I have never regretted it.
I would also encourage new counselors to engage in professional associations, volunteering and advocating from the outset. It may seem daunting to have that responsibility on top of learning their way as new professionals. However, it is crucial they know there will most likely be someone in those associations ready to guide them in this endeavor, and as the saying goes, “many hands make light work.”
This concludes the fourth interview for the annual Lifetime Achievement in Counseling Series. TPC is grateful to Joshua D. Smith, NCC, and Dr. Neal D. Gray for providing this interview. Joshua D. Smith is a doctoral student in counselor education and supervision at the University of North Carolina at Charlotte. Neal D. Gray is a professor and Chair of the School of Counseling and Human Services at Lenoir-Rhyne University. Correspondence can be emailed to Joshua Smith at jsmit643@uncc.edu.
Nov 29, 2019 | Volume 9 - Issue 4
Ariann Evans Robino
Explanations of compassion fatigue generally consider the client–counselor relationship as the primary source of challenges to wellness. Because of the nature of the current sociopolitical climate and the increased exposure through media, the counseling profession should consider expanding the influences on compassion fatigue related to current events. This article introduces the concept of global compassion fatigue (GCF), a phenomenon that provides an opportunity for counselor self-awareness. Implications for adopting GCF into the counselor impairment literature include understanding how global events impact counselor development and clinical practice as well as the importance of maintaining a wellness lifestyle to protect against its effects. Counselors’ involvement in advocacy and social justice are also explored as contributors to GCF.
Keywords: global compassion fatigue, counselor impairment, advocacy, self-awareness, wellness
Counselors and counselors-in-training (CITs) feel the weight of societal stressors. According to the ACA Code of Ethics, “promoting social justice” (American Counseling Association [ACA], 2014, p. 3) is a core value of the counseling profession. Furthermore, because of its impact on the profession, scholars have declared social justice as the fifth force in counseling (Ratts, 2009; Ratts, D’Andrea, & Arredondo, 2004). Representatives from ACA have acted in accordance by addressing the federal government’s recent prohibition of specific language associated with diverse populations (Yep, 2017) as well as releasing a statement of support shortly after the 2016 presidential election calling on all counselors to remain strong in their beliefs and actively assist those in need (Roland, 2016). Similarly, the closing keynote speaker at ACA’s Illuminate Symposium on June 10, 2017, Dr. Cheryl Holcomb-McCoy, encouraged attendees to take action against human rights offenses through vocal opposition in multiple settings, including social media (Meyers, 2017). These positions demonstrate the desired role of counselors to engage in advocacy and activism for global issues.
Natural disasters, threats to civil rights, violence, terrorist attacks, and animal welfare concerns are simply a few of the powerful issues that humans face as highly social and emotional beings. Although advocacy is one avenue of handling the emotional unrest related to these events, the complex nature of counselors’ personal and professional identities presents an invitation to consider these sensitive issues currently faced by society. Professional counselor identity allows counselors to make meaning of their work during these times of strong emotion (Solomon, 2007). Considering how these events affect both counselors’ and CITs’ personal lives and clinical practice produces opportunities for counselor professional development and greater self-awareness. The purpose of this article is to explore global compassion fatigue (GCF), a phenomenon related to the human condition and how global events impact professional counselors and other helpers. This article begins with a review of current counselor impairment concepts as well as the role of wellness in managing these conditions. Then, the reader is introduced to GCF and how a review of the literature supports the examination of this new concept. Next, I provide a detailed conceptualization of the phenomenon and implications for the field. Finally, suggestions for future research are provided.
Understanding Compassion Fatigue
Compassion fatigue research spans the literature of multiple disciplines, including nursing, social work, and counseling (Compton, Todd, & Schoenberg, 2017; Lynch & Lobo, 2012; Sorenson, Bolick, Wright, & Hamilton, 2016). Counselors typically understand compassion fatigue as an event occurring as a result of counselor–client interaction. Charles Figley (1995) first defined the concept of compassion fatigue as “a state of exhaustion and dysfunction—biologically, psychologically, and socially—a result of prolonged exposure to companion stress and all that it evokes” (p. 253) and conceptualized it as a response to the emotional demands of hearing and witnessing stories of pain and suffering. Symptoms of compassion fatigue include re-experiencing the client’s traumatic event, avoidance of reminders of the event and/or feeling numb to those reminders, and persistent arousal (Figley, 1995). Researchers carefully note the differences between compassion fatigue, vicarious traumatization, and burnout (Lawson & Venart, 2005; Meadors, Lamson, Swanson, White, & Sira, 2010). Vicarious traumatization, defined as a significant altering of cognitive schemas and a disruption of an individual’s sense of identity, worldview, and meaning, occurs as a result of empathic engagement with the traumatic experiences of a client (McCann & Pearlman, 1990). Vicarious traumatization symptoms involve a more covert change in thought and cognitive schema rather than an observable experiencing of symptomatology (Jenkins & Baird, 2002). Burnout is a process that occurs because of occupational stressors such as high caseloads, low morale, and minimal support (Maslach & Jackson, 1981). It is associated with emotional exhaustion, strain, and overload in addition to a reduction in personal accomplishment and job satisfaction (Maslach, 1982). Counselors are more likely to experience compassion fatigue, vicarious traumatization, and burnout when they have a previous history of personal trauma (Baird & Kracen, 2006), high emotional involvement with clients (Adams, Boscarino, & Figley, 2006), fewer perceived coping mechanisms (Baird & Kracen, 2006), and lower self-awareness (P. Clark, 2009). However, the goal of this article is to expand upon the phenomenon of compassion fatigue as distinguished from these other explanations of impairment to understand better how global events outside of the counselor–client dyad impact counselors. Although other impairment concepts hold value and applicability to counselors, compassion fatigue and its relationship to emotional suffering as a result of a desire to help others most closely aligns with the concept presented in this article. When considered in the context of counselors, an awareness of compassion fatigue, its effects, and how to mitigate those effects is vital for client welfare.
Counselor Impairment and Wellness
According to the ACA Code of Ethics, counselors should “monitor themselves for signs of impairment from their own physical, mental, or emotional problems” (ACA, 2014, p. 9). The ACA Code of Ethics dedicates an entire section to counselor impairment (C.2.g.), which states that, in the interest of client protection, counselors should cease providing services while impaired, seek assistance to solve issues of impairment, and assist colleagues and supervisors in recognizing and rectifying their own impairment (ACA, 2014). When counselors are impaired, it can result in significant harm to clients through an interference with the counseling process, trust violations, and ethical breaches (Lawson, Venart, Hazler, & Kottler, 2007). Adopting an alternative lens for viewing the impairment literature presents an opportunity for counselors to monitor themselves and others for potential issues as indicated by the ACA Code of Ethics (ACA, 2014). In addition, the ACA Code of Ethics guides counselors to “engage in self-care activities to maintain and promote their own emotional, physical, mental, and spiritual well-being to meet their professional responsibilities” (ACA, 2014, p. 8). As self-advocacy for wellness can promote better professional practice within the counseling community (Dang & Sangganjanavanich, 2015), counselors are encouraged to avoid and rectify issues of impairment through positive, health-promoting strategies.
Recognizing this area of need within the profession, ACA established the Taskforce on Counselor Wellness and Impairment in 2003 to address the needs of impaired counselors (Lawson & Venart, 2005). The taskforce identified goals for education for counselors on impairment and how to prevent it, securing treatment for impaired counselors, teaching self-care strategies, and advocating within the organization and at both the state and national levels to address issues associated with impairment. Although the taskforce focused on the broader topic of impairment, compassion fatigue remains a component of this experience. The creation, cultivation, and maintenance of a wellness lifestyle is a primary means of addressing and rectifying counselor impairment and compassion fatigue (Lawson & Venart, 2005).
Wellness is defined as “a way of life oriented toward optimal health and well-being in which body, mind, and spirit are integrated by the individual to live life more fully” (Myers, Sweeney, & Witmer, 2000, p. 252). Wellness and prevention are core components of counselors’ professional identities (Mellin, Hunt, & Nichols, 2011). As a result, researchers have studied the benefits of wellness strategies for counselors (Cummins, Massey, & Jones, 2007), counselor educators (Wester, Trepal, & Myers, 2009), and CITs (Yager & Tovar-Blank, 2007). Additionally, Figley (1995) specifically identified poor self-care as a primary risk factor for experiencing compassion fatigue, and Chi Sigma Iota’s (CSI; n.d.) advocacy themes, specifically Theme 6, outline the need for advocacy related to prevention and wellness for clients and counselors (Lee, 2012). The development of a taskforce, the extensive literature associated with compassion fatigue and wellness, and CSI’s identification of wellness as an area of advocacy indicate a clear relationship between counselor experience and counselor practice. Based on previous research, ACA’s stance on counselor self-care, and humans’ innate desire to engage in complex processes to achieve optimal functioning and well-being, it is beneficial for counselors to consider a new phenomenon related to their consistent exposure to global issues through media and social media. Counselors currently conceptualize compassion fatigue as a linear process occurring as a result of the cumulative direct exposure to clients’ distressing experiences. This article presents an expanded perspective on counselor compassion fatigue occurring as a result of exposure to current events and issues. Furthermore, this article offers a language for this experience as well as a conceptualization of the phenomenon.
GCF
I suggest the term global compassion fatigue to describe the process by which an individual experiences extreme preoccupation and tension as a result of concern for those affected by global events without direct exposure to their traumas through clinical intervention. GCF requires examining compassion fatigue outside of client-specific experiences and within a larger context. This invites counselors and CITs to explore how they are human and existing in a conflicted, polarized, and oftentimes troubling world.
Figure 1 provides a visual depiction of these constructs. After exposure to a traumatic global event, humans experience an acute stress-related psychological response (Holman, Garfin, & Silver, 2013); for counselors this may manifest as GCF because of their foundational helping skills rooted in the ability to feel and exhibit empathy for the issues faced by others (A. J. Clark, 2010). Once this response occurs, counselors can utilize wellness and self-care strategies and engage in social justice advocacy efforts as deterrents to GCF. If they bypass these methods, they might experience the extreme preoccupation and tension that are indicators of GCF. However, counselors can interrupt and manage their GCF by moving to wellness and advocacy strategies.
Figure 1. Process of GCF. After media exposure to a global event and engaging in an emotional response, counselors can immediately experience GCF. Wellness and advocacy are two methods of either addressing GCF after experiencing it or through prevention to deter the experience.
GCF differs from vicarious traumatization in that it does not denote permanent change in cognitive schema; rather, a counselor can experience GCF transiently and in response to significant global and communal events. Counselors experiencing GCF do so outside of clients’ presenting problems. Although no current counseling literature describes this phenomenon, Stebnicki (2007) proposed the concept of empathy fatigue, which “results from a state of emotional, mental, physical, and occupational exhaustion that occurs as the counselors’ own wounds are continually revisited by their clients’ life stories of chronic illness, disability, trauma, grief and loss” (p. 318). Whereas GCF does bear similarity to empathy fatigue, empathy fatigue remains related to an occurrence resulting from direct clinical exposure (Stebnicki, 2007), and GCF involves counselor introspection unrelated to session content. Relatedly, Bayne and Hays (2017) recently conducted a study to conceptualize the conditions of empathy within the counseling process. They developed an exploratory model of counselor empathy that acknowledges the multidimensionality of the empathic process, including the variables associated with counselor impairment. GCF proposes that counselors’ intense emotional experiences related to global concerns are associated with empathy and a desire to help those directly affected. Current events that may cause a counselor to experience GCF include politics, natural disasters, violence (including mass shootings), terrorist attacks, threats to human rights, and animal abuse.
Compassion fatigue research is the best point of reference when considering the experience of GCF. Compassion fatigue manifests through physical, psychological, spiritual, and social symptoms (Lynch & Lobo, 2012), and counselors experiencing GCF also can exhibit these symptoms. However, counselors must consider the source of their feelings of fatigue. For example, Coetzee and Klopper (2010) noted, “compassion fatigue is caused by the prolonged, intense, and continuous care of patients, use of self, and exposure to stress” (p. 239). I suggest that GCF involves a similar experience, although as a result of continuous concern for other beings, a desire to help recover from or solve the issues affecting those beings, and repeated exposure to current events harming individuals on a large scale. Additionally, ACA’s Advocacy Competencies call for professional counselors to engage in systemic and sociopolitical advocacy on a continuum ranging from the microlevel (i.e., the individual) to the macrolevel (i.e., the public; Lewis, Arnold, House, & Toporek, 2003). Therefore, it is a counselor’s duty to remain aware of systemic, environmental, and political factors impacting clients in addition to immersing themselves in advocacy and mechanisms for change. Such actions may leave counselors susceptible to impairment in response to global issues, although moving from awareness to action also can help prevent or mitigate GCF.
Researchers have explored the effects of distressing events on helping professionals. Early research described the relationship between clergy members’ compassion fatigue and their time spent with trauma victims following the September 11th terrorist attacks (Flannelly, Roberts, & Weaver, 2005). Counselors responding after a natural disaster (Lambert & Lawson, 2013) and trauma counselors (Sansbury, Graves, & Scott, 2015) are populations often researched in the compassion fatigue literature. For example, Day, Lawson, and Burge (2017) reported the results of a qualitative research study exploring compassion fatigue and shared trauma in clinicians providing services after the shootings at Virginia Tech in 2007. Day et al. raised an interesting point between a counselor’s direct and indirect exposure to global events as well as the level of impairment resulting from the experience. Given the possibility that unresolved trauma can cause issues in functioning, direct exposure to an event removes the possibility that a counselor is experiencing GCF. This shared trauma may result in similar symptomatology, but these symptoms are attributed to the commonality of the trauma experience (Figley Institute, 2012).
From a different framework, researchers have explored the experiences of non-counselors when exposed indirectly to traumatic global events. Although many Americans were not in New York at the time of the September 11th attacks, nor were they likely to have known someone associated with the attacks, the stress of the event was felt across the country in the form of trauma symptoms (Schuster et al., 2001). Individuals living in Britain also experienced psychological changes as a result of the vicarious media exposure to these terror attacks on America (Linley, Joseph, Cooper, Harris, & Meyer, 2003). Similarly, college students at a separate university described an increase in acute stress symptoms as they learned about the shootings at Virginia Tech on television (Fallahi & Lesik, 2009). This research indicates that individuals can experience emotional duress in response to indirect exposure to global or national issues. Ultimately, it is important to remember that, despite extensive training and experience, counselors are humans navigating a society that can upset them in various ways. GCF awareness furthers counselor insight and promotes opportunities for evaluating self-care, wellness, and efficacy under these conditions. Such awareness requires an understanding of the role media plays in individuals’ experiencing of traumatic global events.
The Impact of Media
Previous researchers evaluated the impact of television viewing on an individual’s stress symptoms and levels of vicarious exposure (Fallahi & Lesik, 2009; Linley et al., 2003), suggesting that the role of technology can significantly affect a counselor’s ability to create boundaries and step away from the tragic circumstances occurring in the world around them. With 62% of adults obtaining their news from social media sites in 2016, an increase from 49% in 2012 (Gottfried & Shearer, 2016), it is clear that regular social media use can result in high levels of exposure to distressing news content. Additionally, four out of five adults in the United States reported constantly “checking” their cellular phones for emails, text messages, and social media (American Psychological Association, 2017). This same survey also described higher stress levels in the “constant checker” population than those using technology less frequently.
Researchers have discovered a link between emotional well-being and use of television media. Schlenger et al. (2002) found a statistically significant relationship between the levels of post-traumatic stress disorder symptoms and the numbers of hours spent watching television coverage of the September 11th terrorist attacks when assessing the psychological reactions of 2,273 adults residing in major metropolitan cities in the United States one to two months after the attacks. Fallahi and Lesik (2009) also identified a problematic association between indirect exposure to a tragic event through news media sources and symptoms of acute stress disorder.
Therefore, if a counselor or CIT is particularly sensitive to the content to which they are exposed through the media, they increase their risk of experiencing GCF. Conversely, social media also might provide an opportunity for community and connection in the face of global issues. The idea of community is no longer constrained within the bounds of physical associations; rather, the internet provides access to distant communities and relationships (Gruzd, Wellman, & Takhteyev, 2011). Supporters and activists involved in the Black Lives Matter movement are an example of such a community. Black Lives Matter erupted on social media as a Twitter hashtag created to raise awareness for and demonstrate protest against police brutality on members of the Black community (Petersen-Smith, 2015). Through this online movement, individuals were able to exhibit solidarity and take a stand against racism toward Black people with their use of social media (Schuschke & Tynes, 2016). Similarly, the #MeToo internet-based movement brought attention to women’s rights and sexual violence (Hostler & O’Neil, 2018), and social media platforms also provide a method of addressing the stigma of mental health and addiction (de la Cretaz, 2017).
ACA has an active social media presence through online pages and forums on their website, Facebook, Twitter, and LinkedIn (ACA, 2017). The ACA Code of Ethics (ACA, 2014) states that counselors will use social media only when it is in the best interest of the client while protecting their identity and well-being (Section H). This is another example in which a position is based on a situation specifically involving the client and counselor. Although researchers have explored the role of social media in counselor education (Tillman, Dinsmore, Chasek, & Hof, 2013) and recommendations have been made for using social media ethically in clinical practice (Giota & Kleftaras, 2014), researchers have yet to explore how social media affects practicing counselors on an emotional level. Adopting GCF into the counselor impairment literature would suggest a need for ACA to also establish recommendations for counselors’ social media use and how excessive exposure to global events can affect their work as counselors.
A New Perspective
As social beings dependent upon one another for survival, humans have an evolutionary and biological drive to feel connected and invested in others. Specifically, humans are interested in the welfare of others on a neurological level (Lieberman, 2013). Counselors and CITs can feel a need to help others based on evolutionary compulsions rooted in social psychology. However, they also can feel this drive to an amplified extent because of their consistent demonstration and use of empathy, a foundational helping skill that allows counselors to “enter the client’s phenomenal world, to experience the client’s world as it were your own without ever losing the ‘as if’ quality” (Rogers, 1961, p. 284). Although all humans are susceptible to experiencing fatigue as a result of high exposure to global issues through media, not all humans work in a helping profession based in the empathic experience. Therefore, similar to the need for counselors to monitor themselves for impairment as a result of direct engagement with clients’ presenting issues, counselors also need to monitor for impairment from global issues. Regardless of continuous exposure to distressing global events, counselors continue to help others on a consistent basis. This indicates a critical need for counselors to understand their relationship to social media and the global events to which they experience an emotional response.
Symptoms of GCF can manifest similarly to traditional compassion fatigue. These symptoms can include emotional and physical exhaustion associated with care for others, desensitization to stories and experiences, poorer quality of care, feelings of depression or anxiety, increased stress, difficulty concentrating, and preoccupation (Figley Institute, 2012). Ultimately, it is the responsibility of the counselor to understand the source of these symptoms. Unlike counselors’ direct work with clients in which there may be greater opportunities to assist in managing or addressing a pain-inducing problem, emotional and cognitive responses to global issues present a different type of challenge. Managing issues in which a person may perceive little control and direct influence can cause responses such as rumination (Nolen-Hoeksma, Wisco, & Lyubomirsky, 2008) and fear (Pain & Smith, 2008). Although counselors can experience these feelings regarding clients (Sansbury et al., 2015), there are greater opportunities for direct interaction with the client needing assistance. In most cases, counselors are unable to directly impact the people involved in the global events to which they are continuously exposed through media and social media. Optimal human functioning involves integration of the mind, body, and spirit (Myers et al., 2000). GCF can impact this integration when counselors are unable to live fully through the exhaustion of exposure to global events. Wellness strategies and forms of advocacy can prevent or rectify these experiences. Myers et al. (2000) acknowledged that “global events, whether of natural (e.g., floods, famines) or human (e.g., wars) origin, have an impact on the life forces and life tasks depicted in [wellness models]” (p. 252). In addition, advocacy in the wake of social events can provide feelings of efficacy and social connection (Scott & Maryman, 2016). This new perspective provides implications for the profession of counseling, including recommendations, cultural considerations, and areas of future research.
Implications for Counselors
In a “plugged-in” society, it is possible to become overwhelmed with the daily stream of news and information. Additionally, counselors can be at higher risk of experiencing impairment because of their empathic nature (Figley, 1995) and ethical duty to engage in social justice for causes that improve equity for individuals and groups (ACA, 2014). As leaders and advocates, GCF may be present in counselors’ daily clinical work. Licensed counselors in private practice may not be receiving ongoing supervision (Bernard & Goodyear; 2014); therefore, no external individual is monitoring how they are managing GCF and its effects. Counselors outside of supervision must exercise great care to practice self-awareness and approach others for assistance. Furthermore, counselors in high-volume settings often work with large caseloads that present with complex issues (Belling et al., 2011; Lombardo, 2018), and it may be easy for them to ignore their own needs while addressing the needs of others. Given the critical period of counselor development, GCF also must be considered within the context of counselor education. GCF during the formative period of graduate-level education in counseling can impede overall skill development. As new counselors find themselves more likely to experience compassion fatigue (Figley, 1995), the same may hold true for GCF. GCF may result in a type of developmental stalling in which counseling students feel an “empathy overload.” Such an overload of empathic emotions may impede the student’s transformation into a counselor. This provides implications for counselor education programs to measure students’ responses to emotionally distressing stimuli (O’Brien & Haaga, 2015) of both clinical and global nature as well as openly and unashamedly discuss signs and symptoms of impairment (Merriman, 2015).
I propose that counselors can manage GCF similarly to compassion fatigue because of the possibility of the two phenomena appearing symptomatically similar. However, GCF requires a greater level of self-awareness, recognition, and acceptance in order to address it. Counselors must learn how to distinguish between the two concepts and understand the possibility for overlap. A number of tools used to manage compassion fatigue can be used for GCF. Supervision, personal counseling, and consultation are all avenues of accountability, monitoring, and fidelity to the profession (Bernard & Goodyear, 2014). Although advocacy can be another tangible method of preventing or mitigating GCF, activism can cause emotional, mental, and physical exhaustion (Chen & Gorski, 2015); therefore, advocacy paired with careful attention to wellness can allow counselors to be most effective in helping to address global issues (Roysircar, 2009). Self-care practices and a wellness lifestyle may also act as protective factors to GCF. Myers et al. (2000) noted, “If one’s spirituality is healthy . . . [it] provides a firm foundation and core for the rest of the components of wellness” (p. 258). This indicates counselors developing an optimistic outlook in response to global events creates greater buffering or management of GCF. Similarly, these authors also state that self-direction allows a person to “move smoothly through time and space”
(p. 258). The cumulative pressure of global stressors necessitates firm self-direction to maintain focus in the chaos of present time and space. Wellness is cumulative and enhances longevity for professional practice (Myers et al., 2000). Ultimately, counselors are ethically responsible for ensuring they practice healthy boundaries and work within their competencies (ACA, 2014). An open dialogue with colleagues, self-awareness of strong responses to global events, pursuing systemic change through advocacy, and cultivating personal wellness encourage management of GCF (Robino & Pignato, 2017).
GCF holds particular relevance for counselors of color. Individuals from historically marginalized populations must understand, identify, and address their experiences and the effects of systemic and individualized racism as well as the psychological trauma of oppression and marginalization (Carter, 2007). The number of publicized events that occur in relation to civil rights issues and social justice concerns warrant additional consideration of GCF in specific populations. For example, police brutality against Black males can cause GCF in many counselors, particularly in counselors of color because of the negative psychological health outcomes for communities of color that stem from racism and discrimination (Carter & Forsyth, 2009; Comas-Díaz, 2016). Furthermore, violence (e.g., the Charleston, South Carolina, shooting targeting a specific religious group consisting of people of color and the Charlottesville, Virginia, protests that resulted in the death of a counter-protester) and localized natural disasters (e.g., fires in Tennessee and the Western United States that affected entire communities and hurricanes like Harvey, Irma, and Maria that caused devastation in the Southern United States and Puerto Rico) also increase the risk of GCF in counselors indirectly or somewhat directly exposed to these events. At the time of this writing, the president of the United States has signed an Immigration Executive Order (Executive Order No. 13,769, 2017) that calls for banning residents of certain Middle Eastern countries from entering the United States. In addition, the public expressed outrage at the removal of children from families seeking asylum at the U.S.–Mexico border (Goldstein, 2018). Such traumatic events become a systemic, multi-level public health issue (Magruder, McLaughlin, & Elmore Borbon, 2017) and increase the possibility of GCF among concerned individuals, including counselors and counseling students.
The emergence of this concept paves the way for a broad range of research avenues. First, I recommend the study of GCF in counselor education programs. With CITs particularly sensitive to the nuances of the counseling profession (Bernard & Goodyear, 2014), the critical period of graduate education requires an examination into how GCF can affect counselor development. Second, the management of GCF calls for greater practice of self-care and exercising of insight. For example, researchers could explore the use of mindfulness and reflexivity in assessing how to treat counselors impacted by global events. Additionally, future research could explore the relationship of counselors’ social media use and GCF experiences. Statistics indicating the increase of social media as a news source (Gottfried & Shearer, 2016) raise questions of how counselors are impacted by their own internet activity. Researchers also could investigate counselor advocacy on social media. Although this article proposes that counselors may experience frustrations that contribute to GCF as a result of social media exposure to distressing global events, Dr. Holcomb-McCoy described social media as a tool for advocacy (Meyers, 2017), which may help in mitigating GCF. Such studies may assist counselors in delineating between GCF and other phenomena of impairment.
Finally, greater research is needed to assess and measure GCF. No accurate measurement yet exists for the phenomenon of GCF. Compassion fatigue measurements assess the negative aspects of helping others through direct contact (Figley, 1996). For GCF, this does not address the negative aspects of compassion for indirect exposure to global events. The Impact of Events Scale-Revised (IES-R; Weiss, 2007) measures the subjective distress associated with a traumatic event. However, the IES-R measures symptoms associated with post-traumatic stress disorder. Although it captures the experience of an external global event, it does not capture the transient, yet profound, emotional experience of GCF. The answer to assessing GCF may lie in the development of an instrument that combines compassion fatigue assessments and the IES-R to measure GCF symptoms as it relates to global events.
Conclusion
This article introduces the concept of GCF into the counseling literature. By expanding the literature on other explanations of impairment, we broaden opportunities for self-awareness and professional development. Previously researched impairment concepts require an expansion into this new perspective by incorporating the effects of exposure to current events. This new phenomenon also contributes to counselor wellness research and the importance of maintaining a healthy wellness lifestyle as a deterrent to GCF. Adopting this concept and language into the literature on impairment and wellness encourages further consideration of counselor health, counselors’ management of distressing global events, and how this may impact both counselors and clients as humans.
As counselors become competent in their roles as advocates for social justice, their involvement in critical global events necessitates attention to the cumulative toll such a role may entail. In addition, consistent exposure to emotionally debilitating global events through social media places counselors in a peculiar position in which they must balance their need to remain informed of events and their need to remain healthy and well. Counselors carry the extra responsibility of remaining present and empathic with their clients while also protecting the empathy they experience for the world around them. Counselors’ marginalized and impacted cultural identities also factor into their experiences of GCF. In this regard, wellness becomes not simply an ethical duty, but also a professional imperative in the interest of both counselor and client welfare.
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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Nov 28, 2019 | Volume 9 - Issue 4
Nesime Can, Joshua C. Watson
Scholars have described compassion fatigue as the result of chronic exposure to clients’ suffering and traumatic stories. Counselors can struggle when they experience compassion fatigue because of various reasons. As such, an exploration of factors predictive of compassion fatigue may help counselors and supervisors buffer adverse effects. Utilizing a hierarchical linear regression analysis, we examined the association between wellness, resilience, supervisory working alliance, empathy, and compassion fatigue among 86 counselors-in-training (CITs). The research findings revealed that resilience and wellness were significant predictors of compassion fatigue among CITs, whereas empathy and supervisory working alliance were not. Based on our findings, counselor educators might consider enhancing their current training programs by including discussion topics about wellness and resilience, while supervisors consider practicing wellness and resilience strategies in supervision and developing interventions designed to prevent compassion fatigue.
Keywords: compassion fatigue, counselors-in-training, wellness, resilience, supervisory working alliance
Balancing self-care and client care can be a challenge for many counselors. When counselors neglect self-care, they can become vulnerable to several issues, including increased anxiety, distress, burnout, and compassion fatigue (Ray, Wong, White, & Heaslip, 2013). Counselors might be especially prone to experiencing compassion fatigue because they repeatedly hear traumatic stories and clients’ suffering in sessions (Skovholt & Trotter-Mathison, 2016). This phenomenon is likely pronounced among counselors-in-training (CITs), as lack of experience, skillset, knowledge, and support can lead to struggles when working with clients (Skovholt & Trotter-Mathison, 2016). Coupled with the increased anxiety, distress, and disappointment, CITs can experience compassion fatigue early in their career development, which can lead to exhaustion, disengagement, and a decline in therapeutic effectiveness (Rønnestad & Skovholt, 2013). At this developmental stage, negative experiences can lead to feelings of doubt and a lack of confidence among CITs and potentially lead to career dissatisfaction. Therefore, it is essential and necessary to better understand the predictive factors of compassion fatigue among CITs to prevent its early onset.
Compassion Fatigue in Counseling
Counselors listening to their clients’ fear, pain, and suffering can feel similar emotions. Figley (1995) defined this experience as compassion fatigue; it also can be defined as the cost of caring (Figley, 2002). Whether working in mental health agencies, schools, or hospital settings, counselors experience compassion fatigue because of exposure to large caseloads, painful stories, and lack of support and resources (Skovholt & Trotter-Mathison, 2016). Despite this exposure, counselors are expected to place their personal feelings aside and provide the best treatment possible in response to the presenting issues and needs of their clients (Figley, 2002; Ray et al., 2013; Turgoose, Glover, Barker, & Maddox, 2017). Maintaining this sense of detached professionalism has its costs, as a number of counselors find themselves at risk for experiencing physical, mental, and emotional exhaustion, as well as feelings of helplessness, isolation, and confusion—a situation collectively referred to as compassion fatigue (Eastwood & Ecklund, 2008; Thompson, Amatea, & Thompson, 2014).
Merriman (2015b) stated that ongoing compassion fatigue negatively impacts counselors’ health as well as their relationships with others. Additionally, compassion fatigue can lead to a lack of empathy toward clients, decrease in motivation, and performance drop in effectiveness, making even the smallest tasks seem overwhelming (Merriman, 2015b). When this occurs, counselors can project their anger on others, develop trust issues, and experience feelings of loneliness (Harr, 2013). Therefore, the demands of the counseling profession can affect many counselors’ wellness and potentially could hurt the quality of client care provided (Lawson, Venart, Hazler, & Kottler, 2007; Merriman, 2015a). Further, counselors experiencing compassion fatigue might have difficulties making effective clinical decisions and potentially be at risk for harming clients (Eastwood & Ecklund, 2008). Consequently, scholars appear to agree that compassion fatigue is an occupational hazard that mental health care professionals need to address (Figley, 2002; Merriman, 2015a).
Factors Associated With Compassion Fatigue
Many researchers have studied the relationships between compassion fatigue and various constructs, such as empathy, gender, mindfulness, support, and wellness (e.g., Beaumont, Durkin, Martin, & Carson, 2016; Caringi et al., 2016; Ray et al., 2013; Sprang, Clark, & Whitt-Woosley, 2007; Turgoose et al., 2017). Researchers conducted most of these studies among novice and veteran mental health professionals. Scant research among CITs exists. Our research attempts to fill this gap by exploring factors affecting CITs given their unique position as both students and emerging professionals. The following review of the literature supports the inclusion of predictor variables used in this study.
Empathy and Compassion Fatigue
One of the most widely studied concepts across various cultures is empathy, as it has been determined to be one of the major precipitants of compassion fatigue (Figley, 1995). However, findings in the literature regarding the association between compassion fatigue and empathy remain mixed (e.g., MacRitchie & Leibowitz, 2010; O’Brien & Haaga, 2015; Wagaman, Geiger, Shockley, & Segal, 2015). For instance, O’Brien and Haaga (2015) compared trait empathy and empathic accuracy with compassion fatigue after showing a videotaped trauma self-disclosure among therapist trainees (a combined group of advanced and novice graduate students) and non-therapists. The results indicated that there was no significant association between participants’ levels of compassion fatigue and empathy scores. However, MacRitchie and Leibowitz (2010) found a significant relationship between compassion fatigue and empathy after exploring the relation of these variables on trauma workers whose clients were survivors of violent crimes. The mixed results of these previous studies suggest further research is needed to understand better the relationship between empathy and compassion fatigue and how this relationship impacts counseling practice.
Supervisory Working Alliance and Compassion Fatigue
Although reviewed literature addressed studies suggesting supervision and support are related factors to compassion fatigue, research on this relationship is still insufficient. Kapoulitsas and Corcoran (2015) conducted a study and found that a positive supervisory relationship has a significant role in developing resilience and reducing compassion fatigue among counselors. Knight (2010) also found that students uncomfortable talking with their supervisor reported a higher risk for developing compassion fatigue. Additionally, organizational support appears to reduce compassion fatigue, whereas an absence of support increases practitioners’ and interns’ risk of developing compassion fatigue symptoms (Bride, Jones, & MacMaster, 2007). Given the intense need for support and guidance CITs need during their initial work with clients, it is expected that those students who do not actively work with their supervisors can struggle and be more vulnerable for compassion fatigue.
Wellness, Resilience, and Compassion Fatigue
Although counselors are encouraged to practice self-care activities to continue to enhance personal well-being (American Counseling Association [ACA], 2014; Coaston, 2017; H. L. Smith, Robinson, & Young, 2008), not all CITs can balance caring for self and others. When CITs do not receive training in the protective factors for compassion fatigue, they risk becoming more vulnerable to violating the ACA code of ethics (Merriman, 2015a; Merriman, 2015b). Kapoulitsas and Corcoran (2015) and Skovholt and Trotter-Mathison (2016) highlighted the importance of resilience and self-care activities as protective factors for compassion fatigue. Wood et al. (2017) evaluated the effectiveness of a mobile application called Provider Resilience to reduce compassion fatigue scores of mental health professionals. After a month of utilization, the results indicated that the application was effective in reducing compassion fatigue. Additionally, Lawson and Myers (2011) conducted a study with professional counselors to examine counselor wellness about compassion fatigue and found a negative correlation between total wellness scores and compassion fatigue scores. As CITs balance academic, family, and work demands, the probability of decreased wellness and a corresponding increase in compassion fatigue exists.
Compassion Fatigue Among CITs
Most CITs are often unable to master all counselor competencies (Rønnestad & Skovholt, 2013), and therefore they might not know how to deal with possible stressors and the emotional burden of their work (Star, 2013). Although they are learning counseling skills to provide the best care possible to clients, CITs may find themselves working with seriously troubled or traumatized clients without obtaining quality supervision and support (Skovholt & Trotter-Mathison, 2016). Lack of skills and resources increases the likelihood of CITs developing compassion fatigue (Merriman, 2015b). However, there is a lack of focus in compassion fatigue education on preparing CITs to manage compassion fatigue symptoms (Merriman, 2015a). Although scholars have examined compassion fatigue among counselors, there is still a dearth of studies investigating the level of compassion fatigue among CITs and addressing its protective factors within this population (Beaumont et al., 2016; Blount, Bjornsen, & Moore, 2018; Thompson et al., 2014). Subsequently, further research is needed to understand better potential protective factors that can be enhanced to offset the negative impact of compassion fatigue on CITs and the counseling process. Thus, with this study, we aimed at assessing the relationship between resilience, wellness, supervisory working alliance, empathy, and compassion fatigue among CITs in the United States. To accomplish this goal, we sought to answer the following research questions: (1) What is the prevalence of compassion fatigue among CITs? and (2) Do empathy, supervisory working alliance, resilience, and wellness significantly predict levels of compassion fatigue among CITs?
Method
Participants
Participants recruited for this study consisted of master’s-level counseling students who are at least 18 years of age and enrolled in an internship course in the United States through mostly professional listservs (e.g., Counselor Education and Supervision Network Listserv [CESNET-L], Texas Association for Counselor Education and Supervision Network Listserv [TACESNET-L], Counseling Graduate Student Network [COUNSGRADS]). Because of the impossibility of knowing how many individuals received the email invitation, we were unable to calculate and determine a response rate. Accordingly, a total of 114 CITs initially agreed to participate in this study. Before data analysis, we inspected the data set for possible entry errors and missing data. After the inspection, we excluded 28 participants from all subsequent data analyses resulting in the reduced sample of 86 CITs used to address our research questions. Overall, the sample consisted of 78 female (90.7%) and eight male (9.3%) participants, and the mean age of the participants was 32.89 years (SD = 9.72) with participants’ ages ranging between 21 and 62 years. Participants were from diverse ethnic and racial backgrounds, with the sample consisting of White (n = 48, 55.8%), Hispanic/Latino (n = 18, 20.9%), Black/African American (n = 12, 14.0%), and Asian (n = 5, 5.8%) CITs. Three participants (3.5%) listed their ethnicities as “other” when providing demographic information. Participants reported their program enrollment as follows: clinical mental health counseling program (n = 47, 54.7%); school counseling program (n = 23, 26.7%); marriage, couple, and family counseling program (n = 4, 4.7%); college counseling and student affairs program (n = 3, 3.5%); addiction counseling program (n = 2, 2.3%); and other programs (n = 7, 8.1%). Additionally, most of the participants (n = 73, 84.9%) reported enrollment in a CACREP-accredited program with the remaining participants (n = 13, 15.1%) enrolled in a non–CACREP-accredited program.
Procedure
Upon receiving institutional review board approval, we recruited participants from different institutions with the primary researcher contacting professional colleagues at various departments to disseminate the online survey link to potential participants during the 2017 summer and fall semesters. We also recruited participants through professional listservs (e.g., CESNET-L, TACESNET-L, COUNSGRAD), with listserv participants being provided the same informed consent and survey link through a secure website. The survey completion process took approximately 15–20 minutes.
Measures
We used the following self-administered survey questionnaires and a separate demographic data sheet in our data collection.
Professional Quality of Life Scale (ProQOL). This scale is designed to measure the mental and emotional consequences of working with individuals who experienced trauma or painful events (Stamm, 2010). The ProQOL includes two main traits, Compassion Satisfaction (positive) and Compassion Fatigue (negative). Compassion Satisfaction is related to the joy individuals develop when they do their work well (Stamm, 2010). Compassion Fatigue consists of two subscales: Secondary Traumatic Stress (STS) and Burnout. Scholars have defined STS as an emotional state that occurs when an individual becomes upset or traumatized as a result of their exposure to victim experiences (Figley, 2002). The second part of Compassion Fatigue is Burnout, which is a multidimensional syndrome related to the social work environment. Burnout could be related to work overload, lack of control, insufficient rewards, unfairness, and value conflict at a workplace (Skovholt & Trotter-Mathison, 2016).
The ProQOL is a 30-item Likert-type self-report assessment with responses of never, rarely, sometimes, often, and very often for each item. A sample item is “I feel depressed because of the traumatic experiences of the people I [help].” This assessment has 10 questions per each of three main scales measuring separate constructs. However, the Compassion Fatigue scale includes two of these constructs, which are the Burnout and the STS scales. According to Stamm (2010), the ProQOL has good construct validity, as researchers have noted its efficacy in over 200 published articles. Finally, alpha coefficient values for the Burnout and STS scales were .75 and .81, respectively (Stamm, 2010), and are similar (.72 and .79) to the Cronbach’s alpha values from the current study presented in Table 1.
Table 1
Descriptive Statistics of the Study Variables (N = 86)
|
|
|
|
Range |
|
|
| Variable |
M |
SD |
Min |
Max |
Skew |
α |
| Compassion Fatigue |
41.48 |
8.03 |
22 |
60 |
.19 |
|
|
BO |
21.34 |
4.38 |
12 |
32 |
– |
.72 |
|
STS |
20.14 |
4.96 |
10 |
38 |
– |
.79 |
| Empathy |
21.86 |
4.12 |
9 |
28 |
-.51 |
.80 |
| Supervisory Working Alliance |
5.82 |
.97 |
2.16 |
7 |
1.26 |
|
|
CF |
6.65 |
1.30 |
2.17 |
8.17 |
– |
.90 |
|
R |
5.80 |
.96 |
2.33 |
7 |
– |
.93 |
| Resilience |
3.43 |
.79 |
1 |
4.67 |
-.74 |
.89 |
| Wellness |
47.58 |
6.23 |
27 |
56 |
-1.39 |
.86 |
|
|
|
|
|
|
|
|
|
|
|
|
Note. BO = Burnout; STS = Secondary Traumatic Stress; CF = Client Focus; R = Rapport
Interpersonal Reactivity Index (IRI). Davis (1983) developed the IRI to measure the reactions of a person to other individuals’ observed experiences. The 28-item instrument has four subscales: Empathic Concern, Perspective Taking, Fantasy, and Personal Distress (Davis, 1983). Researchers report separate subscale scores, as a total score for the instrument has not been recommended (Davis, 1983). In this study, we only used the Empathic Concern subscale to collect data regarding empathy scores of CITs.
Davis (1983) described empathic concern as an emotional response, such as compassion and sympathy, to someone else in need. The 7-item subscale is a self-report assessment with a 5-point Likert-type scale, ranging from Does not describe me well to Describes me very well. A sample item is “I am often quite touched by things that I see happen.” An alpha coefficient of .77 has been reported for the Empathic Concern subscale (Péloquin & Lafontaine, 2010), while the Cronbach’s alpha value of the IRI in the current study was .80.
Supervisory Working Alliance Inventory: Trainee Form (SWAI-T). Efstation, Patton, and Kardash (1990) developed this inventory to measure supervisees’ perceptions about the effectiveness of the working relationship with their supervisors, and we used the SWAI-T to measure the construct of the supervisory working alliance. With a total of 19 items, the self-report assessment includes a 7-point Likert-type scale with responses ranging from almost never to almost always. A sample item is “When correcting my errors with the client, my supervisor offers alternative ways of intervening with the client.” The SWAI-T has two subscales—Client Focus and Rapport—and the Cronbach alpha coefficients of these scales were .77 and .90, respectively (Efstation et al., 1990). For the current study, we calculated Cronbach alpha values of .90 for the Client Focus subscale and .93 for the Rapport subscale. Because some researchers have found high correlations between these two subscales, they decided to combine them in their studies (e.g., Ganske, 2007; White & Queener, 2003). Therefore, in this study, after conducting a correlation analysis with the subscale scores, we also chose to combine subscales as the results of subscale scores were highly correlated.
Brief Resilience Scale (BRS). The BRS was developed to measure a person’s ability to recover from stress and cope with challenging situations (B. W. Smith et al., 2008). The BRS is used to measure the construct of resilience. As a 6-item self-report assessment, the BRS includes a 5-point Likert-type scale with responses ranging from strongly disagree to strongly agree. A sample item is “I usually come through difficult times with little trouble.” B. W. Smith and colleagues (2008) reported that the Cronbach’s alpha values of the BRS range from .80 to .91, and we calculated a Cronbach alpha of .89 for the current study.
Flourishing Scale (FS). The FS was designed to measure individuals’ self-perceived success in areas like optimism and relationships (Diener et al., 2010) and used to measure the construct of wellness in this study. The FS is an 8-item self-report assessment with a 7-point Likert-type scale with responses ranging from strongly disagree to strongly agree (Diener et al., 2010). A sample item is “I lead a purposeful and meaningful life.” Diener and colleagues (2010) reported moderately high reliability with a .87 Cronbach’s alpha coefficient, and in the current study, the FS had a Cronbach alpha of .86.
Data Analysis
Statistical power analysis. We used an a priori type of the G*Power to set the minimum number of participants needed to detect statistical power for this research design. Based on an alpha of .05, a power level of .90, and four predictors (Faul, Erdfelder, Buchner, & Lang, 2009), the computation results suggested that a minimum of 73 participants was required to detect statistical significance with at least a moderate size effect (.15). We had 86 participants, suggesting adequate power.
Preliminary analyses. We analyzed all data using the Statistical Package for the Social Sciences, Version 20 (SPSS; IBM Corporation, 2011). Before addressing our stated research questions, we cleaned the dataset and addressed missing data. We did not observe any pattern between missing data points. Therefore, the type of missing data was completely random, which was addressed using the series of mean function within the SPSS. Next, we calculated descriptive statistics and alpha coefficients for each scale used in the study (see Table 1). Before performing hierarchical regression analyses, we tested all associated model assumptions. First, we examined study variables based on their types and concluded each utilized a continuous scale. We then assessed normality with the Shapiro-Wilk test of normality (W > .05), indicating data was normally distributed for the dependent variable. To identify outliers, we examined boxplots. Although there were a few mild outliers, no extreme scores were detected. We assessed linearity and homoscedasticity through inspection of standardized residual plots. To assess for the assumption of multicollinearity, we examined the correlation matrix of study variables to determine if any correlated highly. According to Field (2013), correlations above .80 are considered high and may indicate the presence of multicollinearity. In the present study, none of the correlation coefficients were above .50 (see Table 2). Collectively, these findings indicated no evidence suggesting any of the model assumptions had been violated. As a result, the dataset was deemed appropriate for analysis using a hierarchical regression design.
Primary analysis. Descriptive statistics were calculated to organize the data by producing means, mode, median, standard deviations, and minimum and maximum scores for the study variables (Field, 2013). Individually, we reviewed descriptive statistics for the compassion fatigue variable, and results were reported to address the first research question. Next, we performed a three-step hierarchical linear regression to address the second research question.
Table 2
Intercorrelations for Scores on the Study Variables
|
Variable |
1 |
2 |
3 |
4 |
5 |
| 1. |
ProQOL-CF |
– |
|
|
|
|
| 2. |
SWAIT-T |
.04 |
– |
|
|
|
| 3. |
IRI-EC |
-.06 |
.04 |
– |
|
|
| 4. |
BRS |
-.47** |
-.09 |
-.11 |
– |
|
| 5. |
FS |
-.45** |
.12 |
.25* |
.35** |
– |
Note. N = 86; ProQOL = Professional Quality of Life (Compassion Fatigue [CF] subscale score is presented); IRI = Interpersonal Reactivity Index (Empathic Concern [EC] subscale score is presented); SWAI-T = Supervisory Working Alliance Inventory: Trainee Form; BRS = Brief Resilience Scale; FS = Flourishing Scale.
*p < .05. **p < .01.
Results
Compassion fatigue scores of CITs represent the sum of scores of all items on the STS and Burnout subscales. According to the ProQOL administration manual (Stamm, 2010), individuals scoring below 22 may indicate little or no issues with Burnout and STS, while scores between 23 and 41 indicate moderate levels of Burnout and STS, and scores above 42 indicate higher levels of Burnout and STS. For this sample, participants’ Burnout scores ranged from 12 to 32 with a mean of 21.34 (SD = 4.38), and STS scores ranged from 10 to 38 with a mean of 20.14 (SD = 4.96). These results indicated a low risk of both Burnout and STS among CITs.
To address the second research question, we performed a three-step hierarchical linear regression analysis. With this analysis, we aimed to assess the association between resilience, wellness, supervisory working alliance, empathy, and compassion fatigue. We chose to implement a hierarchical multiple regression analysis because scholars previously have highlighted the essential relationship between empathy, supervision, and compassion fatigue (Figley, 2002; MacRitchie & Leibowitz, 2010). In the first step, empathy scores entered the model as a predictor variable, as Figley (1995) stated that empathy is one of the main factors contributing to compassion fatigue. However, among this sample, we found that empathy was not a significant predictor of compassion fatigue: F(1, 84) = .2, p = .66 , R2 = .002 (adjusted R2 = -.01). Then, we added supervisory working alliance scores to the model in the second step, as both Knight (2010) and Miller and Sprang (2017) emphasized the importance of supervisory support for mental health practitioners. Results revealed that the supervisory working alliance variable also was not a significant predictor of compassion fatigue: F(2, 83) = .16, p = .85, R2 = .004 (adjusted R2 = -.02). In the third step, resilience and wellness scores were entered into the model to determine whether these variables significantly improved the amount of explained variance in compassion fatigue. Results showed that this combination of variables significantly predicted 26% of the variance in compassion fatigue: F(4, 81) = 8.57, p < .001, R2 = .30. Therefore, it was concluded that CITs with greater wellness and resilience reported developing less compassion fatigue (see Table 3).
Table 3
Hierarchical Regression Analysis Results for Variables Predicting Compassion Fatigue
| Variables |
B |
SEB |
β |
R2 |
ΔR2 |
| Step 1 |
|
|
|
|
.002 |
-.01 |
| Empathy |
-.09 |
.21 |
-.05 |
|
|
| Step 2 |
|
|
|
|
.004 |
-.02 |
| Empathy |
-.10 |
.21 |
-.05 |
|
|
| SWA |
.33 |
.91 |
.04 |
|
|
| Step 3 |
|
|
|
|
.30* |
.26 |
| Empathy |
-.03 |
.19 |
-.02 |
|
|
| SWA |
.36 |
.78 |
.04 |
|
|
| Wellness |
-.39 |
.14 |
-.30* |
|
|
| Resilience |
-3.66 |
1.05 |
-.36* |
|
|
Note. SWA = Supervisory Working Alliance
*p < .05.
Discussion
In this study, CITs reported having a low risk of compassion fatigue. When we examined the Burnout and STS scores separately, the main contributors of compassion fatigue (Stamm, 2010), both subscale scores indicated participants having a low risk for STS and Burnout. This finding is similar to results found by Beaumont and colleagues (2016) in their study of compassion fatigue, burnout, self-compassion, and well-being relationships among student counselors and student cognitive behavioral psychotherapists. According to their research findings, a total of 54 student participants reported high scores on self-compassion and well-being and reported less compassion fatigue and burnout (Beaumont et al., 2016).
One of the goals of this study was to seek understanding of whether wellness and resilience explain a statistically significant amount of variance in compassion fatigue among CITs after accounting for empathy and supervisory working alliance. The results indicated that empathy and supervisory working alliance were not significant predictors of compassion fatigue. Regarding empathy and compassion fatigue relation results, the findings of this study did not support Figley’s (1995) assumption of empathy as one of the main contributors to compassion fatigue. This result also is inconsistent with Wagaman and colleagues’ (2015) results indicating a significant association between empathy and compassion fatigue among social workers. However, current results aligned with those studies that found no correlation between empathy and compassion fatigue (e.g., O’Brien & Haaga, 2015; Thomas & Otis, 2010). An explanation of the variability between this inquiry and previous studies might lie with the difference between participants’ field of study and measurement differences. Also, none of the previous studies used CITs solely as their sample, nor used a similar way to measure the construct of empathy. Additionally, CITs would have less experience working with clients compared to experienced counselors, and thus less time for feelings of compassion fatigue to build.
Although scholars addressed the importance of supervision and supervisory working alliance to help prevent compassion fatigue (Kapoulitsas & Corcoran, 2015; Merriman, 2015a), this study’s results indicated supervisory working alliance was not a significant predictor of compassion fatigue among CITs. Like current results, Ivicic and Motta (2017) and Williams, Helm, and Clemens (2012) found no statistically significant association between supervisory working alliance and compassion fatigue among mental health practitioners. It is noteworthy that these studies highlighting the importance of supervision and the supervisory relationship are qualitative in design, and participants did not consist solely of CITs. Additionally, their results emphasized the importance of supervision as support to counter the negative impact of trauma exposure (Kapoulitsas & Corcoran, 2015; Ling, Hunter, & Maple, 2014). According to the current study results, CITs did not report experiencing a high level of compassion fatigue. This finding could be interpreted as CITs not yet feeling the need for supervisory support to help with compassion fatigue.
Results also indicated that resilience and wellness were significant predictors of compassion fatigue among CITs. In other words, when reflecting on both the regression and correlation results, CITs with greater resilience and wellness reported lower scores of compassion fatigue and these results were consistent with Tosone, Minami, Bettmann, and Jasperson’s (2010) research findings. Regarding a wellness and compassion fatigue relationship, Beaumont and colleagues (2016) conducted a study with student counselors and student cognitive behavioral psychotherapists. The results of Beaumont et al.’s study revealed that individuals with high scores of self-compassion and well-being reported having less compassion fatigue and burnout. Thomas and Morris (2017) also highlighted the significance of self-care and well-being not only for preventing and helping to manage the potentially damaging impact of practice, but also for facilitating the counselor’s personal and professional growth.
Implications for Counselor Educators and Supervisors
The research findings provide data-driven results regarding compassion fatigue among CITs that have meaningful implications for counselor educators and supervisors. Present study results revealed that CITs indicated experiencing a low risk of compassion fatigue. However, raising awareness on this issue may still help CITs as a preventative measure to cope with possible compassion fatigue experience in the future. To address this issue, counselor educators may consider raising awareness on this topic by reviewing current counseling program curricula to add discussion questions related to compassion fatigue and its empirically predictive factors—wellness and resilience. Roach and Young (2007) stated that students in counseling programs reported group counseling, counseling techniques, legal and ethical issues, practicum, and wellness courses as contributing most to their knowledge and skills regarding wellness. Therefore, counselor educators might use different assignments, including group discussions, projects, and role-playing exercises, to open a discussion about the compassion fatigue phenomenon and the relation with its predictive factors and these courses. Counselor educators may also use the ProQOL scale as an assignment in an assessment and testing course to inform CITs about how to use this instrument as a self-monitoring aid. For example, professional counselors may feel overwhelmed because of working with trauma survivors after graduation and start noticing compassion fatigue symptoms in themselves. These individuals may self-administer the ProQOL scale to determine whether they have developed compassion fatigue. Additionally, in a practicum or an internship course, CITs may fill out the ProQOL as part of their continuing personal wellness plan by comparing personal results over time and sharing their thoughts and reflections about the results.
Supervisors need to find ways to raise awareness of compassion fatigue and its protective factors with CITs. For instance, during internship experience, supervisors may develop a site training including compassion fatigue awareness for CITs, as CITs should be prepared for the possible emotional and psychological consequences in working with trauma survivors. Student counselors also should be encouraged to advocate for themselves when they notice symptoms of compassion fatigue. Supervisors might consider the administration of the ProQOL scale regularly to assess both organizational and individual risks (Newell & MacNeil, 2010). Additionally, supervisors can use the ProQOL scale with their supervisees to start a conversation about compassion fatigue. Although the ProQOL is not a diagnostic test, the 30-item self-report scale can be utilized readily as a conversation starter in supervision sessions.
The results suggested that empathy and supervisory working alliance did not predict CITs’ compassion fatigue level. However, wellness and resilience are significantly related to contributing to it. Therefore, both counselor educators and supervisors might consider enhancing CITs’ resilience and wellness a worthwhile endeavor. For example, Miller and Sprang (2017) developed a component-based practice and supervision model to reduce compassion fatigue for use in training, supervision, and clinical practice. A tool like this one can be added to existing training curricula and supervision practice to improve CITs’ resilience and wellness.
Limitations
The results of this study aim to provide greater clarity regarding the predictive factors of compassion fatigue among CITs. However, interpretation of results should take into consideration the limitations that emerged because of uncontrollable influences and choices we made. The study was limited in its ability to represent all CITs throughout the United States, as we utilized a convenience sampling approach. Additionally, we gathered data through self-report questionnaires, which introduce the possibility of response bias in the findings. Although we assumed participants answered each question honestly, they might not have been honest in their responses because of the fear of being perceived as weak or less competent. It is important to note that being in an internship class might also increase participants’ interest in the profession as they currently are engaged in the practice of counseling. Therefore, participants might have had a higher level of enthusiasm and reported less compassion fatigue. Also, individuals who suffer from compassion fatigue might have preferred not to respond to these items. Finally, although participants were enrolled in an internship class, each participant may have different numbers of hours of client experience.
Future Directions for Research
Additional research should be conducted to expand and clarify the current research findings of compassion fatigue among CITs. A phenomenological study using a qualitative research method is recommended to expand the findings of this current study. Future researchers may use the ProQOL scale to assess CITs’ level of compassion fatigue and then conduct interviews with the volunteer participants reporting a higher level of compassion fatigue to better understand CITs’ experience with compassion fatigue and its contributing factors. The data collected through a qualitative study may provide greater insight into the phenomenon of compassion fatigue among CITs. Additionally, researchers can replicate the present study with early-career counselors who have recently graduated, because of the noted intensity of those first years after graduation (Skovholt & Trotter-Mathison, 2016). Therefore, future researchers exploring novice counselors’ experiences with compassion fatigue will help counselor educators and supervisors better understand when counselors may start developing compassion fatigue symptoms, as well as how they cope with the symptoms.
Conclusion
CITs may struggle when they continuously hear painful stories of clients because of a lack of experience, skillset, or support (Skovholt & Trotter-Mathison, 2016). Researchers have described this experience as compassion fatigue. With this study, we aimed to provide a better understanding of the predictive factors of compassion fatigue among CITs. Using data-driven research results to determine ways to work with CITs on compassion fatigue and its predictive factors can be beneficial in preventing compassion fatigue symptoms from an early onset. CITs may take precautionary measures to ensure they remain enthusiastic and energized by the work they do. Further, implications of the current study may help CITs start their professional careers better prepared to provide their clients with the optimal care needed throughout the counseling relationship by minimizing compassion fatigue.
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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Nesime Can is an instructor at Ankara University in Turkey. Joshua C. Watson, NCC, is a professor and department chair at Texas A&M University–Corpus Christi. Correspondence can be addressed to Nesime Can, Ankara University Faculty of Educational Sciences, Department of Educational Sciences, Program of Counseling and Guidance, Office 3111, Çankaya, Ankara, Turkey 06590, nesime.can@ankara.edu.tr.
