Apr 2, 2017 | Volume 7 - Issue 2
Alwin E. Wagener
Metaphors are linked to how individuals process information and emotions, and they are important to understand and utilize in counseling. A description of the structure of metaphors and metaphor theory is provided. The role of metaphors in emotional processing is explained, and the process of counseling is tied to the therapeutic usage of metaphors. Building from that information, approaches to using metaphors in counseling are described, and metaphors are divided into client-generated and counselor-generated categories, with corresponding information on how metaphors can be used in the counseling process. The counseling process is then separated into categories of exploration, insight and action, and descriptions of metaphor usage along with composite case examples are provided for each category to show how incorporating metaphors in clinical practice can be therapeutically beneficial in supporting positive client changes.
Keywords: metaphor, exploration, insight, action, emotional processing
Metaphorical language occurs commonly in communication, with a study by Steen, Dorst, Herrmann, Kaal, and Krennmayr (2010) finding that metaphoric language is used 18.6% of the time in academic writing, 11.8% in fiction and 7.7% in conversation. Examples of types of metaphoric language that may commonly appear in conversation are: she rushed to his defense (in the context of arguing on his behalf), she broke down and cried and when I walked into the house, she attacked me for not calling to say I would be late (in this case meaning that she was upset and spoke in a harsh manner). In these examples, the metaphors are rushed to his defense, broke down, and attacked. These words are not literal descriptions but instead use descriptions of physical processes to metaphorically describe emotional and verbal activities. These metaphors might appear in clients’ normal speech and may be commonly overlooked as being metaphoric. The frequency of these metaphors in language provides opportunities for greater exploration and understanding of clients. Research findings also support metaphors occurring at a higher rate when describing emotions and discussing emotional experiences, making metaphors even more important for counselors to recognize and address (Fainsilber & Ortony, 1987; Lubart & Getz, 1997; Samur, Lai, Hagoort, & Willems, 2015; Smollan, 2014).
Metaphors are not simply a linguistic or literary device; they play an important role in learning and cognitively organizing an understanding of the world (Aragno, 2009; Evans, 2010; Lakoff & Johnson, 1980). The importance of metaphors for learning and understanding is a prime reason for counselors to be conversant in metaphors and their uses in counseling. Counseling involves supporting clients in learning and understanding so they can make changes that enable them to reach their goals. Recognizing and working with client metaphors can be beneficial for professional counselors, as there is research supporting metaphor frequency and types varying in relation to emotional changes (Gelo & Mergenthaler, 2012; Tay, 2012; Wickman, Daniels, White, & Fesmire, 1999). Therefore, clients’ metaphors can provide insight into their emotional states and how they are conceptualizing their situations. In addition, metaphors can be used in treatment interventions and for monitoring changes in client conceptualizations and emotions over the course of treatment (Gelo & Mergenthaler, 2012; Kopp & Eckstein, 2004; Lakoff & Johnson, 1980; Sims, 2003; Tay, 2012). However, to effectively use metaphors in counseling practice, it is helpful to understand the basic terminology and structure of metaphors, as this allows the counselor to recognize metaphor types associated with increased emotional processing and the integration of new awareness (Gelo & Mergenthaler, 2012; Lakoff & Johnson, 1980; Tay, 2012). Therefore, this manuscript begins with a brief description of metaphor structure and forms so that the later sections linking metaphors to emotional states and changes and providing approaches for working with metaphors in counseling are more understandable and useful.
Metaphor Structure
Metaphors are a symbolic approach for implying similarity between experiences, thoughts, emotions, actions or objects (Evans, 2010; Seitz, 1998). The structure of a metaphor can be broken down into two domains, the target domain and the source domain. The target domain refers to the concept the metaphor is being used to explain. The source domain is the concrete topic to which the target domain is being linked. By combining the two domains in a metaphoric expression, an understanding of the target domain’s properties is established. The description of properties through the relationship between domains is referred to as conceptual mapping (Tay, 2012). For example, within the metaphor, she is on fire, she is the target domain and fire is the source domain. Through the linkage of these domains, the she referred to is understood to have qualities like that of a fire—in this case, an intense energy.
Metaphors are further classified as having forms that are either simple or complex and either conventional or unconventional. Simple metaphors have one target and one source domain, and complex metaphors have one target with more than one source domain (Lakoff & Johnson, 1980). Conventional metaphors are those that are commonly used within a culture, and unconventional metaphors are those that are not commonly used (Lakoff & Johnson, 1980).
Metaphors and Emotional Change
The process of counseling requires a focus on the emotional experience of clients. Clients’ emotions guide the counselor to what is most affecting and important to clients, so the counseling process often involves developing clients’ recognition of emotional patterns and needs, as well as the generation of new emotional perspectives. Because emotions are at the heart of counseling, the specific connection between emotions and metaphors needs exploration. Research has shown that metaphor usage is connected to emotional change, and specifically, there is support for an increased occurrence of metaphors when talking about emotions, especially intense emotions (Crawford, 2009; Fainsilber & Ortony, 1987). Lakoff and Johnson (1980) described metaphor as an approach for conceptualizing the experience of emotion in a form that is relatable to other individuals. Metaphor is viewed as a way to cognitively organize the emotional experience (Crawford, 2009; Lakoff & Johnson, 1980). It is possible that intense emotions are an experience not directly relatable to other individuals without references, and this may explain research evidence supporting an increased use of metaphor when describing intense emotional experiences (Crawford, 2009; Smollan, 2014). In addition to the possible need for source domains as references to describe intense emotions, metaphors may be ideal for relating emotional experiences because of their ability to encapsulate specific and content-rich information in a concise and broadly understandable manner (Fainsilber & Ortony, 1987).
The link between metaphor and emotion is supported by a number of studies showing that when comparing literal and metaphoric language with the same intended meaning and emotional valence, metaphoric language is related to greater activation of brain regions (particularly the left amygdala) associated with emotion (Bohrn, Altmann, & Jacobs, 2012; Citron & Goldberg, 2014; Citron, Güsten, Michaelis, & Goldberg, 2016) along with higher participant ratings of the emotion contained in metaphor (Fetterman, Bair, Werth, Landkammer, & Robinson, 2016; Mohammad, Shutova, & Turney, 2016). Connecting these findings more directly with counseling practice, Fetterman et al. (2016) found that having participants write metaphorically about personal experiences significantly reduced negative affect in comparison to a control condition in which participants were writing literally about personal experiences. For those participants who wrote metaphorically, there was an increased preference for metaphor usage. These findings support the theory that metaphors are linked to emotional processing and provide more backing for counselors addressing and working with metaphors in counseling.
One additional study that provides a lens into metaphors in counseling practice was conducted by Gelo and Mergenthaler (2012). They performed single-subject research investigating whether the type of metaphor (unconventional or conventional) and frequency of metaphor use were related to client change in counseling. This research was based on previous studies suggesting that unconventional metaphors occur more frequently when clients are involved in emotional and cognitive change processes (Gelo & Mergenthaler, 2012). Gelo and Mergenthaler found that client metaphor usage was associated with periods of emotional and cognitive change, and the client used more unconventional metaphors when reflecting on emotional change, but not while experiencing emotional change. Though it is hard to generalize from a small study, this is an important observation that supports the conceptual idea that metaphors are used to organize emotional experiences and integrate the experiences with the cognitive domain (Crawford, 2009; Lakoff & Johnson, 1980).
Taken in combination, studies examining the relationship between metaphor and emotion indicate that metaphors are linked to processing and communicating emotion, which makes metaphors important for counselors to understand, address and utilize. These studies also suggest that metaphors may have an important role for counselors who are supporting emotional change in clients. Therefore, these research findings inform recommendations for integrating metaphors into counseling.
Metaphor Sources and Approaches
Metaphors in counseling come from two sources, the client and the counselor. The source of the metaphor is important to consider when describing approaches to working with metaphors in clinical practice; thus, client-generated and counselor-generated metaphors will be discussed separately.
Client-Generated Metaphors
The nature of client-generated metaphors can allow for assessment of clients (Gelo & Mergenthaler, 2012; Stewart & Barnes-Holmes, 2001; Wickman et al., 1999). This assessment may only consist of recognizing how clients are conceptualizing experiences, but it also may involve working directly with metaphors to better understand relationships. Noticing the increased usage of complex and unconventional metaphors may be helpful for recognizing when clients may benefit from greater support and conceptual assistance to integrate new concepts or behaviors and explore emotions (Gelo & Mergenthaler, 2012).
To work directly with metaphors in counseling, several approaches are helpful. Kopp and Craw (1998) and Sims (2003) offered similar models with steps to facilitate insight using client-generated metaphors. Both models begin by having the counselor ask the client to elaborate on the metaphor and then follow up by asking the client questions to provide more detail, including emotions connected to the metaphor. Following client elaboration, additional questions and reflections from the counselor support the generation of client insight. To reinforce insight and apply it to the current situation, Kopp and Craw’s model has the client imagine changes in the metaphor that support counseling goals, whereas Sims’ model directs the client to connect the metaphor with past experiences and future goals. Both models describe the use of basic counseling skills to address client metaphors and are easily incorporated into counseling work. An important takeaway regarding client metaphors is that metaphors have significance for the client and are appropriate for exploration in counseling (Tay, 2012; Wickman et al., 1999).
Another approach for working with metaphors in counseling practice was described by Tay (2012), who identified two types of metaphor processing in counseling that can be selectively used based on the purpose of the metaphor exploration. The first type is correspondence processing. Correspondence processing requires exploring the entailments of metaphors. The term entailments refers to a layering and transfer of meaning in the relationship between the symbols in the metaphor. The entailments are the associations and properties of the domains in the metaphor that are not specifically used in the metaphor (Lakoff & Johnson, 1980). For instance, she is on fire might be used to indicate that she is energetically accomplishing a lot, but could also have entailments of meaning related to fire being culturally associated with destruction and being difficult to control.
Correspondence processing describes the cognitive combining of properties between target and source domains as a conceptual mapping that equates the entailments of both domains to facilitate thinking about and using the metaphor in a variety of forms. An exploration of the entailments of those metaphors is often necessary for correspondence mapping and is accomplished by expanding upon the metaphor. To expand on the metaphor, additional descriptions of content related to the metaphor are generated. For example, if the metaphor, love is a journey, is used for correspondence processing, then the expansion might include asking the client for descriptions of journeys that may elicit information such as: there are rough roads in the journey, there are fellow travelers and sometimes it is necessary to find shelter. These descriptions could map back to love to indicate that, respectively, relationships can be emotionally difficult, two people come together when in love, and breaks from relationships are sometimes necessary.
The second type of cognitive processing is class inclusion. Class inclusion refers to a linking of the target and source domain through the core conceptual properties of the domains without expanding the metaphor to understand entailments (Tay, 2012). For instance, in the metaphor example used above, love is a journey, a class inclusion processing would involve asking the client what is important about a journey. Those responses might include needing time to get to a destination and the acceptance of risk in moving toward the destination, and then those responses would be applied to love. This would indicate that love requires an acceptance of risk and a willingness to put in the time in order to achieve love. In this process, the linking of each entailment of the source domain to the target domain is not necessary; instead, broader concepts that connect the domains are the focus.
Counseling use of these approaches is based on client and therapeutic needs. For complex concepts that need to be better understood, metaphors may be shaped in a manner consistent with correspondence and processed as such, whereas for communicating core messages and principles, class inclusion may be preferable (Tay, 2012). These two approaches are both important for metaphor-based interventions because they provide two directions for exploration—understanding core messages or increasing understandings of the relationships and context surrounding the concept being described in metaphor (Tay, 2012). Exploring client metaphors using counseling skills and guided by the conceptual frameworks described above can increase understanding and awareness in both clients and counselors.
Counselor-Generated Metaphors
Counselor-generated metaphors involve the use of metaphors to intentionally support the therapeutic process. The application of metaphors by counselors can occur through the reintroduction of metaphors first generated by clients but with changes to support therapeutic growth, or the sharing of new metaphors as a way to help clients recognize thoughts, feelings and behaviors, or understand and integrate new concepts and behaviors (Millikin & Johnson, 2000; Tay, 2012; Wickman et al., 1999). The metaphors may be short and involve a very clear target and source domain, or they can be as long and complex as stories. In addition, depending on a client’s ability to understand and recognize metaphor and the purpose for which the metaphor is intended, the exploration of the metaphor may be brief or more involved (Millikin & Johnson, 2000; Tay, 2012; Wickman et al., 1999).
One specific type of introduced metaphor is the disquisition, a narrative form of metaphor (Millikin & Johnson, 2000). Disquisitions are stories that involve similar interactions and concerns as those of clients because they are developed or adopted specifically for the therapeutic needs of the client. These stories take many forms, including fictional stories of other clients in counseling and fairy tale-type stories, though the stories need to closely relate to the client’s issue. The purpose of these stories is to normalize the client’s experience, increase insight, deepen emotions and facilitate new perspectives (Millikin & Johnson, 2000). This is a very deliberate therapeutic usage of metaphor that generally requires a reservoir of stories to draw from for particular situations or the very adaptive and creative generation of appropriate stories.
Another approach is to use client-generated metaphors as a starting place for generating therapeutic, counselor-adapted metaphors. The appeal to this approach is the direct connection of client conceptualizations, represented within their metaphors, to new concepts through metaphoric imagery. With the introduction of this type of metaphor, it is often necessary to help clients reformulate relationships from the original metaphor to the new metaphor. This reformulation may be used in support of change that has occurred or as a tool to help clients generate new concepts and behaviors (Gelo & Mergenthaler, 2012; Tay, 2012; Wickman et al., 1999). As with disquisitions, this is also a very deliberate use of metaphor for specific therapeutic effect.
Metaphors and Contraindications
Before transitioning from approaches to using metaphors in counseling to the application of those approaches, it is important to briefly discuss whether metaphor-based approaches should be avoided with some types of clients or situations. A review of research produces no clear contraindications for using metaphors in client interventions, even with those experiencing psychotic disorders. In fact, a recent systematic review by Mould, Oades, and Crowe (2010) of 28 studies of clients with psychotic disorders found support for metaphors as a useful intervention with psychotic clients and describes metaphors as a tool for reorganizing clients’ cognitive understanding in a way that is grounded in reality. In addition, though metaphors seem to present a challenge for some individuals with learning disabilities and autism, interventions to help them understand metaphors have been successfully introduced into counseling (Mashal & Kasirer, 2011). It would be advisable to use caution when introducing metaphors in counseling and to tailor metaphor work to clients’ cognitive abilities and ability to evaluate reality, but with that said, there is no clear evidentiary reason precluding metaphor interventions across mental health diagnoses and therapies. In fact, metaphors are considered a ubiquitous and foundational aspect of cognitive and emotional processing and communication (Blasko, 1999; Evans, 2010; Steen et al., 2010; Tay, 2012).
Therapeutic Metaphors
To create a clearer sense of the use of metaphor in counseling, the three-part model of counseling described by Hill (2009) will be used. The model describes counseling as involving the self-explanatory stages of exploration, insight and action, with the recognition that these stages are not linear, the stages may overlap and not all stages will be incorporated in all counseling approaches. In the following sections corresponding to the three stages, there are descriptions of metaphor usage appropriate to the purpose of those stages.
Exploration
In counseling, the development of a therapeutic alliance is paramount (Baldwin, Wampold, & Imel, 2007; Del Re, Flückiger, Horvath, Symonds, & Wampold, 2012; Flückiger, Del Re, Wampold, Symonds, & Horvath, 2012). The generation of an effective therapeutic alliance is achieved by communicating to clients that they are safe, heard and understood and by establishing a shared purpose for counseling (Flückiger et al., 2012). One approach is through empathic reflection. With research and theoretical support for metaphors being used to communicate emotions (Crawford, 2009), the reflection and exploration of metaphors and emotions connected to metaphors is appropriate (Tay, 2012; Witztum, van der Hart, & Friedman, 1988). Understanding the client-generated metaphors in this step also may become useful later in the therapeutic process, as the metaphors can then be transformed and reintroduced to support positive changes.
In exploring client-generated metaphors, the counselor will want to be aware of the type of metaphor being used and how it relates to what the client is working to address. Particular attention should be paid to the complex and unconventional metaphors of clients, as those metaphors may be indicative of areas that are challenging, confusing or emotionally difficult for the client. If the counselor recognizes that the client may be seeking to better understand a concept for which the client provided a metaphor, the correspondence mapping approach to exploring the metaphor may be particularly useful. For clients who seem to be using metaphor to describe beliefs or rules, class inclusion may be the more appropriate approach (Tay, 2012).
The choice between class inclusion and correspondence mapping will be influenced by the content of the metaphor and client willingness to engage in the exploration. If the client is willing and able to explore the metaphor and it seems therapeutically appropriate to expand understanding related to the target domain, then the correspondence approach can facilitate that exploration. For example, if a client says about her partner, he is a turtle hiding in his shell, responses based on a correspondence approach could be what makes a turtle go into its shell and what makes up your partner’s shell? Depending on the response to the questions, it may be possible to make more connections between the metaphor and specific aspects of the client’s situation. One way to strengthen the use of this approach in counseling is to reflect back client-generated elaborations in a form that links elements of the metaphor with clients’ emotions and concerns (Greenberg, 2010; Johnson, 2004; Kopp & Craw, 1998; Sims, 2003; Tay, 2012). The correspondence approach can be very helpful as a way to explore important aspects of the client’s situation and challenges.
In a class inclusion approach, the process might look a little different. Rather than discussing specific elements of the imagery, the theme or message of the metaphor is the focus. Taking the same metaphor of the turtle, the message that she cannot reach her partner and believes he is avoiding her becomes the focus. Responses to this message might be: you feel you can’t reach him; how do you feel when you can’t reach him; and what would it look like if he didn’t hide in his shell? This is an approach addressed to the primary message of the metaphor, but it moves away from the metaphor itself to access other metaphors and understandings related to the message. The class inclusion approach allows for an exploration of core messages, emotional reactions and beliefs.
Insight
The insight stage of counseling involves expanding a client’s awareness to recognize patterns, effects of thoughts, emotions, behaviors and possibilities. Unconventional metaphors, complex metaphors or metaphor clusters may occur more frequently during the insight stage as the client develops new awareness (Crawford, 2009; Gelo & Mergenthaler, 2012; Lakoff & Johnson, 1980). It also is important to note that during the experiencing of emotion, it is likely that there will be less metaphor usage than when clients are working to explain and integrate emotions (Gelo & Mergenthaler, 2012). The client-generated metaphors, particularly the unconventional and complex metaphors, in addition to indicating expanding perspectives, can be a tool for furthering clients’ insights and integrating those insights in a way consistent with their counseling goals.
Working with metaphors in this stage expands on the metaphor work in the exploration stage by
focusing on metaphors in relation to goals and patterns related to clients’ situations (Tay, 2012). Reflections and questions are often helpful to use in response to clients’ complex and unconventional metaphors, as reflections and questions may encourage the continued development of new awareness and incorporation of new awareness into different aspects of clients’ lives (Hill, 2004; Kopp & Craw, 1998; Tay, 2012). In addition, clients can be encouraged to develop new insights by having the counselor ask the client to change the metaphor to how he or she would like it to appear and then exploring the new metaphor through class inclusion, correspondence mapping or both (Hill, 2004; Kopp & Craw, 1998). The changed metaphor can be used to deepen feelings, clarify goals and recognize patterns (Tay, 2012). To illustrate this process, a composite dialogue from a case example is provided.
Client (Cl): I’m caught in a whirlwind that’s spinning my head in a circle.
Counselor (Co): Say more about being caught in a whirlwind that’s spinning your head in a circle.
Cl: I just do not know what to do, the relationship still is not changing.
Co: So you’re afraid that the whirlwind will carry you away?
Cl: Not exactly, more that I’ll just stay right where I am.
Co: The whirlwind blocks everyone else from getting to you.
Cl: Yes, I’m all alone in it.
Co: Could you describe how this metaphor might change if you didn’t feel alone?
Cl: Well, I guess I would be holding my partner’s hand in the eye of the whirlwind where we are safe and together.
Co: How does that feel?
Cl: It feels really good.
Co: You really want that connection, but right now you feel scared, alone and trapped in the cycle.
In this example, a complex and unconventional metaphor, composed of two combined metaphors, that the client spontaneously introduced into the session became a tool to deepen and expand awareness concerning the challenges experienced in her current relationship. In the first part of the metaphor, the target domain is the client’s current situation and the source domain is a whirlwind. In the second part of the metaphor, the target domain is the client’s head and the source domain is spinning in a circle. In the example, the client was first asked questions following a class inclusion approach, which allowed for the identification of the important concepts with which the client is struggling—namely, feeling stuck in her current situation and alone in her relationship. Then, by asking the client to change the metaphor based on changing the feelings she identified as particularly concerning, a clearer awareness of her goal to be connected and feel safe with her partner was identified. The utility of this approach is made clear in this example, and it is also important to emphasize that this approach, by changing the context of clients’ descriptions from their everyday life to the imagined, may enable clients to provide descriptions that are outside what they currently view as possible. In the above example, it may have been difficult, given the client’s current frustrations and challenges, to clearly describe what she wanted in her relationship, but in relation to the metaphor of the whirlwind, she could directly and simply state a transformation in the metaphor that spoke to her goal. The insight from this metaphor exploration provides a focus for future therapeutic counseling work.
Another way of promoting client insight is through counselor-generated metaphors. Disquisitions, as described above, are a narrative form of metaphor introduced by the counselor. The use of disquisitions may be particularly appropriate when there are fewer metaphors being used, perhaps indicating either active emotional experiencing or a lack of cognitive and emotional change, because the disquisitions can both highlight the need for change and direct the form it takes (Gelo & Mergenthaler, 2012; Millikin & Johnson, 2000). The way these metaphors are processed with clients depends on therapeutic needs. A composite case example of a class inclusion approach to a disquisition about relationship interactions in couples counseling follows. (It is important to note that in this example, male and female genders were assigned to match with the genders of the couple, but these genders can be changed to fit the situation.)
Co: This reminds me of a story. There once was a lonely skunk. He lived all alone in the forest and desperately wanted a friend. One day he came upon a solitary porcupine. The porcupine also was lonely and looking for a friend. The skunk started walking up to the porcupine softly grunting his hello. The porcupine backed away in terror, showing her teeth. The skunk thought this was a friendly greeting, so he kept approaching. The porcupine was backed against a rock and kept showing her teeth in warning. The skunk came close and just out of reach sat down, prepared to make a new friend. As soon as he sat, the porcupine shoved her way past, fleeing into the forest and leaving quills stuck in the skunk, who out of instinct sprayed the porcupine. The skunk was left lonely, confused and in pain, and the porcupine was terrified and alone, with her eyes burning in pain. Now why do you think I told this story?
Client 1 (Cl1): Because we don’t communicate well.
Client 2 (Cl2): And because we hurt each other when we try to connect.
Co: Yes, but that’s not what either of you want. In fact, I suspect that just like in the story, you both want a close friend and partner.
Cl1 and Cl2: Yes.
Co: So, it sounds like the real problem for you two isn’t that you both want something different. It’s that, like the skunk and porcupine, the interaction between you and your interpretation of that interaction keeps you both from getting what you want—a loving, connected partner.
The disquisition provides a powerful image that represents the interaction cycle of the couple. The message of the story is discussed, and through this discussion there is recognition and awareness of a problem in the relationship that has similarities with the story. However, to bring out the specifics of the relationship interaction cycle, it is necessary to go into more detail. To do that, the metaphor can be left at this point to focus on the specifics of how each partner contributes to the interaction cycle in the relationship, but another option is to take a correspondence approach and tie specific behaviors to specific parts of the story. There are several positive benefits of the correspondence approach. First, there is already agreement that the story is related to what is happening in their relation-ship, so it provides an agreed-upon story with which details can be linked. It also gives a strong image that can be used throughout counseling to reinforce awareness and contrast change. Finally, it can create a feeling of more safety because details of interactions that are uncomfortable to acknowledge can first be discussed based on the imagery (Romig & Gruenke, 1991). The correspondence approach can facilitate going into more detail and emotion more quickly with resistant clients than would otherwise be possible, and through that more detailed exploration it can then be used to generate shared insight into patterns of thoughts, emotions and behaviors that are problematic for the couple.
Action
The action stage is focused on behavioral change and is often based on what has been learned in the exploration and insight stages. It is likely that client-generated metaphors at this stage may become more simple and conventional, though their metaphors also are likely to be changed from those at the beginning of counseling. Metaphors are likely to become less common and take simpler forms at this stage, which may be an indication that the client is incorporating a new awareness of his or her situation (Crawford, 2009; Gelo & Mergenthaler, 2012). At this point in the counseling process, metaphors may be useful for clarifying behavioral changes to be implemented and considerations for their implementation. As an aside, it is important to pay attention to the types of client metaphors at this point, and if the counselor observes unconventional metaphors and complex metaphors, it may be appropriate to work on exploration and insight rather than action. This is because unconventional and complex metaphors are more likely to occur when the client is struggling through emotional and cognitive change (Crawford, 2009; Gelo & Mergenthaler, 2012; Lakoff & Johnson, 1980), which would indicate that the client may not have developed the perspective necessary to implement changes.
In generating action plans, a helpful approach is to use metaphors to provide a different perspective related directly to the client’s experience. If a client has been using a metaphor related to an issue that is the focus of behavioral planning, then asking the client what change they would make to the metaphor and then linking that change back to the client’s life can generate new ideas. The following is a composite case example of that approach.
Co: You are saying that your goal is to not fight with your mother anymore. As we focus on how that might happen, I am reminded of the metaphor you gave earlier about the conflict with your mother. You said that your mother is smothering you. That she holds you so close that you can’t breathe. Did I say that right?
Cl: That’s what it feels like.
Co: Well I am wondering what would you change in that metaphor?
Cl: I would have my mother not hold me so tight that I can’t breathe.
Co: So having a little more room to breathe would really change things. (Client nods)
Co: I also notice that you are not saying that you want your mother far away from you or to ignore you; you just want her to give you a little more space.
Cl: Yes.
Co: So, what you are looking for is a way to not feel controlled by her and still feel connected to her. (Client nods)
Co: How might you do that?
Cl: Well I guess I could move out of the basement of her house.
In the example above, it would have been possible to generate an action plan without using a metaphor, but it can be observed that the metaphor added a strong connection to the emotional experience of the client and helped to open the client to identifying a change that made sense based on his goal. The ability to generate a greater connection with clients through the use of clients’ metaphors can empower clients to make changes directly connected to what is most affecting them. There also are times when clients have difficulty making changes because of fear, and in those situations, providing a path to identifying potential changes indirectly through metaphor can be very beneficial and can allow ideas to be discussed in a manner that may provoke less fear in the client.
Conclusion
Metaphors often seem simple, but they have a deeper conceptual role, and through observing metaphor usage in clients, actively exploring metaphors with clients and generating metaphors to address therapeutic goals for clients, metaphors can become a valuable tool in counseling. The above descriptions and examples provide some practical ways that understanding and using metaphors can positively impact counseling work. Client-generated metaphors provide a lens into the internal world of clients that combines their emotional reactions and experiences in an understandable manner and creates a bridge so clients’ internal worlds can be shared with the counselor. Counselor-generated metaphors provide a tool to further guide and support clients in the pursuit of their goals. Through both client-generated and counselor-generated metaphors, the inner experience of clients can be more directly accessed and positive change can be facilitated. Therefore, the recognition and incorporation of metaphors can be an incredibly valuable tool for counselors. It is hoped that the information provided in this manuscript will serve as a foundation for incorporating metaphor awareness and usage into counseling practice and will stimulate counselors to seek out additional training and information and develop research on the application and effectiveness of using metaphors in counseling.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest or funding contributions for the development of this manuscript.
References
Aragno, A. (2009). Meaning’s vessel: A metapsychological understanding of metaphor. Psychoanalytic Inquiry, 29, 30–47. doi:10.1080/07351690802247021
Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75, 842–852. doi:10.1037/0022-006X.75.6.842
Blasko, D. G. (1999). Only the tip of the iceberg: Who understands what about metaphor? Journal of Pragmatics, 31, 1675–1683.
Bohrn, I. C., Altmann, U., & Jacobs, A. M. (2012). Looking at the brains behind figurative language—A quanti-tative meta-analysis of neuroimaging studies on metaphor, idiom, and irony processing. Neuropsychologia, 50, 2669–2683. doi:10.1016/j.neuropsychologia.2012.07.021
Citron, F. M. M., & Goldberg, A. E. (2014). Metaphorical sentences are more emotionally engaging than their literal counterparts. Journal of Cognitive Neuroscience, 26, 2585–2595. doi:10.1162/jocn_a_00654
Citron, F. M. M., Güsten, J., Michaelis, N., & Goldberg, A. E. (2016). Conventional metaphors in longer passages evoke affective brain response. NeuroImage, 139, 218–230. doi:10.1016/j.neuroimage.2016.06.020
Crawford, L. E. (2009). Conceptual metaphors of affect. Emotion Review, 1, 129–139. doi:10.1177/1754073908100438
Del Re, A. C., Flückiger, C., Horvath, A. O., Symonds, D., & Wampold, B. E. (2012). Therapist effects in the thera-peutic alliance-outcome relationship: A restricted-maximum likelihood meta-analysis. Clinical Psychology Review, 32, 642–649. doi:10.1016/j.cpr.2012.07.002
Evans, V. (2010). Figurative language understanding in LCCM theory. Cognitive Linguistics, 21, 601–662. doi:10.1515/COGL.2010.020
Fainsilber, L., & Ortony, A. (1987). Metaphorical uses of language in the expression of emotions. Metaphor and Symbolic Activity, 2, 239–250.
Fetterman, A. K., Bair, J. L., Werth, M., Landkammer, F., & Robinson, M. D. (2016). The scope and consequences of metaphoric thinking: Using individual differences in metaphor usage to understand how metaphor functions. Journal of Personality and Social Psychology, 110, 458–476. doi:10.1037/pspp0000067
Flückiger, C., Del Re, A. C., Wampold, B. E., Symonds, D., & Horvath, A. O. (2012). How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis. Journal of Counseling Psychology, 59, 10–17. doi:10.1037/a0025749
Gelo, O. C. G., & Mergenthaler, E. (2012). Unconventional metaphors and emotional-cognitive regulation in a metacognitive interpersonal therapy. Psychotherapy Research, 22, 159–75. doi:10.1080/10503307.2011.629636
Greenberg, L. S. (2010). Emotion-focused therapy: An overview. Turkish Psychological Counseling and Guidance Journal, 4, 1–12.
Hill, C. E. (Ed.). (2004). Dream work in therapy. Washington, DC: American Psychological Association.
Hill, C. E. (2009). Helping skills: Facilitating exploration, insight, and action (3rd ed.). Washington, DC: American Psychological Association.
Johnson, S. M. (2004). The practice of emotionally focused couple therapy (2nd ed.). New York, NY: Taylor and Francis Group.
Kopp, R. R., & Craw, M. J. (1998). Metaphoric language, metaphoric cognition, and cognitive therapy. Psycho-therapy: Theory, Research, Practice, Training, 35, 306–311.
Kopp, R. R., & Eckstein, D. (2004). Using early memory metaphors and client-generated metaphors in Adlerian therapy. Journal of Individual Psychology, 60, 163–174.
Lakoff, G., & Johnson, M. (1980). The metaphorical structure of the human conceptual system. Cognitive Science, 4, 195–208. doi:10.1207/s15516709cog0402_4
Lubart, T. I., & Getz, I. (1997). Emotion, metaphor, and the creative process. Creativity Research Journal, 10, 285–301.
Mashal, N., & Kasirer, A. (2011). Thinking maps enhance metaphoric competence in children with autism and learning disabilities. Research in Developmental Disabilities, 32, 2045–2054. doi:10.1016/j.ridd.2011.08.012
Millikin, J. W., & Johnson, S. M. (2000). Telling tales: Disquisitions in emotionally focused therapy. Journal of Family Psychotherapy, 11, 73–79.
Mohammad, S. M., Shutova, E., & Turney, P. D. (2016). Metaphor as a medium for emotion: An empirical study. In Proceedings of the Fifth Joint Conference on Lexical and Computational Semantics (pp. 23–33). Berlin, Germany.
Mould, T. J., Oades, L. G., & Crowe, T. P. (2010). The use of metaphor for understanding and managing psychotic experiences: A systematic review. Journal of Mental Health, 19, 282–93. doi:10.3109/09638231003728091
Romig, C. A., & Gruenke, C. (1991). The use of metaphor to overcome inmate resistance to mental health counseling. Journal of Counseling & Development, 69, 414–418.
Samur, D., Lai, V. T., Hagoort, P., & Willems, R. M. (2015). Emotional context modulates embodied metaphor comprehension. Neuropsychologia, 78, 108–114. doi:10.1016/j.neuropsychologia.2015.10.003
Seitz, J. A. (1998). Nonverbal metaphor: A review of theories and evidence. Genetic, Social & General Psychology Monographs, 124, 95–119.
Sims, P. A. (2003). Working with metaphor. American Journal of Psychotherapy, 57, 528–536.
Smollan, R. K. (2014). The emotional dimensions of metaphors of change. Journal of Managerial Psychology, 29, 794–807. doi:10.1108/JMP-04-2012-0107
Steen, G., Dorst, A., Herrmann, J., Kaal, A., & Krennmayr, T. (2010). Metaphor in usage. Cognitive Linguistics, 4, 765–796. doi:10.1515/COGL.2010.024
Stewart, I., & Barnes-Holmes, D. (2001). Understanding metaphor: A relational frame perspective. The Behavior Analyst, 24, 191–199.
Tay, D. (2012). Applying the notion of metaphor types to enhance counseling protocols. Journal of Counseling & Development, 90, 142–149.
Wickman, S. A., Daniels, M. H., White, L. J., & Fesmire, S. A. (1999). A “primer” in conceptual metaphor for counselors. Journal of Counseling & Development, 77, 389–394.
Witztum, E., van der Hart, O., & Friedman, B. (1988). The use of metaphors in psychotherapy. Journal of Contemporary Psychotherapy, 18, 270–290.
Alwin E. Wagener, NCC, is an Adjunct Professor at the University of North Carolina – Charlotte. Correspondence can be addressed to Alwin Wagener, P.O. Box 1443, Black Mountain, NC 28711, alwinwagener@gmail.com.
Mar 23, 2017 | Volume 7 - Issue 2
Randall M. Moate, Jessica M. Holm, Erin M. West
Clinical courses are important in the development of students pursuing a master’s degree in clinical mental health counseling (CMHC). Despite the importance of clinical courses, little is known about what CMHC students perceive as being helpful about their teachers of clinical courses. To investigate this, we sought the viewpoints of beginning counselors who were in their first four years of working as licensed counselors post-graduation. Thirty-two beginning-level counselors completed a Q sort that assessed the perceived helpfulness of their teachers of clinical courses in their CMHC master’s degree program. Three different learning preferences—application-oriented learners, intrinsically motivated learners, and affective-oriented learners—were observed among participants in the study.
Keywords: clinical courses, beginning counselors, Q sort, learning preferences, learners
Counselor educators who teach in clinical mental health counseling (CMHC) master’s degree programs are responsible for preparing counselors-in-training to acquire important content knowledge and develop competent clinical skills (Schwitzer, Gonzalez, & Curl, 2001). Didactic-oriented courses in CMHC curricula (e.g., ethics, diagnosis, cultural diversity, career counseling) tend to emphasize the acquisition of important content knowledge and are often associated with larger class sizes (Sperry, 2012). Clinical courses (e.g., skills, practicum, internship) emphasize development of clinical skills through experiential and applied learning opportunities and are typically associated with smaller class sizes. Although experiential and applied learning can be infused into didactic-oriented courses, they are fundamental to the pedagogy of clinical courses.
For students, engagement in clinical courses requires a shift from passive to active learning, with an increased emphasis on putting what they have learned into action (Auxier, Hughes, & Kline, 2003; Skovholt & Ronnestad, 1992). Clinical courses require students to engage in activities such as role plays, case formulizations and skill demonstrations (Young & Hundley, 2013). Although these types of learning experiences tend to be impactful for students (Furr & Carrol, 2003), they can also pose new emotional and cognitive challenges. Students in clinical courses are frequently observed by peers and instructors demonstrating skills, techniques and clinical thinking, which may be anxiety-provoking for students who are unsure of themselves as counselors-in-training.
We believe counselor educators encounter different types of pedagogical challenges teaching clinical courses when compared to didactic courses. For example, teachers interact closely with students in clinical courses on account of classroom dynamics that are more up close and personal. Additionally, there is an increased need for teachers to help students overcome emotional (e.g., feeling anxious about being observed by peers during a counseling demonstration) and physical (e.g., difficulty demonstrating a basic skill) challenges that arise through curricula focused on skill development. Further, teachers of clinical courses are challenged to evaluate students and provide feedback based on their direct observation of trainees’ ability to perform basic skills, advanced techniques and clinical-thinking abilities.
Unfortunately, little empirical research is available to counselor educators to inform their pedagogical choices in clinical courses (Barrio Minton, Wachter Morris, & Yaites, 2014). We believe that better understanding students’ viewpoints of their teachers in clinical courses and what they perceive as beneficial for their clinical practice could provide counselor educators with valuable information to inform their pedagogy in these courses. The current study was designed to contribute in this regard by exploring what aspects of teachers of clinical courses were perceived as helpful by recent graduates of CMHC programs who were working as beginning counselors.
Teaching in Higher Education
Higher education researchers have focused on personal characteristics of teachers as a way to explore what students perceive as effective teaching; results of such research suggest that students attribute several different characteristics to their teachers’ effectiveness. Examples include perceptions of teacher warmth (Best & Addison, 2000), compassion and interest in students (Sprinkle, 2008), rapport with students, effective delivery of information, focus on interpersonal relationships with students in the classroom (Goldstein & Benassi, 2006), and effective course organization and usefulness (Young & Shaw, 1999). Students additionally believed that effective teachers sparked interest in the course material and were accessible for support as needed (Feldman, 1988). From this research, it appears students value and perceive teacher effectiveness through both teachers’ relational abilities and their effective delivery of course material.
In addition to studying personal characteristics of teachers, some higher education researchers have conceptualized different models of teaching styles. One notable model of teaching styles was created by Grasha (1994) through analysis of interviews with higher education faculty members. Grasha identified five teaching styles among faculty members: expert, formal authority, personal model, facilitator and delegator. An expert style refers to the direct transfer of knowledge to students through teaching modalities such as lecture. The formal authority style refers to defining clear expectations and learning objectives for students, which are based on an instructor’s perceived authority on a subject, and providing direct feedback. A personal style refers to instructors teaching by personal example and encouraging students to learn appropriate behaviors through observation. The facilitator style refers to teachers serving as a guide and consultant, encouraging students to move toward independent learning. Finally, the delegator style refers to a hands-off approach in which students are given freedom to function independently. Rather than the teaching styles being exclusive, Grasha noted that teachers display varying degrees of each of the styles within their classrooms. Consequently, different combinations of teaching styles create a unique learning experience for students.
Another stylistic aspect of teaching that has been categorized in higher education literature is teacher-centered and learner-centered pedagogy. Instructors who use teacher-centered approaches are characterized by working in an expert role to disseminate knowledge to students. Conversely, teachers who utilize learner-centered approaches take the role of facilitator and aim to create an active learning environment (Smart, Witt, & Scott, 2012). Research on the effectiveness of these two approaches remains inconclusive, and some researchers have suggested that a teaching approach that utilizes both teacher- and learner-centered styles is probably ideal (Baeten, Dochy, & Struyven, 2012).
Teaching in Counselor Education
Little research exists that examines pedagogy within counselor education programs. Barrio Minton et al. (2014) completed a content analysis of published articles related to teaching and learning within counseling and found a clear focus on techniques and content rather than pedagogical practices and students’ learning experiences. Further, only a third of the articles were empirically based, and less than 15% had clear pedagogical foundations, indicating that the majority of the literature available on teaching in counselor education is conceptual in nature. Among these conceptual pieces, Malott, Hall, Sheely-Moore, Krell, and Cardaciotto (2014) aimed to bridge evidence-based practices of teaching in higher education with best practices in counselor education. Malott and colleagues affirmed that although counselor-based characteristics (e.g., empathy, positive regard) are essential for effectiveness in teaching counseling courses, they are not sufficient. They suggested that counselor educators should create effective learning environments characterized by creating strong rapport with students, engaging students in active learning (e.g., case studies, role plays) and providing opportunities for feedback throughout the course. Pietrzak, Duncan, and Korcuska (2008) examined factors that impacted counseling students’ perceptions of teaching effectiveness and found that students rated an entertaining delivery style and perceived knowledge of the teacher as the most influential factors.
An examination of the limited literature that exists on pedagogy within counselor education programs identified three important theoretical perspectives: developmental, constructivist and contextual teaching. The developmental approach to teaching suggests that teachers should alter their teaching style and techniques to meet the changing developmental needs of students, progressing from a content-oriented and highly structured emphasis to facilitating active learning experiences (Granello & Hazler, 1998). According to the constructivist perspective, it is important for counselor educators to facilitate students’ engagement in reflective thinking and the personal construction of knowledge (McAuliffe & Eriksen, 2010; Nelson & Neufeldt, 1998). Similarly, the emphasis on contextual teaching is to help students find personal meaning in what they are learning by placing information within a context of how it is relevant to them (Granello, 2000). Although the reviewed literature adds important context to the area of teaching in counselor education, none of the research specifically examines the unique nature of teaching in clinical courses.
Purpose of the Study
The current study is the first to explore beginning counselors’ perceptions of helpful aspects of teachers of clinical courses in CMHC. Clinical courses were selected as a focus in this study because of their key role in student development of skills needed for professional practice and the lack of information on teaching clinical courses within the counselor education literature. We believed exploring the perspectives of beginning professional counselors, rather than students, was valuable for two important reasons: (a) beginning counselors are close enough to their master’s degree program experiences to be reflective about their teachers and (b) beginning counselors are able to consider helpful aspects of their teachers in light of their real-world experiences as professional counselors.
Method
We used a Q methodology to investigate aspects of counselor educators of clinical courses in CMHC that were perceived to be helpful by beginning-level counselors. Q methodology embraces both the analytic rigor of quantitative methodologies and the richness and depth of qualitative methodologies (Watts & Stenner, 2012). We selected Q methodology for this study because it was designed for systematic exploration of subjective human phenomena (i.e., people’s preferences) on topics such as teaching (Ramlo, 2016).
Phase 1: Concourse Development
This study was completed in two phases. The first phase involved developing the concourse. In Q methodology a concourse represents a collection of ideas that is composed around a topic (Stephenson, 1978). The concourse for this study was generated in two ways. First, we conducted a literature review and selected important themes for inclusion in the concourse. Second, after obtaining Institutional Review Board approval, we conducted interviews with five participants and then included statements from the participant interviews into the concourse. Five beginning-level professional counselors were interviewed and asked the following question: “What was it about teachers of your clinical classes during your program that was most helpful in becoming the professional counselor you are today?” To ensure a diverse range of viewpoints would be represented in the second phase of the study, we interviewed different gendered individuals (i.e., two male counselors, three female counselors) who worked in a variety of professional settings (i.e., two counselors worked in a private practice, one counselor worked in a community agency, and two counselors worked in a hospital setting) and who had differing racial identities (i.e., two Caucasian counselors, one African American counselor, one Asian American counselor, one Hispanic counselor).
The lead researcher then analyzed all of the statements in the concourse (from the literature and participant interviews) and began identifying unique statements, grouping similar statements together. Groups of similar statements were further analyzed by the lead researcher, and one statement was selected from each group. Participant statements selected for inclusion were edited to abbreviate long statements or to change the tense of statements. The co-researchers then reviewed the lead researcher’s analysis to ensure that each remaining statement was distinct from other statements and relevant to the study. This process culminated in a 34-item instrument that would be used in the Q sample (see Table 1).
Phase 2: Q Sample and Q Sort
The second phase of this study entailed constructing a Q sample and administering Q sorts to participants. A Q sample is a composite of stimulus items administered to participants for rank-ordering during the Q sorting process (Stenner, Watts, & Worrell, 2008). Thirty-two participants were given the Q sample and were asked to rank order 34 items in the Q sample on a 9-point scale in the shape of a normal distribution. Prior to rank ordering statements for the Q sort, participants were prompted to reflect on teachers they had in clinical courses during their master’s degree programs and then to reflect on what it was about those teachers that had been most helpful to them in becoming the counselors they are today. Participants were then directed to read all statements and rank order them on a response grid that ranged from +4 (most helpful) to -4 (most unhelpful). After rank ordering the statements, participants were asked to provide written responses to several post-Q sort questions designed to elicit qualitative data about why certain items were important to them. Two examples of post-Q sort response questions were as follows: (a) “describe how the two items you ranked at 4 (most helpful) were helpful to the counselor you have become,” and (b) “describe how the two items you ranked at -4 (most unhelpful) were not helpful to the counselor you have become.”
P Sample
The P sample refers to the participants sampled for the Q sort, which in the case of this study were beginning-level professional counselors. Participants were required to meet the following criteria in order to be eligible for this study: (a) were a graduate of a counselor education master’s degree program in CMHC, (b) accrued at least 400 direct hours of post-master’s clinical service working with clients as a licensed counselor and (c) were no more than four years removed from graduating with their degree. After obtaining a second IRB approval to collect data using the Q sort, participants were recruited in several ways. The researchers called on the telephone and sent general recruitment e-mails to supervisors and directors of counseling agencies, private practices and in-patient
Table 1
34-Item Q Sample and Factor Arrays
| Item |
Statements |
Factor
1 2 3 |
| 1 |
A professor created opportunities for me to get feedback from my peers. |
-3
|
1
|
0
|
| 2 |
A professor encouraged group discussions about relevant topics. |
0
|
0
|
-2
|
| 3 |
A professor modeled behaviors that I could use with clients. |
4
|
2
|
0
|
| 4 |
A professor used role plays in class to explain things. |
3
|
2
|
-1
|
| 5 |
A professor created a safe classroom environment where it felt OK to make mistakes. |
3
|
-1
|
1
|
| 6 |
A professor required me to self-critique my counseling skills by observing video/audio tape of myself. |
-1
|
3
|
2
|
| 7 |
A professor required me to show video/audio tape of my counseling skills to my classmates for feedback. |
-4
|
4
|
0
|
| 8 |
A professor challenged me in uncomfortable, yet helpful ways. |
0
|
0
|
-2
|
| 9 |
A professor helped me to make connections between counseling theories and my clinical practice. |
0
|
3
|
-1
|
| 10 |
A professor helped me to develop my ability to conceptualize clients. |
2
|
4
|
1
|
| 11 |
A professor demonstrated that he/she was open-minded. |
1
|
-2
|
1
|
| 12 |
A professor discussed ethical issues that related to students’ clinical experiences working with clients. |
1
|
0
|
-1
|
| 13 |
A professor who I knew was currently working with clients, or had significant experience as a practicing counselor. |
1
|
2
|
2
|
| 14 |
A professor helped students in the class cultivate close relationships with one another. |
-2
|
-4
|
-3
|
| 15 |
A professor was open, empathetic, and authentic in their interactions with students. |
4
|
-2
|
4
|
| 16 |
A professor shared “in the moment” struggles they faced as a counselor. |
2
|
0
|
-1
|
| 17 |
A professor gave me direct feedback where they made it clear what I was doing well, and what I was not doing well. |
1
|
3
|
0
|
| 18 |
A professor gave me strength-based feedback. |
2
|
0
|
1
|
| 19 |
A professor incorporated multiculturalism and issues of diversity into class. |
0
|
-1
|
0
|
| 20 |
A professor encouraged students to share differing viewpoints on a topic/discussion. |
-1
|
1
|
0
|
| 21 |
A professor helped me to see the purpose in what I was learning by explaining “how” and “why” it would be useful to me in the future. |
2
|
1
|
-3
|
| 22 |
A professor I could sense was passionate about what they were teaching. |
0
|
-1
|
2
|
| 23 |
A professor expected a high standard of performance from me. |
-3
|
1
|
-1
|
| 24 |
A professor was readily accessible to give me extra help when I needed it (e.g., office hours, e-mail, phone). |
-1
|
-3
|
-2
|
| 25 |
A professor I could sense was fully present during my interactions with them. |
0
|
-2
|
1
|
| 26 |
A professor created in-class activities that helped me to become a more reflective thinker. |
1
|
2
|
-2
|
| 27 |
A professor streamlined course readings and assignments down into what was essential. |
-2
|
-3
|
-4
|
| 28 |
A professor held me and other students accountable for our actions. |
-3
|
-1
|
-3
|
| 29 |
A professor had an engaging personality. |
-1
|
-2
|
3
|
| 30 |
A professor used technology to enhance my learning experience. |
-4
|
-4
|
-4
|
| 31 |
A professor I believed was probably a good clinician. |
-1
|
0
|
4
|
| 32 |
A professor who I liked as a person. |
-2
|
-3
|
3
|
| 33 |
A professor I sensed was an expert on what they were teaching. |
-2
|
-1
|
2
|
| 34 |
A professor used examples from their clinical experiences to explain things. |
3
|
1
|
3
|
hospitalization units in Ohio and Texas, requesting that they forward recruitment information for the study to potential subjects. Snowball sampling was also used to recruit participants when participants who had completed the study recommended colleagues who might be willing to participate in the research. Data were collected from participants by sending packets in the mail that consisted of an informed consent, demographic questionnaire, Q sort, post-Q sort questions and a postage prepaid return envelope.
Thirty-two participants met the criteria for inclusion in the study and completed the Q sorting process. In Q methodology a sample size only needs to be large enough for factors (i.e., groups of shared viewpoints) to emerge and is typically 20 and 60 participants (Brown, 1980). Seventy-two percent (n = 23) of the participants in the study were 20–30 years old; 28% (n = 9) were between 31–40 years old. Seventy-two percent (n = 23) of the participants identified as female and 28% (n = 9) of the participants identified as male. Fifty-nine percent (n = 19) of the participants reported they worked in a community counseling agency; 22% (n = 7) reported they worked in a private practice; and 19% (n = 6) reported they worked in a hospital setting. Thirty-eight percent (n = 12) of the participants indicated they had accrued 400–1,000 direct clinical hours working with clients; 22% (n = 7) indicated they had accrued 1,001–1,500 direct clinical hours working with clients; 3% (n = 1) indicated they accrued 1,501–2,000 direct clinical hours working with clients; 9% (n = 3) indicated they accrued 2,001–2,500 direct clinical hours working with clients; and 28% (n = 9) indicated they had accrued more than 2500 direct clinical hours working with clients. Eighty-two percent (n = 26) of participants identified as Caucasian, 9% (n = 3) of participants identified as African American, and 9% (n = 3) of participants identified as Hispanic.
Data Analysis
Data were entered into the PQMethod software program (Schmolck, 2014) and were factor analyzed using principle components analysis (PCA). After the PCA was initiated, a varimax rotation was used to determine reliability, scores and factor loadings. A 3-factor solution was selected for the data because it accounted for each participant loading onto at least one factor. Due to each participant being accounted for by a 3-factor solution, it was unnecessary to search for a fourth factor.
In Q methodology, factor scores are used for interpretation rather than factor loadings. The factor narratives presented in the results section were created through a factor interpretation method developed by Watts and Stenner (2012). This method was designed to consistently approach each factor in the context of all other factors and to provide a holistic factor interpretation by taking into consideration all differences between factors. First, a worksheet was created from the factor array for each individual factor. The worksheet contained the highest (+4) and lowest (-4) ranked items within the factor (note: items of consensus were not included and were analyzed separately) and those items ranked higher or lower within the factor compared to the other two factors. Second, items in the worksheet were compared to participants’ demographic information and qualitative responses associated with that factor to add depth and detail before the final step. Finally, the finished worksheet was used to construct the factor narratives, which were written as stories that reflected the shared viewpoint of each factor.
Results
Of the three factors produced by the PCA of the 32 Q sorts, Factor 1 contained 12 of the participants and accounted for 17% of the variance; Factor 2 contained nine participants and accounted for 13% of the variance; and Factor 3 contained nine participants and accounted for 14% of the variance. There were two Q sorts that were mixed cases (i.e., they had significant loadings on more than one factor) and were removed from the study.
Factor 1: Application-Oriented Learners
A total of 12 participants loaded onto Factor 1, accounting for 17% of the variance, and their demographic traits were unremarkable when compared to the other two factors. Participants of Factor 1 were application-oriented learners who preferred their professors to be pragmatic, supportive and active leaders during class.
Factor 1 individuals preferred it when their professors demonstrated specific techniques or skills they could envision directly applying to their counseling practice. As one participant noted: “I am a visual learner, so seeing helpful behaviors and how I could act with a client helped me visualize what a therapy technique could be like [in session]. I feel like I was used to seeing good counseling behaviors so it felt more natural to do them myself.” When introducing a new concept in class, individuals of Factor 1 perceived it as more helpful when their teachers provided context of why and how it would be useful to them as a professional counselor (item 21). Individuals of Factor 1 also perceived it as helpful when they were able to hear relevant clinical anecdotes from their teachers (items 12, 16), as they served as a practical way of remembering important lessons that applied to real-world counseling situations. This was described by a Factor 1 participant: “Learning by hearing about my professors’ experiences is the easiest way for me to apply information and the easiest way for me to remember it.” Another participant broadly stated, “Real life examples were the biggest influence on my education.”
Persons of Factor 1 preferred it when their teachers were active leaders in the classroom and used their knowledge and experience to efficiently instruct students. They perceived teachers as having a more credible viewpoint than themselves or their classmates because of their advanced training and experience in counseling. Factor 1 individuals did not perceive it as important that their teachers be experts (item 33) or skilled clinicians (item 31), so long as they could effectively lead class by teaching practical information, demonstrating relevant clinical skills and providing them with strength-based feedback. This preference was evident in a desire for receiving strength-based feedback from their instructors (item 18) rather than engaging in self-critique (item 6) and receiving feedback from their peers (items 1, 7). A Factor 1 participant elucidated, “Getting feedback from peers is not effective, mostly because they didn’t know any more than I did about the subject matter and I don’t value their opinion as much as the professors.”
In addition to the belief that peer feedback was unhelpful, persons of Factor 1 also expressed concern about being critiqued by their peers: “I hated showing my video/audio tapes to others because I felt like I was being judged by peers and not being provided helpful suggestions.” Factor 1 individuals also expressed that high expectations from their teachers (item 23) provoked worries of “not being able to measure up” and were perceived as less helpful. One participant narrated, “The words ‘high expectation’ really struck me as negative. I feel afraid that I won’t be able to meet those expectations. I want my professor to be hopeful about my development as a counselor and not have high expectations.” Teachers who created a safe space for mistakes (item 5) through having a person-centered way of being (item 15), were transparent about their own difficulties as a counselor (item 16) and used strength-based feedback (item 18) were perceived as being more helpful, as they helped mitigate worries present in the Factor 1 viewpoint. Describing this viewpoint, one participant responded:
I appreciated knowing that making mistakes was part of the class and that any expectation to be perfect was unreasonable. Also, it felt safe to grow and take risks when I feel empathy and authenticity from my instructors. This allowed me to be vulnerable and share my thoughts and feelings.
Overall, representatives of Factor 1 perceived it as important that their teachers provide them with a safe and encouraging environment in clinical courses.
Factor 2: Intrinsically Motivated Learners
A total of nine participants loaded onto Factor 2, accounting for 13% of the variance, and demographic traits were unremarkable when compared to the other two factors. Participants of Factor 2 were independent, intrinsically motivated and reflective learners who preferred to learn through considering different points of view about a topic.
In contrast to Factor 1 individuals’ preference for concrete and specific practical knowledge, Factor 2 individuals preferred to learn about conceptual topics that were more abstract and through activities that stimulated reflective thinking. This is evident in the Factor 2 participants’ preference for teachers who helped them hone their ability to conceptualize clients (item 10) and who helped facilitate connections between theoretical concepts and clinical practice (item 9). One participant remarked about item 9, “My theoretical orientation is the biggest part of my counseling identity. Having those initial connections made for me helped solidify my understanding of clients.” Individuals of Factor 2 perceived it as helpful when their teachers created activities that prompted reflective thinking (item 26), as this is a foundational component of how they work with clients. One participant noted, “I feel as though I have to reflect 100% of the time in my job. It helps me take a step back to think of what the client is really trying to say.” Persons of Factor 2 also perceived it as helpful when their instructors prompted them to self-reflect through critiquing their counseling skill. As one participant described, “The self-critique of my video tapes was by far my most memorable learning experience. Watching video of myself challenged my self-concept and gave me opportunities to see what I could do to improve.”
Receiving frequent and direct feedback from teachers and peers was perceived as particularly helpful to representatives of Factor 2. Unlike Factor 1, Factor 2 individuals preferred it when their professors held them to high standards (item 23) and provided them with feedback that was clear and direct (item 17) rather than strength-based. A participant elaborated on their preference for direct feedback: “I liked knowing where I stood, so I could try to improve in areas where I was weak. It was refreshing when professors offered this instead of sugar coating things.” Individuals of Factor 2 indicated a strong preference for teachers who required them to show tapes of their clinical work to classmates (item 7). This activity gave them the opportunity to consider a “broad base of opinions,” which they found to be important to their learning; as one participant explained, “I learned the most when I heard different ideas. Then I had to figure out what I thought was true.”
Persons of the Factor 2 viewpoint were independent learners in clinical courses and preferred when their teachers assumed more facilitative roles on the periphery of the learning environment. Their teachers’ personality characteristics (items 11, 15, 25, 29, 32), enthusiasm for teaching (item 22) and ability to create a safe learning environment (item 5) were perceived as less important than their propensity for facilitating dialog among students. This can be seen in the Factor 2 preference for teachers that facilitated group discussions (item 20) and created ample opportunities for peer feedback (item 1). Although Factor 2 individuals valued their teachers’ forthright feedback, they did not place the high level of importance on the teacher’s perspective that Factor 1 did. Instead, Factor 2 representatives regarded their teachers’ perspectives as one of many useful perspectives present in the classroom. One participant seemed to capture the essence of the Factor 2 viewpoint, remarking: “I learned just as much from my interactions with peers in clinical classes as I did from instructors. I believe in these classes teachers can act as facilitators and help students that way, just as much as they can interacting [with students] or lecturing.”
Factor 3: Affective-Oriented Learners
A total of nine participants loaded onto Factor 3, accounting for 13% of the variance, and demographic traits were unremarkable when compared to the other two factors. Participants of Factor 3 were oriented toward affective and relational qualities of their teachers and were inspired to learn through their admiration and respect for their teachers.
It was paramount for Factor 3 individuals to have a positive appraisal of their teachers as human beings so that they could develop an affinity for them. When Factor 3 individuals liked their teachers (item 32), they were able to form strong relationships with them, and these relationships acted as a catalyst for their learning. As one participant explained, “I am much more likely to grow and learn from someone I like.” Another participant shared a similar sentiment in regards to item 32: “I think my relationship with the professors and how I perceived them were just as important, if not more important, than what they taught me or the feedback they gave me.” Persons of Factor 3 strongly preferred when their teachers had a person-centered way of being (item 15), as this helped them feel like their teachers were good people who cared about them: “Having a kind and understanding professor is key! That is a huge make-it-or-break-it thing for me. I wanted my professors to be people I liked, respected and enjoyed being around, and who I sensed cared about me.” Further, Factor 3 representatives perceived it as helpful when they could sense their teachers were fully present with them (item 25), as this indicated to them that their teachers cared for them and were invested in their learning.
In addition to the importance of having a positive appraisal of their teachers as human beings, it was also important for representatives of Factor 3 to believe that their instructors were skilled teachers and counselors. Factor 3 individuals perceived it as helpful when they could sense that their teachers were skilled clinicians (item 31) and were experts on what they were teaching (item 33) in clinical courses. When persons of Factor 3 held positive beliefs about their instructors as human beings, teachers and counselors, it inspired them to emulate their instructors as clinicians. Elucidating this notion, one participant remarked, “It [item 31] gave me greater respect and admiration for them, which motivated me to be influenced by them.” Similarly, another participant stated, “I remember feeling inspired and wanting to ‘just be like’ certain professors as I entered practicum.” After teachers earned Factor 3 individuals’ respect and admiration they were ascribed credibility, which made it less important for them to provide context for what was being taught (item 21) or to streamline assigned readings (item 27). That is, when a teacher they valued taught something in class or assigned reading, those things were immediately assumed to be important.
It was important to persons of Factor 3 that their teachers had charisma during class, which captivated their attention and motivated them to learn. As such, Factor 3 individuals preferred when their teachers were the active figures in the classroom and led class through having an engaging personality (item 29). Elaborating on the importance of this perspective, one participant explained, “It [item 29] helped me to get excited about what I was doing and learning and helped me to get engaged in discussions and activities.” Representatives of Factor 3 also perceived it as helpful when they could sense their teachers were passionate about what they were teaching (item 22). As one participated remarked, “I experienced several professors who loved what they were teaching. This attitude ignited my excitement for counseling and inspired me.” Summarizing Factor 3 representatives’ emphasis on relational characteristics of their teachers, one participant noted, “My relationships with professors had the greatest impact on my growth; more so than any technique they used or material they covered.”
Consensus Statements
There were two items of consensus on which all three factors agreed. It was of moderate importance to all three factors that their teachers were currently working with clients or possessed significant experience working with clients (item 13). Qualitative data seemed to suggest this item enhanced a counselor educator’s credibility when teaching students in clinical courses, providing them with experiences to draw on when demonstrating a technique. One participant explained: “I felt I received more honest and pragmatic lessons from professors that had recent stories, feedback and teachings from being up-to-date and current with everyday practice. Their knowledge meant more to me and left a longer-lasting impression.”
Representatives of the three factors also perceived it as particularly unimportant that counselor educators incorporate technology into clinical courses to enhance learning (item 30). Qualitative feedback from respondents seemed to focus on two different themes in regards to item 30. One, respondents considered technology unnecessary in clinical courses, as they did not perceive that it was relevant to their work as professional counselors: “Technology does not affect how I practice as a counselor. I actually felt that I wasted much time in fighting with technology during my education that could have been better spent further developing my skills.” Two, respondents suggested that technology was perceived as less helpful when it came at the expense of clinical learning occurring in the classroom: “Technology is nice and all, but I appreciated clinical moments in the classroom with my professor and peers.”
Discussion
An important finding of this study was that three different shared viewpoints (i.e., application-oriented learners, intrinsically motivated learners, affective-oriented learners) exist among beginning-level clinical mental health counselors about helpful aspects of teachers in clinical courses. When considering the different teaching preferences that emerged in this study, it may be helpful for counselor educators to conceptualize each factor as a student-learner archetype present in CMHC clinical courses. An example of the Factor 1 application-oriented archetypal student is as follows: a student focused on becoming a competent professional counselor who is apprehensive about his or her lack of knowledge and experience. This student’s ideal teacher explicitly articulates and demonstrates what he or she needs to do to become a competent professional counselor, while providing supportive feedback as he or she tries to achieve that goal. An example of the Factor 2 intrinsically motivated archetypal student is as follows: a student who is a reflective thinker with a broad enjoyment of learning, motivated to become an excellent counselor. His or her ideal teacher helps to develop deeper personal understandings and wisdom through creating opportunities to hear diverse opinions and feedback. An example of the Factor 3 affective-oriented archetypal student is as follows: a student who wants to feel cared for and valued by a teacher as a means of developing a transformational relationship with him or her. His or her ideal teacher is a person he or she admires who inspires the student to want to become a professional counselor.
The preferences of the Factor 1 student-learner archetype are congruent with counselor educators of clinical courses who use developmental (Granello, 2000) and teacher-centered (Baeten et al., 2012) pedagogies. Students from the Factor 1 archetype are unsure of themselves because of their lack of knowledge and experience in counseling. Thus, it may be helpful when counselor educators use their advanced knowledge and experiences as formal authorities to disseminate essential foundational knowledge and skills (Grasha, 1994). These Factor 1 students also may find it helpful when counselor educators use a personal model of teaching to demonstrate how something should be done, which has the dual benefit of helping students learn through observation and creating a clear objective for which to strive (Grasha, 1994). Additionally, the Factor 1 archetype prefers teachers who introduce new information and skills using a contextual approach (Granello & Hazler, 1998) in which they take time to explain how and why what is being taught is relevant to the goal of becoming a competent professional counselor. These approaches to teaching may quell developmental anxieties experienced by Factor 1 students, and counselor educators can encourage further growth through providing strength-based feedback as students perform clinical learning tasks.
The preferences of the Factor 2 student-learner archetype are closely aligned with counselor educators who use constructivist (Nelson & Neufeldt, 1998) and learner-centered pedagogies (Baeten et al., 2012) while teaching clinical courses. The Factor 2 archetype prefers for minimal class time to be used for teacher-led instruction and the majority of class time to be used for reflective learning activities, discussion and exchanging feedback. These Factor 2 students prefer for counselor educators to operate on the periphery of the classroom in the style of a facilitator and delegator, acting as a catalyst who orchestrates a rich learning environment (Grasha, 1994). A rich learning environment from the Factor 2 perspective is a classroom with many active voices openly sharing different points of view, providing one another with candid feedback about their clinical work. An important task then is for counselor educators to create relevant learning activities in class that provoke discussion and reflection. One example of this could be requiring the Factor 2 archetype to present videos or case vignettes of their clinical work with clients in which they are required to conceptualize the client with their classmates. During such an activity, counselor educators may be helpful to Factor 2 students by offering candid feedback, sharing (potentially) alternative viewpoints and prompting them to justify clinical interventions based on their theoretical orientation(s).
The preferences of the Factor 3 student-learner archetype are focused on the personality and relational qualities of counselor educators. This orientation toward the personality qualities of the teacher is congruent with research from undergraduate populations that found instructors with warmth-inducing behaviors (Best & Addison, 2000) and who demonstrated enthusiasm about course content (Feldman, 1988) were associated with effective teaching. Similarly, it is important to the Factor 3 archetype that they perceive their instructors as kind, genuine and passionate about what they are teaching because these personal qualities kindle their interest for learning. Factor 3 students are further motivated to learn when they develop respect and admiration for counselor educators, which can be achieved through expert and formal authority styles of teaching (Grasha, 1994). Factor 3 prefers for counselor educators to lead class in a teacher-centered fashion so that their teachers’ personal qualities are at the forefront of the learning environment. However, dissimilar to teacher-centered approaches that emphasize the importance of mastering course content, the Factor 3 archetype learns primarily through the relationship developed with counselor educators. Their ideal teacher is affable, demonstrates charisma in the classroom and is an exemplar of personality qualities they perceive as important for a counselor to possess. Observing and experiencing these desirable characteristics in counselor educators inspires Factor 3 students to emulate them in their clinical work. Several examples of how counselor educators can engage Factor 3 students are as follows: (a) ethically sharing candid anecdotes that may directly or tangentially relate to course material; (b) asking students how they are feeling about their experiences in the class or in clinical situations; and (c) using humor as a pedagogical tool.
It is interesting to consider results from this study in light of a similar Q study that explored what beginning professional counselors perceived as helpful about teachers from didactic courses (Moate, Cox, Brown, & West, in press). In both studies, three factors emerged from the data that bear great similarities to one another, despite each study being comprised of different participants and Q sort items. This may suggest that to some degree a commonality exists between CMHC students’ perceptions of what is helpful about teachers in both clinical and didactic courses. However, unlike the previous study that found a high level of agreement among the three factors about the helpfulness of counselor educators of didactic courses, the factors in this study demonstrated three distinct viewpoints about their preferences. This may suggest that it is more challenging for counselor educators in clinical courses to find a pedagogical middle ground that is mutually pleasing to each student-learner archetype. Thus, counselor educators may need to spend more time in clinical courses considering how they can accommodate the different learning perspectives present in their classroom.
Limitations and Future Research
This study used Q methodology to explore different shared viewpoints that exist among beginning-level counselors about their perceptions of helpful aspects of counselor educators teaching clinical courses in CMHC. Although we believe that student learning preferences are an important perspective for counselor educators to consider, we also recognize that this represents only one side of a coin. It would be helpful for future research to explore what counselor educators perceive as being important for CMHC students to learn in clinical courses to prepare them for the rigors of being professional counselors. This added perspective could elucidate important pedagogical items that were not accounted for in this study.
Implications for Teaching Practice
Because of the three distinctive teaching preferences among CMHC students in clinical courses, counselor educators may need to spend more time considering how they can accommodate diverse student learning needs when teaching clinical courses. An important first step may be for counselor educators to reflect on their teaching and learning bias by considering the following questions: (a) with which student-learner archetype did they most closely identify as a student; (b) which student-learner archetype’s teaching preferences most closely align with their style of teaching; and (c) to which student-learner archetype do they prefer to teach? Counselor educators who possess self-awareness of their teaching and learning biases in relation to the student-learner archetypes presented in this study may be better able to make pedagogical adjustments that are beneficial to students who are most unlike their preferences. For example, a counselor educator who identifies as having a pedagogical style that they believe aligns with the Factor 1 (application-oriented) preferences might consider ways to better engage Factor 2 and Factor 3 learners. This could entail structural considerations when designing the course and lesson planning for each class or being intentional about emphasizing or de-emphasizing certain personality characteristics during class.
We also believe that counselor educators can use the findings of this study as a tool to conceptualize students with whom they work in clinical courses. Having such a conceptualization tool may help counselor educators modify their pedagogical approach when working with students individually in a classroom setting. Smaller class sizes and interactive environments in clinical courses provide counselor educators with greater opportunities to communicate directly with students. Consequently, counselor educators have greater potential in clinical courses to make adjustments based on the perceived needs of the individual students. For example, rather than working in the same way with all students (e.g., providing strength-based feedback), a counselor educator who notices that a student has traits of the Factor 2 archetype may consider providing feedback that is corrective in nature.
The findings from this study highlight different teaching preferences that exist among beginning counselors about helpful aspects of teachers in clinical courses. It is probably unrealistic and unnecessary for counselor educators to make drastic changes to their pedagogy in pursuit of perfectly meeting the learning preferences of all CMHC students in a clinical class. Rather, we broadly suggest that counselor educators should be reflective of their own teaching characteristics and biases and consider making small modifications to their pedagogical approach that will be more inclusive for students with preferences different than their own.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest or funding contributions for the development of this manuscript.
References
Auxier, C. R., Hughes, F. R., & Kline, W. B. (2003). Identity development in counselors-in-training. Counselor Education and Supervision, 43, 25–38. doi:10.1002/j.1556-6978.2003.tb01827.x
Baeten, M., Dochy, F., & Struyven, K. (2012). Using students’ motivational and learning profiles in investigating their perceptions and achievement in case-based and lecture-based learning environments. Educational Studies, 38, 491–506. doi:10.1080/03055698.2011.643113
Barrio Minton, C. A., Wachter Morris, C. A., & Yaites, L. D. (2014). Pedagogy in counselor education: A 10-year content analysis of journals. Counselor Education and Supervision, 53, 162–177.
doi:10.1002/j.1556-6978.2014.00055.x
Best, J. B., & Addison, W. E. (2000). A preliminary study of perceived warmth of professor and student evaluations. Teaching of Psychology, 27, 60–62.
Brown, S. R. (1980). Political subjectivity: Applications of Q methodology in political science. New Haven, CT: Yale University Press.
Feldman, K. A. (1988). Effective college teaching from the students’ and faculty’s view: Matched or mismatched priorities. Research in Higher Education, 28, 291–329.
Furr, S. R., & Carroll, J. J. (2003). Critical incidents in student counselor development. Journal of Counseling & Development, 81, 483–489. doi:10.1002/j.1556-6678.2003.tb00275.x
Goldstein, G. S., & Benassi, V. A. (2006). Students’ and instructors’ beliefs about excellent lecturers and discussion leaders. Research in Higher Education, 47, 685–707. doi:10.1007/s11162-006-9011-x
Granello, D. H. (2000). Contextual teaching and learning in counselor education. Counselor Education and Super-vision, 39, 270–283. doi:10.1002/j.1556-6978.2000.tb01237.x
Granello, D. H., & Hazler, R. J. (1998). A developmental rationale for curriculum order and teaching styles in counselor education programs. Counselor Education and Supervision, 38(2), 89–105. doi:10.1002/j.1556-6978.1998.tb00561.x
Grasha, A. F. (1994). A matter of style: The teacher as expert, formal authority, personal model, facilitator, and delegator. College Teaching, 42(4), 142–149.
Malott, K. M., Hall, K. H., Sheely-Moore, A., Krell, M. M., & Cardaciotto, L. (2014). Evidence-based teaching in higher education: Application to counselor education. Counselor Education and Supervision, 53, 294–305. doi:10.1002/j.1556-6978.2014.00064.x
McAuliffe, G., & Eriksen, K. (2010). Handbook of counselor preparation: Constructivist, developmental, and experiential approaches. Thousand Oaks, CA: Sage.
Moate, R., Cox, J., Brown, S., & West, E. (in press). Helpfulness of teachers in didactic courses. Counselor Education and Supervision.
Nelson, M. L., & Neufeldt, S. A. (1998). The pedagogy of counseling: A critical examination. Counselor Education and Supervision, 38(2), 70–88. doi:10.1002/j.1556-6978.1998.tb00560.x
Pietrzak, D., Duncan, K., & Korcuska, J. S. (2008). Counseling students’ decision making regarding teaching effectiveness: A conjoint analysis. Counselor Education and Supervision, 48(2), 114–132. doi:10.1002/j.1556-6978.2008.tb00067.x
Ramlo, S. (2016). Mixed method lessons learned from 80 years of Q methodology. Journal of Mixed Methods Research, 10, 28–45. doi:10.1177/1558689815610998
Schmolck, P. (2014). PQMethod (Version 2.35). [Computer Software]. Retrieved from http://schmolck.userweb.mwn.de/qmethod
Schwitzer, A. M., Gonzalez, T., & Curl, J. (2001). Preparing students for professional roles by simulating work settings in counselor education courses. Counselor Education & Supervision, 40, 308–319. doi:10.1002/j.1556-6978.2001.tb01262.x
Skovholt, T. M., & Ronnestad, M. H. (1992). Themes in therapist and counselor development. Journal of Counseling & Development, 70, 505–515. doi:10.1002/j.1556-6676.1992.tb01646.x
Smart, K. L., Witt, C., & Scott, J. P. (2012). Toward learner-centered teaching: An inductive approach. Business Communication Quarterly, 75, 392–403. doi:10.1177/1080569912459752
Sperry, L. (2012). Training counselors to work competently with individuals and families with health and mental health issues. The Family Journal: Counseling and Therapy for Couples and Families, 20, 196–199. doi:10.1177/1066480712438527
Sprinkle, J. E. (2008). Student perceptions of effectiveness: An examination of the influence of student biases. College Student Journal, 42, 276–293.
Stephenson, W. (1978). Concourse theory of communication. Communication, 3, 21–40.
Stenner, P., Watts, S., & Worrell, M. (2008). Q-methodology. In C. Willig & W. Stainton-Rogers (Eds.), The Sage handbook of qualitative research in psychology (pp. 215–239). London, UK: Sage.
Watts, S., & Stenner, P. (2012). Doing Q methodological research. London, UK: Sage.
Young, M. E., & Hundley, G. (2013). Connecting experiential education and reflection in the counselor education classroom. In J. D. West, D. L. Bubenzer, J. A. Cox, & J. M. McGlothlin (Eds.), Teaching in counselor education: Engaging students in learning (pp. 51–66). Alexandria, VA: Association for Counselor Education and Supervision.
Young, S., & Shaw, D. G. (1999). Profiles of effective college and university teachers. The Journal of Higher
Education, 70, 670–686.
Randall M. Moate is an Assistant Professor at the University of Texas at Tyler. Jessica M. Holm is an Assistant Professor at the University of Texas at Tyler. Erin M. West is a Lecturer at the University of Texas at Tyler. Correspondence can be addressed to Randall Moate, The Department of Psychology and Counseling, University of Texas at Tyler, 3900 University Blvd., Tyler, TX 75799, rmoate@uttyler.edu.
Feb 28, 2017 | Volume 7 - Issue 1
Alexis Miller, Jennifer M. Cook
Many theories are used to conceptualize adolescent substance use, yet none adequately assist mental health professionals in assessing adolescents’ strengths and risk factors while incorporating cultural factors. The authors reviewed common adolescent substance abuse theories and their strengths and limitations, and offer a new model to conceptualize adolescent substance use: The Adolescent Substance Use Risk Continuum. We posit that this strengths-based continuum enables clinicians to decrease stigma and offer hope to adolescents and their caregivers, as it integrates relevant factors to strengthen families and minimize risk. This model is a tool for counselors to use as they conceptualize client cases, plan treatment and focus counseling interventions. A case study illustrates the model and future research is suggested.
Keywords: adolescents, substance use, case conceptualization, cultural factors, strengths-based
For decades, theorists have worked to understand adolescent behaviors and conceptualize adolescent substance use. These theories have provided a strong base to conceptualize adolescent substance use, yet none integrate important counseling-focused concepts such as strengths and cultural factors. The Adolescent Substance Use Risk Continuum (ASURC) expands upon previous theoretical models and is designed to enhance counselors’ ability to conceptualize adolescent substance use from a strengths-based, stigma-reducing, and culturally sensitive perspective. The ASURC adds to counselors’ abilities to conceptualize adolescent substance use and enhances their abilities to create comprehensive treatment plans and interventions.
Theoretical Underpinnings
The theory of planned behavior (TPB; Ajzen, 1985), social learning theory (SLT; Akers, 1973), social control theory (SCT; Elliott, Huizinga, & Ageton, 1985), and social development theory (SDT; Hawkins & Weis, 1985) are four theories that have been applied to adolescent substance use. The TPB was developed to describe an individual’s behavior in a general sense, while the other three theories were developed to explain deviant and delinquent behavior. Even though these four theories were developed in the 1970s and 1980s and were not developed specifically for adolescent substance use, researchers have applied these theories to predict substance use within this population (Corrigan, Loneck, Videka, & Brown, 2007; Malmberg et al., 2012; Schroeder & Ford, 2012).
The TPB was developed as an expansion of the theory of reasoned action, which describes behavior as contingent upon an individual’s beliefs about a certain behavior and the perceived social pressure on the individual to perform that behavior (Ajzen, 1985). In addition to individual beliefs and perceived social pressure, the TPB adds an additional element to describe behavioral intention: self-efficacy. Self-efficacy refers to one’s perception of control to complete certain behaviors (Ajzen, 1985). Petraitis, Flay, and Miller (1995) introduced two types of self-efficacy related to adolescent substance use: use self-efficacy and refusal self-efficacy. Use self-efficacy consists of adolescents’ beliefs about their ability to obtain alcohol or other drugs, whereas refusal self-efficacy is indicative of adolescents’ beliefs about their abilities to refuse social pressure to use substances (Petraitis et al., 1995).
SLT was developed to explain so-called deviant behavior, and it is heavily influenced by behavioral theories, particularly operant conditioning and reinforcement. Therefore, behavior is learned when it is reinforced (Akers, 1973). The anticipation of either reinforcement or punishment can lead to behavioral increase or decrease, depending on who has the most influence on the adolescent, and who controls the reinforcement or punishment. Delinquent behavior can be influenced and maintained by a variety of sources, including parents, family, peers and school (Petraitis et al., 1995).
Similar to SLT, SCT emphasizes the importance of rewards and punishments in terms of deviant or delinquent behavior (Elliott et al., 1985). The result of either punishment or reinforcement is influenced mainly by an individual’s socialization into what the authors described as conventional society (Elliott et al., 1985). Conventional society points to general societal norms, largely congruent with dominant cultural norms. Therefore, according to SCT, an adolescent with a strong attachment to conventional society would have stronger internal and external controls and would be less motivated to choose delinquent behaviors. Inversely, an adolescent with a weak attachment to conventional society would have weaker internal and external controls and be more likely to engage in deviant behaviors (Elliot et al., 1985).
Hawkins and Weis (1985) integrated SLT and SCT to develop the SDT. The SDT is a developmental model of delinquent behavior that focuses on how adolescents are socialized through family, peers and school. Delinquent behaviors develop when adolescents are not socialized into conventional society appropriately. Opportunities for involvement with conventional individuals are seen as necessary but not sufficient for an individual to develop positive social bonds (Hawkins & Weis, 1985). There are two mediating factors associated with this socialization process toward positive social bonds: skills possessed by an adolescent and reinforcement of the opportunities for involvement (Hawkins & Weis, 1985). Skills that enhance an adolescent’s ability toward social bonds include adolescents’ social skills, or skills needed to interact and form social bonds with others (Hawkins & Weis, 1985). Similar to SLT and SCT, the SDT stresses the need for reinforcement, where behavior must be reinforced to continue (Hawkins & Weis, 1985).
Strengths and Limitations of Theoretical Underpinnings
The aforementioned models have made significant contributions to how counselors conceptualize adolescent substance use. Particularly, these models highlight the role social influences play in adolescent substance use and, accordingly, how social influences impact behavioral factors like reinforcement, punishment and reward (Akers, 1973; Elliot et al., 1985; Hawkins & Weis, 1985; Petraitis et al., 1995). Additionally, all models have been validated empirically to be predictive of adolescent substance use (Corrigan et al., 2007; Malmberg et al., 2012; Schroeder & Ford, 2012). Although these studies provide empirical support for predicting adolescent substance use and highlight social influences and behavioral factors, limitations exist, namely a lack of specificity related to social influences, the use of problematic language, and failure to incorporate cultural factors and contexts. Below, we detail the strengths and limitations of the aforementioned models to provide a rationale for a more encompassing, strengths-based approach to conceptualizing adolescent substance use.
Social Influences
Research has shown that social factors, such as family and peer group, play a mediating role in adolescent substance use in both positive and negative ways (Piko & Kovács, 2010; Van Ryzin, Fosco, & Dishion, 2012). Also, research highlights how important social influences are on adolescents’ substance use. The TPB suggests that substance use is dependent upon the adolescent’s individual attitudes of substance use and perceived social pressure to use substances (Petraitis et al., 1995). SLT and SCT emphasize how behavior, including substance use, is learned through reinforcement or punishment (Akers, 1973 Elliott et al., 1985). Someone in the adolescent’s life has to reward or punish the adolescent’s substance use for it to continue or cease.
Further, the SDT emphasizes the socialization process in regards to deviant behavior in adolescents. According to the SDT, socialization begins within the family unit, where a child has variable opportunities to develop social, cognitive and behavioral skills (Hawkins & Weis, 1985). As a child grows older, ostensibly these skills are reinforced positively within the school setting and peer group (Hawkins & Weis, 1985). However, if children are not socialized appropriately in the family system, children may not develop socially, cognitively and behaviorally as expected. In turn, they may turn to substance use to cope with stressful life events. Further, if adolescents were not socialized appropriately in early childhood, they may be at greater risk to become involved with adolescents who use substances.
While the four theories emphasize social influences as a factor in adolescent substance use, the TPB, SLT and SCT used the term social influences in a general sense only, and do not differentiate between the different types of social influences. There are a variety of social influences, including family, peers, school, sports teams, clubs and religious organizations, and each can have a varied impact on adolescents’ substance use. For example, involvement in religious organizations can protect some adolescents from substance use (Steinman & Zimmerman, 2004), while engagement with sports teams may increase adolescent substance use for others (Farb & Matjasko, 2012). The SDT was the only model discussed that divides socialization into three units: family, peer and school; however, the SDT suggests that family, peer, and school units all go through the same development process, seemingly at the same rate. Presumably, an adolescent is given the same opportunity for involvement with all three units toward the goal of creating healthy social bonds, and these opportunities are influenced by an adolescent’s current social skills and reinforcement from others (Hawkins & Weis, 1985). This adolescent substance use conceptualization can be problematic because it suggests the family, peer group and school all go through the same developmental process simultaneously and fails to recognize that different units can have different influences (some positive, some negative) on an adolescent, and these influences may develop asymmetrically. Further, the SDT proposes that a “social bond” (Hawkins & Weis, 1985, p. 80) to conventional society is a common goal and that adolescents have the social skills in place to create these bonds. Although it is hoped that adolescents will have strong social skills and that their support systems will endeavor to create healthy social bonds, this may not be the case for all adolescents. Further, some adolescents who have strong social skills may use them to procure substances and influence others to use.
Problematic Language
The developers of SLT, SCT, and SDT used the terms deviant behavior, delinquent behavior, and conventional society to describe aspects contained in their theories. In juvenile justice literature, the terms deviant and delinquent point to adolescent behaviors considered to be age-inappropriate and destructive to self and family, as well as illegal (Pope, 1999). However, these terms are not used to simply describe behaviors as they were intended—they have become labels used to classify and marginalize adolescents who have made poor choices and acted in ways incongruent with conventional society (Constantine, 1999). Often, these terms are applied to adolescents who encompass non-dominant cultural identities (e.g., race, social class), which can serve to further oppress and marginalize adolescents who may experience societal and structural inequality. At the very least, these terms define adolescents by choices they have made and may lead to assumptions about who they are, adding additional stigma and shame to worthy individuals who can learn to make different choices, which is incongruent with a strengths-based perspective.
Conventional society is a term used to describe societal norms, determined most often by dominant U.S. cultural groups (Duncan, 1999). Similar to the issues with the terms deviant and delinquent, the term conventional society may not account accurately for cultural nuances and differences that vary from dominant culture expectations, furthering societal and structural oppression, discrimination and inequality clients experience (Constantine, 1999). For example, according to SCT, weak attachment to conventional society contributes to weaker internal and external controls, and an adolescent can develop a weak attachment to conventional society when she experiences a strain between her aspirations and her perceptions of the opportunity to actualize such aspirations. Therefore, through an SCT lens, if this adolescent lives in a low-income neighborhood where crime and unemployment are prevalent, she may be perceived to have a weak attachment to conventional society (Petraitis et al., 1995), without taking into account that her environment is out of sync with conventional society and cultural norms as defined by the dominant culture.
Cultural Factors
The final common limitation of the aforementioned models is the lack of inclusion of cultural influences on adolescents’ substance use. As mentioned previously, these four models highlight the importance of social influences on adolescents’ substance use yet do not specifically take cultural factors into consideration. The TPB discusses social influences in regard to an adolescent’s beliefs and perceived social pressure (Ajzen, 1985); however, there is no mention that these beliefs might be influenced by cultural values and experiences. Similarly, SLT suggests that an adolescent’s deviant behavior is influenced by positive or negative reinforcement received within the social context (Akers, 1973), yet fails to acknowledge that these positive or negative reinforcements are most likely influenced by cultural factors. The SDT outlines the socialization process through three different units (Hawkins & Weis, 1985), all of which exist within cultural contexts that influence adolescents’ substance use, yet the authors do not cite this as a possibility. Similarly, SCT discusses social influences on a systemic level, focusing on adolescent academic and occupational goals (Elliott et al., 1985). Adolescents’ cultural factors can influence their academic and occupational goals, as well as their perception of the likelihood of obtaining these goals. The theme among these four models is that they include factors influenced by culture without specifically mentioning or addressing culture or cultural variations.
We suggest a conceptual model for adolescent substance use that addresses specific social influences, uses inclusive and strengths-based language, and integrates cultural factors. We propose the ASURC as a model to meet this need. The ASURC asserts that while different social contexts are intertwined with one another, they all influence adolescent substance use in distinct ways. Further, the ASURC model uses strengths-based terms to reduce stigma and shame, and empowers clients and their caregivers to make person-affirmative choices. Finally, the ASURC integrates cultural components into all aspects of the model in order to provide appropriate context, acknowledging that adolescent substance use develops in a cultural context.
The Adolescent Substance Use Risk Continuum
The aforementioned theoretical models contain strengths and limitations and influenced the development of the ASURC model. Prior models emphasized social influence on adolescent substance use, and we emphasize social influences in our model as well. However, we believe that different social systems will have different influences on each adolescent, and each social system develops at its own rate. Further, the included areas are not meant to be predictive of substance use, and can serve both as strengths and risk factors, depending on the individual’s circumstances. The areas featured in our model include: parental and caregiver engagement, relationship between parents and caregivers and adolescent, family history of substance use, biological factors, level of susceptibility to peer pressure, childhood adversity, and academic engagement. While we believe the areas in our model have distinct impacts on adolescents, all areas interact and influence one another, and all areas are influenced by singular and intersecting cultural identities.
The ASURC emphasizes the importance of cultural considerations when conceptualizing adolescent substance use. We used Hays’ (1996) “ADDRESSING” model as a foundation. The included cultural factors are by no means exhaustive; counselors are encouraged to expand this list to work with their clients appropriately. Cultural factors should be considered in terms of the individual, family, community and societal contexts when applied to the ASURC areas. Further, it is important to consider ways in which cultural identities can serve as protective or risk factors, depending on the individual’s dominant and non-dominant cultural identities, and the identities most salient to the client. Client cultural influences are subjective experiences, and counselors should take great care and time to determine their relevance for each client.
Further, the ASURC is a strengths-based approach to conceptualizing adolescent substance use. Previous theories contain the use of problematic language, such as conventional society, deviant behavior, and delinquent behavior, when describing adolescent substance use. We feel the use of this language can lead to stigma and instill a sense of shame for this population. Focusing on strengths while using the ASURC will aid clinicians in fostering a sense of hope while working with this population. Strengths are not a separate component of the model, but rather are incorporated in each aspect of the model.
As the name suggests, the ASURC (Adolescent Substance Use Risk Continuum) is a continuum, ranging from minimal risk to high risk. The continuum starts at minimal risk instead of no risk because substance use and addiction can occur in anyone. Further, a continuum suggests that an adolescent can move bi-directionally along the continuum depending on changes. This potential for movement can instill hope and serve to reduce shame associated with adolescent substance use. To use the ASURC model (see Figure 1), one starts at the bottom of the model and considers how the areas listed serve as adolescent protective or risk factors. When working through these areas, cultural identities are incorporated. These identities are represented above the entire model to indicate how they influence everything underneath them. Cultural factors should be considered from the perspective of the individual, family, community and society as a whole, because their influence could be different in each area. Finally, the counselor determines where the adolescent falls on the risk continuum. Because multiple aspects influence an individual’s location on the continuum, it is important to note the protective and risk factors associated with each of the model’s areas for any specific client. This assessment can assist counselors in developing holistic treatment plans that address not only adolescents’ substance use, but also their strengths and areas that could be enhanced as they strive to eliminate substance use.
Model Components
Cultural Influences
There are many cultural factors to consider when conceptualizing adolescent substance use. The ASURC is based on Hays’ (1996) ADDRESSING model. There are nine overlapping cultural influences included in the ADDRESSING model: age, disability status, religion, ethnicity, socioeconomic status, sexual orientation, indigenous heritage, national origin and gender (Hays, 1996). To these we added race and language. This list is not exhaustive but rather a starting point to consider how culture can be a protective or risk factor for adolescents.
When clinicians consider adolescents’ cultural identities, it is important to do so within individual, family, community and societal contexts. To consider only one context diminishes the multiplicity of adolescents’ experiences, and it can negate the impact these contexts have on them. For example, it is common for societal context to be overlooked in favor of individual experiences due to the importance placed on individualism by the dominant culture (Johnson, 2006). When societal context is neglected, structural inequality may be ignored. Structural inequality denotes the oppression or restrictions non-dominant groups experience when they attempt to access resources, including mental health treatment, which are available without hindrance to dominant culture groups. Structural inequality can impact adolescents’ beliefs about their ability to choose not to use substances and their ability to achieve success and access resources, and can reduce hope about their life circumstances (Hancock, Waites, & Kledaras, 2012).
Religion and spirituality. Religion and spirituality can be a protective factor for adolescents. Higher levels of religious involvement tend to correlate with lower levels of substance use (Mason, Schmidt, & Mennis, 2012). Mason et al. (2012) identified two specific aspects of religiosity associated with lower levels of alcohol and drug use: social religiosity and perceived religious support. Social religiosity refers to public displays of religious behavior, such as church attendance and participation in religious activities; perceived religious support encompasses emotional support one receives from a religious institution as well as tangible support like materials or money donated by a religious organization (Mason et al., 2012). Private religiosity, such as personal importance of religion and individual prayer, was not found to be a protective factor (Mason et al., 2012), suggesting the more social aspects of religion are more beneficial for preventing adolescent substance use. Similarly, religion may be a risk factor when adolescents, such as lesbian, gay, or bisexual (LGB) youth, feel judged, shamed, or shunned by their religious community, which may increase the likelihood of substance use (Barnes & Meyer, 2012).
Ethnicity. Ethnicity is significant because reported substance abuse and dependence rates are higher for people of color than for White people in the population (Substance Abuse and Mental Health Services Administration, 2012). Of the total population of people of color, who represent only 38.5% of the U.S. population, 9,319,277 people reported substance abuse and dependence. This number is particularly staggering when compared to White people, who represent 61.5% of the population, 15,713,373 of whom reported substance abuse and dependence (Substance Abuse and Mental Health Services Administration, 2012). These statistics demonstrate that adolescents of color are more likely to develop substance abuse issues than their White counterparts. However, these statistics do not incorporate issues related to structural inequality, nor do they speak to restricted treatment access or racial groups’ protective factors that could be bolstered. For example, Native Americans, who have the highest statistical rate of substance use, also emphasize spirituality and the importance of the extended family (Sue & Sue, 2013). These factors can serve as protective factors for Native American adolescents. Similarly, researchers have found religious engagement among African American adolescents to be a protective factor (Steinman & Zimmerman, 2004). African American adolescents who attended religious services regularly had lower substance use rates than their peers who did not.
Socioeconomic status. Socioeconomic status (SES), particularly education level, influences substance use in adolescents, and subsequently intersects with race and ethnicity. Adolescents who drop out of high school are more likely to engage in substance use, and lower levels of education are associated with higher prevalence of substance-related diagnoses (Henry, Knight, & Thornberry, 2012). American Indian, Latino, and African American adolescents’ math and reading proficiency rates are less than half of White adolescents, most likely due to structural inequality in low-income schools. Students in these groups are less likely to graduate from high school than their White peers (Henry et al., 2012). Furthermore, living in poverty or low SES are associated with higher risks of substance use, and adolescents from racial minority groups are at a higher risk for living in poverty and low-SES families (Van Wormer & Davis, 2013).
Sexual orientation. Sexual orientation is another cultural factor to consider. The LGB community is at greater risk for substance use compared to heterosexual individuals (Brooks & McHenry, 2009). One explanation for the increased risk in the LGB community may be due to homophobia and heterosexual superiority and internalized homophobia, which can lead individuals in the LGB community to turn to substances as a way to cope (Brooks & McHenry, 2009). Further, gay bars are a mainstay of the LGB community, and even though adolescents may not be allowed to drink legally, bar environments may be integral during adolescents’ coming out process (Brooks & McHenry, 2009). Socialization in a bar environment can lead to adolescent substance use as a way to fit in and cope.
Caregiver Engagement and Adolescent–Caregiver Relationship
Family environment can serve as a protective or risk factor for adolescent substance use. A key factor associated with family environment is parental or caregiver supervision. Strong caregiver supervision has been shown to minimize an adolescent’s risk-taking behavior, such as substance use (Van Ryzin et al., 2012). While caregiver supervision is an important protective factor for adolescents, it also is important for adolescents to be able to experience a sense of autonomy within their family of origin. Allen, Chango, Szwedo, Schad, & Marston (2012) defined autonomy within the family of origin as adolescents’ ability to have opinions and beliefs that differ from their caregiver(s) and can be fostered through a supportive adolescent–caregiver relationship. Positive relationships between caregivers and adolescents can increase self-esteem and healthy coping skills, leading to a decrease in risk-taking behaviors (Piko & Kovács, 2010). According to Piko and Kovács (2010), high levels of both satisfaction and caregiver support perceived by the adolescent define this positive relationship. Further, positive relations within the family can lead to higher levels of family obligation perceived by the adolescent. Family obligation is the perceived importance of spending time together, family unity and family social support; higher levels have been found to deter adolescents from unhealthy risk taking, including the use of alcohol and drugs (Telzer, Fuligni, Lieberman, & Galván, 2013).
Conversely, low caregiver involvement can be a risk factor for adolescent substance use. Adolescents who have low caregiver supervision are more likely to engage with peers who use substances and, subsequently, use substances as a way to find social support (Van Ryzin et al., 2012). Additionally, adolescents who do not have positive relationships with their caregivers have a more difficult time self-regulating their behaviors and increased risk for using substances as a way to cope with stress (Hummel, Shelton, Heron, Moore, & van den Bree, 2013).
Family Substance Abuse History and Biological Risks
Family history of substance use is an additional risk factor for adolescents. Children of parents and caregivers who abuse alcohol are four times more likely to develop an addiction (Van Wormer & Davis, 2013). This risk may be partly due to biological predisposition, and part may be environmental. Scientists have begun to better understand how genes affect substance use disorder development and posit that 40–60% of alcohol use disorders can be explained by genes (Van Wormer & Davis, 2013). It can be difficult to determine whether an individual’s addiction is inherited through genetic composition or is learned via the family environment, or a combination of both. Genetics can include predisposition to impulsivity, and some scientists believe individuals at risk for substance use disorders may be biologically predisposed to overreact to stressful situations and life events. Individuals predisposed genetically to engage in sensation-seeking and impulsive behaviors are more likely to experiment with alcohol and other substances (Van Wormer & Davis, 2013). While biological risk can increase adolescents’ predisposition to develop addiction, it does not necessarily lead to addiction (Van Wormer & Davis, 2013). This message can instill hope and infuse self-efficacy in families who may have a history of substance abuse.
Adolescence is marked by an increase in risk-taking behaviors, which may be associated with developmental biology (Telzer et al., 2013). Adolescents show a heightened response in the ventral striatal, which is part of the brain’s reward system. This heightened response in the ventral striatal can cause adolescents to engage in more reward-seeking behaviors compared to children and adults. Further, adolescents show less activation in pre-frontal regions of the brain, the part of the brain in charge of executive functioning, which can lead to increased risk-taking behaviors (Telzer et al., 2013). Research has shown that an increase in family obligation can lead to decreased sensitivity in the ventral striatal and increased activity in the pre-frontal region of the brain (Telzer et al., 2013). These findings suggest that improved quality in the adolescent–caregiver relationship can jettison substance abuse. Specifically, increased family obligation can help buffer some adolescent biological risks for substance use.
Susceptibility to Peer Influences
Peer relationships can play a role in the development of adolescent substance use. During adolescence, individuals start to spend more time with peer groups than with their families (Piko & Kovács, 2010). Additionally, adolescence is marked by a heightened sense of reward. This focus on reward can lead to an increased desire for adolescents to please their peers, making it more difficult for them to resist peer pressure (Van Ryzin et al., 2012). If adolescents associate with peers who use alcohol and drugs, they are more likely to begin using substances as a way to be accepted by their peer group (Van Ryzin et al., 2012).
Inversely, if adolescents are associated with peers who are not involved in substance use, they are less likely to use substances (Van Ryzin et al., 2012). Moreover, there is a negative correlation between adolescents who are involved in supervised extracurricular activities and substance use (Farb & Matjasko, 2012). Specifically, involvement in school-based activities such as performing arts, leadership groups and clubs is associated with lower rates of substance use (Darling, Caldwell, & Smith, 2005). However, there is a positive correlation between athletics and substance abuse, meaning adolescents involved in athletics are more likely to engage in substance use (Farb & Matjasko, 2012). Researchers believe this positive correlation is due to the subculture of high school athletics that promotes alcohol and drug use (Denault, Poulin, & Pedersen, 2009).
Childhood Adversity
Adolescents who experienced childhood adversity are at greater risk for developing substance use disorders (Benjet, Borges, Medina-Mora, & Méndez, 2013). Childhood adversity refers to family instability such as parental and caregiver mental illness, substance use, and criminal behavior, witnessing domestic violence, and experiencing abuse, neglect, interpersonal loss, and socioeconomic disadvantage. Researchers have suggested that this relationship is due to the self-medication hypothesis, in that adolescents who experience childhood adversity may turn to alcohol and drugs in order to alleviate the pain they encounter as a result of such experiences (Benjet et al., 2013).
Not only are adverse childhood experiences a risk factor for developing substance use disorders, but also for substance use opportunities (Benjet et al., 2013). One possible explanation for such opportunities is the presence of substances in the family environment. For adolescents who experienced child abuse or neglect or who witnessed domestic violence, there is an increased chance that substances were present in their household, making it easier for them to gain access to substances (Benjet et al., 2013).
The absence of childhood adversity can be a protective factor against adolescent substance use (Benjet et al., 2013). Another protective factor in terms of childhood adversity is early intervention (Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011). Early intervention can help children develop healthy coping skills to manage stress. Healthy coping strategies can be implemented to replace more negative coping strategies like substance use (Durlak et al., 2011).
Academic Engagement
Academic engagement can have positive and negative effects on adolescents’ potential substance use. Adolescents who drop out of high school are more likely than their counterparts to engage in substance use (Henry, Knight, & Thornberry, 2012). Further, early school disengagement can be a warning sign to predict high school dropout (Henry et al., 2012). For some adolescents, school engagement can be a protective factor. Particularly, adolescents who experience a positive school climate and have strong school engagement are less likely to use substances (Piko & Kovács, 2010). A positive relationship between adolescents and their teachers can be another protective factor. Previous studies have shown that adolescents who have a positive relationship with their teachers and have a high level of perceived support from teachers are less likely to engage in substance use (Demanet & Van Houtte, 2012).
The case study below provides an example of how clinicians can use the ASURC to conceptualize and plan interventions when working with this population.
Case Study
John is a 14-year-old, biracial male and high school freshman. He lives with his mother and grandmother, both of whom are African American, and they reside in a low socioeconomic neighborhood. Both John’s mother and grandmother work full-time, and his mother works a second job, leaving John unsupervised after school and on the weekends. John’s father, a 38-year-old Puerto Rican male, left the home when John was 4 years old. Prior to his father’s departure, John witnessed domestic violence between his parents. During a fight, John intervened on his mother’s behalf and his father hit him. After this event, John’s mother forbade her husband from living in their home and sought counseling services for her son. After his father left, John had only sporadic visits with him, mainly due to his father’s alcohol use. In addition to John’s father’s alcohol use, there is family history of substance use on his mother’s side. His maternal great-aunts use alcohol, and his maternal uncle uses marijuana daily.
This year, John made the varsity football team and has been spending time with the senior football players after practice during the week and on weekends. In addition to being involved with the football team, John is involved with his church community. At school, John is an average student, earning mostly Bs and Cs, and he reports that he enjoys learning.
John started drinking and smoking cigarettes shortly after joining the football team in order to impress the junior and senior football players. Initially, John was hesitant to drink or smoke; however, after using more frequently, he started to enjoy it and reported feeling more relaxed. Currently, John drinks with his friends on the football team two to three times a week and smokes with them daily. John drinks only when he is with this group of peers, yet he has started to smoke when he is alone.
Over the past two months, John’s grandmother has caught him sneaking back into the house at night smelling like alcohol and cigarettes. The first two times this occurred, John’s grandmother decided not to tell his mother because she believed John when he said it would not happen again. When John’s grandmother caught him a third time, she told his mother. John’s mother was surprised when she heard this news because she believed she and John had a close and honest relationship. Distraught, John’s mother brought him to counseling.
Case Analysis Using the ASURC Model
Conceptualizing this case using the ASURC model reveals that John has both protective and risk factors related to his substance use. In terms of his family environment, John’s mother reports that she and John have a close and honest relationship. This close relationship serves as a protective factor for John because a positive relationship between adolescents and their parents is associated with a decreased risk of adolescent substance use (Piko & Kovács, 2010). Yet, John has minimal supervision at night and on the weekends due to his mother and grandmother’s work schedules. Low caregiver supervision is a risk factor for John because research shows that it is associated with an increased risk of adolescent substance use (Van Ryzin et al., 2012). The family’s low SES impacts John’s low caregiver supervision, and low SES can be associated with a higher risk of substance use (Von Wormer & Davis, 2013).
This year, John joined the football team, and previous research has shown that involvement in athletics in high school can be a risk factor for substance use (Farb & Matjasko, 2012), and adolescents who become associated with peers who use are at an increased likelihood to use (Van Ryzin et al., 2012). Furthermore, adolescence is a period characterized by a heightened sense of reward (Van Ryzin et al., 2012), suggesting that John may have an increased desire to please his peers and difficulty resisting peer pressure. At this point in time, John is drinking only when he is with his friends on the football team, suggesting this peer group is influencing John, yet he has begun smoking alone. Additionally, John is involved in his church community, which serves as a protective factor because being involved in a faith community lowers the risk for substance use in adolescents (Mason et al., 2012). Religious engagement, particularly among African American adolescents, can be a protective factor (Steinman & Zimmerman, 2004), which may be true for John if he identifies with this part of his racial identity as a biracial youth.
The next area of risk and protective factors in the ASURC model is childhood adversity. John witnessed domestic violence between his parents when he was younger, and as a result of attempting to intervene on behalf of his mother, John was hit by his father, a risk factor for adolescent substance use (Benjet et al., 2013). Fortunately, John’s mother sought counseling services for her son after the incident occurred. Early intervention can help offset the negative effects of these experiences (Durlak et al., 2011), and it is possible counseling provided John with healthy coping strategies.
According to the ASURC model, biological factors can impact adolescent substance use. John has a family history of substance use on both his maternal and paternal sides, and genes can play a role in the development of substance use disorders (Van Wormer & Davis, 2013). Further, adolescents experience an increase in risk-taking behaviors due to biological changes associated with adolescence (Telzer et al, 2013), and these changes may cause John to engage in increased risk-taking and pleasure-seeking behaviors.
Higher levels of academic engagement correlate with lower levels of substance use (Henry et al., 2012). John reported that he enjoys learning, suggesting he could have a high level of academic engagement. Nonetheless, John is currently earning Bs and Cs at school, pointing to a disconnection between his motivation to learn and his current grades. This disconnect could be due to associated cultural factors. John is biracial and living in a low socioeconomic neighborhood, and adolescents who live in such neighborhoods and are racial minorities can be at a disadvantage due to structural inequality (Henry et al., 2012).
Case Discussion
When taking all of the risk and protective factors into account, we placed John on the low end of moderate risk using the ASURC model. While John does have various risk factors contributing to his substance use, he also has protective factors that can help to buffer these factors. Further, John’s cultural identities impact him in various areas of the model. In particular, John’s biracial identity and living in a low socioeconomic neighborhood could be risk factors for substance use, while being involved in his church community is a protective factor. It would be important to explore with John how he views his race, SES, and religion, and if he sees them as protective or not. Further, it would be helpful to understand how John views his gender and sexual orientation, and how these identities affect his worldview.
Using the ASURC model to conceptualize John’s case can assist counselors with their interventions with John and his family. While using the model, a counselor is able to assist John and his family to identify current strengths such as positive family relationships, involvement in his church community, and potential for high academic engagement. Identifying these strengths allows John and his caregivers to concretize what is helpful in their situation and allows the counselor to encourage more of these behaviors as tools to strengthen weaker areas. For example, because there are strong family relationships, John’s mother and grandmother can increase their engagement with John when they are away from home via texts or phone calls. Increasing parental engagement will be beneficial for the family, particularly John’s mother and grandmother knowing who John is spending time with because his substance use is heavily influenced by his friendships on the football team. Similarly, because John likes to learn yet is not achieving high grades in school, tutoring programs can be sought to bolster his academic performance and solidify his academic engagement, as well as fill his time with positive activities that may decrease his desire to use. Additionally, it may be helpful to educate John and his caregivers about biological predispositions and risk factors in adolescence. This information can empower John to make positive choices when he understands both that he is not destined to develop an addiction and that he is experiencing normal physical changes. Additionally, it could prove helpful to talk with John and his family about how they might be experiencing structural inequality due to their race and SES. Engaging them in this conversation can normalize their experiences and serve to determine points where advocacy with and on behalf of the family may alleviate some of the strain they experience. Finally, because John’s risk level is on the low end of moderate, structured substance abuse treatment may not be warranted at this time. Interventions could include assessing John’s readiness to stop using and working through a change commitment while strengthening John’s protective factors in an effort to decrease his risk factors.
Future Research
Currently, the ASURC is a conceptual framework yet to be evaluated for efficacy with adolescent populations. Empirical research is needed to determine the model’s viability, validity and efficacy. Further, qualitative research would inform clinicians about the ways in which adolescents and their families felt stronger and more empowered by engaging in counseling practices that use this model’s approach.
Further research can be conducted to evaluate the degree of influence different components of the model have on adolescents with substance use concerns. Also, future research could investigate the relationship the model components have with one another, particularly the interplay of different cultural identities. Research is warranted to determine additional ways in which cultural factors can be used to strengthen clients and their families to mitigate deficit-based research and the pervasive negative cultural messages about non-dominant cultural groups and their struggles with substance use.
Conclusion
The ASURC is a strengths-based approach focused on identifying protective and risk factors as counselors conceptualize adolescent substance use. While previous theories conceptualized adolescent substance use using strengths, they had limitations, including only discussing social influences in a general sense, use of problematic language, and lack of cultural influences. The ASURC builds upon the strengths of previous models while addressing their limitations. The ASURC model emphasizes the need for a strengths-based approach while working with adolescent populations and focuses on the importance of the consideration of cultural influences during the conceptualization process.
Finally, this model serves as a tool to help guide interventions that best serve adolescents and their families. Using the ASURC model for case conceptualization can help counselors determine the most salient factors of the model to the particular case, which will in turn assist in the treatment planning process. Future research is warranted to determine the viability of the ASURC model as an evidence-based practice.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
References
Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl & J. Beckmann (Eds.), Action-control: From cognition to behavior (pp. 11−39). New York, NY: Springer.
Akers, R. L. (1973). Deviant behavior: A social learning approach (2nd ed.). Belmont, CA: Wadsworth.
Allen, J. P., Chango, J., Szwedo, D., Schad, M., & Marston, E. (2012). Predictors of susceptibility to peer influence regarding substance use in adolescence. Child Development, 83, 337−350.
doi:10.1111/j.1467-8624.2011.01682.x
Barnes, D. M., & Meyer, I. H. (2012). Religious affiliation, internalized homophobia, and mental health in lesbians, gay men, and bisexuals. American Journal of Orthopsychiatry, 82, 505−515.
doi:10.1111/j.1939-0025.2012.01185.x
Benjet, C., Borges, G., Medina-Mora, M. E., & Méndez, E. (2013). Chronic childhood adversity and stages of substance use involvement in adolescents. Drug and Alcohol Dependence, 131, 85−91.
doi:10.1016/j.drugalcdep.2012.12.002
Brooks, F., & McHenry, B. (2009). A contemporary approach to substance abuse and addiction counseling: A counselor’s guide to application and understanding. Alexandria, VA: American Counseling Association.
Constantine, M. G. (1999). Labeling theory. In J. S. Mio, J. E. Trimble, P. Arredondo, H. E. Cheatham, & D. Sue (Eds.), Key words in multicultural interventions: A dictionary (pp. 169−170). Westport, CT: Greenwood Press.
Corrigan, M. J., Loneck, B., Videka, L., & Brown, M. C. (2007). Moving the risk and protective factor framework toward individualized assessment in adolescent substance abuse prevention. Journal of Child & Adolescent Substance Abuse, 16(3), 17−34. doi:10.1300/J029v16n03_02
Darling, N., Caldwell, L. L., & Smith, R. (2005). Participation in school-based extracurricular activities and adolescent adjustment. Journal of Leisure Research, 37, 51−76.
Demanet, J., & Van Houtte, M. (2012). School belonging and school misconduct: The differing role of teacher and peer attachment. Journal of Youth and Adolescence, 41, 499−514. doi:10.1007/s10964-011-9674-2
Denault, A.-S., Poulin, F., & Pedersen, S. (2009). Intensity of participation in organized youth activities during the high school years: Longitudinal associations with adjustment. Applied Developmental Science, 13(2), 74−87. doi:10.1080/10888690902801459
Duncan, L. (1999). Social norms. In J. S. Mio, J. E. Trimble, P. Arredondo, H. E. Cheatham, & D. Sue (Eds.), Key words in multicultural interventions: A dictionary (pp. 239−240). Westport, CT: Greenwood Press.
Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor, R. D., & Schellinger, K. B. (2011). The impact of enhancing students’ social and emotional learning: A meta-analysis of school-based universal interventions. Child Development, 82, 405−432. doi:10.1111/j.1467-8624.2010.01564.x
Elliott, D. S., Huizinga, D., & Ageton, S. S. (1985). Explaining delinquency and drug use. Beverly Hills, CA: Sage.
Farb, A. F., & Matjasko, J. L. (2012). Recent advances in research on school-based extracurricular activities and adolescent development. Developmental Review, 32, 1−48. doi:10.1016/j.dr.2011.10.001
Hancock, T. U., Waites, C., & Kledaras, C. G. (2012). Facing structure inequality: Students’ orientation to oppression and practice with oppressed groups. Journal of Social Work Education, 48, 5−25.
doi:10.5175/JSWE.2012.201000078
Hawkins, J. D., & Weis, J. G. (1985). The social development model: An integrated approach to delinquency prevention. Journal of Primary Prevention, 6, 73−97. doi:10.1007/BF01325432
Hays, P. A. (1996). Addressing the complexities of culture and gender in counseling. Journal of Counseling & Development, 74, 332−338. doi:10.1002/j.1556-6676.1996.tb01876.x
Henry, K. L., Knight, K. E., & Thornberry, T. P. (2012). School disengagement as a predictor of dropout, delin-quency, and problem substance use during adolescence and early adulthood. Journal of Youth and Adolescence, 41(2), 156−166. doi:10.1007/s10964-011-9665-3
Hummel, A., Shelton, K. H., Heron, J., Moore, L., & van den Bree, M. (2013). A systematic review of the relation-ships between family functioning, pubertal timing and adolescent substance use. Addiction, 108, 487−496. doi:10.1111/add.12055
Johnson, A. G. (2006). Privilege, power, and difference (2nd ed.). New York, NY: McGraw-Hill.
Malmberg, M., Overbeek, G., Vermulst, A. A., Monshouwer, K., Vollebergh, W. A., & Engels, R. C. (2012). The
theory of planned behavior: Precursors of marijuana use in early adolescence? Drug and Alcohol Dependence, 123, 22−28. doi:10.1016/j.drugalcdep.2011.10.011
Mason, M. J., Schmidt, C., & Mennis, J. (2012). Dimensions of religiosity and access to religious social capital: Correlates with substance use among urban adolescents. The Journal of Primary Prevention, 33, 229−237. doi:10.1007/s10935-012-0283-y
Petraitis, J., Flay, B. R., & Miller, T. Q. (1995). Reviewing theories of adolescent substance use: Organizing pieces in the puzzle. Psychological Bulletin, 117, 67–86. doi:10.1037/0033-2909.117.1.67
Piko, B. F., & Kovács, E. (2010). Do parents and school matter? Protective factors for adolescent substance use. Addictive Behaviors, 35, 53−56. doi:10.1016/j.addbeh.2009.08.004
Pope, R. L. (1999). Deviance. In J. S. Mio, J. E. Trimble, P. Arredondo, H. E. Cheatham, & D. Sue (Eds.), Key words in multicultural interventions: A dictionary (pp. 92−93). Westport, CT: Greenwood Press.
Schroeder, R. D., & Ford, J. A. (2012). Prescription drug misuse: A test of three competing criminological theories. Journal of Drug Issues, 42, 4−27. doi:10.1177/0022042612436654
Substance Abuse and Mental Health Services Administration. (2012). Results from the 2011 national survey on drug use and health: Summary of national findings. NSDUH, H-44(12−4713). Rockville, MD: Author.
Steinman, K. J., & Zimmerman, M. A. (2004). Religious activity and risk behavior among African American adolescents: Concurrent and developmental effects. American Journal of Community Psychology, 33(3), 151−161. doi:10.1023/B:AJCP.0000027002.93526.bb
Sue, D. W., & Sue, D. (2013). Counseling the culturally diverse: Theory and practice (6th ed.). New York, NY: John Wiley & Sons, Inc.
Telzer, E. H., Fuligni, A. J., Lieberman, M. D., & Galván, A. (2013). Meaningful family relationships: Neuro-cognitive buffers of adolescent risk taking. Journal of Cognitive Neuroscience, 25, 374−387.
doi:10.1162/jocn_a_00331
Van Ryzin, M. J., Fosco, G. M., & Dishion, T. J. (2012). Family and peer predictors of substance use from early adolescence to early adulthood: An 11-year prospective analysis. Addictive Behaviors, 37, 1314−1324. doi:10.1016/j.addbeh.2012.06.020
Van Wormer, K., & Davis, D. R. (2013). Addiction treatment: A strengths perspective (3rd ed.). Belmont, CA:
Brooks/Cole.
Alexis Miller, NCC, is a professional counselor for the Dual Diagnosis Partial Hospitalization Program at Rogers Memorial Hospital in Madison, WI. Jennifer M. Cook, NCC, is an Assistant Professor at Marquette University. Correspondence can be addressed to Rogers Memorial Hospital, Attn: Alexis Miller, 406 Science Dr., Suite 110, Madison, WI 53711, alexis.miller626@gmail.com.
Feb 24, 2017 | Book Reviews
The authors of The Psychosis Response Guide: How to Help Young People in Psychiatric Crises look at an area of mental health that is often stigmatized and confusing, but also is a problem that is affecting many people. This book attempts to demystify how young people experience a psychiatric crisis and what steps others can take to stabilize the situation and provide necessary support. Iati and Waford explain mental illness in a way that is easy to comprehend and adaptable to many situations. The book provides step-by-step guidelines for recognizing the symptoms and warning signs of a psychiatric crisis and determining when an individual should seek professional help. Detailed examples and vignettes give a real-life perspective to those seeking to support those living with psychosis.
This book is intended for those who are not in the counseling profession. Family members, friends, co-workers and peers can obtain the information needed to recognize and potentially intervene in a psychotic crisis. Iati and Waford are diligent when providing the crucial information needed to identify a psychiatric crisis, but are cautious when instructing their readers to act without the guidance of professional help. The book consistently reminds its readers that everyone is unique, and that there is value to knowing one’s limits and not jumping to conclusions based on one situation.
Readers can connect to this book through the personal vignettes shared within. These perspectives make the experiences that many people struggle with real and personable. Mental illness carries many stereotypes and myths; however, Iati and Waford provide facts to guarantee that readers finish this book with an intentional understanding of how to notice when a psychotic crisis is occurring and how to intervene. Readers are now able to comprehend and convey specific disorders, symptoms and potential treatment options. Knowledge gained from this book can allow for a stronger support system for young people experiencing a psychotic crisis, because the foundational information in the book is accessible to all.
Although the information provided is concise and valuable, and leads people to have a better understanding of mental illness, it still may be difficult to digest for readers who are not in the mental health care profession. It can be an overwhelming experience if a family is in crisis and desperately reading through this book to find answers. Iati and Waford diligently remind the reader to seek professional help, but under pressure, families may attempt to approach the person in psychotic crisis in a way that is harmful. I am concerned that readers may substitute this book for professional help, as can be the case for many books that provide mental health information.
Counseling professionals have the opportunity to use this book as a resource for the families with which they work. While the focus is often on the clients, counselors also can educate their clients’ families on mental illness and what families can expect. By reading this book, counselors can feel prepared when explaining mental illness to families, and encourage support and understanding toward young people experiencing a psychotic crisis.
Practical takeaways are available for the counseling profession, such as simple assessments and outlined criteria for disorders, along with ideas for developing a treatment plan. This is a resource that counselors can refer to throughout their career for better informing their clinical practice, how they consult with colleagues, and how they supervise counselors-in-training. Even though the book may not be directed at counselors, this can be an opportunity for counselors to review what they know about mental illness and improve how they work with young adult clients.
Iati, C. A., & Waford, R. N. (2016). The psychosis response guide: How to help young people in psychiatric crises. New York, NY: Springer.
Reviewed by: Jillian M. Blueford, The University of Tennessee, Knoxville
The Professional Counselor
https://tpcwordpress.azurewebsites.net
Feb 20, 2017 | Volume 7 - Issue 1
Laura Boyd Farmer, Corrine R. Sackett, Jesse J. Lile, Nancy Bodenhorn, Nadine Hartig, Jasmine Graham, Michelle Ghoston
Using quantitative and qualitative analysis, the perceived impact of post-master’s experience (PME) during counselor education and supervision (CES) doctoral study was examined across five core areas of professional identity development: counseling, supervision, teaching, research and scholarship, and leadership and advocacy. The results showed positive perceptions of the impact of PME in four of the five core areas, with significant relationships between the amount of PME and perceived impact on supervision and leadership and advocacy. Implications inform CES doctoral admissions committees as well as faculty who advise master’s students interested in pursuing a doctoral degree in CES.
Keywords: counselor education and supervision, doctoral study, post-master’s experience, doctoral admissions, professional identity
The master’s degree in counseling serves as the entry-level degree in the field, and students entering a doctoral program in counselor education and supervision (CES) are believed to have already met the standards of an entry-level clinician (Goodrich, Shin, & Smith, 2011). Therefore, the doctoral degree in CES is to prepare counselors for leadership in the profession within a variety of roles including supervision, teaching, research and scholarship, and leadership and advocacy, as well as counseling practice (Bernard, 2006; Council for Accreditation of Counseling and Related Educational Programs [CACREP], 2015; Goodrich et al., 2011; Sackett et al., 2015). Though CACREP (2015) recognizes previous professional experience as one of the doctoral program admission criteria, the counselor education field lacks clear professional standards regarding the amount and type of counseling experience necessary for admittance to doctoral programs (Boes, Ullery, Millner, & Cobia, 1999; Sackett et al., 2015; Schweiger, Henderson, McCaskill, Clawson, & Collins, 2012; Warnke, Bethany, & Hedstrom, 1999). Conventional wisdom may tell us the more post-master’s counseling experience a doctoral applicant has, the more enriched their doctoral experience will be; however, the CES field does not have empirical data for how CES doctoral students perceive the impact of their post-master’s experience (PME) on their doctoral education. Therefore, the purpose of the study was to explore the perceived impact of PME on doctoral study in CES.
In this study, researchers explored the perceived impact of PME across the five core areas of doctoral professional identity development outlined by CACREP (2015; Section 6. B.1-5). The following research questions guided the study: (1) How do advanced doctoral students and recent doctoral graduates perceive the impact of PME on the development of the five core areas of professional identity during doctoral study: counseling, supervision, teaching, research and scholarship, and leadership and advocacy? and (2) Is the amount of PME and the setting of PME related to the perceived impact of PME on the five core areas of professional identity during doctoral study: counseling, supervision, teaching, research and scholarship, and leadership and advocacy? Practically, the results inform CES doctoral admissions committees in considering applicants with and without PME. CES doctoral admissions committees must decide whether and how much PME should be required for admittance to their programs. PME is an important consideration in selecting doctoral students, yet few applicants have this experience (Nelson, Canada, & Lancaster, 2003), making it difficult to require. The results also inform CES faculty who advise master’s students interested in pursuing a doctoral degree. CES faculty members frequently encounter ambitious master’s students who are interested in pursuing a doctoral degree, and one of the many considerations in that conversation is whether and how much PME should be obtained before doctoral study begins. Though PME is deemed important, many CES faculty members advise master’s students to go straight into doctoral study based on factors such as maturity, academics and skill level (Sackett et al., 2015). This is an issue for the field since experience is an important qualification in hiring CES faculty members (Bodenhorn et al., 2014; Rogers, Gill-Wigal, Harrigan, & Abbey-Hines, 1998) and clinical experience informs teaching (Rogers et al., 1998; Sackett et al., 2015), supervision (Sackett et al., 2015), and research (Munson, 1996; Sackett et al., 2015). Thus, exploring further the impact of PME on doctoral students’ development is critical.
Relevant CES Literature on Post-Master’s Experience
The field of CES lacks clarity regarding the amount or type of counseling experience preferable for incoming doctoral students (Sackett et al., 2015; Schweiger et al., 2012; Warnke et al., 1999). Recently, Swank and Smith-Adcock (2014) found that most CES doctoral programs in their study recommended, rather than required, one to two years of clinical experience for admission, while some suggested licensure for admission. Similarly, Nelson et al. (2003) found that counseling experience was a necessary component to doctoral admissions, though program representatives relayed the difficulty in requiring PME since so few applicants have experience. Twenty of the 25 CACREP-accredited programs in their sample rated successful work experience as a criterion for admission to their doctoral programs. Sixteen of those reported that work experience is always or often helpful in selecting strong doctoral students. CES doctoral programs deem experience is important in admissions, yet CES faculty members often advise master’s students to go immediately into doctoral programs (Sackett et al., 2015). Thus, there will likely continue to be a shortage of experienced doctoral applicants for doctoral admissions committees to choose from. As such, it is critical to explore the impact of PME on the areas of CES study to inform advisors at the master’s level how to advise their students on gaining PME prior to pursuing doctoral work.
Sackett et al. (2015) conducted a recent study to explore how CES faculty are advising master’s-level students interested in doctoral work regarding the amount of PME to obtain beforehand. CES faculty expressed the significant influence of clinical practice on the areas of teaching, research and supervision. Respondents identified the importance of clinical experience in providing for stimulation in research and in establishing credibility in teaching and supervision. Though there was much support for PME in the qualitative findings from this study, many respondents emphasized individual circumstances in evaluating readiness for doctoral work in CES, such as age, maturity, academics and skill level. For other respondents, the experience gained through master’s and doctoral training was enough, especially in cases where students were working in clinical capacities while completing their doctoral degrees. Thus, there is some indication in CES that PME is an important consideration in doctoral student admissions (Nelson et al., 2003; Swank & Smith-Adcock, 2014) and some indication that CES faculty members perceive the importance of PME in the areas of teaching, supervision and research (Sackett et al., 2015). The current study adds to the literature by exploring CES doctoral students’ perceptions of PME on their experiences in doctoral study.
Other Helping Professions’ Literature on PME
Related disciplines are concerned with the question of PME as well. In marriage and family therapy, students with clinical experience have been rated as better clinicians by faculty than those who did not have clinical experience (Piercy et al., 1995). Proctor (1996) and Munson (1996) wrote about opposing viewpoints on whether social work doctoral programs should admit students with limited to no post-master’s in social work (MSW) experience. Proctor’s stance was that requiring post-MSW experience for admission to doctoral programs in social work was a detriment to the field, as it meant the discipline might miss out on students who are research-minded and eager to continue with their education. On the other hand, Munson argued that post-MSW experience is essential for graduates of social work doctoral programs to fulfill the needs of the field, which include building knowledge, conducting practice research and effectively teaching social work practice. In clinical psychology, O’Leary-Sargeant (1996) found academic criteria to be most important in doctoral student admissions, while clinical competence also was important. It appears that determining PME’s place in the priority list for doctoral admissions and its impact on doctoral work is a concern for related disciplines as well.
As there are no clear guidelines for considering PME in doctoral student admissions (Sackett et al., 2015; Schweiger et al., 2012), and empirical studies exploring the doctorate in counselor education are scarce (Goodrich et al., 2011), with none specifically exploring the perceived impact of PME on doctoral students’ experiences, researchers set out to add to the literature in this area. Both doctoral admissions committees and faculty members advising master’s students who wish to pursue doctoral study encounter the dilemma of if and how much PME experience is important to gain prior to pursuing doctoral work. Given this, the purpose of this study was to explore the perceived impact of PME on the five core areas of doctoral professional identity: counseling, supervision, teaching, research and scholarship, and leadership and advocacy.
Method
To investigate the perceived impact of PME on doctoral study, quantitative and qualitative methods were utilized for their complementarity (Johnson, Onwuegbuzie, & Turner, 2007). The study was guided by the research questions: (1) How do advanced doctoral students and recent doctoral graduates perceive the impact of PME on the development of the five core areas of professional identity during doctoral study: counseling, supervision, teaching, research and scholarship, and leadership and advocacy? and (2) Is the amount of PME and the setting of PME related to the perceived impact of PME on the five core areas of professional identity during doctoral study: counseling, supervision, teaching, research and scholarship, and leadership and advocacy? Institutional Review Board approval was acquired prior to data collection. The researchers asked participants to rate the perceived impact of their PME or lack of PME using an 11-point Likert scale (-5 to +5; strong negative impact to strong positive impact), and analyzed themes using participants’ responses to open-ended questions for the five core areas of doctoral professional identity.
Participants
Fifty-nine advanced doctoral students or recent graduates completed an online questionnaire. To define participants’ status to degree completion, all fell into one of three groups: recent doctoral graduates (completed a CES doctoral degree within the last three years), ABD doctoral students (all but dissertation; completed all coursework and were working on dissertation studies), and advanced doctoral students (two years into completing coursework). Among participants, 13 (22%) were recent doctoral graduates, 32 (54%) were ABD doctoral students, and 13 (22%) were advanced doctoral students. One participant did not answer this question.
Participants were asked to indicate the type of setting and experience that best described their PME, checking all items that applied. There were 10 options provided and an option for “other” that included a comment box. Forty-nine percent (n = 29) indicated PME in community-based agencies, 31% (n = 18) worked in K–12 school settings, 20% (n = 12) worked in private practice, and 7% (n = 4) worked in inpatient settings. Four participants indicated post-master’s work in more than one setting. Additionally, 37% (n = 22) indicated that their PME provided experiences working with diverse populations, 31% (n = 18) gained experience working with families, and 24% (n = 14) gained experience working with clients who had substance use issues. Less than 10% of participants indicated other counseling settings and experiences such as play therapy, bilingual counseling, day treatment and in-home counseling.
The 59 participants indicated a range of time spent in PME from zero years up to 19 years before entering doctoral study. Thirty-four percent (n = 20) indicated between zero and one year of experience, 25% (n = 15) between one and three years of experience, 19% (n = 11) between three and five years of experience, 17% (n = 10) between five and 10 years of experience, and 5% (n = 3) indicated more than 10 years of PME prior to entering doctoral study.
Procedure
Survey links were distributed through two national electronic list-servs, CESNET (the Counselor Education and Supervision NETwork) and COUNSGRAD (for graduate students in counselor education). The study invitation was sent to the listservs on two separate occasions approximately one month apart. Simultaneously, the study invitation was sent to regional Association for Counselor Education and Supervision leaders requesting that it be distributed to their membership lists. Additionally, CACREP liaisons were asked to send the survey link and invitation to their doctoral students. The survey was delivered through SurveyMonkey, a commonly used software product with a secure feature that was used for this research. The following research question was identified to potential participants: How do doctoral students and recent doctoral graduates reflect on how their post-master’s counseling experience or lack of experience impacted their experiences as a doctoral student? A response rate could not be calculated, as it is not possible to identify how many potentially appropriate participants received the research request.
PME Questionnaire
The authors collaborated on identifying questions that would serve to answer the research questions, focusing on five core areas of doctoral professional identity: counseling, supervision, teaching, research and scholarship, and leadership and advocacy. Two questions were asked about each of the five areas. “To what extent do you believe your post-master’s experience impacted your ability to develop [area] skills in your doctoral program?” used an 11-point Likert scale with the end points being (-5) strong negative impact and (+5) strong positive impact. Following the scaling question, an open-ended follow-up question was asked: “Please comment on how your experience impacted your [area] skills, and whether more or less experience would be beneficial.” Basic demographic questions were included regarding the type of experience gained prior to doctoral study, length of doctoral study and year of graduation. A pilot survey was sent to six people: two recent doctoral graduates, two ABD doctoral students, and two advanced doctoral students completing coursework. Feedback was provided on clarity and time involved.
Data Analysis
Quantitative analyses included correlation and multiple linear regression to examine the relationship between the amount of PME obtained and the perceived impact on the five core areas of doctoral study. The research team hypothesized that the amount of PME would predict a positive relationship with the perceived impact on some core areas of doctoral study, although which core areas would be statistically significant were unknown. Therefore, this study represents an exploration of the relationships between previously unexamined variables in the literature.
An independent samples t-test examined the relationship between PME setting (clinical mental health or school) and the perceived impact of PME on the five core areas. For this analysis, several setting options (community-based agencies, private practice and inpatient hospitals) were combined into one setting labeled “clinical mental health,” which was compared to K–12 school settings (labeled “school”). The research team hypothesized that there would be no statistically significant differences between PME setting and any of the five core areas of doctoral study. There are no prior studies that examine these variables.
For the qualitative analysis, the first, third and fourth authors served as the data analysis team. The data analysis team analyzed responses to the open-ended questions using a constant comparative method described by Anfara, Brown, and Mangione (2002). Additionally, the team used a form of check coding described by Miles and Huberman (1994). The team members independently completed a first iteration of data analysis by assigning open codes for each of the five open-ended questions by reading responses to each item broadly and observing regularities (Anfara et al., 2002). The team members completed a second iteration of analysis, which included comparison within and between codes to establish categories and identify emergent themes. The constant comparative method provided a systematic way to analyze large amounts of data by organizing it into manageable parts first, and then identifying themes and patterns.
For the final step of analysis, the data analysis team rotated through a process of peer review as recommended by Miles and Huberman (1994). For each open-ended question, two team members were assigned as coders and one was assigned the role of peer reviewer. Once the team members arrived at individually derived themes, the team met together to discuss the findings and arrive at consensus for naming themes. During this meeting, the peer reviewer led the discussion by probing and seeking clarification on the original comment wording, thus helping the team to reach consensus for the themes. Consensus was reached when the three team members came to agreement on the final themes. The data analysis team sent the original data and final themes for each of the five core areas to the remaining four authors, who served as additional peer reviewers by examining the analysis.
Results
Quantitative and qualitative analyses were conducted in this study of the perceived impact of PME on the five core areas of doctoral development for advanced doctoral students completing coursework, ABD doctoral students, and recent doctoral graduates. The results are presented in the following sections, with discussion to follow.
Quantitative Results: Correlation, Multiple Regression and Independent Samples T-test
Correlational analysis was used to explore the relationships among all variables: amount of PME obtained (years), and the perceived impact of PME on counseling, supervision, teaching, research and scholarship, and leadership and advocacy. A correlational matrix presents the relationships among the variables in Table 1. Among significant relationships, the amount of PME was related to perceived impact on development in supervision (r(57) = .43, p < .01) and leadership and advocacy (r(57) = .39, p < .01).
Table 1
Correlation Matrix for Main Study Variables
Note. Variables 2–6 represent the perceived impact of PME on the core area of doctoral identity development (counseling, teaching, supervision, research and scholarship, and leadership and advocacy)
Multiple linear regression was used to examine whether the amount of PME (independent variable) predicted the perceived impact of PME on each of the five core areas of doctoral development: counseling, supervision, teaching, research and scholarship, and leadership and advocacy (dependent variables). The results of the regression analysis indicated that amount of PME predicted 38% of variance in the perceived impact of PME (R2 = .38, F (6, 47) = 4.80, p < .01). The amount of PME significantly predicted the perceived impact of PME on two variables: supervision (β = .44, p < .01) and leadership and advocacy (β = .34, p < .05). A post hoc power analysis was conducted utilizing G*Power. With an alpha level of .01, a sample size of 59, and a medium effect size of .61 (Cohen, 1992), achieved power for the multiple linear regression was .98.
Finally, an independent samples t-test was conducted to compare the perceived impact of PME in school PME and clinical mental health PME settings. Results showed a significant difference between school PME (M = 4.43, SD = 1.02) and clinical mental health PME (M = 3.10, SD = 1.89) for the core area of leadership and advocacy (t(51) = -3.26, p = .02), reflecting that doctoral students with PME in schools perceived a significantly higher positive impact of their PME on the development of leadership and advocacy compared to doctoral students with PME in clinical mental health settings. In other words, both PME settings (school and clinical mental health) perceived a positive impact of their PME on the development of leadership and advocacy. However, doctoral students who had PME as school counselors perceived this experience as having a significantly greater impact on their development in leadership and advocacy than doctoral students who had obtained PME in clinical mental health settings.
The remaining four core areas of doctoral development were not significantly different when comparing PME settings. With an alpha level of .05, a sample size of 59, and a medium effect size of .88 (Cohen, 1992), achieved power for the independent samples t-test was .83.
Qualitative and Descriptive Results: Scaled and Open-Ended Responses
The following results describe respondents’ perceptions about the impact of PME on five core areas of doctoral development: counseling, supervision, teaching, research and scholarship, and leadership and advocacy (CACREP, 2015). Data was gathered for each core area using an 11-point Likert scale (-5 to +5) and was collapsed into five categories for ease of discussion. The categories were: (a) strong positive impact, +4 and +5; (b) weak to moderate positive impact, +1 through +3; (c) no impact, 0; (d) weak to moderate negative impact, -1 through -3; and (e) strong negative impact, -4 and -5. Table 2 reflects the percentage of responses in each core area. Table 3 provides a summary of qualitative themes. In the sections that follow, percentage results are summarized first, followed by a discussion of the qualitative themes within each core area of doctoral development.
Table 2
Descriptive Statistics: Perceived Impact of PME on Core Areas of Doctoral Professional Identity
Core Area of Doctoral Development: Counseling. A majority of participants (60%) responded that PME had a strong positive impact on their ability to develop counseling skills in their doctoral program. Another 29.3% indicated a weak to moderate positive impact. Five themes emerged from the written responses describing the perceived impact of PME on the development of counseling skills.
Theme 1: Increased confidence. Developing confidence in one’s counseling skills was frequently discussed as a benefit of having PME prior to doctoral study. Having confidence in the counseling skills already established through practice allowed for even more clinical growth during doctoral study. Many respondents stated they had greater confidence than their peers who lacked PME. Confidence also was viewed as advantageous when being asked to try a new clinical skill or technique: “I was more familiar with multiple clinical skills and my level of comfort when trying new clinical skills was higher than those who did not have the same clinical experience.”
Theme 2: Integration of theory into practice. Participants described the perceived impact of PME as being useful for helping to integrate theory into practice during doctoral study. While learning theories and reading about concepts establishes a foundation for counseling skills, participants reported that PME provided the context needed to test theoretical understanding in practice. Others commented that having some PME and then returning to the classroom for doctoral study gave them a greater understanding and appetite for theory. Theory was learned more thoroughly with a contextual base of experience upon which to build, as one respondent described:
My experience impacted my counseling skills; however, my experience alone did not help me conceptualize theory. I learned theory much more thoroughly post-master’s (once in doctoral studies) and then was able to identify how I had been using it all along as well as to incorporate new knowledge.
Table 3
Perceived Impact of PME: Qualitative Themes by Core Area of Doctoral Development
Theme 3: Conceptualizing cases. Case conceptualization was identified as a benefit of having PME. Participants described having greater clinical understanding and ability to apply knowledge as an advantage of PME. Others commented that having a context with which to build upon existing skills was useful and contributed to more complex conceptualizations of clients and problems.
Theme 4: Honing counseling techniques. Participants reported that their PME refined the counseling techniques they had gained in master’s study, enabling them to expand their repertoire and focus on honing advanced techniques during their doctoral work. One participant expressed feeling greater “comfort when trying new clinical skills” during doctoral study while another stated they were “able to focus on refining higher level skills” in their doctoral program.
Theme 5: The unique experience of school counselors. There was a notable theme regarding the distinct difference in school counselors’ experience when considering the impact of PME on counseling skill development. Some school counselors commented that they did not regularly use counseling skills while working in schools due to the variety of other responsibilities placed on school counselors. Another respondent stated that clinical supervision was crucial to developing clinical competence and that they did not receive clinical supervision while working as a school counselor. For those doctoral students with PME as school counselors, they expressed they would have benefitted by having more experience in several areas, such as use of the Diagnostic and Statistical Manual of Mental Disorders, dual-diagnosis, and substance use treatment. Some school counselors described using only specific theories in their setting (e.g., reality therapy, cognitive behavioral therapy), and that practicing with a broad range of techniques would have been useful prior to doctoral study.
Core Area of Doctoral Development: Supervision. The largest group of participants (48.3%) responded that PME had a strong positive impact on their ability to develop supervision skills in their doctoral program. Another group of participants (31%) rated PME as having a weak to moderate positive impact on their supervision skills. Five themes emerged from the written responses describing how PME impacted the development of supervision skills.
Theme 1: Increased confidence as a doctoral supervisor. Participants reported greater confidence while developing supervision skills as a result of having PME. In general, doctoral students in training are asked to enter into a supervisory relationship with master’s students in training in order to develop supervision skills. Having counseling experience as a professional in the field assisted doctoral students to feel more confident in this new role, as one respondent commented, “I was able to supervise students in my former position, but also I feel the years of experience have given me insight that I can be confident in the information I pass on.”
Alternately, doctoral students who do not have PME are asked to step into the same supervisory role, but may feel inadequately prepared to be in a position of hierarchy and expertise. Most doctoral students who have not had PME have recently graduated from their master’s program; therefore, the difference between the supervisor and supervisee in terms of experience is small. A participant spoke to this struggle: “Naturally clinical supervision and counseling are related. Because of this, it would have helped to have a more solid grasp on my own counseling skills and for me to have personal experiences to draw upon when supervising.”
Theme 2: Formative experiences in supervision. Through obtaining PME, participants reflected on their initial experiences of receiving supervision as a necessary backdrop for learning how to provide supervision. Whether those initial experiences in supervision were described as positive or negative, participants stated that they learned a great deal about becoming a supervisor through the process of receiving supervision. Initial supervision experiences also were described as either “clinical” in nature or “administrative.” Regardless of the type of supervision received, the experience was regarded as helpful in preparing them for doctoral study to advance their skills as a supervisor.
There were some participants who reported being provided with supervision during their PME and others reported that they lacked supervision. In both instances, participants acknowledged that they valued supervision as a result of their PME. Among those lacking quality supervision, one respondent stated, “My [post-master’s] supervision was mostly administrative and as a result I was at a disadvantage coming into a clinical supervisory environment.” On the other side, one participant described their master’s and doctoral program as providing “lousy supervision” and not regularly attending scheduled supervision meetings. Both experiences capture the sentiment: inadequate supervision, as a graduate student or professional, influences one’s expectations of what defines effective supervision.
A final benefit of PME described by participants was the ability to understand the supervisee’s experience. Having experienced the position of being a supervisee first-hand enabled a greater understanding of supervisees’ struggles and real-world challenges that are faced when providing counseling. One respondent expressed, “I understood the situations the students were facing since I had recently faced them with my clients (e.g., transportation, childcare, resistance).” Some participants reflected on the experience of building rapport with a supervisor, and how influential this was in their development. Due to these experiences in the field, the importance of strengthening the supervisory relationship and establishing a safe place in the supervision environment were considered paramount. Overall, participants reported that having experience as a supervisee enabled them to realize and appreciate critical aspects of providing effective supervision.
Theme 3: Providing resources to supervisees. Participants reported that having PME, which often included supervision, enabled them to provide better resources to supervisees as doctoral students. Some of these resources included community resources, referral options, counseling stories, therapeutic tools and techniques, varied perspectives, and a more diverse conceptualization of clients and issues. Here, a respondent illustrates this theme:
[I believe] it is super important to have . . . clinical experience when supervising students in a doctoral program. You have to be able to understand the student’s experience, have experience with many different client populations and modalities, be able to conceptualize client problems, and give students tools to advance their skills.
Theme 4: Credibility with supervisees. Greater credibility as a supervisor was regarded as an important benefit of having PME. Through the eyes of their supervisee, having more PME was perceived as helpful to establish credibility. This theme included two aspects: the doctoral supervisor having something valuable to offer in supervision, and the supervisee reporting greater confidence in a supervisor who had professional counseling experience. In this quote, a respondent describes feelings of credibility as a supervisor based on their PME: “I am able to understand the intricacies of a school system, thus I can help my students think of problem-solving strategies to work with their students and supervisors.”
Core Area of Doctoral Development: Teaching. The largest group of participants (38.9%) responded that PME had a strong positive impact on their ability to develop teaching skills in their doctoral program. Another group of participants (33.4%) rated PME as having a weak to moderate positive impact on their teaching skills. A smaller group of participants (22.2%) responded that PME had no impact at all on the development of teaching skills. Four themes emerged from the written responses describing how PME impacted the development of teaching skills.
Theme 1: Confidence in teaching. Having more confidence was frequently cited as a benefit to having PME and developing teaching skills during doctoral study. Some participants stated that many aspects of counseling involve teaching to a degree; therefore, having PME strengthened the ability to teach in the classroom. On the other side, there were some participants who regretted not having more PME directly related to teaching. One participant wrote, “I wish I had more experience teaching, managing a classroom, developing innovative and attention catching ideas. I know it’s more me than anything else so I need to develop my style more.”
Theme 2: Providing examples in the classroom. Perhaps the theme with the most support from participants was the perceived benefit of PME in their ability to provide examples while teaching. Those with PME had plenty of practical examples from their experience to draw from, which helped them a great deal while teaching. One participant wrote, “I was able to use examples drawn from my clinical experience to bring certain topics to life. I was also better able to describe some clinical issues and to teach certain skills.” Several participants wrote that they received positive feedback from students about the value of their stories and examples to enhance learning. Some also stated that they felt better prepared to conduct a live role-play in class to bring a technique to life because they had benefitted from PME. One respondent illustrated this idea well: “It’s difficult to teach something you have no experience with. There were others in my cohort who had no real clinical experience prior to starting their doctoral program and they were much less effective as teachers.”
Theme 3: Developing a new skill. Some participants responded that teaching was an entirely new skill that was unrelated to their PME. For these participants, teaching was a skill that was solely developed during doctoral study, as this respondent wrote: “Teaching was not a part of my post-master’s work. This was an entirely new set of skills I learned in doctoral study. Neither more nor less experience would have made a difference for me in this area.”
Theme 4: Value of prior teaching experiences. The fourth theme captures the positive impact described by those participants whose PME included teaching experiences prior to pursuing their doctoral degree. In particular, those with school counseling experience described preparing and implementing classroom guidance lessons as a natural comparison to teaching. Some participants had PME that involved providing training and giving presentations, which was also associated with teaching. For these participants, their specific PME had a positive impact on their development as a teacher during doctoral study, as this respondent reported: “Having an education background and then opportunity in my school to perform classroom guidance lessons, while different, still gave me an important opportunity to practice developing lesson plans.”
Core Area of Doctoral Development: Research and Scholarship. The largest group of participants (46.3%) responded that PME had no impact on their ability to develop research and scholarship skills in their doctoral program. Smaller groups of participants reported a range of weak to moderate to strong positive impact on their research and scholarship development. This was the only area of doctoral development that most participants described as being unrelated to PME. Three themes emerged from the written responses describing how PME impacted the development of research and scholarship.
Theme 1: No impact on research development. Most participants stated that their ability to develop research skills during their doctoral program was unrelated to having PME in the field. For these participants, research was regarded as an advanced skill unique to doctoral study. Many participants expressed that research and scholarship was not essential in their post-master’s positions, as is relayed in this quote: “Research is one area where [PME] is not as vital.”
Theme 2: Basic research experiences were useful. A few participants responded that obtaining some basic research experience was useful during the time between master’s and doctoral study. In general, it is necessary for counselors in the field to conduct basic searches for knowledge to support their practice. These searches may take the form of using the Internet to find resources for clients or reviewing text-books or articles when using a particular technique or theory. School counselors discussed their use of online research for building school guidance programs. In addition, some counselors gained basic research skills in their PME through collecting and analyzing data regarding the provision of services or client outcomes. One participant described her experience with a research study:
I worked in a clinical trial of CBT, CBT + medication, and medication only. This exposure really helped me get an idea of what research is possible in mental health . . . so it had a large impact on me. I pursued my doctorate largely because I wanted to engage in research and scholarship.
Theme 3: Contributed to area of research focus. Participants credited their PME as informing their ability to examine relevant topics for research. Some stated that their PME inspired their area of research focus. One participant noted that by working with specific populations, such as a specific ethnic minority population, “discrepancies and gaps in service” were found and helped the participant think about questions to pursue through research.
Core Area of Doctoral Development: Leadership and Advocacy. A majority of participants (58.2%) responded that PME had a strong positive impact on their ability to develop leadership and advocacy skills in their doctoral program. Another group of participants (23.7%) rated PME as having a weak to moderate positive impact on their leadership and advocacy skills. Five themes emerged from the written responses describing how PME was perceived to impact the development of leadership and advocacy skills.
Theme 1: Sense of responsibility to the profession. Participants described a heightened sense of responsibility to provide leadership and advocacy in the counseling field based on their PME. Some acknowledged a feeling of, “This is my job now,” related to the assumption of responsibility as a doctoral student in CES. Assuming greater responsibility was the most common theme discussed by participants, emerging in various forms.
Many participants described a sense of being propelled into leadership and advocacy through their PME. One school counselor wrote, “My job forced me to fight for myself, my students, teachers and parents. It was the best experience because I had to do it, or my job would be ineffective and possibly in jeopardy.” Another participant wrote:
Due to the nature of my job, I was doing a significant amount of advocacy. . . . Many of the kids on my caseload had multiple challenges, such as racial minority status, lack of citizenship, poverty, and/or domestic violence, and it was part of my responsibility to help them address the challenges they faced in all aspects of their lives in order to improve their mental health and functioning in school and at home.
Overall, participants described their PME as the most formative training for developing leadership and advocacy skills. PME provided a sense of purpose and meaning to advocacy and leadership in the counseling profession.
Theme 2: Awareness of advocacy needs within diverse client populations. Participants responded that a greater awareness of the needs of diverse populations, particularly minority populations, was a result and benefit of their PME. Through working with underrepresented populations, they had a greater appreciation for the need to develop leadership and advocacy skills. One participant also described having a “deeper understanding of the difficulties faced by certain populations within our society,” which laid the groundwork for developing leadership and advocacy skills in the doctoral program. Once involved in a doctoral program, advocacy felt like a way to “join forces with people who care” to address inequities and help marginalized groups. In this way, having exposure to different cultural groups through their PME provided the context for understanding and developing advocacy action strategies.
Theme 3: Motivation and direction for leadership and advocacy. Participants described that the motivation and direction for their leadership and advocacy work was inspired by the sense of responsibility and the awareness of needs that originated in their PME. In this way, PME helped to pave the way for the focus of their subsequent leadership and advocacy work. Regarding leadership, participants reflected that direct counseling work “consumed them” once in the profession and, as a result, professional development became something that you fit in when you could. Once they re-entered into graduate work as a doctoral student, they valued leadership and professional involvement and could give these aspects of development a more passionate focus. In a way, not having much time for professional development and leadership roles while directly serving clients provided motivation for becoming involved as a doctoral student.
Participants also reported that the presentations they submit to conferences are motivated by the needs they became aware of during their PME. Many credited their PME for helping them develop awareness of the future needs counselors were going to face, which motivated their advocacy for improved counselor training.
Theme 4: Development of leadership and advocacy skills on-the-job. Many participants described the need to develop leadership and advocacy skills on-the-job during their PME, and how valuable this was to their doctoral work. Participants experienced first-hand the lack of funding and resources in the community and school settings, which forced them to act in creative ways to get clients’ and students’ needs met. In addition, some described working in a position with multiple roles or serving multiple school campuses, which forced them to learn how to initiate programs independently, balance multiple roles, communicate with a variety of stakeholders, and thus develop leadership skills. Advocacy also was essential to develop on-the-job, as described by this participant:
I worked as a bilingual counselor, the only one at my clinic, working with a specific population for a period of time. I had to do a lot of leadership and advocacy work at the clinic to help my supervisors and colleagues understand this specific population and the resources that were available in the community specifically for this population.
Theme 5: Confidence to speak up. Again, confidence emerged as a theme with regard to developing leadership and advocacy skills during doctoral study. Having PME gave participants the necessary confidence to speak up in classes, in meetings and at conferences. Many reported that they became much more confident about voicing concerns and advocating due to their first-hand knowledge of issues facing counselors in the field, as did this respondent:
I think my post-master’s skills made me more confident about speaking up in meetings and conferences and it enhanced my advocacy skills because I knew what the issues facing clinicians were. It didn’t always make me popular or well understood among counselor educators with little clinical experience, however.
For these respondents, having greater confidence to use one’s voice seemed a natural result of having some years of experience with “boots on the ground” and becoming acclimated to the real-world experience of working as a counselor.
Discussion
The results from this study help fill a gap identified in the literature regarding clarity in the counselor education field on the amount of counseling experience preferable for incoming doctoral students (Sackett et al., 2015; Schweiger et al., 2012; Warnke et al., 1999). Results of this study indicate that doctoral students and recent doctoral graduates of counselor education programs perceived a positive impact of their PME on doctoral study. The positive impact of PME was described across all five core areas of doctoral development as defined by CACREP (2015; Section 6. B.1-5), yet was particularly strong regarding counseling, supervision, teaching, and leadership and advocacy. Quantitative analysis confirmed a significant predictive relationship between the amount of PME obtained and the perceived impact on development of supervision and leadership and advocacy as doctoral students. While some participants perceived that their PME had a positive impact on the development of research and scholarship, this impact was far less pronounced than in other core areas, and many expressed that their PME had no impact on development in the area of research and scholarship. These findings align with and extend upon previous findings (Sackett et al., 2015) that CES faculty members believe PME informs the supervision, teaching and research of CES doctoral students.
Previous research has noted the strenuous nature of entering CES doctoral studies, with such a transition being marked by fluctuations in both emotion and confidence (Dollarhide, Gibson, & Moss, 2013; Hughes & Kleist, 2005). This transition involves the expansion of professional roles to include that of a counselor, student, educator, supervisor, and researcher and scholar (Dollarhide et al., 2013; Lambie & Vaccaro, 2011; Limberg et al., 2013; West, Bubenzer, Brooks, & Hackney, 1995). A notable theme in the current study was the confidence that participants experienced and attributed to PME. With the tendency for new doctoral students to experience self-doubt in these multiple roles, the confidence gained through PME may help to mobilize internal resources, moving them forward in the developmental process as a CES doctoral student.
Considering all themes that emerged in this study of CES doctoral students and recent graduates, there is strong support for the value of experiential learning that is gained through PME. According to Kolb’s theory of experiential learning, concrete lived experiences provide the basis for reflection; then, from these reflections new information can be assimilated and abstract concepts can be formed (Kolb, 1984). Participants in this study described a common benefit of PME: having a base of experiences as a professional counselor to reflect upon during doctoral study. The process of reflecting on lived experiences as a counselor supports crystallization of knowledge in a doctoral program where additional theories, skills, techniques, and advanced facets of professional identity are developed.
Even though the majority of participants described a positive perceived impact of PME toward doctoral development, there were some who did not perceive as much benefit. This finding is reminiscent of Sackett et al.’s (2015) finding that some CES faculty members reported the counseling experience gained through the master’s and doctoral programs alone is enough and that success in a doctoral program is more reliant on the characteristics of each student. It is possible that learning styles may best predict whether and which master’s students benefit from PME prior to doctoral study. Kolb’s experiential learning theory (1984) stated that individuals have a preference among four modes of the learning cycle: concrete experience, reflective observation, abstract conceptualization and active experimentation. Considering Kolb’s four learning styles, it is possible that those participants who have a preference for abstract conceptualization rely less on lived experiences as a counselor to understand and apply concepts; thus, doctoral students with this preferred learning style might successfully develop in the five core areas of doctoral identity without perceiving any benefits from PME. Future research is needed to examine this hypothesis.
Research and scholarship was the only core area of doctoral professional identity that PME was perceived to have no impact on for a large group of participants (46.3%). This finding may be worth considering for CES faculty who advise master’s students interested in pursuing a doctoral degree. Depending on the master’s student’s career goal, obtaining PME may be less of a priority if aiming for a research faculty position, where teaching and supervision would not be a requirement.
Significance of Supervision, Leadership and Advocacy
A unique finding in this study was the positive, predictive relationship between the amount of PME obtained and the perceived impact on developing one’s identity in the areas of supervision and leadership and advocacy. Specifically, doctoral students who had more years of PME perceived a greater impact on their development in the areas of supervision and leadership and advocacy. For supervision, doctoral students who have not obtained any PME would be stepping into a new role where they are expected to provide teaching, consultation, and support for the skill development of counselors-in-training (Bernard & Goodyear, 2014). Having little to no time between being in the master’s student role of receiving supervision and to the role of providing supervision may present significant challenges. Alternatively, a “master” clinician does not automatically become a “master” supervisor; specialized knowledge and skills are required to develop supervision competency (Bernard & Goodyear, 2014). While obtaining some PME is perceived to significantly impact supervision development, the amount of PME may not be the only factor that influences supervision competence.
Open-ended comments shed further light on the perceived impact of PME and developing leadership and advocacy. Participants commented that through their lived experiences in schools and agencies, PME provided doctoral students with a sense of urgency about the needs of clients and the profession, thus motivating their advocacy work. Participants also acknowledged PME as valuable fodder for understanding their potential as leaders. Through the context of experience as a counselor, participants were better able to understand their ability to impact the profession through leadership and advocacy work as a counselor, supervisor and counselor educator.
Relevance of PME Setting
This study explored whether the setting of PME, school or clinical mental health, was related to the perceived impact of that experience on the five areas of doctoral identity development. The only significant difference in the setting where PME was obtained was in the areas of leadership and advocacy development. Those with school counseling experience perceived a greater impact of PME on leadership and advocacy development. For participants in this study, spending time working in a school system was essential to establishing a sense of oneself as a leader and advocate in school counseling.
Implications
While some evidence exists that PME is an important consideration in CES doctoral student admissions (Nelson et al., 2003; Swank & Smith-Adcock, 2014), the current study provides evidence of the perceived impact of PME in professional development as a CES doctoral student, especially in the areas of counseling, supervision, teaching, and leadership and advocacy. Quantitative analysis revealed a significant relationship between the amount of PME and perceived development in supervision and leadership and advocacy. Doctoral admissions committees may consider these findings as they weigh the pros and cons of applicants applying for doctoral study who have differing amounts of PME. Additionally, CES faculty advising master’s students whose ultimate goal is to pursue a doctoral degree may consider these findings as they offer guidance and support to students in the decision-making process.
Across the five core areas of doctoral professional identity development, PME was frequently perceived to boost confidence during doctoral study. However, there were some participants who reported a lack of confidence in the core areas of teaching and research, despite having PME. It would seem that teaching and research represent novel aspects of doctoral identity development, as both skill sets are not always involved in PME as a professional counselor. Research and scholarship is a primary focus of doctoral course content. In fact, the CACREP 2016 standards require CES doctoral students to become proficient in both qualitative and quantitative methodology (CACREP, 2015; Section 6 B.4.), which usually requires the completion of three or more research courses. With regard to teaching, many doctoral students are an integral part of counselor education programs, with roles as co-instructors, teaching assistants and guest lecturers. Yet, development of proficient teaching skills may extend beyond these co-teaching experiences during doctoral study, where vicarious learning and role modeling are heavily relied upon. As some participants in this study described, teaching is likely to be a new area of identity to develop; yet most (72.3%) reported that having years of PME aided their development as a teacher because they had real counseling experience to draw from and ample clinical examples to contextualize course content. Therefore, doctoral admissions committees should strongly consider the value of PME for doctoral applicants as a basis for development as a teacher.
In the current study, a wide variety of PME was represented (from 0–19 years), yet a question remains: How much experience is optimal to obtain? The current study only examined doctoral students’ perceptions. Within one theme in the current study, participants speculated about reaching a point of “diminishing returns,” in which too much time away from an academic setting (attaining PME) could result in a depletion of academic skills. However, two to three years of PME would typically allow CES applicants the opportunity to gain a counseling license, streamlining the career opportunities available to them upon graduation. Sackett at al. (2015) found that many CES faculty members advise master’s students to gain enough experience to earn licensure prior to pursuing doctoral study. For CES graduates who choose to continue practicing counseling in the field, provide supervision, or serve in administrative positions, state licensure is necessary. For CES graduates pursuing a faculty position, Bodenhorn et al. (2014) found that a majority of faculty postings sought applicants with licensure or two to three years of counseling experience. For either post-doctoral trajectory, obtaining at least two to three years of PME may be most beneficial.
Future Research
This study provided an initial exploration of the perceived impact of PME on core areas of identity development as a doctoral student, while privileging the perspective of those doctoral students. Future studies are needed to examine the relationship between post-master’s counseling experience, development during doctoral study, and professional impact as a counselor educator and supervisor. Specifically, studies should explore professional outcomes of counselor educators with varying levels of PME. For example, what are students’ perceptions of faculty members and supervisors with more or less counseling experience? How is the type of institution (high teaching versus high research) related to the amount and benefit of professional counseling experience? Is continued professional practice after earning the CES doctoral degree related to professional success, career satisfaction, teaching evaluations or scholarship productivity? Future research focusing on these issues will add to the literature on this aspect of the CES profession by answering these questions.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
References
Anfara, V. A., Jr., Brown, K. M., & Mangione, T. L. (2002). Qualitative analysis on stage: Making the research process more public. Educational Researcher, 31(7), 28–38.
Bernard, J. M. (2006). Tracing the development of clinical supervision. The Clinical Supervisor, 24, 3–21. doi:10.1300/J001v24n01_02
Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th ed.). New York, NY: Pearson.
Bodenhorn, N., Hartig, N., Ghoston, M. R., Graham, J., Lile, J. J., Sackett, C. R., & Farmer, L. B. (2014). Counselor education faculty positions: Requirements and preferences in CESNET announcements 2005–2009. The Journal for Counselor Preparation and Supervision, 6. doi:10.7729/51.1087
Boes, S. R., Ullery, E. K., Millner, V. S., & Cobia, D. C. (1999). Meeting the challenges of completing a counseling
doctoral program. Journal of Humanistic Education & Development, 37(3), 130–144. doi:10.1002/j.2164-4683.1999.tb00415.x
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159.
Council for Accreditation of Counseling and Related Educational Programs. (2015). 2016 CACREP Standards. Council for Accreditation of Counseling and Related Educational Programs. Retrieved from http://www.cacrep.org/for-programs/2016-cacrep-standards
Dollarhide, C. T., Gibson, D. M., & Moss, J. M. (2013). Professional identity development of counselor education doctoral students. Counselor Education and Supervision, 52, 137–150. doi:10.1002/j.1556-6978.2013.00034.x
Goodrich, K. M., Shin, R. Q., & Smith, L. C. (2011). The doctorate in counselor education. International Journal for the Advancement of Counselling, 33, 184–195. doi:10.1007/s10447-011-9123-7
Hughes, F. R., & Kleist, D. M. (2005). First-semester experiences of counselor education doctoral students. Counselor Education and Supervision, 45, 97–108. doi:10.1002/j.1556-6978.2005.tb00133.x
Johnson, R. B., Onwuegbuzie, A. J., & Turner, L. A. (2007). Toward a definition of mixed methods research. Journal of Mixed Methods Research, 1, 112–133.
Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice-Hall.
Lambie, G. W., & Vaccaro, N. (2011). Doctoral counselor education students’ levels of research self-efficacy, perceptions of the research training environment, and interest in research. Counselor Education and Supervision, 50, 243–258. doi:10.1002/j.1556-6978.2011.tb00122.x
Limberg, D., Bell, H., Super, J. T., Jacobson, L., Fox, J., DePue, M. K., . . . Lambie, G. W. (2013). Professional identity development of counselor education doctoral students: A qualitative investigation. The Professional Counselor, 3, 40–53.
Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook (2nd ed.). Thousand Oaks, CA: Sage.
Munson, C. E. (1996). Should doctoral programs graduate students with fewer than two years of post-MSW practice experience? No! Journal of Social Work Education, 32(2), 167–172.
Nelson, K. W., Canada, R. M., & Lancaster, L. B. (2003). An investigation of nonacademic admission criteria for doctoral-level counselor education and similar professional programs. The Journal of Humanistic Counseling, 42, 3–13.
O’Leary-Sargeant, J. L. (1996). A comparison of the relative ability of measures of interpersonal and academic intelligence in the prediction of clinical competence. Dissertation Abstracts International, 57(04), 2877B. (UMI No. AAG9627243)
Piercy, F. P., Dickey, M., Case, B., Sprenkle, D., Beer, J., Nelson, T., & McCollum, E. (1995). Admissions criteria as predictors of performance in a family therapy doctoral program. The American Journal of Family Therapy, 23, 251–259. doi:10.1080/01926189508251355
Proctor, E. K. (1996). Should doctoral programs graduate students with fewer than two years of post-MSW practice experience? Yes! Journal of Social Work Education, 32(2), 161–167.
Rogers, J. R., Gill-Wigal, J. A., Harrigan, M., & Abbey-Hines, J. (1998). Academic hiring policies and projections: A survey of CACREP- and APA-accredited counseling programs. Counselor Education and Supervision, 37(3), 166–178. doi:10.1002/j.1556-6978.1998.tb00542.x
Sackett, C. R., Hartig, N., Bodenhorn, N., Farmer, L. B., Ghoston, M., Graham, J., & Lile, J. (2015). Advising master’s students pursuing doctoral study: A survey of counselor educators and supervisors. The Professional Counselor, 5, 473–485. doi:10.15241/crs.5.4.473
Schweiger, W. K., Henderson, D. A., McCaskill, K., Clawson, T. W., & Collins, D. R. (2012). Counselor preparation: Programs, faculty, trends (13th ed.). New York, NY: Taylor and Francis.
Swank, J. M., & Smith-Adcock, S. (2014). Gatekeeping during admissions: A survey of counselor education programs. Counselor Education and Supervision, 53, 47–61. doi:10.1002/j.1556-6978.2014.00048.x
Warnke, M. A., Bethany, R. L., & Hedstrom, S. M. (1999). Advising doctoral students seeking counselor education faculty positions. Counselor Education and Supervision, 38, 177–190. doi:10.1002/j.1556-6978.1999.tb00569.x
West, J. D., Bubenzer, D. L., Brooks, D. K., Jr., & Hackney, H. (1995). The doctoral degree in counselor education
and supervision. Journal of Counseling & Development, 74, 174–176. doi:10.1002/j.1556-6676.1995.tb01846.x
Laura Boyd Farmer is an Assistant Professor at Virginia Tech. Corrine R. Sackett is an Assistant Professor at Clemson University. Jesse J. Lile is a couple’s counselor in Boone, NC. Nancy Bodenhorn is an Associate Professor at Virginia Tech. Nadine Hartig is an Associate Professor at Radford University. Jasmine Graham is a Clinical Assistant Professor at Indiana University Purdue University Indianapolis. Michelle Ghoston is an Assistant Professor at Gonzaga University. Correspondence can be addressed to Laura B. Farmer, School of Education (0302), 1750 Kraft Drive, Ste 2000, Blacksburg, VA 24061, lbfarmer@vt.edu.
