Michael T. Kalkbrenner
College counselors work collaboratively with professionals in a variety of disciplines in higher education to coordinate gatekeeper training to prepare university community members to recognize and refer students in mental distress to support services. This article describes the cross-validation of scores on the Mental Distress Response Scale (MDRS), a questionnaire for appraising university community members’ responses to encountering a student in mental distress, with a sample of faculty members. A confirmatory factor analysis revealed the dimensions of the MDRS were estimated adequately. Results also revealed demographic differences in faculty members’ responses to encountering a student in mental distress. The MDRS has implications for augmenting the outreach efforts of college counselors. For example, the MDRS has potential utility for enhancing campus-wide mental health screening efforts. The MDRS also has implications for supporting psychoeducation efforts, including gatekeeper training workshops, for professional counselors practicing in college settings.
Keywords: Mental Distress Response Scale, mental health, college counselors, gatekeeper, outreach
College counselors play crucial roles in supporting students’ personal, social, and academic growth, as well as students’ success (Golightly et al., 2017). Outreach and prevention programming, including campus violence prevention and supporting college student mental health, are two key elements in the practice of college counselors (Brunner et al., 2014; Golightly et al., 2017). Addressing these two key areas has become increasingly challenging in recent years because of the prevalence of campus violence incidents, including mass shootings in the most severe cases, and the frequency of mental health distress among college students, which has increased substantially since the new millennium (Auerbach et al., 2016; Barrett, 2014; Vieselmeyer et al., 2017). In fact, supporting college student mental health has become one of the greatest challenges that institutions of higher education are facing (Reynolds, 2013).
Most college students suffering from mental health issues do not seek treatment (Downs & Eisenberg, 2012). In response, college counselors, student affairs professionals, and higher education administrators are working collaboratively to develop and implement mental health awareness initiatives and gatekeeper training workshops, which include training university community members (e.g., students, faculty, and staff) as referral agents to recognize and refer students who are showing warning signs for suicide or other mental health issues to support services (Albright & Schwartz, 2017; Hodges et al., 2017). Faculty members are particularly valuable referral agents, as they tend to interact with large groups of students on frequent occasions, and they generally report positive attitudes about supporting college student mental health (Albright & Schwartz, 2017; Kalkbrenner, 2016).
Despite the utility of faculty members as gatekeepers for recognizing and referring students to the university counseling center and to other resources, the results of a recent national survey indicated that a significant proportion of faculty members (63%) do not refer a student in mental distress to support services (Albright & Schwartz, 2017). The literature is lacking research on how faculty members are likely to respond to encountering a student in mental distress, including but not limited to making a faculty-to-student referral to mental health support services. The primary aim of this investigation was to confirm the psychometric properties of the Mental Distress Response Scale (MDRS), a screening tool for measuring university community members’ responses to encountering a student in mental distress. Past investigators validated the MDRS for use with 4-year university students (Kalkbrenner & Flinn, 2020) and community college students (Kalkbrenner, 2019). If found valid for use with faculty members, college counselors could find the MDRS useful for screening and promoting faculty-to-student mental health support. A review of the extant literature is provided in the following section.
Mental Health and the State of Higher Education
Active shooter incidents on college campuses are some of the most tragic events in American history (Kalkbrenner, 2016). The 2015 massacre that occurred on a college campus in Oregon received attention at the highest level of government; former President Barack Obama urged the nation to decide when voting “whether this cause of continuing death for innocent people should be a relevant factor.” (Vanderhart et al., 2015, section A, p. 1). Seung-Hui Cho was a perpetrator of another one of these tragedies at Virginia Polytechnic Institute in 2007. According to Cho’s mother, he had a history of social isolation and unresolved mental health issues (Klienfield, 2007). Without treatment, the effects of mental health disorders can be debilitating and widespread for students, including impairments in academic functioning, attrition, self-harm, social isolation, and suicide or homicide in the most serious cases (Kalkbrenner, 2016; Shuchman, 2007). The early detection and treatment of students who are at risk for mental health disorders is a harm-prevention strategy for reducing campus violence incidents and promoting college student mental health (Futo, 2011; Kalkbrenner, 2016). Consequently, the practice of college counselors involves deploying outreach and systems-level mental health support interventions (Albright & Schwartz, 2017; Brunner et al., 2014; Golightly et al., 2017).
The Role of College Counselors in Providing Systems-Level Interventions
Providing individual counseling is a key role of college counselors (Golightly et al., 2017). In recent years, however, the practice of college counselors has been extended to providing systems-level and preventative mental health interventions to meet the growing mental health needs of college student populations (Brunner et al., 2014; Golightly et al., 2017). In particular, college counselors and their constituents engage in both campus-wide and targeted prevention and outreach programs (Golightly et al., 2017; Lynch & Glass, 2019), including gatekeeper training workshops to prepare university community members as referral agents or train them to recognize and refer students at risk for suicide and other mental health issues to the university counseling center (Albright & Schwartz, 2017; Brunner et al., 2014). These collaborative, educative, and preventative efforts are particularly crucial given the increase in both the severity and complexity of mental health disorders among college students (Gallagher, 2015; Reetz et al., 2016). The findings of past investigators suggest that faculty members are particularly viable referral agents for recognizing and referring students in mental distress to the counseling center (Kalkbrenner, 2016; Margrove et al., 2014).
Faculty Members as Referral Agents
Faculty members have a propensity to serve as referral agents (i.e., recognize and refer students in mental distress to resources) because of their frequent contact with students and their generally positive attitudes and willingness to support their students’ mental and physical wellness (Albright & Schwartz, 2017). Albright and Schwartz (2017) found that approximately 95% of faculty members and staff considered connecting students in mental distress to resources as one of their roles and responsibilities. Similarly, Margrove et al. (2014) found that 64% of untrained university staff members expressed a desire to receive training to recognize warning signs of mental health disorders in students.
Past investigators extended the line of research on the utility of faculty members as gatekeepers by identifying demographic differences by gender and help-seeking history (previous attendance in counseling) in faculty members’ tendency to support college student mental health (Kalkbrenner & Carlisle, 2019; Kalkbrenner & Sink, 2018). In particular, Kalkbrenner and Sink (2018) identified gender as a significant predictor of faculty-to-student counseling referrals, with faculty who identified as female more likely to make faculty-to-student referrals to the counseling center compared to their male counterparts. Similarly, Kalkbrenner and Carlisle (2019) found that faculty members’ awareness of warning signs for mental distress in students was a significant positive predictor of faculty-to-student referrals to the counseling center. In addition, faculty members with a help-seeking history (previous attendance in counseling) were significantly more aware of warning signs for mental distress in their students compared to faculty without a help-seeking history (Kalkbrenner & Carlisle, 2019).
Faculty Members’ Responses to Encountering a Student in Mental Distress
Despite the growing body of literature on institutional agents’ participation in gatekeeper training (i.e., recognize and refer), research on the measurement and appraisal of how faculty members are likely to respond when encountering a student in mental distress is in its infancy. The results of a recent national survey of college students (N = 51,294) and faculty members (N = 14,548) were troubling, as 63% of faculty members did not refer a student in psychological distress to mental health support services (Albright & Schwartz, 2017). Making a referral to the university counseling center is one possible response of students and faculty members to encountering a peer or student in mental distress (Kalkbrenner & Sink, 2018). However, the findings of Albright and Schwartz (2017) highlight a gap in the literature regarding how university community members are likely to respond when encountering a student in mental distress, including but not limited to making a faculty-to-student referral to the college counseling center.
To begin filling this gap in the literature, Kalkbrenner and Flinn (2020) developed, validated, and cross-validated scores on the MDRS to assess 4-year university students’ responses to encountering a student in mental distress, including but not limited to making a referral to mental health support services. In a series of two major phases of psychometric analyses, Kalkbrenner and Flinn identified and confirmed two dimensions or subscales of the MDRS, including Diminish/Avoid and Approach/Encourage, with two large samples of undergraduate students. The Diminish/Avoid subscale measures adverse or inactive responses of university community members to encountering a student in mental distress (e.g., stay away from the person or warn the person that mental issues are perceived as a weakness). The Approach/Encourage subscale appraises facilitative or helpful responses of university community members when encountering a student in mental distress that are likely to help connect the person to resources (e.g., talking to a college counselor or suggesting that the person go to the campus counseling or health center). However, the psychometric properties of the MDRS have not been tested with faculty members. If found valid for such purposes, the MDRS could be a useful tool that college counselors and their constituents can use to screen and promote faculty-to-student referrals to mental health support services. In particular, the following research questions were posed: (1) Does the two-dimensional hypothesized MDRS model fit with a sample of faculty members? and (2) To what extent are there demographic differences in faculty members’ responses to encountering a student in mental distress?
Participants and Procedures
Data were collected electronically from faculty members using Qualtrics, a secure e-survey platform. A nonprobability sampling procedure was used by sending a recruitment email message with an electronic link to the survey to 1,000 faculty members who were teaching at least one course at a research-intensive, mid-Atlantic public university at the time of data collection. A total of 221 faculty members clicked on the electronic link to the survey and 11 responses were omitted from the data set because of 100% missing data, resulting in a useable sample size of 210, yielding a response rate of 21%. This response rate is consistent with the response rates of other investigators (e.g., Brockelman & Scheyett, 2015; Kalkbrenner & Carlisle, 2019) who conducted survey research with faculty members. For gender, 58% (n = 122) identified as female, 41% (n = 86) as male, and 0.5% (n = 1) as non-binary or third gender, and 0.5% (n = 1) did not specify their gender. For ethnicity, 79.0% (n = 166) identified as Caucasian, 6.2% (n = 11) as African American, 3.8% (n = 8) as Hispanic or Latinx, 2.9% (n = 6) as Asian, 2.9% (n = 6) as multiethnic, 0.5% (n = 1) as Hindu, and 0.5% (n = 1) as Irish, and 5.2% (n = 11) did not specify their ethnic identity. Participants ranged in age from 31 to 78 (M = 50; SD = 11). Participants represented all of the academic colleges in the university, including 28.6% (n = 60) Arts and Letters, 22.9% (n = 48) Education, 18.1% (n = 38) Sciences, 12.9% (n = 27) Health Sciences, 9% (n = 19) Engineering and Technology, and 7.6% (n = 16) Business, while 1% (n = 2) of participants did not specify their college.
Following informed consent, participants were asked to indicate that they met the inclusion criteria for participation, including (1) employment as a faculty member, and (2) teaching at least one course at the time of data collection. Participants then responded to a succession of demographic items about their gender, ethnicity, age, academic college, and highest level of education completed. Lastly, respondents indicated their rank and help-seeking history (previous attendance in counseling or no previous attendance in counseling) and if they had referred at least one student to mental health support services.
Mental Distress Response Scale (MDRS)
The MDRS is a screening tool comprised of two subscales (Approach/Encourage and Diminish/Avoid) for measuring university community members’ responses to encountering a student in mental distress (Kalkbrenner & Flinn, 2020). The items that mark the Approach/Encourage subscale appraise responses to mental distress that are consistent with providing support and encouragement to a student in mental distress (e.g., “suggest that they go to the health center on campus”). The Diminish/Avoid subscale measures adverse or inactive responses to encountering a student in mental distress (e.g., “try to ignore your concern”). Kalkbrenner and Flinn (2020) found adequate reliability evidence for an attitudinal measure (α > 0.70) and initial validity evidence for the MDRS in two major phases of analyses (exploratory and confirmatory factor analysis [CFA]) with two samples of college students. Kalkbrenner (2019) extended the line of research on the utility of the MDRS for use with community college students and found adequate reliability (α > 0.80) and validity evidence (single and multiple-group confirmatory analysis).
A CFA based on structural equation modeling was computed using IBM SPSS Amos version 25 to cross-validate scores on the MDRS with a sample of faculty members (research question #1). Using a maximum likelihood estimation method, the following goodness-of-fit indices and thresholds for defining model fit were investigated based on the recommendations of Byrne (2016) and Hooper et al. (2008): Chi square absolute fit index (CMIN, non-significant p-value with an x2/df ratio < 3), comparative fit index (CFI > 0.95), incremental fit index (IFI > 0.95), Tucker-Lewis index (TLI > 0.95), goodness-of-fit index (GFI > 0.95), root mean square error of approximation (RMSEA < 0.07), and standardized root mean square residual (SRMR < 0.08). Based on the findings of past investigators (e.g., Kalkbrenner & Sink, 2018) regarding demographic differences in faculty members’ propensity to support college student mental health, a 2 X 2 (gender X help-seeking history) MANOVA was computed to investigate demographic differences in faculty members’ responses to encountering a student in mental distress (research question #2). The independent variables included gender (male or female) and help-seeking history (previous attendance in counseling or no previous attendance in counseling). Discriminant analysis was used as the post hoc procedure for significant findings in the MANOVA (Warne, 2014). The researcher examined both main effects and interaction effects and applied Bonferroni adjustments to control for the familywise error rate.
The researcher ensured that the data set met the necessary assumptions for CFA (Byrne, 2016; Field, 2018). A missing values analysis revealed that less than 5% of data was missing for all MDRS items. Little’s Missing Completely at Random (MCAR) test revealed that the data was missing at random: χ2 (387) = 407.98, p = 0.22. Expectation maximization was used to impute missing values. Outliers were winsorized (Field, 2018) and skewness and kurtosis values for the MDRS items (see Table 1) were largely consistent with a normal distribution (+ 1; Mvududu & Sink, 2013). Inter-item correlations between the 10 items were favorable for CFA, and Mahalanobis d2 indices revealed no extreme multivariate outliers. The researcher ensured that the sample size was sufficient for CFA by following the guidelines provided by Mvududu and Sink (2013), including at least 10 participants per estimated parameter with a sample > 200.
Descriptive Statistics for MDRS Items
|1. I would stay away from this person
|2. Suggest that they go to the health center on campus
|3. Try to ignore your concern
|4. Take them to a party
|5. Tell them to “tough it out” because they will feel better over time
|6. Suggest that they see a medical doctor on campus
|7. Avoid this person
|8. Suggest that they see a medical doctor in the community
|9. Warn the person that others are likely to see their mental health issues as a weakness
|10. Talk to a counselor about your concern
SEKurtosis = 0.15, SESkewness = 0.17.
Note. Values were winsorized and reported as standardized t-scores (M = 50; SD = 10).
The 10 MDRS items (see Table 1) were entered in the CFA. A strong model fit emerged based on the GFI recommended by Byrne (2016) and Hooper et al. (2008). The CMIN absolute fit index demonstrated no significant differences between the hypothesized model and the data: χ2 (34) = 42.41, p = 0.15, CMIN/df = 1.25. In addition, the CFI = 0.98, GFI = 0.96, IFI = 0.98, TLI = 0.98, RMSEA = 0.03, 90% confidence interval [<.00, .06], and SRMR = 0.05 also demonstrated a strong model fit. Internal consistency reliability analyses (Cronbach’s coefficient alpha) revealed satisfactory reliability coefficients for an attitudinal measure, Diminish/Avoid (α = 0.73) and Approach/Encourage (α = 0.70). In addition, the path model coefficient (-0.04) between factors supported the structural validity of the scales (see Figure 1).
Confirmatory Factor Analysis Path Diagram for the Mental Distress Response Scale
Note. CFA = confirmatory factor analysis, MDRS = Mental Distress Response Scale.
A 2 X 2 (gender X help-seeking history) MANOVA was computed to investigate demographic differences in faculty members’ responses to encountering a student in mental distress (research question #2). G*Power was used to conduct an a priori power analysis (Faul et al., 2007) and revealed that a minimum sample size of 151 would provide a 95% power estimate, α = .05, with a moderate effect size, F2(v) = 0.063. A significant main effect emerged for gender: F(3, 196) = 8.27, p < 0.001, Wilks’ λ = 0.92, = 0.08. The MANOVA was followed up with a post hoc discriminant analysis based on the recommendations of Warne (2014). The discriminant function significantly discriminated between groups: Wilks’ λ = 0.91, X2 = 18.85, df = 2, p < 0.001. The correlations between the latent factors and discriminant function showed that Diminish/Avoid loaded more strongly on the function (r = 0.98) than Approach/Encourage (r = 0.29), suggesting that Diminish/Avoid contributed the most to group separation in gender. The mean discriminant score on the function was -0.27 for participants who identified as female and 0.37 for participants who identified as male.
The results of tests of internal consistency reliability (Cronbach’s coefficient alpha), CFA, and correlations between factors supported the psychometric properties of the MDRS with a sample of faculty members. The results of the CFA were promising as GFI demonstrated a strong model fit between the two-dimensional hypothesized MDRS model and a sample of faculty members (research question #1). In particular, based on one of the most conservative and rigorous absolute fit indices, the CMIN (Byrne, 2016; Credé & Harms, 2015), the researchers retained the null hypothesis—there were no significant differences between the hypothesized factor structure of the MDRS and a sample of faculty members. The strong model fit suggests that Approach/Encourage and Diminish/Avoid are two latent variables that comprise faculty members’ responses to encountering a student in mental distress. The findings of the CFA add to the extant literature about the utility of the MDRS for use with 4-year university students (Kalkbrenner & Flinn, 2020), community college students (Kalkbrenner, 2019), and now with faculty members.
An investigation of the path model coefficient between subscales (see Figure 1) revealed a small and negative association between factors, which supports the structural validity of the MDRS. In particular, the low and negative relationship between the Approach/Encourage and Diminish/Avoid subscales indicates that the dimensions of the MDRS are measuring discrete dimensions of a related construct. As expected, faculty members who scored higher on the Approach/Encourage subscale tended to score lower on the Diminish/Avoid subscale. However, the low strength of the association between factors suggests that faculty members’ responses to encountering a student in mental distress might not always be linear (e.g., a strong positive approach/encourage response might not always be associated with a strong negative diminish/avoid response). Haines et al. (2017) demonstrated that factors in the environment and temperament of a person showing signs of mental distress were significant predictors of mental health support staff’s perceptions of work safety. It is possible that under one set of circumstances faculty members might have an approach/encourage response to mental distress. However, under a difference set of circumstances, a faculty member might have a diminish/avoid response. For example, the extent to which a faculty member feels threatened or unsafe might mediate their propensity of having diminish/avoid or approach/encourage responses. Future research is needed to evaluate this possibility.
Consistent with the findings of previous researchers (Kalkbrenner & Carlisle, 2019; Kalkbrenner & Sink, 2018), the present investigators found that faculty members who identified as male were more likely to report a diminish/avoid response to encountering a student in mental distress compared to female faculty members. Similarly, Kalkbrenner and Sink (2018) found that male faculty members were less likely to make faculty-to-student referrals to the counseling center, and Kalkbrenner and Carlisle (2019) found that male faculty members were less likely to recognize warning signs of mental distress in college students. Similarly, the multivariate results of the present investigation revealed that male faculty members were more likely to report a diminish/avoid response to encountering a student in mental distress when compared to female faculty members. The synthesized findings of Kalkbrenner and Carlisle (2019), Kalkbrenner and Sink (2018), and the present investigation suggest that faculty members who identify as male might be less likely to recognize and refer a student in mental distress to mental health support services. The MDRS has valuable implications for enhancing the practice of professional counselors in college settings.
Implications for Counseling Practice
Outreach, consultation, and psychoeducation are essential components in the practice of college counselors (Brunner et al., 2014; Golightly et al., 2017). The findings of the present investigation have a number of practical implications for enhancing college counselors’ outreach and psychoeducation work—for example, gatekeeper workshops geared toward promoting faculty-to-student referrals to mental health support resources. The complex and multidimensional nature of college student mental health issues calls for interdisciplinary collaboration between college counselors and professionals in a variety of disciplinary orientations in higher education (Eells & Rockland-Miller, 2011; Hodges et al., 2017). College counselors can take leadership roles in coordinating these collaborative efforts to support college student mental health. In particular, college counselors can work with student affairs officials, higher education administrators, and their constituents, and attend new faculty orientations as well as department meetings to administer the MDRS, establish relationships with faculty, and discuss the benefits of gatekeeper training as well as supporting college student mental health. The results of the MDRS can be used to gain insight into the types of responses that faculty members are likely to have when encountering a student in mental distress. This information can be used to structure the content of gatekeeper training workshops aimed at promoting faculty-to-student referrals to mental health support services. Specifically, college counselors might consider the utility of integrating brief interventions and skills training components into gatekeeper training workshops. Motivational interviewing, for example, is an evidence-based, brief approach to counseling that includes both person-centered and directive underpinnings with utility for increasing clients’ intrinsic motivation to make positive changes in their lives (Iarussi, 2013; Resnicow & McMaster, 2012). Professional counselors who practice in higher education are already using motivational interviewing to promote college student development and mental health (Iarussi, 2013). Although future research is needed, integrating motivational interviewing principles (e.g., expressing empathy, rolling with resistance, developing discrepancies, and supporting self-efficacy; Iarussi, 2013) into gatekeeper training workshops might increase faculty members’ commitment to supporting college student mental health.
The MDRS has the potential to enhance college counselors’ outreach and mental health screening efforts (Golightly et al., 2017). College counselors can incorporate the MDRS into batteries of pretest/posttest measures (e.g., the MDRS with a referral self-efficacy measure) for evaluating the effectiveness of mental health awareness initiatives and gatekeeper training programs for faculty and other members of the campus community. If administered widely, the MDRS might have utility for assessing faculty members’ responses to students in mental distress across time and among various campus ecological systems, providing data to drive the prioritization and allocation of outreach efforts aimed at facilitating and maintaining referral networks for connecting students in mental distress to support services.
The results of the present study have policy implications related to campus violence prevention programming. The sharp increase in campus violence incidents has resulted in several universities implementing threat assessment teams as a harm-prevention measure (Eells & Rockland-Miller, 2011). Threat assessment teams involve an interdisciplinary collaboration of university faculty and staff for the purposes of recognizing and responding to students who are at risk of posing a threat to themselves or to others. College counselors can take leadership roles in establishing and supporting threat assessment teams at their universities. College counselors can administer the MDRS to faculty and staff and use the results as one way to identify potential threat assessment team members. University community members who score higher on the Approach/Encourage scale might be inclined to serve on threat assessment teams because of their propensity to support college student mental health. The brevity (10 questions) and versatility of administration (paper copy or electronically via laptop, smartphone, or tablet) of the MDRS adds to the practicality of the measure. Specifically, it might be practical for college counselors and their constituents to administer the MDRS during new faculty orientations, annual opening programs, or department meetings, or via email to faculty and staff. Results can potentially be used to recruit threat assessment team members.
Our findings indicate that when compared to their female counterparts, male faculty members might be more likely to have a diminish/avoid response when encountering a student in mental distress. College counselors might consider working collaboratively with student affairs professionals to implement gatekeeper training and mental health awareness workshops in academic departments that are comprised of high proportions of male faculty members. It is possible that male faculty members are unaware of how to identify warning signs of mental distress in their students (Kalkbrenner & Carlisle, 2019). College counselors might consider the utility of distributing psychoeducation resources for recognizing students in mental distress to faculty and staff. As just one example, the REDFLAGS model is an acronym of eight red flags or warning signs for identifying students who might be struggling with mental health issues (Kalkbrenner, 2016). Kalkbrenner and Carlisle (2019) demonstrated that the REDFLAGS model is a promising psychoeducational tool, as faculty members’ awareness of the red flags was a significant positive predictor of faculty-to-student referrals to the counseling center. The REDFLAGS model appears to be a practical resource for college counselors that can be distributed to faculty electronically or by paper copy, or posted as a flyer (Kalkbrenner, 2016; Kalkbrenner & Carlisle, 2019).
Limitations and Future Research
The findings of the present study should be considered within the context of the limitations. A number of methodological limitations (e.g., self-report bias and social desirability) can influence the validity of psychometric designs. In addition, the dichotomous nature of the faculty-to-student counseling referral variable (referred or not referred) did not provide data on the frequency of referrals. Future researchers should use a continuous variable (e.g., the number of student referrals to the counseling center in the past 2 years) to appraise faculty-to-student referrals. Future researchers can further test the psychometric properties of the MDRS through cross-validating scores on the measure with additional, unique populations of faculty members from a variety of different geographic and social locations. Invariance testing can be computed to examine the degree to which the MDRS and its dimensions maintain psychometric equivalence across different populations of faculty members. In addition, the criterion validity of the MDRS can be examined by testing the extent to which respondents’ MDRS scores are predictors of their frequency of student referrals to the counseling center and to other resources. Furthermore, future qualitative research is needed to investigate faculty members’ unique experiences around supporting college student mental health.
The low and negative association between the Approach/Encourage and Diminish/Avoid subscales suggests that faculty members might have an approach/encourage response to encountering a student in mental distress under one set of circumstances; however, they might have a diminish/avoid response under a difference set of circumstances. Future investigators might test the extent to which attitudinal variables mediate respondents’ MDRS scores—for example, the extent to which faculty members’ sense of safety predicts their MDRS scores. In addition, given the widespread public perception of individuals living with mental illness as violent and dangerous (Varshney et al., 2016), future researchers might identify demographic and background differences (particularly mental health stigma) among participants’ MDRS scores.
Summary and Conclusion
Mental health outreach and screening are essential components in the practice of college counselors, including training referral agents to recognize and refer students who might be struggling with mental health distress to support services (Golightly et al., 2017). Taken together, the results of the present study indicate that the MDRS and its dimensions were estimated sufficiently with a sample of faculty members. Our findings confirmed the two-dimensional hypothesized model for the types of responses that faculty might have when encountering a student showing signs of mental distress. In particular, the results of a CFA provided support for the MDRS and its dimensions, confirming a two-dimensional construct for the types of responses (approach/encourage and diminish/avoid) that faculty members might have when encountering a student in mental distress. Considering the utility of faculty members as gatekeepers and referral agents (Hodges et al., 2017; Kalkbrenner, 2016), researchers, practitioners, and policymakers may find the MDRS a useful screening tool for identifying the ways in which faculty members are likely to respond when encountering a student in mental distress. Results can be used to inform the content of mental health awareness initiatives and gatekeeper training programs aimed at promoting approach/encourage responses to connect students who need mental health support to the appropriate resources.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
Albright, G. & Schwartz, V. (2017). Are campuses ready to support students in distress?: A survey of 65,177 faculty, staff, and students in 100+ colleges and universities. https://www.jedfoundation.org/wp-content/uploads/2017/10/Kognito-JED-Are-Campuses-Ready-to-Support-Students-in-Distress.pdf
Auerbach, R. P., Alonso, J., Axinn, W. G., Cuijpers, P., Ebert, D. D., Green, J. G., Hwang, I., Kessler, R. C., Liu, H., Mortier, P., Nock, M. K., Pinder-Amaker, S., Sampson, N. A., Aguilar-Gaxiola, S., Al-Hamzawi, A., Andrade, L. H., Benjet, C., Caldas-de-Almeida, J. M., Demyttenaere, K., . . . Bruffaerts, R. (2016). Mental disorders among college students in the World Health Organization World Mental Health Surveys. Psychological Medicine, 46, 2955–2970. https://doi.org/10.1017/S0033291716001665
Barrett, D. (2014, September 24). Mass shootings on the rise, FBI says. The Wall Street Journal. http://online.wsj.com/articles/mass-shootings-on-the-rise-fbi-says-1411574475
Brockelman, K. F., & Scheyett, A. M. (2015). Faculty perceptions of accommodations, strategies, and psychiatric advance directives for university students with mental illnesses. Psychiatric Rehabilitation Journal, 38, 342–348. https://doi.org/10.1037/prj0000143
Brunner, J. L., Wallace, D. L., Reymann, L. S., Sellers, J.-J., & McCabe, A. G. (2014). College counseling today: Contemporary students and how counseling centers meet their needs. Journal of College Student Psychotherapy, 28, 257–324. https://doi.org/10.1080/87568225.2014.948770
Byrne, B. M. (2016). Structural equation modeling with AMOS: Basic concepts, applications, and programming (3rd ed.). Routledge.
Credé, M., & Harms, P. D. (2015). 25 years of higher-order confirmatory factor analysis in the organizational sciences: A critical review and development of reporting recommendations. Journal of Organizational Behavior, 36, 845–872. https://doi.org/10.1002/job.2008
Downs, M. F., & Eisenberg, D. (2012). Help seeking and treatment use among suicidal college students. Journal of American College Health, 60, 104–114. https://doi.org/10.1080/07448481.2011.619611
Eells, G. T., & Rockland-Miller, H. S. (2011). Assessing and responding to disturbed and disturbing students: Understanding the role of administrative teams in institutions of higher education. Journal of College Student Psychotherapy, 25, 8–23. https://doi.org/10.1080/87568225.2011.532470
Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175–191. https://doi.org/10.3758/BF03193146
Field, A. (2018). Discovering statistics using IBM SPSS Statistics (5th ed.). SAGE.
Futo, J. (2011). Dealing with mental health issues on campus starts with early recognition and intervention. Campus Law Enforcement Journal, 41, 22–23.
Gallagher, R. P. (2015). National survey of college counseling centers 2014. http://d-scholarship.pitt.edu/id/eprint/28178
Golightly, T., Thorne, K., Iglesias, A., Huebner, E., Michaelson-Chmelir, T., Yang, J., & Greco, K. (2017). Outreach as intervention: The evolution of outreach and preventive programming on college campuses. Psychological Services, 14, 451–460. https://doi.org/10.1037/ser0000198
Haines, A., Brown, A., McCabe, R., Rogerson, M., & Whittington, R. (2017). Factors impacting perceived safety among staff working on mental health wards. BJPsych Open, 3, 204–211.
Hodges, S. J., Shelton, K., & King Lyn, M. M. (2017). The college and university counseling manual: Integrating essential services across the campus. Springer.
Hooper, D., Coughlan, J., & Mullen, M. R. (2008). Structural equation modelling: Guidelines for determining model fit. The Electronic Journal of Business Research Methods, 6, 53–60.
Iarussi, M. M. (2013). Examining how motivational interviewing may foster college student development. Journal of College Counseling, 16(2), 158–175. https://doi.org/10.1002/j.2161-1882.2013.00034.x
Kalkbrenner, M. T. (2016). Recognizing and supporting students with mental health disorders: The REDFLAGS Model. Journal of Education and Training, 3, 1–13. https://doi.org/10.5296/jet.v3i1.8141
Kalkbrenner, M. T. (2019). Peer-to-peer mental health support on community college campuses: Examining the factorial invariance of the Mental Distress Response Scale. Community College Journal of Research and Practice. https://doi.org/10.1080/10668926.2019.1645056
Kalkbrenner, M. T., & Carlisle, K. L. (2019). Faculty members and college counseling: Utility of The REDFLAGS Model. Journal of College Student Psychotherapy. https://doi.org/10.1080/87568225.2019.1621230
Kalkbrenner, M. T., & Flinn, R. F. (2020). Development, validation, and cross-validation of the Mental Distress Reaction Scale (MDRS). Journal of College Student Development.
Kalkbrenner, M. T., & Sink, C. A. (2018). Development and validation of the College Mental Health Perceived Competency Scale. The Professional Counselor, 8, 175–189. https://doi.org/10.15241/mtk.8.2.175
Kleinfield, N. R. (2007, April 22). Before deadly rage, a life consumed by a troubling silence. The New York Times. http://www.nytimes.com/2007/04/22/us/22vatech.html?pagewanted=all
Lynch, R. J., & Glass, C. R. (2019). The development of the Secondary Trauma in Student Affairs Professionals Scale (STSAP). Journal of Student Affairs Research and Practice, 56, 1–18.
Margrove, K. L., Gustowska, M., & Grove, L. S. (2014). Provision of support for psychological distress by university staff, and receptiveness to mental health training. Journal of Further and Higher Education, 38, 90–106. https://doi.org/10.1080/0309877X.2012.699518
Mvududu, N. H., & Sink, C. A. (2013). Factor analysis in counseling research and practice. Counseling Outcome Research and Evaluation, 4, 75–98. https://doi.org/10.1177/2150137813494766
Reetz, D. R., Bershad, C., LeViness, P., & Whitlock, M. (2016). The Association for University and College Counseling Center Directors annual survey. https://www.aucccd.org/assets/documents/aucccd%202016%
Resnicow, K., & McMaster, F. (2012). Motivational interviewing: Moving from why to how with autonomy support. International Journal of Behavioral Nutrition and Physical Activity, 9, 19.
Reynolds, A. L. (2013). College student concerns: Perceptions of student affairs practitioners. Journal of College Student Development, 54, 98–104. https://doi.org/ 10.1353/csd.2013.0001
Shuchman, M. (2007). Falling through the cracks—Virginia Tech and the restructuring of college mental health services. The New England Journal of Medicine, 357, 105–110. https://doi.org/10.1056/NEJMp078096
Vanderhart, D., Johnson, K., & Turkewitz, J. (2015, October 2). Oregon shooting at Umpqua College kills 10, sheriff says. The New York Times. https://www.nytimes.com/2015/10/02/us/oregon-shooting-umpqua-community-college.html?smid=pl-share
Varshney, M., Mahapatra, A., Krishnan, V., Gupta, R., & Deb, K. S. (2016). Violence and mental illness: What is the true story? Journal of Epidemiology & Community Health, 70, 223–225.
Vieselmeyer, J., Holguin, J., & Mezulis, A. (2017). The role of resilience and gratitude in posttraumatic stress and growth following a campus shooting. Psychological Trauma: Theory, Research, Practice, and Policy, 9, 62–69. https://doi.org/10.1037/tra0000149
Warne, R. T. (2014). A primer on multivariate analysis of variance (MANOVA) for behavioral scientists. Practical Assessment, Research & Evaluation, 19(17), 1–10.
Michael T. Kalkbrenner, PhD, NCC, is an assistant professor at New Mexico State University. Correspondence can be addressed to Michael Kalkbrenner, 1220 Stewart St., OH202B, NMSU, Las Cruces, NM 88001, email@example.com.
Kathryn Marburger, Sheri Pickover
Providing treatment to survivors of human trafficking requires mental health professionals to understand complex layers of multiple traumas. These layers include an understanding of how trafficking occurs; what gender, ages, sexual orientations, life circumstances, and ethnicities are most at risk to be trafficked; the lasting impact of trafficking on human development, mental health, and family relationships; and the stigma victims face from their own families, communities, and mental health providers. These survivors suffer from physical ailments and post-traumatic stress disorder, and they are at high risk for developing comorbid disorders such as depression and addiction disorders. Integrated treatment options to alleviate these concerns, including cognitive behavioral therapy, trauma-focused therapy, ecologically focused therapy, and family therapy, are presented.
Keywords: human trafficking, trauma, post-traumatic stress disorder, addiction disorder, sexual orientation
Human trafficking is often referred to as modern-day slavery and is found in every corner of the globe (Cecchet & Thoburn, 2014; Department of Homeland Security [DHS], n.d.; Gerassi, 2015; Hardy et al., 2013; Hodge, 2014; Litam, 2017; Polaris, n.d.-b; Sanchez & Stark, 2014; Zimmerman & Kiss, 2017). The United Nations defines trafficking as:
the recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or
use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or
of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the
consent of a person having control over another person, for the purpose of exploitation. (Office of the
High Commissioner for Human Rights, 2000, article 3, para. 1)
The International Labour Office (2017) has estimated that 40.3 million people are victims of modern-day slavery throughout the world. This means that one person in every 1,000 is being victimized through modern-day slavery. Offering high rewards with minimal risk, human trafficking is a profitable and fast-growing criminal enterprise. Human trafficking profits surpass illegal arms trafficking and are second only to drug trafficking (Busch-Armendariz et al., 2014; Greer & Davidson Dyle, 2014; UNICEF USA, 2017). The International Labour Office (2014) has estimated that the profits from human trafficking are $150 billion a year, of which $99 billion comes from sexual exploitation.
The DHS reported that the crime of human trafficking is often hidden in plain sight in both legal and illegal industries; victims can be any gender, sexual orientation, age, and nationality, including documented or undocumented immigrants (DHS, n.d.; Rothman et al., 2017). However, statistics on human trafficking within the United States are lacking (DHS, n.d.; Gerassi, 2015; Miller-Perrin & Wurtele, 2017; Varma et al., 2015), and a uniform system of collecting data to identify victims currently does not exist, which increases the difficulty of obtaining accurate data (Gerassi, 2015; Miller-Perrin & Wurtele, 2017). Additional factors that contribute to the underreporting of human trafficking include legal and social services that are not readily accessible to victims, fear of punishment from traffickers, and fear or distrust of law enforcement. Moreover, some victims may not even recognize themselves as being the victims of human trafficking (De Chesnay, 2013; Miller-Perrin & Wurtele, 2017).
Human trafficking is a crime that inflicts complex layers of trauma on victims and survivors. The goal of this article is to provide mental health professionals with a systemic view of this crime from various perspectives so that they can implement wraparound-focused treatment plans. The perspectives adopted include how individuals become trafficked, sociocultural factors, the impact on the victims’ development and mental health, family relationships, and the stigma victims face from communities and their families. Having knowledge of these complex factors will allow mental health professionals to devise trauma-sensitive approaches to treat survivors of human trafficking. For the purpose of this paper, the term victims refers to individuals who are actively under the control of the trafficker, and the term survivors refers to individuals who are no longer being exploited.
Sexual exploitation and forced labor are two of the most common forms of human trafficking (Busch-Armendariz et al., 2014; De Chesnay, 2013; Greer & Davidson Dyle, 2014; Hodge, 2014; Martinez & Kelle, 2013; Miller-Perrin & Wurtele, 2017; U.S. Department of State, 2017). Human Rights First (2017) reported that 19% of human trafficking victims are trafficked for sex, and yet sex trafficking accounts for 66% of trafficking profits worldwide. Sex trafficking includes a wide variety of traditionally accepted forms of labor, including commercial sex, exotic dancing, and pornography. It is a form of oppression placing men, women, and children throughout the world at risk of sexual exploitation (Litam, 2017; Polaris, n.d.-a; Zimmerman & Kiss, 2017).
Traffickers treat victims’ bodies as resources to be used and repeatedly sold for money or goods such as pornography, cigarettes, drugs, clothing, and shelter (Busch-Armendariz et al., 2014; Greer & Davidson Dyle, 2014; Litam, 2017; Miller-Perrin & Wurtele, 2017; Sanchez & Stark, 2014). International trafficking often receives more attention; however, most trafficking occurs domestically within the same country (Martinez & Kelle, 2013; Zimmerman & Kiss, 2017). Furthermore, trafficking does not have to include crossing a state line, nor does it necessarily involve moving locations (Busch-Armendariz et al., 2014). Domestic minor sex trafficking is flourishing in every region, state, and community in the United States (Countryman-Roswurm & Bolin, 2014), with Midwestern cities showing increased rates of recruitment; such cities have access to several highways to transport victims to destination cities, including Detroit, Chicago, and Las Vegas, where demand for sexual exploitation is highest (Litam, 2017).
Sex trafficking has been linked not only to escort and massage services, strip clubs, and pornography, but also to major sporting events, entertainment venues, truck stops, business meetings, and conventions (Busch-Armendariz et al., 2014; Hardy et al., 2013; Litam, 2017). As long as demand exists, the opportunity for traffickers to sell victims is limitless. The internet increases the convenience and reduces the risk for traffickers and consumers. For instance, although Backpage.com was shut down by the U.S. government in 2017 for participating in and profiting from sex trafficking advertisements, and other websites like Craigslist began to censor and remove sex advertisements (Anthony et al., 2017; Leary, 2018; Peterson et al., 2019), numerous websites are used by traffickers not only to lure victims but also to advertise and sell to consumers. These websites include Eros.com, Bedpage.com, and social media platforms such as Instagram, Facebook, Twitter, Tinder, and Grindr (Jordan et al., 2013; Litam, 2017; Moore et al., 2017; O’Brien, 2018). The physical and psychological abuse victims experience from both traffickers and consumers leaves victims traumatized (Graham et al., 2019; Greer & Davidson Dyle, 2014; Litam, 2017; Moore et al., 2017; Zimmerman & Kiss, 2017).
The Victims of Trafficking
One out of every four victims of human trafficking is a child (International Labour Office, 2017), and these children are often found in the child welfare and juvenile justice systems, and runaway and homeless youth shelters (Moore et al., 2017; U.S. Department of State, 2017). In 2016, it was estimated that one out of six runaways was a victim of sex trafficking and 86% had been in foster care or social services when they ran away (Polaris, n.d.-a). Runaway youth are usually approached by traffickers within 48 hours of living on the street (Jordan et al., 2013). Traffickers recruit runaway or homeless children into trafficking rings, exposing them to extreme forms of abuse that result in many being killed from the violence inflicted or from diseases acquired through sexual abuse (Litam, 2017).
Sex trafficking is prevalent throughout the world, affecting men, women, children, families, and communities. Individuals also are trafficked for various other purposes, including domestic service, agricultural work, commercial fishing, the textile industry, construction, mining, factory work, and petty crime (U.S. Department of State, 2017; Zimmerman & Kiss, 2017). Although men have been confirmed to be victims in all areas of trafficking, they are disproportionately subjected to forced labor, whereas women and children account for the majority of sexually exploited victims (International Labour Office, 2017). Although trafficking occurs in all parts of the world and can affect anyone, several factors increase the risk of trafficking, including gang activity, a history of childhood abuse, and poverty. Substance abuse also plays a key role (De Chesnay, 2013; Moore et al., 2017; O’Brien, 2018).
Substance abuse within families is a risk factor for children becoming the victims of trafficking (Hardy et al., 2013; Miller-Perrin & Wurtele, 2017). Parents or other family members with an addiction can force youth into sexual exploitation, selling or trading them to support their drug addiction (De Chesnay, 2013; Litam, 2017). Traffickers often force substance use on victims in order to control and sexually exploit them (De Chesnay, 2013; Gerassi, 2015; Hodge, 2014; Hom & Woods, 2013; Litam, 2017; Moore et al., 2017). Substance abuse also may be a way for trafficking victims to cope with the abuse they endure (Miller-Perrin & Wurtele, 2017).
Trafficking victims who engage in substance abuse usually experience detrimental personal outcomes, including an increased likelihood of engaging in high-risk behaviors (i.e., unprotected sex), infection from needles, and overdosing (Gerassi, 2015; Zimmerman et al., 2011). They often commit drug-related crimes for their trafficker and are therefore at risk of arrest and conviction for prostitution and drug offenses (Litam, 2017; Miller-Perrin & Wurtele, 2017; Zimmerman et al., 2011). Arrests, drug charges, substance abuse, and violent clients can trap trafficking victims in a vicious circle of re-traumatization by their traffickers, their potentially abusive consumers, and the criminal justice system (Gerassi, 2015; Zimmerman et al., 2011).
Impact on Physical and Mental Health
A concern for children who fall prey to sex trafficking is the impact these experiences have on their development. Not only are victims affected by educational deprivation, but trafficking also causes serious harm to their psychological, spiritual, and emotional development (Miller-Perrin & Wurtele, 2017; Rafferty, 2008; Sanchez & Stark, 2014). Child victims suffer from an increased risk of several emotional problems such as guilt, shame, anxiety, hopelessness, and loss of self-esteem (Miller-Perrin & Wurtele, 2017; Rafferty, 2008). Some of the mental health consequences for child victims include depression, dissociation, post-traumatic stress disorder (PTSD), eating disorders, somatization, poor attachment, antisocial behaviors, substance use disorders, self-harm, and suicidality (Kiss et al., 2015; Miller-Perrin & Wurtele, 2017; Rafferty, 2008). Furthermore, because of the exposure to the violence and sexual assault linked to trafficking, child victims have been found to be at higher risk of sexually transmitted infections, reproductive health problems from unsafe abortions, fractures, genital lacerations, malnutrition, and dental problems (Miller-Perrin & Wurtele, 2017).
Trafficking poses significant risk to child victims’ long-term mental health. Survivors trafficked in childhood report a high prevalence of mental health problems such as depression, anxiety, and PTSD. These mental health problems also affect adult victims (Hom & Woods, 2013; Oram et al., 2016). Among women who have survived trafficking, there are increased rates of anxiety and stress disorders, disassociation, depression, personality disorders, low self-esteem, suicidal ideation, and poor interpersonal relationships (Sanchez & Stark, 2014). Additionally, somatic symptoms such as headaches, fainting, and memory problems are commonly reported among women who are victims of trafficking (Oram et al., 2016). A high prevalence of sexually transmitted infections has been reported in both men and women (Hom & Woods, 2013; Oram et al., 2016; Sanchez & Stark, 2014). Borschmann et al. (2017) found high rates of self-harm among adult victims of human trafficking.
Pregnancy is a common occurrence for trafficked women (Bick et al., 2017; Gerassi, 2015; Hom & Woods, 2013; Oram et al., 2016; Sanchez & Stark, 2014). Several barriers to maternity services have been identified for pregnant victims, including traffickers preventing women from seeking care and the victims feeling reluctant because they might not have valid documents (Bick et al., 2017). Additionally, children and family members are often used by traffickers to threaten and coerce victims, which further isolates victims and distances them from their families (Hardy et al., 2013; Hodge, 2014; Juabsamai & Taylor, 2018; Sanchez & Stark, 2014).
Sex trafficking often involves the exploitation of victims by force, and the brutal nature of the crime can cause complex mental health problems for victims (Gerassi, 2015; Greer & Davidson Dyle, 2014; Hodge, 2014; Hom & Woods, 2013; Litam, 2017). Victims endure high levels of trauma, and survivors show increased rates of depression, anxiety, PTSD, and substance use disorders (Gerassi, 2015). The goal of traffickers is to physically and psychologically break victims down into subservience (Hodge, 2014). Not only are victims forced to engage in humiliating sexual acts and use substances, but traffickers also use recurrent beatings, rape, and even murder as tactics to control their victims (De Chesnay, 2013; Gerassi, 2015; Hodge, 2014; Hom & Woods, 2013; Litam, 2017). Victims may believe that the traffickers have their best interests in mind and develop significant bonds with their traffickers, similar to Stockholm syndrome, and may be reluctant to escape (De Chesnay, 2013; Hodge, 2014; Hom & Woods, 2013; Litam, 2017). In addition, victims of sexual exploitation have not only endured physical and emotional abuse from their traffickers, but there also is a strong correlation with childhood abuse (Gerassi, 2015; Miller-Perrin & Wurtele, 2017). However, issues of physical and mental health tend to be exacerbated by issues of economic deprivation and racial inequality. These factors may act as a catalyst for putting individuals more at risk of human trafficking (Greer, 2013).
Sex traffickers often target vulnerable individuals, including runaway and homeless youth; victims of domestic abuse or sexual assault; victims of war; and individuals who experience social discrimination, including gender, racial, ethnic, and socioeconomic inequality (Anthony et al., 2017; Miller-Perrin & Wurtele, 2017). For example, LGBTQ homeless youth account for 20% of the homeless youth population in the United States, yet 58.7% of homeless LGBTQ youth are victims of sex trafficking (Martinez & Kelle, 2013). Martinez and Kelle (2013) further noted that this figure is significantly higher than the 33.4% of the heterosexual homeless youth. Furthermore, LGBTQ youth are more than seven times more likely to experience acts of violence than their cisgender peers (Anthony et al., 2017). Trafficking often affects victims of poverty. Studies of sexual exploitation and domestic sex trafficking also have reported higher rates of violence against women of color, especially African American women, and undocumented immigrants (Gerassi, 2015; Zimmerman & Kiss, 2017).
Finally, individuals with intellectual disabilities are at risk because of an unfamiliarity with sexual activities and an inability to understand the nature of sexual abuse and exploitation (Reid, 2018). As a result, such individuals are at a higher risk of becoming victims of trafficking (Greer & Davidson Dyle, 2014; Hodge, 2014; Miller-Perrin & Wurtele, 2017; Reid, 2018).
Women who have been victims of trafficking have often been found to come from abusive households (Gerassi, 2015; Hom & Woods, 2013; O’Brien, 2018; Oram et al., 2016). As a result, once victims are free from their traffickers, they have often been found to not only lack social support but also lack basic needs such as shelter and financial support (Hom & Woods, 2013; Le, 2017; Oram et al., 2016). Reconciliation with supportive family often plays a key role for trafficking survivors; however, because of stigma, some victims are met with shame and judgment from their families and are not welcomed (Hom & Woods, 2013; Juabsamai & Taylor, 2018; McCarthy, 2018; Zimmerman & Kiss, 2017).
Unfortunately, it is not uncommon for victims to be exploited by someone they know and love. Oftentimes a trafficker is a family member, intimate partner, friend, or acquaintance (Gerassi, 2015; Hardy et al., 2013; Hom & Woods, 2013; Le, 2017; Miller-Perrin & Wurtele, 2017; Moore et al., 2017), which further complicates survivors’ ability to establish trusting relationships. Moreover, law enforcement may charge adult victims with prostitution. Not only is the victim caught in legal limbo, but they are re-victimized by law enforcement (Sanchez & Stark, 2014). Finally, female survivors who socialize with men after being freed from their traffickers have reported being triggered with memories of their abusive experiences, further affecting their ability to develop healthy, stable relationships and social support (Hom & Woods, 2013).
Victims of human trafficking have often been robbed of their identities, had their self-esteem demolished, and already experienced physical and psychological abuse before they became victims of human traffickers. Once they leave their traffickers, survivors have a variety of immediate, short-, and long-term needs that must be addressed to help promote resiliency while they are reintegrating into the community (Busch-Armendariz et al., 2014; Graham et al., 2019; Hom & Woods, 2013; Le, 2017; McCarthy, 2018; O’Brien, 2018; Twigg, 2017). Immediate needs include ensuring safety; finding medical care, food, shelter, clothing, and counseling; and acquiring identiﬁcation, language interpretation services, and legal and immigration assistance (Busch-Armendariz et al., 2014; Graham et al., 2019; Hom & Woods, 2013; McCarthy, 2018; Polaris, n.d.-a; Twigg, 2017). Education, employment, and establishing friendships have been identified as vital ongoing needs to successfully alleviate stress while reintegrating into the community (Hom & Woods, 2013; McCarthy, 2018; O’Brien, 2018; Polaris, n.d.-a; Twigg, 2017). However, it is important to note that survivors are often met with substantial challenges while seeking basic services. For instance, many programs may be underfunded or ill-equipped to handle the high demand for services (Polaris, n.d.-a). This reaffirms the crucial need to meet survivors with empathetic and nonjudgmental attitudes to help prevent re-victimization and a return to traffickers (Anthony et al., 2018; Hodge, 2014; Hom & Woods, 2013; McCarthy, 2018).
Family support can provide survivors with significant protection while reintegrating into the community. Reconnecting with family typically increases the likelihood of a sustainable return process (McCarthy, 2018; Twigg, 2017). However, reconciliation might require a careful approach, as the process can be met with difficulties, including stigma, dysfunctional family environments, or the family’s direct involvement with the victim’s trafficking (Le, 2017; McCarthy, 2018; Twigg, 2017; Zimmerman & Kiss, 2017). In some cases, shame within a cultural context is a prohibitive factor for many to return to their families because of the association with prostitution or having been trafficked (Hom & Woods, 2013). As a result, it is necessary to provide comprehensive, culturally sensitive interventions for trafficking survivors (Hodge, 2014; Hom & Woods, 2013; Le, 2017; McCarthy, 2018). Family continues to be essential to survivors’ sense of identity, and, upon return, cultural beliefs and values that previously formed their self-concept remain influential to survivors (Le, 2017). Many women have noted that marriage and children play an integral role in successfully reintegrating into their community and gaining acceptance from family members (McCarthy, 2018). However, issues of economic deprivation and racial inequality act as a barrier to successful community reintegration and put an individual at higher risk for trafficking (Greer, 2013).
This brief literature review has confirmed that victims of human trafficking suffer from a wide array of mental health concerns, including PTSD, depression, anxiety, and substance abuse, and from stigma associated with being victims of human trafficking. Mental health treatment should address these complex concerns and provide for comprehensive assessment and treatment planning.
Working with trafficked clients poses a series of challenges for counselors because an intervention modality specific to sex-trafficked survivors has yet to be developed (Hopper et al., 2018; Jordan et al., 2013). Treatments are borrowed from evidence-based interventions initially developed for PTSD, domestic violence, and captivity, and a holistic approach is essential (De Chesnay, 2013; Hom & Woods, 2013; Jordan et al., 2013). Four essential practices for providers include ensuring safety and conﬁdentiality, engagement of trauma-informed care, performing a comprehensive needs assessment, and delivery of comprehensive case management that coordinates physical and mental health and legal services. As a result of the multiple traumas trafficking victims endure, the path to restoring wellness is often long and complex, requiring additional time and patience from mental health counselors (Hodge, 2014; Hom & Woods, 2013).
Mental health counselors should conduct a needs assessment to identify the physical, emotional, and spiritual needs of trafficking survivors (Hodge, 2014; Hom & Woods, 2013). Survivors are often in need of medical treatment, as traffickers do not bother with preventative care or what they may consider minor treatment and only allow victims to seek treatment when a condition interferes with earning money (De Chesnay, 2013). Similarly, survivors are often resistant to seek help from mental health providers because of fear of physical violence or threats of retaliation from their traffickers if they disclose their circumstances (De Chesnay, 2013; Hodge, 2014; Litam, 2017). Survivor-centered approaches are recommended initially to acknowledge and validate the survivor’s experience, give the survivor control, and build a sense of safety and trust (Hodge, 2014; Hom & Woods, 2013; Twigg, 2017).
However, after months or years of abuse, trafficking survivors often need a wide array of services to meet their distinctive needs (Hodge, 2014; Hom & Woods, 2013; McCarthy, 2018; Polaris, n.d.-a). The U.S. government has enacted several policies to help victims of trafficking, including the Victims of Trafficking and Violence Protection Act of 2000, which allows victims who have been trafficked from abroad to be issued visas, enabling them to reside in the United States (Davy, 2016; Hodge, 2014). Survivors need to be met with nonjudgmental attitudes, acceptance, understanding, and genuine concern, and they should be slowly encouraged to take on risks associated with leaving their traffickers (Hodge, 2014; Hom & Woods, 2013; McCarthy, 2018). Providing survivors with emotional support and encouragement opposes the isolated world created by their trafficker. Survivors have explained that street outreach programs can play an essential role in establishing contact, allowing victims to become aware of the resources available and begin breaking down the sense of isolation (Hom & Woods, 2013). Additionally, it is vital to empower survivors so that they can understand they are in control (Anthony et al., 2018; Hodge, 2014; Hom & Woods, 2013; Twigg, 2017). Research on resiliency has found creativity, humor, flexibility, and movement are important factors in improving self-esteem, prosocial behaviors, and hope among traumatized individuals (Litam, 2017).
Counselors working with trafficking survivors should be equipped to use several trauma-sensitive interventions to assist with the individual needs of each survivor (Busch-Armendariz et al., 2014; De Chesnay, 2013; Hardy et al., 2013; Hodge, 2014; Hom & Woods, 2013; Litam, 2017; Miller-Perrin & Wurtele, 2017; Twigg, 2017). Trauma-sensitive interventions recognize safety as the foundation for working with individuals to end self-harm, develop trusting relationships, overcome obstacles, leave dangerous situations, and promote wellness (Hopper et al., 2018). Although it may be painful for trafficking survivors to verbalize their traumatic experiences, creative therapies offer alternative methods of communication and expression (De Chesnay, 2013; Litam, 2017).
Although evidence-based practices for treating sex-trafﬁcking survivors are not widespread, counseling techniques exist that have been shown to be effective with child sex abuse victims, including trauma-focused cognitive behavioral therapy and dialectical trauma-focused cognitive behavior therapy (De Chesnay, 2013; Twigg, 2017). Similarly, participating in group counseling can empower survivors of sex trafficking and provide them with an opportunity to share their experiences, generating a sense of community and support (Hopper et al., 2018). Peer support has been noted to be a vital component of intervention, both as a motivating factor to remain in treatment and as help in the prevention of survivors returning to their traffickers (De Chesnay, 2013; Litam, 2017; Twigg, 2017). Furthermore, discussing stigmatized topics within group settings can help reduce shame, as it is common for trafficked survivors to feel that no one else has gone through similar situations (Hickle & Roe-Sepowitz, 2014; Litam, 2017). Having a setting to address the shame can help survivors recognize the commonality of their experiences and build support (Countryman-Roswurm & Bolin, 2014; Litam, 2017).
As human trafficking affects individuals, families, and communities, it is necessary to adopt treatment models that engage families and communities as well as individual-based treatment models. Twigg (2017) found that survivors require and benefit from therapeutic support in order to achieve successful family and community reunification. However, like individual treatment, family therapy models specific to human trafficking survivors do not exist, but current family therapy models developed around trauma could be adapted for use with human trafficking survivors. Apsche et al. (2008) developed Family Mode Deactivation Therapy, a cognitive behavior family therapy model for use with youth and families in residential treatment that uses ongoing assessment and community skill development to reduce the behavioral symptoms associated with trauma. The researchers found this model reduced recidivism more effectively than a non–family-based approach. Hughes (2017) developed an attachment-focused family treatment for children who have experienced developmental trauma. This two-phase treatment provides therapy to a caregiver first, then transitions to joint sessions to reframe the trauma experience.
Similarly, using ecologically based family therapy with individuals involved in sex trafficking has been found to improve outcomes for sobriety and depression (Murnan et al., 2018). Agani et al. (2010) recommended the use of the linking human systems community resilience model, which is based on transgenerational and ecosystemic structural family therapies. This model focuses on identifying the strengths of community and family members, bringing them together to encourage their competency and using community leaders to solve problems. Other novel approaches to working with survivors of crime include the Family Group Project, which involves group therapy aimed at recreating a family environment to re-integrate survivors into the community (Allen et al., 2015).
A Survivor’s Story
Research provides one perspective on the plight of human trafficking victims and survivors, but a first-person account provides insight to the worldview of an actual survivor. One of the authors met with a human trafficking advocate in order to gain further perspective on the needs of survivors. The advocate, who requested that the author provide no identifying information beyond her gender, disclosed during the interview that she was a survivor who had been trafficked by her husband. Her trafficker had been blackmailing a John, a term commonly used for an exploitive consumer. She was arrested during a raid and remained in jail for 3 months because she refused to say anything. She explained that it took her a year to build up the strength and courage to testify in court because her trafficker blackmailed her. He threatened to tell her family about the exploitative acts and substance use, which he forced her to engage in. He would say, “Do you really want your family to know what you have been up to?” However, once her family was notified of her predicament, she reported that her family members provided emotional support. She explained that it was through their support she was able to come forward and testify.
Although she came forward and testified against her trafficker, she was not viewed as a victim, and she was charged with prostitution. As she explained, advocates are trying to change the legislation and work with police in her local area so that human trafficking victims are not charged with crimes. For instance, not only was she charged with prostitution, but she also had to pay the John $3,000, the money her trafficker had stolen from him. Despite never having seen the money, she was ordered to repay it and was placed on a repayment schedule. Even more disheartening, her trafficker made a plea deal and did not have to repay any money and the charges of trafficking were dropped. All these events provide an example of how the legal system can re-victimize a survivor. Although she had been the victim of trafficking, which stigmatized her, she also was told that she owed money to someone her trafficker had stolen from, thus re-victimizing her.
The charge of prostitution remained on her record and became something she had to explain to potential employers. With the support of her family and by attending therapy, she was able to rebuild her life. She had a bachelor’s degree in social work when she met her ex-husband and was able to obtain her limited license. She decided to pursue a master’s degree and was once again faced with the challenge of disclosing the charge on her record and reliving the trauma of explaining what happened. The first university she applied to denied her application, and this placed her in a deep depression; however, she was accepted at another university and after graduating became an advocate for survivors of human trafficking. She also shared that although it took time to be able to trust someone again, she has established an intimate relationship and will soon be married.
Counselors treating a human trafficking survivor need to develop a wide-ranging view of assessment, treatment, case management, support, advocacy, and termination from counseling. Human trafficking survivors suffer from a complex variety of developmental, mental health, and social issues that require counselors to not only engage the individual in treatment, but also to act as an advocate against stigma within their family and the community.
The myriad of issues faced by these individuals, from navigating the criminal justice system, coping with multiple layers of physical and emotional trauma, overcoming substance abuse, overcoming family and community alienation, coping with dual stigmas of human trafficking and mental health diagnoses, to finally reintegrating into daily work and life, require counselors to be vigilant in the assessment process. Counselors need to consider assessment an ongoing extensive process that should occur throughout every session and focus not just on mental health needs, but also on physical health and basic needs, and career support. Counselors will need to assess risk of the individual returning to the trafficker and have referrals ready to help the client stay safe. Human trafficking survivors will need a counselor able to quickly identify short-term crisis needs during long-term treatment.
When entering the treatment phase, counselors need to research multiple treatment modalities that may not directly relate to human trafficking but may support the client. For example, a counselor will need to navigate working with substance use, trauma, family issues, and career concerns. Counselors will need to widen their view of their role within the therapeutic relationship. Human trafficking survivors may require case management services more than long-term counseling when first entering care, yet the need to build a strong therapeutic relationship is paramount for ongoing treatment. The counselor should consider taking on the case management role as needed to promote consistency in the treatment process. As an advocate, the counselor will need to engage multiple individuals and systems into the treatment process to ensure comprehensive care. Counseling skills aimed at engaging families, law enforcement personnel, legal personnel, and medical professionals in treatment are essential for treating survivors. Counselors would also benefit from strength-based approaches with this population, as research indicates survivors most benefit from being able to identify their own qualities of self-protection and resiliency, which empowers their recovery process. This empowerment also allows for a supportive termination process, ensuring that the survivor has ongoing access to a support network in order to facilitate long-term recovery.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
Agani, F., Landau, J., & Agani, N. (2010). Community-building before, during, and after times of trauma: The application of the LINC model of community resilience in Kosovo. American Journal of Orthopsychiatry, 80, 143–149. https://doi.org/10.1111/j.1939-0025.2010.01017.x
Allen, D. F., Carroll, M. A., Allen, V. S., Bethell, K. Y., & Manganello, J. A. (2015). Community resocialization via instillation of family values through a novel group therapy approach: A pilot study. Journal of Psychotherapy Integration, 25(4), 289–298. https://doi.org/10.1037/a0039563
Anthony, B., Amatullah, A. H., Anderson, J., Arias, E. F. P., N.M.B., Crisp, J. D., Crosson, L., D’Souza, H., Fasthorse, H., Hollis, J., John, D., Johnson, D., Johnson, N., Liles, T., Lipenga, F., Lundstrom, M., Marty, R., McCarty, T., Moninda, Morrissey, A., . . . Woworuntu, S. (2018). On-Ramps, intersections, and exit routes: A roadmap for systems and industries to prevent and disrupt human trafficking. https://polarisproject.org/wp-content/uploads/2018/08/A-Roadmap-for-Systems-and-Industries-to-Prevent-and-Disrupt-Human-Trafficking.pdf
Anthony, B., Penrose, J. K., Jakiel, S., Couture, T., Crowe, S., Fowler, M., Keyhan, R., Sorensen, K., Myles, B., & Badavi, M. A. (2017, March). The typology of modern slavery: Defining sex and labor trafficking in the United States. https://polarisproject.org/wp-content/uploads/2019/09/Polaris-Typology-of-Modern-Slavery-1.pdf
Apsche, J. A., Bass, C. K., & Houston, M.-A. (2008). Family mode deactivation therapy as a manualized cognitive behavioral therapy treatment. International Journal of Behavioral Consultation and Therapy, 4(2), 264–277. https://doi.org/10.1037/h0100848
Bick, D., Howard, L. M., Oram, S., & Zimmerman, C. (2017). Maternity care for trafficked women: Survivor experiences and clinicians’ perspectives in the United Kingdom’s National Health Service. PLOS ONE, 12(11), e0187856. https://doi.org/10.1371/journal.pone.0187856
Borschmann, R., Oram, S., Kinner, S. A., Dutta, R., Zimmerman, C., & Howard, L. M. (2017). Self-harm among adult victims of human trafficking who accessed secondary mental health services in England. Psychiatric Services, 68(2), 207–210. https://doi.org/10.1176/appi.ps.201500509
Busch-Armendariz, N., Nsonwu, M. B., & Heffron, L. C. (2014). A kaleidoscope: The role of the social work practitioner and the strength of social work theories and practice in meeting the complex needs of people trafficked and the professionals that work with them. International Social Work, 57, 7–18. https://doi.org/10.1177/0020872813505630
Cecchet, S. J., & Thoburn, J. (2014). The psychological experience of child and adolescent sex trafficking in the United States: Trauma and resilience in survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 6, 482–493. https://doi.org/10.1037/a0035763
Countryman-Roswurm, K., & Bolin, B. L. (2014). Domestic minor sex trafficking: Assessing and reducing risk. Child and Adolescent Social Work Journal, 31, 521–538. https://doi.org/10.1007/s10560-014-0336-6
Davy, D. (2016). Anti–human trafficking interventions: How do we know if they are working? American Journal of Evaluation, 37, 486–504. https://doi.org/10.1177/1098214016630615
De Chesnay, M. (2013). Psychiatric-mental health nurses and the sex trafficking pandemic. Issues in Mental Health Nursing, 34, 901–907. https://doi.org/10.3109/01612840.2013.857200
Department of Homeland Security. (n.d.). Blue campaign: What is human trafficking? https://www.dhs.gov/blue-campaign/what-human-trafficking
Gerassi, L. (2015). From exploitation to industry: Definitions, risks, and consequences of domestic sexual exploitation and sex work among women and girls. Journal of Human Behavior in the Social Environment, 25, 591–605. https://doi.org/10.1080/10911359.2014.991055
Graham, L. M., Macy, R. J., Eckhardt, A., Rizo, C. F., & Jordan, B. L. (2019). Measures for evaluating sex trafficking aftercare and support services: A systematic review and resource compilation. Aggression and Violent Behavior, 47, 117–136. https://doi.org/10.1016/j.avb.2019.04.001
Greer, B. T. (2013). Hiding behind tribal sovereignty: Rooting out human trafficking in Indian country. The Journal of Gender, Race & Justice, 16, 453–482.
Greer, B. T., & Davidson Dyle, S. (2014). Balancing the equity of mental health injuries: Examining the “trauma exception” for sex trafficking T-VISA applicants. International Journal of Migration, Health and Social Care, 10(3), 159–191. https://doi.org/10.1108/IJMHSC-11-2013-0042
Hardy, V. L., Compton, K. D., & McPhatter, V. S. (2013). Domestic minor sex trafficking: Practice implications for mental health professionals. Affilia, 28, 8–18. https://doi.org/10.1177/0886109912475172
Hickle, K. E., & Roe-Sepowitz, D. E. (2014). Putting the pieces back together: A group intervention for sexually exploited adolescent girls. Social Work With Groups, 37(2), 99–113.
Hodge, D. R. (2014). Assisting victims of human trafficking: Strategies to facilitate identification, exit from trafficking, and the restoration of wellness. Social Work, 59(2), 111–118. https://doi.org/10.1093/sw/swu002
Hom, K. A., & Woods, S. J. (2013). Trauma and its aftermath for commercially sexually exploited women as told by front-line service providers. Issues in Mental Health Nursing, 34(2), 75–81.
Hopper, E. K., Azar, N., Bhattacharyya, S., Malebranche, D. A., & Brennan, K. E. (2018). STARS experiential group intervention: A complex trauma treatment approach for survivors of human trafficking. Journal of Evidence-Informed Social Work, 15(2), 215–241. https://doi.org/10.1080/23761407.2018.1455616
Hughes, D. (2017). Dyadic developmental psychotherapy (DDP): An attachment-focused family treatment for developmental trauma. Australian and New Zealand Journal of Family Therapy, 38, 595–605. https://doi.org/10.1002/anzf.1273
Human Rights First. (2017). Human trafficking by the numbers. http://www.humanrightsfirst.org/sites/default/files/TraffickingbytheNumbers.pdf
International Labour Office. (2014). Profits and poverty: The economics of forced labour. http://www.ilo.org/wcmsp5/groups/public/—ed_norm/—declaration/documents/publication/wcms_243391.pdf
International Labour Office. (2017). Global estimates of modern slavery: Forced labour and forced marriage. http:/www.ilo.org/wcmsp5/groups/public/@dgreports/@dcomm/documents/publication/wcms_575479.pdf
Jordan, J., Patel, B., & Rapp, L. (2013). Domestic minor sex trafficking: A social work perspective on misidentification, victims, buyers, traffickers, treatment, and reform of current practice. Journal of Human Behavior in the Social Environment, 23, 356–369. https://doi.org/10.1080/10911359.2013.764198
Juabsamai, K. J., & Taylor, I. (2018). Family separation, reunification, and intergenerational trauma in the aftermath of human trafficking in the United States. Anti-Trafficking Review, 10, 123–138. https://doi.org/10.14197/atr.201218108
Kiss, L., Yun, K., Pocock, N., & Zimmerman, C. (2015). Exploitation, violence, and suicide risk among child and adolescent survivors of human trafficking in the Greater Mekong Subregion. JAMA Pediatrics, 169(9), e152278–e152278. https://doi.org/10.1001/jamapediatrics.2015.2278
Le, P. D. (2017). “Reconstructing a sense of self”: Trauma and coping among returned women survivors of human trafficking in Vietnam. Qualitative Health Research, 27, 509–519.
Leary, M. G. (2018). The indecency and injustice of section 230 of the Communications Decency Act. https://scholarship.law.edu/cgi/viewcontent.cgi?article=1990&context=scholar
Litam, S. D. A. (2017). Human sex trafficking in America: What counselors need to know. The Professional Counselor, 7, 45–61. https://doi.org/10.15241/sdal.7.1.45
Martinez, O., & Kelle, G. (2013). Sex trafficking of LGBT individuals: A call for service provision, research, and action. The International Law News, 42(4), 1–6.
McCarthy, L. A. (2018). Life after trafficking in Azerbaijan: Reintegration experiences of survivors. Anti-Trafficking Review, 10, 105–122. https://doi.org/10.14197/atr.201218107
Miller-Perrin, C., & Wurtele, S. K. (2017). Sex trafficking and the commercial sexual exploitation of children. Women & Therapy, 40, 123–151. https://doi.org/10.1080/02703149.2016.1210963
Moore, J. L., Houck, C., Hirway, P., Barron, C. E., & Goldberg, A. P. (2017). Trafficking experiences and psychosocial features of domestic minor sex trafficking victims. Journal of Interpersonal Violence. https://doi.org/10.1177/0886260517703373
Murnan, A., Wu, Q., & Slesnick, N. (2018). Effects of ecologically-based family therapy with substance-using, prostituting mothers. Journal of Family Therapy, 40, 557–583. http://doi.org/10.1111/1467-6427.12187
O’Brien, J. E. (2018). “Sometimes, somebody just needs somebody—anybody—to care:” The power of interpersonal relationships in the lives of domestic minor sex trafficking survivors. Child Abuse & Neglect, 81, 1–11. https://doi.org/10.1016/j.chiabu.2018.04.010
Office of the High Commissioner for Human Rights. (2000). Protocol to prevent, suppress and punish trafficking in persons, especially women and children, supplementing the United Nations convention against transnational organized crime. https://www.ohchr.org/Documents/ProfessionalInterest/ProtocolonTrafficking.pdf
Oram, S., Abas, M., Bick, D., Boyle, A., French, R., Jakobowitz, S., Khondoker, M., Stanley, N., Trevillion, K., Howard, L., & Zimmerman, C. (2016). Human trafficking and health: A survey of male and female survivors in England. American Journal of Public Health, 106, 1073–1078. https://doi.org/10.2105/AJPH.2016.303095
Peterson, M., Robinson, B., & Shih, E. (2019). The new virtual crackdown on sex workers’ rights: Perspectives from the United States. Anti-Trafficking Review, 12, 189–193. https://doi.org/10.14197/atr.2012191212
Polaris. (n.d.-a). Myths, facts, and statistics. https://polarisproject.org/myths-facts-and-statistics
Polaris. (n.d.-b). Human trafficking. https://polarisproject.org/human-trafficking
Rafferty, Y. (2008). The impact of trafficking on children: Psychological and social policy perspectives. Child Development Perspectives, 2, 13–18.
Reid, J. A. (2018). Sex trafficking of girls with intellectual disabilities: An exploratory mixed methods study. Sexual Abuse, 30(2), 107–131. https://doi.org/10.1177/1079063216630981
Rothman, E. F., Stoklosa, H., Baldwin, S. B., Chisolm-Straker, M., Kato Price, R., & Atkinson, H. G. (2017). Public health research priorities to address U.S. human trafficking. American Journal of Public Health, 107, 1045–1047. https://doi.org/10.2105/AJPH.2017.303858
Sanchez, R., & Stark, S. W. (2014). The hard truth about human trafficking. Nursing Management, 45, 18–23. https://doi.org/10.1097/01.NUMA.0000440630.41142.66
Twigg, N. M. (2017). Comprehensive care model for sex trafficking survivors. Journal of Nursing Scholarship, 49(3), 259–266. https://doi.org/10.1111/jnu.12285
UNICEF USA. (2017, January 13). What fuels human trafficking? https://www.unicefusa.org/stories/what-fuels-human-trafficking/31692
U.S. Department of State. (2017). Trafficking in persons report. https://www.state.gov/wp-content/uploads/2019/02/271339.pdf
Varma, S., Gillespie, S., McCracken, C., & Greenbaum, V. J. (2015). Characteristics of child commercial sexual exploitation and sex trafficking victims presenting for medical care in the United States. Child Abuse & Neglect, 44, 98–105. https://doi.org/10.1016/j.chiabu.2015.04.004
Zimmerman, C., Hossain, M., & Watts, C. (2011). Human trafficking and health: A conceptual model to inform policy, intervention and research. Social Science & Medicine, 73, 327–335.
Zimmerman, C., & Kiss, L. (2017). Human trafficking and exploitation: A global health concern. PLOS Medicine, 14(11), e1002437. https://doi.org/10.1371/journal.pmed.1002437
Kathryn Marburger is a graduate student at the University of Detroit Mercy. Sheri Pickover, PhD, LPC, is an associate professor at Central Michigan University. Correspondence can be addressed to Sheri Pickover, 195 Ojibway Court, Mt. Pleasant, MI 48859, firstname.lastname@example.org.
Ryan M. Cook, Laura E. Welfare, Connie T. Jones
This study examined the incidence of intentional nondisclosure by postgraduate, prelicensed counselors receiving supervision as they pursue licensure, which has not been previously examined. Examining the responses of 107 prelicensed counselors, we found that 95.3% reported withholding some degree of information from their supervisors, and 53.3% completely withheld a concern from their supervisors. Participants completely withheld supervision-related incidents (e.g., negative reactions to supervisor, questioning supervisor’s competency) more frequently than they withheld client-related incidents (e.g., clinical mistakes, personal issues). We offer strategies for prelicensed counselors, supervisors, counselor educators, and counselor credentialing bodies to reduce intentional nondisclosure. These strategies include creating a collaborative environment, developing supervision contracts, and attending to power differentials in supervision.
Keywords: intentional nondisclosure, clinical supervision, prelicensed counselors, supervisors, counselor educators
Counselors who desire licensure as full, independent professional counselors must complete a postgraduate supervised field experience (Henriksen et al., 2019). The primary purpose of postgraduate supervision is to ensure that prelicensed counselors provide counseling services that are in accordance with legal, ethical, and professional standards as they begin their professional careers (Borders et al., 2011; Magnuson et al., 2000). Unlike university-based supervision, to which prelicensed counselors are more accustomed (Magnuson et al., 2000), postgraduate supervision requires prelicensed counselors to regularly self-direct their supervision experience. That is, in postgraduate supervision, prelicensed counselors are called to more autonomously self-identify their clinical concerns and developmental needs, and to convey this information to their supervisors (Cook & Sackett, 2018).
Although supervisees’ self-reports can enrich the supervision process (Noelle, 2002), relying on prelicensed counselors to self-select information to share with their supervisor may be problematic (Ladany et al., 1996). While supervision is intended to facilitate supervisees’ professional development, there also is an evaluative component inherent in the supervisory relationship (Borders et al., 2011). The supervisor’s evaluations of the supervisee’s clinical performance are tied to their professional progress (i.e., obtaining full, independent licensure; Magnuson et al., 2000). As such, it benefits supervisees to present themselves in a manner that will yield positive evaluations from their supervisors and to withhold information that could result in their supervisors developing a negative perception of their clinical competencies (Cook, Welfare, & Romero, 2018; Ladany et al., 1996).
Supervisees withholding information from their supervisors is a well-established phenomenon in supervision literature (Cook, Welfare, & Romero, 2018; Gibson, et al., 2019; Hess et al., 2008; Ladany et al., 1996). Termed supervisee nondisclosure, researchers have shown that the frequency of supervisee nondisclosure in clinical supervision is high—ranging from 60% to 97.2% (Cook, Welfare, & Romero, 2018; Ladany et al., 1996; Mehr et al., 2010). But these studies were based on samples of counselors-in-training (CITs) or trainees in allied professions such as psychology. To date, only one qualitative study has examined the phenomenon of nondisclosure in a sample of postgraduate supervisees. Sweeney and Creaner (2014) found that counseling psychology graduates in Ireland (N = 6), like supervisees in mental health training programs (Cook, Welfare, & Romero, 2018; Ladany et al., 1996), commonly withhold information from their supervisors.
What seems most problematic are the instances in which a supervisee identifies a concern or perceives an issue and decides to withhold it from their supervisors anyway (Cook & Welfare, 2018; Yourman & Farber, 1996). These instances are known as supervisee intentional nondisclosure. Ladany and colleagues (1996) suggested that the information being intentionally withheld by supervisees is likely to be the most important information to their clinical and professional development. As such, supervisees who withhold information may inadvertently undermine their own professional growth.
Supervision scholars (Cook, Welfare, & Romero, 2018; Gibson et al., 2019; Hess et al., 2008; Ladany et al., 1996) have found that the types of information withheld by supervisees can be broadly categorized into supervision-related incidents (e.g., negative reactions to a supervisor, evaluation concerns, fears of correcting a supervisor, concerns about the process of supervision) and client-related incidents (e.g., clinical mistakes, general reactions to clients, concerns about lack of professional competencies). The reasons for these intentional nondisclosures most often point to issues in the supervisory relationship (e.g., supervisory working alliance; Cook & Welfare, 2018; Hess et al., 2008), supervisee personality traits (e.g., attachment styles; Cook & Welfare, 2018), and supervisor–supervisee power differentials (e.g., fear of negative evaluation concerns, desire to present oneself favorably to the supervisor; Hess et al., 2008; Ladany et al., 1996). In total, the types of information being intentionally withheld by supervisees, as well as the reasons for their nondisclosures, reflect issues that are inherent in a hierarchal and evaluative relationship such as the supervisory relationship (Hess et al., 2008; Mehr et al., 2010; Sweeney & Creaner, 2014).
Prelicensed counselors, like CITs and supervisees from allied professions, experience similarly high stakes in clinical supervision. However, as described in detail below, postgraduate supervision differs from university-based supervision (Magnuson et al., 2000), and prelicensed counselors are more advanced in their professional development as compared to CITs (Rønnestad & Skovholt, 2003). For these reasons, the salient issues that prelicensed counselors are hesitant or unwilling to discuss with their supervisors might differ from those of CITs. Relatedly, the degree to which they fail to disclose information might also differ. Thus, in our investigation we examined the types of information being withheld in postgraduate supervision by 107 prelicensed counselors and the degree to which they were unwilling to discuss their concerns with their supervisors.
Postgraduate Supervision for Licensure
Postgraduate supervision is required for counselors who desire licensure as full and independent professional counselors in all 50 states in the United States as well as Guam, Puerto Rico, and the District of Columbia. The specific requirements of postgraduate supervision differ in each licensing jurisdiction (e.g., frequency of supervision, hours of required supervision; Henriksen et al., 2019). Although prelicensed counselors often are more self-aware of their client needs and developmental concerns than CITs (Loganbill et al., 1982; Rønnestad & Skovholt, 2003; Stoltenberg & McNeill, 2010), prelicensed counselors also are facing new challenges as counselors such as managing more complex caseloads (Freadling & Foss-Kelly, 2014) and possibly questioning their own clinical competencies (Rønnestad & Skovholt, 2003). Thus, a supervised field experience is critical to helping prelicensed counselors transition from CITs to professional counselors (Henriksen et al., 2019).
As compared to university-based supervision, there are unique features of postgraduate supervision for prelicensed counselors (Magnuson et al., 2000). Namely, prelicensed counselors engaged in postgraduate supervision are tasked to self-direct their supervision experience (Cook & Sackett, 2018) more than they were during university-based supervision. For example, prelicensed counselors may have less access to their supervisors than they did during their graduate training. Henriksen et al. (2019) conducted a content analysis of supervision requirements for postgraduate supervision. Based on their findings, no jurisdiction required supervisors and supervisees engaging in postgraduate supervision to meet at a frequency that equaled the Council for Accreditation of Counseling and Related Educational Programs’ (CACREP) required averages of an hour of individual supervision or 1.5 hours of group supervision per week. It is important to note that it is certainly possible for prelicensed counselors to meet with their supervisors more than is required, but these standards provide a useful benchmark. Prelicensed counselors also may have fewer opportunities than CITs for their clinical work to be directly observed by their supervisors (Magnuson et al., 2000), which could perpetuate the supervisors’ reliance on supervisees’ self-report in supervision (Cook & Sackett, 2018) and unintentionally encourage supervisee nondisclosure (Ladany et al., 1996). For example, Fall and Sutton (2004) found that prelicensed counselors used self-report in their supervision sessions 80% of the time. Comparatively, other methods to monitor supervisees’ work, such as direct observation of a counseling session, audio and video recording, or live supervision, were used far less often (each used 10% of the time).
In addition, the interpersonal dynamics between supervisor and supervisee in postgraduate supervision may differ from those experienced during university-based supervision. Unlike the development-oriented process of university-based supervision, Magnuson et al. (2000) poignantly described postgraduate supervision as a “business relationship” (p. 177). Some prelicensed counselors pay for supervision from someone who does not work at their place of employment, while other prelicensed counselors work with a supervisor at their place of employment (Magnuson et al., 2000). In the latter situation, the supervisors providing clinical supervision also can be evaluating the prelicensed counselor as an administrative supervisor. Although the dual roles may be logistically advantageous for agencies, having combined clinical and administrative supervision could be problematic (Borders et al., 2011; Magnuson et al., 2000). In sum, as compared to university-based supervision, the businesslike nature of postgraduate supervision as well as the heavy reliance on prelicensed counselors to self-direct their supervision experience can change how these counselors utilize intentional nondisclosure in postgraduate supervision.
The degree to which prelicensed counselors are willing to disclose information to their supervisors has implications for clinical supervisors as well. Clinical supervisors assume legal responsibility for the quality of services rendered to their supervisees’ clients (Magnuson et al. 2000). With the dependence on prelicensed counselors to self-report information in clinical supervision (Fall & Sutton, 2004) and the potential absence of regular direct observation (Gray & Erickson, 2013; Magnuson et al., 2000), supervisors are reliant on prelicensed counselors to accurately recall details of their counseling work and to honestly discuss their developmental needs. If prelicensed counselors, like CITs, were to feel unsure about presenting themselves honestly to their supervisors, their decision could unintentionally undermine the work of their clinical supervisors, who have a legal duty to their supervisees and the supervisees’ clients (Magnuson et al., 2000).
No study has examined what prelicensed counselors perceive as salient in their clinical supervision experience and the degree to which they are willing to discuss concerns with their supervisors. Postgraduate supervision is critically important to a counselor’s developmental growth (Henriksen et al., 2019). Prelicensed counselors are mandated to receive clinical supervision (Henriksen et al., 2019), which means that supervisee intentional nondisclosure is a relevant issue. As such, an investigation of supervisee intentional nondisclosure in a sample of postgraduate, prelicensed counselors is needed. Therefore, the aim of our study was to examine prelicensed counselors’ self-reported incidents of intentional nondisclosure in clinical supervision. Specifically, our investigation was guided by two research questions: (a) What is the frequency of intentional nondisclosure in clinical supervision as reported by prelicensed counselors, and (b) Which concerns do prelicensed counselors find most difficult to discuss with clinical supervisors?
Participants and Procedures
Participants in the current study were prelicensed counselors pursuing full, independent licensure as professional counselors. We aimed to recruit a nationally representative sample, so we obtained mailing addresses for persons pursuing licensure in two states in each of the five Association for Counselor Education and Supervision (ACES) regions. Specifically, we solicited participation from prelicensed counselors in Arkansas, Colorado, Idaho, Iowa, Oklahoma, Oregon, Rhode Island, Texas, Vermont, and Washington. We randomly selected up to 150 names from each state. After eliminating and replacing unverifiable mailing addresses, we identified 1,347 potential participants. We first received IRB approval and then solicited participation by mailing paper-and-pencil survey packets to the potential participants. We asked participants to anonymously respond about their current, licensed clinical supervisor. Participants returned the surveys to the authors using a prepaid envelope. Of the 1,347 mailed packets, 330 packets (24.5%) were “returned to sender” and never received by the potential participants. Of the remaining 1,017 packets distributed to potential participants, 109 survey packets were returned. However, two participants’ responses were incomplete and subsequently removed. The number of usable packets was 107, resulting in a response rate of 10.5%. This response rate, although low, is consistent with previous survey research employing a mailing recruitment strategy (Barden et al., 2017). Because data collection was anonymous, we are unable to identify the state of origin for participants included in our sample.
The age of participants ranged from 24 to 67 (M = 38.79, SD = 11.20). The majority of participants identified as White (83.2%), while eight participants identified as Hispanic (7.5%), five participants identified as African American/Black (4.7%), two participants identified as Asian (1.9%), two participants identified as Multiracial (1.9%), and one participant did not respond to this item (0.9%). Eighty-five participants identified as female (79.4%), 21 participants identified as male (19.6%), and one participant identified as non-binary (0.9%). The demographic characteristics of the participants in the current study are comparable to counseling professionals in general (CACREP, 2018). On average, the participants received 64.73 (SD = 29.79) minutes of clinical supervision per week. Finally, 56 participants were assigned a supervisor at their job (51.4%), 28 paid for supervision from someone who did not work at their employment site (26.4%), 17 chose a supervisor at their place of employment (15.9%), and six participants indicated other (5.6%; e.g., free supervision from someone outside their job).
Supervisee Nondisclosure Scale (SNDS)
The SNDS is an instrument designed to capture the degree to which participants disclosed or withheld information to their supervisors (Ellis & Colvin, 2016; Siembor, 2012). Siembor (2012) developed a pool of 30 items, informed by prior research on nondisclosure (Hess et al., 2008; Ladany et al., 1996). Participants indicate their level of disclosure using a 7-point Likert scale with three defined levels: (1 = fully disclosed, 4 = sometimes disclosed, 7 = decided not to disclose). Higher scores indicate higher levels of nondisclosure. Participants are given the option to select not applicable for items describing incidents that have not occurred during their supervision experiences. The items include information related to the supervision experience (e.g., “Negative reactions that I had about my supervisor’s behavior or attitudes”) and items related to the supervisee’s clinical work (e.g., “Clinical mistakes that I did make”). Abbreviated item stems for all 30 SNDS items are presented in Table 1. The internal reliability of all 30 items was strong (α = .88, n = 107) and consistent with prior research (α = .84; McKibben et al., 2018).
We created a survey to collect self-report demographic data for both the supervisee and supervisor (e.g., gender, race). We also asked participants to share about the details of their supervision experience (e.g., time in supervision, administrative versus clinical supervision, selecting a supervisor).
Across all 30 SNDS items, 95.3% of the participants reported some degree of intentional nondisclosure (i.e., partially or fully withheld) for at least one item. The number of incidents of intentional nondisclosure endorsed by participants ranged from 0 to 26 (M = 10.68; SD = 6.62). Also, 53.3% indicated that they fully withheld information from their clinical supervisor for at least one item. The range of incidents completely withheld by participants was 0 to 14 (M = 1.73, SD = 2.6). This finding suggests that intentional nondisclosure by prelicensed counselors in clinical supervision is quite common.
The Frequency of Intentional Nondisclosure in Clinical Supervision
To address the first research question, we examined the frequency of participants who responded that they utilized intentional nondisclosure on each item (i.e., what percent withheld information?). To do so, we analyzed the self-reported responses on each item using the four groups: not applicable, fully disclosed, sometimes disclosed, and decided not to disclose (see Table 1). For each item, participant responses of not applicable were categorized in the not applicable group, responses of 1 were categorized in the fully disclosed group, responses of 2 to 6 were categorized in the sometimes disclosed group, and responses of 7 were categorized in the decided not to disclose group. The incidence of partial or complete nondisclosure per item ranged from 69.2% (“disagreement with one’s supervisor”) to 1.9% (“supervisor attraction issue”), and the average incidence across the items was 35.6% (SD = 15.8%). After “disagreement with one’s supervisor,” the items with the highest incidence rates were “negative reaction to supervisors’ behavior or attitudes” (66.3%), “perceived that my supervisor is wrong” (60.7%), “personal issue” (49.6%), and “personally identifying with a client” (e.g., countertransference; 48.6%). In addition to revealing what supervisees chose to withhold, the results indicated issues that did not emerge in supervision and those that emerged but were fully disclosed. For example, items frequently marked not applicable were “supervisor attraction issue” (97.2%), “client attraction issue” (86.9%), “unsafe in supervision” (86.0%), and “supervisors’ attire and/or appearance” (84.1%). In contrast, “client information” and “clinical mistake” came up often and were fully disclosed.
Incidence of Intentional Nondisclosure by Prelicensed Counselors in Clinical Supervision for State Licensure as Professional Counselors
|Incident of Potential Intentional Nondisclosure
|Decided Not to Disclose
|Negative reaction to supervisors’ behavior or attitudes SRI
|Supervisors’ competence SRI
|Needs not being met in supervision SRI
|Supervisors’ display of stereotypes or bias SRI
|Supervisors’ attire and/or appearance SRI
|Consult with peer and/or another supervisor SRI
|Supervision process concerns SRI
|Power differentials SRI
|Focus of supervision SRI
|Unsafe in supervision SRI
|Perceived that my supervisor
is wrong SRI
|Disagreement with one’s supervisor SRI
|Supervision format issues SRI
|Personal issue CRI
|Personally identify with client (e.g., countertransference) CRI
|Evaluation concern SRI
|Client attraction issue CRI
|Client attracted to counselor CRI
|Positive reaction to supervisor SRI
|Issues with colleague SRI
|Positive reaction to client CRI
|Feeling inadequate CRI
|Clinic setting concerns CRI
|Supervisor attraction issue SRI
|Unprofessional behavior with client CRI
|Future clinical mistake CRI
|Clinical mistake CRI
|Client information CRI
|Negative reaction to client CRI
Note. Percentages may not equal 100% for each item because of rounding.
SRI = Supervision-Related Incident
CRI = Client-Related Incident
a = Items are ranked based on incidence of total nondisclosure (i.e., score of 7).
The Most Difficult to Discuss Items
In addition to the per-item incidence rates, we also calculated which concerns were most often totally withheld from supervisors. We hoped to understand what items participants might be completely unwilling to discuss in supervision. Interestingly, we ranked all 30 SNDS items by the number of participants who reported using total nondisclosure, and this revealed that the 13 items with the highest endorsement were all supervision-related incidents. There were 24 participants (22.4%) who reported completely withholding their negative reaction to their supervisors’ behavior or attitudes. Relatedly, 18 participants (16.8%) did not discuss their concerns about their supervisors’ competence, and 16 participants (15.0%) did not tell their supervisors that they believed they were not getting enough out of supervision. Regarding client-related incidents, the highest-rated total nondisclosure was personal issues related to work with clients, which was reported by five participants (4.7%). The full results regarding the most difficult to discuss items are presented in Table 1.
Our study examined the incidence of intentional nondisclosure by prelicensed counselors receiving postgraduate supervision for licensure as professional counselors. We found that 95.3% of prelicensed counselors in this study reported they withheld some degree of information from their clinical supervisors. This was comparable to the rates of intentional nondisclosure by trainees from allied professions (Ladany et al., 1996; Mehr et al., 2010). On average, participants reported 10.68 of 30 (SD = 6.62) intentional nondisclosures in clinical supervision, which also is comparable to the 8.06 nondisclosures reported by psychology trainees in the study by Ladany et al. (1996), although we should acknowledge that Ladany et al. used a different measure to capture incidents of nondisclosure in their study. Like allied professions, intentional nondisclosure by postgraduate, prelicensed counselors appears to be routine in clinical supervision. Further, we surmise that even though postgraduate, prelicensed counselors are more developmentally advanced than CITs (e.g., self-aware, motivated; Stoltenberg & McNeill, 2010), in a hierarchical and evaluative relationship such as clinical supervision, they too will withhold information. This suggests that prelicensed counselors, who are empowered to self-direct their postgraduate supervision experience, are doing just that—they are self-directing their supervision experience, including editing or concealing concerns about their clients and supervision experience from their supervisors. As such, supervisors who are reliant on supervisee self-report may not be getting a full picture of supervisee concerns or needs. This finding reveals implications for prelicensed counselors and supervisors alike. Delving further into the types of incidents being withheld in postgraduate supervision, as well as the frequency of these incidents, can help tell a more complete story of supervisee intentional nondisclosure by prelicensed counselors.
Overall, we found that participants were more willing to discuss commonly occurring client-related incidents than they were to disclose supervision-related incidents. However, the participants still reported hesitancy in disclosing many of their client-related concerns. This is evidenced by participants identifying client-related issues as salient issues to their supervision experience, and although they withheld some degree of this information from their clinical supervisors, they did not completely withhold the information. Although prior research has found that supervisees are less apprehensive to discuss client-related issues with their clinical supervisors (Ladany et al., 1996; Mehr et al., 2010; Yourman & Farber, 1996), there may be unique differences for prelicensed counselors that help to explain the findings from the current study. Notably, it is possible that as theorized (Loganbill et al., 1982; Stoltenberg & McNeill, 2010), prelicensed counselors are better able to self-monitor their own needs. As prelicensed counselors gain more clinical experience, they are able to autonomously address their client-related concerns (Rønnestad & Skovholt, 2003) and do not need to fully elaborate on their client-related concerns to their supervisors. However, when prompted by a survey such as this one, they recognize that there is more information to share about the incident (i.e., some degree of nondisclosure). Also, given the limited time in supervision for licensure, prelicensed counselors appear to need to prioritize specific information about their clinical work and seek guidance about their most pressing clinical needs (Cook & Sackett, 2018). Thus, at times they are unable to fully discuss the intricacies of their client caseloads.
We also found that prelicensed counselors are most hesitant and sometimes unwilling to discuss supervision-related concerns with their clinical supervisors. In the current study, the most common nondisclosures included disagreements with one’s supervisor, negative perceptions of one’s supervisor, and believing one’s supervisor was wrong, all directly pertaining to the supervisor. High levels of nondisclosure in relation to these types of incidents have been reported in prior research with psychology trainees (Mehr et al., 2010). Prelicensed counselors are likely to have started to develop their own counseling style (Rønnestad & Skovholt, 2003), which may or may not align with their supervisors’ approach to counseling. As such, it is likely that supervisees sometimes disagree with their supervisors or believe that their supervisor handled a situation poorly (Magnuson et al., 2002). It is possible that supervisees’ concerns about voicing dissent to their supervisors could reflect a weak or insecure supervisory relationship, which has been found to be a significant predictor of nondisclosure (Cook & Welfare, 2018; Mehr et al., 2010).
A little more than half of the participants (53.3%) reported that they completely withheld information from their supervisors. That is, these participants recognized something as being salient in their clinical supervision but refrained from disclosing any information about their concern with their supervisor. Perhaps most startling, the top 13 items (out of 30 items total) were all supervision-related incidents and some of these incidents occurred with staggering frequency. For example, a number of participants completely withheld their negative reactions to their supervisor’s behavior or attitudes (22.4%), never disclosed that they questioned their supervisor’s competence (16.8%), and declined to discuss that their needs were not being met in supervision (15.0%). These findings underscore the inherent power imbalance between supervisees and supervisors (Cook, McKibben, & Wind, 2018; De Stefano et al., 2017; Ladany et al., 1996). Although prelicensed counselors perceive concerns about their supervisor or their supervision experience, they are unwilling to broach these topics with their evaluative supervisors (Gibson et al., 2019).
It is difficult to say why the participants in the current study felt unfulfilled by their supervision experience or wondered about their supervisors’ competencies. We must exercise judgment before assuming that the supervisors of the participants in the current study were providing substandard supervision (Ellis et al., 2014). However, it also seems important that supervisees perceive their postgraduate supervision experience as a meaningful one, given the stakes associated with clinical supervision (Magnuson et al., 2000). For example, many prelicensed counselors pay for supervision, which can be a substantial financial investment for new prelicensed counselors. Relatedly, in situations in which prelicensed counselors’ clinical supervisors also are their administrative supervisors, sustained employment may depend on the supervisor’s favorable review. Regardless, these findings highlight the importance of outlining clear expectations of clinical supervision for supervisees (Magnuson et al., 2002) and developing a quality supervisory relationship in order to mitigate supervisee nondisclosure (Cook & Welfare, 2018; Mehr et al., 2010). In sum, these findings offer insight into the experiences of prelicensed counselors in postgraduate supervision, which can yield lessons for prelicensed counselors, supervisors, counselor educators, and counselor credentialing bodies in order to mitigate the occurrence of intentional nondisclosure in the future.
Implications for Prelicensed Counselors
Prelicensed counselors need to take an active role in their postgraduate supervision experience. Learning to navigate the nuances of supervision in addition to learning to be a practicing counselor early in one’s career is a daunting task (Freadling & Foss-Kelly, 2014). Prelicensed counselors who are contemplating withholding information from their clinical supervisors should consider their ethical and professional responsibilities to clients (American Counseling Association, 2014). Counselors who are starting postgraduate supervision may find it helpful to consult resources to help acculturate them to the specifics of postgraduate supervision and to explore strategies other than nondisclosure for addressing their concerns in supervision (Cook & Sackett, 2018; Magnuson et al., 2000; Pearson 2001, 2004).
Also, prelicensed counselors should consider which of the incidents described herein could be most relevant to their postgraduate supervision experience. Specifically, our prelicensed counselor participants were most apprehensive to discuss supervision-related concerns with their clinical supervisors. Unlike clients, who have the freedom to choose a different counselor if they are dissatisfied with their counseling services, supervisees likely have limited options when it comes to changing supervisors (De Stefano et al., 2017). Many of the concerns expressed by our participants reflect the inherent power differential between supervisors and supervisees. As such, prelicensed counselors who are dissatisfied with their supervision experience can find it helpful to broach some of these commonly reported issues with their clinical supervisors (Cook, McKibben, & Wind, 2018). The Power Dynamics in Supervision Scale was designed to operationalize supervisees’ perceptions of power and to aid in the discussion of power dynamics in clinical supervision (Cook, McKibben, & Wind, 2018). Prelicensed counselors may find such an instrument a helpful way to invite these discussions in an objective and nonthreatening manner with their supervisors. Such discussion between supervisors and supervisees can make it easier for supervisees to disclose more honestly if that issue arises (Knox, 2015).
Finally, some participants perceived their supervision experience as substandard, while a few more participants reported feeling unsafe in supervision or recognized power differentials between themselves and their supervisors. Although uncommon, our study is not the first one in which supervisees in the counseling profession report substandard or harmful experiences (Cook, Welfare, & Romero, 2018). Furthermore, no one should endure supervision that they perceive to be inadequate or harmful (Ellis et al., 2014). Supervisees can find it helpful to consult with a trusted colleague or another supervisor. For more egregious issues, prelicensed counselors may seek help from a professional association ethics consultant or a representative from their state licensing board (Cook, Welfare, & Romero, 2018). For those supervisees who are paying for supervision (26.4% in the current study), finding another supervisor may be the most viable solution.
Implications for Supervisors, Counselor Educators, and Counselor Credentialing Bodies
Addressing supervisee intentional nondisclosure must be a priority for clinical supervisors who are providing postgraduate supervision. If supervisors are to rely on supervisee self-report (Fall & Sutton, 2004), it will benefit supervisors to create a safe and open supervision environment that invites supervisee disclosure (Cook & Welfare, 2018; Gibson et al., 2019; Mehr et al., 2010). Encouragingly, prelicensed counselors appear more apt to discuss client-related incidents than supervision-related incidents; however, it also seems that clinical supervisors are not getting the full picture of their supervisees’ clinical work because there is some degree of nondisclosure. Notably, prelicensed counselors reported hesitancy in fully discussing their personal issues related to their work with clients, clinical mistakes, and reactions to clients. As prelicensed counselors continue their professional development, they can desire to try new interventions in their counseling work or have novel insights into how their personal experiences are impacting their clinical work (Rønnestad & Skovholt, 2003). Understandably, they might be apprehensive about discussing these issues with their evaluative supervisors. Supervisors will find it helpful to facilitate a discussion with their supervisees about the lifelong journey of being a professional counselor (Rønnestad & Skovholt, 2003) and the normality of sometimes feeling stuck in one’s clinical work with clients (Cook & Sackett, 2018) or going through stages of feeling stagnation, confusion, and integration, as discussed in the foundational model of Loganbill et al. (1982).
Prelicensed counselors’ unwillingness to discuss their supervision-related concerns, particularly those incidents that are commonly occurring such as negative impressions of one’s supervisor, negative reactions to a supervisor’s competence, and the belief that one’s needs are not being met in clinical supervision, seems to be most problematic. There are infrequently occurring issues that supervisees are completely unwilling to discuss (e.g., romantic attraction to one’s supervisor) that can lead to ruptures in the supervisory relationship (Nelson et al., 2008). Prior research suggests that supervisees who possess a favorable impression of their supervisory relationship are less likely to withhold information from their supervisors (Cook & Welfare, 2018; Gibson et al., 2019; Mehr et al., 2010). As such, supervisors need to take steps during formation of the supervisory relationship and throughout the supervision experience to create a safe and open environment that invites supervisee disclosure. Supervisors will find it helpful to specifically attend to the issues identified in our study such as how to professionally address disagreements between supervisors and supervisees, and to discuss supervisees’ personal expectations of clinical supervision.
Counselor educators can play a critical role in helping CITs learn strategies to navigate postgraduate supervision and understand the concept of intentional nondisclosure. For example, counselor educators can better prepare CITs for some of the nuanced differences of postgraduate supervision (Magnuson et al., 2002) versus the supervision they receive in their training programs. Counselor education programs can share resources (Cook & Sackett, 2018; Magnuson et al., 2002; Pearson, 2001, 2004) with CITs before they graduate to teach them about postgraduate supervision and help them learn about the experiences of prelicensed counselors. Further, counselor educators can teach CITs to be their own advocates in postgraduate supervision because they will be expected to self-direct their supervision experience (Magnuson et al., 2000). Advocacy in this context can include teaching soon-to-be graduates the importance of utilizing supervision contracts and training them to prepare their own supervision contracts to use with their postgraduate supervisors. These supervision contracts should outline key information to conducting adequate supervision (Ellis et al., 2014), including but not limited to (a) the frequency of clinical supervision (e.g., weekly individual or triadic supervision sessions), (b) the modalities to be utilized in supervision (e.g., self-report, audio or video recording), (c) the relevant ethical and professional guidelines that will guide the supervision experience, and (d) the roles and responsibilities for both the supervisor and supervisee. Preparing these documents prior to graduation can ensure that supervisees are well-informed of their rights as supervisees (Munson, 2002) and help easily identify signs of substandard postgraduate supervision (Ellis et al., 2014).
Counselor educators might also share the findings from this study with their CITs and facilitate a discussion about the concerns identified by the participants. Educating CITs on the concept of intentional nondisclosure is important, as it can aid CITs in identifying what influences their own intentional nondisclosure. With greater self-awareness, they may be able to identify the temptation if it ever presents itself. Counselor educators also can teach CITs about the potential harm to clients when supervisees choose to engage in intentional nondisclosure. For example, if supervisees purposefully withhold about the triggers they experience when working with a client, they run the risk of not providing effective counseling services and, even worse, harming the client (Hess et al., 2008; Ladany et al., 1996).
Finally, given that our study was the first study to examine supervisee intentional nondisclosure in a sample of prelicensed counselors, it is important to offer recommendations for state licensure boards and nationwide credentialing bodies that may improve the supervision experience for supervisees and supervisors. These prelicensed counselors withheld specific supervision-related concerns, including the belief that their expectations of clinical supervision were not being met and that they disapproved of their supervisors’ behaviors. Unlike university-based supervision in which supervision requirements and supervisors’ training and credentials (e.g., time in supervision, required supervision training, direct observation) are clearly outlined by accreditation bodies (CACREP, 2015), the supervision requirements for those pursuing state licensure vary from state to state (Field et al., 2019; Gray & Erickson, 2013; Henriksen et al., 2019). Some scholars have questioned if the supervision being provided is minimally adequate, or if supervisors are aware that they are providing inadequate or harmful supervision (Ellis et al., 2014). It is unclear how many supervisors in our study had received clinical supervision training or were providing supervision in accordance with professional standards (i.e., Borders et al., 2011). For example, only six of the 10 states that we sampled had licensure board requirements for clinical supervisors to have completed supervision training (Field et al., 2019), and none required a supervision credential such as the Approved Clinical Supervisor (issued by the National Board for Certified Counselors). It is important for all state licensure boards to require supervision training in order to best position supervisors to provide quality supervision. Relatedly, Field et al. (2019) found that only 47.1% of states require supervisors to complete a supervision contract or supervision philosophy prior to conducting postgraduate supervision. At a minimum, all licensure jurisdictions should require these documents as a part of the application packet for prelicensed counselors when they register their supervisor with their licensing board. By requiring these documents, state licensure boards and credentialing bodies can encourage a dialogue between supervisors and supervisees about some of the concerns identified in our study.
Limitations and Opportunities for Future Research
Like in all studies, there are limitations that need discussion. We aimed to collect data from a nationally representative sample; however, our findings could have been impacted by the varying licensure regulations in each state. As such, future research could benefit from a retest of the incidence of nondisclosure by prelicensed counselors in other states. Relatedly, although our response rate was consistent with prior counseling research that collected data via mailings (Barden et al., 2017), future researchers could explore other data collection methods (e.g., electronic survey) to increase participants’ responsiveness. Also, it is possible that the topic of nondisclosure was acutely salient to the persons who chose to participate in the current study, which could have influenced our findings. Future scholars are urged to examine more demonstrable factors of the supervisory relationship that may help to explain intentional nondisclosure by prelicensed counselors such as the incidents of inadequate and harmful supervision, which appear to influence supervisees’ willingness to disclose in supervision. Finally, future researchers should explore if nondisclosure occurs less frequently in supervision dyads that regularly use one of a number of supervisory relationship inventories (Tangen & Borders, 2016) to assess the perceived quality of their supervisory relationship.
In sum, postgraduate supervision has important implications for prelicensed counselors and supervisors alike. Thus, it behooves both prelicensed counselors and clinical supervisors to mitigate supervisee intentional nondisclosure. The findings presented in this study provide insight into the type of information being withheld by supervisees and the degree to which they are hesitant to discuss certain concerns. Clinical supervisors who hope to create an environment that promotes supervisee disclosure will benefit from specifically targeting some of the issues identified herein.
Conflict of Interest and Funding Disclosure
This research was funded by the Southern
Association for Counselor Education and Supervision.
American Counseling Association. (2014). ACA code of ethics.
Barden, S. M., Sherrell, R. S., & Matthews, J. J. (2017). A national survey on multicultural competence for professional counselors: A replication study. Journal of Counseling & Development, 95, 203–212. https://doi.org/10.1002/jcad.12132
Borders, L. D., DeKruyf, L., Fernando, D. M., Glosoff, H. L., Hays, D. G., Page, B., & Welfare, L. E. (2011). Best practices in clinical supervision. https://acesonline.net/wp-content/uploads
Cook, R. M., McKibben, W. B., & Wind, S. A. (2018). Supervisee perception of power in clinical supervision: The Power Dynamics in Supervision Scale. Training and Education in Professional Psychology, 12, 188–195. https://doi.org/10.1037/tep0000201
Cook, R. M., & Sackett, C. R. (2018). Exploration of prelicensed counselors’ experiences prioritizing information for clinical supervision. Journal of Counseling & Development, 96, 449–460. https://doi.org/10.1002/jcad.12226
Cook, R. M., & Welfare, L. E. (2018). Examining predictors of counselor-in-training intentional nondisclosure. Counselor Education and Supervision, 57, 211–226. https://doi.org/10.1002/ceas.12111
Cook, R. M., Welfare, L. E., & Romero, D. E. (2018). Counselor-in-training intentional nondisclosure in onsite supervision: A content analysis. The Professional Counselor, 8, 115–130. https://doi.org/10.15241/rmc.8.2.115
Council for Accreditation of Counseling and Related Educational Programs. (2015). 2016 CACREP standards. https://www.cacrep.org/for-programs/2016-cacrep-standards
Council for Accreditation of Counseling and Related Educational Programs. (2018). Annual report 2017. http://www.cacrep.org/wp-content/uploads/2019/05/CACREP-2017-Annual-Report.pdf
De Stefano, J., Hutman, H., & Gazzola, N. (2017). Putting on the face: A qualitative study of power dynamics in clinical supervision. The Clinical Supervisor, 36, 223–240. https://doi.org/10.1080/07325223.2017.1295893
Ellis, M. V., Berger, L., Hanus, A. E., Ayala, E. E., Swords, B. A., & Siembor, M. J. (2014). Inadequate and harmful clinical supervision: Testing a revised framework and assessing occurrence. The Counseling Psychologist, 42, 434–472. https://doi.org/10.1177/0011000013508656
Ellis, M. V., & Colvin, K. F. (2016, June). Supervisee non-disclosure in clinical supervision: Developing the construct and testing the psychometric properties of the SNDS. Paper presented at the Twelfth International Interdisciplinary Conference on Clinical Supervision, Garden City, NY.
Fall, M., & Sutton, J. M., Jr. (2004). Supervision of entry level licensed counselors: A descriptive study. The Clinical Supervisor, 22, 139–151. https://doi.org/10.1300/J001v22n02_09
Field, T. A., Ghoston, M., & McHugh, K. (2019). Requirements for supervisors of counselor licensure candidates in the United States. Journal of Counselor Leadership and Advocacy, 6, 55–70. https://doi.org/10.1080/2326716X.2018.1489315
Freadling, A. H., & Foss-Kelly, L. L. (2014). New counselors’ experiences of community health centers. Counselor Education and Supervision, 53, 219–232.
Gibson, A. S., Ellis, M. V., & Friedlander, M. L. (2019). Toward a nuanced understanding of nondisclosure in psychotherapy supervision. Journal of Counseling Psychology, 66, 114–121. https://doi.org/10.1037/cou0000295
Gray, N. D., & Erickson, P. (2013). Standardizing the pre-licensure supervision process: A commentary on advocating for direct observation of skills. The Professional Counselor, 3, 34–39. https://doi.org/10.15241/ndg.3.1.34
Henriksen, R. C., Jr., Henderson, S. E., Liang, Y.-W., Watts, R. E., & Marks, D. F. (2019). Counselor supervision: A comparison across states and jurisdictions. Journal of Counseling & Development, 97, 160–170. https://doi.org/10.1002/jcad.12247
Hess, S. A., Knox, S., Schultz, J. M., Hill, C. E., Sloan, L., Brandt, S., Kelley, F., & Hoffman, M. A. (2008). Predoctoral interns’ nondisclosure in supervision. Psychotherapy Research, 18, 400–411.
Knox, S. (2015). Disclosure—and lack thereof—in individual supervision. The Clinical Supervisor, 34, 151–163. https://doi.org/10.1080/07325223.2015.1086462
Ladany, N., Hill, C. E., Corbett, M. M., & Nutt, E. A. (1996). Nature, extent, and importance of what psychotherapy trainees do not disclose to their supervisors. Journal of Counseling Psychology, 43, 10–24. https://doi.org/10.1037/0022-022.214.171.124
Loganbill, C., Hardy, E., & Delworth, U. (1982). Supervision: A conceptual model. The Counseling Psychologist, 10, 3–42. https://doi.org/10.1177/0011000082101002
Magnuson, S., Norem, K., & Wilcoxon, S. A. (2000). Clinical supervision of prelicensed counselors: Recommendations for consideration and practice. Journal of Mental Health Counseling, 22, 176–188.
Magnuson, S., Norem, K., & Wilcoxon, S. A. (2002). Clinical supervision for licensure: A consumer’s guide. The Journal of Humanistic Counseling, Education and Development, 41, 52–60.
McKibben, W. B., Cook, R. M., & Fickling, M. J. (2018). Feminist supervision and supervisee nondisclosure: The mediating role of the supervisory relationship. The Clinical Supervisor, 38, 38–57.
Mehr, K. E., Ladany, N., & Caskie, G. I. L. (2010). Trainee nondisclosure in supervision: What are they not telling you? Counselling and Psychotherapy Research, 10, 103–113. https://doi.org/10.1080/14733141003712301
Munson, C. E. (2002). Handbook of clinical social work supervision (3rd ed.). The Haworth Press.
Nelson, M. L., Barnes, K. L., Evans, A. L., & Triggiano, P. J. (2008). Working with conflict in clinical supervision: Wise supervisors’ perspectives. Journal of Counseling Psychology, 55(2), 172–184. https://doi.org/10.1037/0022-0126.96.36.199
Noelle, M. (2002). Self-report in supervision: Positive and negative slants. The Clinical Supervisor, 21, 125–134. https://doi.org/10.1300/J001v21n01_10
Pearson, Q. M. (2001). A case in clinical supervision: A framework for putting theory into practice. Journal of Mental Health Counseling, 23, 174–183.
Pearson, Q. M. (2004). Getting the most out of clinical supervision: Strategies for mental health. Journal of Mental Health Counseling, 26, 361–373. https://doi.org/10.17744/mehc.26.4.tttju8539ke8xuq6
Rønnestad, M. H., & Skovholt, T. M. (2003). The journey of the counselor and therapist: Research findings and perspectives on professional development. Journal of Career Development, 30, 5–44. https://doi.org/10.1177/089484530303000102
Siembor, M. J. (2012). The relationship of role conflict to supervisee nondisclosure: Is it mediated by the supervisory working alliance? (Doctoral dissertation). Retrieved from ProQuest Dissertations & Theses Global. (3552103).
Stoltenberg, C. D., & McNeill, B. W. (2010). IDM supervision: An integrated developmental model for supervising counselors & therapists (3rd ed.). Routledge.
Sweeney, J., & Creaner, M. (2014). What’s not being said? Recollections of nondisclosure in clinical supervision while in training. British Journal of Guidance & Counselling, 42, 211–224. https://doi.org/10.1080/03069885.2013.872223
Tangen, J. L., & Borders, L. D. (2016). The supervisory relationship: A conceptual and psychometric review of measures. Counselor Education and Supervision, 55, 159–181. https://doi.org/10.1002/ceas.12043
Yourman, D. B., & Farber, B. A. (1996). Nondisclosure and distortion in psychotherapy supervision. Psychotherapy: Theory, Research, Practice, Training, 33, 567–575. https://doi.org/10.1037/0033-3188.8.131.527
Ryan M. Cook, PhD, ACS, LPC, is an assistant professor at the University of Alabama. Laura E. Welfare, PhD, NCC, ACS, LPC, is an associate professor at Virginia Tech. Connie T. Jones, PhD, NCC, ACS, LPCA, LCAS, is an assistant professor at the University of North Carolina at Greensboro. Correspondence can be addressed to Ryan Cook, 310 Graves Hall, Box 870231, Tuscaloosa, AL 35487, email@example.com.
William H. Snow, J. Kelly Coker
Distance education has become a mainstay in higher education, in general, and in counselor education, specifically. Although the concept sometimes still feels new, universities have been engaged in some form of distance learning for over 20 years. In the field of distance counselor education, it is imperative to understand where we have been, where we are now, and where we are going. This article will lay the foundation for the special section of The Professional Counselor on distance counselor education and will explore the history of using technology in education, recent research about distance education in counseling and counselor education, and topic areas discussed throughout this special section. This special section will bring clarity to current and emerging best practices in the use of technology in the distance education of professional counselors, clinical supervisors, and counselor educators.
Keywords: online, distance education, counselor education, technology, best practices
Counselor educators have become comfortable and adept over the years at fostering students’ development in clinical skills in traditional residential formats. For many counseling faculty, in-class, face-to-face (F2F), personal encounters are foundational and irreplaceable. For educators with this mindset, distance learning is not an opportunity but a threat to what they consider the best teaching and learning practice (Layne & Hohenshil, 2005). No matter one’s personal preference or belief, the advent of distance learning is challenging the sovereignty of the purely residential experience.
For the purposes of this discussion, we are using the term distance education versus the more prolific term online education. The U.S. Department of Education’s Office of Postsecondary Education (OPE) has officially adopted the broader term of distance education, which focuses on the physical separation in the teacher–student relationship (OPE, 2012). This is in contrast to the term online education, which emphasizes the internet-facilitated communication that supports the teaching relationship at a distance.
The number of students in distance education programs has been increasing each year (Friedman, 2018). By 2016, over 6 million students in the United States were engaged in distance education, and nearly half were exclusively taking online classes (Seaman et al., 2018). Over two-thirds of the students were enrolled in distance learning courses at public universities (Lederman, 2018). In contrast, the total number of residential students dropped by over 1.1 million (6.4%) between 2012 and 2016 (Seaman et al., 2018). The growth in enrollment and the future of higher education continues to move toward distance education.
The same trends have impacted counselor education. At the time of this writing, the Council for the Accreditation of Counseling and Related Educational Programs (CACREP) reported that there are 69 CACREP-accredited master’s programs that are considered distance education, 34 of which are clinical mental health counseling programs (CACREP, n.d.). Over 25% of counseling students are now enrolled in academic programs defined as distance education (Snow et al., 2018). Because an increasing number of programs are including distance education opportunities, the need for an exploration of efficacious deliveries of distance education content is imperative (Cicco, 2012).
The growth in distance education programs is often based on mixed motivations. One motivation is the desire to provide greater access for traditionally underserved populations (Bennett-Levy et al., 2012). For example, distance education can benefit students in rural areas as well as those living abroad (Sells et al., 2012). Remotely located service providers can benefit as well. Agencies that lack immediate physical access to counselor education programs now have the online tools to train members of their community locally in advanced mental health skills through distance education so they can continue serving their communities while in school. Distance education programs also can better support working adults and caregivers who in theory are within geographic proximity of a campus but are constrained by complex schedules, responsibilities, and mobility-related issues (e.g., disabilities, difficult travel). The ability to engage in academic studies from any location around the globe, within a more flexible scheduling model, is a game-changer (Bennett-Levy et al., 2012). Additionally, adult learners increasingly prefer the autonomy and self-direction found in these distance education formats (Ausburn, 2004).
Distance education programs allow access to a greater pool of qualified, diverse faculty. Qualified counselor educators anywhere in the world with access to a computer and an internet connection are prospective instructors. Most importantly, distance education programs eliminate the constraints of geographic proximity, worsening traffic commutes, and parking concerns. For the distance education program, it is all about access for any faculty member or student in the world (Reicherzer et al., 2009).
A more pragmatic motivation for universities is to view distance education programming as a source of revenue, growth, and efficiency (Jones, 2015). For example, distance education courses eliminate the costs and limitations of brick-and-mortar classrooms. Unfortunately, students may not benefit when universities increase online class sizes and hire less expensive adjuncts to increase the bottom line (Newton, 2018). Some universities might even tack on special technology or distance education fees.
It is our belief that the counseling profession should take the lead in proactively investigating the promise of the distance education experience, including the technologies, pedagogies, and methods. We must determine which best practices create excellent educational experiences for the ultimate benefit of our counseling students and the clients they will serve. This special section of The Professional Counselor is an essential step in that direction.
A History of Learning Technologies and Their Impact on Distance Counselor Education
If we take a step back, we can see that there has been a continual movement toward infusing technology into the general educational process and, more recently, specifically in counseling and counselor education. We have moved from a strictly oral tradition in which vital knowledge and skills were passed on in F2F interactions to a present-day, technologically mediated set of interactions in which teacher and student may never meet in person and where dialogues are reduced to bits and bytes of information transmitted across the internet.
In ancient times, essential knowledge, skills, histories, and traditions were only preserved in the memories of those able to experience events directly or to receive critical information from others. People were living repositories of essential skills of survival, cultural insight, and wisdom. If they failed to pass it on orally or through example, what they knew and embodied was lost forever. It is a surprise to many that Socrates did not pen a single word. His choice of influence was through discussions with his followers and came to be known as the Socratic method. Socratic concepts would have been lost forever, but fortunately, followers such as Plato put them in writing.
The Written Word
Socrates’s ideas on teaching and learning lived through an early technology: the written word. The technological advancement of written language, writing devices, and the availability of parchment and paper as a set of communication tools was revolutionary in furthering information sharing and learning. Scholarship became associated with the ability not only to think critically, but also to read about the thoughts of others and respond in writing to contribute to the public discourse. Written documents were copied and distributed in what was the earliest form of distance education. During the medieval period, the copying of important texts often fell to those within monastic religious life, usually as a compulsory duty. Copying books for six or more hours per day for years was a noted source of drudgery (Greenblatt, 2011), but the printing press removed the need for such anguish.
The Printing Press
The limitation of scribes hand-copying documents meant that access to readable material was for society’s select few. Gutenberg’s invention of the printing press in approximately 1438 increased access to print (Szabo, 2015). For the first time in history, the works of scholars, philosophers, and artists could be printed in books and made available to a wider public. With written materials available, the literacy rates in Europe rose from approximately 10% in the 1400s to over 90% by the middle of the 20th century (Roser & Ortiz-Ospina, 2018). The printing press laid the groundwork for innovation in education as well. In the 1720s, the printing press allowed for the first distance education correspondence courses in Boston, representing the “written era” of technology-enhanced education (Drumbauld, 2014). More technologies would eventually revolutionize progress in educational methods.
Sound Recordings and Film
The phonograph was invented by Thomas Edison in 1877 as a device to both record and play back sound (Thompson, 2016). It did not replace writing and books but could record and preserve the sounds of music, events, and the words of famous people and other languages. For example, when people could hear what foreign dialects sounded like from the lips of native speakers, language instruction was transformed.
The development of celluloid film recording and motion pictures in 1895 led to newsreels and documentaries in the early 1900s that provided the public with information about current affairs and historical and cultural events. For the first time in history, people could experience significant events in recorded sight and sound versus only reading about them. Moreover, they could now learn by seeing (O’Shea, 2003).
Radio, Television, and the Telephone
Relatedly, the advent of commercial radio broadcasting in the 1920s provided the first live reporting of events (University of Minnesota, n.d.). For example, radio audiences heard powerful first-hand emotions in the reporter’s voice as he watched the Hindenburg disaster unfolding before his eyes. In the 1920s, colleges and universities began to take advantage of this new, powerful medium. For example, Pennsylvania State University was the first university to be granted a broadcast license to begin offering college courses over the radio (Dawson, 2018).
The “radio era” quickly transitioned to the “TV Era” in the late 1960s when televisions were in most homes in the United States. People could both see and hear world events at a distance. Stanford University was one of the first institutions to capitalize on this burgeoning technology for educational purposes. The Stanford Instructional Television Network was started in 1968 and offered instruction for part-time engineering students (LeDesma, 1987).
Radio and television broadcasts were significant innovations. Their drawback from an educational perspective was that they were primarily one-way mediums and the audience was merely a passive recipient of sights and sounds. It was the telephone that provided the masses with the first means to engage in two-way conversations at a distance. For the first time in history, the average person could not just listen at a distance, but also could talk back. An early telephone-based education using this two-way communication medium was offered by the University of Wisconsin in 1965 (Drumbauld, 2014). Computers and the internet would soon become the next revolutionary communications medium.
Computers and the Internet
Computers were useful as standalone information processors, but it was the unifying ability for computers to communicate that set the stage for the next revolution in information dissemination since Gutenberg’s printing press—the internet. The internet is in actuality a shortened version of the term internetworking, which was born in 1969 when the Advanced Research Projects Agency Network (ARPANET) successfully sent the first message between computers (Leiner et al., 1997). That was followed by the standardization of the Transmission Control Protocol/Internet Protocol (TCP/IP) to give all researchers a standard computer language in order to talk together on this small but growing assemblage of internetworked computers (Leiner et al., 1997). Technical advances continued to follow, but the fledgling internet was not accessible to the average person. Defense researchers, academics, and early computer buffs with the drive and savvy to understand and write in computer languages like Unix to execute functions like domain name system lookup, file transfer protocol, and simple message transfer protocol dominated the internet (Leiner et al., 1997). The basic networking foundations were developed, but the average person was waiting for the time when the internet would move from the researchers’ lab to broader computing access.
For decades, computers were costly in price, massive in size, and difficult to maintain, and required a dedicated, specialized operating staff. This meant computer access was only for select university personnel, government employees, larger businesses, and electronic hobbyists. Access changed with the advent of the Apple II in 1977, the IBM PC in 1981, the Apple Macintosh in 1984, and the Windows operating system in 1990 (Allan, 2001). The era of the personal computer (PC) was born and it soon became a must-have technology and home appliance for an increasing number of individuals in society. Functional, affordable, and easy to operate, computers were now available to the general consumer, opening up a worldwide network of information sharing.
The World Wide Web
Early PCs were standalone machines, and few connected to the government-dominated internet. In the 1980s, there began a movement for PCs to connect to proprietary, fledgling dial-up modem-driven services like America Online (AOL; Rothman, 2015). These computer connection services allowed dial-up modem access, information sharing, and file uploading and downloading for a monthly subscription (Haigh et al., 2015). Email communications could be sent but only for those on closed, proprietary networks.
Some universities began their own networks or used services like AOL in order to connect faculty, staff, and students. These online services were far more comfortable to use than the more complex internet, which still required a level of technical sophistication. Although these services were accessible, they were somewhat isolated as each service provider had an exclusive dial-up modem for access and an entity unto itself.
In 1990, only 2.6 million people worldwide had access to the fledgling internet (Roser et al., 2020). A significant breakthrough occurred with the development of hypertext language in 1991 and the first integrated web browser, called Mosaic, in 1993 (Hoffman, n.d.). Access to the internet and its wealth of resources suddenly became available with a point and click of a computer mouse. The term World Wide Web accurately described internet connectivity that spanned the world and connected smart devices to include computers, tablets, gaming consoles, and phones. If a device had a central processing unit, it could connect. By 2018, 4.2 billion people, or 55.1% of the world population, had internet access (Internet World Stats, 2019). In response, the number of digital websites grew from 130 in 1993 to over 1.9 billion today (InternetLiveStats.com, n.d.).
The Digital Age
Digitization has created a world library and communication platform where text, audio, and video recordings are available to anyone with a computer, tablet, gaming console, or smartphone connected to the internet. Anything that can be digitized can be stored and transmitted in real time. The internet merely has taken our previous modes of physical and analog forms of communication and moved them into the digital stream. Internet publishing is a simple extension of Gutenberg’s printing press. The local library is now a part of the World Wide Web library. Text messaging is the modern-day telegraph, and cellular phone services have cut out the need for copper wiring. Streaming audio and video are what radio and television were. Cutting edge videoconferencing platforms are the new F2F communication mode. Reality has now become a virtual reality. For the counselor educator, all of the world’s accumulated technological advances and resources can rest in the palm of your hand. All of the technologies have come together to support progress toward what we call the distance learning era.
Even though we tend to think of distance education as a recent development, Pennsylvania State University offered correspondence education to rural farmers using U.S. mail in 1892, over 125 years ago (Dawson, 2018). Correspondence courses were the precursors to the more sophisticated distance education approach offered by the University of Phoenix in 1976. The 1990s brought about the most significant changes regarding online educational delivery, with the University of California-Berkeley offering the first completely online curriculum in 1994, and Western Governor’s University, established in 1997, helping Western states maximize educational resources through distance education (Drumbauld, 2014). Today, the distance education student population has grown to over 6 million students in the United States (Seaman et al., 2018). Counselor education programs have developed along with this national trend. Today, 69 counseling programs are offering CACREP-accredited distance education degrees (CACREP, n.d.).
Web-Facilitated Faculty–Student and Student–Student Interactions
In the early 1990s, Moore and Thompson (1990) and Verduin and Clark (1991) defined the core conditions that distance education should achieve to become as effective as F2F instruction. These conditions were timely instructor feedback to students and regular student-to-student interactions. Almost 30 years later, those conditions have been fulfilled. Secure audio- and videoconferencing platforms, such as Zoom and Adobe Connect, now allow faculty and students to connect F2F in real time, synchronously (Benshoff & Gibbons, 2011).
E-learning platforms, such as Blackboard, Canvas, and Moodle, now provide an integrated solution for faculty to asynchronously post syllabi, assignments, and instructional resources for instant download by students. Students can then respond to faculty questions via threaded discussions, upload papers, and take online assessments. Faculty, in turn, can review student work and provide feedback as fast as they can type.
It is now clear that with the combined power of the PC and facilitated technologies, timely instructor feedback and regular student-to-student interactions are possible. The future is here, and all that remains is for counselor education instructional pedagogy to catch up, as well as keep up, with the technological advances that are driving changes in education.
Clarity of Focus: What Is Distance Counselor Education?
Terms like online education, distance learning, and hybrid program, without a clear understanding of their proper use, are problematic. The determination of an academic program as distance education, online, hybrid, or residential has implications for federal financial aid, regional accreditors, and CACREP. So, what is distance education, how is it linked to advances in educational technology, and how does it relate to counselor education?
In practice, various terms, such as distance learning, online learning, and online education, are used. The OPE (2012) has officially adopted the term distance education and further defines distance education as instructional delivery that uses technology in courses for students separated from their instructor to support “regular and substantive interaction between the students and the instructor, either synchronously or asynchronously” (p. 5). The technologies referred to by the OPE are generally internet-based and may include the use of email, audioconferencing, videoconferencing, streaming videos, DVDs, and learning management systems.
Januszewski and Molenda (2013) defined educational technology as “the study and ethical practice of facilitating learning and improving performance by creating, using and managing appropriate technological processes and resources” (p. 1). Simply put, educational technology is about the physical tools we use in education and the processes that we implement to intentionally shape the relationship of the tools to the subject matter, teacher, student, and social learning environment. These tools and processes combine to form the educational pedagogy to support learning and the OPE (2012) mandate for “regular and substantive interaction between student and instructor” (p. 5).
The OPE (2012) categorizes programs as distance education if at least 50% or more of their instruction is via distance learning technologies. In contrast, residential programs, as categorized by the OPE, CACREP, and federal financial aid regulations, are allowed to infuse significant distance education elements into their instructional coursework as long as they do not exceed the 49% threshold. As an example, a 60 semester unit (90 quarter units) residential program could still offer 29 semester units (44.5 quarter units) of distance education coursework and technically remain residential by OPE standards.
The Continuum of Residential to Distance Education Programming
At one end of the spectrum are purely residential programs, offering 100% of courses in person. The next step along the spectrum is residential hybrid programs. These are still considered residential in providing the preponderance of courses in residence, but they can contain up to 49% of their credit units online and technically maintain their residential classification. Next along the spectrum are limited residency distance learning programs. These provide 50% or more of courses online but require some level of on-campus participation. A 2018 study by Snow et al. found that 90% of CACREP-accredited distance education programs were considered limited residency. They required students to attend a campus residency at least once and up to four times during their degree program. Finally, at the opposite end of the spectrum is a small but growing number of programs offering entirely distance education formats. These offer 100% of their coursework at a distance with no campus residency requirement.
The Infusion of Distance Education Technology in All Education
It is difficult to imagine any counselor education in 2020 to be technology-free and without some integration of distance education elements into individual class sessions, full courses, or programs. In concept, one could argue that there is a bit of online educator in the majority of faculty members today, whether they realize it or not. Most universities now require faculty, even the most technophobic, to have access to a computer and read and respond to email communications. Critical information is commonly only accessible on institutional web pages. Confidential information, such as student advising information, is often available online via secure portals—no more hard copy student files. Grades are now commonly put online. All of these widely used technologies support students learning at a distance.
The advent of the modern learning management system in the form of web-based platforms, such as Blackboard, Canvas, and Moodle, has added a level of access and interactivity to all programs in the teaching spectrum, from entirely residential to entirely online. Faculty engaged in all formats can use these educational platforms to post text, audio, video, and recorded lectures. Students can view materials, upload their papers, and post responses for review and grading. Discussion groups can interact using asynchronous, threaded discussions within these portals. Embedded grade books keep students informed of their progress at all times. These learning platforms, along with other educational technologies, are now commonly employed in both residential and distance education courses, making the programs look increasingly more similar than different.
Reducing the Distance in Distance Education
Assuming the presence of residential courses with as much technology infused into them as many distance education courses, what is the difference? Both formats require “regular and substantive interaction between the students and the instructor” (OPE, 2012, p. 5). The key word in distance education is distance. The OPE (2012) refers to distance education where students are physically separated from their instructor. Academic programs are required to support, facilitate, and ultimately ensure that regular and substantive interactions occur between students and instructors. The implicit assumption is that residential faculty in close physical proximity to their students have adequate if not superior amounts of regular and substantive interactions with students and thus greater connection and engagement. But, is that necessarily true?
We suggest that rather than focus on whether a class is considered residential or distance education, the concern should be about the amount of regular and substantive interactions, which decrease the social distance between students and faculty and thus help foster community and quality student engagement. Reducing social distance, a measure of relationship and connection, is a significant factor in promoting student engagement. The Great Schools Partnership (2016) defined student engagement as “the degree of attention, curiosity, interest, optimism, and passion that students show when they are learning or being taught, which extends to the level of motivation they have to learn and progress in their education” (para. 1). There is ample evidence that students who feel a sense of community and connection, no matter what the delivery model, demonstrate better academic performance and higher levels of satisfaction and retention (Benshoff & Gibbons, 2011; Chapman et al., 2011; Rovai & Wighting, 2005). The decreased social distance between faculty and students is a good indicator of “regular and substantive interactions” and thus greater student engagement in the learning process. The physical proximity of faculty and students within residential learning programs can certainly provide opportunities for direct interaction and decreased social distance, but without appropriate faculty desire to connect and engaging pedagogy, there is no guarantee. Numerous studies involving residential programs document cases of student disconnect, alienation, and reduced graduation rates on college campuses (e.g., Feldman et al., 2016; O’Keefe, 2013; Redden, 2002; Rovai & Wighting, 2005; Tinto, 1997). Helping students feel connected to their faculty, fellow students, and campuses is an important task for those operating in both residential and distance learning arenas. Distance education faculty using the appropriate technological tools and pedagogy can overcome the obstacles of physical separation and facilitate meaningful, regular, and substantive interactions.
As we reflect on our educational careers, the authors remember auditorium-style classes in large lecture halls. The physical distance to the instructor might have been 50 feet, but it might as well have been 50 miles as it was difficult to connect with an instructor when competing with 99 other students for attention. Conversely, we have experienced an online class where faculty and students were geographically scattered, but small class sizes allowed us all to make stronger connections. We have come to believe that online education done right can take the distance out of distance education.
The ability of students and faculty to connect at a distance is ever increasing. What was once almost purely an asynchronous model of instruction (i.e., threaded discussion posts and emailed assignments) now has evolved with the addition of interactive videos and training modules, recorded lectures, “real-time” synchronous classes, and live videoconferencing for classroom experiences, advising, and clinical supervision. These tools are allowing students to watch expert counseling role models demonstrate and practice clinical skills themselves while getting real-time feedback from instructors and fellow students. For many counselor education programs, distance education and online learning experiences are now better characterized as virtual remote classrooms.
The Special Section: Distance Counselor Education
This special section reviews the historical context of distance education, seeks to understand the critical elements and best practices for effective distance education, and makes modest projections about future trends. Six additional articles can be found in this issue that provide greater focus on the following areas of consideration: (a) student selection, development, and retention; (b) challenges and solutions of clinical training in the distance environment; (c) distance education pedagogy similarities and differences compared to residential instruction; (d) legal and ethical considerations for distance counselor education; (e) opportunities and challenges of multicultural and international distance education; and (f) student perceptions and experiences in distance education.
Student Selection, Development, and Retention: Who Can Best Succeed?
There are several measures of student success, including retention, academic performance, and graduation rates. Researchers have examined the success of students enrolled in online programs or classes to better understand those factors that lead to or impede student success. Sorenson and Donovan (2017) sought to explore why undergraduate students at an online, for-profit university were dropping out. The authors determined that attrition could be attributed to several factors, including a perceived lack of support by the university and faculty, difficulty balancing multiple priorities, a lack of awareness of how much time is required, and academic issues (Sorenson & Donovan, 2017).
How do we determine the best “fit” through our student selection process? A student’s undergraduate college grade point average does seem to serve as a significant predictor of success in graduate distance learning programs (Cochran et al., 2014). Graduate Record Exam scores, previous work experience, and application essays also are commonly used to select students, but Overholt (2017) did not find them useful in predicting student success among non-traditional graduate student populations. Gering et al. (2018) determined that more salient factors for predicting success included initiative, the ability to take responsibility for one’s education, and time management. Yukselturk and Bulut (2007) have described these factors as representing self-regulated learners.
Gering et al. (2018) also found some external student success factors to be crucial, including a supportive family, strong social connections with other students, strong teaching presence, and receiving prompt and regular feedback and guidance. It is clear then that student success in distance learning courses is partially dependent upon student attributes but also on their level of external support, the actions of the instructor, and a supportive institution.
Clinical Training in the Virtual Remote Environment: What Are the Challenges and Solutions?
It is one thing to offer didactic learning at a distance but quite another when we think about how to conduct engaging clinical skills development in the distance education environment. How do we support the development of appropriate knowledge, skills, and dispositions to help counseling students succeed? The virtual remote classroom allows students to observe faculty experts and student volunteers engaged in clinical role-play simulations. Students can team up with other students in virtual breakout rooms to practice skills they have just watched remotely. Videoconference tools with embedded recording features can capture verbal and non-verbal interactions. Faculty can subsequently observe student role plays live or via recorded sessions.
According to Reicherzer et al. (2012), online and hybrid counselor training programs using a blend of asynchronous, synchronous, and in-person training can produce counselors capable of meeting site supervisors’ expectations of clinical skill preparation before entering practicum and internship. Other researchers found that student learning outcomes are higher for hybrid or blended programs than for fully online or fully residential programs (Means et al., 2010).
Graduates of such programs have an advantage over residential students in their experience with the technologies required for implementing telemedicine and online counseling in their practices—a necessary competency for future practice in the 21st century. With their background in distance learning, these students will have firsthand knowledge of what it takes to properly implement online tools for facilitating strong therapeutic connections. Their remote experiences will provide valuable insights to mental health agency leaders who eventually need to integrate telemedicine into their work to keep pace with future trends and demands (Zimmerman & Magnavita, 2018). This will set these students apart from other clinicians graduating today who lack the training outcomes to participate competently with the proper ethical safeguards in the online world (Barnett, 2018).
Virtual Remote Educational Pedagogy: Similar or Different From Residential Instruction?
In education, the preferred relationship of balancing course content, pedagogy, and technology will vary by institution and instructor. One example is the philosophy of José Bowen (2012). He prefers the live classroom experience, creating more value within the live classroom experience and using technology outside the classroom (Bowen, 2012). He is not against technology, but he believes it is best used outside the classroom to free up more time for richer in-class dialogue. Other programs may adopt a model with more reliance on technology for primary content delivery with the instructor taking a backseat to the online delivery systems. In the context of online and technology-enhanced counselor education, how do those of us who work and teach virtually maximize the available technology to create a vibrant, interactive experience? Can we leverage technological tools to provide the resources needed for success while still creating an impactful and compelling experience? What is the appropriate balance?
In a study of online courses with demonstrated effectiveness, Koehler et al. (2004) determined that three components must dynamically constrain and interact with each other: content, pedagogy, and technology. Faculty must demonstrate expertise in their subject matter, skill teaching in an online environment, and an understanding of as well as effectiveness in utilizing technology in dynamic ways. If all three are present in a course, students report having a better learning experience.
Total distance learning, blended learning, and fully residential learning approaches share another common success—the importance of a positive, supportive learning community. In a study by Murdock and Williams (2011), distance learning students who felt connected and a part of the university community reported more satisfying learning experiences. At least in these cases, successful connection was more important than any particular teaching pedagogy or technology.
Legal and Ethical Considerations in Online Delivery
Online educators are subject to the same statutory and regulatory compliance concerns as their residential counterparts. Online educators have additional complications, challenges, and risks because of their reliance on web-based technologies and online communication. Security, privacy, and access are some of the considerations faced by educators teaching at a distance.
Cybersecurity is now an overarching concern in higher education (White, 2015). Most, if not all, of the student’s personal information, academic record, and submitted course materials are stored in computer files in cloud-based storage. Increasingly, physical student records do not exist as backups. We are moving toward total dependence on reliable, secure access to internet-based storage and retrieval solutions. Distance educators face a level of risk each time student and institutional information is stored, accessed, and shared across cyberspace. There are plenty of bad actors in society focused on disrupting and exploiting these kinds of private information.
The Family Education Rights and Privacy Act (U.S. Department of Education, 2018) requires the protection of the student’s personally identifiable information and education records from unauthorized disclosure. Protection requirements apply to the institution in general; educational service providers providing outsourced services; and every administrator, staff member, and faculty member with access to student records. Although cybersecurity is an important security component, there are other simple, practical questions for the individual educator to ponder. For example, when involved in asynchronous communications via email, how do you know it is the actual student? When a distance learning faculty member gets a phone call from an online student they do not know well, how do they verify identity? In 2007, a residential student impostor lived on Stanford’s campus for 6 months, ate in the cafeteria, and lived the campus experience until finally caught (Novinson, 2007). If it can happen in a residential setting where we interact with students directly, it can surely happen in an online environment.
Compliance regulations for the Health Insurance Portability and Accountability Act of 1996 (HIPAA) govern the security of communications that clinical site supervisors, clinicians in training, and faculty supervisors maintain about client cases (HIPAA, 2015). Clinical faculty conducting individual, triadic, or group supervision via telecommunication must verify that technologies meet HIPAA compliance. There also is the requirement that student clinicians must not be discussing confidential issues within earshot of friends, families, and roommates—and not doing so via the local coffee shop’s wireless hotspot.
Online education provides access to students at a distance, and in many respects, it provides access and opportunities for those who previously had few options to extend their learning. Online courses may not prove accessible to people with disabilities as the reliance on embedded web technologies may present challenges (Edmonds, 2004). The Americans with Disabilities Act (ADA) requires educational institutions to make their physical campuses accessible to people with disabilities and the virtual campuses as well. The ADA government website provides guidelines of what is required to make web-based information accessible to those with various disabilities (United States Department of Justice, n.d.).
Issues of student sexual harassment can occur, necessitating Title IX investigations and interventions (Office for Civil Rights, 2018). University administrators must learn how to handle these and other related issues at a distance with students who may be physically separated.
Online educators must comply with federal statutes and regulations, those in their institution’s home state, and those in the state in which the student resides. State-by-state approval is possible but cumbersome. There are initiatives, such as the National Council for State Authorization Reciprocity Agreements, to establish a state-level reciprocity process (National Council for State Authorization Reciprocity Agreements, n.d.).
Multicultural and International Distance Education: What Are the Opportunities and Challenges?
Another important consideration is how well distance counseling programs effectively attract, retain, and support students from diverse backgrounds. Since its rise in availability, distance education has been a strong draw for people from diverse backgrounds, particularly women of color (Columbaro, 2009). Walden University, one of the largest online universities in the country, reported in 2015 that of its almost 42,000 graduate students, 76.7% were women and 38.7% were African American (Walden University’s Office of Institutional Research and Assessment, 2015).
In addition to the strong representation of students of color in online education, there is a growing number of international students who also are taking advantage of opportunities to learn at a distance (Kung, 2017). Kung (2017) reported data from the Institute of International Education that showed a 7.1% increase in the number of international students studying in U.S. colleges and universities. Distance learning can accelerate this increase as online students do not require an F-1 visa to participate at a distance. With this rise, Kung calls for an increase in cultural awareness, sensitivity, and preparation for working with international students in online settings.
Counselor Education at a Distance: Student Perspectives
Given the rise in the number of distance counselor education programs, it seems that there would be a wealth of literature to help us understand the real experiences of students training to be professional counselors in online formats. Although there have been studies examining general student perceptions of engagement, social presence, and outcomes in online learning environments (Bolinger & Halupa, 2018; Lowenthal & Dunlap, 2018; Murdock & Williams, 2011), specific experiences of online counseling students across the wide variety of delivery methods has not, to these authors’ knowledge, been conducted. As technology improves and options for learning management, videoconferencing, and student assessment platforms increase, programs training counselors at a distance have a widening variety of ways in which this learning can occur.
Asynchronous, synchronous, blended, hybrid, and fully online are just a few modalities that counseling students use to experience their education. A glimpse into the experiences of students will shed light on how our most important players in this ever-changing game of distance counselor education view the efficacy of their respective training, now and in the future.
The Future of Distance Counselor Education
As we examine emerging technologies and near-future possibilities, it can seem like science fiction. The use of avatars and other simulation and gaming technologies in counselor training, for example, have been examined for potential substitutions for counseling practice with peers and real people. Walker (2009) studied the use of avatars in one virtual platform, Second Life, for skills training among master’s-level counseling students. Counseling students’ attitudes regarding the effectiveness of this medium to enhance skills development were measured, and findings suggested that this technological enhancement was efficacious to student learning, engagement, and overall skill development.
Virtual reality (VR) is already used in counseling and is being explored as a way to create environments that can help address trauma and phobias and enhance mindfulness training and techniques. Riva and Vincelli (2001) contend that the use of VR in clinical settings can serve as a “sheltered setting” (p. 52) where clients can explore distress-producing stimuli in a safe and controlled environment.
What potential does this technology have in the training of the next counselors? Might we have “virtual” clients that counselors interact with, in real time, in a VR environment? Buttitta et al. (2018) of California State University, Northridge’s counselor education program are already doing so in training their counseling students. They recently presented initial findings at the 2018 Western Association for Counselor Education and Supervision (WACES) Conference where they demonstrated how they could change the avatar’s voice and physical look to become a person of any age, gender, or ethnicity. Their initial impressions are that student learning is as good with avatars as with role-playing students.
We see this idea tested in training programs in other fields. Plessas (2017) conducted a study of the effectiveness of using VR “phantom heads” for dental students to practice their skills on. Findings suggested that along with concurrent, augmented feedback from supervisors, this training method creates a level of efficiency and safety. Additional platforms for virtual counseling are being developed, necessitating enhanced training of counselors who are equipped to work with new technologies and environments.
As counselor training programs become more technologically savvy, different models and methods of online pedagogy are available to them. What once was almost purely an asynchronous model of instruction (i.e., discussion posts and assignments in a learning management system like Blackboard or Canvas) now has the ability to add interactive videos and training modules, recorded lectures and discussions, and “real-time” synchronous classes and supervision groups using platforms such as Zoom, Skype, or GoToMeeting. The opportunity–capability gap between distance education and residential classrooms is shrinking. According to Cicco (2011), there is greater efficacy of training when online learning includes opportunities for counseling modeling by experts using videos and podcasts as well as opportunities for students to engage in the practice and demonstration of clinical skills. Today’s distance education classroom can do all that and more.
Students in online core counseling skills courses have reported higher self-efficacy (using the Counseling Self-Estimate Inventory) than their counterparts in traditional F2F classrooms (Watson, 2012). Repeated studies draw similar conclusions regarding gains in self-efficacy using online instruction (Smith et al., 2015). Higher levels of internal motivation, student confidence, and self-efficacy are due in part to the structure of online courses and the requirement for students to engage in independent, autonomous learning exercises (Wadsworth et al., 2007).
The evidence we have examined leads us to the conclusion that not only is online and distance education here to stay, but there also are excellent reasons and justifications for its current use and future expansion. We trust that this special section will help to shed light on those aspects of distance counselor education programs proven effective and provide information to the benefit of all counselor training programs—no matter what delivery methods are utilized.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
Allan, R. A. (2001). A history of the personal computer: The people and the technology (1st ed.). Allan Publishing.
Ausburn, L. J. (2004). Course design elements most valued by adult learners in blended online education environments: An American perspective. Educational Media International, 41, 327–337.
Barnett, J. E. (2018). Integrating technological advances into clinical training and practice: The future is now! Clinical Psychological Science Practice, 8(25), 1–4. https://doi.org/10.1111/cpsp.12233
Bennett-Levy, J., Hawkins, R., Perry, H., Cromarty, P., & Mills, J. (2012). Online cognitive behavioural therapy training for therapists: Outcomes, acceptability, and impact of support. Australian Psychologist, 47(3), 174–182. https://doi.org/10.1111/j.1742-9544.2012.00089.x
Benshoff, J. M., & Gibbons, M. M. (2011). Bringing life to e-learning: Incorporating a synchronous approach to online teaching in counselor education. The Professional Counselor, 1, 21–28.
Bolinger, D. U., & Halupa, C. (2018). Online student perceptions of engagement, transactional distance, and outcomes. Distance Education, 39, 299–316. ttps://doi.org/10.1080/01587919.2018.1476845
Bowen, J. A. (2012). Teaching naked: How moving technology out of your college classroom will improve student learning. Jossey-Bass.
Buttitta, D., Gehart, D., Minton, S., & Spencer, S. (2018, November). Transforming counselor education with virtual reality. WACES Annual Conference 2018. Symposium conducted at the meeting of the Western Association for Counselor Education and Supervision, Santa Rosa, CA.
Chapman, R., Baker, S. B., Nassar-McMillan, S., & Gerler, E. (2011). Cybersupervision: Further examination of synchronous and asynchronous modalities in counseling practicum supervision. Counselor Education and Supervision, 50(5), 298–313.
Cicco, G. (2011). Assessment in online courses: How are counseling skills evaluated? Journal of Educational Technology, 8(2), 9–15. https://eric.ed.gov/contentdelivery/servlet/ERICServlet?accno=EJ1102103
Cicco, G. (2012). Counseling instruction in the online classroom: A survey of student and faculty perceptions. Journal on School Educational Technology, 8(2), 1–10. https://eric.ed.gov/contentdelivery/servlet/ERICServlet?accno=EJ1101712
Cochran, J. D., Campbell, S. M., Baker, H. M., & Leeds, E. M. (2014). The role of student characteristics in predicting retention in online courses. Research in Higher Education, 55, 27–48.
Columbaro, N. L. (2009). E-mentoring opportunities for online doctoral students: A literature review. Adult Learning, 20(3–4), 9–15. https://doi.org/10.1177/104515950902000305
Council for the Accreditation of Counseling and Related Educational Programs. (n.d.). Directory of accredited programs. https://cacrep.org/directory
Council for the Accreditation of Counseling and Related Educational Programs. (2015). 2016 CACREP standards. http://www.cacrep.org/wp-content/uploads/2018/05/2016-Standards-with-Glossary-5.3.2018.pdf
Dawson, M. (2018, December 11). We are . . . wherever you are: Penn State marks 125 years of distance learning. https://news.psu.edu/story/496777/2017/12/11/academics/we-are-wherever-you-are-penn-state-marks-125-years-distance
Drumbauld, B. (2014, July 11). A brief history of online learning (infographic). https://www.straighterline.com/blog/brief-history-online-learning-infographic
Edmonds, C. D. (2004). Providing access to students with disabilities in online distance education: Legal and technical concerns for higher education. American Journal of Distance Education, 18, 51–62.
Feldman, D. B., Davidson, O. B., Ben-Naim, S., Maza, E., & Margalit, M. (2016). Hope as a mediator of loneliness and academic self-efficacy among students with and without learning disabilities during the transition to college. Learning Disabilities Research & Practice, 31(2), 63–74.
Friedman, J. (2018, January 11). Study: More students are enrolling in online courses. https://www.usnews.com/higher-education/online-education/articles/2018-01-11/study-more-students-are-enrolling-in-online-courses
Gering, C. S., Sheppard, D. K., Adams, B. L., Renes, S. L., & Morotti, A. A. (2018). Strengths-based analysis of student success in online courses. Online Learning, 22(3), 55–85. https://doi.org/10.24059/olj.v22i3.1464
Great Schools Partnership. (Ed.). (2016). Student engagement. In The glossary of education reform. https://www.edglossary.org/student-engagement
Greenblatt, S. (2011). The swerve: How the world became modern. W. W. Norton.
Haigh, T., Russell, A. L., & Dutton, W. H. (2015). Histories of the internet: Introducing a special issue of Information & Culture. Information & Culture: A Journal of History, 50(2), 143–159.
Health Insurance Portability and Accountability Act of 1996. https://aspe.hhs.gov/report/health-insurance-portability-and-accountability-act-1996
Hoffman, J. (n.d.). The history of the web. https://thehistoryoftheweb.com/timeline
Internet World Stats. (2019). Internet world stats. Usage and population statistics. https://www.internetworldstats.com/stats.htm
InternetLiveStats.com. (n.d.). Total number of websites. http://www.internetlivestats.com/total-number-of-websites
Januszewski, A., & Molenda, M. (2013). Educational technology: A definition with commentary. Routledge.
Jones, C. (2015). Openness, technologies, business models and austerity. Learning, Media and Technology, 40, 328–349. http://doi.org/10.1080/17439884.2015.1051307
Koehler, M. J., Mishra, P., Hershey, K., & Peruski, L. (2004). With a little help from your students: A new model for faculty development and online course design. Journal of Technology and Teacher Education, 12, 25–55. https://pdfs.semanticscholar.org/4df3/3eb2f0b7e70dcf3358ccbf25fb6f2583ea9f.pdf
Kung, M. (2017). Methods and strategies for working with international students learning online in the U.S. TechTrends: Linking Research and Practice to Improve Learning, 61, 479–485.
Layne, C. M., & Hohenshil, T. H. (2005). High tech counseling: Revisited. Journal of Counseling & Development, 83, 222–226. https://doi.org/10.1002/j.1556-6678.2005.tb00599.x
Lederman, D. (2018, January 5). Who is studying online (and where)? Inside Higher Ed. https://www.insidehighered.com/digital-learning/article/2018/01/05/new-us-data-show-continued-growth-college-students-studying
LeDesma, B. (1987, November 20). Stanford instructional television network: Network brings classes to working students. The Stanford Daily, p. 8. https://archives.stanforddaily.com/1987/11/20?page=8§ion=MODSMD_ARTICLE25#article
Leiner, B. M., Cerf, V. G., Clark, D. D., Kahn, R. E., Kleinrock, L., Lynch, D. C., Postel, J., Roberts, L. G., & Wolff, S. (1997). Brief history of the internet. https://www.internetsociety.org/internet/history-internet/brief-history-internet
Lim, J., Kim, M., Chen, S. S., & Ryder, C. E. (2008). An empirical investigation of student achievement and satisfaction in different learning environments. Journal of Instructional Psychology, 35(2), 113–119.
Lowenthal, P. R., & Dunlap, J. C. (2018). Investigating students’ perceptions of instructional strategies to establish social presence. Distance Education, 39, 281–298. https://doi.org/10.1080/01587919.2018.1476844
Means, B., Toyama, Y., Murphy, R., Bakia, M., & Jones, K. (2010). Evaluation of evidence-based practices in online learning: A meta-analysis and review of online learning studies. U.S. Department of Education Office of Planning, Evaluation, and Policy Development Policy and Program Studies Service. https://www2.ed.gov/rschstat/eval/tech/evidence-based-practices/
Moore, M. G., & Thompson, M. M. (1990). The effects of distance learning: A summary of literature. ASCDE research monograph no. 2 (ED330321). ERIC. https://files.eric.ed.gov/fulltext/ED330321.pdf
Murdock, J. L., & Williams, A. M. (2011). Creating an online learning community: Is it possible? Innovative Higher Education, 36, 305–315. https://doi.org/10.1007/s10755-011-9188-6
National Council for State Authorization Reciprocity Agreements. (n.d.). SARA for institutions. http://nc-sara.org/content/sara-and-institutions
Newton, D. (2018, May 23). Study: Online college classes cost less to deliver because they are larger, hire cheaper teachers. Forbes. https://www.forbes.com/sites/dereknewton/2018/05/23/study-online-college-classes-cost-less-to-deliver-because-they-are-larger-hire-cheaper-teachers
Novinson, D. (2007, May 24). Imposter caught. The Stanford Daily. https://www.stanforddaily.com/2007/05/24/imposter-caught
Office for Civil Rights. (2015, September). Title IX and sex discrimination. U.S. Department of Education. https://www2.ed.gov/about/offices/list/ocr/docs/tix_dis.html
Office of Postsecondary Education, Accreditation Division. (2012). Guidelines for preparing/reviewing petitions and compliance reports. U.S. Department of Education. https://www.asccc.org/sites/default/files/USDE%20_agency-guidelines.pdf
O’Keeffe, P. (2013). Sense of belonging: Improving student retention. College Student Journal, 47, 605–613. https://pdfs.semanticscholar.org/2fd4/83eb62cf5094f147c9a129470808bc2d07f2.pdf
O’Shea, J. S. (2003). Motion pictures and the college: A history of “learning by seeing.” Bulletin of the American College of Surgeons, 88(8), 16–23.
Overholt, C. E. (2017). Predicting non-traditional student success in online higher education programs through logistic regression (Publication No. 10243850) [Doctoral dissertation, The Chicago School of Professional Psychology]. ProQuest Dissertations and Theses Global.
Plessas, A. (2017). Computerized virtual reality simulation in preclinical dentistry: Can a computerized simulator replace the conventional phantom heads and human instruction? Simulation in Healthcare: Journal of the Society for Simulation in Healthcare, 12, 332–338.
Redden, C. E. (2002, October). Social alienation of African American college students: Implications for social support systems. Paper presented at the National Convention of the Association for Counselor Education and Supervision, Park City, UT. https://eric.ed.gov/?id=ED470257
Reicherzer, S., Coker, K., Rush-Wilson, T., Buckley, M. Cannon, K., Harris, S., & Jorissen, S. (2012). Assessing clinical mental health counseling skills and practice standards in distance education. Counseling Outcome Research and Evaluation, 3(2), 104–115. https://doi.org/10.1177/2150137812452558
Reicherzer, S., Dixon-Saxon, S., & Trippany, R. (2009, June). Quality counselor training in a distance environment. Counseling Today, 51(12), 46–47. https://www.counseling.org/resources/library/Counseling%20Today/June2009CTOnline.pdf
Renfro-Michel, E. L., O’Halloran, K. C., & Delaney, M. E. (2010). Using technology to enhance adult learning in the counselor education classroom. Adultspan Journal, 9, 14–25.
Riva, G., & Vincelli, F. (2001). Virtual reality as an advanced imaginal system: A new experiential approach for counseling and therapy. International Journal of Action Methods, 54(2), 51–64.
Roser, M., & Ortiz-Ospina, E. (2018, September 20). Literacy. https://ourworldindata.org/literacy
Roser, M., Ritchie, H., & Ortiz-Ospina, E. (2020). Internet. https://ourworldindata.org/internet
Rothman, L. (2015, May 22). A brief guide to the tumultuous 30-year history of AOL. http://time.com/3857628/aol-1985-history/
Rovai, A. P., & Wighting, M. J. (2005). Feelings of alienation and community among higher education students in a virtual classroom. The Internet and Higher Education, 8(2), 97–110.
Seaman, J. E., Allen, I. E., & Seaman, J. (2018). Grade increase: Tracking distance education in the United States. Babson Survey Research Group. https://onlinelearningsurvey.com/reports/gradeincrease.pdf
Sells, J., Tan, A., Brogan, J., Dahlen, U., & Stupart, Y. (2012). Preparing international counselor educators through online distance learning. International Journal for the Advancement of Counselling, 34, 39–54. https://doi.org/10.1007/s10447-011-9126-4
Siemens, G, Gašević, D., & Dawson, S. (2015). Preparing for the digital university: A review of the history and current state of distance, blended, and online learning. http://linkresearchlab.org/PreparingDigitalUniversity.pdf
Smith, R. L., Flamez, B., Vela, J. C., Schomaker, S. A., Fernandez, M. A., & Armstrong, S. N. (2015). An exploratory investigation of levels of learning and learning efficiency between online and face-to-face instruction. Counseling Outcome Research and Evaluation, 6, 47–57.
Snow, W. H., Lamar, M. R., Hinkle, J. S., & Speciale, M. (2018). Current practices in online education. The Professional Counselor, 8, 131–145. https://doi.org/10.15241/whs.8.2.131
Sorenson, C., & Donovan, J. (2017). An examination of factors that impact the retention of online students at a for-profit university. Online Learning, 21(3), 206–221. https://olj.onlinelearningconsortium.org/index.php/olj/article/view/935
Szabo, L.-V. (2015). On press, communication, and culture. Saeculum, XIV (XVI), (1/2), 359–365.
Thompson, C. (2016, January). How the phonograph changed music forever. Smithsonian Magazine. https://www.smithsonianmag.com/arts-culture/phonograph-changed-music-forever-180957677/
Tinto, V. (1997). Classrooms as communities: Exploring the educational character of student persistence. Journal of Higher Education, 68, 599–623. https://doi.org/10.1080/00221546.1997.11779003
United States Department of Justice. (n.d.). Website accessibility under Title II of the ADA. https://www.ada.gov/pcatoolkit/chap5toolkit.htm
University of Minnesota. (n.d.). 7.2 evolution of radio broadcasting – Understanding media and culture: An introduction to mass communication. https://open.lib.umn.edu/mediaandculture/chapter/7-2-evolution-of-radio-broadcasting/
U.S. Department of Education. (2018). Family Educational Rights and Privacy Act (FERPA). https://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html.
Verduin, J. R., Jr., & Clark, T. A. (1991). Distance education: The foundations of effective practice. Jossey-Bass.
Wadsworth, L. M., Husman, J., Duggan, M. A., & Pennington, M. N. (2007). Online mathematics achievement: Effects of learning strategies and self-efficacy. Journal of Developmental Education, 30, 6–14. https://pdfs.semanticscholar.org/a6f4/cd4929597a691e533caa447a20c545336895.pdf
Walden University’s Office of Institutional Research and Assessment. (2015). Walden graduate student
population and demographics. https://www.waldenu.edu/-/media/Walden/files/about-
Walker, V. L. (2009). Using 3D virtual environments in counselor education for mental health interviewing and diagnosis: Student perceived learning benefits (Publication No. 3374779) [Doctoral dissertation, Regent University]. ProQuest Dissertations and Theses Global.
Watson, J. C. (2012). Online learning and the development of counseling self-efficacy beliefs. The Professional Counselor, 2, 143–151. https://doi.org/10.15241/jcw.2.2.143
White, L. (2015). Top 10 campus legal issues for boards. Association of Governing Boards of Universities and Colleges. https://agb.org/product/top-10-campus-legal-issues-for-boards/
Yukselturk, E., & Bulut, S. (2007). Predictors for student success in an online course. Educational Technology & Society, 10(2), 71–83. https://pdfs.semanticscholar.org/5721/20ca1c8593e338228cdec390b5aa284678c7.pdf
Zimmerman, J., & Magnavita, J. (2018). Adopting new technology for your practice: How to assess fit
and risks. In J. Magnavita (Ed.), Using technology in mental health practice (pp. 209–221).
American Psychological Association. https://doi.org/10.1037/0000085-013
William H. Snow, PhD, is an associate professor at Palo Alto University. J. Kelly Coker, PhD, NCC, LPC, is an associate professor at Palo Alto University. Correspondence can be addressed to William Snow, 1791 Arastradero Road, Palo Alto, CA 94304, firstname.lastname@example.org.
Savitri Dixon-Saxon, Matthew R. Buckley
This article reviews relevant research that provides context for a commentary by two long-time distance counselor educators and supervisors with over 35 years of combined professional experience. The authors explore factors that support successful outcomes for graduate students within distance counselor education programs, which include how students are selected, supported in their development, and retained in the program. Discussion targets how distance learning promotes open access to students who historically have been marginalized, who are living in rural areas, and who have not had the same access to educational opportunities. We focus on the roles and responsibilities of institutional and program leadership and program faculty in the areas of building and sustaining a learning community, faculty engagement in and out of the classroom, and retention and gatekeeping of students. Finally, we discuss considerations for building and sustaining credibility within the university culture, supporting the specialized needs of a CACREP-accredited program, and managing the student–program relationship.
Keywords: student selection, student development, student retention, distance education, counselor education
Distance counselor education has evolved from a place of skepticism to an accepted and legitimate method of training master’s- and doctoral-level counselors and counselor educators and supervisors. Snow et al. (2018) noted that “Changing the minds of skeptical colleagues is challenging but naturally subject to improvement over time as online learning increases, matures, and becomes integrated into the fabric of counselor education” (p. 141). A foundational driver in this evolution has been the necessity of program stakeholders to be creative and innovative in using distance technology to achieve similar or sometimes better results than traditional, residence-based programs. In this article, we will address characteristics of students in distance counselor education programs, their specific needs, the concept of andragogy and adult learners, considerations for selecting and retaining distance learning students, the importance of supporting the development of digital competence, and orienting students to the distance program. Additionally, we will discuss the roles and responsibilities of institutional and program leadership and program faculty in three key areas related to optimal student development and program efficacy: community building, faculty presence and engagement in and out of the classroom, and student retention and gatekeeping. Finally, we raise considerations in building and sustaining credibility within the university culture, supporting the specialized needs of a program accredited by the Council for the Accreditation of Counseling and Related Educational Programs (CACREP), and managing the student–program relationship (Urofsky, 2013). In this article, we use the research literature on distance counselor education to support insights we have gained over 35 years of combined experience teaching and administrating online counselor education in a large for-profit institution. To avoid confusion, throughout this article we will be using the term distance counselor education as encompassing online learning, virtual learning, online counselor education, or other terms denoting distance learning in counselor education.
The thought of training counselors using distance education has stimulated incredulity in many counselor educators because of the nature of counselor education (Snow et al., 2018). The underlying concern was that students trained in distance education programs could not be adequately prepared because of the high-touch, interpersonal nature of counselor preparation in which students encountered faculty and supervisors in traditional face-to-face settings. For those venturing into this new frontier, the challenge was to create an effective combination of academic and experiential learning that would provide students with the appropriate foundation for practice to ensure that there were sufficient opportunities to observe and evaluate skills development and comportment. An outcome of distance counselor education was also the realization that offering students a more flexible higher education format was one of the best vehicles to increasing opportunity and access for students (Carlsen et al., 2016). Over the years, we have recognized that facilitating distance learning opportunities was one of the counseling profession’s greatest opportunities to create a more diverse workforce of counselors equipped to provide services in a myriad of traditionally underserved communities, strengthen and support counselors using a variety of technological tools in their work, and enhance students’ exposure to diversity, thereby creating a counseling workforce better able to practice cultural humility (Fisher-Borne et al., 2015; Shaw, 2016). This enhanced cultural competence happens in part because students engage with a widely diverse set of colleagues and faculty that represent various regions of the United States and the world and touch on the areas of socioeconomic, sociocultural, ethnic, spiritual, and religious domains in learners, practitioners, and clients. Essentially, we have recognized that distance education benefits both student and educator, consumer and provider, community and profession.
There have been significant advancements in best practices regarding student selection, development, and retention for distance counselor education. These advancements and modifications, however, need to align with the expectations and guidance of the 2014 ACA Code of Ethics (American Counseling Association [ACA], 2014) and the accreditation standards of CACREP, which also changed to accommodate distance counselor education preparation programs. Many of the best practices for student selection, development, and retention in distance education emerged from what counselor educators gleaned from traditional educational environments. In addition, curricular activities evolved and have been developed with a healthy respect for the interpersonal nature of educating counselors, while developing and utilizing technologies that could accomplish the same objectives achieved in traditional programs, even though the activities to accomplish those objectives are distinct. We have found that developing best practices for selection, development, and retention of counselor education students at a distance has resulted from working with and observing students and responding to their unique needs while balancing where we have “been.” Additionally, engaging in continuous dialogue with program stakeholders and using essential assessment data has helped us become better at meeting students’ needs in a distance education environment. An important aspect of developing best practices is understanding who our students are and what specialized needs they bring to their graduate work when enrolling in a distance counselor education program.
Understanding Our Students in Distance Counselor Education
The first generation of students who pursued distance counselor education were mostly older students, women, people with disabilities, working adults, and students who were more racially and ethnically diverse (Smith, 2014), and although those distinctions are not as clear now as they were a decade ago (Ortagus, 2017), responding to the needs of early distance education students informed counselor educators in creating a model of educating these students that met their educational and developmental needs. Programs committed to facilitating student access and inclusion discovered the need to adjust outdated thinking from traditional criteria as the basis for selection and admission into graduate counseling preparation programs (Bryant et al., 2013) to broaden access. One area of focus essential to program success was looking carefully at the needs of non-traditional and minority students.
Choy (2002) defined non-traditional students as students who either are enrolled part-time, are financially independent, have dependents other than a spouse or partner, or are single parents. In addition, we know that non-traditional students are likely to have delayed enrolling in higher education, work at least 35 hours a week, and be over the age of 25. These circumstances contribute to non-traditional students being much more career-decided than traditional students, and we find that these students are very disciplined, with non-traditional female students having higher grade point averages than their peers (Bushey-McNeil et al., 2014). However, we also know that these students have challenges. For example, non-traditional students are more likely to have a history of academic failures in their past, which may undermine confidence in their ability to succeed. They also have significant time constraints and family responsibilities (Grabowski et al., 2016). We know that although students in distance education succeed overall at a comparable rate to students in traditional residential institutions, students from underrepresented groups do not perform as well in distance education (Bushey-McNeil et al., 2014; Minichiello, 2016). While there have been some changes in the demographics of distance education students in higher education, with an increasing number of traditional student consumers of online education (Clinefelter & Aslanian, 2016), the majority of students in distance education counseling programs are still non-traditional students, precipitating the need for admissions policies that may not mirror traditional graduate admissions practices but allow for consideration of work and service activities in the process. The importance of understanding the demographics of distance counselor education students is in being responsive to their needs on a situational, institutional, and dispositional level.
Responding to the Needs of Distance Learning Students
Effectively engaging distance learning students and creating learning experiences responsive to their specific needs requires understanding that factors impacting success are situational, institutional, and dispositional (Bushey-McNeil et al., 2014). As mentioned earlier, at any one point in the student’s academic career, a non-traditional student can be a parent, a partner, an employee, a caregiver, or some other significant and time-consuming role, which constitutes a situational factor (Bushey-McNeil et al., 2014). These competing responsibilities have a significant impact on student success (Grabowski et al., 2016).
There also are institutional considerations that impact a student’s success. Institutional considerations include programmatic policies and practices, limited course offerings or offerings that are only available during the day, lack of childcare, and lack of financial assistance (Bushey-McNeil et al., 2014). Students in brick-and-mortar environments often feel that they are not receiving the support they need from their educational institution (Grabowski et al., 2016; Kampfe et al., 2006). The distance learning environment certainly makes managing childcare, work responsibilities, and inflexible schedules less of an obstacle in pursuit of higher education. Finally, there are dispositional concerns related to the limits that non-traditional students place on themselves based on their perceptions of their ability to succeed and their lack of self-confidence (Bushey-McNeil et al., 2014). Institutional and program leadership and program faculty must be sensitive to what these students bring to their educational experience and respond productively to these concerns by providing the kind of flexibility necessary to help them develop the skills and professional dispositions needed for professional practice. This support also requires programs to be alert to the skills needed to be successful in a distance learning environment, including and especially andragogical elements within the curriculum.
Andragogy and the Distance Learner
Students in distance learning programs need flexibility, hands-on laboratory experiences, in-depth orientation to technology, greater access to instructors, competency assessment and remediation designed to refresh skills and knowledge, and opportunities for self-reflection and support (Minichiello, 2016) in order to be successful. These needs are aligned with what we understand about the learning principle called andragogy, which is “the art and science of helping adults learn” (Teaching Excellence in Adult Literacy Center, 2011, p. 1). According to Knowles (1973), adults learn best in situations that allow them to apply information and problem-solving techniques to experiences and situations that are relevant to their own lives. In addition, adults look for opportunities to immediately apply newly acquired knowledge (Yarbrough, 2018).
Consistent with this need, instructors in an andragogical learning environment see the learner’s experience as valuable and are willing, in the process of acting as subject matter experts, to allow the learner to guide and customize the learning process (Palmer, 2007; Salazar-Márquez, 2017). Adult learning theory should be the foundation of the online learning experience, and the online learning environment should be reflective of a partnership between subject matter expert and facilitator and the adult learner, who is a personal life expert and leader in the learning experience (Clardy, 2005). The teacher as facilitator helps the learner apply the knowledge and skills to situations relevant to the learner’s experiences and evaluates the application of that newly acquired knowledge. In distance counselor education, faculty members also enact the roles of supervisor, mentor, and gatekeeper, which adds to the complex nature of orienting students to what these roles mean and how they are related to the teaching role. Faculty members also need to consider how they enact these roles throughout the learning process in meeting the needs of distance students.
In distance counselor education programs, program faculty and administrators have discovered that student success is rooted in providing students with support throughout the program, finding ways to engage them and giving them the opportunity to benefit from their faculty and peers’ experiences and expertise, getting them connected to university support services early, and, consistent with andragogical learning principles, identifying opportunities to affirm or support them in developing their own sense of self-efficacy and sense of agency (Clardy, 2005). There are significant opportunities to incorporate these elements in the selection, development, and retention activities of the program.
Selecting and Retaining Distance Learning Students
The goal of the entire educational process in counselor education centers on offering students experiences, education, and skill development that provide a firm orientation to the profession and the expectations of the counseling profession. Each step, from admissions to graduation and even alumni relationships, should be designed to inform students’ understanding of the profession. Although programs demonstrate flexibility in the way they meet professional standards with the admissions process, the processes must reflect professional standards like those described by CACREP (2015, Standards 1.K–L and 6.A.3–4). Supporting counselor education students at a distance begins with the selection or admissions process.
Historically, graduate admissions policies have focused on undergraduate grade point average, standardized test scores, personal interviews, and personal statements (Bryant et al., 2013). However, there are criticisms of these practices in that, although they are perceived to be race-neutral and objective, they do not account for the fact that there is differential access to quality pre-college education based on race and socioeconomic status (Park et al., 2019). Traditionally, low-income students and many students of color are denied access to the most prestigious graduate programs. Many online institutions, both public and private, are employing broad-access admissions practices for their online programs to increase access, opportunity, and fairness (Park et al., 2019).
A broad-access admissions policy differs from an open-access admissions policy. Open admissions typically means there are no requirements for admissions beyond having completed the requisite education before entering a program. Broad access generally means that requirements such as grade point average are designed to give potential students opportunity to participate in the experience, and consideration is given to factors other than academic performance. Broad access provides an opportunity for higher education to people who have been traditionally left out for a variety of reasons, such as the inability to access higher education or because less than stellar undergraduate performances have made it difficult for students to access graduate school. There are some variations to broad-access policies for many online institutions that have as their goal educating adult learners and increasing access and opportunity for people who have traditionally been excluded from higher education.
Although many online programs do not require standardized tests, such as the Graduate Record Examination or the Miller Analogies Test, and may have a lower undergraduate grade point average requirement than other institutions, a robust process for evaluating a candidate’s readiness for a graduate counseling program is essential. In addition to ensuring that the admission decisions are based on the applicant’s career goals, potential success in forming effective counseling relationships, and respect for cultural differences as described by the CACREP standards (CACREP, 2015, Section 1. L), programs also consider the candidate’s professional and community service as an indicator of their aptitude for graduate study. As important as it is to assess students’ readiness for graduate work through their previous academic performance and professional and service activities, programs also need to assess students’ digital readiness or competence for the tasks required in an online program (da Silva & Behar, 2017).
Developing Digital Competence
In the online education environment, it is imperative for students to either have or quickly develop digital competence. Digital competence is essentially the knowledge, attitudes, and skills required to effectively use the instructional technology found in a distance education environment. Students in the online environment have varying degrees of digital competence. Some students in the distance education environment are digital natives and others are digital immigrants (Salazar-Márquez, 2017). Digital natives are those who have always been a part of a highly technological world and are accustomed to accessing information quickly and easily. Their optimal functioning occurs when they are connected and receive immediate gratification. By contrast, those who are not disposed to technological mastery or have had little exposure to technology are digital immigrants and are forced to learn a new language and perpetually demonstrate this new language (as a second language), always speaking or behaving relative to their first language. For the digital immigrant, the requirements of navigating the course classroom and the university resources and creating assignments that require them to use technology can be very challenging.
Although digital natives can navigate the distance education environment with relative ease, they also can be very critical of the speed and efficiency of online systems. Digital immigrants, on the other hand, must navigate instructional content and the learning platform. As one might expect, it is much easier for a digital immigrant to communicate with a digital immigrant and a digital native to communicate with a digital native. But education is not homogenous, and there are both students and faculty who are natives and immigrants trying to partner with each other for an effective learning experience, which can pose a challenge in developing a productive learning community. Although digital immigrants can provide useful recommendations for improving technology and the learning platforms, we encourage program faculty and administration to focus on creating and maintaining systems that are universally beneficial and can be used easily for both natives and immigrants. If an assessment of digital competence is not part of the admissions process, it should be a part of the enrollment and on-boarding process to ensure that students know how to use technology required in the program, and should be an ongoing part of the educational experience.
Orientation to the Program
Critical parts of the admissions and retention processes for counselor education students include the full disclosure of what will be expected as students move through the program and the activities designed to make sure that students are fully aware of what they will be able to do with their degree after its completion. The Association for Graduate Enrollment Management Governing Board (2009) indicates that best practices for graduate enrollment management professionals include making sure that students understand the requirements of their degree program early. This is particularly important to students in distance education programs. Distance learning students, who are still largely non-traditional students, must be informed of program expectations early so that they can decide their ability to manage the different program requirements. For many distance education students, one of the greatest challenges is planning time away from work or family for the synchronous requirements such as group counseling laboratories, residency experiences, supervision, and field experiences.
Helping Students Plan. In addition to being informed of these requirements, administrators and faculty must make sure that students understand not just the requirements but also the relevance and timing of requirements. Non-traditional students need to understand how the timing of programmatic activities impacts their development and progression in the program. One of the best ways to retain students throughout a program is to encourage them to plan appropriately so that they can appropriately manage their personal responsibilities during the times they are engaged in experiences (e.g., field experience or residency) required for the academic program.
Providing Credentialing Information. Pre-admissions orientation also should include information about the credentialing process. It is quite common for students in distance counselor education programs to reside in different states with varying regulations regarding licensing and credentialing for practice. The pre-admissions process should include sharing as much information as possible about students’ opportunities to practice and their credentialing opportunities, but students also should be informed that the laws and requirements for licensure vary by state and can change during the time the student is enrolled in the academic program. Helping students invest in being responsible for monitoring licensure and credentialing laws in their state is essential. Finally, the program faculty and administration must ensure that students understand the expectations for student conduct and comportment throughout the program. Students must understand the evaluation process that will occur for specific program milestones. Throughout the program, the program should make information available about support that is designed for student success.
Faculty, Program Leaders, and University Administrators as Agents of Student Development
As with traditional brick-and-mortar counselor education programs, distance education programs are supported by two sets of institutional personnel. First, they are indirectly supported by a hierarchy of administrators, support staff, and program leadership, and secondly, students are directly supported by program faculty, who often become the primary, student-facing representatives, models, and mentors for both the institution and graduate programs. The challenge for distance counselor education programs becomes to lessen the impact of physical distance between faculty and students by facilitating meaningful, productive, and collaborative learning experiences for students with the use of distance technology as students matriculate through the curriculum, ensuring that students feel fully supported in the process (Benshoff & Gibbons, 2011; Carlisle et al., 2017; Lock & Johnson, 2016; Milman et al., 2015; Sibley & Whitaker, 2015; Suler, 2016; Whitty, 2017). Success in this endeavor requires that institutional administration, program leadership, and faculty create and sustain a shared vision of how to train and support students consistent with institutional values, accreditation standards, best practices, and professional credentialing and licensure board requirements, which support student success beyond the graduate degree. We have found that these reciprocal relationships are essential to the process of enacting such a shared vision and, ironically, call upon counselor educators to utilize their counseling and conceptual skills, emotional intelligence, interpersonal expertise, and advocacy to inform and persuade institutional stakeholders in how best to train and prepare master’s- and doctoral-level counselors and counselor educators. Essential to the process of building and sustaining a successful program is nurturing productive relationships with invested stakeholders, which is within the scope of professional preparation and the experience of counselor educators. Faculty and program leadership are well-advised to perceive themselves as program ambassadors not only to students and other external constituents (e.g., prospective students, colleagues outside of the institution, licensure boards, professional organizations, accrediting bodies, the public), but also to their internal constituents. (e.g., university and college administration, colleagues in related disciplines, other essential decision-makers).
As previously noted, numerous factors impact students’ ability to be successful in distance counseling programs, including personal factors related to work and family circumstances; personal history related to success in school and self-efficacy (Kampfe et al., 2006; Wantz et al., 2003); and programmatic factors related to timeliness and efficacy of student support, online course platforms and curriculum development, technological support, and faculty engagement (Wantz et al., 2003). Although educators cannot control or predict students’ personal circumstances, they can control what occurs within the program in how they respond to supporting students. The reciprocal relationships between institutional and program leadership and program faculty constitute a foundation upon which to build a successful program. We have introduced the importance of developing a shared vision between these groups and specifically wish to address both institutional and program leadership and program faculty responsibilities in three critical program areas, namely building a community of learners, faculty presence and engagement in and out of the classroom, and student retention and gatekeeping.
Building a Learning Community for Student Development
Having a sense of community and belonging is essential to students’ success and retention (Berry, 2017). Many students in the online environment report feeling isolated (Berry, 2017) and are challenged to be resourceful, organized, and creative in ways they might not if they were enrolled in a traditional counselor education program. Time management, developing an intrinsic motivation to self-start, and strategically applying creativity in problem solving often become part of the skillset students develop out of necessity when working in a distance graduate program. These skills often manifest for students within their own version of cyberspace where they must rely upon themselves to persist in their graduate work. In order to combat the sense of isolation that contributes to student attrition, program faculty and administrators must work together to create a sense of community for students, which is largely accomplished using technology.
The Role of Course Development, Technology, and Program Leadership in Building a Learning Community. Technology is the primary apparatus that supports distance learning, but like any tool, it needs to be utilized with purpose, intention, and careful planning. As Snow et al. (2018) noted, numerous commercial products have been developed to enhance student learning, including synchronous audio and video platforms (e.g., Zoom, Adobe Connect, Kaltura) and classroom platforms (e.g., Blackboard, Canvas, Udemy) designed to help provide a usable space to house and disseminate the curriculum and support student learning. The key to effective use of these platforms includes developing courses designed for online learning, supporting faculty in course development and maintenance, and using technology to connect with and support the student experience. Although institutional leadership is often enthused about the potential for online learning and the use of technology to support it, faculty reactions appear to be mixed (Kolowich, 2012), and not all counselor education faculty embrace distance education as a legitimate method for training counselors (Snow et al., 2018), even though they may teach in distance programs as both core and adjunct faculty.
Increasingly in distance counselor education programs, technology is utilized that allows for more digital synchronous interactions between students and their peers and faculty. To increase student engagement, the use of videoconferencing, webcasts, and telephone conferences are often helpful with the learning process (Higley, 2013). Recognizing that interaction and engagement between students and faculty is a significant contributor to student success, faculty and program leadership look for ways in which technology can enhance those opportunities throughout the programs. Students can upload practice videos, experience virtual simulations, and participate in synchronous practice experiences through videoconferences where they directly communicate with faculty and peers. Some universities also have dedicated virtual social spaces for students to connect with each other and engage on a personal level. But invariably, these spaces are underutilized after the beginning of an academic term. Students are beginning to create their own social media sites for community building, sharing their experience of specific courses and instructors and challenges with securing sites for field experience. Although tempting to do so, university officials must guard against the desire to micromanage these experiences in order to manage public perceptions regarding their programs. Much like the conversations that go on in study groups and campus student centers everywhere, students need spaces to share their sentiments about their experience and benefit from their peers’ experiences. Besides, many of the students on these sites are very quick to correct erroneous assumptions or combat negative comments with accounts of their own positive experiences. Additionally, unadulterated feedback can be useful for programs in identifying areas for improvement.
Residential Laboratories. Over the years, there has been an evolution in the perception of counselor educators’ abilities to prepare counselors at a distance. As previously noted, once thought of as a suboptimal way to train counselors, distance learning is now being accepted and seen as legitimate (Snow et al., 2018). However, many distance counselor education programs have found that including a residential component to their primarily online programs positively impacts student success, student collaboration, engagement, and overall student satisfaction, as well as the strength of the learning community. In these residential laboratories, students practice skills in a synchronous environment where they get immediate feedback on their skill development and remediation if needed. They also work with peers without the constraints of those situational concerns referenced earlier, and they engage with their faculty and academic advisors. Students are able to connect with one another meaningfully and close the virtual distance by being able to interact with each other in person in real time. For distance learners, the opportunity to connect in person with a group of like-minded peers all striving for the same goal benefits them emotionally as well as academically. Most importantly, residential experiences allow faculty and program administrators to observe and conduct a more in-depth assessment of their students. These in-person residencies go a long way in building a sense of community for students (Snow et al., 2018).
Faculty as Community-Building Facilitators in the Virtual Classroom. As the primary facilitator of the classroom learning experience, the faculty contributes to community building. Faculty community building starts with an internal assessment of personal and shared professional values that drive student connection and enhance learning. Palmer (2007) described faculty developing a subject-centered posture where both faculty and students become part of a community of learners committed to engaging in “a collective inquiry into the ‘great thing’ [subject of focus]” (p. 128), which serves as the basis for optimal student development. “We know reality only by being in community with it ourselves” (Palmer, 2007, p. 100), which challenges the notion of faculty being the only experts that disseminate knowledge. As noted previously, andragogy promotes the idea that faculty members have a wealth of professional knowledge that they may use to stimulate experiences that will impact students in their growth and that the faculty seek to stimulate what students already bring both in their professional and personal life experience. Palmer (2007) noted that “good education is always more process than product” (p. 96) and that learning is sometimes a disruptive process in which students may feel temporarily dissatisfied with ideas, concepts, and processes that are unfamiliar as they get their values and biases bumped into. The job of faculty becomes being vigilant and recognizing opportunities to describe the experience through developing a balance between support and challenge that invites students to apply what they learn to their emerging professional and personal selves. Developing this kind of learning community means that faculty members must be willing to be vulnerable in the learning process just as their students are. They should resist seeing students solely as customers in their programs instead of as potential colleagues in the counseling profession. A careful examination of what counselor educators and supervisors do and the shared values that drive professional identity is essential in developing this kind of community of learners (Coppock, 2012). For faculty, this approach parallels the goal of developing cultural humility, which is a highly sought learning outcome for students (Fisher-Borne et al., 2015; Shaw, 2016).
Faculty members need to consider how they will personalize the virtual classroom and what areas they want to emphasize for their students. For example, forums dedicated to building connections through using photographs or small video introductions can enhance the classroom as a safe environment for students to interact. Making these introductions fun and engaging can go a long way to helping decrease the distance students may experience. Depending on the flexibility of the program for faculty to modify the classroom according to their preferences, faculty can create spaces for students to share their ideas and thoughts freely and help students discover how their ideas compare to those of their peers. Students often attempt to make only minimal and requisite connections between their ideas and their peers, but faculty can encourage a more meaningful discourse in which students’ expressed ideas are essential through modeling this themselves.
Additionally, faculty members aid students in becoming responsible community members in the classroom and professional community. The faculty models openness and acceptance of the personhood and individual perspectives of each student by offering encouraging responses that support their perspectives and challenge them to consider other points of view. By immediately attending to students’ expressions of thoughts and ideas that may be counterintuitive to the ACA ethical code or that might alienate other community members, faculty members facilitate a community where all students feel safe and included. Learning how to become professionals in a virtual community becomes an additional skillset that students develop as they engage in distance learning. This direct modeling has powerful implications for the kinds of relationships students establish with colleagues and clients within work settings they will engage in during their practicum and internship experiences.
Faculty Presence and Engagement as Conduits for Student Development
It is indisputable that faculty engagement with students in distance counselor education is essential. Students rely on faculty to provide clear steps in a process that requires self-motivation, resourcefulness, creativity, and persistence. An important part of building a productive learning community and promoting the culture of distance learning is helping students not only to engage in the subject (i.e., assignments, learning resources, readings, projects), but also to engage each other in order to maintain the relational quality of face-to-face interactions. We encourage faculty and program leadership to see students as individuals, to foster essential relationships, and to operationalize their caring for students in all their activities (Hall et al., 2010). As Hall et al. (2010) have noted, these activities require that those involved in preparing counselors at a distance remain focused and intentional about what they do when enacting their shared vision.
The Role of Institutional and Program Leadership in Faculty Engagement. The development and maintenance of online curriculum is central to student development, and careful planning, typically within a curriculum committee, helps maintain a vibrant and responsive curriculum (Brewer & Movahedazarhouligh, 2018). Course development for a distance education program, although vital, can be intimidating to faculty unfamiliar with the process who can have reservations about the efficacy of distance learning and their own ability in using technology to accomplish course goals. Sibley and Whitaker (2015) noted that faculty resistance needs to be responded to by institutional administration and program leadership with understanding and support. Wantz et al. (2003) assessed program leadership and faculty perceptions of online learning and discovered that faculty perceptions included concerns about the efficacy of online distance education, the belief that certain subject areas (i.e., practice and application of counseling skills, ability to accurately assess student mastery) might not be appropriate for a distance model, the cost–benefit balance and exertion of time and effort in creating and maintaining an online course, and the need to be compensated for this time and effort. Although this study is over 15 years old, it does give an important touchpoint concerning the perspectives of some faculty who work within residential and online programs.
For programs that rely heavily on faculty to create online curriculum, institutional and program leadership and administration will need to carefully review compensation policies and practices in programs that require faculty to integrate course development into their workload. Snow et al. (2018) verified that some faculty exhibit resistance toward distance learning, specifically faculty who themselves are teaching online courses either as adjuncts for online programs or who are being required to teach online courses as part of their full-time positions. Sibley and Whitaker (2015) noted that “since faculty participation can neither be mandated nor fabricated, institutions must make online learning attractive, accessible, and valuable to faculty” (para. 23). This starts with online instructional development teams cultivating a deep sense of respect for the expertise the counselor education faculty members possess and working to establish consultative relationships when developing the online curriculum, including helping faculty see what has been done successfully in other courses. Hall et al. (2010) described a philosophy of approaching distance learning from a humanistic framework: “The challenge was not to allow technology to limit or destroy the essence of the individuals involved in the learning process” (pp. 46–47), but for faculty to maintain the relationality with their students consistent with shared professional values that acknowledge counselor preparation as a high-touch (i.e., interpersonal, mentoring, supervising) endeavor. An important part of the successful deployment and maintenance of distance counselor education programs is in continually nurturing a values-based approach; soliciting buy-in from essential stakeholders; seeing and using technology as a tool and not a barrier to enhance connection and learning; and supporting the development of the curriculum, including scheduled revisions based on systematically collected assessment data (CACREP, 2015).
Understanding how to develop curriculum for counselor preparation programs is an essential point where online instructional development and program faculty meet. For example, according to media richness theory (Whitty, 2017), media-rich learning environments lend themselves best to subject areas that are “more ambiguous and open to interpretation” (p. 94) rather than topics that are clear and unambiguous, such as mathematical or scientific formulas. Media-rich learning is characterized by the following four criteria: the capacity for immediate feedback (i.e., clarity of the material), the capacity to transmit multiple cues (i.e., the ability to develop clear and meaningful consensus), language variety (i.e., being able to convey context to complex concepts and ideas), and the capacity of the medium to have a personal focus (i.e., making the learning personal and relevant to the perspectives and needs of the learner). Sibley and Whitaker (2015) point out that some faculty may see technology (including media) as a barrier between them and students rather than a tool to facilitate increased insight, conceptual understanding, and skill mastery, so supporting faculty in experimenting and adopting ways of interacting with technology is a logical starting place. Institutional and program leadership can help faculty become familiar with and invested in learning platforms through initial and ongoing training. Leadership also can help support faculty directly by determining what parts of the classroom can be personalized and modified (including learning activities and assignments) and which parts must remain constant for accreditation standards and learning outcomes assessment.
Additionally, institutional and program leadership are well-advised to develop processes that can monitor faculty activity within the virtual classroom that will reinforce expectations of what faculty should do weekly in the classroom (e.g., faculty must check into the classroom a minimum of four days per week, respond to 75% of student postings with substantive responses in the discussion forum, must review and grade assignments within 7 days, and must respond to student inquiries within 48 hours of receiving them) without coming across as micromanaging and punitive. Leadership may certainly achieve compliance, but they cannot demand engagement, which is based on the discretionary time, attention, effort, and energy faculty devotes to the learning endeavor based on their deeply held values and commitment to the shared vision they have for educating students.
We recommend that leadership strive for transparency in how monitoring of classroom activity is accomplished, its intent, and the use of assessment data. Without transparency, leadership takes on the risk of stoking faculty concerns about negative evaluations and ultimately the security of employment. Establishing peer monitoring through periodic course audits within a collegial, developmental, and supportive approach that is non-threatening to faculty will go a long way to sustaining faculty engagement in the classroom. Some larger distance education programs assign course stewards (i.e., a faculty member responsible for a particular course in the curriculum) who act as the first line of contact for faculty who may have questions about aspects of the course or particular assignments, or who might struggle with a student issue, and can support faculty directly through informal peer mentoring. This becomes especially important for adjunct faculty who need assistance in contextualizing the course into the larger program objectives and feeling invested in the success of program students. These kinds of structures and processes will be helpful if institutional and program leadership is committed to communicating regularly with faculty and promoting an environment of support and accountability.
Finally, institutional and program leadership can encourage a culture of openness to peer review and classroom observation that will help faculty improve their techniques and in a way that is non-threatening (Palmer, 2007). Developing and scheduling events and activities that foster professional renewal and connection between faculty can help strengthen the value of reflective practice in teaching that is essential throughout a faculty member’s career. Palmer (2007) writes the following about the tendency for faculty to remain “private” about their work in the classroom:
Involvement in a community of [andragogical] discourse is more than a voluntary option for individuals who seek support and opportunities for growth. It is a professional obligation that educational institutions should expect of those who teach—for the privatization of teaching not only keeps individuals from growing in their craft, but fosters institutional incompetence as well. By privatizing teaching, we make it hard for educational institutions to become more adept at fulfilling their mission. (p. 148)
Being able to see one’s teaching style, approach, and interactions through a colleague’s eyes can help faculty make appropriate adjustments and strengthen reflective practice, which is ironically what faculty expect from their students in a distance counseling program. This can model a culture of openness for the entire learning community.
Faculty Role in Student Engagement. We believe that faculty engagement with students and facilitating meaningful engagement of the subject matter in the classroom lies at the heart of student success, both within the program and in establishing a foundation for lifelong learning. Diminishing the distance in a distance counselor education program means that faculty members are eager to connect meaningfully with students, be open to their feedback about what is or is not working for them in the classroom, and take the time and effort to supply a rationale for particular assignments and activities, which includes how these learning experiences are relevant to professional growth. The value faculty offers is largely in their ability to make the curriculum come alive and to engage the student in seeing the subject matter differently than they might assume. This means that faculty members are challenged to use their time and effort strategically in developing therapeutic stories, analogies, and insights that can be utilized for a variety of professional circumstances, clinical situations, cultural encounters, and ethical dilemmas. Recognizing effort and validating students’ points of view, including being sensitive to the various personal contexts, shaped by life experience, that students bring to their learning, is essential in nurturing faculty–student relationships. In their theory on group development, Bennis and Shepard (1956) held that group members, prior to engaging in productive, emotionally intimate, affirming interactions with peers, first make decisions about the authority in the room, including accepting how the leader models engagement and psychological safety. It is not inconceivable that this similar dynamic occurs within the virtual classroom as students encounter the faculty leader and make decisions about how to approach the classroom, including using their experience as a springboard into how to behave and what to expect. Student engagement in the classroom is enhanced in three specific areas of faculty engagement: timely, relevant, consistent, and targeted feedback; substantive and relevant responses in discussion forums; and prompt and direct follow-up when necessary with students.
Timely, Relevant, Consistent, and Targeted Feedback. Feedback is the life blood of student development in a counselor preparation program, and students depend on faculty to provide affirming and corrective feedback on numerous levels that is proportional to learning activities and assignments. Proportionality is demonstrated when the faculty aligns feedback with what is most important within the goals and objectives of a course. For example, a common complaint of graduate program adult learners is that faculty members may sometimes become so overly concerned about student adherence to the American Psychological Association (APA) publication style manual that they minimize the content, concepts, insights, and ideas students attempt to convey in their raw and imperfect form. When students encounter this kind of disproportionate feedback, they learn what the faculty member most values and work to meet the implicit expectations, sometimes to the detriment of learning other and perhaps more important concepts related to the subject matter. When this occurs, students may subjugate all other considerations and simply seek to pass the course, while sacrificing learning and a love for the subject matter. The impression also might inadvertently be conveyed that authority ultimately rules which can reenact the wounds of past academic failures in students who do not view themselves as high performing.
Timely, relevant, consistent, and targeted feedback occurs when faculty members recognize and validate the effort students put into their work; respectfully describe what they see working well within student product and performance; provide a developmentally sensitive critique of the identified concern, while being careful not to overwhelm the student with a list of deficits; and offer respectful, corrective alternatives and offer to meet with the student to clarify anything that might be confusing. Timeliness is best achieved by staying on top of grading and meeting the established time parameters of when assignments will be evaluated and grades returned to the student. Feedback related to counseling or conceptual skills performance (such as in field experience) also includes faculty providing sample language that might be used in demonstrating the particular skill work that can help stimulate students in finding their own voices in how to communicate a particular thing to their clients.
Substantive and Relevant Responses in Discussion Forums. Discussion forums are often the most lively and engaging areas in a virtual classroom and where, often in distance counselor education, a significant part of the virtual teaching and learning takes place. Here students engage in articulating their insights and understanding of the subject matter and engage one another and faculty in respectful and honest interaction. Students can perceive online discussions as less threatening, particularly when verbalizing sensitive material, including values-driven points of view (Ancis, 1998), which often emerge in coursework such as ethics, social and cultural foundations, group counseling, and field experience courses. On the other hand, some students, because they perceive themselves as not being physically seen or heard, might engage in the online disinhibition effect (Suler, 2016), wherein they can say things that are controversial or disrespectful based on the belief that being anonymous is the same as being undetectable. Or they may make comments that would be irresponsible in professional communications, which would obviously need to be corrected. Often these discussions are asynchronous, and students have the benefit of being able to clearly think about the subject matter, read, observe, and comprehend the learning resources (e.g., course readings and media), and prepare responses to discussion prompts to meet the requirements of the weekly assignment. Because students develop a routine within the classroom, they have been reinforced in how to respond, including deciding how much time and effort they will expend in developing their responses. In situations where students may simply default to becoming formulaic in their responses, faculty members can help students engage with the material more meaningfully through formative and summative feedback. A much more powerful way to help students engage in the discussion forum is for faculty to model what engaged responses look like and to encourage and invite students to engage more fully in their learning.
Faculty can engage creatively in the discussion forums by embedding YouTube videos, sharing links to TED talks, sharing important and relevant websites, and occasionally sharing humorous memes to help counter the effects of formulaic, routine, and mundane participation. Students can be encouraged to post a short video describing their reactions as a way of lessening the virtual distance and reminding class members of what each other looks like. Often, synchronous meetings occur through interactive video platforms where students are able to hear and see and be heard and seen by others, so encouraging connections with and between students within these learning opportunities can help prepare students to engage with the subject matter more meaningfully (Benshoff & Gibbons, 2011).
A primary benefit of online discussions is that the discussion can also be preserved in an organized fashion for retrieval by students and faculty members (the discussions can be copied and pasted and stored electronically), thus chronicling and capturing the essence of the discussion, reinforcing what students said to their peers (the expression of their own perspectives), highlighting specific and targeted feedback related to the particular topic, and preserving essential references that might be useful for follow-up. Faculty can indirectly assess the efficacy of their responses to determine the degree to which their contributions are adding value or are simply facilitative in getting students to engage in the discussions with each other. This can include the instructor copying and pasting verbatim “chat” in the chat functions of live, synchronous video interactions where students can share insights, suggestions, websites, and other resources for student follow-up and review.
Prompt and Direct Follow-Up with Students. Perhaps the most effective and often time-consuming manifestation of faculty engagement is following up with students with live chats, phone calls, video interactions (e.g., Zoom, Skype, Adobe Connect technology), or face-to-face in real time for a variety of reasons. Often, students get the message from faculty, “If you need me, please reach out to me,” which translates to email interactions to address logistic concerns in the classroom. Students assume that because they need to be resourceful and proactive in their distance program, they will need to take care of themselves, by themselves, without seeking faculty interaction or intervention. Faculty advising and mentoring in residential programs appears clear cut; a student can drop into a faculty member’s office and address a concern or have a chat about professional or personal matters. This function may be more nebulous in a distance education environment unless the faculty makes explicit how they will follow up with students and interact with them personally. Faculty can address questions or concerns and also engage students in important advising regarding professional, ethical, academic, credentialing, and licensure issues; consult about clients they may encounter (if students are in their field experience); and have dedicated focused consultation on these important matters. Helping students feel valued means that faculty give uninterrupted time and resist multitasking, which can sometimes become a default for people who are part of a distance learning community. Faculty can engage students in skills practice and can record these practice sessions for students to retrieve and review as needed. Skills practice and mastery in distance counselor education has been identified as a central function for faculty in their work with students (Fominykh et al., 2018; Shafer et al., 2004; Trepal et al., 2007) and has been identified in helping strengthen self-efficacy beliefs in students (Watson, 2012). Faculty can initiate a student outreach in cases where they might feel concern over a student’s performance or change in classroom behavior. In these ways, the faculty lessens the distance, hold students closer to areas of support, and reassures students that they are practically cared for in their graduate work.
Student Retention and Gatekeeping
Student retention and gatekeeping functions are foundational to ensuring a broad access policy and maintaining quality control of program graduates. Students who struggle with academic and personal concerns need to have direct support from program faculty and administration in times in which they feel most challenged (Kampfe et al., 2006). Counselor educators and supervisors are ethically charged as gatekeepers for the counseling profession (ACA, 2014; Bryant et al., 2013; Dougherty et al., 2015; Dufrene & Henderson, 2009; Gaubatz & Vera, 2002; Homrich et al., 2014) and the implementation of gatekeeping is systemic and dependent on institutional and program leadership and program faculty to execute successfully. Leadership and faculty have separate but related functions in successful gatekeeping and in student retention.
The identification of students who struggle will almost always be within the oversight of individual faculty members. As noted previously, students can enter a distance counselor education program with academic challenges and with multiple and competing priorities as they balance family, work, and school responsibilities. CACREP (2015) requires that programs make students aware of counseling services available to them in cases where therapeutic help is warranted. Library services, writing center services, student support services, tutoring and mentoring, and disability services are often utilized to help students succeed in their academic pursuits. Academic leadership is charged with developing and maintaining systems, processes, and protocols that are activated when a student needs help and faculty members are essential in helping students access these services when needed. Faculty engagement is intricately tied to the successful utilization of these services, as students will see faculty as their “go-to” person to help sort through tricky issues and develop an action plan. Clear, two-way communication between faculty and academic leadership can assist in refining these processes and services.
Faculty Roles in Student Retention and Gatekeeping. Students in distress will often revert to actions that are driven by stress and anxiety rather than what is in their best interests, including moving away from those who can help them sort through challenging situations. As noted previously, faculty engagement helps students feel confident that the faculty cares about them not just as students, but as people. Caring and compassion is operationalized when faculty members are proactive in contacting students when there is a change in classroom performance and available when students reach out for assistance. Although it is tempting in a distance counselor education program to refer students to a particular service or give a phone number or a website address, we have found that students sometimes interpret such a referral as “passing the buck” and feel frustrated as this patented answer can be experienced as the typical response in other interactions with the university and program. Meeting students where they are in this context means that the faculty is well-enough aware of the services available that they can talk through the process of what a support contact would look like and what students might expect. This is an important part of developing productive relationships with internal constituents and nurturing contacts within the institution that will help expedite assistance when needed. In this way, faculty credibility is strengthened, and students feel cared for at times when it matters most.
Gatekeeping is a process typically enacted by faculty when there is a concern in student behavior and can be assessed at different points within students’ progress through their respective programs. Because of the highly personal nature of gatekeeping (i.e., identifying concerns and counseling with a student about his or her personal or professional behavior, values, ethics, and attitudes), some faculty may be reluctant to initiate conversations directly with students and might need additional supports from faculty, teams, or committees specially designated to address these student concerns. As previously noted, faculty members need to assess their own professional and personal values in making decisions about how they will engage students in difficult and courageous conversations regarding their professional development. Also, because of the nature of gatekeeping, the faculty is well-advised to document these student conversations in a follow-up email to the student, copied to other appropriate support people to ensure that problem identification, response, and associated actions are clear with identifiable timelines. This will help create the basis for a specific and targeted remediation plan (Dufrene & Henderson, 2009). Just as all students are individuals with specific contexts, all gatekeeping issues are not created equal. Students can present with skill deficits that require remediation in skills work where it is appropriate to assign them to a skills mentor who would help them work through skills challenges. The skills mentor would likely make reports to the gatekeeping committee regarding progress and additional supports if warranted. Students also can present with dispositional concerns that require a different response and intervention. Homrich et al. (2014) developed standards of conduct expected of counselor trainees throughout their programs that can act as an important foundation for developing dispositional standards that can be disseminated to students in orientation meetings and used periodically throughout key assessment points where dispositional concerns might be present.
It is inaccurate to assume that while some graduate counseling students are already professionals within a mental health setting (e.g., case manager, psychiatric technicians, intake representative), they know how to conduct themselves professionally and what constitutes professional behavior (Dougherty et al., 2015; Homrich et al., 2014). Faculty members who are proactive in modeling and talking explicitly about professionalism can influence students to consider their own behavior and make needed adjustments to be more in line with shared professional values and help them become more reflective in their practice (Rosin, 2015), strengthen their resiliency (Osborn, 2004), and develop effective reflective responding skills (Dollarhide et al., 2012). Faculty modeling of professional dispositions, reflective practice, and self-care will help normalize the commitment to the shared values of the profession and mentor students who may struggle to adopt and adjust to the demands of a profession that relies on professionals to commit and practice ethical values.
Institutional Support for Gatekeeping. The relationships with chief legal counsel and the dean of students are important to program administrators and faculty being able to effectively execute their role as gatekeepers to the counseling profession. Although program leadership makes the decisions about the evaluation process for students—the remediation plans and dismissal recommendations that relate to comportment, academics, and skill development—the decisions to dismiss are usually done in consultation with colleagues from the dean of students’ office and chief legal counsel.
Deans of Students as Gatekeeping Partners. In an era of increased litigiousness, students increasingly appeal the decisions of program leadership, often to the dean of students (Johnson, 2012). It is the role of the dean of students to support the overall mission of the university and enforce the roles of the institution, but this also is the person responsible for building community and being concerned about the emotional and physical welfare of students. Counselor educators work closely with the dean of students when students have violated university or program policy and when they are trying to identify the appropriate ways to respond to conduct and comportment concerns. The relationship between the program faculty and administrators and the dean of students is critical to ensuring that appropriate interventions are put in place to protect the individual student, the greater student body, the community, and the profession.
Chief Legal Counsel as Gatekeeping Partners. Equally important is the relationship between chief legal counsel and the program faculty and administration. The role of the general legal counsel in any organization is to “oversee the legal and compliance function” (McArdle, 2012, para. 2) of the organization. In higher education, it means that counsel also is providing oversight to internal compliance with university policies and making sure that the scope of those policies is not too broadly interpreted. This is very much a risk management role in some settings (McArdle, 2012). University lawyers advise us on the interpretation and the applicability of legal documents such as policy manuals, contracts, and articulation agreements. They also participate in significant dispute mediations and formal dispute resolution (Meloy, 2014).
Counselor educators are mandated to dismiss students who are deemed unfit for the profession and students for whom it is determined that their issues of concern cannot be remediated to the degree that they will be able to provide competent services to diverse clients (ACA, 2014). In addition, counselor educators are required by the 2014 ACA Code of Ethics to participate in ongoing evaluation of those they supervise and to provide remediation when needed (ACA, 2014). But the code also requires program leaders to dismiss from the training programs those who are unable to provide competent service. CACREP standards require that program faculty and administrators have a developmental and systematic assessment process. Administrators should work with legal counsel to ensure that no comportment dismissal is viewed as malicious or punitive. General counsel helps stakeholders ensure that a student’s rights have been protected in the process and that the dismissal process is a fair one. The challenge is to protect the university, the student, and the public (McAdams et al., 2007).
Counselor educators should receive guidance on institutional policy prior to implementation. There can be frustration on the part of counseling faculty and administrators that general counsel does not support their goals or their professional requirements. However, some of this frustration can be avoided if programs provide general counsel and other administrators with a profile of their responsibilities to the profession and the community with their training programs. It is important for counselor education administration and faculty to develop a relationship with general counsel early based on mutual alliance. Although the administration is not obligated to take the advice of general counsel in how they respond to a student situation, it is advisable to consider their guidance very carefully.
Building and Sustaining Credibility Within the University Culture
Most of the discussion around student selection, development, and retention has been focused on students, faculty, and the program. However, a program’s reputation and role in the institutional mission and the program administrators’ ability to communicate the value proposition of the program are critical contributors to selection, development, and retention. A full exploration of this idea is beyond the scope of this article, so these ideas will only be discussed briefly, with a charge to counselor educators, especially administrators of programs, to work together to ensure that preparation programs are able to demonstrate innovation, flexibility, and responsiveness so that the institutional and community value of these programs is clear and so that programs are able to secure sufficient resources to effectively educate, evaluate, and develop students.
One of the greatest challenges program administrators face in higher education is competing for limited resources (Pucciarelli & Kaplan, 2016). In addition, program administrators are continually challenged to demonstrate the relevance of their programs. As program administrators plan for the sustainability of their future, they must examine the changing needs of the profession to which they are responsible, the mission of the institution, the program mission, the preparation and needs of their students, the needs of the community they are serving, the availability of resources, the regulatory environment impacting professional practice, and the needs of the faculty and administrators providing oversight to the program. Considering the needs of many constituents is a very challenging proposition, but it is one made easier when there are clear guiding principles and philosophies or mission and vision for the program. Although not static, the mission and vision communicate the program’s aspirations and intentions to everyone. They also serve to give a program a clear identity in the university community. Using the mission and vision of the program as a reference point serves to inform all decision-making, particularly those decisions that relate to how learners in a program should be educated and which resources are a priority.
Managing the Student–Program Relationship
The changing dynamics of the student–program relationship do not rest entirely with student attitudes. Many of our university operations and recruitment strategies, designed to achieve student enrollment targets to attract the numbers and kinds of students the institutions desire, closely resemble strategies used in business (Hanover Research, 2014). Online programs have been particularly inclined to employ creative marketing strategies in order to convince potential learners to shift their paradigm from brick-and-mortar institutions as the only source of higher education to online institutions (OnlineUniversities.com, 2013). The unintended consequence is that this approach often fosters a customer–business relationship that can, at times, be counterproductive to the student–faculty/supervisee–supervisor relationship. In the face of critical evaluations of their professional comportment and skill development, students will oftentimes interject commentary about the price of the degree and their expectations that they will complete their academic programs primarily because of the money invested in that education.
We have found that what sometimes exacerbates this dynamic is a racially charged climate, and many students, especially students who are traditionally marginalized, are suspicious of faculty members’ motives for identifying student development needs. This is a challenge for online programs where, for much of their academic program, students only have a one-dimensional (i.e., faculty member’s written word) understanding of their faculty and administrators. Finally, because of this largely one-dimensional perception, it is more challenging to develop relationships with these students. Focusing on the relationship with students and being relationally oriented is essential. Faculty and administrators, in their efforts to attract, develop, and retain students, should be focused on relationship building at every opportunity, thereby creating an academic environment where students are clear about the expectations of the academic and professional practice community and understand the range of consequences for behavior that is outside those expectations.
Distance counselor education programs and counselor educators pay as much attention to students’ selection, development, and retention as traditional programs, often within a context of general skepticism about the ability to adequately train counseling students at a distance. However, as distance counselor educators, we are committed to educating counselors and counselor educators in this arena because of our commitment to access and opportunity for students and the communities they serve. We believe in all the essential ways that online education is the true equalizer for non-traditional and traditionally marginalized students, and broad-access admissions policies provide us with a vehicle to increase access. Being successful in this arena requires a commitment from program faculty, program administrators, and other university administrators. It also requires us to understand the needs of the online student population and commit to systematic ways of developing the adult learner while acknowledging and employing the individual student’s experiences as assets to the developmental process. Although we may employ technology to a greater degree than our colleagues in traditional education settings, we put the professional standards of quality and ethical practice, community and relationship building, and student academic and skill development as the foundation for all activities related to selection, development, and retention.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
American Counseling Association. (2014). 2014 ACA code of ethics.
Ancis, J. R. (1998). Cultural competency training at a distance: Challenges and strategies. Journal of Counseling & Development, 76, 134–143. https://doi.org/10.1002/j.1556-6676.1998.tb02386.x
The Association for Graduate Enrollment Management Governing Board. (2009). Best practices for graduate enrollment management professionals. https://nagap.org/documents/BestPracticesforGraduateEnrollmentManagementProfessionals10-28-09_2_.pdf
Bennis, W. G., & Shepard, H. A. (1956). A theory of group development. Human Relations, 9, 415–437.
Benshoff, J. M., & Gibbons, M. M. (2011). Bringing life to e-learning: Incorporating a synchronous approach to online teaching in counselor education. The Professional Counselor, 1, 21–28.
Berry, S. (2017). Building community in online doctoral classrooms: Instructor practices that support community. Online Learning, 21(2), 42–63. https://doi.org/10.24059/olj.v21i2.875
Brewer, R., & Movahedazarhouligh, S. (2018). Successful stories and conflicts: A literature review on the effectiveness of flipped learning in higher education. Journal of Computer Assisted Learning, 1–8. https://doi.org/10.1111/jcal.12250
Bryant, J. K., Druyos, M., & Strabavy, D. (2013). Gatekeeping in counselor education programs: An examination of current trends. Ideas and Research You Can Use: VISTAS 2013. https://www.counseling.org/docs/default-source/vistas/gatekeeping-in-counselor-education-programs.pdf?sfvrsn=7f6e77b5_13
Bushey-McNeil, J., Ohland, M. W., & Long, R. A. (2014, June 15–18). Nontraditional student access and success in engineering (Paper ID #9164) [Paper presentation]. 121st ASEE Annual Conference & Exposition, Indianapolis, IN, United States.
Carlisle, R. M., Hays, D. G., Pribesh, S. L., & Wood, C. T. (2017). Educational technology and distance supervision in counselor education. Counselor Education and Supervision, 56, 33–49.
Carlsen, A., Holmberg, C., Neghina, C., & Owusu-Boampong, A. (2016). Closing the gap: Opportunities for distance education to benefit adult learners in higher education. UNESCO Institute for Lifelong Learning. https://files.eric.ed.gov/fulltext/ED573634.pdf
Choy, S. (2002). Nontraditional undergraduates. U.S. Department of Education, National Center for Education Statistics. https://nces.ed.gov/pubs2002/2002012.pdf
Clardy, A. (2005). Andragogy: Adult learning and education at its best? [Unpublished manuscript]. Towson University, Towson, MD.
Clinefelter, D. L., & Aslanian, C. B. (2016). Online college students 2016: Comprehensive data on demands and preferences. The Learning House, Inc.
Coppock, T. E. (2012, March 1). A closer look at developing counselor identity. Counseling Today. Alexandria, VA: American Counseling Association. https://ct.counseling.org/2012/03/a-closer-look-at-developing-counselor-identity
Council for Accreditation of Counseling and Related Educational Programs. (2015). 2016 CACREP standards.
da Silva, K. K. A., & Behar, P. A. (2017). Digital competence model of distance learning students. Proceedings of the IADIS International Conference on Cognition & Exploratory Learning in the Digital Age, 109–116.
Dollarhide, C. T., Shavers, M. C., Baker, C. A., Dagg, D. R., & Taylor, D. T. (2012). Conditions that create therapeutic connection: A phenomenological study. Counseling and Values, 57, 147–161.
Dougherty, A. E., Haddock, L. S., & Coker, J. K. (2015). Student development and remediation processes for counselors in training in a virtual environment. Ideas and Research You Can Use: VISTAS 2015. https://www.counseling.org/docs/default-source/vistas/student-development-and-remediation-processes-for-counselors-in-training-in-a-virtual-nvironment.pdf?sfvrsn=fe417f2c_8
Dufrene, R. L., & Henderson, K. L. (2009). A framework for remediation plans for counseling trainees. In G. R. Walz, J. C. Bleuer, & R. K. Yep (Eds.), Compelling counseling interventions: VISTAS 2009 (pp. 149–159). American Counseling Association. https://www.counseling.org/resources/library/VISTAS/2009-V-Print/Article%2014%20Dufrene%20Henderson.pdf
Fisher-Borne, M., Cain, J. M., & Martin, S. L. (2015). From mastery to accountability: Cultural humility as an alternative to cultural competence. Social Work Education, 34, 165–181.
Fominykh, M., Leong, P., & Cartwright, B. (2018). Role-playing and experiential learning in a
professional counseling distance course. Journal of Interactive Learning Research, 29, 169–188.
Gaubatz, M. D., & Vera, E. M. (2002). Do formalized gatekeeping procedures increase programs’ follow-up with deficient trainees? Counselor Education and Supervision, 41, 294–305.
Grabowski, C., Rush, M., Ragen, K., Fayard, V., & Watkins-Lewis, K. (2016). Today’s non-traditional student: Challenges to academic success and degree completion. Inquiries Journal, 8(3), 1–2. http://www.inquiriesjournal.com/articles/1377/todays-non-traditional-student-challenges-to-academic-success-and-degree-completion
Hall, B. S., Nielsen, R. C., Nelson, J. R., & Buchholz, C. E. (2010). A humanistic framework for distance education. The Journal of Humanistic Counseling, Education and Development, 49, 45–57.
Hanover Research. (2014, March). Trends in higher education marketing, recruitment, and technology. Hanover Research Academy Administration and Practice. https://www.hanoverresearch.com/media/Trends-in-Higher-Education-Marketing-Recruitment-and-Technology-2.pdf
Higley, M. (2013, October 15). Benefits of synchronous and asynchronous e-learning. eLearning Industry. https://elearningindustry.com/benefits-of-synchronous-and-asynchronous-e-learning
Homrich, A. M., DeLorenzi, L. D., Bloom, Z. D., & Godbee, B. (2014). Making the case for standards of conduct in clinical training. Counselor Education and Supervision, 53, 126–144.
Johnson, B. (2012). Being the dean of students in challenging times. Independent School, 71(4), 76–81.
Kampfe, C. M., Smith, S. M., Manyibe, E. O., Moore, S. F., Sales, A. P., & McAllan, L. (2006). Stressors experienced by interns enrolled in a master’s rehabilitation counselor program using a distance education model. Rehabilitation Education, 20, 201–212. https://doi.org/10.1891/088970106805074467
Knowles, M. (1973). The adult learner: A neglected species (ED084368). ERIC. https://files.eric.ed.gov/fulltext/ED084368.pdf
Kolowich, S. (2012, June 21). Conflicted: Faculty and online education, 2012. Inside Higher Ed. https://www.insidehighered.com/news/survey/conflicted-faculty-and-online-education-2012
Lehfeldt, E. A. (2018, October 3). What is your philosophy of higher education? Inside Higher Ed. https://www.insidehighered.com/advice/2018/10/03/administrators-should-prepare-philosophy-education-statement-when-they-apply-jobs
Lock, J., & Johnson, C. (2016). From assumptions to practice: Creating and supporting robust online collaborative learning. International Journal on E-Learning, 16, 47–66.
McAdams, C. R., III, Foster, V. A., & Ward, T. J. (2007). Remediation and dismissal policies in counselor education: Lessons learned from a challenge in federal court. Counselor Education and Supervision, 46, 212–229. https://doi.org/10.1002/j.1556-6978.2007.tb00026.x
McArdle, E. (2012, July 1). In the driver’s seat: The changing role of the general counsel. Harvard Law Bulletin. https://today.law.harvard.edu/feature/in-the-drivers-seat-the-changing-role-of-the-general-counsel
Meloy, A. (2014). Using your general counsel effectively. The Presidency, 17(2), 23–24.
Milman, N. B., Posey, L., Pintz, C., Wright, K., & Zhou, P. (2015). Online master’s students’ perceptions of institutional supports and resources: Initial survey results. Online Learning, 19(4), 45–66.
Minichiello, A. L. (2016). Towards alternative pathways: Nontraditional student success in a distance-delivered, undergraduate engineering transfer program [Doctoral dissertation, Utah State University]. Digital Commons @USU. https://digitalcommons.usu.edu/etd/4950
OnlineUniversities.com. (2013, February 11). Higher ed marketing secrets: The ingenious business of recruiting online students. https://www.onlineuniversities.com/blog/2013/02/higher-ed-marketing-secrets-the-ingenious-business-recruiting-online-students
Ortagus, J. C. (2017). From the periphery to prominence: An examination of the changing profile of online students in American higher education. The Internet and Higher Education, 32, 47–57.
Osborn, C. J. (2004). Seven salutary suggestions for counselor stamina. Journal of Counseling & Development, 82, 319–328. https://doi.org/10.1002/j.1556-6678.2004.tb00317.x
Palmer, P. J. (2007). The courage to teach: Exploring the inner landscape of a teacher’s life. Jossey-Bass.
Park, J. J., Yano, C. R., & Foley, N. F. (2019, March 27). What makes a fair college admissions process? JSTOR Daily. https://daily.jstor.org/what-makes-a-fair-college-admissions-process
Pucciarelli, F., & Kaplan, A. (2016). Competition and strategy in higher education: Managing complexity and uncertainty. Business Horizons, 59, 311–320. https://doi.org/10.1016/j.bushor.2016.01.003
Rosin, J. (2015). The necessity of counselor individuation for fostering reflective practice. Journal of Counseling & Development, 93, 88–95. https://doi.org/10.1002/j.1556-6676.2015.00184.x
Salazar-Márquez, R. (2017). Digital immigrants in distance education. International Review of Research in Open and Distributed Learning, 18, 231–242.
Shafer, M. S., Rhode, R., & Chong, J. (2004). Using distance education to promote the transfer of motivational interviewing skills among behavioral health professionals. Journal of Substance Abuse Treatment, 26, 141–148. https://doi.org/10.1016/S0740-5472(03)00167-3
Shaw, S. (2016, December 27). Practicing cultural humility. Counseling Today. American Counseling Association. https://ct.counseling.org/2016/12/practicing-cultural-humility
Sibley, K., & Whitaker, R. (2015, March 16). Engaging faculty in online education. Educause Review. https://er.educause.edu/articles/2015/3/engaging-faculty-in-online-education
Smith, D. F. (2014, May 22). Who is the average online college student? [Infographic]. EdTech: Focus on Higher Education. https://edtechmagazine.com/higher/article/2014/05/who-average-online-college-student-infographic
Snow, W. H., Lamar, M. R., Hinkle, J. S., & Speciale, M. (2018). Current practices in online counselor education. The Professional Counselor, 8, 131–145. https://doi.org/10.15241/whs.8.2.131
Suler, J. R. (2016). Psychology of the digital age: Humans become electric. Cambridge University Press.
Teaching Excellence in Adult Literacy Center. (2011). TEAL Center Fact Sheet No. 11: Adult Learning Theories. https://lincs.ed.gov/sites/default/files/11_%20TEAL_Adult_Learning_Theory.pdf
Trepal, H., Haberstroh, S., Duffey, T., & Evans, M. (2007). Considerations and strategies for teaching online counseling skills: Establishing relationships in cyberspace. Counselor Education and Supervision, 46, 266–279. https://doi.org/10.1002/j.1556-6978.2007.tb00031.x
Urofsky, R. I. (2013). The Council for Accreditation of Counseling and Related Educational Programs: Promoting quality in counselor education. Journal of Counseling & Development, 91, 6–14.
Wantz, R. A., Tromski, D. M., Mortsolf, C. J., Yoxtheimer, G., Brill, S., & Cole, A. (2003). Incorporating distance learning into counselor education programs: A research study. In J. W. Bloom & G. R. Walz (Eds.), Cybercounseling and cyberlearning: An encore (pp. 327–344). CAPS Press.
Watson, J. C. (2012). Online learning and the development of counseling self-efficacy beliefs. The Professional Counselor, 2, 143–151. https://doi.org/10.15241/jcw.2.2.143
Whitty, M. T., & Young, G. (Eds.). (2017). Cyberpsychology: The study of individuals, society and digital technologies. Wiley.
Yarbrough, J. R. (2018). Adapting adult learning theory to support innovative, advanced, online learning– WVMD Model. Research in Higher Education Journal, 35. http://aabri.com/manuscripts/182800.pdf
Savitri Dixon-Saxon, PhD, NCC, LPC, is Vice Provost at Walden University. Matthew R. Buckley, EdD, NCC, ACS, BC-TMH, LPC, LCMHC, is Senior Core Faculty at Walden University. Correspondence can be addressed to Savitri Dixon-Saxon, 100 Washington Ave. South, Suite 900, Minneapolis, MN 55401-2511, email@example.com.
Szu-Yu Chen, Cristen Wathen, Megan Speciale
This article focuses on the clinical training aspects of a distance counselor education program and highlights what clinical courses look like in an online synchronized classroom. Using three courses as examples, including group counseling, child and adolescent counseling, and practicum and internship, the authors share unique challenges they have encountered and solutions they have adopted when training distance students on counseling skills. The authors further discuss pedagogy, teaching strategies, and assessments that have been utilized to engage diverse distance learners in synchronized class meetings in order to maintain equivalent quality and learning outcomes with traditional clinical training methods. Finally, the authors provide recommendations for future research to increase and solidify the reality of distance clinical training in counselor education programs.
Keywords: online clinical training, distance counselor education, virtual environment, synchronized classroom, pedagogy
The rapid development of technology over the past decade has caused significant changes in higher education (Swanger, 2018). According to Allen et al. (2016), in 2015 over 6 million students participated in distance learning courses. Following these national trends, distance learning opportunities in counselor education have grown (Snow et al., 2018), delivery modes for distance counselor education programs have been developed, and attention to distance learning pedagogy has become a critical focus. At the same time, counselor educators have held the belief that counselor education, especially clinical skills training, should be learned and taught in person because of the intricacies related to developing rapport and the complexity of the counselor–client relationship (Benshoff & Gibbons, 2011). As the helping relationship is key to effective counseling (Layne & Hohenshil, 2005), providing clinical training via distance education can be a concern in regard to students’ learning experience and growth, and ultimately their ability to connect and work with clients.
Despite this caution, the Council for Accreditation of Counseling and Related Educational Programs (CACREP) accredited program models have begun to shift the perspective in the counselor education field. Alongside numerous pedagogies specific to the online format, the Association for Counselor Education and Supervision (ACES) Technology Interest Network (2017) has published its own guidelines for online learning, showing its support of this method of counselor training. Additionally, to date, CACREP has accredited a number of fully online counselor education programs, supporting the provision of quality counselor training despite an absence of in-person contact between faculty and students. However, scholarly research around best practices and effectiveness of distance counselor education has not substantially increased. Barrio Minton (2019) reported in a thematic analysis of counselor education and supervision articles published in 2017 that only 4% pertained to distance counselor education.
A benefit of distance learning counselor training programs is that students worldwide have an opportunity to pursue an accredited advanced degree in counseling in the United States. When programs approach this type of training with a culturally competent perspective, qualified faculty, and intentional pedagogy specific to distance learners, they not only allow the profession of counseling to grow nationally and globally, they provide opportunities for individuals whose life circumstances have created a barrier to pursuing a counseling degree. With this responsibility, counselor educators recognize that it is crucial to continuously explore challenges and benefits of facilitating clinical training within the realm of technology. It also is vital for counselor educators to continue examining ways to create safe and student-centered learning communities, maintain meaningful teacher–student relationships, and model counseling relationships and clinical skills in a virtual environment. Thus, research and instruction around sound distance learning pedagogy is imperative (Perry, 2017).
This article focuses on the clinical training aspects of a counselor training program and highlights what clinical courses look like in a remote synchronized classroom. We will share unique challenges and solutions we have encountered when training distance students on counseling skills in group counseling, child and adolescent counseling, and practicum and internship. We discuss pedagogy and teaching strategies that we have utilized to engage diverse distance learners in synchronized class meetings in order to maintain equivalent quality and learning outcomes with traditional counseling programs. Finally, because of a dearth of research concerning distance training in counselor education, this article provides research recommendations to increase and solidify the reality of distance counselor education training programs. In order to ethically provide quality training, counselor educators must know what works and what best practices in distance learning produce quality counselors. In fact, Barrio Minton (2019) argued that “scholarly attention to methods for and effectiveness of distance teaching and supervision is the most neglected area within counselor education and supervision” (p. 12). With the number of online programs increasing, this should no longer be the case.
Review of Clinical Training in Distance Education
The 2016 CACREP Standards (2015) emphasize clinical training regarding general and program-specific knowledge, skills, and practice. Specifically, counselors must have knowledge, skills, and practice in conducting clinical interviewing; diagnostic assessments; case conceptualization; and individual, group, and career counseling. Students are expected to demonstrate ethically, developmentally, and culturally appropriate strategies and techniques for building and maintaining face-to-face (F2F) and technology-assisted therapeutic relationships, as well as prevention and interventions regardless of the context of the training medium (CACREP, 2015).
Although distance learning is not a new phenomenon, online counselor education has been slow to progress. Currently, CACREP (2015) defines an online counseling program as one having 50% or more of the counseling curriculum offered via distance technology. As of 2019, the CACREP database indicated 55 CACREP-accredited institutions offering 72 online master’s degree programs, compared to five CACREP-accredited online counselor education programs in 2012. As the number of CACREP-accredited online programs continues to grow, online clinical training has become a controversial topic given the nature of therapeutic relationship-focused and skills-based education. According to Perry (2017), some major concerns include whether distance students obtain as much knowledge and are able to develop comparable counseling skills as students who attend F2F training programs. To date, limited literature focuses on online clinical training and few researchers have examined the efficacy of teaching counseling practice skills through online courses (Barrio Minton, 2019). There are few studies comparing online and F2F programs’ learning outcomes in counselor education. We consider this a particularly important area to explore given that counselor supervisors and educators must conduct counselor education and clinical training programs in an ethical manner whether in traditional, hybrid, or online formats (American Counseling Association, 2014).
Online Clinical Skills Training
Concerns about the ability to translate clinical skills in an online environment are prevalent among educators (Barrio Minton, 2019; Perry, 2017). There is little research to facilitate changed attitudes around this common mindset. Researchers have examined the efficacy of distance students’ clinical skills development in the mental health professions. Murdock et al. (2012) assessed students’ skill development learning outcomes between online and in-person counseling skills courses based on Ivey and Ivey’s (1999) counseling skills training textbook. Participants included 19 students enrolled online and 18 students enrolled in person. Students were taught by the same instructor and the courses were facilitated similarly. A counselor served as an independent evaluator and 15 transcripts of counseling skills sessions were randomly selected. Results showed no significant difference in basic counseling skills based on the mode of course delivery. Similarly, Murdock et al. (2012) and Ouellette et al. (2006) found no significant differences between online and F2F sections of an interviewing skills course for undergraduate social work students.
Wilke et al. (2016) conducted a quantitative study to compare master’s social work students’ development of clinical assessment and clinical skills of crisis intervention between 74 students enrolled in an in-person class and 78 students in an asynchronous online class. All student participants were taught by the same instructor and were given the same assignments, including an assessment and treatment plan of a fictional case and a digital role-play. The role-play assignment was graded by a doctoral student who was blinded to the course delivery format. The results showed that there was no significant difference for students’ skill development between F2F and online classes. Wilke and colleagues concluded that clinical skills seem to be taught as effectively online as in a traditional classroom within the context of the same instructor.
Bender and Dykeman (2016) explored students’ perceptions of supervision in both online and F2F contexts. Counseling faculty and doctoral students provided supervision to 17 F2F students and 12 synchronous online students. Supervision took place for 90 minutes each week in a 10-week period. A posttest assessment, the Group Supervisor Impact Scale (Getzelman, 2003), was given to all participants to measure supervisee satisfaction, self-efficacy, and the supervisory relationship. The results showed no significant differences in the students’ perceived perspective of supervision effectiveness between the online or traditional supervision students. These articles stand out as starting a base of evidence for the effectiveness of online clinical training in counselor education; however, much more qualitative and quantitative research is necessary regarding a multitude of educational aspects connected to CACREP standards to sufficiently evidence the quality of online clinical training.
Assessment and Evaluation of Online Clinical Training
Reicherzer and colleagues (2012) pointed out challenges for online and hybrid programs in observing and assessing students’ counseling skills and practice because of the potential limits of a distance learning environment. Various counselor educators described similar challenges in providing experiential clinical training in a remote learning community. For example, Snow and colleagues (2018) surveyed 31 online counselor educators to investigate the features of current online counseling programs and educators’ online teaching experience, including the challenges they encountered and the strategies they used to ensure students’ success. The results indicated that some of the major challenges related to clinical training included providing experiential clinical training to distance students and supporting quality practicum and internship experiences for distance students.
Reicherzer and colleagues (2012) recommended that instructors develop program-specific standards and use technology to gather multiple artifacts that measure student learning outcomes associated with knowledge and skills. It is important for the program to determine what learning components must be taught in residencies (Reicherzer et al., 2012). Snow and colleagues (2018) further noted that asynchronous online teaching might not be an effective method for modeling, observing, and assessing students’ interpersonal and counseling skills. However, synchronous videoconferencing technologies may provide distance students and educators the same opportunity to conduct skills demonstration, provide immediate feedback, and practice experiential activities, such as role-plays (Snow et al., 2018). Furthermore, it is critical to include skills-based activities throughout the program and ensure students meet necessary learning outcomes before they advance to clinical field experiences (Reicherzer et al., 2012).
To address an increasing trend of distance counselor education, the ACES Teaching Initiative Taskforce (2016) provided suggestions for delivering a high-quality online educational experience for counseling students. It is proposed that instructors’ presence and engagement with students are key to students’ online learning experience. Thus, Hall et al. (2010) postulated a humanistic practice in distance education. Specifically, the authors proposed that instead of heavily relying on technology, instructors should make efforts to foster teacher–student relationships at the beginning of the class and intentionally maintain relationships throughout the course delivery by considering students’ personal, social, and cultural needs. It seems that with advances in technology, embracing humanistic educational foundations can help to ensure the integrity of the counseling profession.
Challenges and Opportunities of Online Clinical Training
Some educators might consider the integration of technology in the counseling training program as an opportunity for continued development in the counseling profession. Yet, others might question the capability and success of online modalities in meeting learning outcomes and standards (Snow et al., 2018) and view it as a threat given that the profession emphasizes therapeutic relationships as the core of effective counseling (e.g., Layne & Hohenshil, 2005). This argument is founded on the assumption that technology cannot provide students with a productive learning experience compared to F2F experiences (Layne & Hohenshil, 2005). Additionally, some online counselor educators identified changing their teaching style to fit an online classroom to be a major challenge (Snow et al., 2018). As a result, many educators are seeking ways to effectively maintain a focus on interpersonal relationships within a technologically oriented teaching format for some professions, including counseling, that are practiced through personal contact (Hall et al., 2010; Lundberg, 2000).
We have perceived and experienced various challenges and opportunities when providing clinical training in a virtual learning environment. Koehler et al. (2004) indicated that to effectively develop online courses, there are three components that must dynamically interact with each other: content, pedagogy, and technology. When the instructor has expertise in the subject, has skill in teaching effectively in an online environment, and understands and effectively utilizes technology in dynamic ways, students report having a better learning experience. Although there is an increasing focus on general online pedagogy in counselor education, concrete and practical strategies for online clinical training are rarely discussed. Accordingly, we aim to illustrate strategies that counselor educators can consider integrating into various skill-based courses to accommodate diverse learning styles, provide supports for students’ learning, and deliver quality clinical training.
Fostering an Effective Learning Environment for Clinical Skills Training
The element of classroom safety is an important consideration in fostering an effective virtual environment for clinical skills training. Because role-plays and mock counseling assignments often include information that is sensitive in nature, it is essential that students maintain confidentiality during and after class meetings (ACES Technology Interest Network, 2017). Although attending class in a private location is preferred, students in synchronous settings may join the class from a variety of locations in which privacy cannot be guaranteed (e.g., coffee shops, shared living spaces, and libraries), so it is important to establish classroom guidelines that address classroom confidentiality. Example guidelines that ensure a safe and respectful online environment may include: (a) using headphones in class to prevent the accidental sharing of classmates’ private information, (b) limiting background noise, (c) ensuring there is proper lighting so the student’s face is illuminated, (d) closing all other open windows on the computer to increase focus, and (e) avoiding side conversations with other students or outside persons during class.
Synchronous Tools for Clinical Skills Training
With the expansion of technology, instructors have been able to apply numerous synchronized technological tools to enhance students’ engagement and benefit students’ clinical skills development in the virtual space. One of the features of many videoconferencing software programs is breakout rooms, which function similar to small group breakouts in traditional classrooms. With breakout rooms, instructors can assign students to small groups in a virtual classroom where students can conduct case discussions and role-plays. Instructors can join each small group remotely to facilitate observations and assessment of students’ clinical skills, as well as provide feedback on students’ discussion and questions. This allows students to receive individual feedback immediately and to incorporate recommendations into their practice simultaneously.
Online counseling practice systems are another opportunity that can benefit students’ practice of counseling skills in the online realm. Instructors can incorporate this technology tool into the curriculum for students to practice specific counseling skills, such as paraphrasing, reflection of feeling, and question asking. These platforms usually provide a variety of short video clips of diverse mock clients with different presenting issues. Instructors can set up different modules and assign students to practice different skills every week. Students can watch video clips and record their therapeutic responses to mock clients as many times as they deem necessary. After students submit their responses, instructors evaluate their responses online and provide feedback by recording their skills demonstration. Additionally, instructors play mock client video clips during the synchronized class meeting and demonstrate effective therapeutic techniques. These online practice systems also serve as an additional opportunity for students to practice counseling skills in a technology-assisted counseling setting and help them understand the potential of online counseling settings.
Assessment of Clinical Skills
Although synchronous videoconferencing platforms allow counselor educators an opportunity to observe students’ verbal and facial/nonverbal communication, assessment of the full range of counseling microskills involved with facilitating a therapeutic environment is limited. Qualities such as eye contact, body positioning, proximity, and other subtle nonverbals are important markers of students’ therapeutic stance (Lambie et al., 2018); however, there are significant challenges to observing these behaviors over synchronous video. Because of the variations in the placement of student webcams and computer monitors, eye contact and body nonverbals cannot be measured consistently, so educators attempt to capture this behavior using real-time role-plays in class, as well as pre-recorded role-plays of the student performing mock counseling with an outside acquaintance (e.g., friend, family member, or other student). Using multiple points of observation, educators can gain deeper insight into the student’s nonverbal abilities and have multiple opportunities to provide feedback.
As both verbal and nonverbal communication are central to the assessment of students’ conveyance of empathy and non-judgment, limited access of students’ therapeutic presence in a synchronous format also poses challenges to the observation of cultural competency. In a residential classroom, group dialogue provides a critical opportunity for educators to assess student comfort in discussing cultural topics, such as discrimination, power, and privilege (Sue et al., 2009). During these conversations in a synchronous online format, it is difficult to observe the microbehavior associated with discomfort and reactivity, especially in classes with larger enrollment, and students that are struggling with the conversation can elect to remain muted or turn off their camera. As such, educators may find it beneficial to divide the class into smaller breakout groups to facilitate increased student engagement and bolster students’ sense of safety in smaller group settings. In this format, educators are better able to observe when and why students become disengaged or triggered by the dialogue and then intervene accordingly.
Examples of Online Clinical Skills Training in Counseling Courses
The delivery model of distance counselor education at our institution consists of synchronous class meetings via videoconference software and asynchronous learning via a learning management system. Students are required to participate in the synchronized virtual classroom meeting weekly for 1.5 hours. Instructors asynchronously assign weekly readings, facilitate additional discussion board activities, and post video lectures or other video resources.
Students enrolled in the online program are required to attend a one-week intensive basic counseling skills course residentially prior to taking other skills-focused courses online, such as group and child and adolescent counseling. We provide examples of facilitating advanced counseling techniques training in a synchronized format. Specifically, we illustrate how to structure and assess students’ clinical competencies and utilize creative and ethical solutions in group, child and adolescent, and practicum and internship courses in a virtual learning community.
Group Counseling Skills Training
Group counseling is identified by CACREP (2015) as one of the eight core content areas required for all graduates of accredited counseling and related educational programs. It is unique in that, in addition to knowledge and skill learning outcomes, there also is a requirement that educators provide “direct experiences in which students participate as group members in a small group activity, approved by the program, for a minimum of 10 clock hours over the course of one academic term” (CACREP, 2015, p. 12). This experiential component distinguishes the group counseling course as a premier opportunity for clinical skills training; however, to date, there is little research attesting to educational best practices in synchronous online learning environments about group counseling. Thus, in the development of this course, the instructors supplemented the limited existing research with consultation of group work specialists, group counseling instructors, and counselor educators specializing in synchronous online education. Through these dialogues, the following 11-week course structure was established, which is generally revised with each course offering by incorporating student feedback, continued consultation, and updated research.
The required 10-week experiential component of group counseling in an 11-week online course can be achieved in a variety of ways. Common strategies include: (a) inviting external licensed group counselors (paid or volunteer) to facilitate a group counseling experience for students (without instructor observation), (b) implementing an instructor-led group counseling experience for students, (c) allowing students to serve as both group facilitators and group members in an alternating facilitation schedule (instructor-observed), and (d) requiring all students to locate and participate in an external group of their choosing (Merta et al., 1993; Shumaker et al., 2011). In consideration of the common challenges associated with an externally led and instructor-led group, including ethical concerns regarding potentially harmful dual relationships and problematic professional boundaries between students, as well as limitations imposed by the online training format, instructors chose to implement an alternating student-led structure for the experiential groups. A more thorough review of the benefits and limitations of each approach may be found in Shumaker et al. (2011).
At the beginning of the course, students are assigned to a small group ranging in membership from five to seven students each. Given the online setting, smaller groups may be more manageable for student facilitators and can give student members increased opportunities for engagement. Each group is responsible for determining a facilitation schedule for the 10 experiential groups in which students will choose the week(s) that they wish to lead the group. Students are directed to collaborate with group members to determine a specific focus of the group, falling within the realm of counseling professional development. The group meets in online breakout rooms for 60 minutes in each of the 10 weekly videoconferences. Periodically, instructors will incorporate a group reflecting team that will observe the group session live with their video and microphones off; record displayed group counseling skills, process, and content observations; and provide feedback for the group and group co-leaders based on the current lecture topics.
Because of the potential for dual relationships, the in-class experiential group is not intended to be a therapy group. The group is described as a process group in which members will discuss issues related to professional development, and students are urged to exercise caution and intentionality regarding the nature of their personal disclosure. Students are reminded that the group experience is an assignment for the course in which participation in the group will be evaluated. Cautions regarding the limits of confidentiality and privacy are highlighted and an online practice screening session and example of a group informed consent is utilized.
Clinical Training and Assessment
The clinical skill outcomes determined for this course were developed in line with the 2016 CACREP Standards and the Association for Specialists in Group Work’s Professional Standards for the Training of Group Workers (2000). Group counseling clinical skills are assessed through the instructors’ online observation of: (a) each student leading a group, (b) course role-plays based on working with group roles that clients often take on, and (c) the ability to identify clinical skills when observing the group as a reflecting team member. Finally, the synchronous nature of the online group counseling course allows for dispositional assessment of students, as inappropriate behaviors are discussed throughout the class and are integrated into the group rules by the course instructor. In addition, the group instructor can intervene through synchronous technology when necessary, as they are able to do so in the F2F group counseling classroom.
Challenges, Strengths, and Solutions
Challenges related to teaching group counseling online include facilitating a humanistic relationship between group members and instructors as well as among small group members in the online environment. Holmes and Kozlowski (2015) compared online counseling group courses with a small group component with a similar in-person group counseling course. The results showed that students assessed the in-person group counseling experience more positively than the online groups. This study signifies that there is more work to be done to improve the delivery of group counseling clinical training in online settings. A challenge that may contribute to this phenomenon is that students are often not trained on the nuances of noticing nonverbals in a videoconference setting. A second challenge is the variability in where students are located while doing group. Although students may be in a confidential setting, it might not be the most helpful setting to participate in a practice group session. For example, instructors have observed students in their cars, lying on their beds, sitting in a beauty salon, and having the television on while participating in group. Clear boundaries and expectations regarding the students’ background are vital, as contexts can be distracting for group members, group leaders, and for the individual. Technological difficulties also can impede the development of group rapport and trust as students’ screens can freeze during a discussion. Similarly, group leaders can have legitimate issues that make it difficult for them to be understood and communicate, and some students may be continuously logging on and off because of internet connection problems. Facilitating a discussion regarding thoughts and emotions around group technology issues is an effective way to normalize frustration and collaboratively brainstorm strategies to facilitate connection despite these realities.
There are, however, notable advantages to teaching group counseling online. These include the ability for the group supervisor to give immediate feedback to group leaders through online chat and video options. With consent, group sessions can be easily recorded for transcription assignments, supervision, real-time classroom discussion, and utilizing a reflecting team. Other supports and areas of importance include group rules about how students will utilize microphones. For instance, will they stay muted throughout the group until they want to share, or will everyone keep their microphones on so they feel freer to talk without having the extra step of turning on their microphone? Another consideration is whether to allow group members access to private chat abilities while in group. Instructors have experienced times when this has been distracting, as student group members may bring up unrelated topics while another person is sharing verbally. However, the chat function also can allow for increased support for individuals sharing, as group members can type in multiple responses. This can be a challenge for group co-leaders as they navigate both the group chat and group work occurring verbally.
Child and Adolescent Counseling Skills Training
Child and adolescent counseling is another clinical skill-focused course in which students are expected to understand and practice a variety of developmentally appropriate approaches to working with diverse youth. According to the 2016 CACREP Standards (2015), this course may assess students’ learning outcomes not only in areas of core content, but also in specialty areas, such as school counseling, clinical mental health counseling, and family counseling. Given the first author’s specialization in play therapy, she aims to provide opportunities for students to practice basic play therapy techniques and other age-appropriate modalities such as expressive arts activities. Therefore, this course is highly experiential.
When teaching play therapy skills in a virtual classroom, some unique challenges include students’ access to toys and art materials, space for play therapy demonstration and role-plays, and limited observations of nonverbal communication. Consequently, the following section focuses on how instructors adapt the virtual classroom environment to strive for maintaining quality clinical training and assessment in child and adolescent counseling competencies.
To develop child and adolescent counseling competencies, students are expected to practice various play therapy techniques and take turns as counselors and mock clients during weekly synchronized meetings. Over the 11-week class, the instructor usually begins the class with a group discussion about assigned readings and clinical session videos. The instructor also highlights some important materials and demonstrates specific play therapy skills during this time. After the instructor’s modeling, students usually practice skills in small breakout rooms for 40 minutes. The instructor observes students’ role-plays and provides live feedback in the breakout rooms. At the end of the class, the instructor brings students back to the large group to provide overall feedback and allow students to process their role-play experience.
Clinical Training and Assessment
The instructor utilizes multiple assessments to observe students’ development of child and adolescent counseling skills. Course assignments designed to measure clinical skills outcomes include: (a) in-class participation evaluations based on the student’s level of engagement in the role-plays and case discussions and (b) a recorded play or activity session with a child or adolescent with a session critique. One of the major clinical skills assignments is for students to facilitate a 30-minute play session with a child or an activity session with an adolescent depending on the student’s preferred working population. Students are recommended to find friends’ and relatives’ children for this role-play assignment. Students can also use their own children if they feel comfortable with this option. Students are expected to record the session and provide critiques and personal reflection for their session. This assignment allows students to practice their play therapy skills and language with an actual child or adolescent outside of the classroom and, most importantly, to experience the relationship-building process with a child or adolescent.
Students’ child and adolescent counseling clinical skills are assessed through the instructor’s observation of students’ ability to communicate with children or adolescents through developmentally and culturally appropriate interventions and therapeutic responses. The instructor also assesses students’ knowledge and competencies in areas of ethics, diagnosis, treatment planning, caregiver and teacher consultations, and advocacy. The weekly synchronized meeting also allows the instructor to conduct disposition assessments of students, including how students receive constructive feedback from the instructor and peers.
Challenges, Strengths, and Solutions
Normally, online instructors are likely to sit in front of a web camera to facilitate the class activities or skills demonstration. However, when working with child clients in a playroom setting, counselors must move around to follow child clients’ play and attend to their play behavior and nonverbal communication. When facilitating creative arts activities with preadolescents or adolescents, counselors sometimes need more space for the activity and need to focus on the client’s process of creation, which involves critical observations of nonverbal communication.
In consideration of these challenges of toys and space, instructors can consider some creative strategies. For instance, when demonstrating skills, the instructor can set up a corner of the room with purposefully selected toys and ensure the camera captures a wide angle of the room so that students are able to observe the instructor’s verbal and nonverbal therapeutic skills. To have students personally experience the power of play and creative arts activities, instructors can facilitate activities involving basic art materials, such as colored pencils and markers, that students have easy access to in their settings. Instructors also encourage students to use any objects that are accessible to students and to be spontaneous when role-playing therapy skills so that students can experience children’s creativity. Students are encouraged to adjust their camera so that their peers can better observe their play behavior and body language during the role-plays.
Although instructors demonstrate various therapeutic responses, it is important to acknowledge the limits of demonstration and role-play experience because of the online environment. It is also imperative to consider ethical issues when assessing students’ clinical skills. For example, when students conduct a play or activity session assignment, instructors need to provide clear guidelines for the purpose of the assignment in that students are not providing therapy for children; instead, students are practicing therapeutic play skills and language. Instructors also want to provide informed consent information for the child’s guardians, including video and audio recording for this assignment and that only the instructor will review the session for the training purpose. Last, instructors want to ensure the privacy of all video materials; therefore, it is recommended that students record videos using HIPAA-compliant software programs and submit them using course platforms.
Online Clinical Skills Training in Practicum and Internship
A major portion of clinical training in a counseling program is group supervision of practicum and internship courses. Although students are most often working F2F with their clients and on-site supervisors, the group supervision experience for distance students takes place in a synchronous format, meeting HIPAA and confidentiality requirements legally and ethically. Jencius and Baltrinic (2016) highlighted the ethical imperative of online supervision competence when faculty are assigned to teach the practicum and internship courses. According to CACREP (2015), practicum and internship group supervision students must meet on average for 1.5 hours per week of group supervision at a 1:12 faculty to student ratio, and qualified supervisors with relevant experience, professional credentials, and counselor supervision training must be a part of the counseling faculty or a student under the supervision of a counseling faculty. While in these courses, counseling students accumulate at least 700 clinical hours, of which 280 must be direct client contact. Through these courses, CACREP standards are met, student learning outcomes assessed, and strengths and challenges are experienced. Following best practices in online learning and CACREP standards, the following online practicum and internship course was designed.
The courses are designed to evaluate basic clinical skills, facilitate theory-based clinical insights, and advance students’ clinical skills through role-plays, case presentations, course discussions, readings, reflective assignments, and experiential activities. Online courses take place once a week for 1.5 hours during an 11-week quarter. In class, students review and present actual video or audio recordings (if allowed by the practicum and internship site) of clinical work, participate in giving feedback to other students in the course, participate in reflecting teams, and follow ethical and legal considerations for client confidentiality. Weekly, students present a client case presentation based on sessions from their practicum or internship site following a specific outline. If a site allows video presentations of clients, a 5–10-minute clip of a session is presented (with the client’s consent). Students receive feedback from their peers as well as the group supervisor. In the online practicum or internship course, consent is necessary from the site regarding how video and supervision are handled in the online format. It is imperative that a HIPAA-compliant mode of course delivery is utilized for the weekly class meeting and that students presenting videos and cases are instructed on specific expectations of recording, storing, and transferring their video clips and client information that protects their clients’ confidentiality. For example, it would not be appropriate for a student to record, store, and then upload a client session on their cellular phone without proper security compliance in place. At our institution, the ability to utilize the course delivery modality to record sessions is helpful as it provides a HIPAA-compliant way to record and store session clips.
Clinical Training and Assessment
It is important to note that for practicum and internship courses, the structure, expectations, and assessment of students do not differ substantially from the traditional class. Students in practicum and internship meet the CACREP standards the program has identified for these courses through the Counseling Competencies Scale-Revised (Lambie et al., 2018), whereby instructors and students evaluate and discuss their ratings together through reflective assignments, role-plays, class discussion, and the client case presentation. Group supervisors also are able to monitor students on their dispositions as they participate in giving feedback to their peers, discuss ethical dilemmas and other issues that come up for students during the practicum experience, assess their case presentation and response to peer and supervisor feedback, and review reflective assignments such as journaling or self-care plans.
Challenges, Supports, and Solutions
Challenges for teaching practicum and internship courses online include discussing informed consent with clients, practicum and internship sites’ buy-in and understanding of how the course works in an online format, the technology limitations of the instructors and students, and technology difficulties that might be encountered during discussions and class presentations. Also, as supervising instructors are rarely in the same location as students in a distance course, there are challenges in knowing and understanding the context of a variety of cultures, regions, and contexts. Legal issues, licensure requirements, and site requirements differ from state to state and can be challenging to navigate. The practicum and internship supervisor also can be in a different time zone from the site supervision, which can make coordinating meetings difficult. Finally, as group supervision is a type of group, there are many similarities with the challenges of teaching group clinical skills (e.g., making sure students are in a confidential location where no one else can see or hear video clips or class discussions regarding clients). Instructors must be clear about the seriousness of violating confidentiality and the expectations they have for the course. Additionally, it can be difficult to give and receive constructive feedback in a setting where nonverbals are more challenging to see and experience. Instructors must work to build rapport and trust and openly discuss with the class the strengths and weaknesses of technology regarding their supervision experience.
Strengths of online practicum and internship delivery include opportunities to develop cultural competency as students from different areas, regions, states, and even countries discuss client cases from their context. Instructors can utilize the chat options of the online format to ask questions while video clips are being shared or point out particulars without stopping the video. Potentially, client information does not have to be transferred as many places when students do not have to come to campus, versus students having client information go from their site, to their home, to their university setting, and back. Also, students are able to have more flexibility in choosing a site that is not region-bound. The availability of this format can be helpful to many sites and ultimately to clients who might not be located near a university with a counselor education program and who would benefit from having practicum and internship students working with them. It also provides opportunities for students that might not otherwise be able to complete a practicum or internship to enroll in a program and successfully complete it without needing to move and leave family or work obligations. With proper training of instructors, clear expectations for students, and legally and ethically appropriate technology, the practicum and internship course in an online format can be an effective modality for counseling students.
Discussion and Recommendations for Future Research
This article has overviewed the current literature regarding master’s-level online clinical training, provided a reference for challenges and opportunities regarding online pedagogy in counselor education courses, and described examples of online clinical course structures. When facilitating online clinical training, instructors must understand the unique nature of counseling and be intentional about maintaining student relationships within the realm of technology. This is especially critical for ensuring that the program strategically integrates the technology to advance the delivery of the program rather than the program heavily relying on the use of technology. In this article, we have identified humanistic approaches and specific strategies to ensure that meaningful teacher–student relationships and rigorous assessments remain the focus of instruction when technology is integrated. Facilitating personal and professional growth in distance counselor education presents many challenges to students and instructors. If instructors can intentionally and creatively use technology to promote distance students’ learning and training, a distance delivery format can reach students who would not have the opportunity to pursue counselor education.
Currently, the online delivery of counselor training skills is outpacing foundational research literature. For attitudes and pedagogy to change around the online academic environment, more research is needed. Future research could best focus on comparing the outcome of students’ counseling skills, including multicultural counseling competencies, between traditional and online courses. Skills needed for building rapport in the online environment may differ from F2F settings. Therefore, research regarding how the instructors’ and students’ use of language online impact the helping relationship and teacher–student relationship in virtual classrooms can be valuable. There also is a need to explore counselor educators’ understanding and experiences in conducting online clinical training, as well as students’ perspectives in receiving online clinical training and supervision. Future studies also might investigate different course structures and delivery methods for specific clinical skills courses so that the best methods for online clinical training could be applied by more counselor education programs.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
Allen, I. E., Seaman, J., Poulin, R., & Straut, T. T. (2016). Online report card: Tracking online education in the United States. https://onlinelearningsurvey.com/reports/onlinereportcard.pdf
American Counseling Association. (2014). 2014 ACA code of ethics.
Association for Specialists in Group Work. (2000). Professional standards for the training of group workers.
Association of Counselor Education and Supervision Teaching Initiative Taskforce. (2016). Best practices in teaching in counselor education report. https://acesonline.net/wp-content/uploads/2018/11/ACES-Teaching-Initiative-Taskforce-Final-Report-2016.pdf
Association of Counselor Education and Supervision Technology Interest Network. (2017). ACES guidelines for online learning in counselor education. https://acesonline.net/knowledge-base/aces-guidelines-for-online-learning-2017-2
Barrio Minton, C. A. (2019). Counselor Education and Supervision: 2017 inaugural review. Counselor Education and Supervision, 58, 4–17. https://doi.org/10.1002/ceas.12120
Bender, S., & Dykeman, C. (2016). Supervisees’ perceptions of effective supervision: A comparison of fully synchronous cybersupervision to traditional methods. Journal of Technology in Human Services, 34, 326–337. https://doi.org/10.1080/15228835.2016.1250026
Benshoff, J. M., & Gibbons, M. M. (2011). Bringing life to e-learning: Incorporating a synchronous approach to online teaching in counselor education. The Professional Counselor, 1, 21–28.
Council for Accreditation of Counseling and Related Educational Programs. (2015). 2016 CACREP standards. http://www.cacrep.org/wp-content/uploads/2017/08/2016-Standards-with-citations.pdf
Getzelman, M. A. (2003). Development and validation of the Group Supervision Impact Scale [Doctoral dissertation, University of Southern California]. USC Digital Library. http://digitallibrary.usc.edu/cdm/ref/collection/p15799coll3/id/493832
Hall, B. S., Nielsen, R. C., Nelson, J. R., & Buchholz, C. E. (2010). A humanistic framework for distance education. Journal of Humanistic Counseling, Education and Development, 49, 45–57.
Holmes, C. M., & Kozlowski, K. A. (2015). A preliminary comparison of online and face-to-face process groups. Journal of Technology in Human Services, 33, 241–262. https://doi.org/10.1080/15228835.2015.1038376
Ivey, A. E., & Ivey, M. B. (1999). Intentional interviewing and counseling: Facilitating client development in a multicultural society (4th ed.). Brooks/Cole.
Jencius, M., & Baltrinic, E. R. (2016). Training counselors to provide online supervision. In T. Rousmaniere & E. Renfro-Michel (Eds.), Using technology to enhance clinical supervision (pp. 251–268). American Counseling Association.
Koehler, M. J., Mishra, P., Hershey, K., & Peruski, L. (2004). With a little help from your students: A new model for faculty development and online course design. Journal of Technology and Teacher Education, 12, 25–55.
Lambie, G. W., Mullen, P. R., Swank, J. M., & Blount, A. (2018). The Counseling Competencies Scale: Validation and refinement. Measurement and Evaluation in Counseling and Development, 51, 1–15. https://doi.org/10.1080/07481756.2017.1358964
Layne, C. M., & Hohenshil, T. H. (2005). High tech counseling: Revisited. Journal of Counseling & Development, 83, 222–226. https://doi.org/10.1002/j.1556-6678.2005.tb00599.x
Lundberg, D. J. (2000). Integrating on-line technology into counseling curricula: Emerging humanistic factors. Journal of Humanistic Counseling, Education and Development, 38, 142–151.
Merta, R. J., Wolfgang, L., & McNeil, K. (1993). Five models for using the experiential group in the preparation of group counselors. The Journal for Specialists in Group Work, 18, 200–207.
Murdock, J., Williams, A., Becker, K., Bruce, M., & Young, S. (2012). Online versus on-campus: A comparison study of counseling skills courses. The Journal of Human Resource and Adult Learning, 8, 105–118.
Ouellette, P. M., Westhuis, D., Marshall, E., & Chang, V. (2006). The acquisition of social work interviewing skills in a web-based and classroom instructional environment: Results of a study. Journal of Technology in Human Services, 24(4), 53–75. https://doi.org/10.1300/J017v24n04_04
Perry, E. (2017). Counselor education unplugged? An exploration of current attitudes surrounding the use of online learning as a modality in graduate counselor education [Doctoral dissertation, Duquesne University]. Duquesne Scholarship Collection. https://dsc.duq.edu/cgi/viewcontent.cgi?article=1142&context=etd
Reicherzer, S., Coker, K., Rush-Wilson, T., Buckley, M., Cannon, K., Harris, S., & Jorissen, S. (2012). Assessing clinical mental health counseling skills and practice standards in distance education. Counseling Outcome Research and Evaluation, 3(2), 104–115. https://doi.org/10.1177/2150137812452558
Shumaker, D., Ortiz, C., & Brenninkmeyer, L. (2011). Revisiting experiential group training in counselor education: A survey of master’s-level programs. The Journal for Specialists in Group Work, 36(2), 111–128. https://doi.org/10.1080/01933922.2011.562742
Snow, W. H., Lamar, M. R., Hinkle, J. S., & Speciale, M. (2018). Current practices in online counselor education. The Professional Counselor, 8, 131–145. https://doi.org/10.15241/whs.8.2.131
Swanger, D. (2018). The future of higher education in the U.S.: Issues facing colleges and their impacts on campus. https://www.fmcc.edu/about/files/2018/08/The-Future-of-Higher-Education-in-the-US2.pdf
Sue, D. W., Lin, A. I., Torino, G. C., Capodilupo, C. M., & Rivera, D. P. (2009). Racial microaggressions and difficult dialogues on race in the classroom. Cultural Diversity & Ethnic Minority Psychology, 15, 183–190. https://doi.org/10.1037/a0014191
Wilke, D. J., King, E., Ashmore, M., & Stanley, C. (2016). Can clinical skills be taught online?
Comparing skill development between online and F2F students using a blinded review. Journal
of Social Work Education, 52, 484–492. https://doi.org/10.1080/10437797.2016.1215276
Szu-Yu Chen, PhD, NCC, LPC, RPT, is an assistant professor at Palo Alto University. Cristen Wathen, PhD, NCC, LCPC, is a core faculty member at Palo Alto University. Megan Speciale, PhD, NCC, LMHC, is an assistant professor at Palo Alto University. Correspondence can be addressed to Szu-Yu Chen, 1791 Arastradero Rd., Palo Alto, CA 94304, firstname.lastname@example.org.