Counseling in New Orleans 10 Years After Hurricane Katrina: A Commentary on the Aftermath, Recovery and the Future

Dec 10, 2015 | Article, Volume 5 - Issue 4

Theodore P. Remley, Jr.

TPC Editor Note: Earlier this year I was in the wonderful city of New Orleans and realized it was the 10th anniversary of Hurricane Katrina. In 2005 I was involved with operations at the National Board for Certified Counselors that sent 240 National Certified Counselors to New Orleans and the surrounding area to provide direct crisis counseling and disaster relief. Having done similar work in New York City following the attacks in 2011, I found myself reflecting on what it might be like 10 years later in the Crescent City from a counseling perspective.

Of course I immediately thought to contact Dr. Ted Remley, who was living in New Orleans and teaching in counselor education at the time of the storm. I knew that his personal perspective would be invaluable, leading me to ask him to write this commentary about his reflections on mental health services in New Orleans today. Dr. Remley returned to the city last year to teach in a doctoral program in counselor education and supervision. His many years of experience and astute vision of the global process of counseling have resulted in the following personal analysis. It is my hope that this article is commemorative of the challenges that all mental health workers experienced during and after Hurricane Katrina, and the heroic services they provided during a time of extreme stress and loss. — J. Scott Hinkle, NCC

Ten years after Hurricane Katrina, the counseling profession in New Orleans has changed. The author, along with a group of counseling and other mental health professionals who were providing services at the time of the hurricane and still working in the city 10 years later, provided their impressions of counseling in New Orleans a decade after the storm. The population of New Orleans and the presenting problems of clients shifted after Hurricane Katrina. The residents have required help from counselors, supervisors, counselor educators and agency administrators in order to adapt to new challenges. The need for counselors to possess skills in trauma counseling was one of the lessons learned from the disaster. Agency administrators also advised using caution after a disaster when considering funding offers and research study proposals. While it may be impossible to prepare thoroughly for each unique disaster, Hurricane Katrina taught counseling professionals in New Orleans that after a disaster, flexibility and creativity are required to survive.

Keywords: Hurricane Katrina, mental health, trauma, disaster, counselor educator

Pausing to assess counseling and other mental health services in New Orleans 10 years after Hurricane Katrina has been a worthwhile endeavor. Many people are curious about what has happened to New Orleans since the hurricane, and counselors are particularly interested in how counseling and other mental health services have changed. The unique challenges due to Hurricane Katrina faced by New Orleans counselors who live and work in the city have not been forgotten or put aside since the storm.

The state of counseling and other mental health services in New Orleans a decade after the hurricane are presented in this article along with some of my own observations. This article does not report a qualitative study, but instead offers a summary of the impressions of counseling and other mental health services from a select group of professionals who were providing services at the time of Hurricane Katrina and still working in mental health agencies in New Orleans 10 years later. Rather than presenting only my observations of the state of counseling in New Orleans today, I asked several others to share their impressions and I have attempted to summarize their experiences.

Scholars have examined the aftermath of Hurricane Katrina and studied numerous aspects of the results of the devastating storm (Chan, Lowe, Weber, & Rhodes, 2015; Wang et al., 2007; Weisler, Barbee, & Townsend, 2006). Specific areas of investigation have included a school-based disaster recovery program for children (Walker, 2008), the precipitation of suicide (Kessler, Galea, Jones, & Parker, 2006), the disruption of mental health treatment (Wang et al., 2008), and the differences between people who were displaced and those who returned to New Orleans (Priebe, 2014). Analyses have been completed of leadership in the city (Gohl, Barclay, Vidaurri, Newby, & Arquette, 2015), the restructured education system (Lazarchik, 2015), the social capital and repopulation of New Orleans (Rackin & Weil, 2015), and tourism (Thomas, 2014; Vernet, 2015). Similarly, to obtain an up-close and personal perspective of the changes in counseling and other mental health services, I contacted professionals who were working in mental health agencies in the New Orleans area before or at the time of Hurricane Katrina and were still at a local agency today. These individuals also had a perspective and analysis regarding the effects of the hurricane, having had a major role in the continuation of counseling services at their agencies after the storm. And, like all residents of New Orleans, they also had to rebuild their personal lives following the hurricane.

The Changed City

New Orleans 10 years after Hurricane Katrina is different from the New Orleans that existed in August 2005. While the French Quarter, Uptown and other affluent neighborhoods appear hardly changed, at a deeper level the city is not the same as it was before the hurricane. The most obvious change, aside from the areas where houses are still boarded up and abandoned, is the population. New Orleans now holds 93% of the number of people it had prior to Hurricane Katrina (Shrinath, Mack, & Plyer, 2014). However, it is important to note that for several months after Hurricane Katrina, the city was still covered in floodwaters and had almost no people. Although the population has been reduced by 7%, a number of people living in New Orleans are new to the city. Many residents who lived in New Orleans before Hurricane Katrina did not return. The population loss affected the day-to-day lives of both the people who relocated to other areas of the United States and those who stayed behind and lost contact with relatives, friends and neighbors. Shrinath et al. (2014) provided a review of the changes in the New Orleans population that have occurred since Hurricane Katrina based on data provided by the U.S. Census Bureau. Overall, the population has become smaller, older, more educated and a bit poorer. In addition, New Orleans is now more Hispanic and Caucasian, and less African American.

New Orleans public schools have largely been replaced since Hurricane Katrina with charter schools, which nine out of 10 students now attend (Khadaroo, 2014). Many schools now contract with agencies that provide mental health counseling at school, significantly altering the role of traditional school counselors, and in some cases, replacing them. Today, counselors working as mental health counselors in schools in New Orleans are called upon to diagnose and treat emotional and mental disorders and to be much more involved in family counseling than school counselors were in the past. Consequently, traditional school counselors have been forced to interface with contracted mental health counselors and redefine their roles and responsibilities.

Implications for Counselors and Counselor Educators in New Orleans

One of the facts that counselors learned from Hurricane Katrina is that the demographics of a population will likely change after a disaster (Arendt & Alesch, 2014). Counselors will need to shift from serving one population to another, and will be required to learn new skills. Following a disaster, administrators will need to provide continuing education for counselors so that they can learn new skills, and counselor educators will need to prepare graduate students for work in disaster environments.

Changes in the median age of New Orleans citizens after the hurricane have resulted in an older population, fewer children and more people living alone, which have had a significant impact on counselors providing services in the city today. Counselors with little to no expertise in providing services for elderly, isolated clients have had to be educated on new skills. In fact, many counselors who previously worked with children are now counseling older adults with different needs.

Prior to Hurricane Katrina, few schoolchildren had access to mental health counseling to the extent that they do in today’s charter schools. Counselor educators in New Orleans now prepare counselors who wish to work in schools for both the traditional role of school counselors in parochial or public schools and for the new role of school mental health counselors for those positions in agencies that contract to provide services in charter schools.

Counselors in New Orleans served a population challenged by poverty prior to Hurricane Katrina and continue to provide services to people who are impoverished at a much higher rate than people living in many other areas of the United States. Counseling individuals living in poverty requires special skills in order to serve their needs (Ratts & Pedersen, 2014). As a result, universities in New Orleans are required to prepare their graduates to understand and serve clients of poverty. Moreover, a report issued in the fall of 2012 by The Data Center, an independent research organization in New Orleans, indicated that 37% of the people in New Orleans live in asset poverty, defined as not having enough funds to support a household for 3 months if the main source of income was lost (Shrinath et al., 2014). Asset poverty has particularly severe implications in New Orleans because evacuations from hurricanes are necessary every few years and require funds or credit. Counselors in New Orleans who provide services to poor clients must help their clients prepare for hurricane evacuation despite not having needed financial resources. This narrative is told countless times during each evacuation maneuver.

My Story in Brief

I am a counselor educator and was one of the counseling professionals in New Orleans who chose to relocate after Hurricane Katrina. While such decisions are complicated and are motivated by multiple factors, the primary concerns that led to my departure were that the university where I was working, like all entities in New Orleans, was unstable and experiencing severe financial stress, and I was caring for my elderly mother who needed regular medical attention that was not readily available in the city after the hurricane. I resigned from the university in New Orleans in May 2006, almost a year after the hurricane, and relocated to another state to teach in a counselor education program. I had the opportunity to return to New Orleans eight years later and assumed my current position as a counselor education professor in 2014. When I left New Orleans in 2006, I was sad to be leaving my colleagues and friends, quite apprehensive about my professional future, financially vulnerable, and concerned about health care for my family members as well as myself. When I returned eight years later, I was happy to be returning to my circle of friends, delighted to be welcomed by colleagues, comfortable with my professional future, financially secure, and confident that health care was readily available in New Orleans. When I returned, I found a city that was different in many ways since the hurricane, and a city that also was much the same.

The differences in New Orleans 10 years after Hurricane Katrina, from a personal perspective, were both subtle and striking. After living with my family temporarily in the mountains of Georgia, my return to New Orleans for a visit about two months after the storm was astonishing. Public services were limited. On the other hand, the city was functioning. People were going to work, utilities had been restored, and residents who had returned were doing their best to resume the lives they had known prior to the storm. I experienced many personal challenges, which included repairing my hurricane-damaged home, finding daily care for my elderly mother, and hosting friends for a year who had lost their home in the flood that followed the hurricane. During these challenges, I remained aware and thankful that my burdens were far fewer than those of many of my neighbors, friends and fellow residents.

New Orleans 10 Years Later: My Perspective

My personal impressions of New Orleans 10 years after the storm are generally positive, but there are many scars for those living in the aftermath of the storm. When I returned in 2014, one of my friends who had not left and was still living in the city said, “After Hurricane Katrina, everything changed” (Anonymous, personal communication, August 1, 2014). He said his friends were gone, he no longer had his job, his children and their families had relocated out of state, and everything seemed a mess. His reaction was not unique. Much has been written about the hardships faced by people after Hurricane Katrina, particularly by the poor and uneducated, but many of the stories of professional mental health workers living in the city at the time of the storm have not been told. For the past decade, counselors in New Orleans have been serving the citizens, including counselors who lost their homes in the flood after the storm.

For me, day-to-day life in New Orleans 10 years after Hurricane Katrina appears to be much what it was before the disaster. There is still too much poverty and crime. Although in the French Quarter one can hardly see any differences a decade later, a drive through the Ninth Ward or the community of Lakeview near Lake Pontchartrain shows the devastating aftermath of the hurricane.

Changes in Mental Health Services in New Orleans Since Hurricane Katrina

     In an effort to encourage the mental health professionals I contacted to be forthright and free from inhibition in their responses, no individuals or agencies are identified; and because of this degree of privacy, only general information is provided. Mental health professionals who were still working at agencies in New Orleans and responded to my questions included counselors, psychologists and social workers in public and private nonprofit agencies that provide a wide array of counseling and other mental health services to all levels of the population. I was able to obtain informal, personal responses to a series of questions from eight mental health professionals who were working in counseling and other mental health agencies before Hurricane Katrina and are still working in agencies a decade later. The information, perspectives and comments they provided helped paint a picture of mental health services in New Orleans today.

It is telling in itself that I was able to locate only a few mental health professionals who were still working in the same agencies in New Orleans 10 years after Hurricane Katrina. The agencies themselves have changed substantially. Although some have flourished, many have decreased in size and a number have ceased to exist. Staff turnover in New Orleans mental health agencies has been significant. Almost all top-level administration positions are held by different people, mental health practitioners have come and gone, and the number of staff members has generally decreased. I contacted the largest governmental mental health agency in the city in an effort to find a person who had been working there at the time of Hurricane Katrina and was still there. Not one administrator or mental health professional fit the criteria; there had been a 100% staff turnover in the past 10 years.

Agency differences 10 years after the hurricane. When asked to compare and contrast the current circumstances at the agencies with the situation 10 years before, the mental health professionals provided a variety of responses. Most agencies are operating 10 years after the disaster in a fashion similar to what they were doing prior to the hurricane. For an agency to have survived after Hurricane Katrina is, in itself, notable. All agencies were closed for several months during the evacuation of the city and some did not reopen for a significant period of time. In several agencies, as might be expected, the services shifted to dealing with trauma, with two agencies now specializing in trauma recovery. Several professionals reported that counseling and other mental health services after the storm were less often provided by licensed mental health professionals. For example, mental health interns who were completing their degree programs, as well as individuals who had completed their degrees and were working toward licensure, were often providing services. These changes might suggest that the quality of counseling services had been compromised in New Orleans. Certainly counselor educators and counselor supervisors have experienced an added burden of preparing new counselors to hit the road running (i.e., be better prepared to deliver professional counseling services earlier in their careers than what might normally be expected). Counseling supervisors have had to closely monitor the work of neophyte professionals to ensure that counseling services are of high quality.

One counseling agency experienced tremendous growth, morphing from a small agency with three part-time mental health professionals to an agency with over 50 mental health providers who are either licensed or working toward licensure. Such significant growth can test an organization’s capacity to function effectively. Administrators at this agency have been challenged to find and hire competent counselors with the needed expertise to serve the population.

Three agency professionals indicated that they have been more focused on evidence-based mental health practices since Hurricane Katrina. They did not indicate why this change had occurred, but it is notable that such a change did become part of the agencies’ practices. It is likely that governmental and private funding agencies required grant recipients to demonstrate engagement in mental health practices that were evidence-based.

Client needs after the hurricane. Mental health professionals reported significant shifts in the populations that they served prior to Hurricane Katrina and afterward. Several reported that the number of services for individuals suffering from trauma had significantly increased, not only from the hurricane, but also from other types of crises, including sexual trauma and other forms of violence.

One agency professional who served primarily indigent clients indicated a significant rise in the demand for free or reduced-cost services from families in households with incomes below $20,000 per year. At this particular agency, 25% of the clients came from families with incomes between zero and $8,000 per year. At the other extreme, an agency that served a more affluent population had an increase in the number of young adult clients who moved to New Orleans to take jobs assisting in the city’s recovery. Consequently, counselors at agencies have had to adjust to serving clientele they may not have worked with in the past. Agency administrators have had to provide significant in-service training to help counselors adjust to changing client needs.

Mental health professionals reported serving more Hispanic clients and indicated that attention-deficit/hyperactivity disorder and depression and anxiety issues have become more prevalent. Several agency professionals indicated that since Hurricane Katrina, they have served more clients in general, and specifically more children. In addition, some counselors who had never counseled children received in-service education in counseling children and adolescents. Currently, there is a need in the city for counselors who are bilingual and can provide counseling services in Spanish.

     Changes in professional-to-client ratios since Hurricane Katrina. Five mental health professionals indicated that their agencies had established a maximum number of clients that each professional could serve in order to ensure that those who were served would receive high quality services. Some agencies established waiting lists and began offering more group services in order to avoid overburdening their professional staff.

Those agencies that had found it financially necessary to decrease their staff had correspondingly decreased the number of clients served. One mental health professional commented that challenges with Medicaid and health insurance reimbursement had made it difficult to afford the number of licensed mental health professionals needed. Agency administrators have had to protect their counselors from stress and burnout as client demand has increased and the number of staff has decreased. Administrators have met this challenge by reducing the number of clients on counselors’ caseloads, establishing waiting lists and offering more group services. The shift to more group services implies that competent group counseling skills and experiences are needed in New Orleans.

     Government funding since the hurricane. When asked whether their agencies had received state or federal funding to support them since Hurricane Katrina, most professionals indicated that their agencies had received such funds. Agency administrators reported receiving funds from a local parish government agency that distributes funds from the federal government (specifically, from the U.S. Department of Housing and Urban Development and the Substance Abuse and Mental Health Services Administration). Some agency administrators also reported receiving funding from the American Red Cross, United Way, and local foundations and charities. Three agencies reported receiving Federal Emergency Management Agency funds for operating costs and reconstruction after the hurricane.

How Would Agencies Be Different if Hurricane Katrina Had Not Happened?

Mental health professionals were asked how they believed their agencies would be different today if Hurricane Katrina had not happened. Responses varied. Two mental health professionals said that if the hurricane had not occurred, their agencies would have continued to struggle financially, indicating that the hurricane had brought at least a degree of relief from financial problems. Perhaps the outside funding that flows into an area after a natural disaster can infuse funds into financially struggling counseling agencies, allowing them to continue to operate when they might not have been able to do so if the disaster had not occurred.

Several mental health professionals reported that because of Hurricane Katrina, agency personnel had learned a great deal and certainly would be able to handle any similar type of natural disaster in a better fashion if one should occur in the future. Today’s counseling graduate students are being taught disaster, crisis and emergency response counseling procedures, as required by the Council for Accreditation of Counseling and Related Educational Programs (2009) in their counselor preparation curriculum. However, most counselors completed their graduate training prior to the time that these standards were implemented, requiring in-service training in post-disaster operations.

Most agency personnel reported that their agencies had benefitted from having experienced Hurricane Katrina. One mental health professional indicated that if not for the hurricane, the agency would not have a close relationship with area schools, would lack evidence-based practices devoted to psychological trauma, and would be wanting in innovation and creativity. Another said that the agency would not have grown as much. Two mental health professionals suggested that Hurricane Katrina had provided their agencies with national attention that allowed the agencies to become leaders in their areas of specialization, which included juvenile justice and trauma. One mental health professional said that without the hurricane, the agency would not have been tested or trained in the following areas: crisis management, grief and loss due to a natural disaster, management of post-traumatic stress disorder, and how to counsel when the counselor is experiencing similar stressors. Lastly, another counseling professional indicated that staff would not have received trauma recovery training if Hurricane Katrina had not occurred.

Recommendations for Mental Health Agencies

Mental health professionals who provided information for my personal analysis offered recommendations for counselors who must contend with a disaster. They also gave recommendations to agency personnel for preparing for a disaster.

Recommendations on Contending With a Disaster

Three mental health professionals suggested that perhaps preparing for specific disasters is impossible, while there was agreement that agencies should be prepared to deal with emotional trauma in the event of a natural disaster. Two mental health professionals suggested that planning for the possibility of a disaster would most likely not be productive. One mental health professional said that “preparing for the next disaster based on experiences from Hurricane Katrina would be like preparing for the next war based on experiences from the last one.” This mental health professional added that all disasters are unique and that it would do no good to base disaster recovery plans on what New Orleans experienced as a result of Hurricane Katrina. Another mental health professional emphasized that being flexible is essential, so that programs can be developed to meet the needs of the community.

Although no amount of disaster preparation can help counseling agencies prepare for all possible challenges, perhaps the best response to disasters is to be flexible, creative and practical, taking on each problem as it is encountered. One mental health professional cautioned that agencies should be prepared not only to treat clients with post-traumatic stress disorder resulting from the disaster, but also to treat trauma symptoms that stem from unresolved trauma from childhood or past life experiences that surface after the newer trauma caused by a recent disaster. The concept that mental health agencies should always be prepared to deal with the trauma that follows a natural disaster was universally voiced by mental health professionals. In addition, self-care for counselors has become a popular topic in the professional literature (Alvarez, 2015; Ohrt & Cunningham, 2012; Thompson, Frick, & Trice-Black, 2011; Witt & McNichols, 2014), and mental health workers in New Orleans emphasized assessment of trauma among counselors for up to two years after a disaster.

The most significant disagreement among mental health professionals concerned whether it is advisable to join in collaborative efforts or partnerships with other agencies after a disaster. While one mental health professional said that collaboration is a key to recovery, and two counselors supported this idea, another mental health professional said that collaborative partnerships have the potential to support incompetence and ruin inter-organizational relationships. A third mental health professional warned that mental health agencies should not chase or accept time-limited funding after a disaster, and should not expand services based on funding that will soon disappear.

One mental health professional indicated that collaboration was touted as the best recovery tool by many after Hurricane Katrina and acknowledged that the concept of collaboration after a disaster could be a win-win for organizations leveraging their collective expertise into post-disaster response and recovery. This mental health professional said that organizations outside the community often want to create a collaborative partnership after a disaster by providing trauma intervention or counselors for a local agency at no cost. However, such offers could possibly be exploitive. Often the intervention offered is not evidence-based, and the outside organization wants to use the agency as a way to increase its own credibility or perhaps raise funds because its employees are responding to the needs of the community after a disaster. Furthermore, this mental health professional warned that university professors who want to conduct research are often more interested in increasing their scholarship productivity than helping a mental health agency recover from a disaster. Counselor educators should of course avoid exploiting disaster situations for the sole purpose of increasing their research publications. Counseling agency administrators need to be cautious after a disaster when they are approached about participating in proposed research or service projects.

One mental health professional gave the following advice regarding response to outside organizations or individuals who want to help after a disaster:

I would create collaboratives that are measured in three or six month intervals when every party can check in and decide if the partnership is still working for them. The more difficult questions can come when one of the collaborative partners is not working to their potential, or is undermining the project unintentionally or intentionally. These are often ugly and very difficult situations to solve, and I don’t have much advice on these situations other than to be transparent and honest and to communicate your concerns with leadership when you see these situations on the horizon. (Anonymous, personal communication, May 28, 2015)

This mental health professional suggested asking hard questions of potential collaborative partners, including, “What’s in it for you? What’s in it for us? How long will you be around? What’s your long-term plan after one or two years? How do we continue this after you are gone? How will your success be measured? Who do you report to and what’s their expectation of this collaborative?”

Recommendations on Preparing for a Disaster

Mental health professionals offered a host of general and specific recommendations regarding how agencies should prepare to face a disaster like Hurricane Katrina in the event that such a disaster should occur. General recommendations included ensuring that an agency is well-managed before a disaster if it is to survive the aftermath. Mental health agencies need to develop strong collaborative relationships with other agencies prior to an emergency. Putting into place evidence-based mental health practices provides a strong foundation for moving forward after a disaster. Staff members need to be flexible in their problem-solving because a culture of flexibility, in contrast to rigidity, helps agencies survive disasters.

Specific advice regarding preparing to survive a disaster such as Hurricane Katrina included the following: create an inventory of equipment to help report losses; operate within financial limitations; create a disaster plan that includes specific actions for before, during and after the disaster; create electronic records and have a server outside the area of operation; cross-train office staff; create and test a disaster communication plan; employ a staff grant writer; and create emergency plans for clients. This advice should be beneficial to counselor educators who teach classes in which disaster counseling topics are addressed.

Conclusions

After reviewing the demographics of New Orleans 10 years after the hurricane and communicating with eight mental health professionals who were working in the city prior to the hurricane, I offer the following observations. Overall, most mental health agencies have maintained the level of services they were providing before Hurricane Katrina, although some have actually expanded. Before Hurricane Katrina, there were not enough counseling and other mental health services for poor and middle-class families in New Orleans, and the same situation continues to exist 10 years after the storm.

A focus and specialty has emerged in most mental health agencies in New Orleans since Hurricane Katrina around issues of trauma. Consequently, the study of trauma has become quite popular in the professional literature (see Alvarez, 2009; Brown-Rice, 2013; Buss, Warren, & Horton, 2015; Cohen et al., 2009; Fernandez & Short, 2014; Hudspeth, 2015; Jones & Cureton, 2014; Jaycox et al., 2010; Langley et al., 2013; Parker & Henfield, 2012; Tosone, Bauwens, & Glassman, 2014). As one mental health professional pointed out, a natural disaster not only precipitates the distress resulting from the crisis experiences, but also brings unresolved prior trauma to the surface for many clients. Since trauma is likely to be a significant focus of mental health agencies after a disaster, disaster preparedness plans should include the education of all staff members on counseling trauma victims.

It appears that mental health agency personnel in other locations who want to learn from the experiences of practitioners who dealt with the aftermath of Hurricane Katrina in New Orleans should consider the advice given by several mental health professionals with whom I communicated—prepare to be flexible in case disaster occurs. Perhaps counselors and administrators who have leadership skills that include creativity and flexibility would be ideal for agencies after disasters have occurred, as opposed to those who have a high need for structure or who have trouble operating without clear procedural guidelines. \

While partnerships and collaborative arrangements have the potential for helping mental health agencies survive and even prosper after a disaster, such arrangements should be evaluated carefully prior to agreement. Leaders in one of the New Orleans agencies attributed their growth and expansion to collaborative relationships and partnerships. However, several other mental health professionals appeared to have had negative experiences with collaborative arrangements and recommended that such offers be viewed with caution. Accepting time-limited financial support also can lead to problems if agencies expand their services based on temporary support and must then scale back after financial resources disappear.

The most important lesson I learned from interviewing agency administrators in New Orleans who have been at their agencies for the 10 years since Hurricane Katrina was that it would have been impossible to prepare for the aftermath of the storm. As a result, it is important after a disaster for counselors and administrators to assess their unique situation, determine what counseling services are needed, provide in-service training when necessary, avoid relying on short-term funding to plan for the future, and pay attention to the self-care of counselors. New Orleans is unique and Hurricane Katrina’s flooding of the city was a unique event. Several mental health professionals indicated that assessing the needs of the community after the storm and responding to those needs, as well as caring for the well-being of their employees, were critical aspects of their successful survival.

Conflict of Interest and Funding Disclosure

The author reported no conflict of interest

or funding contributions for the development

of this manuscript.

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Theodore P. Remley, Jr. is a Professor at Our Lady of Holy Cross College. Correspondence may be addressed to Theodore P. Remley, Jr., 4123 Woodland Drive, New Orleans, LA 70131, tremley@olhcc.edu.

Interdisciplinary Training: Preparing Counselors for Collaborative Practice

Dec 8, 2015 | Article, Volume 5 - Issue 4

Jane E. Atieno Okech, Anne M. Geroski

This article utilizes one counselor education program’s experience as a framework for exploring how to prepare counselors to work in interdisciplinary teams. Based on an interdisciplinary training program that involves faculty and graduate students from counseling, social work, nursing, internal medicine and family medicine, the article explores the role discipline-specific orientations play in the outcome of interdisciplinary training programs. Using practical examples grounded by the program’s experiences and literature on interdisciplinary training, understanding of the dynamics of interdisciplinary training programs is explored. Implications for preparing counselors for interdisciplinary work and future research are provided.

Keywords: counselor education, interdisciplinary training, interdisciplinary teams, collaborative practice, medicine

Counselors typically work in interdisciplinary settings, requiring them to navigate the complex dynamics of collaboration while maintaining a clear focus on the best interests of their clients. Interdisciplinary settings can be described as contexts that require collaboration and consultation between professionals and non-professionals from multiple disciplines in the process of providing service (Nancarrow et al., 2013). Collin (2009) clarified that interdisciplinary collaboration differs from multidisciplinary and transdisciplinary collaboration as it refers to the work of professionals grounded in their own separate disciplines coming together to work on a project that represents a “coordinated and coherent whole” (p. 103). Collin pointed out that this is different from professionals working independently on separate aspects of a project (multidisciplinary) or the coming together of multiple and varied professionals to conceptualize a problem or work on a project that transcends any of the various disciplines (transdisciplinary).

Counselor educators have argued that interdisciplinary collaboration is “a best practice strategy for addressing some of the nation’s critical social problems” (Mellin, Hunt, & Nichols, 2011, p. 140). In fact, collaboration between disciplines has been described as being key to the effective delivery of services (McNair, 2005; Morphet et al., 2014) across a broad-spectrum of community mental health services, hospitals, institutions of higher learning and school contexts. In the field of counseling, the ACA Code of Ethics (American Counseling Association [ACA], 2014) and the standards established by the Council for Accreditation of Counseling and Related Educational Programs (CACREP, 2009) reflect this emphasis on the importance of counselors being able to work with interdisciplinary teams. The ACA Code of Ethics (ACA, 2014), for example, encourages counselors to recognize the value of interdisciplinary teamwork in meeting clients’ best interests, even when certain professional values are not shared:

Counselors who are members of interdisciplinary teams delivering multifaceted services to clients remain focused on how to best serve clients. They participate in and contribute to decisions that affect the well-being of clients by drawing on the perspectives, values, and experiences of the counseling profession and those of colleagues from other disciplines (ACA, 2014, D. 1. C., p. 10).

The ACA Code of Ethics also compels counselors to respect client rights, including those regarding confidentiality, in interdisciplinary treatment contexts (ACA, 2014, A. 2. b., p. 4; B. 3. b., p. 7).  The CACREP (2009) training standards emphasize the importance of teaching counselors to understand the functions of other human service agencies and to learn strategies for inter-agency collaboration. In these standards, addictions, marriage, couples, family and career counselors are required to be familiar with the roles of other mental health professionals, and in the clinical mental health counselor standards, the importance of learning how to develop relationships across helping professions and interdisciplinary treatment teams is highlighted. Additionally, school counselors-in-training under CACREP standards also must learn models of consultation and collaboration as a part of their training programs.

Despite these standards, counselors appear to navigate the challenges of interdisciplinary collaboration with limited understanding and experience. Little has been written about interdisciplinary training or the development of interdisciplinary competencies by counseling professionals (Bemak, 1998). Counseling literature and training standards appear to operate from the premise that the process of professional development is automatically accompanied with the acquisition of skills to work in interdisciplinary teams. In contrast, the medical field and associated disciplines have actively documented interdisciplinary training initiatives as a means for facilitating interdisciplinary competencies among their professionals (Pollard & Miers, 2008). For example, in the United Kingdom, the integration of Interprofessional Education (IPE) is now mandatory in the fields of health and social care, with students being required to complete specific modules that have practical interdisciplinary components (Pollard & Miers, 2008). Medicine in the United States also is actively pursuing interdisciplinary training models with the support of the Institute of Medicine, which recognizes interdisciplinary teamwork as key to effective service delivery (Institute of Medicine, 2003; McNair, 2005). Therefore, while counselors continue to make a case for the value of interdisciplinary work, what remains unclear in the literature is how counselors can attain competence in facilitating and participating in interdisciplinary collaborative practices. It is particularly critical to examine how these competencies can be developed while neophyte counselors are also in the foundational stages of their professional development.

The purpose of this article is to use the experiences of one counselor education program currently engaged in an interdisciplinary training project as a framework for exploring some critical benefits and challenges of interdisciplinary training processes. This article provides a detailed description of the counselor education program’s training module and also describes steps the program has taken to prepare students for interdisciplinary training contextual dynamics, measures the program has taken to advocate for the counseling profession, and efforts to enhance students’ understandings of their professional roles in an interdisciplinary context. Using practical examples grounded by interdisciplinary literature, we expand understanding of shared interdisciplinary values and provide recommendations for more effective practices and future research.

Interdisciplinary Training Program Development

This training collaborative began with an interdisciplinary response to a grant call by the Substance Abuse and Mental Health Services Administration (SAMHSA) to submit a proposal on providing training in Screening, Brief Intervention, and Referral to Treatment (SBIRT). SBIRT is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for adolescents and adults dealing with substance misuse issues (Agerwala & McCance-Katz, 2012; Davoudi & Rawson, 2010; Mitchell et al., 2012). This particular university’s SBIRT Training Collaborative brings together master’s students from the counseling program, the Department of Social Work, the College of Nursing, and family medicine and internal medicine residents in an interdisciplinary training program using a team-based care model of evidence-supported SBIRT interventions. These programs were chosen because they all are disciplines that deal with issues related to substance misuse. Additionally, these were the only disciplines at our university that responded to the call to participate in this particular project. The objective of the project is to offer brief intervention and referral training to medical residents and master’s level graduate students in the area of substance use disorders over a 3-year period. An average of 20 students from each of the participating disciplines were expected to participate in the project annually. This training program began its third year of implementation this year. The SAMHSA grant enabled the interdisciplinary training collaborative to hire SBIRT consultants, a project manager, a project training director and qualified support staff to help administer the project. The funding is a critical part of the success of this project, allowing for faculty course buyouts across the participating disciplines.

The interdisciplinary collaborative aspect of this project began during the initial meeting of educators from the various disciplines, which was organized to discuss submitting a grant proposal in support of an interdisciplinary training program. Each program’s director was required to submit a statement indicating how their program would benefit from an interdisciplinary training project. Two initial meetings and multiple e-mail exchanges later led to the formation of an interdisciplinary collaborative team and an agreement by the team on (a) the core foci of the grant, (b) the level of participation by each program and the roles of faculty representatives on the grant writing, (c) budget allocation parameters, and (d) the establishment of a project advisory council made up of the directors of each of the disciplines represented in the project. The purpose of the project’s advisory council was to develop the curriculum for the program, which included assessing and ultimately agreeing on the online modules to use on the project, and to establish clear guidelines for the clinical training protocol. Secondly, the advisory council also was charged with ensuring that each discipline provided input on the curriculum development and project evaluation processes. This aspect of the dialogue was critical as one of the objectives of the grant was for programs to incorporate interdisciplinary training foci in their individual discipline’s curriculum. Third, the council was charged with the responsibility of implementing and assessing the clinical training aspect of the interdisciplinary training project. Advisory council members committed to serve on interdisciplinary presentation panels and also to provide supervision during the interdisciplinary clinical training sessions. Finally, the council members were expected to be available to address student conduct issues as well as to meet with external grant reviewers during their visits to campus.

The SBIRT Interdisciplinary Training Model

This university’s SBIRT interdisciplinary training format is multifaceted, including online and real-time instruction and practice experiences. All family practice and internal medicine residents and master’s-level graduate students in the participating disciplines are expected to sign a contract that they will participate in all required aspects of the training experience. SBIRT training is offered in four main areas: (1) screening for substance use disorders, (2) motivational interviewing skills, (3) brief intervention, and (4) referral to treatment. Training includes providing conceptual information (e.g., substance use and motivational interviewing), teaching the use of assessment tools to establish risk or levels of substance misuse, and promoting skill development. Modeling and skill practice with feedback from faculty are important components of this training.

The first SBIRT training cohort started with first-year master’s-level graduate students and medical residents. The counseling students involved in the project were in their second semester in the program and concurrently enrolled in a practicum course. For counseling students, the training began with an orientation (counseling program pre-module orientation) to the SBIRT training experience. In the orientation, counseling faculty offered students an overview of the various components of the training project, outlining specific expectations and completion dates. Beginning in the project’s second year, the orientation included the film, The Hungry Heart (O’Brien, 2013), which explores the depth of prescription drug and opiate addiction in our home state. This film was followed by a discussion regarding the need for SBIRT screening and referral skills. While counseling students are required to participate in this orientation, the option to attend the session also is open to participants from other disciplines.

The next component of the training, conducted online, is required for all participants (faculty and students), regardless of discipline. The online training includes four instructional modules (see Figure 1) and requires a commitment of approximately four to six hours. The first of these online training modules offers an introduction to the SBIRT process and includes data regarding alcohol and substance use. This information builds a case for the need for SBIRT screening and referral practices. The other modules provide instruction in the areas of conducting a brief screening intervention, motivational interviewing, and making appropriate referrals. Each module begins with instruction in a particular area and requires completion of a test before the participant is issued a completion certificate. The certification process was included as a means of ensuring that all participating students complete the required didactic training and tests prior to participating in the interdisciplinary clinical training portions of the program.

At the end of the online training period, counseling students are required to attend a 2-hour practice review (counseling program post-module review and skills practice) session (see Figure 1). A similar post-module review and practice session is offered by other SBIRT project faculty for medical residents and to promote interdisciplinary training; each discipline-specific post-module review is open to participants from other disciplines. In this training, counseling faculty offer a brief review of the information provided in the modules, focusing primarily on the steps of the brief negotiated interview (alcohol and substance use screening) and the motivational interview. Participants engage in role-plays to practice these skills and are provided with instruction and feedback by the counseling faculty.

Figure 1 – Interdisciplinary Training Protocol

The intent of this training session is to reinforce counseling students’ sense of competence prior to engaging in interdisciplinary training sessions. This session helps students frame the online training information into counseling-specific terms, steps and experiences while providing them the opportunity to ask questions and clarify their understandings. Importantly, this session requires students to practice the SBIRT skills and to receive feedback and instruction on their use of the skills from familiar faculty in the comfortable environment of counseling peers. Ultimately, this preparation is designed to fortify the confidence that the counseling students bring into the larger, unfamiliar, interdisciplinary practice setting.

Next, all participants in the SBIRT training, regardless of specific discipline, are expected to attend two clinical interdisciplinary training sessions. The first of these focuses on screening and motivational interviewing; the second is on referrals. These sessions begin with an introduction to the concepts that will be covered in that training followed by a panel discussion about the particular application of skills in the various disciplines and the modeling of skills (a role play by two of the program directors). The participants are then required to practice the skills with “live” practice clients (i.e., professional actors from the local community that were already employed by the medical school for medical student training) playing patients/clients with substance use or misuse issues. In this part of the training, participants are randomly assigned to small practice groups, providing an interdisciplinary practice milieu, with a faculty instructor. Each interdisciplinary practice group meets with four professional clients over the course of 2 hours. The participants in each group take turns using screening, motivational interviewing and referral skills. In each group, participants receive feedback and instruction from the faculty instructor who has observed their practice. At the end of the session, the training directors engage participants in a large group discussion about their experiences and observations of being part of an interdisciplinary training group. The intent of this approach is to provide participants with the opportunity to practice with students who have different professional orientations and to receive supervision from faculty who may also have diverse experiences and perspectives; thus, the interdisciplinary focus of this project.

The final component of the training is follow-up. For counseling students, this begins with a follow-up discussion about the training experience with the counseling faculty at the end of the first year of training (after the second interdisciplinary training session). In this meeting, students are asked to reflect on their experiences in SBIRT training and also to discuss their ideas regarding the implementation of this training into their upcoming internship experiences. The purpose of this discipline-specific follow-up is to assess and solidify the integration of the interdisciplinary experiences into their development as professional counselors.

A comprehensive formal evaluation protocol also is in place for the interdisciplinary training program. Students from each of the participating disciplines complete pre- and post-training evaluation forms. During the first year of the project, formal follow-up evaluations were completed in four stages: (1) immediately after students completed the counseling program’s pre-module orientation session; (2) immediately after students completed each of the two interdisciplinary clinical training sessions; (3) six weeks after students completed the final interdisciplinary training session, and (4) six months following completion of the final interdisciplinary clinical training session. These evaluations solicit student self-perceptions of their own competence during the various training experiences and also ask for general feedback about the training process. The six-month follow-up evaluation process is meant to coincide with the students’ internship and residency experiences. The core objective of the final evaluation will be to assess the impact of interdisciplinary training on the students’ current interdisciplinary teamwork experiences.

Interdisciplinary Training Challenges

Interdisciplinary training and practice is complicated; sound logic and good intentions can easily be derailed by any number of intra- and interprofessional challenges. Here we will discuss challenges related to training in silos, and professional orientation, values and attitudes.

Training in Silos

The literature suggests that understanding the skills, knowledge and values of the various disciplines involved in an interdisciplinary collaboration is key to success (Wellmon, Gilin, Knauss, & Linn, 2012). Yet, this may be a challenge when professionals require specialized training that sometimes has the effect of narrowing their views and approaches to service delivery (Forrest, 2004). That is, it can be difficult for professionals to acquire the skills needed for communicating and collaborating across disciplines (Miller & Katz, 2014) when training in silos orients professionals to become strongly acculturated in their own language and practice styles.

We found in the interdisciplinary SBIRT project that these silo effects of discipline-specific training were apparent. It became clear immediately that most of the participants had strong discipline-specific skills and orientation allegiance, and many had little information about conditions and situations beyond their specific training area. This dynamic was evident at both faculty and trainee levels. Faculty had to navigate this dynamic during the process of planning and writing the grant proposal and negotiating the development of the training curriculum in the project’s advisory council (made up of program directors of participating disciplines). For example, the counseling director had to educate her medical practice peers on counselor education curriculum, counseling professional practice, and contexts of counseling practice. Further, the directors of counseling and social work had to educate peers on the similarities and differences between the two professions. At the same time, the directors of the family medicine and internal medicine disciplines had to educate their counseling and social work peers on the difference between the two specializations in medicine. Nursing faculty also addressed the distinct role of nurse practitioners in the field of medicine and the intersections between their roles and that of medical doctors.

At the trainee level, the discipline-specific skills and orientation allegiance was evident, particularly in both the brief intervention and the referral to treatment components of the interdisciplinary training sessions. For example, while many of the medical residents were articulate when explaining the physical effects of potential substance use to their professional clients, they were slow to pick up on sociocultural variables that may have been key to the etiology of the substance misuse (and for later referral) in these same cases. An example of this was a professional client who hinted at challenges with a transgender social location that appeared relevant to his substance misuse. This was not addressed by many of the medical residents and faculty, even when those variables were noted in the training module to be risk factors for substance misuse. This variable appeared to be more readily explored by the counseling and social work participants. Conversely, many of the counseling and social work participants struggled to articulate the medical symptoms, risk factors and ramifications of substance misuse that were so easily identified and explored by their peers in nursing and medicine.

A second example of the silo effects of discipline-specific training arose when participants were engaged in the referral to treatment training. After a few practice sessions, it became clear that many of the counseling and social work participants did not understand the difference between family and internal medicine practices, or when to refer to a nurse as opposed to a doctor. Conversely, many of the medical practitioners did not have a clear understanding of the role of social workers and counselors. Once noted, the program directors were able to address this gap in knowledge about participating professionals. For example, counseling and social work directors were able to educate the medical professionals about counseling and social work professional practice. This facilitated productive conversation about referral sources at the start of the subsequent training session; counseling and social work trainers were able to offer a more clear articulation of the professional training and role of their students. Anecdotes from a few of the medical residents and other trainers afterwards indicated that such information was useful for them in discussing referral to treatment in their practice groups. Clearly, knowing the practice parameters of colleagues is central to effective interdisciplinary practice (Wellmon et al., 2012). This knowledge should include some awareness of discipline-specific orientations, terminology and information regarding conceptual framework (McLean, 2012).

Professional Orientation, Attitudes and Values

Issues related to practicing in silos are further complicated by professional indoctrination, or professional identity orientation and development. Within each of the various helping professions, new practitioners are oriented to acquire their profession’s unique and specialized identity. For example, in the profession of counseling, the establishment of a unique professional identity is considered a foundational training practice, as demonstrated in the 20/20: A Vision for the Future of Counseling initiative (Kaplan & Gladding, 2011) and CACREP standards (CACREP, 2009). This intentional emphasis on professional identity in the counseling profession was promoted in order to emphasize the important philosophical beliefs that are the foundation of the profession (Mellin et al., 2011), to distinguish counselors from other helping professionals, to strengthen the profession, to assure licensure portability, and to establish a sense of pride (Mascari & Webber, 2013). According to Gibson, Dollarhide, and Moss (2010), new professionals are socialized into the language of their profession so as to learn what is expected of them, as well as what they can expect in practice—to behave as “native speakers” (p. 22) in their particular discipline. The challenge for counselor educators, as well as profession-specific educators in other related disciplines, is to teach students to navigate the complex dynamics of collaboration while maintaining a clear understanding of their own professional identity.

When professional identities are established in the context of practicing in silos, as well as competing for resources and job opportunities, interdisciplinary tensions may flourish. The results often are distance, barriers, mistrust and a lack of collegiality between disciplines (Arredondo, Shealy, Neale, & Winfrey, 2004; Miller & Katz, 2014). All of this is further complicated by “hierarchical schemas” (Delunas & Rouse, 2014, p. 101) in health care practice that award some individuals and professions more social capital than others (Bemak, 1998; Meyers, Hales, Young, Nesbitt, & Pomeroy, 2013). Clearly, interdisciplinary practice is hampered when some practitioners undervalue the perspectives of others (McLean, 2012).

In our training sessions, it was difficult to determine the extent to which differences in approach and conceptualization reflected different professional training orientations and professional identities or participants’ (and their professional mentors’) value orientations. That is, while it was clear that the different professions approached the practice components of SBIRT from a different lens, it also seemed that some of the participants valued their own training and knowledge over others. For example, in some of the discussion groups regarding the professional actor who played the role of a client who identified as transgender, some of the medical participants assertively questioned the utility of exploring gender orientation during the screening process. Most of the counseling and social work participants who actively explored the client’s gender orientation in their practice sessions sat in silence as their medical peers challenged faculty trainers on this point. Later, some of the counseling and social work participants described a sense of incompetence regarding knowledge about the medical aspects of substance misuse, as well as difficulties in countering the arguments raised by the medical residents, particularly those against exploring the client’s gender orientation during the screening process, an area in which they had competence.

The confident expression of dissenting opinions by some participants juxtaposed with the relative silence of others during disagreements regarding practice orientation may have been an artifact of how practitioners-in-training are exposed to and experience supervision, particularly when delivered by a professional outside of their own discipline. It also may have mirrored the dynamics of many interdisciplinary treatment teams, which tend to be shaped by professional social hierarchy discourses. Given the strong component of professional identity in the training of the counselors and social workers who participated in our SBIRT training, we wonder if the assertiveness and self-silencing that we witnessed reflects social factors at work that go beyond professional identity orientation. As mentioned by Delunas and Rouse (2014), professional hierarchies in the field and in the lay public put physicians “at the top” (p. 101) and until hierarchical profession-centered structures (Meyers et al., 2013) and power sharing (Bemak, 1998) are realized, interdisciplinary collaboration will be stymied.

Interdisciplinary Training Recommendations

Understanding the challenges that arise from practicing in silos brings up complex issues and political nuances that sit between providing specialized, discipline-specific training, and preparing practitioners to work across disciplines. Wellmon et al. (2012) reminded us that “the skills necessary to work effectively as a member of a healthcare team are not intuitive and cannot be learned exclusively ‘on the job’” (p. 26). Meyers et al. (2013) echoed this sentiment, pointing out that health care professionals simply are not taught teamwork skills. Bemak (1998) called for the deconstruction and redefinition of the counseling profession’s central paradigms so that interdisciplinary collaboration can be a core component of counseling. He also asserted that professional counselors must be provided important skills for engaging in interdisciplinary collaboration. A similar request is made of professionals from other disciplines. Ultimately, if we expect health care practitioners to engage in interdisciplinary practice, they must be trained to engage in such practice.

The literature on interdisciplinary work consistently articulates the difficulty in identifying specific factors that can contribute to effective interdisciplinary work, and it calls for more writing and research by participants in interdisciplinary training programs (Arredondo et al., 2004; Bemak, 1998; Forrest, 2004; Nancarrow et al., 2013; Reubling et al., 2014). Based on our experience in the SBIRT interdisciplinary training and extant research in the field, we offer recommendations for how to promote effective engagement in interdisciplinary work among counselors-in-training. Our recommendations are summarized below in the categories of promoting professional identity and boundaries and teaching skills for collaboration.

Professional Identity and Boundaries

     Professional identity. Due to the silo effects of discipline-specific training, negotiating curriculum and training processes can be challenging in interdisciplinary collaborations. The needs of constituent groups within the training can easily be lost to the louder voices or privileged perspectives. Yet, Mascari and Webber (2006, 2013) and Mellin et al. (2011) pointed out that having a clear sense of one’s own professional identity and one’s scope of practice and also recognizing differences between counseling and other mental health disciplines enhances cross-discipline practice. These authors highlighted the importance of enlisting faculty representatives who are grounded in counselor and counselor educator identities, who also understand the value of interdisciplinary training and who have the interpersonal skills and expertise necessary for negotiating challenging interdisciplinary conversations. An understanding and appreciation of the interdisciplinary training protocol as a tool for enhancing professional interdisciplinary teamwork should be a core-guiding objective for counseling and all participating faculty members (Bemak, 1998), of course, but a solid grounding in one’s own professional identity also is critical.

We learned that counseling faculty must invest in preparing students for participation in interdisciplinary training. The preparation process should be progressive in nature with scheduled periodic check-in sessions, particularly during interdisciplinary clinical training. In our experience, the challenge of navigating professional roles and functions during the interdisciplinary clinical training sessions was most difficult for our students. Counseling students appeared to need multiple opportunities to process their interdisciplinary practice experiences. It was most beneficial to students when the participating faculty had a clear understanding of all the training protocols and processes.

Secondly, positive outcomes came from pre-coaching for skills and knowledge with students during the counseling program post-module review and skills practice review session, and encouraging them to have the confidence to speak up about their concerns, professional differences, identities, and even to volunteer to demonstrate their skills when in the interdisciplinary training sessions. This is consistent with the Reubling et al. (2014) findings in a study comparing students’ attitudes and perceptions in pre- and post-training experiences. Our experience highlighted the value of openly discussing the differences in professional and social capital in society and the impact that those differences have on students’ approaches to the interdisciplinary training experience. Such discussions helped boost students’ confidence to acknowledge issues that they avoided addressing in the initial phases of the training. Having a clear feedback loop from students to faculty, so that faculty can provide feedback to fellow collaborators at subsequent interdisciplinary training sessions, was particularly beneficial.

Finally, having a clear protocol for interventions with non-cooperative and challenging students was beneficial. For example, counseling students were required to sign a behavior and participation contract that was submitted prior to engagement in the interdisciplinary clinical training portions of the program. The foresight by the counseling program to request this contract may have been why no counseling student was cited for behavioral concerns during the interdisciplinary clinical training sessions. There were a handful of participants in other disciplines who required intervention from their own program directors regarding behavioral concerns emerging during interactions with training faculty who were not in their discipline area.

     Professional boundaries. For this counselor education program’s faculty, it was necessary to have a good sense of the boundaries of engagement during the project’s initiation phases. Interdisciplinary training collaborations require much compromise in the curriculum development and training implementation phase; we wanted to be sure that the interdisciplinary training program would enhance rather than compromise the training experience of counseling students. We were consistently willing to compromise and accommodate other disciplines’ perspectives, so long as training processes that are essential to the training of counselors were incorporated in the interdisciplinary training protocol. This is consistent with the recommendations of Nancarrow et al. (2013) regarding interdisciplinary training participants needing to understand and respect the professional roles, functions and boundaries of collaborators.

An example of this negotiated process happened after the first year of collaboration, when counseling faculty suggested changes in the scenarios presented to professional actors playing the roles of clients in the clinical component of the training. During the first year, the preparation of the professional actors was handled solely by a staff member employed by the medical school. As a result, the bulk of their presenting concerns were medical in nature. The majority of the professional actors appeared unprepared to discuss their psychological and sociocultural concerns. This was a major factor that affected collaboration because it made the initial practice session challenging for counseling and social work students who understandably felt that discussing medical presenting concerns was out of the scope of their competence and practice. During the second year of the training cycle, counseling faculty submitted case scenarios for the professional actors that started with an initial contact at a school or clinical mental health setting and that represented varied sociocultural and emotional concerns that coexist with physical medical concerns. This approach was intended to ensure that counseling students would be able to experience clinical training with case scenarios that were within their scope of study and practice and also allow them to practice making referrals to social workers and medical professionals.

Additionally, counseling and social work faculty, the two disciplines outside the medical field, actively advocated for all case scenarios used in the training to be truly interdisciplinary in nature. This meant that all the presenting concerns presented by the professional actors needed to provide an opportunity for an interdisciplinary intervention during the referral process. Negotiating these changes in the second year was easier given the professional relationships, trust and mutual respect that had evolved over the year among faculty from the different participating disciplines. Our challenges in negotiating the professional weighting of the training processes are not unusual and are consistent with what Mascari and Webber (2006, 2013) and Mellin et al. (2011) discussed regarding the challenges inherent to cross-discipline practice among professionals who have received specialized training and who have unique professional identities. We should have never assumed that the coordinator of the professional actors, who is based in the medical school, would understand how to prepare the actors to engage with students in a manner that would allow for an interdisciplinary intervention.

During the second year, faculty from the counseling program were more actively involved in the development of scenarios and instructions that would be shared with the professional actors playing the role of clients/patients in the project. In hindsight, the university SBIRT advisory council should have spent more time in deliberations about the potential obstacles that would emerge from interdisciplinary collaboration. We were excited about this new initiative and spent more time discussing the benefits and potential challenges for students rather than for the faculty and staff involved in the project. Thus, some identified challenges persisted in the second year.

Interdisciplinary focus as a goal. We realized the importance of all key participants (faculty and program directors) having a clear understanding of the interdisciplinary training goal of this project. For example and as mentioned, counseling faculty had to advocate multiple times for an interdisciplinary outlook as the curriculum and training protocol was planned and developed.  In hindsight, we realize that while the core focus of the project was interdisciplinary training, participants and trainers seemed to return to familiar patterns of silo training as the project was carried out. We are reminded that an interdisciplinary focus requires constant reminders and intentionality to keep the focus interdisciplinary.

Another artifact of the challenges inherent to interdisciplinary initiatives that emerged was that it appeared participants (students) were not fully prepared to receive feedback during the training from faculty who were not in their own discipline. After the first year of implementation, the program directors placed more emphasis and deliberated at length on how to assist trainees with navigating the dynamics of interdisciplinary training, and a protocol was discussed for addressing student-related training challenges. However, as mentioned above, a similar process was not identified for participating faculty and program directors. That is, at the director level, a process was not articulated for how to assure a truly interdisciplinary focus would be honored during the planning and implementation stages of the project, nor was a protocol developed to articulate how professional disagreements would be managed. While a process for navigating professional differences emerged organically, the absence of such a conversation in the early stages caused tense deliberations as participating faculty and program directors tried to communicate their professional boundaries, roles and functions. Therefore, we recommend that interdisciplinary teams develop protocols for addressing differences in perspectives for both students and training faculty. There is value in investing in leadership that understands the practice of the various disciplines involved in a project and has a commitment to infusing interdisciplinary and collaborative practices in every aspect of a training program (Nancarrow et al., 2013).

Skills for Collaboration

As previously mentioned, some authors have suggested that interdisciplinary collaboration requires particular skills or competencies (e.g., Arredondo et al., 2004; Bemak, 1998; Delunas & Rouse, 2014; Meyers et al., 2013) that are not regularly taught to health care professionals. These authors suggested that working in interdisciplinary teams also requires particular attitudes and special knowledge that are communicated through interpersonal skills.

     Collaboration attitudes. Working with others across disciplines requires a certain spirit or willingness to share, collaborate and respect others (Nancarrow et al., 2013). This includes avoiding judgment, working in the spirit of “joining” (Miller & Katz, 2014, p. 7), and overcoming professional hostilities, prejudices or phobias (Bemak, 1998). It also requires openness to collective decision making, an ability to redefine one’s role in an interpersonal context (Bemak, 1998) and demonstrating a sentiment of appreciation and accommodation to multiple perspectives (Arredondo et al., 2004). Included here is an ability to be flexible—to “share your street corner” as Miller and Katz (2014, p. 10) put it, or “playing well” with others (Arredondo et al., 2004, p. 791).

Being flexible also means remembering that one professional orientation/approach is not the only valid approach (Bemak, 1998); it requires an ability to be uncomfortable—“leaning into discomfort” (Miller & Katz, 2014, p. 8). An attitude of collaboration also requires being open to feedback (Nancarrow et al., 2013) and a willingness to negotiate power (Bemak, 1998; McLean, 2012). In our SBIRT training project, it appeared that a true spirit of collaboration developed over time among trainers. Its development appeared to emerge, as the examples from earlier discussions in this article illustrate, from the assertiveness and confidence as much as from the flexibility of faculty who may have otherwise been marginalized from decision making. Thus, it is possible that collaborative attitudes are more likely to develop when everyone in the group has had an opportunity to contribute, whether by invitation or self-assertiveness. It is essential to highlight the fact that even counseling and social work faculty, who have been trained to be open to multiple perspectives, engaged from time to time in their familiar silo foundation to professional orientation.

     Collaboration knowledge. Interdisciplinary practice requires that individuals have professional competence in their own areas of expertise (Nancarrow et al., 2013) as well as an ability to effectively communicate this discipline-specific information effectively to others (Wellmon et al., 2012). It also requires an ability to learn about the language and roles that define other disciplines (Miller & Katz, 2014; Nancarrow et al., 2013). Knowledge about organizations or systems theory, as well as models of consultation, also is extremely helpful to professionals working across disciplines (Arredondo et al., 2004). Arredondo et al. (2004) and McLean (2012) point to a need to have an intuitive understanding of interpersonal and group dynamics. Finally, Arredondo et al. suggested that awareness of one’s own beliefs, values and personal history—all of which are at play when interacting with others—and having “emotional intelligence” (p. 794) are necessary for effective interdisciplinary participation. It appears that as the various members of the interdisciplinary training team in our project asserted their voices at the decision-making table in our project, other trainers were able to learn more about discipline-specific practices and training needs. In order for this process to happen in a way that did not alienate others, we found it necessary to make careful decisions about what to say where and when. Knowledge of how to work in groups and teams was critical, especially for the professionals who were at risk of marginalization in the “collaborative” process.

     Collaboration skills. The display of collaboration skills is predicated upon a firm grounding in collaborative attitudes and requisite knowledge, including those mentioned above. Putting these ideas into practice requires strong interpersonal skills such as listening, empathy, humor, facilitation, assessment (Arredondo et al., 2004), ability to participate in power sharing (McLean, 2012), and being able to use feedback to make subsequent changes (Nancarrow et al., 2013). Collaboration also requires problem-solving and decision-making skills (Nancarrow et al., 2013; Wellmon et al., 2012) as well as assertiveness, confidence and ability to communicate one’s ideas appropriately (Miller & Katz, 2014; Nancarrow et al., 2013).  Finally, most agree that skills for collaboration include being flexible (Arredondo et al., 2004; Miller & Katz, 2014).  Power sharing is possible when participants demonstrate competence in their area of expertise as well as interest in learning about collaborators’ fields of specialization. As already noted in our training project, the demonstration of professional competence, confidence and the ability to engage interpersonally in the spirit of collaboration and collegiality created an opportunity for power sharing. We also noticed in the SBIRT project that when we were flexible and willing to accommodate other’s beliefs and values, they in turn made efforts to accommodate ours.

Conclusion

Counselor educators need to examine pedagogical means of providing counseling students with the knowledge, values and skills to work effectively in interdisciplinary teams. For one counselor education program, the experience of interdisciplinary training provoked passionate dialogue among students and faculty regarding their professional roles, functions, professional advocacy and positioning among other behavioral health professionals. Multiple opportunities for exploring interdisciplinary training and professional identity development processes were evident in the training project described in this article.

Of course, learning about interdisciplinary collaboration does not need to happen solely within a project such as this. Counseling internships typically offer an abundance of opportunities for interdisciplinary collaboration, and the points raised in this article are relevant to all training venues available for counseling students. As mentioned, providing counselors-in-training with a firm foundation in professional orientation both in terms of philosophical underpinnings as well as a clear understanding of their future scope of practice are critical. Additionally, instruction on the scope of practice and roles of other professionals with whom they may be working in practice settings is important. Assuring that counselors enter into internship settings with adequate competence is, of course, critical. But additionally, providing students with positive appropriate feedback so they develop a clear sense of confidence is equally as important for work in collaborative settings. Finally, offering counseling students “pre-training” in collaborative practice, including the requisite skills and attitudes mentioned in this article, is an important component of preparing counselors for interdisciplinary practice. In training sessions such as these, counseling students should be coached to talk about the work they are trained to do, required to assert their perspective in treatment team decision making and offered feedback on the ways in which their voices are heard by others.

In terms of future directions, an exploration of counseling students’ perceptions of the impact of interdisciplinary training on their professional identity development and their ability to work with interdisciplinary teams would be valuable for the field. The outcome of such a study might increase the understanding of the pedagogical experiences that enhance interdisciplinary work competencies for counselors.

STATEMENT OF FUNDING

The interdisciplinary training initiative reported in this publication is part of the Vermont SBIRT Training Collaborative funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), Grant #TI025395-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of SAMHSA.

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Jane E. Atieno Okech, NCC, and Anne M. Geroski are Associate Professors at the University of Vermont. Correspondence can be addressed to Jane Okech, Mann Hall 101B, 208 Colchester Avenue, Burlington, VT 05405, jokech@uvm.edu.

Advising Master’s Students Pursuing Doctoral Study: A Survey of Counselor Educators and Supervisors

Dec 7, 2015 | Article, Volume 5 - Issue 4

Corrine R. Sackett, Nadine Hartig, Nancy Bodenhorn, Laura B. Farmer, Michelle R. Ghoston, Jasmine Graham, Jesse Lile

This study explored what faculty members are recommending to counselor education master’s students regarding post-master’s experience when considering doctoral studies and what the current faculty hiring preferences are in reference to the amount of post-master’s experience needed. Advisors in counselor education master’s programs encounter these questions, and the authors believe the findings are beneficial in helping provide answers. Findings indicate faculty members believe post-master’s experience informs supervision, teaching, research and professional identity during the doctoral program and in faculty roles. Findings also indicate faculty members consider the characteristics and circumstances of each individual in determining how important post-master’s experience is prior to entering a doctoral program.

Keywords: counselor education, faculty, supervision, post-master’s experience, doctoral study

An important duty of faculty counselor educators is advising master’s-level students interested in obtaining doctoral education. A doctoral degree is designed to provide the student with advanced competencies in clinical practice, classroom instruction, supervision, research and leadership so that the student may serve as a future leader for the profession of counselor education in academic positions (Bernard, 2006; Goodrich, Shin, & Smith, 2011). While the primary focus of the counselor education doctoral degree is to prepare future leaders in the profession (Goodrich et al., 2011), counselor education has historically lacked clear professional standards regarding the amount or type of necessary counseling experience for admission into doctoral programs (Boes, Ullery, Millner, & Cobia, 1999; Schweiger, Henderson, McCaskill, Clawson, & Collins, 2012; Warnke, Bethany, & Hedstrom, 1999).

When applying for and entering a doctoral-level counselor education and supervision (CES) program, it is assumed that the student has achieved the competencies of an entry-level clinician and has met the requirements of a Council for Accreditation of Counseling and Related Educational Programs (CACREP) accredited master’s program (Goodrich et al., 2011). However, few guidelines have been provided to doctoral applicants about the types or amount of post-master’s experience (PME) necessary or preferred for optimal hiring into a faculty position, for which CES graduates are uniquely qualified. Lack of guidelines can create confusion about how graduate students can best position themselves for successful academic employment (Schweiger et al., 2012; Warnke et al., 1999).

Though conventional wisdom may tell us that the more experience one has, the better, we do not have empirical data in the CES field of how counselor educators are advising master’s students on this issue, or of what faculty search committees prefer in terms of the clinical experience level of candidates. Thus, this study broadly examines the questions: What are faculty members recommending to counselor education master’s students regarding PME when considering doctoral studies? What are current faculty hiring preferences in reference to levels of experience needed? Faculty members, supervisors and advisors frequently encounter these questions from master’s students, and the researchers believe students, faculty and ultimately the counseling field will benefit from information clarifying the current industry standard for counselor education.

Research on CES Preferred Clinical Experience

The field of counselor education lacks clear professional standards regarding the amount or type of necessary counseling experience for admission into doctoral programs (Schweiger et al., 2012; Warnke et al., 1999). One study’s findings concluded that work experience was a necessary component to doctoral admissions (Nelson, Canada, & Lancaster, 2003). Of the 25 CACREP programs that participated in this study, 20 programs rated successful work experience as a criterion for admission to their doctoral programs. In addition, 16 of those reported that work experience is often helpful or always helpful in selecting good doctoral students. One of their respondents reported difficulty in requiring successful work experience because so few applicants had post-master’s counseling experience.

A recent study reviewed the requirements and preferences listed in counselor education faculty position postings on the Counselor Education and Supervision Network (CESNET) between 2005 and 2009 (Bodenhorn et al., 2014). The researchers found 83% of assistant and associate professor position announcements listed counseling experience or licensure as a required or preferred qualification. This remains consistent with a previous finding from Rogers, Gill-Wigal, Harrison, and Abbey-Hines (1998) that counselor education programs ranked clinical experience as the second most important criteria for faculty positions, second only to a PhD in counselor education. Researchers of the 1998 study asserted that although it is clear in their findings that clinical experience is important, whether that clinical experience occurs during internships or outside of coursework is unclear.

These studies showed that experience is prioritized in doctoral admissions (Nelson et al., 2003), as well as in hiring CES faculty members (Bodenhorn et al., 2014; Rogers et al., 1998), yet the counselor education field still lacks important information around this topic. Specifically, the field is lacking data indicating what advice counselor educators give master’s-level students about the amount of experience to obtain prior to entering a doctoral program, and data indicating the amount of post-master’s clinical experience CES faculty search committees prefer in candidates. The current study addresses these gaps in the literature in the exploration of preferences for PME.

Research on Other Helping Professions’ Preferred Clinical Experience

A review of American Psychological Association (APA) accredited clinical psychology programs found academic criteria to be the most important in selecting doctoral students, with achievement of clinical competence also being important (O’Leary-Sargeant, 1996, as cited in Nelson et al., 2003). Another study’s findings included that success in a marriage and family therapy doctoral program correlated positively with age, and students with clinical experience were rated as better clinicians than those who did not have clinical experience (Piercy et al., 1995). It should be noted that researchers did not distinguish between participants who became faculty or expert clinicians in their study.

In the related field of social work, Proctor (1996) and Munson (1996) had opposing viewpoints of whether doctoral programs should admit graduate students with fewer than 2 years of post-master’s in social work (MSW) experience. Proctor argued that doctoral programs in social work should not require PME because it is a detriment to the field. He justified this viewpoint with the idea that by requiring experience, programs are missing out on students who are research-minded and eager to continue with their education; therefore, programs may lose them to other disciplines. Proctor also argued this requirement delays the onset of careers in social work education and research, with educators and researchers starting often in their late thirties and early forties, behind their counterparts in other disciplines. Munson argued that it is not possible 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, without post-MSW experience.

     The research in CES and related fields in the area of experience preferred for doctoral programs and faculty positions is dated. Further, the CES field is lacking data on how counselor educators are advising master’s students in terms of amount, if any, of PME that would be beneficial to obtain prior to entering a doctoral program. The field also is lacking clear data on preferences of CES search committees on clinical experience gained outside of program practicum and internships. An exploration of these two questions will equip counselor educators in more effectively advising master’s students who are interested in doctoral programs and faculty careers in CES.

Method

The authors used a survey with both closed and open-ended questions to gain both quantitative and qualitative data about the research questions: What are faculty members recommending to counselor education master’s students regarding PME when considering doctoral studies? What are current faculty hiring preferences regarding levels of experience needed? Surveys were developed by the research team and piloted among CES colleagues with questions about serving on search committees and what priority considerations are given during a search for CES clinical and tenure-track faculty. Hypothetical situations involving a master’s student asking for advice about pursuing a doctoral degree and a search committee situation also were posed in the survey, with space to provide a rationale for the responses, which garnered qualitative data.

Procedure

Access to participants was developed in two different formats, using the same survey. Using a purchased list of 500 randomly selected members of the Association for Counselor Education and Supervision (ACES), half of the names on the list were contacted by postal mail, and half were contacted by e-mail with a request to complete the survey. Response rates have been shown to be higher for surveys sent through postal mail than for surveys sent electronically (Shannon & Bradshaw, 2002) and the researchers aimed to maximize the response rate; however, financial constraints mandated that only half of the surveys be sent through postal mail. Three weeks after the surveys were distributed, a reminder was sent electronically to request completion of the survey, providing the alternative of electronic completion for those who had received the initial request in postal mail. The survey was housed on SurveyMonkey, using the secure feature. The authors input the results in SurveyMonkey for the postal responses.

Simultaneously, the authors sent a survey electronically to the liaison for each of the programs listed on the CACREP Web site as accredited for a doctoral CES program. A question from that survey was used to provide insight about positive and negative impact of post-master’s counseling experience on students’ performance in doctoral classes.

Participants

     One hundred and sixty-six respondents completed the ACES survey (33% response rate). In terms of rank, 35 respondents (21%) indicated they were a professor, 53 (32%) associate professor, 49 (30%) assistant professor, 23 (14%) non-tenure track (clinical or adjunct), and 6 (3%) indicated they fell into an other category. About 51% of the respondents had taught a doctoral-level counselor education course before (84), and the other half had not (81), having only taught master’s-level classes. Twenty-seven percent (44) of respondents reported they had never served on a CES faculty search committee. Among the respondents who indicated they had served on CES faculty search committees, 44% (72) served on 1–4 committees, 19% (31) served on 5–8 committees, 4% (7) served on 9–12 committees, and 6% (10) served on more than 12 committees. Eighteen out of 57 CACREP liaisons responded to the survey (32% response rate). Demographic data was not collected from this group.

Survey Design

To respond to the stated research questions, the authors deemed it was important to request demographic information on rank, programs offered, doctoral teaching experience and the number of search committees on which the participants had served. Two questions were developed asking for level of importance of qualifications when considering candidates for a tenure-track position and a non-tenure track (i.e., adjunct or clinical) position. The qualifications the authors identified were: post-master’s counseling, publications, grants, supervision, college teaching, professional organization involvement and professional organization leadership. Participants rated the level of importance as 1 (not at all), 2 (somewhat), 3 (quite a bit) and 4 (extremely). The participants also were asked to provide a minimum quantity for each qualification, if the participant deemed the qualification to be quite a bit or extremely important. The qualifications included were selected based on surveying position announcements for CES positions. Four hypothetical scenarios were presented to the participants that included situations involving serving on a search committee and serving as an advisor to a master’s student with particular questions about pursuing a doctoral degree. Each of the hypothetical scenario questions asked for a response and a rationale for that response. Researchers piloted the survey with three faculty members who all reported that the survey was clear. The pilot participants’ responses were reviewed to ensure survey questions measured what was intended.

Data Analysis

Authors analyzed the demographic and scaling questions by count and percentages using the SurveyMonkey results produced by the software. The results include numerical count of the participant responses.

The authors analyzed responses to the open-ended comment requests using a constant comparative method described by Anfara, Brown, and Mangione (2002), along with a form of check coding described by Miles and Huberman (1994). The first three authors were the analysis team for this process. Two team members independently conducted a first iteration of assigning open codes for each of the five open-ended questions by reading the data from each question broadly and noticing regularities (Anfara et al., 2002). The two authors then conducted a second iteration of comparison within and between codes in order to create categories and identify themes. The constant comparative method of analysis allows a way to make sense of large amounts of data by organizing into manageable parts first and subsequently identifying themes and patterns.

The third team member served in a peer review capacity (Miles & Huberman, 1994) during the categorizing and theme identification for that question. For each question, different team members were assigned as coders and the peer reviewer. Once the team members assigned individually derived themes, the team came together and the peer reviewer for each question led the discussion to arrive at consensus for the categories. Each coder presented individually derived themes, listened to the other and, in areas of difference, the team discussed analysis and wording. During this discussion, the peer reviewer clarified and probed using the original comment wording, and the team came to consensus for the themes through this process. These team members sent the themes and the original data for each of the questions to each of the other authors, who served in another layer of peer review to examine the analysis.

Results

Hiring Preferences and Practices for CES Positions

When evaluating applicants for tenure-track CES positions at the assistant professor level, the largest group of respondents (46%) reported that post-master’s counseling experience was quite a bit important. Forty-four percent of those respondents deemed 2 years to be the minimum number of experience. Also rated quite a bit important by most respondents was supervision experience (40%), with a minimum of 2 years of experience (45%), and professional organization involvement (43%), with a minimum of 2 years of experience (33%). As for publications, grants, college teaching and professional organization leadership experience, most respondents (48%, 55%, 35%, and 57% respectively) reported those qualifications were somewhat important when evaluating applicants for tenure-track positions. Respondents who deemed these areas as important reported a minimum of 2 publications submitted (41%), 1 year of college teaching experience (49%), and 1 year of professional organization leadership experience (71%).

When asking the same question, but when hiring for a non-tenure-track (clinical or adjunct) CES faculty position, respondents reported a different emphasis on priorities. Most respondents (43%) indicated that PME was extremely important, with a minimum number of 2 years (28%), and supervision experience was quite a bit important (43%), with a minimum of 2 years (31%). Most respondents indicated grants and professional organization leadership as not at all important (74% and 50% respectively), and respondents were split between not at all important (48%) and somewhat important (48%) for publications. The majority of respondents indicated college teaching (41%) and professional organization involvement (42%) as somewhat important.

Seventy-two participants responded to a question to indicate the top three priorities of counseling experience preferred for the most recent tenure-track CES assistant or assistant/associate professor faculty search committee they served on. The majority of respondents (64%) indicated school counseling experience was preferred, while 61% preferred experience with populations diverse in culture or ethnic identity, and 59% preferred experience in community-based agencies. Other areas of experience preference included the following: families (25%), addictions (17%), other (13%), private practice (13%), populations diverse in age (11%), play therapy (9%), populations diverse in religious/spiritual identity (9%), populations diverse in sexual identity (7%), inpatient or day treatment (5%), bilingual (2%) and in-home treatment (1%).

Hypothetical Situation Hiring for Tenure Track

Participants were asked which candidate they would prefer to hire for a tenure-track assistant professor position, given two candidates with all things being equal with one exception. Candidate 1 earned a master’s degree, directly entered and completed a doctoral program and then went into the field and gained 3 years of professional experience. Candidate 2 earned a master’s degree, directly went into the field and gained 3 years of professional experience, then entered and completed a doctoral program. One hundred and thirty-eight participants responded to this question. Sixty percent of respondents would prefer candidate 2, 34% would have no preference and 6% would prefer candidate 1. Four themes emerged in the qualitative responses to this question: (1) PME is more relevant and important in training master’s students, (2) PME makes the doctoral program more valuable, (3) research staleness and (4) fit.

     PME is more relevant and important in training master’s students relates to what the candidate would be doing in their role as a counselor educator, and participants reported having the clinical experience following their master’s program and prior to their doctoral program was more beneficial in training master’s students. One participant indicated:

This candidate understands what it’s like to work in the field with a master’s degree—a very different experience than working with a PhD. They will be able to better prepare students for the common pressures and issues of working with a master’s (degree) in an agency. This was critical for me as I began teaching.

Another participant spoke to this, specifically in training school counselors:

(The) candidate needs to understand the professional role of a school counselor. This is best accomplished when employed as a school counselor—then a doctoral program afterwards—allows more thorough research on a profession. They understand at a ground level through personal experience.

The second theme, PME makes the doctoral program more valuable, represents participants’ beliefs that having the clinical experience prior to their doctoral studies would make that learning more valuable, as they would have practical experience to help make sense of the abstract learning. One participant illustrated this theme: “I believe the post-master’s degree experience provides candidates with context that helps make doctoral study richer and more relevant to practice.” Another participant pointed to the benefit of PME evident in this theme: “Having experience prior to the PhD allows the (doctoral) student to anchor knowledge and the clinical experiences at the doctoral level, especially courses like supervision.”

The third theme, research staleness, speaks to participants’ concerns that candidates who had been practicing for several years after graduating from a doctoral program would be out of touch with research and writing required in academia. A participant clearly stated this concern: “. . . the candidate that worked after doctoral program may lose scholarly writing and research skills.” Another participant relayed a similar concern:

I think coming right from the doc-level program would provide some of the most current literature/research knowledge for the new faculty, as well as increase the likelihood that the person is poised to submit manuscripts, have a research agenda and probably would have some grant writing experience. I know how busy the counselors in the field are with client productivity, and I think it’s harder to commit to writing and research as a full-time clinician.

Finally, the fourth theme, fit, encompasses participants’ feelings that either candidate would be fine if they were a good fit for the position and program. One participant shared his or her concern for the individual, rather than when they accrued experience:

They have the same amount of professional experience, just at different times in their career. I think there would probably be some pros and cons to each path. I would be more interested in HOW they each spoke about their experiences and the decision-making process they used.

Another participant stated that either candidate would work: “Regardless of order, the applicant received some of the same experience. Either the doctoral work informed their clinical work or their clinical work informed their doctoral work.”

Hypothetical Advising Situations

Researchers asked participants how they would respond to a hypothetical advising situation with a master’s student:

Hypothetically, in October, a master’s-level student who will graduate in May comes to you for advice. The student’s ultimate goal is to be a faculty member and is planning to apply to doctoral programs for entrance in August. Please indicate what your response would be and explain your response in the space below.

One hundred and forty-two participants responded to this question. Twenty-nine percent responded that their recommendation would depend on the quality of the work accomplished by the student. Twenty-seven percent responded that it would depend on the age and maturity of the student. Eighteen percent responded that it would depend on some other factor. Fifteen percent responded they would encourage the student, and 12% responded that they would discourage the student. Three themes emerged from the explanations related to this question: (1) depends on the quality of the student (quality of work, etc. and things related to readiness), (2) need PME and license and (3) encourage student regardless.

The first theme, depends on the quality of the student, includes responses about the quality of the master’s student’s work, maturity level, life experience and readiness. This participant’s response highlights this theme:

It really depends on the quality of work AND the life experiences and maturity level of the student (not the age, but the maturity level). Thus, if (the student) had high levels of quality work, and had experience in a variety of settings (e.g., volunteering, clinical work, GA, etc.) outside of “just” coursework, and seemed to have a breadth of understanding and perspective (i.e., maturity), then I would encourage the doctoral program. However, if any of these areas were lacking I might discuss the possibility of gaining some experience first before applying. It also depends on how active (the student) was in terms of service at the master’s level (e.g., CSI, or community activities).

Although this respondent clearly differentiated maturity from age, other respondents indicated age was a factor, such as this participant: “If the student is younger or has very limited mental health experience, I would probably suggest getting some counseling experience before beginning a doctorate.”

The second theme, needs PME and license, includes the respondents who felt that regardless of the student qualities, PME and licensure are important. The following quote illustrates this theme: “I would encourage the student to work in the field and gain licensure or certification first. I believe that working provides valuable insight into the profession and prepares professors to be more effective when teaching students.”

Finally, on the other end of the spectrum from the previous theme, some respondents said they would encourage any of their students who wished to pursue a doctorate, making up the third theme, encourage student regardless. A respondent expressed the opinion, “One can never know the success level of prospective doctoral student[s]. If they have the desire, they should be encouraged to pursue their goal.”

In another hypothetical situation, researchers asked respondents the following:

Hypothetically, a master’s student who has the GOAL OF becoming a FACULTY MEMBER asks you for advice. The question asked is how many years of post-master’s clinical experience the student should obtain prior to applying to a doctoral program. What would your advice be?

There were 136 respondents to this question. Forty-nine percent would advise at least 2 years of post-master’s clinical experience, 21% would advise the student to enter the doctoral program right away without any experience, 13% would advise obtaining at least 3 years of experience, 14% would advise at least 1 year, 3% would advise at least 5 years, and none would advise more than 5 years. Two themes emerged related to the associated rationale for respondents’ choices to this question: (1) depends on personal factors of the student and (2) enough time to gain experience.

The first theme, depends on personal factors of the student, included factors such as quality of the student, their readiness and maturity level, as well as doctoral program of interest. One respondent spoke to the importance of the student’s readiness:

If the student feels ready to enter the doctoral program, then I would encourage them. I would tell them to trust their own sense of timing. I would not recommend it if they were just trying to get through without being fully interested, eager and invested in the program.

Another respondent stressed the importance of considering each student and the quality of master’s performance and desires for the future:

I did not respond here because it does not include an “it depends” answer, as it depends what experience they have, what they have gained in their master’s program, have they gone above and beyond the call of doing the basic requirements of clinical internship in the master’s program and what type of faculty member are they hoping to be (e.g., teaching only, research heavy, etc.). Thus, it really depends on the uniqueness of each student as to what I would recommend.

Finally in this theme, some respondents referred to the importance of considering which doctoral programs the student is interested in applying to. One respondent spoke to this consideration here:

Doctoral programs are designed differently. Some are designed to have clinical hours built in and are good for individuals going straight through while other programs require 2–5 years of work experience in the field and have less supervision and clinical hours.

Other respondents reported that having experience before entering a doctoral program was critical, regardless of the student, making up the second theme, enough time to gain experience. These respondents spoke to needing enough experience to earn licensure and supervision licensure and to develop a sense of professional identity first. Many also felt students should get a sense of the field before entering a doctoral program to see if they would prefer to practice at the master’s level. The following respondent spoke to the need for experience primarily to aid in his or her future doctoral student role of supervising and teaching master’s students:

In 2 years, a student would have completed or (be) near completion of licensure requirements and thus have some applied knowledge from which to draw upon. In so doing, the prospective doctoral student would bring experience and be better positioned, hierarchically speaking, to work with master’s degree-seeking students. With no experience, the doctoral student may find themselves in a position where they would be supervising or teaching a master’s degree seeking student with greater clinical/life experience creating . . . an interesting power differential.

Similarly, another respondent expressed, “How can one teach or supervise what he or she has not yet experienced?”

Many respondents indicated that gaining licensure before entering a doctoral program was critical: “Licensure in most states requires a minimum of 2 years post-master’s supervised work. I think licensure should be required before proceeding.” Speaking to the need to develop professional identity and to confirm career goals, a respondent said, “(Two years)—this provides enough time to establish a professional identity, create a track record of excellence in the field and clarify their desire to enter the academy.”

Not all respondents believed PME was vital for future faculty members however, as is evident with the following quote: “I entered right away and it worked out fine for me. I don’t think it makes a big difference either way.” Another respondent expressed concern that students who take time away from school often do not return: “I believe that people who go into post-master’s work almost never go back to get their doctorate, no matter how strong the intentions of the person are at graduation.”

In a final hypothetical situation, we asked participants the following:

Hypothetically, a master’s student who has the GOAL of becoming an ADVANCED PRACTITIONER asks you for advice. The question asked is how many years of post-master’s clinical experience the student should obtain prior to applying to a doctoral program. What would your advice be?

There were 134 respondents to this question. Thirty-eight percent would advise at least 2 years of experience, 16% responded there is no need for a doctoral degree in this situation, 10% would advise that no experience is needed and to enter right away, another 13% would advise at least 5 years of experience before applying to a doctoral program, 13% would advise at least 3 years, 9% at least 1 year, and 1% would advise more than 5 years. Four themes emerged related to this question: (1) uncertainty about the purpose of the question, (2) no need for a doctorate to practice, (3) depends on the student and their attributes and (4) desire to specialize.

The first theme, uncertainty about the purpose of the question, encompasses many responses that communicated confusion about the meaning of “advanced practitioner.” This is evident in the following quote: “Not sure what you mean by advanced practitioner.” The intention of the question was to capture potential guidance given to advisees who may seek to obtain a doctoral degree with a goal to enter or return to the clinical field, or to advance into supervision or administrative positions. However, this theme clearly shows there was confusion among respondents over the question and its intent.

The second theme, no need for a doctorate to practice, consists of responses expressing the lack of need for someone to pursue a doctoral degree in order to practice because counselors can become fully licensed at the master’s level. As one respondent stated, “A master’s degree is a terminal degree. Our 60-hour requirement makes our master’s degree an advanced clinical degree. No further coursework is needed for full licensure.” This theme also includes responses indicating that a degree in CES does not prepare you for further clinical practice, as this respondent communicated: “Degrees in counselor education are really about preparing someone for a faculty or supervisor position, in my opinion, and often require little in the way of advanced counseling skill development.”

For this question, as in many of the others, a theme emerged related to the individual student, depends on the student and their attributes. One respondent said that young and bright people can make it happen: “Still believing that bright young people can master most things easily, I don’t believe that waiting to get experience is necessary.”

The final theme, desire to specialize, includes responses indicating the following recommendations: use PME to find a specialization before pursuing a doctorate, PME would make the doctoral program more meaningful, and some students may decide they do not need the doctorate in order to do what they want. A respondent illustrated this theme: “Get some counseling experience and have your counseling license in hand before embarking on doctoral study. Gain some perspective about the areas you want to study in depth, based on what challenges you encounter in actual practice.”

Impact of PME on Doctoral Student Performance

Finally, researchers asked CACREP liaisons about the positive or negative impact of post-master’s counseling experience on their doctoral students’ performance in class. Two themes emerged in the participants’ answers: (1) the more experience the better and (2) experience is valuable, but not essential.

In the first theme, the more experience the better, respondents described the ways that PME helps doctoral students in the classroom. This includes observations from CACREP liaisons that doctoral students who have worked in the field know what mental health issues look like and how to respond. They also are better able to apply content learned in the doctoral program to practice. PME helps doctoral students feel more confident and increases their credibility with master’s students they are teaching and supervising.  When doctoral students have PME, they are better equipped to help master’s students in their developmental journey. One respondent illustrated some of these thoughts:

The more experience the better, particularly in terms of supervision and teaching. Without a fairly substantial fund of knowledge about applied practice, doctoral students have difficulty helping master’s counselors-in-training understand abstract concepts in practical terms. What does PTSD look like? How do I respond to a client who becomes suicidal in session? . . . Because our doc students begin providing supervision in the first year of their program, I would be particularly concerned if the ONLY experience they had was in their own master’s internships. They would be essentially just one year (maybe semester) ahead of those they are supervising.

In the second theme, experience is valuable, but not essential, respondents wrote about the experience gained in the master’s and doctoral programs being enough. An example of this rationale is shown here: “. . . although we will admit students without post-master’s experience, we offer deep clinical experience while in our doc program. Many doc students complete two full years of internship while in the program.”

Discussion

     The findings of this study help fill a gap in the literature identified by Boes et al. (1999) and Warnke et al. (1999) about the amount of counseling experience needed prior to entering doctoral programs. Goodrich et al. (2011) and Bernard (2006) asserted that doctoral degrees in CES are intended to provide the student with advanced competencies in clinical practice, classroom instruction, supervision, research and leadership so that the student may serve as a future leader for the profession of counselor education in academic positions. Specifically, these findings shed light on what faculty members are recommending to master’s students regarding PME prior to entering a doctoral program and faculty members’ preferences in hiring colleagues with regard to PME.

PME is important both for doctoral students and faculty members, as is indicated by our findings. According to respondents, experience informs supervision, teaching, research and professional identity during the doctoral program and in faculty roles. These findings are compatible with previous research (Bodenhorn et al., 2014; Munson, 1996; Nelson et al., 2003; Rogers et al., 1998). Nelson et al.’s (2003) findings point to the importance of PME in doctoral admissions. They found this was a helpful factor in selecting quality doctoral students, though their participants reported not all applicants have this experience. As for future faculty members, experience has been found to be important as well by Rogers et al. (1998) and Bodenhorn et al. (2014). Bodenhorn established that the majority of assistant and associate professor announcements on CESNET listed counseling experience or licensure as a required or preferred qualification, and Rogers et al. found that counselor education programs ranked clinical experience as their second most important criteria for faculty positions. Similarly, in the social work discipline, Munson (1996) asserted social work PhDs need to have post-MSW experience in order to fulfill the needs of the field, which include teaching master’s-level students and researching to enhance knowledge.

CES faculty spoke to the importance of clinical practice in areas of teaching, supervision and research. Munson (1996) connected clinical experience to research performance in reporting that doctoral students who lack clinical experience tend to avoid practice-related dissertation studies. Similarly, respondents in our study wrote about doctoral students’ clinical experience providing fodder for research ideas. Further, clinical experience may validate teaching credibility (Rogers et al., 1998). This was evident in this study’s findings as well, along with validating supervision credibility. There was concern among respondents about doctoral students providing supervision to master’s students who would possibly be only one semester behind them in experience. In addition, respondents expressed concern that doctoral students and future faculty members with no PME would exhibit rote, by-the-book teaching, rather than drawing on clinical experience to illustrate abstract concepts in counseling.

Though there was much support for PME in our findings, many respondents emphasized evaluating the circumstances of each student individually. Among the circumstances that stood out were age and maturity. Some respondents expressed concern that it can be difficult to return to school once individuals have careers and families. The academic and skill level of the master’s student was another factor emphasized by respondents. Proctor (1996) asserted that the social work field might miss out on academically skilled and eager students by requiring PME. This may be a fear for some in the counselor education field as well. Indeed, within this study’s findings, there was a tension between academically and clinically gifted students entering doctoral programs right away and the importance of getting experience.

For many respondents, the amount of experience obtained during the master’s and doctoral programs is enough, especially in cases where students work in clinical positions while completing their doctoral degrees. Some respondents pointed out that doctoral programs in CES are designed differently, with some emphasizing clinical work as part of the doctoral training and others operating on the assumption that the doctoral student is already an experienced clinician. For example, faculty members might support a master’s student going straight to a doctoral program if the student is applying to a doctoral program with robust opportunities to gain clinical experience.

Implications

These findings will help counselor educators better advise master’s students who have aspirations for doctoral work. Specifically, this study informs the CES field about the value placed on PME. It may be beneficial for advisors to share the findings of this study with advisees who are considering doctoral programs. In addition, advisors may consider the academic and skill level strength of the master’s student and may emphasize more years of clinical experience before applying to doctoral programs to those students who could benefit from the additional experience. Further, students who exhibit more maturity through age and life experience may be perceived as ready to handle doctoral work sooner than those who have entered the master’s program immediately from their undergraduate program.

Responses in this study are in line with Goodrich et al.’s (2011) findings that CACREP-accredited doctoral programs train students in somewhat different ways. Advisors may have familiarity with a variety of doctoral programs and can help their advisees consider the cultures of each to find the best fit in terms of experience, as well as other characteristics.

Finally, it appears clear that experience is valuable; thus, advisors would be wise to encourage students to get PME. The findings of this study show that counselor educators believe experience enriches individuals’ teaching, supervision and research. As such, master’s students will make more effective future doctoral students and faculty members if they gain PME first.

There are limitations to this study that are important to note. While a 33% response rate is considered acceptable, we would prefer to have more than 166 responses. There is likely a portion of professional counselor educators who are not members of ACES and therefore were not included in our sample, and there is no way to determine the numbers or the characteristics of those who choose membership and those who do not. A significant number of the participants had not served on search committees or taught a doctoral class, so those responses might be considered more theoretical than historical. Finally, our hypothetical question related to how participants would advise master’s students with the goal of becoming an advanced practitioner was not clear or well received given the confusion evident in the responses.  Regardless of these limitations, the results of this study are compelling. Because of the length of the survey, the demographic questions did not include personal demographics such as gender, age, or ethnicity. Similarly, we did not ask for the type of university at which the participant works (e.g., Carnegie research or teaching designation). There may be intricacies of type of university and relevance of experience or advice that were not identified in this study.

Future research is needed on the role PME plays in the development of the counselor educator as a scholar, teacher and academic leader. Additional research exploring the impact of PME on a CES faculty member’s success in a faculty role, particularly teaching and supervision, would be helpful to the field. Furthermore, research delineating the different types of institutions and possibly different qualifications would assist CES advisors. Lastly, research exploring current practices and potential in the CES field for producing doctoral-trained counselors to represent the counseling discipline at the administrative and supervisory levels of mental health facilities may provide beneficial information for advancing the field.

Conflict of Interest and Funding Disclosure

The authors reported no conflict of interest

or funding contributions for the development

of this manuscript.

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Corrine R. Sackett is an Assistant Professor at Clemson University. Nadine Hartig is an Associate Professor at Radford University. Nancy Bodenhorn is an Associate Professor at Virginia Tech. Laura B. Farmer is an Assistant Professor at Virginia Tech. Michelle R. Ghoston is an Assistant Professor at Gonzaga University. Jasmine Graham is an Assistant Professor at Gardner-Webb University. Jesse Lile is an Assistant Professor at the University of Saint Joseph. Correspondence can be addressed to Corrine R. Sackett, Clemson University, 307 Tillman Hall, Clemson, SC 29634, csacket@clemson.edu.