An Examination of Counselors’ Religiosity, Spirituality, and Lesbian-, Gay-, and Bisexual- Affirmative Counselor Competence

May 26, 2017 | Volume 7 - Issue 2

Laura Boyd Farmer

Counselors in school and community settings, counselor educators and counseling students (N = 453) participated in a study of self-perceived competence to serve lesbian, gay and bisexual (LGB) clients. Using the same large data set as Farmer, Welfare, and Burge (2013), the author examined different research questions focused on counselor religiosity and spirituality. Through multiple regression analysis, the following variables predicted LGB-affirmative counseling competence: counselors’ self-identified religiosity, spirituality, education, number of LGB clients counseled and LGB interpersonal contact. Spirituality had a positive relationship with competence, whereas religiosity was negatively related. Further exploration of the intersection of counselor religiosity and spirituality as it relates to LGB-affirmative counseling is warranted.

Keywords: LGB, lesbian, gay, bisexual, religiosity, spirituality, counselor competence

Lesbian-, gay- and bisexual- (LGB-) affirmative counseling encompasses a broad base of knowledge, awareness of attitudes, and skills that affirm and honor the lived experiences of sexual orientation diverse individuals, representing the ethical standard of care for all non-heterosexual clients (Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling, 2012; Israel & Selvidge, 2003). Whitman and Bidell (2014) defined LGB-affirmative counseling as “a practice that adopts a science-based perspective of LGB sexual (or affectional) orientations as normal and healthy expressions of human development, sexuality, relationship, and love” (p. 164). In the last decade, the issue of providing competent, affirming care to clients who identify as lesbian, gay and bisexual (LGB) has risen to the forefront of professional dialogue for counselors. Two legal cases (Keeton v. Anderson-Wiley, 2011; Ward v. Polite, 2012) inspired meaningful discussion about the intersection of counselors’ religious and spiritual values and ethical counseling practices when working with sexual orientation diverse clients. The American Counseling Association (ACA) Code of Ethics (2014) mandates that counselors attend to value conflicts while working with clients to avoid the potentially harmful imposition of personal values (Kaplan, 2014). Still, some counselors are left with the task of integrating conflicting religious values with competent and affirming counseling practices with LGB clients (Herlihy, Hermann, & Greden, 2014; Robertson & Avent, 2016).

The political and social landscape surrounding LGB issues in the United States is in a state of flux. While the historic Obergefell v. Hodges (2015) decision established marriage equality for same-sex couples nationally, there have been conflicting influences on affirmative care. Conscience clause legislation, intended to protect mental health practitioners who deny services based on their own “sincerely held principles” (TN HB1840, 2016), has emerged in several states (e.g., Mississippi, Tennessee) as a response to the revised ACA Code of Ethics (2014). Conversion therapy or reparative therapy remains legal in 45 states despite being discredited and ethically opposed by all major mental health professions, including the ACA (American Psychological Association, 2017; Whitman, Glosoff, Kocet, & Tarvydas, 2013). Specifically, those ascribing to some religious affiliations assume a moral stance against non-heterosexual partnerships which is often rooted in narrow scriptural interpretations and traditional views on what constitutes a marriage (Lalich & McLaren, 2010). Smith and Okech (2016a) further probed professional discourse through their investigation of the Council for Accreditation of Counseling and Related Educational Programs (CACREP) accreditation status of counseling programs housed within religious institutions that disaffirm or disallow diverse sexual orientations, initiating an exchange of dialogue in the Journal of Counseling & Development (Sells & Hagedorn, 2016; Smith & Okech, 2016b). These authors highlighted incongruencies between the policies and philosophical statements of religiously affiliated institutions and the values espoused by the ACA Code of Ethics. In light of these prominent events and professional dialogue, counselors’ religious beliefs, as they relate to working with LGB clients, have received greater attention (Balkin, Watts, & Ali, 2014; Kaplan, 2014; Whitman & Bidell, 2014).

Spirituality, much like religion, is another complex facet of identity that contributes to counselor values. Although it has been established that counselors’ conservative religious beliefs may impact LGB-affirmative counseling (Balkin et al., 2014; Bidell, 2014), the impact of counselors’ spirituality is less understood. To date, no studies have investigated counselor religiosity and spirituality as potentially different aspects of identity that may relate to LGB-affirmative counselor competence, nor has the religious affiliation of counselors been explored. Therefore, the researcher sought to examine counselors’ self-identified religiosity and spirituality, as they relate to LGB-affirmative counseling competence.

The author conducted a large study of LGB-affirmative counselor competence that found school counselors perceived themselves as having lower competence to serve LGB clients than community-based counselors (Farmer, Welfare, & Burge, 2013). Using the same data set, the lead author has examined several new variables for the current study, including counselors’ self-identified religiosity, spirituality, education level, experience counseling LGB clients and LGB interpersonal contact. By examining these variables, new information is offered to the current professional discourse about the relevance of counselors’ religious and spiritual beliefs when counseling LGB clients.

Defining Religiosity and Spirituality

There are diverse opinions regarding definitions of religiosity and spirituality (Zinnbauer, Pargament, & Scott, 1999). The inconsistency in definitions creates a complex problem for researchers of religiosity and spirituality because it is difficult to know what meaning participants attribute to these terms (Zinnbauer et al., 1997). Although religiosity and spirituality have been shown to coincide for some, they are distinctly separate aspects of identity for others (Pargament, Sullivan, Balzer, Van Haitsma, & Raymark, 1995).

Religiosity has been broadly defined as the degree to which individuals subscribe to institution-alized beliefs or doctrines (Vaughan, 1991). Among basic methods of measuring religiosity is the indication of whether or not one identifies with a religious affiliation (Clark & Schellenberg, 2006). The frequency of service attendance and engagement in religious behaviors (e.g., prayer, scripture reading) are other methods of measuring religiosity (Lippman, Michelsen, & Roehlekepartain, 2005; Piedmont, 2001; Whitley, 2009). Self-ratings of religiosity are widely used that involve asking people to identify the importance of religion in their lives (Rainey & Trusty, 2007; Whitley, 2009). Chatters, Levin, and Taylor (1992) proposed a 3-dimensional model of religiosity that included organizational involvement (formal church attendance), nonorganizational involvement (informal activities such as prayer or scriptural study at home), and subjective religiosity (personal beliefs, attitudes and perceived importance of religion in one’s life). Aligning with these models, religiosity is understood in the current study as the degree of importance of religion in one’s life; frequency of service attendance and religious behavior (e.g., prayer, scriptural reading); and identification with a religious affiliation.

Alternately, spirituality is considered to be unique to individuals’ life experience and interpretation (Pargament, 2013). Spirituality is broadly described as an individual’s internal orientation toward a greater transcendent reality that joins “all things into a more unitive harmony” (Piedmont, 1999, p. 988). To develop a definition of spirituality, a “Summit of Spirituality” included 15 ACA members with representatives from a cross-section of ACA divisions who began the process of forming the counseling profession’s Spiritual Competencies (Association for Spiritual, Ethical, and Religious Values in Counseling, 2013). The summit resulted in the following description:

Spirituality is a capacity and tendency that is innate and unique to all persons. The spiritual tendency moves the individual toward knowledge, love, meaning, peace, hope, transcendence, connectedness, compassion, wellness, and wholeness. Spirituality includes one’s capacity for creativity, growth, and the development of a value system. (“Summit Results,” 1995, p. 30)

Pargament claimed “spirituality is the core function of religion” (2013, p. 271). In other words, people become involved in religion as a way to connect to the sacred and support their spirituality. Therefore, spirituality is a distinct motivation and human process that may exist apart from religion (Pargament, 2013). The current study is grounded in this understanding by examining counselors’ religious and spiritual identities as separate constructs (Pargament et al., 1995).

Counselors and Religiosity

Within studies of LGB-affirmative counselor competence, several factors have been shown to

negatively influence counselor competence, such as religiosity, church attendance, political conservatism, and heterosexism (Balkin, Schlosser, & Levitt, 2009; Bidell, 2014; Rainey & Trusty, 2007; Satcher & Schumacker, 2009). Scholars have postulated that the way scriptural references are interpreted may account for this negative influence, specifically interpretations that deem non-heterosexual behavior as immoral and socially deviant (Altemeyer, 2003; Poteat & Mereish, 2012; Whitley, 2009). Alternate views on scriptural references such as these include an understanding of cultural context, analysis of contradictory messages, and consideration of the human lens through which scripture was written (Dewey, Schlosser, Kinney, & Burkard, 2014; Friedman, 2001).

Bidell (2014) explored religious conservatism as it relates to counselor competence with LGB clients in a study of 228 counseling students, counselor educators and counseling supervisors in university settings. Religious conservatism was defined as religious fundamentalism, or “the belief that there is one set of religious teachings that clearly contain the . . . inerrant truth about humanity and deity” (Altemeyer & Hunsberger, 1992, p. 118). Religious conservatism was a significant negative predictor of LGB-affirmative counselor competence (β = -.532), whereas LGB interpersonal contact (β = .299) and LGB-specific training (β = .143) were positive predictors. In the analysis of the Sexual Orientation Counselor Competency Scale (SOCCS) subscales for attitudinal awareness, knowledge and skill, Bidell (2014) found that the attitudinal awareness and skill subscales were significantly related to religious conservatism, whereas knowledge was not. Implications suggest that counselors are influenced by conservative religious beliefs and attitudes toward LGB individuals.

More evidence has emerged concerning counselor religiosity and prejudice toward LGB individuals. Higher frequency of church attendance was a significant predictor of counselors’ negative attitudes toward LGB individuals (Satcher & Schumacker, 2009). Counselors who have more rigid and authoritarian orientations of religious identity exhibit more LGB prejudice (Balkin et al., 2009; Bidell, 2014; Sanabria, 2012). In light of these findings, more scholarly attention is focusing on ways to support “religiously conservative” counselors through the process of negotiating values conflicts (Choudhuri & Kraus, 2014; Fallon et al., 2013; Robertson & Avent, 2016; Whitman & Bidell, 2014).

Counselors and Spirituality

Ample research combines religion and spirituality, assuming these are synonymous aspects of identity or sources of values. However, some key studies have focused on the distinct contributions of spirituality in counselor development. Morrison and Borgen (2010) examined counselor empathy as it relates to and is influenced by counselor spirituality. Using the critical incident technique, 12 counselors with Christian beliefs identified 242 incidents where their spirituality helped their empathy toward clients and 25 incidents where their spirituality hindered empathy. Helping categories included counselors’ empathic connection with clients, the ability to draw on values of compassion and acceptance, and understanding other cultures. Hindering categories included experiences in which the client’s actions were contrary to the counselor’s belief system and having limited empathy due to counselor biases. Implications highlight the important role of spirituality in counselors’ felt empathy as well as the need for counselor training programs to create space for personal reflection on spiritual beliefs.

In a quantitative study, Saslow et al. (2013) sought to clarify meaning in the relationship between counselor spirituality and compassion while controlling for religiosity. Using an online sample from Amazon’s Mechanical Turk (n = 149), a nationally representative sample (n = 3,481), and a college undergraduate sample (n = 118), the authors measured global religiosity and spirituality, religious and spiritual practices, religious fundamentalism, self-transcendence, spiritual identity, questing orientation, global positive affect, dispositional compassion, awe, and love. Using principal components analysis, religiosity and spirituality loaded as distinct factors. Spirituality significantly predicted compassion after controlling for religiosity and positive affect. Alternately, religiosity was not a significant predictor of compassion while controlling for spirituality. Implications suggest compassion is central to spirituality.

Although researchers have focused on the relevance of client spirituality in the counseling process (Cashwell & Young, 2011; Parker, 2011), empirical studies investigating the impact of counselor spirituality are lacking. To date, no studies have examined the relationship between counselors’ self-identified spirituality, as differentiated from religiosity, and LGB-affirmative counselor competence. Therefore, the study was guided by the following research questions:

1) What are the relationships between counselors’ (a) self-identified religiosity, (b) self-identified spirituality, (c) education level, (d) counseling experience with LGB clients, (e) LGB interpersonal contact, and (f) LGB-affirmative counselor competence?

2) How do the variables of (a) self-identified religiosity, (b) self-identified spirituality,
(c) education level, (d) counseling experience with LGB clients, and (e) LGB interpersonal contact predict LGB-affirmative counselor competence?

3) Are there differences in counselors’ (a) self-identified religiosity, (b) self-identified spirituality, and (c) LGB-affirmative counselor competence among religious affiliation groups?

The author hypothesized that higher levels of self-identified religiosity would predict lower LGB-affirmative counselor competence, as established in Bidell’s previous study (2014). The author also hypothesized that all variables assessed would help explain the variance in counselors’ LGB-affirmative counselor competence.

Method

Procedure

The author used the same data set reported in Farmer et al. (2013) using different research questions and examining five new variables. The sample (N = 1,480) consisted of members of a state-level professional counseling association located in the Southeastern United States, including licensed professional counselors, professional school counselors, counselors-in-residence (post-master’s counselors working toward licensure), counseling graduate students and counselor educators. The researcher secured approval from the Institutional Review Board, obtained participant information from the state organization’s membership directory, and sent a recruitment e-mail inviting participation in the anonymous online survey using SurveyMonkey. Two reminder e-mails were sent at five and 10 days after initial contact. There were 556 respondents, yielding a response rate of 37.5%. The final sample included 453 participants following data-cleaning procedures and eliminating those respondents whose practice setting could not be verified.

Participants

Of the 453 participants, 212 (46.8%) described their primary practice setting as school, 110 (24.3%) described their practice setting as community, 93 (20.5%) were described as counseling graduate students, and 38 (8.4%) were counselor educators. Participants’ ages ranged from 22 to 75 years, with an average age of 41.5 years (SD = 13.5). Seventy-three participants (16.1%) identified as men and 379 (83.7%) identified as women (one participant omitted this item). With regard to race, 376 participants (83.0%) identified as Caucasian, 55 (12.1%) as African American, eight (1.8%) as Hispanic, eight (1.8%)

as multiracial or other, three (0.7%) as American Indian, one (0.2%) as Asian, and one (0.2%) as Hawaiian or Pacific Islander (one participant omitted this item). Regarding sexual orientation, 425 participants (93.8%) identified as heterosexual, seven (1.5%) as lesbian, five (1.1%) as gay, five (1.1%) as bisexual, one (0.2%) as questioning, and four (0.9%) as other (six participants omitted this item). Participants were also asked to identify their religious affiliation (e.g., Protestant Christian, Catholic, Other Religious Affiliation, No Religious Affiliation). Table 1 displays descriptive data on religious affiliation and SOCCS scores.

Instruments

Two instruments and an information questionnaire were used to collect data. The SOCCS (Bidell, 2005) was used to assess LGB-affirmative counselor competence. The Marlowe-Crowne Social Desirability Scale—Short Form C (MC-C; Reynolds, 1982) assessed the authenticity of participant responses. An information questionnaire gathered demographic and personal background information, including items for counselors to indicate self-identified religiosity and spirituality.

Sexual Orientation Counselor Competency Scale. This instrument measures participants’ self-perceptions of LGB-affirmative counseling competence including attitudes, knowledge and skills (Bidell, 2005). The SOCCS contains 29 items that are rated on a 1–7 scale (1 = not at all true, 7 = totally true). Ten items measure attitudes (e.g., “The lifestyle of an LGB client is unnatural or immoral”), eight items measure knowledge (e.g., “There are different psychological/social issues impacting gay men versus lesbian women”), and 11 items measure skill (e.g., “I feel competent to assess the mental health needs of a person who is LGB in a therapeutic setting”). Convergent validity was established for each of the three subscales (attitudinal awareness, knowledge and skill) using existing measures of LGB bias, multicultural knowledge and basic counseling skills, respectively. Bidell (2005) reported strong internal consistency for the SOCCS: .90 for the overall score, .76 for Knowledge, .88 for Attitudes, and .91 for Skill. In this sample (N = 453), the coefficient alphas are reasonably comparable: .87 for the overall score, .72 for Knowledge, .87 for Attitudes, and .87 for Skill.

Table 1

Mean Values for SOCCS Total and Subscales by Religious Affiliation

Group	N	M	Attitudes	Knowledge	Skill
Protestant Christian	237	4.51	6.17	4.04	3.34
Assembly of God	1
Baptist	36
Brethren	4
Christian	82
Church of Christ	1
Disciples of Christ	4
Episcopal	17
Lutheran	9
Mennonite	3
Methodist	48
Morman	2
Non-Denominational	12
Pentecostal	1
Presbyterian	17
Catholic	88	4.70	6.51	4.22	3.41
Roman Catholic	87
Byzantine Catholic	1
Other Religious Affiliation	29	5.25	6.85	4.69	4.19
Buddhist	4
Jewish	9
Native American	1
Religious Soc. Friends	5
Taoist	1
Unitarian	9
No Religious Affiliation	99	4.95	6.74	4.43	3.70
None identified	93
Agnostic	5
Atheist	1

Total	453	4.69	6.41	4.20	3.49

Marlowe-Crowne Social Desirability Scale—Short Form C (MC-C). This 13-item self-report instrument measures participants’ tendency to answer questions to portray oneself in favorable ways (e.g., “I am always willing to admit when I make a mistake.”). The items are answered as true or false and then summed for a total score. Higher scores on the MC-C reflect higher levels of social desirability. In this sample, internal consistency of the 13 items in the MC-C was .77 (N = 453), which is comparable to previous tests of the internal consistency of the MC-C (Reynolds, 1982).

Information questionnaire. An information questionnaire was developed to gather basic demographic and background information. In addition to demographic variables of age, race, ethnicity, sexual orientation and gender identity, five additional variables were evaluated: (a) self-identified religiosity, (b) self-identified spirituality, (c) education level, (d) counseling experience with LGB clients (the number of LGB clients worked with), and (e) LGB interpersonal contact (the number of friends and relatives who identify as LGB).

A brief, 4-item measure of self-identified religiosity captured the importance of religion in participants’ lives based on previous studies (Rainey & Trusty, 2007; Whitley, 2009) and census methods of measuring religiosity (Clark & Schellenberg, 2006; Lippman et al., 2005). Participants were asked to rate the importance of religion in their lives (0 = not at all, 1 = somewhat, 2 = important, 3 = very important), service attendance (0 = never, 1 = few times a year, 2 = few times a month, 3 = once a week or more), personal practices (0–7 scale = number of days per week spent engaging in religious behavior such as praying, reading scripture), and religious affiliation (open-ended; 0 = no identified religious affiliation, 1 = identified religious affiliation). Item scores were transformed into z-scores and then summed, where higher scores indicate higher levels of religiosity. In this sample, internal consistency of the four items in the religiosity measure was .82.

A brief, 5-item measure of self-identified spirituality was used to assess distinct aspects of spirituality from religiosity. A modified version of the Spiritual Transcendence Index (STI) was used, where spiritual transcendence refers to “a subjective experience of the sacred that affects one’s self-perception, feelings, goals, and ability to transcend difficulties” (Seidlitz et al., 2002, p. 441). The STI demonstrated high consistency and validity across several samples in exploratory studies, including adaptations of the STI such as those employed in this study (Good, Willoughby, & Busseri, 2011; Kim & Seidlitz, 2002; Seidlitz et al., 2002). The modified version of the STI used four items that did not include the term “God.” In this study, it was important that the concept of spirituality not be limited to only theists. For the four items, participants were asked to rate their experience of the following on a 1–6 scale (1 = strongly disagree to 6 = strongly agree): “My spirituality gives me a feeling of fulfillment,” “Even when I experience problems, I can find a spiritual peace within,” “Maintaining my spirituality is a priority for me” and “My spirituality helps me to understand my life’s purpose.” Finally, one question was posed in a similar format to Nelson, Rosenfeld, Breitbart, and Galietta (2002) asking respondents to rate the importance of spirituality in their lives (0 = not at all, 1 = somewhat, 2 = important, 3 = very important), which mirrors the wording of the parallel item in the religiosity measure. Item scores were transformed into z-scores and then summed, where higher scores reflect higher levels of self-identified spirituality. In this sample, internal consistency of the five items in the spirituality measure was .96 (N = 453), reflecting strong scale reliability. Validity of modified versions of the STI also has been established (Good et al., 2011; Kim & Seidlitz, 2002).

Data Cleaning

To ensure quality and rigor, participants who answered less than 70% of the items on the SOCCS or MC-C were eliminated from the sample, based on the methodology of Henke, Carlson, and McGeorge (2009) and Rock, Carlson, and McGeorge (2010). Of the 556 initial respondents, 61 did not complete the required 70% minimum (20 of 29 items) on the SOCCS. The religiosity and spirituality measures included only four and five items, respectively; therefore, if even one item was omitted from either measure, those participants were eliminated from the sample (n = 15). Finally, 27 respondents did not indicate their primary practice setting and were eliminated from the sample because the researcher could not confirm that they were a counselor.

Further data cleaning was necessary for participants who completed more than 70–100% of the SOCCS or MC-C. For those who omitted one to eight items (n = 89) on the SOCCS or one to three items on the MC-C (n = 8), mean imputation accounted for missing items (Montiel-Overall, 2006). Of those 89 cases that were modified using mean imputation for the SOCCS, 61 participants had omitted only one item and 12 omitted only two items. The remaining 16 participants omitted three to seven items.

Results

The purpose of the study was to investigate the following factors as they relate to and predict LGB-affirmative counselor competence: counselor self-identified religiosity, spirituality, education level, counseling experience with LGB clients and LGB interpersonal contact. To answer the research questions, correlational analysis, multiple regression and analysis of variance (ANOVA) were conducted. The researcher completed post-hoc power analyses using G*power at the .05 level of statistical significance. The effect size and achieved power is reported for each analysis.

For Research Question 1, a correlational matrix presents the relationships among all variables in Table 2. There was a significant, although weak, correlation between LGB-affirmative counselor competence and social desirability (r2 = -.15, p < .01). This suggests that the SOCCS results were not significantly inflated by social desirability.

Table 2

Correlation Matrix for Main Study Variables

Variable	1	2	3	4	5	6	7	8	9	10
1. MC-C	–	-.15**	-.06	-.28**	-.05	.08	.10*	-.03	-.06	-.01
2. SOCCS Total		–	.57**	.62**	.88**	-.30**	-.04	.31**	.35**	.24**
3. Attitudes			–	.12*	.27**	-.47**	-.31**	.08	.11*	.18**
4. Knowledge				–	.35**	-.17**	.04	.16**	.05	.17**
5. Skill					–	-.11*	.08	.34**	.45**	.18**
6. Religiosity						–	.60**	-.01	.03	-.12*
7. Spirituality							–	.07	.11*	-.04
8. Education								–	.22**	.06
9. LGB clients									–	.10
10. LGB interpersonal										–

Note. MC-C = Marlow Crowne Social Desirability Scale – Short Form C; SOCCS Total = Sexual Orientation Counselor Competency Scale Total score; Attitudes = SOCCS Attitudinal Awareness Subscale; Knowledge = SOCCS Knowledge Subscale; Skill = SOCCS Skill Subscale; Religiosity = self-identified religiosity measure; Spirituality = self-identified spirituality measure; Education = highest degree earned in counseling; LGB clients = number of LGB clients counseled; LGB interpersonal = number of LGB friends/relatives

Among initial findings, religiosity had a significant negative relationship with SOCCS total scores (r = -.30, p < .01) including significant negative relationships for all three of the SOCCS subscales (Attitudes, r = -.47; Knowledge, r = -.17; and Skill, r = -.11). Spirituality was not related to SOCCS total scores (r = -.04, p > .05), yet spirituality was strongly correlated with religiosity (r = .60, p < .01).

For Research Question 2, multiple regression analysis was conducted to determine predictors of LGB-affirmative counselor competence. The criterion variable was total score on the SOCCS and the predictors were (a) religiosity, (b) spirituality, (c) education level, (d) counseling experience with LGB clients, and (e) LGB interpersonal contact. The results of the regression indicated that these five predictors explained 31% of variance in SOCCS scores (R2 = .31, F(5, 391) = 35.31, p < .01). All five variables significantly predicted SOCCS scores: religiosity (β = -.40, p < .01), spirituality (β = .13, p < .05), education (β = .23, p < .01), number of LGB clients worked with (β = .28, p < .01), and LGB interpersonal contact (β = .13, p < .01). Notably, there was a negative β value for religiosity, indicating an inverse relationship with SOCCS scores compared to a positive β value for spirituality and SOCCS scores. With a medium effect size of .45 (Cohen, 1992), achieved power for the multiple regression was 1.00.

For Research Question 3, ANOVA was used to examine differences in three variables (religiosity, spirituality, and LGB-affirmative counselor competence) across the following religious affiliation groups: Protestant Christian, Catholic, Other Religious Affiliation, and No Religious Affiliation. Table 1 displays the affiliations included in each group.

Religious affiliation and religiosity. A one-way, between-subjects ANOVA compared the effect of religious affiliation on religiosity in four groups: Protestant Christian (n = 237), Catholic (n = 88), Other Religious Affiliation (n = 29), and No Religious Affiliation (n = 99). There was a significant effect of religious affiliation on religiosity [F(3, 449) = 156.69, p = .000]. Post-hoc comparisons using Tukey HSD indicated that the mean score for No Religious Affiliation (M = -4.12, SD = 2.30) was significantly lower than Protestant Christian (M = 1.61, SD = 2.20), Catholic (M = .45, SD = 2.39), and Other Religious Affiliation (M = -.73, SD = 2.11). In addition, Protestant Christian (M = 1.61, SD = 2.20) was significantly higher in religiosity than Catholic (M = .45, SD = 2.39) and Other Religious Affiliation (M = -.73, SD = 2.11) groups. With a large effect size of 1.04 (Cohen, 1992), achieved power for the ANOVA was 1.00.

Religious affiliation and spirituality. A one-way, between-subjects ANOVA compared the effect of religious affiliation on spirituality in four conditions: Protestant Christian, Catholic, Other Religious Affiliation, and No Religious Affiliation. There was a significant effect of religious affiliation on spirituality [F(3, 449) = 16.17, p = .000]. Post-hoc comparisons using Tukey HSD indicated that the mean score for Protestant Christian (M = 1.22, SD = 3.45) was significantly higher than Catholic (M = -.69, SD = 4.29) and No Religious Affiliation (M = -2.31, SD = 6.06) groups. With a medium effect size of .31 (Cohen, 1992), achieved power for the ANOVA was 0.99.

Religious affiliation and LGB-affirmative counseling competence. A one-way, between-subjects ANOVA compared the effect of religious affiliation on LGB-affirmative counseling competence in four groups: Protestant Christian, Catholic, Other Religious Affiliation, and No Religious Affiliation. There was a significant effect of religious affiliation on LGB-affirmative counseling competence [F(3, 449) = 12.98, p = .000]. Post-hoc comparisons using Tukey HSD indicated that the mean score for Protestant Christian (M = 4.51, SD = .77) was significantly lower than No Religious Affiliation (M = 4.95, SD = .78). Furthermore, the mean score for Other Religious Affiliation (M = 5.25, SD = .78) was significantly higher than Protestant Christian (M = 4.51, SD = .77) and Catholic (M = 4.70, SD = .75). Using G*Power, post-hoc power analysis was conducted. With a small effect size of .23 (Cohen, 1992), achieved power for the ANOVA was .98.

Discussion

Results of this study indicate that counselor religiosity and spirituality are each significant predictors of LGB-affirmative counselor competence. Counselor religiosity had a negative relationship with LGB-affirmative counselor competence (β = -.40, p < .01), whereas counselor spirituality had a positive relationship with LGB-affirmative counselor competence (β = .13, p < .01). Although counselors’ self-identified spirituality and religiosity were correlated (r = .60, p < .01), the opposing directions of the relationship between counselor religiosity and spirituality with LGB-affirmative counseling competence is intriguing.

The current study examined counselors’ self-identified religiosity as the degree of involvement in their religions, without knowledge of the specific nature of religious beliefs. It is possible that the negative relationship found between religiosity and LGB-affirmative competence is associated with conservative or fundamentalist beliefs, as found in Bidell’s (2014) study. Nonetheless, the significance of counselors’ self-identified spirituality as a positive predictor of LGB-affirmative counseling competence is new and useful information. Spirituality has been linked to empathy (Morrison & Borgen, 2010) and compassion for others (Saslow et al., 2013), which also may be factors related to LGB-affirmative counseling competence. Further empirical investigation of these variables is necessary to draw further conclusions.

The current study substantiates previous findings that education, the number of LGB clients worked with, and LGB interpersonal contact are positive predictors of LGB-affirmative counselor competence (Bidell, 2014). Reviewing the correlations of the SOCCS subscales (Table 2), education was most strongly related to skill (r2 = .34, p < .01), weakly related to knowledge (r2 = .16, p < .01) and unrelated to attitudes (r2 = .08, p > .05). It may be surmised that more education may move the marker on LGB-affirmative knowledge and skill, but is less related to affirming attitudes. Counseling experience with LGB clients was moderately correlated to skill (r2 = .45, p < .01), weakly related to attitudes (r2 = .11, p < .05), and unrelated to knowledge (r2 = .05, p > .05). Considering that counselors perceive themselves to have affirming attitudes toward LGB clients but have lower knowledge and skill (Bidell, 2012, 2014; Farmer et al., 2013; Graham, Carney, & Kluck, 2012), obtaining more counseling experience with LGB clients may be essential to strengthen self-perceived skill.

Finally, the ANOVA results suggest differences between religious affiliation groups in this study. Counselors in the “Protestant Christian” group were significantly lower in LGB-affirmative competence than counselors with “No Religious Affiliation.” Likewise, counselors in the “Other Religious Affiliation” group were significantly higher in LGB-affirmative competence than the “Protestant Christian” and “Catholic” groups. Furthermore, there were no significant differences in spirituality between “Protestant Christian” and “Catholic” groups, yet there was a significant difference in the religiosity of these two groups. These results suggest that the two groups shared similarly high spirituality but did not share the same religiosity as it was measured in this study.

If religion is theorized as a function of spirituality (Pargament, 2013), then results of this study seem to support that counselor spirituality may facilitate LGB-affirmative dispositions. It is possible that only certain religious beliefs interfere with this relationship to negatively affect LGB-affirmative counseling. As further support, there was a significant difference between “Protestant Christian,” “Catholic,” and “Other Religious Affiliation” groups with regard to LGB-affirmative competence. No firm conclusions can be drawn, but these results provide fodder for those in the field of professional counseling to discuss and consider.

Limitations

When self-report measures are used in a study of multicultural competence, there is a risk that participants may respond more favorably due to the influence of social desirability. Furthermore, self-perceived LGB-affirmative competence was measured using the SOCCS, which may not reflect actual competence with LGB clients. There is a chance of sampling bias due to the possibility that those who had greater interest in the topic of the study self-selected to participate. Finally, the nature of participants’ religious beliefs was not examined; therefore, there may be wide variability in beliefs within each of the religious affiliation groups examined (e.g., Protestant Christian, Catholic, Other Religious Affiliation).

Implications

Results of this study suggest that religiosity and spirituality both predict LGB-affirmative counselor competence, but in different ways. Spirituality was a direct, positive predictor of LGB-affirmative counselor competence, while religiosity was a negative predictor. Results align with previous findings that suggest for highly religious counselors, LGB-affirmative counselor competence is most impacted by attitudes as opposed to the development of knowledge and skill (Bidell, 2014).

Considerations for Counselors

Religiosity and spirituality may each provide structure or ideological substance needed to develop one’s sense of values concerning counseling LGB clients. Whereas religion may derive ideological substance from certain doctrines, scriptures or teachings, spirituality is likely to derive ideological substance from more intuitive or nontangible forms of meaning-making that drive human connection (Zinnbauer et al., 1999). Considering this, it seems possible that counselors who identify as both highly religious and spiritual could experience inner conflict related to integrating LGB-affirmative values if their religious doctrines or teachings have been interpreted in such a way as to condemn same-sex relationships (Altemeyer, 2003; Poteat & Mereish, 2012; Whitley, 2009). In this case, such counselors may be trying to negotiate two important ways of knowing and making meaning about the world: one derived from religious teachings and the other from intuitive or heart-centered means. Thus, if a counselor is experiencing a values conflict between their personal religious beliefs and LGB-affirmative practices supported by the ACA Code of Ethics (2014), it may be mutually beneficial to explore the common thread of spirituality to forge empathic connection.

Practical suggestions for counselors include self-reflection on spiritual and religious values and beliefs, peer consultation, supervision, and seeking consult from a variety of religious and spiritual leaders. It may be helpful for counselors to consider values from their religious affiliations that are congruent with LGB-affirmation to encourage integration. Through these activities, counselors may develop a deeper understanding of the complex ideas, beliefs and values that are important to their religious and spiritual selves.

Counselor Educators and Supervisors

Whitman and Bidell (2014) offered recommendations to counselor educators and supervisors for training LGB-affirmative counselors, such as conducting a thorough and honest appraisal of the program’s level of LGB-affirmative counselor education integration, providing clear informed consent to potential students regarding the LGB-affirmative approach infused into the curriculum, and encouraging student exploration of how personal values may affect worldview. As a pedagogical technique for encouraging self-exploration, Fischer and DeBord (2007) recommended evoking conversation with students when conflict is perceived between a student’s religious values and professional obligations. Normalizing these experiences of struggle for students may be helpful, particularly for those whose religious beliefs are salient to their cultural identities (Robertson & Avent, 2016; Scott, Sheperis, Simmons, Rush-Wilson, & Milo, 2016). In these situations, students may be encouraged to explore and question the assumptions and beliefs that are involved in the perceived conflict with professional and ethical values (Whitman & Bidell, 2014). Kocet and Herlihy (2014) also proposed an ethical decision-making model and approach to managing values conflicts for counselors.

Finally, LGB interpersonal contact had a positive impact on LGB-affirmative counseling competence in this study. Learning activities designed to increase contact with LGB individuals, such as panel discussions or immersion experiences (e.g., Pride Festival attendance) may encourage students to consider personal views more deeply and develop new ways of understanding themselves and the world around them. Considering that counselors’ self-perceived skill was correlated to the amount of counseling experience with LGB clients, it may be useful for counselor educators to find ways to diversify client demographics for practicum and internship students, including affectional orientation, to strengthen LGB-affirmative counseling skills.

Future Research

Although this study captured self-identified religiosity and spirituality through brief measures, a more robust and multidimensional measure of religiosity and spirituality is recommended for future studies. Further investigation of the intersection of counselor religiosity and spirituality is recommended because of the strong correlation between these variables, and might be best explored through qualitative studies. The specific nature of religious beliefs held by highly religious counselors was not verified and may be explored. Future researchers should also explore factors, such as developing empathy for clients, that potentially mediate the effect of prejudicial religious beliefs on LGB-affirmative counselor competence.

Conclusion

In this study, counselor spirituality was a direct predictor of LGB-affirmative counselor competence, evoking the question: What might contribute to a counselor’s sense of spirituality, apart from religious doctrine or dogma that might otherwise compromise an affirming disposition toward LGB clients? Spirituality has been described as an innate capacity that moves us toward “knowledge, love, meaning, peace, hope, transcendence, connectedness, compassion, wellness and wholeness” and contributes to our value system (“Summit Results,” 1995, p. 30). Perhaps the spiritual experience of compassion and the desire for connection provides a broader understanding and embodiment of LGB-affirmative counseling practices at the human level. After all, it stands to reason that multicultural counseling competence across diverse populations stems from an inward striving for unconditional acceptance and validation of the unique experiences of others. To nurture these connections in ourselves and in our work is perhaps one of the greatest gratifications of being a professional counselor.

Conflict of Interest and Funding Disclosure

The authors reported no conflict of interest

or funding contributions for the development

of this manuscript.

References

Altemeyer, B. (2003). Why do religious fundamentalists tend to be prejudiced? The International Journal for the Psychology of Religion, 13, 17–28. doi:10.1207/S15327582IJPR1301_03

Altemeyer, B., & Hunsberger, B. E. (1992). Authoritarianism, religious fundamentalism, quest, and prejudice. The International Journal for the Psychology of Religion, 2, 113–133. doi:10.1207/s15327582ijpr0202_5

American Counseling Association. (2014). ACA code of ethics. Alexandria, VA: Author.

American Psychological Association. (2017). Just the facts about sexual orientation and youth: Efforts to change sexual orientation through therapy. Retrieved from http://www.apa.org/pi/lgbt/resources/just-the-facts.aspx

Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling. (2012). Competencies for counseling with lesbian, gay, bisexual, queer, questioning, intersex and ally individuals. Alexandria, VA: Author.

Association for Spiritual, Ethical, and Religious Values in Counseling. (2013). Spiritual and religious competencies. Alexandria, VA: Author. Retrieved from http://www.aservic.org/resources/spiritual-competencies

Balkin, R. S., Schlosser, L. Z., & Levitt, D. H. (2009). Religious identity and cultural diversity: Exploring the relationships between religious identity, sexism, homophobia, and multicultural competence. Journal of Counseling & Development, 87, 420–427. doi:10.1002/j.1556-6678.2009.tb00126.x

Balkin, R. S., Watts, R. E., & Ali, S. R. (2014). A conversation about the intersection of faith, sexual orientation, and gender: Jewish, Christian, and Muslim perspectives. Journal of Counseling & Development, 92, 187–193. doi:10.1002/j.1556-6676.2014.00147.x

Bidell, M. P. (2005). The sexual orientation counselor competency scale: Assessing attitudes, skills, and knowledge of counselors working with lesbian, gay, and bisexual clients. Counselor Education and Supervision, 44, 267–279. doi:10.1002/j.1556-6978.2005.tb01755.x

Bidell, M. P. (2012). Examining school counseling students’ multicultural and sexual orientation competencies through a cross-specialization comparison. Journal of Counseling & Development, 90, 200–207. doi:10.1111/j.1556-6676.2012.00025.x

Bidell, M. P. (2014). Personal and professional discord: Examining religious conservatism and lesbian-, gay-, and bisexual-affirmative counselor competence. Journal of Counseling & Development, 92, 170–179.
doi:10.1002/j.1556-6676.2014.00145.x

Cashwell, C. S., & Young, J. S. (Eds.). (2011). Integrating spirituality and religion into counseling: A guide to competent practice (2nd ed.). Alexandria, VA: American Counseling Association.

Chatters, L. M., Levin, J. S., & Taylor, R. J. (1992). Antecedents and dimensions of religious involvement among older Black adults. Journal of Gerontology, 47(6), S269–S278. doi:10.1093/geronj/47.6.S269

Choudhuri, D. D., & Kraus, K. L. (2014). Buddhist perspectives for addressing values conflicts in counseling: Possibilities from practice. Journal of Counseling & Development, 92, 194–201.
doi:10.1002/j.1556-6676.2014.00148.x

Clark, W., & Schellenberg, G. (2006). Who’s religious? Canadian Social Trends, 81, 2–9. Retrieved from http://www.statcan.gc.ca/pub/11-008-x/2006001/pdf/9181-eng.pdf

Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159.

Dewey, J. J. H., Schlosser, L. Z., Kinney, R. S., & Burkard, A. W. (2014). Faithful allies: The experiences of LGB-affirming, White Christian clergy. Journal of LGBT Issues in Counseling, 8, 298–321.
doi:10.1080/15538605.2014.933467

Fallon, K. M., Dobmeier, R. A., Reiner, S. M., Casquarelli, E. J., Giglia, L. A., & Goodwin, E. (2013). Reconciling spiritual values conflicts for counselors and lesbian and gay clients. Adultspan Journal, 12, 38–53. doi:10.1002/j.2161-0029.2013.00014.x

Farmer, L. B., Welfare, L. E., & Burge, P. L. (2013). Counselor competence with lesbian, gay, and bisexual clients: Differences among practice settings. Journal of Multicultural Counseling and Development, 41(4), 194–209. doi:10.1002/j.2161-1912.2013.00036.

Fischer, A. R., & DeBord, K. A. (2007). Perceived conflicts between affirmation of religious diversity and affirmation of sexual identity: That’s perceived. In K. J. Bieschke, R. M. Perez, & K. A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients (2nd ed., pp. 317–339). Washington, DC: American Psychological Association.

Friedman, R. E. (2001). Commentary on the Torah. San Francisco, CA: Harper San Francisco.

Good, M., Willoughby, T., & Busseri, M. A. (2011). Stability and change in adolescent spirituality/religiosity: A person-centered approach. Developmental Psychology, 47, 538–550. doi:10.1037//a0021270

Graham, S. R., Carney, J. S., & Kluck, A. S. (2012). Perceived competency in working with LGB clients: Where are we now? Counselor Education and Supervision, 51, 2–16. doi:10.1002/j.1556-6978.2012.00001.x

Henke, T., Carlson, T. S., & McGeorge, C. R. (2009). Homophobia and clinical competency: An exploration of couple and family therapists’ beliefs. Journal of Couple & Relationship Therapy, 8, 325–342. doi:10.1080/15332690903246101

Herlihy, B. J., Hermann, M. A., & Greden, L. R. (2014). Legal and ethical implications of using religious beliefs as the basis for refusing to counsel certain clients. Journal of Counseling & Development, 92, 148–153. doi:10.1002/j.1556-6676.2014.00142.x

Israel, T., & Selvidge, M. M. D. (2003). Contributions of multicultural counseling to counselor competence with lesbian, gay, and bisexual clients. Journal of Multicultural Counseling & Development, 31, 84–98. doi:10.1002/j.2161-1912.2003.tb00535.x

Kaplan, D. M. (2014). Ethical implications of a critical legal case for the counseling profession: Ward v. Wilbanks. Journal of Counseling & Development, 92, 142–146. doi:10.1002/j.1556-6676.2014.00140.x

Keeton v. Anderson-Wiley, 664 F.3d 865 (11th Cir. 2011).

Kim, Y., & Seidlitz, L. (2002). Spirituality moderates the effect of stress on emotional and physical adjustment. Personality and Individual Differences, 32, 1377–1390. doi:10.1016/S0191-8869(01)00128-3

Kocet, M. M., & Herlihy, B. J. (2014). Addressing value-based conflicts within the counseling relationship: A decision-making model. Journal of Counseling & Development, 92, 180–186.
doi:10.1002/j.1556-6676.2014.00146.x

Lalich, J., & McLaren, K. (2010). Inside and outcast: Multifaceted stigma and redemption in the lives of gay and lesbian Jehovah’s Witnesses. Journal of Homosexuality, 57, 1303–1333. doi:10.1080/00918369.2010.517076

Lippman, L., Michelsen, E., & Roehlekepartain, E. C. (2005). Indicators of child, family, and community connections: The measurement of family religiosity and spirituality. Paper prepared for the Office of the Assistant Secretary for Planning and Evaluation, U. S. Department of Health and Human Services. Retrieved from http://aspe.hhs.gov/hsp/connections-papers04

Montiel-Overall, P. (2006). Implications of missing data in survey research. The Canadian Journal of Information and Library Science, 30 (3/4), 241–269.

Morrison, M., & Borgen, W. A. (2010). How Christian spiritual and religious beliefs help and hinder counselors’ empathy toward clients. Counseling and Values, 55, 25–45.

Nelson, C. J., Rosenfeld, B., Breitbart, W., & Galietta, M. (2002). Spirituality, religion, and depression in the terminally ill. Psychosomatics, 43, 213–220. doi:10.1176/appi.psy.43.3.213

Obergefell v. Hodges, 576 U. S. (2015).

Pargament, K. I. (2013). Spirituality as an irreducible human motivation and process. The International Journal for the Psychology of Religion, 23, 271–281.

Pargament, K. I., Sullivan, M. S., Balzer, W. K., Van Haitsma, K. S., & Raymark, P. H. (1995). The many meanings of religiousness: A policy capturing approach. Journal of Personality, 63, 953–983.
doi:10.1111/j.1467-6494.1995.tb00322.x

Parker, S. (2011). Spirituality in counseling: A faith development perspective. Journal of Counseling & Development, 89, 112–119. doi:10.1002/j.1556-6678.2011.tb00067.x

Piedmont, R. L. (1999). Does spirituality represent the sixth factor of personality? Spiritual transcendence and the five-factor model. Journal of Personality, 67, 985–1014. doi:10.1111/1467-6494.00080

Piedmont, R. L. (2001). Spiritual transcendence and the scientific study of spirituality. Journal of Rehabilitation, 67, 4–14.

Poteat, V. P., & Mereish, E. H. (2012). Ideology, prejudice, and attitudes toward sexual minority social policies and organizations. Political Psychology, 33, 211–224. doi:10.1111/j.1467-9221.2012.00871.x

Rainey, J. S., & Trusty, J. (2007). Attitudes of master’s-level counseling students toward gay men and lesbians. Counseling and Values, 52, 12–24. doi:10.1002/j.2161-007X.2007.tb00084.x

Reynolds, W. M. (1982). Development of reliable and valid short forms of the Marlowe-Crowne Social Desirability Scale. Journal of Clinical Psychology, 38, 119–125.

Robertson, D. L., & Avent, J. R. (2016). African American counselors-in-training, the Black church, and lesbian-, gay-, and bisexual-affirmative counseling: Considerations for counselor education programs. Counseling and Values, 61, 223–238. doi:10.1002/cvj.12039

Rock, M., Carlson, T. S., & McGeorge, C. R. (2010). Does affirmative training matter? Assessing CFT students’ beliefs about sexual orientation and their level of affirmative training. Journal of Marital and Family Therapy, 36, 171–184. doi:10.1111/j.1752-0606.2009.00172.x

Sanabria, S. (2012). Religious orientation and prejudice: Predictors of homoprejudice. Journal of LGBT Issues in Counseling, 6(3), 183–201. doi:10.1080/15538605.2012.708894

Saslow, L. R., John, O. P., Piff, P. K., Willer, R., Wong, E., Impett, E. A., . . . Saturn, S. R. (2013). The social significance of spirituality: New perspectives on the compassion-altruism relationship. Psychology of Religion and Spirituality, 5, 201–218. doi:10.1037/a0031870

Satcher, J., & Schumacker, R. (2009). Predictors of modern homonegativity among professional school counselors. Journal of LGBT Issues in Counseling, 3, 21–36. doi:10.1080/15538600902754452

Scott, S. K., Sheperis, D. S., Simmons, R. T., Rush-Wilson, T., & Milo, L. A. (2016). Faith as a cultural variable: Implications for counselor training. Counseling and Values, 61, 192–205. doi:10.1002/cvj.12037

Seidlitz, L., Abernethy, A. D., Duberstein, P. R., Evinger, J. S., Chang, T. H., & Lewis, B. L. (2002). Development of the Spiritual Transcendence Index. Journal for the Scientific Study of Religion, 41, 439–453. doi:10.1111/1468-5906.00129

Sells, J. N., & Hagedorn, W. B. (2016). CACREP accreditation, ethics, and the affirmation of both religious and sexual identities: A response to Smith and Okech. Journal of Counseling & Development, 94, 265–279. doi:10.1002/jcad.12083

Smith, L. C., & Okech, J. E. A. (2016a). Ethical issues raised by CACREP accreditation of programs within institutions that disaffirm or disallow diverse sexual orientations. Journal of Counseling & Development, 94, 252–264. doi:10.1002/jcad.12082

Smith, L. C., & Okech, J. E. A. (2016b). Negotiating CACREP accreditation practices, religious diversity, and sexual orientation diversity: A rejoinder to Sells and Hagedorn. Journal of Counseling & Development, 94, 280–284. doi:10.1002/jcad.12084

Summit results in formation of spirituality competencies. (1995, December). Counseling Today, 38(6), 30.

TN HB1840 | 2015-2016 | 109th General Assembly. (2016, May 02) LegiScan. Retrieved February 20, 2017, from https://legiscan.com/TN/bill/HB1840/2015

Vaughan, F. (1991). Spiritual issues in psychotherapy. Journal of Transpersonal Psychology, 23, 105–119.

Ward v. Polite, 667 F.3d 727 (6th Cir. 2012).

Whitley, B. E., Jr. (2009). Religiosity and attitudes toward lesbians and gay men: A meta-analysis. The International Journal for the Psychology of Religion, 19, 21–38. doi:10.1080/10508610802471104

Whitman, J. S., & Bidell, M. P. (2014). Affirmative lesbian, gay, and bisexual counselor education and religious

beliefs: How do we bridge the gap? Journal of Counseling & Development, 92, 162–169.
doi:10.1002/j.1556-6676.2014

Whitman, J. S., Glosoff, H. L., Kocet, M. M., & Tarvydas, V. (2013). Ethical issues related to conversion or reparative therapy. Counseling Today. Retrieved from https://www.counseling.org/news/updates/2013/

01/16/ethical-issues-related-to-conversion-or-reparative-therapy

Zinnbauer, B. J., Pargament, K. I., Cole, B. C., Rye, M. S., Butter, E. M., Belavich, T. G., . . . Kadar, J. L. (1997). Religion and spirituality: Unfuzzying the fuzzy. Journal for the Scientific Study of Religion, 36, 549–564.

Zinnbauer, B. J., Pargament, K. I., & Scott, A. B. (1999). The emerging meanings of religiousness and spirituality: Problems and prospects. Journal of Personality, 67, 889–919. doi:10.1111/1467-6494.00077

Laura Boyd Farmer is an Assistant Professor at Virginia Tech University. Correspondence can be addressed to Laura Farmer, 1750 Kraft Drive, Suite 2004, Blacksburg, VA 24061, lbfarmer@vt.edu.

Self-Efficacy, Attachment Style and Service Delivery of Elementary School Counseling

May 26, 2017 | Volume 7 - Issue 2

Kimberly Ernst, Gerta Bardhoshi, Richard P. Lanthier

This study explored the relationships between demographic variables, self-efficacy and attachment style with a range of performed and preferred school counseling activities in a national sample of elementary school counselors (N = 515). Demographic variables, such as school counselor experience and American School Counselor Association (ASCA) National Model training and use, were positively related to performing intervention activities that align with the ASCA National Model. Results of hierarchical regression analyses supported that self-efficacy beliefs also predicted levels of both actual and preferred service delivery of intervention activities. Interestingly, self-efficacy beliefs also predicted higher levels of performing “other” non-counseling activities that are considered to be outside of the school counselor role. An insecure attachment style characterized by high anxiety predicted a lower preference for intervention activities and also predicted the discrepancy between actual and preferred “other” non-counseling activities, revealing a higher preference for performing them.

Keywords: school counselor, ASCA National Model, self-efficacy, attachment style, service delivery

Professional school counselors are important contributors to education and serve an essential role in the academic, personal, social and career development of all students (American School Counselor Association [ASCA], 2012). Over the past decade, school counselors have been increasingly called upon to embrace data-driven, evidence-based standards of practice (ASCA, 2012; Erford, 2016) that bolster the achievement of all students (Shillingford & Lambie, 2010). Comprehensive developmental school counseling programs that are consistent with the ASCA National Model are currently considered best practice (ASCA, 2012) and identified as an effective means of delivering services to all students (Burnham & Jackson, 2000; Carey & Dimmitt, 2012; Gysbers & Henderson, 2012).

Data from school counseling research indicate that comprehensive developmental school counseling programs make a positive difference in student outcomes (Carey & Dimmitt, 2012; Scarborough & Luke, 2008). These programs are shown to impact overall student development positively, including academic, career and emotional development, as well as academic achievement (Fitch & Marshall, 2004; Lapan, Gysbers, & Petroski, 2001; Sink & Stroh, 2003). Furthermore, a range of individual school counselor activities and interventions is associated with positive changes in a number of important student outcomes, including academic performance, school attendance, classroom behavior and self-esteem (Whiston, Tai, Rahardja, & Eder, 2011).

However, studies examining actual school counselor practice indicate that school counselors spend a significant amount of time on activities that are not reflective of ASCA best practices, including clerical, administrative and fair share duties that take them away from performing essential school counseling activities (Bardhoshi, Schweinle, & Duncan, 2014; Burnham & Jackson, 2000; Foster, Young, & Hermann, 2005; Scarborough & Luke, 2008). A factor impeding school counselors’ ability to perform activities that align with best practices includes being burdened with time-consuming tasks that are outside their scope of practice (Bardhoshi et al., 2014). This may stem from either the historically ambiguous school counselor role (Gysbers & Henderson, 2012) or from competing demands from numerous stakeholders who may not fully understand the components of an effective school counseling program (Bemak & Chung, 2008). Indeed, school counselors report not spending adequate time engaged in the professional activities that they prefer (Scarborough, 2005; Scarborough & Luke, 2008), even though these preferences are consistent with best practice recommendations (Scarborough & Culbreth, 2008). Therefore, for many school counselors, performing within their professional role and sticking to best practice recommendations regarding their service delivery can be challenging and stressful (McCarthy, Kerne, Calfa, Lambert, & Guzmán, 2010).

Given that school counseling program implementation and interventions that align with ASCA are associated with positive outcomes for students in a variety of domains, and that tension exists between the actual and preferred practice of school counselors, the question now becomes: What factors contribute to effective school counseling service delivery? Studies indicate a positive relationship between years of experience and school counselor practice (Scarborough & Culbreth, 2008; Sink & Yillik-Downer, 2001), as it may take several years of experience to implement the breadth and complexity of interventions in a programmatic manner. Research outside the field of school counseling also has expanded beyond demographic variables to indicate that a number of individual characteristics, such as attachment style (Dozier, Lomax Tyrrell, & Lee, 2001; Hazan & Shaver, 1987), emotional stability, locus of control, self-esteem (Judge & Bono, 2001) and self-efficacy (Judge & Bono, 2001; Larson & Daniels, 1998), are related to an individual’s work performance.

To understand the underlying mechanisms that affect school counselor work performance, studies have explored potential organizational (e.g., school climate, perceived administration support), structural (e.g., training, supervision), and personal variables (e.g., experience, self-efficacy) related to counselor practice (Scarborough & Luke, 2008). Two school counselor interpersonal variables are of special focus in this study: self-efficacy and attachment. Individuals with higher levels of self-efficacy set higher goals for themselves and show higher levels of commitment, motivation, resilience and perseverance in achieving set goals (Bodenhorn & Skaggs, 2005), making the examination of school counselor self-efficacy important in investigating effective service delivery. On the other hand, attachment theory highlights the process by which early childhood development influences an individual’s capacity to relate to others and regulate emotion. Many lines of theoretical and empirical research in education and psychology have examined how attachment characteristics influence adult functioning, supporting the introduction of school counselor attachment style as a factor relating to work performance (Desivilya, Sabag, & Ashton, 2006; Hazan & Shaver, 1987; Kennedy & Kennedy, 2004; Marotta, 2002). School counselor self-efficacy and attachment characteristics are personal attributes conceptualized to contribute to the ability of school counselors to perform intervention activities that align with ASCA recommendations and positively impact student development and achievement.

Self-Efficacy

Self-efficacy involves beliefs about one’s own capability to successfully perform given tasks to accomplish specific goals (Lent & Hackett, 1987). As individuals confront important problems and tasks, they choose actions based on their beliefs of personal efficacy (Bandura, 1996). Self-efficacy may be a critical factor in school counselor work performance. Two meta-analytic studies of empirical research examining self-efficacy have shown that for a variety of occupations, there is a positive relationship between self-efficacy and work performance (Larson & Daniels, 1998; Stajkovic & Luthans, 1998). Studies examining school counselor self-efficacy have been a more recent addition to the literature, with reported results indicating that self-efficacy is related to school counselor gender, teaching experience (Bodenhorn & Skaggs, 2005), and supportive staff and administrators (Sutton & Fall, 1995).

In a study that extended the findings of previous self-efficacy research (Sutton & Fall, 1995), Scarborough and Culbreth (2008) examined factors that predicted discrepancies between actual and preferred practice in school counselors. Both self-efficacy beliefs and the amount of perceived administrative support predicted the difference between school counselors’ actual and preferred practice, with higher levels of support and outcome expectancy predicting higher levels of preferred intervention activities performance. In the current study, we plan to extend Scarborough and Culbreth’s work by examining the links between comprehensive elementary school counselor practice and overall school counselor self-efficacy while introducing attachment characteristics as a possible variable related to school counselor performance.

Attachment

Attachment theory describes how early experiences with attachment figures (e.g., mother) create inner representations referred to as internal working models. Those internal working models then shape patterns of behavior in response to significant others and to stressful situations (Mikulincer, Shaver, & Pereg, 2003). Adult attachment categories reflect those created in infancy and childhood and include secure, preoccupied (or anxious), dismissing (or avoidant), and fearful (both anxious and avoidant) styles (Bartholomew & Horowitz, 1991). In adults, attachment style encompasses affective responses in a variety of relationships, including co-workers, and can be activated by a number of stressful situations, including a stressful work environment (Mikulincer & Shaver, 2003, 2007).

Working effectively in a job or career contributes in meaningful ways to life satisfaction, self-esteem and social status, whereas not working effectively (and experiencing overload or burnout) can be extremely stressful and can cause serious emotional and physical difficulties (Mikulincer & Shaver, 2007). Specifically for school counselors, Wilkerson and Bellini (2006) reported that emotion-focused coping is a significant predictor of burnout, lending support to the examination of interpersonal factors in school counselor practice. To work effectively and not succumb to burnout, school counselors may have to activate self-regulatory skills associated with attachment, such as exploring alternatives, refining skills, adjusting to variation in tasks and role demands, and exercising self-control (Mikulincer & Shaver, 2007). In the field of school counseling, challenges include facing multiple demands and conflicting responsibilities (Cinotti, 2014); therefore, interpersonal communication, negotiation and adaptation become essential. Although attachment theory has received very little attention in school counseling literature (Pfaller & Kiselica, 1996), existing research suggests that various aspects of work are likely to be affected by individual differences in attachment style (Mikulincer & Shaver, 2007).

The purpose of this study was to explore demographic and interpersonal factors related to elementary school counseling practice. This research employed an associational survey research design to examine the relationships between school counselor overall self-efficacy, attachment style, and a range of performed and preferred activities in a sample of ASCA members who are elementary school counselors. Building on previous studies, we controlled for the anticipated variance in school counselor activities that might be contributed by previously identified demographic variables, including years of experience, ASCA National Model training and ASCA National Model use (Scarborough & Culbreth, 2008).

The first research question inquired about the relationship between self-efficacy beliefs and school counselor performed and preferred intervention activities that align with ASCA, controlling for the potential effect of the identified demographic variables. We hypothesized that self-efficacy beliefs would predict both school counselor preference and actual performance of these core activities, after controlling for the potential effect of relevant demographic variables. The second research question inquired about the relationship between attachment style and both counseling and non-counseling activities, controlling for the effect of the identified demographic variables. We hypothesized that school counselors who endorse higher levels of anxiety may prefer to engage in fewer intervention activities and more non-counseling activities. This could be in an effort to please others and conform to the administrative, fair share and clerical demands of the job. No hypothesis was forwarded on attachment avoidance and discrepancies between actual and preferred activities, as related research has not examined a possible relationship.

Method

Participants

The sample for this study consisted of elementary-level school counselors whose e-mail addresses were listed on the ASCA national database. We made the decision to select only elementary school counselors because of the unique emphasis on student personal and social development at this level (Dahir, 2004), as well as the distinct developmental needs of the student population that could potentially tap into school counselor attachment (Scarborough, 2005). Recruitment e-mails were sent to 3,798 ASCA member elementary school counselors through SurveyMonkey, employing a 3-wave multiple contact procedure. The original sample was adjusted to 3,550 because of undeliverable e-mail addresses. In total, 663 individuals responded to the survey, yielding a return rate of 19%. A priori power analysis using G*Power software determined that a minimum sample of 107 participants likely was necessary when conducting a multiple regression analysis with three independent variables. This G*Power calculation was based on an alpha level of .05, minimum power established at .80 and a moderate treatment effect size, and was conducted in the planning stages to inform needed sample size and minimize the probability of Type II error (Faul, Erdfelder, Buchner, & Lang, 2009). Therefore, surveys with incomplete data were completely removed from the analysis, resulting in a final sample size of 515 and a usable response rate of 14.5%.

The sample consisted of 89.6% females and 9.8% males (3 participants did not indicate gender). In terms of race and ethnicity, 86.6% were Caucasian, 6% African American, 2.9% Hispanic, 1.6% Multiracial, 1.4 % Asian/Pacific Islander, and 0.4% Native American (1.2% did not indicate race or ethnicity). The predominately female and Caucasian sample is consistent with school counseling research and reflective of the population (Bodenhorn & Skaggs, 2005).

Years of experience ranged from < 1 to 38, with a mean of 10.24 years. School enrollment ranged from 70 to 3,400 students, with a mean of 583.49 students. The large maximum enrollment number was caused by the inclusion of elementary-level counselors who were employed in K–12 schools. Counselor caseload ranged from 6 to 1,500, with the mean being 454.68 students. The mean age of respondents was 44 years, with a standard deviation of 11.02 years, and an age range spanning from 25 to 68 years. Regarding ASCA National Model (2012) training, only 8.5% reported not having received any training, with the overwhelming majority of the participants having received training from professional development opportunities sought on their own (67.6%), as part of master’s-level coursework (53.2%), or through their school district (31.5%). Only 5.2% of respondents reported no use of the ASCA National Model, with 14% reporting limited use, 33.8% some use, 31.5% a lot of use, and 15% extensive use.

Instruments

Instrumentation consisted of four measures, including a demographic questionnaire, the School Counselor Activity Rating Scale (SCARS; Scarborough, 2005), the School Counselor Self-Efficacy Scale (SCSE; Bodenhorn & Skaggs, 2005) and the Experiences in Close Relationships Scale-Short Form (ECR-Short Form; Wei, Russell, Mallinckrodt, & Vogel, 2007).

Demographic questionnaire. A demographic questionnaire consisting of 14 questions collected relevant information regarding participant age, gender, ethnicity, region, school setting (i.e., private, public) and level (e.g., elementary, middle), student enrollment, counselor caseload characteristics, degree earned, licensure and certification, years of experience and training in and use of the ASCA National Model. Demographic data were selected for inclusion based on a literature review indicating important relationships between these variables and school counseling outcomes (Scarborough & Culbreth, 2008; Sink & Yillik-Downer, 2001).

School Counselor Activity Rating Scale (SCARS). The SCARS is a 48-item scale reflecting best practice recommendations for school counselors based on the ASCA National Standards (Campbell & Dahir, 1997) and the ASCA National Model (ASCA, 2003). It was designed to measure the frequency with which school counselors perform specific work activities, and the preferred frequency of performing those activities (Scarborough, 2005; Scarborough & Culbreth, 2008). The instrument contains five sections—counseling, consultation, curriculum, coordination and “other” activities. Participants indicate their actual and preferred performance of common school counseling activities on a frequency scale (1 = rarely do this activity to 5 = routinely do this activity), including “other” non-counseling activities that fall outside the school counselor role (e.g., coordinate the standardized testing program). A SCARS total score is calculated by adding the totals from each subscale or calculating mean scores, with higher scores indicating higher levels of engagement.

The SCARS validation study supported a four-factor solution representing the counseling, coordination, consultation and curriculum categories. Analysis on the “other” school counseling activities subscale, consisting of 10 items reflecting non-counseling activities, resulted in three factors: clerical, fair share and administrative. Convergent and discriminant construct validity also were reported (Scarborough, 2005). Cronbach’s alpha reliability coefficients, as reported by Scarborough on the eight subscales of actual and preferred dimensions, were .93 and .90 for curriculum; .84 and .85 for coordination; .85 and .83 for counseling; .75 and .77 for consultation; .84 and .80 for clerical; .53 and .58 for fair share; and .43 and .52 for administrative. In the current study, the Cronbach’s alpha coefficients for actual and preferred practice were .90 and .83 for curriculum; .84 and .86 for coordination; .80 and .81 for counseling; and .76 and .73 for consultation.

The intervention total subscale in our study consisted of the composite of the counseling, consultation, curriculum and coordination subscales, with Cronbach’s alpha reliability coefficients of .91 on both the actual and the preferred use dimensions. Similar to Scarborough (2005), the “other” duties subscale, consisting of clerical, fair share and administrative duties, had moderate reliability, with Cronbach’s alpha of .63 on the actual, and .68 on the preferred. The activities total subscale consisted of a combination of all SCARS subscales, with Cronbach’s alpha being .89 on the actual and .90 on the preferred. Various studies have been conducted since the initial validation of the SCARS and support its use as a tool yielding valid and reliable school counselor process scores (Scarborough & Culbreth, 2008; Shillingford & Lambie, 2010).

School Counselor Self-Efficacy Scale (SCSE). The SCSE (Bodenhorn & Skaggs, 2005) is a 43-item

self-report instrument designed to measure school counselor self-efficacy. The SCSE uses a 5-point Likert-type scale to measure responses (ranging from 1 = not confident to 5 = highly confident) and consists of five subscales: personal and social development; leadership and assessment; career and academic development; collaboration; and cultural acceptance. A composite mean is calculated to demonstrate overall self-efficacy. SCSE responses were evaluated for reliability, omission, discrimination and group differences (Bodenhorn & Skaggs, 2005), with results supporting high reliability for the composite scale (α = .95). Analyses also indicated group differences demonstrating score validity for the scale—participants who had teaching experience, had been practicing for three or more years, and were trained in and used the ASCA National Standards reported higher levels of self-efficacy. The total scale SCSE alpha in the current study was .96.

Experiences in Close Relationships Scale (ECR)-Short Form. The ECR-Short Form (Wei et al., 2007) is a 12-item self-report measure designed to assess a general pattern of adult attachment. The ECR-Short Form is based on the longer Experiences in Close Relationship Scale (Brennan, Clark, & Shaver, 1998). Factor analysis revealed two dimensions of adult attachment, anxiety and avoidance, which have received professional consensus (Bartholomew & Horowitz, 1991; Mikulincer & Shaver, 2003). High scores on either or both of these dimensions are indicative of an insecure adult attachment orientation. Low levels of attachment anxiety and avoidance indicate a secure orientation (Bartholomew & Horowitz, 1991; Brennan et al., 1998; Lopez & Brennan, 2000; Mallinckrodt, 2000).

Internal consistency was adequate with coefficient alphas from .77 to .86 for the anxiety subscale and from .78 to .88 for the avoidance subscale, and confirmatory factor analyses provided evidence of construct validity with a two-factor model (i.e., anxiety and avoidance), indicating a good fit for the data. Reported test-retest reliabilities averaged .83. For the current study, ECR-S alphas were .75 for the anxiety subscale and .81 for the avoidance subscale.

Data Analysis
Data were analyzed using the Statistical Package for Social Sciences (SPSS Version 18), with multiple hierarchical regressions used to answer both research questions. Hierarchical regression was selected to determine the relative importance of the predictor variables, over and above that which can be accounted for by other previously identified predictors regarding school counselor service delivery (i.e., years of experience, ASCA National Model training and ASCA National Model use). Predictor variables included self-efficacy beliefs (SCSE total score), attachment anxiety (ECR-Short Form Anxiety subscale) and attachment avoidance (ECR-Short Form Avoidance subscale). Outcome variables included actual (SCARS total Actual scale) and preferred (SCARS total Preferred scale) intervention activities, “other” non-counseling activities (SCARS Other Activities scale) and the discrepancy between actual and preferred intervention and “other” activities.

Prior to analysis of the research questions, correlations were conducted among the predictor and outcome variables. Identified predictors (i.e., years of experience, ASCA National Model training and ASCA National Model use) were also correlated with the SCARS criterion variables. For the hierarchical regression, identified predictors were entered first as a block, followed by the new predictors included in this study (Field, 2009). This predetermined order of entry is congruent with Cohen and Cohen’s (1993) recommendations for using hierarchical regression and entering the demographic variables in the initial step. Additionally, the order of entry reflected the principle of presumed causal priority (Cohen & Cohen, 1993; Petrocelli, 2003). For the second step, we decided to enter attachment anxiety prior to avoidance, as we anticipated it would be more important in predicting the outcome variables (Field, 2009). Reported effect size estimates reflect the following guidelines: r of .1 (small), .3 (medium) and .5 (large); and R2 of .01 (small), .09 (medium) and .25 (large; Cohen, 1988).

Results

We first examined the correlation among the identified school counselor demographic variables (control variables) and the actual and preferred SCARS variables. Years of experience showed a small but significant positive correlation with actual intervention activities (r = .20, p < .05). ASCA National Model use showed a moderate positive correlation with actual intervention activities (r = .44, p < .05), but smaller relationships with preferred intervention activities (r = .15, p < .05). Additional correlation analysis revealed relationships among school counseling experience and the main predictor variables that were of interest in this study. For example, years of experience showed a significant, although small, negative correlation to attachment anxiety (r = -.14, p < .05). Both attachment anxiety and avoid-
ance showed negative correlations to self-efficacy (r = -.20 and -.15, p < .05, respectively). Lastly, self-
efficacy showed a small positive correlation with years of experience (r = .25, p < .05) and ASCA National Model use (r =.27, p < .05).

Self-Efficacy Predicting Actual and Preferred Intervention and Other Activities
Multiple hierarchical regression analyses were conducted to determine if self-efficacy was positively associated with actual and preferred intervention activities, after controlling for demographic variables (see Table 1). Self-efficacy was the predictor variable and actual and preferred intervention activities were the criterion variables in separate analyses. Because years of experience, ASCA National Model training and ASCA National Model use were correlated with the SCARS criterion variables, these control variables were entered as a block prior to entering self-efficacy beliefs. The model for actual activities was significant: F(1, 506) = 112.37, p < .05, supporting the hypothesis. The standardized beta between self-efficacy and actual intervention activities was .40 and the effect size based on the adjusted R2 statistic indicated that 37% of the variance in actual activities was accounted for by self-efficacy, after blocking for the control variables, a large effect size. Results for preferred school counselor activities showed a similar result, as the model for preferred activities also was significant: F(1, 506) = 78.59, p < .05. The standardized beta between self-efficacy and preferred intervention activities was .39, and the adjusted R2 indicated 15% of the variance in preferred activities was accounted for by self-efficacy, after blocking for the control variables, a medium effect size.

Table 1.

Results from hierarchical multiple regression using self-efficacy to predict SCARS actual and preferred intervention activities

	Block 1				Block 2
Predictor Variable	B	SE B	β		B	SE B	β
Actual
Experience (years)	0.01	0.00	0.20*		0.01	0.01	0.10*
A.N.M. Training	-0.02	0.03	-0.60		-0.02	0.03	-0.03
A.N.M. Use	0.22	0.02	0.44*		0.17	0.02	0.34*
Self-Efficacy					0.45	0.04	0.40*
R²	0.23				0.37
F for change in R²	50.46*				112.37**
Preferred
Experience (Years)	0.00	0.00		0.04	-0.00	0.00	-0.05
A.N.M. Training	-0.00	0.03		-0.01	-0.01	0.03	-0.01
A.N.M. Use	0.06	0.02		0.15*	0.02	0.02	0.05
Self-Efficacy					0.37	0.04	0.39**
R²	0.02				0.15
F for change in R²	3.92*				78.59*

Note: Analysis N = 511 (actual & preferred); * p < .05. A.N.M. denotes ASCA National Model.

Similar hierarchical multiple regression analyses were conducted using school counselor self-efficacy as the predictor variable and “other” school counseling activities as the criterion variable, after controlling for demographic variables (see Table 2). The models for preferred and actual “other” activities were both significant; F(1, 506) = 20.89, p < .05; and F(1, 506) = 13.60, p < .05, respectively. The standardized beta for actual “other” activities was .21 and for preferred “other” activities was .17. Self-efficacy accounted for (R² =) 43% of the variance in actual “other” activities performed and (R² =) 33% of preferred “other” activities, indicating large effect sizes.
Table 2.

Results from hierarchical multiple regression using self-efficacy to predict SCARS actual and preferred “other” non-counseling activities

	Block 1			Block 2
Predictor Variable	B	SE B	β	B	SE B	β
Actual
Experience (Years)	0.00	0.00	0.02	-0.00	0.00	-0.03
A.N.M. Training	0.04	0.04	0.05	0.04	0.04	-0.05
A.N.M. Use	-0.04	0.03	-0.06	-0.07	0.03	-0.11
Self-Efficacy				0.29	0.06	0.21*
R²	0.00			0.43
F for change in R²	0.63			20.89*
Preferred
Experience (Years)	0.01	0.00	0.07	0.00	0.00	0.03
A.N.M. Training	-0.02	0.04	-0.03	-0.02	0.04	-0.03
A.N.M. Use	-0.00	0.03	-0.0	-0.00	0.03	-0.00
Self-Efficacy				0.22	0.06	0.17*
R²	0.02			0.33
F for change in R²	1.13			13.60**

Note: Analysis N = 511 (actual & preferred); * p < .05. A.N.M. denotes ASCA National Model.
Attachment Predicting Actual and Preferred Intervention and “Other” Activities
Hierarchical multiple regressions were used to assess the ability of attachment style to predict school counselor interventions and “other” non-counseling activities, after controlling for demographic variables. In our study, attachment style was measured by the ECR-Short Form (Wei et al., 2007) on two dimensions—attachment anxiety and avoidance. As in the regression analyses for counselor self-efficacy, years of experience, ASCA National Model training and ASCA National Model use were entered as a block prior to entering attachment anxiety and avoidance. Attachment anxiety, but not attachment avoidance, revealed predictive utility for the SCARS preferred intervention subscale scores, showing a negative relationship: F(1, 505) = 2.60, p < .05. The standardized beta for preferred intervention activities was -.11 and attachment anxiety accounted for only 2% of the variance for preferred intervention activities, a small effect size.

To test whether attachment anxiety was associated with discrepancies between a range of actual and preferred school counseling activities, separate regression analyses were performed. We used attachment anxiety and attachment avoidance as the predictor variables and the discrepancy score variables that were created by subtracting the actual from the preferred scores for the actual and preferred intervention activities and “other” activities subscales. As before, years of experience, ASCA National Model training and ASCA National Model use were correlated with the SCARS criterion variables and were entered as a block prior to entering the attachment variables. For intervention activities, a relationship was not supported for either attachment anxiety or attachment avoidance. However for the “other” non-counseling activities, a relationship between attachment anxiety and the actual/preferred discrepancy revealed a statistically significant result over and above that accounted for by demographic variables: F(1, 505) = 3.16, p < .05 with a standardized beta of .12. Therefore, attachment anxiety predicted a discrepancy that revealed a higher preference for performing “other” non-counseling activities. However, the effect size showed that anxiety accounted for only 1% of the variance in the “other” activities discrepancy score (see Table 3).

Table 3

Results from hierarchical multiple regression using attachment to predict SCARS intervention scores and the actual/prefer discrepancy scores for intervention and “other” activities

	Block 1						Block 2			Block 1			Block 2
Predictor Variable	B			SE B		β	B	SE B	β	B	SE B	β	B	SE B	β
	Intervention Actual									Intervention Discrepancy
Experience (years)	0.01		0.00		0.20*		0.02	0.00	0.19*	-0.01	0.00	-0.18*	-0.01	0.00	-0.18*
A.N.M. Training	-0.02		0.03		-0.03		-0.02	0.02	-0.02	0.01	0.03	0.02	0.02	0.03	0.02
A.N.M. Use	0.22		0.02		0.44*		0.22	0.02	0.44*	-0.16	0.02	-0.34*	0.16	0.02	0.34*
Anxiety							-0.03	0.02	-0.06				-0.01	0.02	-0.03
Avoidance							0.01	0.02	0.02				0.00	0.02	-0.01
R²			0.23				0.00			0.15			0.00
F for change in R²	50.46*						0.34			29.69*			0.33
	Intervention Preferred									“Other” Discrepancy
Experience (years)	0.00	0.00				0.04	0.00	0.03	0.02	0.04	0.03	0.06	0.03	0.03	0.04
A.N.M. Training	0.00	0.03				-0.01	0.00	0.03	0.00	-0.61	0.31	-0.10*	-0.57	0.31	-0.09
A.N.M. Use	0.06	0.02				0.15*	0.06	0.02	0.14*	0.57	0.24	0.12*	0.57	0.23	0.12*
Anxiety							-0.05	0.02	-0.11*				-0.58	0.23	0.12*
Avoidance							0.01	0.02	0.02				0.29	0.25	0.06
R²	0.02						0.01			0.02			0.01
F for change in R²	3.92*						2.6			3.21*			3.16*

Note: Analysis N = 511 (actual & preferred); * p < .05. A.N.M. denotes ASCA National Model.

Discussion

To date, few studies have examined how school counselor personal characteristics are linked to successful programs (Scarborough & Luke, 2008). Using a nationwide sample, we examined how self-efficacy is related to a range of school counselor activities in elementary schools and introduced attachment style as a potential variable related to school counselor practice. Years of experience working as a school counselor as well as the training in and use of the ASCA National Model in program implementation were identified from the literature as variables of importance and were included in our analyses.

As anticipated the number of years of experience was related to actual performance of intervention activities by school counselors. Also, school counselors in this sample who had received more training in the ASCA National Model were more likely to perform the intervention activities of counseling, consultation, curriculum and coordination. These activities are considered core activities for effective program implementation. Furthermore, counselors who endorsed more fully implementing the ASCA National Model within their program were significantly more likely to perform these core intervention activities and also indicated a preference for spending their time in these activities. This result is in line with previous findings supporting that counselors who incorporated the National Standards for School Counseling Programs (Campbell & Dahir, 1997) into their programs were more likely to have preferences that aligned with professional standards and actually practiced as they preferred (Scarborough & Culbreth, 2008). It is promising that over 75% of school counselors in the current study reported some use to extensive use of the ASCA National Model. The large number of counselors who reported ASCA National Model use could be indicative of a recent focus to define standards of practice and increase positive student outcomes through systematic and programmatic delivery. With regard to non-counseling activities, results did not support a relationship with ASCA National Model training and use.

Looking beyond the demographic variables, the findings of the current study support previous research that found important links between school counselor self-efficacy beliefs and program implementation (Bodenhorn, Wolfe, & Airen, 2010). In the current study, overall school counselor self-efficacy beliefs predicted the delivery of activities aligned with the ASCA National Model above and beyond the demographic variables analyzed. School counselors who believed they were capable of performing in accordance with activities aligned with the ASCA National Standards were more likely to actually perform and want to perform school counseling intervention activities consistent with the ASCA National Model.

It is interesting to note that school counselors with higher self-efficacy beliefs were more likely to perform non-counseling activities when compared to counselors with lower self-efficacy. These results suggest that counselors with higher levels of self-efficacy beliefs may not discriminate between intervention and “other” non-counseling activities, by performing both more frequently. Highly efficacious school counselors may simply do more, whether or not the activity aligns with ASCA recommendations. As demands for school counselors increase and current expectations for school counselors do not perfectly align with professional best practices (Cinotti, 2014), highly efficacious school counselors may tackle all duties earnestly in order to address their responsibilities.

In the current study, attachment anxiety negatively predicted school counselor preferred engagement in intervention activities (i.e., counseling, consultation, curriculum, coordination), indicating that anxiously attached school counselors actually preferred to perform fewer intervention activities. Additionally, school counselor attachment anxiety predicted a discrepancy between actual and preferred activities that are considered outside the scope of school counseling practice, including clerical, administrative and fair share responsibilities. When considering the relationship between attachment anxiety and this discrepancy, which revealed a higher preference for performing these “other” activities, there are a few possible explanations. Perhaps anxiously attached counselors reporting a greater discrepancy on the “other” subscale find it more difficult to align their identity with the counseling professional identity model promoted by ASCA. Although these non-counseling activities do not align with ASCA recommendations, they are nevertheless expected and valued by supervisors. Research has suggested that anxiously attached individuals may tend to take on additional work obligations as a way to please others and tend to be motivated by approval of colleagues and supervisors (Hazan & Shaver, 1987). Additionally, anxiously attached workers seek close relationships with their colleagues and supervisors and have more difficulty resisting unreasonable demands in the workplace (Leiter, Day, & Price, 2015). Given that school administrators directly influence the assignment of inappropriate duties performed by school counselors, and that strong advocacy and leaderships skills are essential to negotiate an identity and role that is more aligned with ASCA recommendations (Cinotti, 2014), anxiously attached school counselors may find it more difficult to test those relationships and may instead endorse the identity expected by their supervisors. Indeed, the literature points out that school administrators perceive school counselors as operating mainly from an educator—versus a counselor—professional identity (Cinotti, 2014).

There was a low variability in attachment scores of this particular sample (i.e., school counselors endorsed relatively high levels of self-efficacy and low levels of attachment insecurity), which could have contributed to the results of this research. Within the clinical training component of their education, school counselors are taught the importance of ongoing self-exploration and to develop awareness of their responses within the context of clinical practice. It is possible that education and training in the importance of self-awareness could interrupt effects on school counselor practice that are related to higher levels of attachment anxiety.

Counselors in this sample consistently indicated that they preferred to spend more time in intervention activities that are in keeping with best practices and are related to positive outcomes for students and preferred to spend less time in non-counseling related activities. When compared to other research using the SCARS, they also reported engaging in fewer non-counseling activities. As performing non-counseling activities is associated with burnout in school counselors (Bardhoshi et al., 2014), this is a positive finding that might be reflective of the current direction of the profession.

Study Limitations

The potential for self-selection and social desirability bias was a limitation of this study. Only elementary school counselors who were ASCA members were invited to participate. It is possible that those members who did volunteer to participate may differ in a variety of ways from those individuals who did not respond. Given the $115 membership fee to join the association, it is possible that counselors from wealthier school districts, with higher salaries or access to a counseling budget assisting with the membership fee, are more heavily represented. School counselors who chose to become members of ASCA may vary distinctly in work-related performance, self-efficacy beliefs and attachment style than those counselors who chose not to become members of the association. ASCA members likely have more professional development opportunities and more exposure to information regarding best practices, which could impact both their self-efficacy beliefs and practice.

Despite our use of multiple contact procedures to obtain an acceptable response rate, a limitation worth noting is the lower response rate. Lower response rates are often noted for online surveys (Dillman, Smyth, & Christian, 2014), including in the field of counseling (Granello & Wheaton, 2004). Although we received over 200 undeliverable e-mails, which reduced the original sample size, there is no way to accurately estimate how many individuals actually received the survey in their inbox (Granello & Wheaton, 2004). It is indeed possible that spam-filtering software resulted in many invitations not reaching their intended recipients. Therefore, our reported response rate represents a conservative estimate (Vespia, Fitzpatrick, Fouad, Kantamneni, & Chen, 2010). In addition, it was assumed that the attrition of 100 participants was likely the result of the time required to complete the survey. Our analysis supported that there were no statistically significant differences between the two groups (i.e., completers and non-completers) on demographic variables and that our final sample size was adequate for the selected statistical tests. However, readers should use caution when generalizing the results of this study to all elementary school counselors. A final consideration is that causal relationships cannot be derived from the results of this study, as the research design was relational in nature.

Implications for School Counseling Practice
Previous studies have indicated that higher levels of school counselor self-efficacy are positively associated with higher levels of comprehensive program implementation (Bodenhorn et al., 2010). For many, the route to increased self-efficacy is through personal and vicarious accomplishments (Bodenhorn et al., 2010; Scarborough & Culbreth, 2008; Sutton & Fall, 1995). Therefore, opportunities to learn and practice the skill set specific to school counseling must be promoted in the education and training of students.

School counselor educators have a crucial role in ensuring that future school counselors have a strong foundation with which to begin their careers. Counselor education programs have often not provided adequate preparation for school counselors because there has been incongruence between their training and their actual roles in schools (McMahon, Mason, & Paisley, 2009). A novice school counselor who has had education and training that is consistent with his or her actual work role will have greater chances of acquiring increased self-efficacy from the start. In a cascade, self-efficacy will likely promote stronger program implementation and, in turn, positive student outcomes.

More specifically, requiring trainees to provide a range of services will support the transition from training to work. Trainees need opportunities to provide specific interventions (e.g., counseling individuals and groups, teaching classroom lessons) while also evaluating the impact of these interventions, teaching them how to use data in their programs and potentially boosting self-efficacy beliefs (Akos & Scarborough, 2004). Trainees should also be given opportunities to engage in coordination activities to gain experience in the organizational aspects of a comprehensive developmental school counseling program. Finally, counselor educators who supervise internship courses must maintain strong communication with site supervisors to ensure continuity and appropriate trainee experiences.

Although effect sizes related to attachment characteristics in this study were small, they imply that attachment theory could be a useful adjunct to understanding school counselor practice. Using attachment concepts as a guide for supervision or structured professional development opportunities could assist school counselors’ ongoing efforts to understand their own behavior and motivations in the work setting. Graduate coursework specific to attachment constructs has the potential to be a useful component of school counselor education, especially because the cultivation of healthy interpersonal relationships has a tremendous potential to facilitate positive change in schools.

Recommendations for Future Counseling Research
The moderately strong association in this study between school counselor self-efficacy and activities recommended by the ASCA National Model indicates that understanding the factors affecting school counselor self-efficacy warrants further attention. Research outside the field of school counseling has identified a positive relationship between attachment security and higher levels of competence and self-efficacy beliefs (Mikulincer & Shaver, 2007). Given that self-efficacy was significantly negatively correlated to both attachment anxiety and avoidance in this study, additional studies examining these relationships may clarify possible connections between school counselor self-efficacy beliefs and attachment characteristics. We did not examine whether SCSE subscales were differentially related to school counselor activities. Doing so could identify professional areas about which counselors feel most efficacious and those that need bolstering. Explaining the reasons some school counselors perform more successfully is an enduring goal of counseling research (Sutton & Fall, 1995).

Our results did indicate significant relationships between attachment anxiety and school counselor practice. Specifically, attachment anxiety predicted a lower preference for intervention activities, as well as a discrepancy between actual and preferred “other” non-counseling activities that revealed a higher preference for performing them. Although small, these results could lead to further understanding of the factors related to differences in school counselor practice. As this study has taken a broad view of how school counselor practice could be affected by attachment dimensions, qualitative studies examining the unique experiences of anxiously attached counselors in their work environment have the potential to reveal important perspectives. Identifying how attachment style may contribute to the endorsement and performance of specific intervention activities could lead to a greater understanding of school counseling practice.

Conflict of Interest and Funding Disclosure

The authors reported no conflict of interest

or funding contributions for the development

of this manuscript.

References

Akos, P., & Scarborough, J. L. (2004). An examination of the clinical preparation of school counselors. Counselor Education and Supervision, 44, 96–107. doi:10.1002/j.1556-6978.2004.tb01863.x

American School Counselor Association. (2003). The ASCA national model: A framework for school counseling programs. Alexandria, VA: Author.

American School Counselor Association. (2012). The ASCA national model: A framework for school counseling programs (3rd ed.). Alexandria, VA: Author.

Bandura, A. (1996). Ontological and epistemological terrains revisited. Journal of Behavior Therapy and Experimental Psychiatry, 27, 323–345. doi:10.1016/S0005-7916(96)000493

Bardhoshi, G., Schweinle, A., & Duncan, K. J. (2014). Understanding the impact of school factors on school counselor burnout: A mixed methods study. The Professional Counselor, 4, 426–443.

Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61, 226–244. doi:10.1037/0022-3514.61.2.226

Bemak, F., & Chung, R. C.-Y. (2008). New professional roles and advocacy strategies for school counselors: A multicultural/social justice perspective to move beyond the nice counselor syndrome. Journal of Counseling & Development, 86, 372–381.

Bodenhorn, N., & Skaggs, G. (2005). Development of the School Counselor Self-Efficacy Scale. Measurement and Evaluation in Counseling and Development, 38, 14–28.

Bodenhorn, N., Wolfe, E. W., & Airen, O. E. (2010). School counselor program choice and self-efficacy: Relationship to achievement gap and equity. Professional School Counseling, 13, 165–174.

Brennan, K. A., Clark, C. L., & Shaver, P. R. (1998). Self-report measurement of adult attachment: An integrative overview. In J. A. Simpson & W. S. Rholes (Eds.), Attachment theory and close relationships (pp. 46–76). New York, NY: Guilford Press.

Burnham, J. J., & Jackson, C. M. (2000). School counselor roles: Discrepancies between actual practice and existing models. Professional School Counseling, 4, 41–49.

Campbell, C. A., & Dahir, C. A, (1997). Sharing the vision: The national standards for school counseling programs. Alexandra, VA: American School Counselor Association Press.

Carey, J., & Dimmitt, C. (2012). School counseling and student outcomes: Summary of six statewide studies. Professional School Counseling, 16, 146–153.

Cinotti, D. (2014). Competing professional identity models in school counseling: A historical perspective and commentary. The Professional Counselor, 4, 417–425.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.

Cohen, J., & Cohen, P. (1993). Applied multiple regression/correlation analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.

Dahir, C. A. (2004). Supporting a nation of learners: The role of school counseling in educational reform. Journal of Counseling & Development, 82, 344–353.

Desivilya, H. S., Sabag, Y., & Ashton, E. (2006). Prosocial tendencies in organizations: The role of attachment styles and organizational justice in shaping organizational citizenship behaviour. International Journal of Organizational Studies, 14, 22–42. doi:10.1108/10553180610739731

Dillman, D. A., Smyth, J. D., & Christian, L. M. (2014). Internet, mail, and mixed-mode surveys: The tailored design method (4th ed.). New York, NY: Wiley.

Dozier, M., Lomax, L., Tyrrell, C. L., & Lee, S.W. (2001). The challenge of treatment for clients with dismissing states of mind. Attachment and Human Development, 3, 62–76.

Erford, B. T. (2016). Professional school counseling: Integrating theory and practice into a data-driven, evidence-based approach. In B. T. Erford (Ed.), Professional School Counseling: A Handbook of Theories, Programs, and Practices (3rd ed., pp. 3–8). Austin, TX: ProEd.

Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41, 1149–1160. doi:10.3758/BRM.41.4.1149

Field, A. P. (2009). Discovering statistics using SPSS (3rd ed.). Los Angeles, CA: Sage.

Fitch, T. J., & Marshall, J. L. (2004). What counselors do in high-achieving schools: A study on the role of the school counselor. Professional School Counseling, 7, 172–179.

Foster, L. H., Young, J. S., & Hermann, M. (2005). The work activities of professional school counselors: Are the national standards being addressed? Professional School Counseling, 8, 313–321.

Granello, D. H., & Wheaton, J. E. (2004). Online data collection: Strategies for research. Journal of Counseling & Development, 82, 387–393.

Gysbers, N. C., & Henderson, P. (2012). Developing and managing your school guidance program (5th ed.). Alexandria, VA: American Counseling Association.

Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511–524. doi:10.1037/0022-3514.52.3.511

Judge, T. A., & Bono, J. E. (2001). Relationship of core self-evaluations traits—self-esteem, generalized self-efficacy, locus of control, and emotional stability—with job satisfaction and job performance: A meta-analysis. Journal of Applied Psychology, 86, 80–92. doi:10.1037//0021-9010.86.1.80

Kennedy, J. H., & Kennedy, C. E. (2004). Attachment theory: Implications for school psychology. Psychology in the Schools, 41, 247–259. doi:10.1002/pits.10153

Lapan, R. T., Gysbers, N. C., & Petroski, G. F. (2001). Helping seventh graders be safe and successful: A statewide study of the impact of comprehensive guidance and counseling programs. Journal of Counseling & Development, 79, 320–330. doi:10.1002/j.1556-6676.2001.tb01977.x

Larson, L. M., & Daniels, J. A. (1998). Review of counseling self-efficacy literature. The Counseling Psychologist, 26, 179–218. doi:10.1177/0011000098262001

Leiter, M. P., Day, A., & Price, L. (2015). Attachment styles at work: Measurement, collegial relationships, and burnout. Burnout Research, 2, 25–35.

Lent, R. W., & Hackett, G. (1987). Career self-efficacy: Empirical status and future directions. Journal of Vocational Behavior, 30, 347–382. doi:10.1016/0001-8791(87)90010-8

Lopez, F. G., & Brennan, K. A. (2000). Dynamic processes underlying adult attachment organization: Toward an attachment theoretical perspective on the healthy and effective self. Journal of Counseling Psychology, 47, 283–300. doi:10.1037/0022-0167.47.3.283

Mallinckrodt, B. (2000). Attachment, social competencies, social support, and interpersonal process in psycho-therapy. Psychotherapy Research, 10, 239–266. doi:10.1093/ptr/10.3.23

Marotta, S. A. (2002). An ecological view of attachment theory: Implications for counseling. Journal of Counseling & Development, 80, 507–510.

McCarthy, C. J., Kerne, V. V. H., Calfa, N. A., Lambert, R. G., & Guzmán, M. (2010). An exploration of school

counselors’ demands and resources: Relationship to stress, biographic, and caseload characteristics.

Professional School Counselor, 13, 146–158.

McMahon, H. G., Mason, E. C. M., & Paisley, P. (2009). School counselor educators as educational leaders promoting systemic change. Professional School Counseling, 13, 116–124. doi:10.5330/PSC.n.2010-13.116

Mikulincer, M., & Shaver, P. R. (2003). The attachment behavioral system in adulthood: Activation, psycho-dynamics, and interpersonal processes. In M. P. Zanna (Ed.), Advances in experimental social psychology (Vol. 35, pp. 53–152). New York, NY: Academic Press.

Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. New York, NY: Guilford Press.

Mikulincer, M., Shaver, P. R., & Pereg, D. (2003). Attachment theory and affect regulation: The dynamics, development, and cognitive consequences of attachment-related strategies. Motivation and Emotion, 27, 77–102. doi:10.1023/A:1024515519160

Petrocelli, J. V. (2003). Hierarchical multiple regression in counseling research: Common problems and possible remedies. Measurement and Evaluation in Counseling and Development, 36, 9–22.

Pfaller, J. E., & Kiselica, M. S. (1996). Implications of attachment theory for the role of school counselors. The School Counselor, 43, 208–217.

Scarborough, J. L. (2005). The School Counselor Activity Rating Scale: An instrument for gathering process data. Professional School Counseling, 8, 274–283.

Scarborough, J. L., & Culbreth, J. R. (2008). Examining discrepancies between actual and preferred practice of school counselors. Journal of Counseling & Development, 86, 446–459. doi:10.1002/j.1556-6678.2008.tb00533.x

Scarborough, J. L., & Luke, M. (2008). School counselors walking the walk and talking the talk: A grounded theory of effective program implementation. Professional School Counseling, 11, 404–416.

Shillingford, M. A., & Lambie, G. W. (2010). Contribution of professional school counselors’ values and leader-

ship practices to their programmatic service delivery. Professional School Counseling, 13, 208–217. doi:10.5330/PSC.n.2010-13.208

Sink, C. A., & Stroh, H. R. (2003). Raising achievement test scores of early elementary school students through comprehensive school counseling programs. Professional School Counseling, 6, 350–364.

Sink, C. A., & Yillik-Downer, A. (2001). School counselors’ perceptions of comprehensive guidance and counsel-ing programs: A national survey. Professional School Counseling, 4, 278–288.

Stajkovic, A., & Luthans, F. (1998). Self-efficacy and work-related performance: A meta-analysis. Psychological Bulletin, 124, 240–261. doi:10.1037/0033-2909.124.2.240

Sutton, J. M., Jr., & Fall, M. (1995). The relationship of school climate factors to counselor self-efficacy. Journal of Counseling & Development, 73, 331–336.

Vespia, K. M., Fitzpatrick, M. E., Fouad, N. A., Kantamneni, N., & Chen, Y.-L. (2010). Multicultural career counseling: A national survey of competencies and practices. The Career Development Quarterly, 59, 54–71. doi:10.1002/j.2161-0045.2010.tb00130.x

Wei, M., Russell, D. W., Mallinckrodt, B., & Vogel, D. L. (2007). The Experiences in Close Relationship Scale (ECR)-Short Form: Reliability, validity, and factor structure. Journal of Personality Assessment, 88, 187–204. doi:10.1080/00223890701268041

Whiston, S. C., Tai, W. L. , Rahardja, D., & Eder, K. C. (2011). School counseling outcome: A meta-analytic

examination of interventions. Journal of Counseling & Development, 89, 37–55.
doi:10.1002/j.1556-6678.2011.tb00059.x

Wilkerson, K., & Bellini, J. (2006). Intrapersonal and organizational factors associated with burnout among school counselors. Journal of Counseling & Development, 84, 440–450. doi:10.1002/j.1556-6678.2006.tb00428.

Kimberly Ernst is a counselor in independent practice in Washington, DC. Gerta Bardhoshi, NCC, is an Assistant Professor at the University of Iowa. Richard P. Lanthier is an Associate Professor at George Washington University. Data for this article originated from the first author’s doctoral dissertation. Correspondence can be addressed to Gerta Bardhoshi, College of Education, N352 Lindquist Center, Iowa City, IA 52242-1529, gerta-bardhoshi@uiowa.edu.

The SuperSkills Model: A Supervisory Microskill Competency Training Model

May 18, 2017 | Volume 7 - Issue 3

Dusty Destler

Streamlined supervision frameworks are needed to enhance and progress the practice and training of supervisors. This author proposes the SuperSkills Model (SSM), grounded in the practice of microskills and supervision common factors, with a focus on the development and foundational learning of supervisors-in-training. The SSM worksheet prompts for competency-based supervisory behaviors from pre-session to post-session, highlighting a culturally aware supervisory relationship; goals and tasks; and feedback and reflection. The versatility of the SSM allows for utility in various settings, accommodates supervisor developmental level, and may be used to evaluate supervisor-in-training development.

Keywords: supervision, supervisors-in-training, SuperSkills Model, microskills, common factors

The profession of counseling has experienced an evolution regarding counseling training methods over the past decades (Capuzzi & Gross, 2009). Compared to literature on training counselors, literature on training supervisors has received less attention and the topic is less understood (Watkins, 2010). Thus, it is not surprising that systems of development for counselors-in-training (CITs) are more advanced than systems for supervisors-in-training (SITs; Watkins, 2010). For example, Ivey, Normington, Miller, Morrill, and Haase (1968) introduced microskills to the field of mental health care, and after four decades, the approach remains a training prototype (Ridley, Kelly, & Mollen, 2011); yet supervisors still lack a standard training model (Watkins, 2012b). Although much overlap exists in counseling and supervision tasks, the process of supervision adds more skill complexity than clinical tasks alone (Pearson, 2000). Further complicating the situation, many clinicians have assumed supervisory positions without training (Knapp & VandeCreek, 1997). Research has found that many supervisors feel incompetent and could be well-served by more supervisory training (Uellendahl & Tenenbaum, 2015).

A movement toward efficient methods of training supervisors should be informed by existing theory. Identifying with a theoretical model is paramount to facilitating growth in CITs (Lampropoulos, 2003). Various models of supervision have been proposed. Bernard and Goodyear (2014) broadly delineated first-wave supervision models into one of three categories: models grounded in psychotherapy theory, developmental models, and process models. Second-wave models are more eclectic, with the ability to combine or cycle between first-wave models as needed. The third-wave models reflect a common-factors approach, gleaning substantiated elements of supervision from the literature to amalgamate into a best-practices method (Bernard & Goodyear, 2014). Despite the combined breadth of models, there remains a lack of knowledge on what constitutes sound supervisory training, signifying the need for consolidation and movement toward supervisory competency models (Milne, Reiser, Cliffe, & Raine, 2011). Established theories of supervision may be enhanced when translated through microskills, which focus on specific behaviors to link theory and practice (Ivey, 1971; Ivey et al., 1968).

Any model that is chosen or created for effective supervisory training should be competency-based, and microskills may be a viable option. The microskills approach has been adapted for the training of supervisors with successful outcomes (James, Milne, & Morse, 2008; Richardson & Bradley, 1984; Russell-Chapin & Ivey, 2004), and there has been a call in the profession to move toward more competency-based forms of supervisor training (Milne et al., 2011). The SuperSkills Model (SSM) proposed in this article combines microskills training with supervision common factors to create a framework with which to enhance the development and training of supervisors. The SSM worksheet provides a consolidated and user-friendly tool to assist with the supervision of SITs (please contact the author for a copy of the worksheet).

A Brief Background of Microskills

The use of microskills as a training instrument was born from the world of education. Succinctly, microtraining uses a systematic format to teach individual helping skills and may utilize recordings of practice, step-by-step training, and self-observation (Ivey et al., 1968). Fortune, Cooper, and Allen (1967) simplified and codified teaching skills into a model they called micro-teaching, aiming to provide students with an introduction to the experience and practice of teaching. The model provided experienced teachers with a vehicle for training novice teachers and gave the research team more control to track training effects.

When Ivey and colleagues (1968) introduced microskills within mental health care, they proposed the training of microcounseling, which focused on the specific behaviors of counseling skills, as useful in counselor education for the quick and effective teaching of counselor trainees. Ivey and colleagues’ adaptation of microskills to the mental health field allowed counselor preparation programs to move from nebulous training techniques to a more systematic approach, providing supervisors with a more delineated method to track trainees’ progress in actual skill behaviors. The structured method of tracking progress assists supervisors in the process of gatekeeping, making it easier to filter out candidates with difficulties or barriers to learning the core counseling skills (Lambie & Ascher, 2016).

The concept of utilizing microskills in the process of training supervisors has been broached by other researchers. Richardson and Bradley (1984) combined microskills and supervision training to create a microsupervision model, which breaks down the supervision skill acquisition process to assessment, modeling, and transfer. These three stages suggest how an SIT’s supervisor identifies skill areas for growth, provides educative and corrective information to the SIT, and allows the SIT opportunities to integrate and display new skills. Russell-Chapin and Ivey (2004) utilized microskill design to develop the Microcounseling Supervision Model (MSM). The Counselling Interview Rater Form (CIRF) is a component of the MSM, which breaks down the counseling session into stages that are then comprised of specific skills to be assessed (Russell-Chapin & Ivey, 2004). The MSM is a useful tool to practice providing constructive feedback, because the CIRF “is mostly used as a method of providing positive, corrective, qualitative and quantitative feedback for supervisees” (Russell-Chapin & Ivey, 2004, p. 167). James, Milne, & Morse (2008) adapted microskills to the dialogue used by supervisors within a cognitive-behavioral supervisory approach. These models can be useful in the development of supervisors; however, there is a need for the creation of a supervision model that rises above current approaches, yet provides enough focus to be specific to clinical supervision (Morgan & Sprenkle, 2007). The proposed SSM acts to fill potential deficiencies by balancing focus between more detailed supervisory actions and a wider breadth of supervisory behaviors.

The Progression of Supervision Models

Clinical supervision is recognized in the mental health professions as the signature pedagogy (Barnett, Erickson Cornish, Goodyear, & Lichtenberg, 2007; Goodyear, Bunch, & Claiborn, 2006). Introducing students to the foundational skills within mental health care has been a practice of supervisors for over 40 years (Ridley et al., 2011). Different professions within mental health care vary in job function and purpose, but the skills, processes, and objectives of supervision remain somewhat uniform across disciplines and cultures (Bernard & Goodyear, 2014). Supervision as an intervention shares characteristics with other interventions—namely teaching, psychotherapy, and consultation—yet is distinct (Milne, 2006). The unique aspects of supervision include the propensity to be provided by and to individuals in the same profession, an evaluative and hierarchical nature, and an extension over time (Bernard & Goodyear, 2014).

The process of supervision is often referred to as isomorphic, meaning that the relationship between client and counselor is often similar in structure to the concurrent relationship between counselor and supervisor (Koltz, Odegard, Feit, Provost, & Smith, 2012). However, this triadic configuration does not take a fourth entity into account: the relationship between the supervisor and the supervisor’s supervisor. This lapse is partially because of the underrepresentation of supervisory training knowledge in the counseling literature (Richardson & Bradley, 1984).

Another parallel between counseling and supervision is the utilization of theory to inform practice. Models of supervision may be classified in a number of ways. Bernard and Goodyear (2014) broadly delineated first-wave supervision models into one of three categories: models grounded in psychotherapy theory, developmental models, and process models. Psychotherapy-based models utilize psychotherapy’s theoretical approaches as a framework for use in supervision. Choice of psychotherapy-based models is often informed by the supervisor’s theoretical approach when in the counselor role. Familiarity with one’s own theory may provide the supervisor a level of comfort and an added sense of competence. Developmental models focus on the developmental needs of the CIT based on the status, pace, or standard of professional development. Focus on individual development allows the supervisor to tailor interventions to the current needs of the supervisee. Also, under the developmental model umbrella, models of social roles take further consideration of CIT contextual needs, based on such factors as cultural or experiential background (Aten, Strain, & Gillespie, 2008). Process models focus on the process within each supervision session, spotlighting the relationship and interactions between supervisor and CIT. Bernard and Goodyear (2014) proposed that these broad categories are best utilized in conjunction with one another.

From the broad first-wave supervision models, Bernard and Goodyear (2014) identified second-wave models of the next generation: combined models and target-issue models. Combined supervision models may blend multiple approaches within one of the above three categories (e.g., two psychotherapy theories) or between the above three categories (e.g., one developmental model and one process model). This approach may allow supervisors to provide what is needed to themselves and their supervisees within the supervisory process. Target-issue models hone in on specific elements or needs within supervision. These may be helpful to supervisors who need a more direct, concentrated approach to address a specific issue that arises in supervision.

Third-wave models have emerged from continued research on specific supervision models, providing an index of evidence from which supervisors and researchers may benefit. A paucity of evidence for efficacy between supervision models has created a movement toward gleaning aspects found to be effective within supervision models (Sprenkle, 1999). Supervisory common factors refer to core components that remain consistent when cutting across models and perspectives (Watkins, Budge, & Callahan, 2015). Integrating different approaches to create common-factors models hinges on the assumption that supervision models are unique; by borrowing strengths from multiple models, new frameworks may be created to fill in weaknesses (Lampropoulos, 2003). For example, Lampropoulos (2003) used the notion of eclecticism by blending common supervisory pathways, stages, and processes to make a case for the incorporation of empirically validated practices both within and outside mental health care. Morgan and Sprenkle (2007) provided a similar process, utilizing broader supervision models and popular supervision conceptualizations to create a model focused on relationship, development, and role continuums in the supervisory position. Aten et al. (2008) described an integrative model that they referred to as transtheoretical.

The Case for Systematizing Supervisor Training

Aside from choosing a model of supervision, there are other elements that affect supervisory development. There are two environments supervisors practice within. Some assume the role in settings that primarily serve the public, acting as a supervisor to clinicians or interns working directly with clients. Others supervise in academic settings, primarily supervising the development of novice counseling students.

A large percentage of mental health professionals will ultimately act in a supervisory role (Norcross, Hedges, & Castle, 2002). This circumstance makes it especially perplexing that counseling professionals receive only minimal supervisory training (Pelling, 2008) and oftentimes no training at all (DeKruyf & Pehrsson, 2011). Supervisors are frequently placed into supervisory positions to learn on the job (Knapp & VandeCreek, 1997). Gonsalvez (2008) referred to this route of becoming a supervisor via the maxim see one, do one, teach one. When training does take place, it may come in the form of didactic (e.g., seminars, workshops, class instruction) or experiential (e.g., supervision of supervision) means (Watkins, 2012a). However, inconsistencies in training requirements for supervisors have been documented as recently as 2014 (Nate & Haddock, 2014). The Center for Credentialing & Education, an affiliate of the National Board for Certified Counselors, established the Approved Clinical Supervisor (ACS) credential, with 15 states having adopted the requirements as of 2016 (Center for Credentialing & Education, 2016). The compulsory conditions of becoming a supervisor still vary greatly.

Becoming a supervisor has developmental hurdles parallel to those of becoming a counselor (Milne, 2006). Processes and activities in both may look identical (Aten, Madson, & Kruse, 2008; Burns & Holloway, 1990). Encountering the shift in perspective from mental health practitioner to mental health supervisor can be troublesome (Watkins, 2013). SITs may experience feelings of anxiety and demoralization, trouble with forming a supervisory identity, and difficulty finding conviction about the meaningfulness of supervision (Watkins, 2013). Not unlike novice counselors, novice supervisors deal with the juggling of new skills and awareness, the discomfort of trying to find one’s own style, and self-doubt (Gazzola, De Stefano, Thériault, & Audet, 2013). These challenges may account for supervision models that aim to utilize SITs’ inherent therapeutic skills (Pearson, 2006).

The role of supervisor adds layers of responsibility that may not be present in the role of counselor alone. Counselors are responsible for advocating on behalf of clients (American Counseling Association [ACA], 2014); however, supervisors advocate for clients and CITs. The dual role of advocacy places the supervisor in the role of gatekeeper of the profession, charged with CIT development and the well-being of clients (Gaete & Ness, 2015). Balancing the duality of advocacy and evaluation may be taxing on new supervisors (Johnson, 2007).

The added responsibility of the supervisory role ushers in ethical issues beyond those incurred by clinicians alone (Rubin, 1997). Practitioners placed unwillingly into the supervisory role with little interest in the practice of supervision may pose a threat to the development of clinicians and future supervisors (Ladany, Mori, & Mehr, 2013). If trained in supervision by someone lacking passion for the practice, the meaningfulness of supervision is unlikely to be transmitted to the SIT (Watkins, 2013). It is more ideal to develop a supervisory identity while surrounded by others in a similar learning process (Watkins, 2013), a dynamic that may not be present for practitioners in the field learning new skills of supervision.

Essential Supervisory Microskills: The SuperSkills Model (SSM)

The purpose of the SSM is to fill the need for a functional training model focused on supervisory behaviors gleaned from the supervision literature and deemed to be common across research. The focus is less on (but may be combined with) conceptualizations of supervisor theory and roles, and more on practical utility of supervisory behavior and process before, during, and after a given supervision session. The goal of the SSM worksheet and each of the foci is to help SITs integrate important aspects of supervision into each session. With this approach and tool, SITs are not left to remember all topics simultaneously; instead, the checklist included in the worksheet assists with staying on task and works toward laying the foundation for more adept integration of key supervisory factors as SITs gain more experience. The SSM worksheet may be utilized in a checklist or written fashion, incorporated into necessary supervision notes for documentation purposes, and completed to varying degrees of formality. Depending on supervisory style, the worksheet may be used during a supervision session or supervision-of-supervision meeting, or outside of these (prior to and/or after session). The SSM worksheet also can be used as a tool for supervisors to track individual progress and accordance with supervisory common factors. Generally speaking, the SSM and its worksheet can be adapted to meet the needs of the individual and environmental context.

Within the SSM, there is an assumption that appropriate preparation has taken place prior to or concurrently with supervision (e.g., supervisory training, development of a supervision contract, continued growth toward approach and identity/style, alignment with a model or structure, vetting of supervisees, ethical and legal considerations). These assumptions suggest that the SSM is not a stand-alone method for teaching and learning supervision, but rather a means to assist the foundational learning of SITs and provide supervisors at any stage in development with continued prompting of current supervisory focal points. As new potential supervisory common factors emerge from the literature, focal points may be altered or added. The first element of the current SSM is a pre-session contemplation that encourages intentionality and consideration of focus in an upcoming supervision session. The second component of the SSM emphasizes tangible supervisory behaviors that work toward creating and fostering a strong supervisory relationship hinging on cultural interest and awareness. The third facet of the SSM highlights supervisory goals and tasks and differentiates between practical and process goal and task foci. Feedback and reflection is the SSM’s fourth dimension, which also gives consideration to SIT response to practical and process events, and includes attention to direct and indirect feedback and positive and constructive feedback. The final item of the SSM is post-session reflection, which allows for assessment of the supervision session. SITs may use this portion of the SSM to evaluate supervisory skill, consider future areas for focus, and document concerns or needs regarding the CIT.

Pre-Session

The first component of the SSM is pre-session reflection. Prior to beginning a supervision session, it may be necessary for an SIT to refer to notes from previous sessions to recall past areas of focus or pressing issues. A CIT may be working on specific counseling skills chosen for review in the upcoming supervision session and SITs need to be mindful of the focus for the session. The focus also includes supervisory skills that the SIT plans to intentionally practice, which should be written in the initial pre-session consideration on the worksheet. However, flexibility is necessary; when CITs experience difficult client presentations, such as suicidal ideation, SITs may need to adjust focus to best serve the development of the CIT and the supervisory environment (Hoffman, Osborn, & West, 2013). As client welfare falls on the shoulders of both the CIT and the supervisor, there may be a need for SITs to inquire for updates in matters that have legal implications (Branson, Cardona, & Thomas, 2015).

Coming into session considering one’s theoretical stance and supervisory style can be beneficial. Even though supervision is highly contextual with many areas to consider, supervision models act as a conceptual map to follow during sessions (Bernard & Goodyear, 2014). The “newness” of the supervisory role and the added layers of awareness may not equate to seamless use of a supervision model; however, using intention in supervision with regard to theory and style may aid continued understanding and improvement as a supervisor. The second pre-session consideration allows SITs to document intentions related to supervisory model, theory, or role.

Culturally Conscious Supervisory Relationships

The SSM’s second component is creating and maintaining a relationship with a focus on cultural factors. The supervisory relationship is a significant mediating factor for successful supervision outcomes (Ellis, 1991). Not only is supervisor focus on culture correlated with positive supervisory relationships (Schroeder, Andrews, & Hindes, 2009; Wong, Wong, & Ishiyama, 2013), but emphasizing culture fulfills the supervisor’s responsibility to facilitate deeper awareness of cultural realities for supervisees (Fukuyama, 1994). Bordin (1983) conceptualized the supervisory relationship as the emotional bond between supervisor and supervisee and one of the triadic components in the supervisory working alliance (SWA). When SITs bring cultural considerations into supervision, stronger SWAs are created (Bhat & Davis, 2007; Crockett & Hays, 2015). Consequently, a lack of comfort in the supervisory relationship may create a less conducive atmosphere for broaching cultural dialogues (White-Davis, Stein, & Karasz, 2016). The SWA positively affects the therapeutic alliance (DePue, Lambie, Liu, & Gonzalez, 2016), CIT satisfaction with supervision (Crockett & Hays, 2015), CIT willingness to disclose information (Gunn & Pistole, 2012; Mehr, Ladany, & Caskie, 2010), and CIT work satisfaction (Sterner, 2009).

The supervisory relationship is a large component of the SWA, and thus correlations of the SWA on other important supervisory factors may have bearing on building cultural relationships. SITs initiating productive conversations surrounding counseling self-efficacy (Ganske, Gnilka, Ashby, & Rice, 2015), CIT anxiety (Gnilka, Rice, Ashby, & Moate, 2016), and sources of stress and coping (Gnilka, Chang, & Dew, 2012; Sterner, 2009) may ultimately strengthen the supervisory relationship. Focus on these factors has been shown to increase the prevalence of CITs bringing up cultural issues in supervision (Nilsson, 2007). Likewise, supervisors who bring cultural considerations into supervision engender higher levels of supervisee self-efficacy in skill and multicultural competence (Constantine, 2001; Crockett & Hays, 2015; Kissil, Davey, & Davey, 2013; Ladany, Brittan-Powell, & Pannu, 1997; Vereen, Hill, & McNeal, 2008).

A culturally conscious supervisory relationship is beneficial to both supervision and counseling environments; thus, documenting relationship-building actions on the worksheet gives appropriate and necessary focus to the actual relationship-building behaviors by the SIT. Providing time in supervision to focus on CIT relationships in both professional/academic and personal settings is important because both domains influence professional development (Rønnestad & Skovholt, 2003) and may ultimately relate to deepening the supervisory relationship (Mutchler & Anderson, 2010). Challenging dominant ideologies in supervision also has positive implications for broaching the concept of power within the supervisory and counseling environments (Hernández & McDowell, 2010). It may be useful for an SIT to inquire about a CIT’s values, beliefs, and on what the counselor places importance, because highlighting culture and relationships in supervision works toward exemplifying the importance of focusing on culture to create therapeutic relationships with clients (Willis-O’Connor, Landine, & Domene, 2016). The SWA is compatible with a multicultural perspective in supervision (Bordin, 1983) and is considered transtheoretical, making the SWA adaptable to different counseling and supervisory theories (Bordin, 1983; Wood, 2005).

Goals and Tasks

The SSM’s third component, goals and tasks, is based on the two other components of Bordin’s (1983) SWA. These are important to include because the SWA may be the most commonly cited factor in supervision literature (Watkins, 2014b). The goals refer to mutually agreed upon and understood objectives between the SIT and supervisee pertaining to the development of the CIT. The tasks refer to the action steps taken to achieve those objectives and the negotiation between SIT and supervisee to frame these steps in appropriate and achievable ways. Goals help to focus and direct supervision sessions while tasks act to pursue and attain the goals (Watkins, 2014b). The SSM worksheet includes space for the SIT to write goals and tasks for the supervision session, and the 11-point Likert scales provide the means to document the degree to which goals/tasks are agreed upon and achieved.

It is natural for novice supervisors to function from the perspective of a clinician, considering that this framework may be most comfortable or available (Watkins, 2014a). However, in doing so, the SIT may miss important components of CIT growth (Ponton & Sauerheber, 2014). Focus for goals and tasks should be directed at the process of counseling the client and the process of becoming (or being) a counselor; the SIT must attend to the space where the counselor’s “professional” meets the “personal” (Ponton & Sauerheber, 2014). For example, if a supervisee is unsure how to proceed with a client’s presenting issue, sole focus on goals and tasks aimed at client conceptualization and practical measures may foster dependence within the CIT to seek answers externally and work against a sense of self-efficacy and independence. Likewise, only attending to goals and tasks centralized to the counselor’s personal process may miss the opportunity to locate practical skills. Balancing goals and tasks with emphasis on the CIT’s process (e.g., potential feelings of inadequacy, confusion, difficulty with ambiguity) and practical abilities (e.g., specific skill use, conceptualization through a specific theoretical lens) may address individual needs and applicable skills to facilitate growth as a counselor. Differences will exist in CIT personality, ability, and developmental progress; therefore, SITs need to determine the appropriate equilibrium between process and practical focus for each supervisee (Reising & Daniels, 1983). The SSM worksheet contains space for the consideration of both practical and process goals and tasks, and the level of agreement and achievement.

Feedback and Reflection

Feedback and reflection comprise the fourth component to the SSM. An integral component to the supervision process, feedback is considered to be a change mechanism consistent across supervisory theory (Goodyear, 2014). Developmental levels of CITs vary (Rønnestad & Skovholt, 2003) and may influence the style of feedback (e.g., direct, indirect). Using the example of CITs who self-criticize their demonstration of skill, it may be useful for SITs to provide direct positive feedback to communicate successful skill demonstration (e.g., “That is a good example of reflecting a feeling.”). However, it is important to be mindful that feedback is a learning mechanism and to gradually remove oneself as support and transfer responsibility to the CIT (van de Pol, Volman, & Beishuizen, 2010). To that end, SITs may consider using indirect feedback to assist CITs to self-identify strengths (e.g., “If you had to identify a skill you did really well, what would it be?”). Instances exist throughout counselor development calling for various levels of direction in supervision (Goodyear, 2014), and SITs will develop a feel for when to provide direct and indirect feedback as they gain experience. To assist with this process, the worksheet includes a conceptual continuum for SITs to document feedback as direct or helping the CIT to self-identify.

Similar to goals and tasks, feedback for CITs should encompass both skill and process components (Liddle, 1986). Focus on learning counseling skills increases a CIT’s professional competency and identity (Aladağ, Yaka, & Koç, 2014). The ability to make skills explicit helps CITs to know what to look for and may assist the CIT and SIT in providing guidance and structure to the feedback process (Russell-Chapin & Sherman, 2000). Likewise, allowing CITs to use self-reflection to explore personal process components and arrive at meaningful conclusions may help facilitate learning, growth, and development (Guiffrida, 2015). For an example of skill versus process focus, consider a CIT learning to reflect feelings. By reviewing a recording of a counseling session, the SIT may witness the client expressing anger; or the SIT may choose to focus on skill, prompting the CIT to try identifying what feeling is being expressed or how to effectively reflect anger to the client. By focusing on process, the SIT may explore the CIT’s relationship with anger (e.g., how others have displayed anger to the CIT or how the CIT expresses anger), as self-reflection could reveal a barrier toward accurately identifying and reflecting anger. The SSM worksheet contains both practical and process feedback and reflection sections for the SIT to consider.

It is an ethical imperative for supervisors to provide ongoing feedback and evaluation to CITs (ACA, 2014). Positive feedback to CITs has been found to increase counseling self-efficacy and lower anxiety, while negative feedback decreases counseling self-efficacy and elicits more anxiety (Daniels & Larson, 2001). Negative feedback may include such elements as vagueness, inconsiderate tone, hidden meaning, delay between an episode and reference to an episode, and subjectivity (Baron, 1988). Alternately, constructive feedback is relevant, shared immediately, factual, helpful, confidential, respectful, tailored, and encouraging (Ovando, 1994). Constructive feedback in supervision has been found to be the highest-ranked demand among CITs (Ladany, Lehrman-Waterman, Molinaro, & Wolgast, 1999), and when combined with microskills training, it has been found to contribute to learning effectiveness (Fyffe & Oei, 1979). CITs who do not receive constructive feedback may experience stagnation in skill progress (Russell-Chapin & Ivey, 2004). Constructive feedback can be challenging for SITs to provide (Motley, Reese, & Campos, 2014), especially because supervisors are trained as counselors and giving evaluative judgment may seem counterintuitive to the therapeutic skill set (Ladany et al., 1999). The struggles associated with constructive feedback may require supervisors to call upon the supervisory relationship, taking inventory of CIT self-efficacy and confidence levels, to inform how and when to provide constructive feedback (Daniels & Larson, 2001). Supervisor impediments to providing quality feedback are recognized by both CITs and SITs (Heckman-Stone, 2004); thus, the addition of positive and constructive feedback sections on the worksheet may prompt SITs to practice providing both forms of feedback to CITs. The explicit cue for feedback also acts as a practical measure to inform SITs’ recording of supervision progress notes following the supervision session.

Post-Session

The SSM’s final component is post-session reflection. Utilizing the post-session for documentation benefits the CIT and the SIT. Maintaining supervision notes is an ethically sound practice and can assist supervisors in documenting practical, ethical, and legal issues (Luepker, 2012). Keeping records of supervision also proves beneficial to the development of SITs’ style and theoretical stance (Bernard, 2014). Timely and accurate documentation may act as a future reminder for areas on which to focus for the CIT or SIT.

The supervision note may have an evaluative component to it. Where applicable, a supervisor may begin to evaluate a CIT based on criteria set by an associated institution (e.g., university, occupational setting) or on agreed-upon standards between the supervisor and CIT (e.g., a measure found in the literature based on specific need). Likewise, the SIT may utilize documentation to evaluate their progress as a supervisor. Each microskill suggestion may act as an area to consider for evaluation or self-evaluation. These areas may include progress on deepening the cultural relationship, assessment of supervisory actions in working toward agreed-upon goals, appraisal of goal achievement, appropriate balance of direct feedback and assisting the CIT to formulate their own answers, appropriate balance of focus on counseling instruction and personal process, examples of interventions consistent with a theoretical model or supervisory role, and exploration of countertransference during the session.

Discussion

The SSM’s flexibility and focus on a behavioral framework may be efficacious in training supervisors from varying cultural identities and helping SITs learn how to supervise counselors of differing backgrounds. CITs gain multicultural knowledge in their development as counselors; this continual learning process is suitable to microskill techniques, as research has shown that newly acquired skills can be employed during continued multicultural awareness (Hall & Richardson, 2014).

The flexibility of the SSM gives SITs freedom in pace and style of development. Just as neophyte counselors are to focus on their own skills and process in early training, gradually increasing their abilities to work effectively with clients, SITs may follow a similar path of needing to focus on supervisory abilities before providing effective supervision (Lampropoulos, 2003).

The freedom to be flexible in supervisory development is corroborated by existing models. Morgan and Sprenkle (2007) suggested a model that conceptualizes supervisor behaviors and roles on continuums, assuming that supervisors will have knowledge of their own styles and strengths to adjust and flex where needed. Goodyear (2014) created a model that provides SITs the ability to choose how to provide feedback, landing anywhere between direct instruction and self-directed learning. The SSM’s composition of common-factor components allows for adaptation to other models with both flexible and focused supervisory interventions. The SSM also utilizes updated research and literature to inform more specified behaviors associated with positive supervisory and therapeutic outcomes.

Conclusions

Supervision continues to become more recognized, accepted, and vital to the mental health professions for the preparation of multiculturally competent counselors (Watkins & Milne, 2014). There remains a dearth of information on how to effectively train supervisors, and a movement toward competency-based models has been suggested (Milne et al., 2011). Just as Ivey and fellow researchers (1968) adapted microskills training to counseling in order to study and bridge theory and practice, consolidating supervisory common factors “could not only provide a template for supervision research, but also for teaching and providing supervision as well” (Morgan & Sprenkle, 2007, p. 2). The SSM and accompanying worksheet are a step toward a simplified conceptualization and user-friendly tool to continue progressing supervision training and practice.

Conflict of Interest and Funding Disclosure

The authors reported no conflict of interest or funding contributions for the development of this manuscript.

References

Aladağ, M., Yaka, B., & Koç, İ. (2014). Opinions of counselor candidates regarding counseling skills training.

Educational Sciences: Theory and Practice, 14, 879–886. doi:10.12738/estp.2014.3.1958

American Counseling Association. (2014). 2014 ACA code of ethics. Alexandria, VA: Author.
Aten, J. D., Madson, M. B., & Kruse, S. J. (2008). The supervision genogram: A tool for preparing supervisors-

in-training. Psychotherapy: Theory, Research, Practice, Training, 45, 111–116.

doi:10.1037/0033-3204.45.1.111

Aten, J. D., Strain, J. D., & Gillespie, R. E. (2008). A transtheoretical model of clinical supervision. Training and Education in Professional Psychology, 2, 1–9. doi:10.1037/1931-3918.2.1.1

Barnett, J. E., Erickson Cornish, J. A., Goodyear, R. K., & Lichtenberg, J. W. (2007). Commentaries on the ethical and effective practice of clinical supervision. Professional Psychology: Research and Practice, 38, 268– 275. doi:10.1037/0735-7028.38.3.268

Baron, R. A. (1988). Negative effects of destructive criticism: Impact on conflict, self-efficacy, and task performance. Journal of Applied Psychology, 73, 199–207. doi:10.1037/0021-9010.73.2.199

Bernard, J. M. (2014). The use of supervision notes as a targeted training strategy. American Journal of Psychotherapy, 68, 195–212.

Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th ed.). Upper Saddle River, NJ: Pearson Education.

Bhat, C. S., & Davis, T. E. (2007). Counseling supervisors’ assessment of race, racial identity, and working alliance in supervisory dyads. Journal of Multicultural Counseling and Development, 35, 80–91.

doi:10.1002/j.2161-1912.2007.tb00051.x

Bordin, E. S. (1983). Supervision in counseling: II. Contemporary models of supervision: A working alliance based model of supervision. The Counseling Psychologist, 11, 35–42. doi:10.1177/0011000083111007

Branson, A., Cardona, B., & Thomas, C. (2015). Supporting couples, marriage, and family therapy trainees in need of performance improvement: Implications for counselor educators and supervisors. The Family

Journal, 23, 309–319. doi:10.1177/1066480715601098

Burns, C. I., & Holloway, E. L. (1990). Therapy in supervision: An unresolved issue. The Clinical Supervisor, 7, 47–60. doi:10.1300/J001v07n04_05

Capuzzi, D., & Gross, D. R. (2009). Introduction to the counseling profession. Upper Saddle River, NJ: Pearson.

Center for Credentialing & Education. (2016). Approved clinical supervisor. Retrieved from http://www.cce- global.org/ACS

Constantine, M. G. (2001). Multiculturally-focused counseling supervision: Its relationship to trainees’ multicultural counseling self-efficacy. The Clinical Supervisor, 20, 87–98. doi:10.1300/J001v20n01_07

Crockett, S., & Hays, D. G. (2015). The influence of supervisor multicultural competence on the supervisory working alliance, supervisee counseling self-efficacy, and supervisee satisfaction with supervision: A mediation model. Counselor Education and Supervision, 54, 258–273. doi:10.1002/ceas.12025

Daniels, J. A., & Larson, L. M. (2001). The impact of performance feedback on counseling self-efficacy and counselor anxiety. Counselor Education and Supervision, 41, 120–130. doi:10.1002/j.1556-6978.2001.tb01276.x

DeKruyf, L., & Pehrsson, D.-E. (2011). School counseling site supervisor training: An exploratory study. Counselor Education and Supervision, 50, 314–327. doi:10.1002/j.1556-6978.2011.tb01918.x

DePue, M. K., Lambie, G. W., Liu, R., & Gonzalez, J. (2016). Investigating supervisory relationships and

therapeutic alliances using structural equation modeling. Counselor Education and Supervision, 55, 263–277. doi:10.1002/ceas.12053

Ellis, M. V. (1991). Critical incidents in clinical supervision and in supervisor supervision: Assessing supervisory issues. Journal of Counseling Psychology, 38, 342–349. doi:10.1037/0022-0167.38.3.342

Fortune, J. C., Cooper, J. M., & Allen, D. W. (1967). The Stanford summer micro-teaching clinic, 1965. Journal of Teacher Education, 18, 389–393.

Fukuyama, M. A. (1994). Critical incidents in multicultural counseling supervision: A phenomenological approach to supervision research. Counselor Education and Supervision, 34, 142–151.

doi:10.1002/j.1556-6978.1994.tb00321.x

Fyffe, A. E., & Oei, T. P. S. (1979). Influence of modelling and feedback provided by the supervisors in a microskills training program for beginning counsellors. Journal of Clinical Psychology, 35, 651–656.

doi:10.1002/1097-4679(197907)35:3<651::AID-JCLP2270350332>3.0.CO;2-Z

Gaete, J., & Ness, O. (2015). Supervision: From prescribed roles to preferred positionings. The Clinical Supervisor, 34, 57–77. doi:10.1080/07325223.2015.1006068

Ganske, K. H., Gnilka, P. B., Ashby, J. S., & Rice, K. G. (2015). The relationship between counseling trainee

perfectionism and the working alliance with supervisor and client. Journal of Counseling & Development, 93, 14–24. doi:10.1002/j.1556-6676.2015.00177.x

Gazzola, N., De Stefano, J., Thériault, A., & Audet, C. T. (2013). Learning to be supervisors: A qualitative investigation of difficulties experienced by supervisors-in-training. The Clinical Supervisor, 32, 15–39.
doi:10.1080/07325223.2013.778678

Gnilka, P. B., Chang, C. Y., & Dew, B. J. (2012). The relationship between supervisee stress, coping resources, the working alliance, and the supervisory working alliance. Journal of Counseling & Development, 90, 63–70. doi:10.1111/j.1556-6676.2012.00009.x

Gnilka, P. B., Rice, K. G., Ashby, J. S., & Moate, R. M. (2016). Adult attachment, multidimensional

perfectionism, and the alliances among counselor supervisees. Journal of Counseling & Development, 94, 285–296. doi:10.1002/jcad.12085

Gonsalvez, C. J. (2008). Introduction to the special section on clinical supervision. Australian Psychologist, 43, 76–78. doi:10.1080/00050060802068547

Goodyear, R. K. (2014). Supervision as pedagogy: Attending to its essential instructional and learning processes. The Clinical Supervisor, 33, 82–99. doi:10.1080/07325223.2014.918914

Goodyear, R. K., Bunch, K., & Claiborn, C. D. (2006). Current supervision scholarship in psychology: A five year review. The Clinical Supervisor, 24, 137–147. doi:10.1300/J001v24n01_07

Guiffrida, D. (2015). A constructive approach to counseling and psychotherapy supervision. Journal of Constructivist Psychology, 28, 40–52. doi:10.1080/10720537.2014.922911

Gunn, J. E., & Pistole, M. C. (2012). Trainee supervisor attachment: Explaining the alliance and disclosure in supervision. Training and Education in Professional Psychology, 6, 229–237. doi:10.1037/a0030805

Hall, K. G., & Richardson, E. D. (2014). Multicultural microskills: Implementation on an existing design. Journal for International Counselor Education, 6, 75–89.

Heckman-Stone, C. (2004). Trainee preferences for feedback and evaluation in clinical supervision. The Clinical Supervisor, 22, 21–33. doi:10.1300/J001v22n01_03

Hernández, P., & McDowell, T. (2010). Intersectionality, power, and relational safety in context: Key concepts in clinical supervision. Training and Education in Professional Psychology, 4, 29–35.
doi:10.1037/a0017064

Hoffman, R. M., Osborn, C. J., & West, J. D. (2013). Clinical supervision of counselors-in-training working with suicidal clients: A grounded theory investigation. The Clinical Supervisor, 32, 105–127.

doi:10.1080/07325223.2013.780991

Ivey, A. E. (1971). Microcounseling: Innovations in interviewing training. Oxford, England: Thomas.

Ivey, A. E., Normington, C. J., Miller, C. D., Morrill, W. H., & Haase, R. F. (1968). Microcounseling and

attending behavior: An approach to pre-practicum training [monograph]. Journal of Counseling Psychology, 15, 1–12.

James, I. A., Milne, D. L., & Morse, R. (2008). Microskills of clinical supervision: Scaffolding skills. Journal of Cognitive Psychotherapy, 22, 29–36. doi:10.1891/0889.8391.22.1.29

Johnson, W. B. (2007). Transformational supervision: When supervisors mentor. Professional Psychology: Research and Practice, 38, 259–267. doi:10.1037/0735-7028.38.3.259

Kissil, K., Davey, M., & Davey, A. (2013). Foreign-born therapists in the United States: Supervisors’

multicultural competence, supervision satisfaction, and counseling self-efficacy. The Clinical Supervisor, 32, 185–211. doi:10.1080/07325223.2013.846746

Knapp, S., & VandeCreek, L. (1997). Ethical and legal aspects of clinical supervision. In C. E. Watkins, Jr. (Ed.), Handbook of Psychotherapy Supervision (pp. 589–599). New York, NY: Wiley.

Koltz, R. L., Odegard, M. A., Feit, S. S., Provost, K., & Smith, T. (2012). Parallel process and isomorphism:

A model for decision making in the supervisory triad. The Family Journal, 20, 233–238. doi:10.1177/1066480712448788

Ladany, N., Brittan-Powell, C. S., & Pannu, R. K. (1997). The influence of supervisory racial identity interaction and racial matching on the supervisory working alliance and supervisee multicultural competence. Counselor Education and Supervision, 36, 284–304. doi:10.1002/j.1556-6978.1997.tb00396.x

Ladany, N., Lehrman-Waterman, D., Molinaro, M., & Wolgast, B. (1999). Psychotherapy supervisor ethical practices: Adherence to guidelines, the supervisory working alliance, and supervisee satisfaction. The Counseling Psychologist, 27, 443–475. doi:10.1177/0011000099273008

Ladany, N., Mori, Y., & Mehr, K. E. (2013). Effective and ineffective supervision. The Counseling Psychologist, 41, 28–47. doi:10.1177/0011000012442648

Lambie, G. W., & Ascher, D. L. (2016). A qualitative evaluation of the Counseling Competencies Scale with clinical supervisors and their supervisees. The Clinical Supervisor, 35, 98–116.

doi:10.1080/07325223.2015.1132398

Lampropoulos, G. K. (2003). A common factors view of counseling supervision process. The Clinical Supervisor, 21, 77–95. doi:10.1300/J001v21n01_06

Liddle, B. J. (1986). Resistance in supervision: A response to perceived threat. Counselor Education and Supervision, 26, 117–127. doi:10.1002/j.1556-6978.1986.tb00706.x

Luepker, E. T. (2012). Record keeping in psychotherapy and counseling: Protecting confidentiality and the professional relationship (2nd ed.). New York, NY: Routledge.

Mehr, K. E., Ladany, N., & Caskie, G. I. L. (2010). Trainee nondisclosure in supervision: What are they not telling you? Counselling & Psychotherapy Research, 10, 103–113. doi:10.1080/14733141003712301

Milne, D. L. (2006). Developing clinical supervision research through reasoned analogies with therapy. Clinical Psychology & Psychotherapy, 13, 215–222. doi:10.1002/cpp.489

Milne, D. L., Reiser, R. P., Cliffe, T., & Raine, R. (2011). SAGE: Preliminary evaluation of an instrument for

observing competence in CBT supervision. The Cognitive Behaviour Therapist, 4, 123–138. doi:10.1017/S1754470X11000079

Morgan, M. M., & Sprenkle, D. H. (2007). Toward a common-factors approach to supervision. Journal of Marital and Family Therapy, 33, 1–17. doi:10.1111/j.1752-0606.2007.00001.x

Motley, V., Reese, M. K., & Campos, P. (2014). Evaluating corrective feedback self-efficacy changes among counselor educators and site supervisors. Counselor Education and Supervision, 53, 34–46.

doi:10.1002/j.1556-6978.2014.00047.x

Mutchler, M., & Anderson, S. (2010). Therapist personal agency: A model for examining the training context. Journal of Marital and Family Therapy, 36, 511–525. doi:10.1111/j.1752-0606.2010.00198.x

Nate, R. D., & Haddock, L. R. (2014). An exploration of counselor supervisor requirements across the United

States. Ideas and research you can use: Vistas 2014. Retrieved from https://www.counseling.org/ knowledge-center/vistas/by-year2/vistas-2014/docs/default-source/vistas/article_31

Nilsson, J. E. (2007). International students in supervision: Course self-efficacy, stress, and cultural discussions in supervision. The Clinical Supervisor, 26, 35–47. doi:10.1300/J001v26n01_04

Norcross, J. C., Hedges, M., & Castle, P. H. (2002). Psychologists conducting psychotherapy in 2001: A study of the Division 29 membership. Psychotherapy: Theory, Research, Practice, Training, 39, 97–102.

doi:10.1037/0033-3204.39.1.97

Ovando, M. N. (1994). Constructive feedback: A key to successful teaching and learning. International Journal of Educational Management, 8, 19–22.

Pearson, Q. M. (2000). Opportunities and challenges in the supervisory relationship: Implications for counselor supervision. Journal of Mental Health Counseling, 22, 283–294.

Pearson, Q. M. (2006). Psychotherapy-driven supervision: Integrating counseling theories into role-based

supervision. Journal of Mental Health Counseling, 28, 241–252. doi:10.17744/mehc.28.3.be1106w7yg3wvt1w

Pelling, N. (2008). The relationship of supervisory experience, counseling experience, and training in

supervision to supervisory identity development. International Journal for the Advancement of Counselling, 30, 235–248. doi:10.1007/s10447-008-9060-2

Ponton, R. F., & Sauerheber, J. D. (2014). Supervisee countertransference: A holistic supervision approach. Counselor Education and Supervision, 53, 254–266. doi:10.1002/j.1556-6978.2014.00061.x

Reising, G. N., & Daniels, M. H. (1983). A study of Hogan’s model of counselor development and supervision. Journal of Counseling Psychology, 30, 235–244. doi:10.1037/0022-0167.30.2.235

Richardson, B. K., & Bradley, L. J. (1984). Microsupervision: A skill development model for training clinical supervisors. The Clinical Supervisor, 2, 43–54. doi:10.1300/J001v02n03_05

Ridley, C. R., Kelly, S. M., & Mollen, D. (2011). Microskills training: Evolution, reexamination, and call for reform. The Counseling Psychologist, 39, 800–824. doi:10.1177/0011000010378438

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. doi:10.1023/A:1025173508081

Rubin, S. S. (1997). Balancing duty to client and therapist in supervision. The Clinical Supervisor, 16, 1–23. doi:10.1300/J001v16n01_01

Russell-Chapin, L. A., & Ivey, A. E. (2004). Microcounselling supervision: An innovative integrated
supervision model. Canadian Journal of Counselling, 38, 165–176.

Russell-Chapin, L. A., & Sherman, N. E. (2000). The Counselling Interview Rating Form: A teaching and evaluation tool for counsellor education. British Journal of Guidance & Counselling, 28, 115–124. doi:10.1080/030698800109655

Schroeder, M., Andrews, J. J. W., & Hindes, Y. L. (2009). Cross-racial supervision: Critical issues in the supervisory relationship. Canadian Journal of Counselling, 43, 295–310.

Sprenkle, D. H. (1999). Toward a general model of family therapy supervision: Comment on Roberts, Winek, and Mulgrew. Contemporary Family Therapy, 21, 309–315. doi:10.1023/A:1021956214595

Sterner, W. R. (2009). Influence of the supervisory working alliance on supervisee work satisfaction and work-

related stress. Journal of Mental Health Counseling, 31, 249–263. doi:10.17744/mehc.31.3.f3544l502401831g

Uellendahl, G. E., & Tenenbaum, M. N. (2015). Supervision training, practices, and interests of California site supervisors. Counselor Education and Supervision, 54, 274–287. doi:10.1002/ceas.12026

van de Pol, J., Volman, M., & Beishuizen, J. (2010). Scaffolding in teacher–student interaction: A decade of research. Educational Psychology Review, 22, 271–296. doi:10.1007/s10648-010-9127-6

Vereen, L. G., Hill, N. R., & McNeal, D. T. (2008). Perceptions of multicultural counseling competency:

Integration of the curricular and the practical. Journal of Mental Health Counseling, 30, 226–236. doi:10.17744/mehc.30.3.g34u122m16q64g44

Watkins, C. E., Jr. (2010). Psychoanalytic developmental psychology and the supervision of psychotherapy supervisor trainees. Psychodynamic Practice, 16, 393–407. doi:10.1080/14753634.2010.510345

Watkins, C. E., Jr. (2012a). Educating psychotherapy supervisors. American Journal of Psychotherapy, 66, 279–309.

Watkins, C. E., Jr. (2012b). Development of the psychotherapy supervisor: Review of and reflections on 30 years of theory and research. American Journal of Psychotherapy, 66, 45–83.

Watkins, C. E., Jr. (2013). Being and becoming a psychotherapy supervisor: The crucial triad of learning difficulties. American Journal of Psychotherapy, 67, 135–151.

Watkins, C. E., Jr. (2014a). Leading and learning in the psychotherapy supervision seminar: Some thoughts on

the beginnings of supervisor development. Journal of Contemporary Psychotherapy, 44, 233–243. doi:10.1007/s10879-014-9268-x

Watkins, C. E., Jr. (2014b). The supervisory alliance as quintessential integrative variable. Journal of Contemporary Psychotherapy, 44, 151–161. doi:10.1007/s10879-013-9252-x

Watkins, C. E., Jr., Budge, S. L., & Callahan, J. L. (2015). Common and specific factors converging in

psychotherapy supervision: A supervisory extrapolation of the Wampold/Budge psychotherapy relationship model. Journal of Psychotherapy Integration, 25, 214–235. doi:10.1037/a0039561

Watkins, C. E., & Milne, D. L. (2014). Clinical supervision at the international crossroads: Current status

and future directions. In C. E. Watkins, & D. L. Milne (Eds.), The Wiley international handbook of clinical supervision (pp. 673–691). Malden, MA: Wiley Blackwell.

White-Davis, T., Stein, E., & Karasz, A. (2016). The elephant in the room: Dialogues about race within cross-

cultural supervisory relationships. The International Journal of Psychiatry in Medicine, 51, 347–356. doi:10.1177/0091217416659271

Willis-O’Connor, S., Landine, J., & Domene, J. F. (2016). International students’ perspectives of helpful and hindering factors in the initial stages of a therapeutic relationship. Canadian Journal of Counselling and Psychotherapy, 50(Suppl. 3), 156–174.

Wong, L. C. J., Wong, P. T. P., & Ishiyama, F. I. (2013). What helps and what hinders in cross-cultural clinical

supervision: A critical incident study. The Counseling Psychologist, 41, 66–85. doi:10.1177/0011000012442652

Wood, C. (2005). Supervisory working alliance: A model providing direction for college counseling supervision.

Journal of College Counseling, 8, 127–137. doi:10.1002/j.2161-1882.2005.tb00079.x

Dusty Destler is a doctoral candidate and Counseling Clinic Supervisor at Idaho State University – Meridian. Correspondence can be addressed to Dusty Destler, 1311 E. Central Drive, Meridian, ID 83642, dmdestler@gmail.com.

2017 Dissertation Excellence Award

May 12, 2017 | Article

TPC received entries for the fourth annual Dissertation Excellence Award from across the United States. After great deliberation, the TPC editorial board committee selected Hannah E. Acquaye to receive the 2017 Dissertation Excellence Award for her dissertation, The Relationship Among Posttraumatic Growth, Religious Commitment, and Optimism in Adult Liberian Former Refugees and Internally Displaced Persons Traumatized by War-Related Events.

Dr. Acquaye is a first-year Assistant Professor of counseling at Western Seminary in Portland, Oregon. Some of the classes she has taught include: theories in counseling, group counseling, research and evaluation in counseling, tests and measurement in counseling, and family systems therapy.

Prior to her position at Western Seminary, she was a doctoral student in the University of Central Florida’s counselor education program. In August 2016, Dr. Acquaye graduated with a Ph.D. after defending her research on refugee trauma and growth. She obtained her master’s degree in Ghana, her home country, where she worked with young adults in schools and churches. Recognizing her inability to help refugees who kept coming to Ghana, especially when they entered the school system, Dr. Acquaye decided to pursue a terminal degree to help her educate more people about assisting this unique population.

Her research passion encompasses counselors and their collaboration to bring interventions to survivors traumatized by war and/conflict, e.g., refugees, dislocated and/or relocated individuals and/or immigrants. To help marry the research and clinical work, Dr. Acquaye is also doing her clinical work with Lutheran Refugee Services, Northwest, in Portland, where she serves both resettled refugees and mainstream clients with mental health challenges.

TPC looks forward to recognizing outstanding dissertations like Dr. Acquaye’s for many years to come.

Read more about the TPC scholarship awards here.

2016 TPC Outstanding Scholar Award Winner – Quantitative or Qualitative Research

May 12, 2017 | TPC Outstanding Scholar

Kathleen Brown-Rice and Susan Furr

Kathleen Brown-Rice and Susan Furr received the 2016 Outstanding Scholar Award for Quantitative or Qualitative Research for their article, “Counselor Educators and Students With Problems of Professional Competence: A Survey and Discussion.”

Dr. Kathleen Brown-Rice is an Assistant Professor at the University of South Dakota. Dr. Brown-Rice is a National Certified Counselor, Licensed Professional Counselor (SD, NE, and NC), Licensed Mental Health Provider (NE), Certified Addiction Counselor (SD), Licensed Clinical Addiction Counselor (NC), Qualified Mental Health Provider (SD), Approved Clinical Supervisor. Her research efforts are on developing and enhancing ethical and competent services to clients and focus on three main areas: a) professional counselor supervision, training and dispositions, b) Native American mental health with an emphasis on the implications of historical trauma, and c) risky substance use. To further understand emotional regulation and intergenerational transmission of pathology, she incorporates neural imaging and genotyping.

Dr. Susan Furr is a Professor in the Department of Counseling at UNC Charlotte. She worked for over 20 years in the field as a school counselor and a counselor at the university counseling center before moving to university teaching. Her research and writing interests include counseling student development and professional dispositions, grief and loss in recovery from addiction, college student development, and psychoeducational groups.

Read more about the TPC scholarship awards here.

2016 TPC Outstanding Scholar Award Winner – Concept/Theory

May 11, 2017 | Article, TPC Outstanding Scholar

Mehmet A. Karaman and Richard J. Ricard

Mehmet A. Karaman and Richard J. Ricard received the 2016 Outstanding Scholar Award for Concept/Theory for their article, “Meeting the Mental Health Needs of Syrian Refugees in Turkey.”

Dr. Mehmet A. Karaman is an Assistant Professor of counseling at the University of Texas Rio Grande Valley. Dr. Karaman has practiced in psychiatric hospitals, community mental health agencies, school districts and non-profit organizations. His research interests include instrument development and validation, cross-cultural studies (e.g., Turkey, Saudi Arabia, Mexico), counseling refugees, achievement motivation, and counseling children and adolescents. He is the past president of Texas Association for Humanistic Education and Development.

Dr. Richard J. Ricard is Assistant Dean and Professor of Counseling & Educational Psychology at Texas A&M University—Corpus Christi. He received his bachelor’s degree from the University of California, San Diego and his M.A. and Ph.D. from Harvard University in developmental psychology. He has been teaching in higher education for over 25 years. Dr. Ricard’s research focuses on program evaluation and implementation of evidence-based counseling interventions with adolescents in schools. His most recent teaching and research focus is on counseling interventions that emphasize mindfulness-based approaches (e.g., DBT, ACT, MBCT) that support counselor and client well-being.

Read more about the TPC scholarship awards here.

Self-Care Through Self-Compassion: A Balm for Burnout

Apr 18, 2017 | Volume 7 - Issue 3

Susannah C. Coaston

Counselors are routinely exposed to painful situations and overwhelming emotions that can, over time, result in burnout. Although counselors routinely promote self-care, many struggle to practice such wellness regularly, putting themselves at increased risk for burning out. Compassion is essential to the helper’s role, as it allows counselors to develop the therapeutic relationship vital for change; however, it is often difficult to direct this compassion inward. Developing an attitude of self-compassion and mindfulness in the context of a self-care plan can create space for an authentic, kind response to the challenges inherent in counseling. This article expands beyond the aspirational aspects of self-compassion and suggests a variety of practices for the mind, body, and spirit, with the intention of supporting the development of an individualized self-care plan for counselors.

Keywords: self-care, self-compassion, burnout, mindfulness, wellness

Wellness, prevention, and human development compose the core of a counselor’s professional identity (Mellin, Hunt, & Nichols, 2011). This fundamental grounding is emphasized within the American Counseling Association’s (ACA) Code of Ethics (ACA, 2014), as well as by the Council for Accreditation of Counseling & Related Education Programs (CACREP; 2016). To fulfill their role in the change process, counselors depend heavily upon compassion, a key component of the therapeutic relationship that—paradoxically—counselors may seldom apply to themselves (Patsiopoulos & Buchanan, 2011). Whereas compassion means being with others in their suffering (Pollack, Pedulla, & Siegel, 2014), self-compassion can be understood as “being touched by and open to one’s own suffering, not avoiding or disconnecting from it, generating the desire to alleviate one’s suffering and to heal oneself with kindness” (Neff, 2003, p. 87). Higher levels of self-compassion can serve as a buffer against burnout (Barnard & Curry, 2011). Therefore, cultivating an attitude of self-compassion may assist counselors in employing self-care practices to refresh, rejuvenate, and recharge their bodies, minds, and souls. The purpose of this manuscript is to reimagine self-care as regular acts of self-compassion that benefit both clients and counselors.

Self-Compassion

Self-compassion, a construct from Buddhist thought, consists of self-kindness, common humanity, and mindfulness, and is characterized by gentleness with oneself when faced with a perceived sense of inadequacy or failure (Neff, 2003). Self-compassion is not based on an evaluation of the self; self-compassion becomes the path to positively relating to oneself (Neff & Costigan, 2014). The concept of self-compassion is consistent with the idea of self-acceptance in the humanistic tradition (Neff, 2003). Carl Rogers (1961) described a successful outcome of psychotherapy as an increase in positive attitudes toward self: “The client not only accepts himself . . . he actually comes to like himself. This is not a bragging or self-assertive liking; it is a rather quiet pleasure in being one’s self” (p. 87). The practice of self-compassion calls for a mindful awareness of emotions, and painful emotions are met with a sense of understanding, connection to our common humanity, and self-kindness (Neff, 2003). Neff and Costigan (2014) described self-compassion’s relationship with pain thusly: “Self-compassion does not avoid pain, but rather embraces it with kindness and goodwill that is rooted in the experience of being fully human” (p. 114). Self-compassion practices have been found to improve psychological functioning in both clinical and non-clinical settings (Neff, Kirkpatrick, & Rude, 2007; Schanche, Stiles, McCullough, Svartberg, & Nielsen, 2011).

Mindfulness is one of the core components of self-compassion and is critical for the awareness of suffering that precedes compassion (Germer & Neff, 2015). Mindfulness is the focusing on the awareness of pain in the present moment, and self-compassion becomes the act of taking that awareness and encouraging kindness toward oneself. The common humanity component of self-compassion becomes one of acknowledgment that, as humans, we are imperfect and make mistakes; recognizing our flawed condition allows for a broader perspective toward our difficulties (Neff, 2003). Adopting such a view of pain reduces the chance of over-identification or getting so wrapped up in one’s emotions that they become exaggerated (Neff & Costigan, 2014). When an individual can recognize pain as a universal occurrence, such a viewpoint then fosters a sense of connection with others who have felt suffering. Pain becomes an uncomfortable but acknowledged part of the human condition. When practicing self-compassion, the self-directed kindness is not done to change the circumstance of suffering, but done because there is suffering. The practitioner asks “What do I need now?” The individual then acts accordingly to provide comfort when experiencing the pain of inadequacy or failure (Germer & Neff, 2015). Learning self-compassion becomes a gift for both clients and the practitioner (Barnett, Baker, Elman, & Schoener, 2007). Making time for one’s self is one way counselors can practice self-care (Patsiopoulos & Buchana, 2011). That self-acceptance can prove vital for counselors, whose work often puts them at a risk for burnout (Yager & Tovar-Blank, 2007).

Counselor Burnout

Burnout is a multidimensional experience consisting of exhaustion, cynicism, and reduced professional efficacy that can result from dissatisfaction with the organizational context of the job position (Maslach, Schaufeli, & Leiter, 2001). Burnout can affect individuals in a variety of ways, with anxiety, irritability, fatigue, withdrawal, and demoralization as major examples (Schaufeli & Enzmann, 1998). Burnout can affect individuals at any point in their career and can hamper productivity and creativity, resulting in a reduction of compassion toward themselves and clients (Grosch & Olsen, 1994). “It is when counseling seems to have little effect that counselors reach despair because their raison d’être for choosing this work—to make a difference in human life—is threatened” (Skovholt, Grier, & Hanson, 2001, p. 171). Caring for others and caring for oneself becomes a difficult balance to achieve for both new and seasoned counselors alike. Carl Rogers (1980) wrote, “I have always been better at caring for and looking after others than I have in caring for myself. But in these later years, I made progress” (p. 80). Self-compassion can serve as a protective factor against such potentially debilitating effects of work-related burnout.

Historically, researchers examined the causes of burnout relating to demographic, personality, or attitudinal differences between individuals (Maslach et al., 2001). Today, burnout is viewed from an organizational standpoint and is concerned with the relationship, or fit, between the person and his or her environment, wherein mismatches can result in burnout over time (Maslach, Leiter, & Jackson, 2012). An individual’s perceptions have a reciprocal relationship with the work environment; how counselors make meaning of their work impacts their satisfaction, commitment, and performance in the workplace (Lindholm, 2003). Counselors experiencing work-related stress and burnout will construct meaning differently and require a tailored self-care plan that reflects their individual assessment of their own fit within their work environment.

Counselor Self-Care

Self-care can be defined as an activity to “refill and refuel oneself in healthy ways” (Gentry, 2002, p. 48). Self-care is vital if we are to remain effective in our role and avoid burnout; however, many counselors do not regularly implement the techniques they recommend to clients in their own lives (O’Halloran & Linton, 2000; Skovholt et al., 2001). Although self-care is widely promoted within the counseling literature, this author contends that inherent in many self-care plans and workplace improvement efforts is the idea that overwhelming work-related stress reflects an inadequacy of the individual. The message in the literature often reflects the view that a counselor’s distress hinges upon inadequate coping resources, poor health practices, or other kinds of personal failing, such as lacking assertiveness or not taking enough time off from work (Bradley, Whisenhunt, Adamson, & Kress, 2013; Killian, 2008; O’Halloran & Linton, 2000). As a result, self-care plans tend to take on the air of a New Year’s resolution, a strategy to get better. This narrow focus reflects the historical view of burnout that focused primarily on its individual dimension, without taking into consideration the organizational, interpersonal, or societal perspectives (Schaufeli & Enzmann, 1998). When self-care plans are written like self-improvement plans, the opportunities for criticism and judgment abound, particularly for new counselors who struggle with anxiety and self-doubt (Skovholt, 2012). When counselors are suffering, experiencing symptoms of burnout, struggling to maintain healthy professional boundaries (i.e., under- or over-involvement), or feeling as though they are not caring for themselves effectively, shame may cause them to be less likely to seek assistance (Graff, 2008). Some counselors may fear negative repercussions as a result of disclosure, such as being perceived as impaired or having professional competency problems (Rust, Raskin, & Hill, 2013).

Self-care is an ethical imperative (ACA, 2014), because utilizing self-care strategies reduces the likelihood of impairment (ACA, 2010). Issues in a counselor’s personal life, burnout in the workplace, mental or physical disability, or substance abuse can result in impairment (ACA, 2010). Sadly, in a survey completed in 2004, nearly two-thirds of participants knew a counselor that they would identify as impaired (ACA, 2010). Counselors who better manage their self-care needs are more likely to set appropriate boundaries with clients and less likely to use clients to meet their own personal or professional needs (Nielsen, 1988). Self-care education has been integrated into the accreditation standards for counselor training (CACREP, 2016), and there are multiple articles discussing how to incorporate the value of wellness and self-care into counselor education programs (Witmer & Young, 1996; Yager & Tovar-Blank, 2007). For counselor educators and supervisors, monitoring counselors-in-training for possible impairment is an important part of the responsibility of gatekeeping (Frame & Stevens-Smith, 1995). However, despite this attention, both students and practicing professional counselors still struggle to implement self-care (Skovholt et al., 2001; E. Thompson, Frick, & Trice-Black, 2011).

Bradley and colleagues (2013) suggested that many of the self-care suggestions in the literature are too general, focusing mainly on general health practices, such as eating healthily and getting enough sleep, or professional recommendations regarding seeking support from colleagues. A case can be made that a counselor would be better served by employing an overall approach to efforts that are based in a self-compassionate mindset. Therefore, actively seeking awareness of one’s own signs and symptoms that indicate suffering can not only help counselors recognize burnout, it also can provide clues toward the first step in soothing.

Mindfulness represents one possible means of increasing such awareness. Mindfulness allows the practitioner to be present in the moment non-judgmentally (Kabat-Zinn, 1994). To practice self-compassion, a counselor needs to be willing to attend to feelings of discomfort, pain, or suffering and acknowledge the experience without self-recrimination (Germer & Neff, 2015). Consider the experience of having a regular client stop attending sessions and returning calls or abruptly discontinuing services. Although common, the ambiguous loss of a connection with a client can be a source of stress and pain (Skovholt et al., 2001). It also can provide an opportunity. Covey (2010) shared the following quote that is often misattributed to Viktor Frankl: “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom” (p. VI). The space Covey describes is our opportunity to be mindful of the stimulus and choose to offer ourselves compassion in response. Choosing to deny, suppress, or distract to avoid these feelings may cause the counselor to miss the trigger to practice self-care. When such feelings are recognized, the counselor may act compassionately toward himself or herself by normalizing or validating the experience. Within self-compassion, the concept of common humanity becomes crucial to precluding the often-automatic tendency to become self-critical for experiencing discomfort (Neff, 2003). Thoughts such as, “I shouldn’t feel this way,” “Just snap out of it; it’s not so bad,” or “What’s wrong with me?” invalidate the sufferer and may cause the counselor to feel as though self-care is an act of indulgence rather than an essential, self-directed gift of kindness. Expressing kindness through self-care acknowledges that counseling can be both difficult and rewarding, a duality representative of the human condition.

When counselors choose to practice self-care, they enhance themselves and their practice. One participant in a narrative inquiry on self-compassion in counseling stated: “What’s so important about self-compassion? Three words: Avoidance of burnout” (Patsiopoulos & Buchanan, 2011, p. 305). Another participant noted, “When we come from a self-compassionate place, self-care is no longer about these sporadic one-time events that you do when you feel burned out and exhausted. Self-care is something you can do all the time” (Patsiopoulos & Buchanan, 2011, p. 305). The consequence of our job as counselors is working compassionately with suffering, and in doing so we suffer (Figley, 2002).

For someone to develop genuine compassion toward others, first he or she must have a basis upon which to cultivate compassion, and that basis is the ability to connect to one’s own feelings and to care for one’s own welfare. . . . Caring for others requires caring for oneself. (Germer & Neff, 2015, p. 48) Self-care, then, is a vital part of a counselor’s responsibilities to clients and to one’s self.

It is important to remember that counseling can be emotionally demanding for counselors in different ways (O’Halloran & Linton, 2000). Self-compassion encourages remembering the shared human experience (Neff, 2003), as the experience of being a professional counselor can be quite isolating, especially for those working in more independent environments (e.g., school counselors, private practitioners; Freadling & Foss-Kelly, 2014; Matthes, 1992). Using mindfulness, counselors can maintain an objective stance that can allow the counselor to view one’s work circumstances with a non-judgmental lens (Newsome, Waldo, & Gruszka, 2012), then act kindly to intervene with a self-care practice that is revitalizing to mind, body, and spirit. Using self-compassion tenets as a guide, self-care plans can be created that are authentic and kind, connect us to the human experience, and reflect a balanced state of self-awareness.

Creating a Self-Compassion–Infused Self-Care Plan

In wellness counseling, optimal functioning of the mind, body, and spirit is the goal for holistic wellness (Myers, Sweeney, & Witmer, 2001). The physical dimension is the most common focus for wellness intervention (Carney, 2007); however, this is quite limiting in a profession that is often sedentary, with long hours and pressure to meet productivity demands (Franco, 2016; Freadling & Foss-Kelly, 2014; Ohrt, Prosek, Ener, & Lindo, 2015). Maintaining one’s health is important but may not be enough to assuage the emotional demands of a high-touch profession in which a strong professional relationship is combined with the often-conflicting pressures of reimbursement; short-term, diagnosis-focused treatment; and behaviorally based outcomes associated with managed care (Cushman & Gilford, 2000; Freadling & Foss-Kelly, 2014). Developing a collaborative treatment plan is a common practice in counseling; it allows the counselor and the client to determine the possible direction and outcomes for their work together (Kress & Paylo, 2015). In the best case, this plan is individualized, specific, and open to revision when necessary. A good self-care plan can follow the same formula.

What follows are specific suggestions regarding self-care practices that stretch beyond the “should,” the “ought to,” and the New Year’s resolution language. When reading the interventions, consider the question Linder, Miller, and Johnson (2000) suggested for clients when encouraging self-care: “How do you reassure yourself?” (p. 4). The suggestions are organized into mind, body, and spirit; however, these are artificial divisions and some interventions may satisfy in multiple ways.

Interventions for the Mind

Mindfulness is a component of self-compassion, but it can also be used intentionally as a regular practice for self-care. Mindfulness can be described as a dispositional trait, a state of being and a practice (Brown, Ryan, & Creswell, 2007). The use of mindfulness has been integrated into many facets of counseling practice (I. Thompson, Amatea, & Thompson, 2014). For those attracted to the practice of mindfulness for self-care, non-judgmental awareness can be integrated as a practice (e.g., a set time for engagement in a particular mindfulness exercise) or as a way of being during particular activities within the day. Exercises such as mindful eating, maintaining sensory awareness while washing dishes, or mindful walking can be helpful for those who are looking for brief, everyday opportunities for self-care. Researchers I. Thompson and colleagues (2014) found that higher levels of mindfulness corresponded with lower levels of burnout. Mindfulness has been suggested as a beneficial way to teach self-care in counselor training (Christopher, Christopher, Dunnagan, & Schure, 2006), and also as a way to reduce stress and increase self-compassion in students training to be in helping professions (Newsome et al., 2012). For any number of reasons, not all counselors may find benefit in mindfulness practices; therefore, some may choose methods of self-care that are more mentally invigorating.

Intellectual stimulation in any endeavor is important to maintain engagement, interest, and enjoyment, but such motivation can be particularly helpful when a work position contains routine, mundane, or downright boring tasks. To create a stimulating work life, seasoned professionals find active ways to continue their professional development, which can decrease the boredom that can lead to burnout (Skovholt et al., 2001). Activities for growth and development can include learning something new within counseling or outside the profession, such as learning a new language, or how to make sushi, write code, or play a strategy game such as the ancient board game, Go.

The role of a counselor involves exposure to circumstances of human suffering, painful emotions, and heartbreaking situations, which increases the risk of burnout due to absorption of the clients’ pain (Ruysschaert, 2009). Finding a way to keep and maintain positive memories, cards and notes, compliments or successes—what this author terms warm and fuzzies—either personally or professionally, in a box, folder, jar, or bulletin board, can be a helpful response. Bradley and colleagues (2013) suggested tracking small changes made by clients when discouraged and sharing the progress with co-workers.

Writing can be a powerful intervention in a counseling setting and can benefit both mental and physical health (Pennebaker & Seagal, 1999; Riordan, 1996). Counselors can use the medium of writing in a multitude of ways. Whether through journaling, narrative, poetry, musical lyrics, or letters, the act of writing can reduce emotional inhibition (Connolly Baker & Mazza, 2004). Creative writing can be used to access the healing benefits of writing without worry about form or audience (Warren, Morgan, Morris, & Morris, 2010).

Warren et al.’s (2010) The Writing Workout is a way to express, validate, and externalize painful emotions. This wellness approach illustrates how creative writing for self-care can cultivate compassion. Narrative writing strategies can allow the writer to change the outcome of a lived experience or reframe a life experience (Connelly Baker & Mazza, 2004). Creating a narrative of an event can help the storyteller organize details and events, reflect and process thoughts and feelings, and derive meaning from experiences (Pennebaker & Seagal, 1999). A creative, mindful writing intervention could be used to examine a clinical situation that may not have gone as the counselor had hoped, or to creatively explore life lessons derived from a clinical encounter. For some clinicians, writing gives voice to emotions too raw to easily speak aloud (Wright, 2003).

Traditional journaling can allow for self-reflection, increased self-awareness, and growth (Lent, 2009; Utley & Garza, 2011). Journal writing can be inherently self-compassionate. Linder et al. (2000) discussed the use of a non-judgmental journaling practice in which there are no wrong words and writers are encouraged to use random sentences and words that do not make sense. Through almost nonsensical form, journaling offers a sense of safety and freedom, while creating a trusting relationship with the journal. Linder et al. (2000) stated, “Journaling finds the meaning in meaninglessness and negates the emptiness through creating writing from the heart. It is an outlet to tell the truth without being judged” (p. 7).

Beyond the traditional journal, counselors may find alternative ways to use journaling for emotional expression, such as use of bullet journaling or a personal blog online. Bullet journaling uses a rapid-logging approach, or a visual code, to represents tasks, events, and notes in a physical notebook (Bullet Journal, 2017). Keeping a bullet journal is a clever way of managing multiple arenas of one’s life in a single place, and the events and notes categories can be particularly helpful in the practice of journaling for self-care. Events are to be written down briefly and objectively despite the degree of emotional content they carry (Bullet Journal, 2017), offering an opportunity to practice the non-reactive skill of mindfulness (Kabat-Zinn, 1994). Once an event has been entered, the counselor can respond mindfully to it by writing at length on the following page. The notes category for bullet journaling consists of ideas, thoughts, or observations (Bullet Journal, 2017), which could include inspirational quotes, eureka moments, or other insights worth reviewing at a later date. The author can use signifiers (i.e., symbols) to create a legend to provide additional context for an event, note, or task. The bullet journal approach for self-expression exemplifies a creative twist on an old concept to better fit the preferences of the writer. Similarly, scrapbook journaling can be used to accommodate the types of expressive media that resonate with the counselor’s personal style or interests (Bradley et al., 2013). Counselors can use photos, poems, song lyrics, and quotes to reflect their emotional state, and then reflect on the emotional patterns or themes that arise. For counselors who prefer to share their thoughts on the Internet, an online blog can be a cost-effective, accessible medium to express oneself emotionally and share thoughts, feelings, and experiences with others (Lent, 2009). Counselors should consider the risks associated with the use of the Internet and maintenance of confidentiality in an online medium in accordance with the ACA Code of Ethics (2014).

Finally, a simple self-care intervention can involve writing oneself a permission slip or prescription for something. This could be the permission to be imperfect, to take a mental health day, or to run through a sprinkler on a hot day. A writing assignment of this sort expresses kindness in providing the very thing that is needed for an emotional recharge. In some cases, this may involve taking a quiet moment to allow one’s mind to wander. This can occur during a warm bath or shower at the end of the day or while savoring a warm cup of coffee or tea in the afternoon. Although mind-wandering can be a threat to effectiveness and productivity when it occurs at inopportune times, taking time for mind-wandering can relieve boredom, stimulate creative thoughts, and facilitate future planning (Smallwood & Schooler, 2015).

Interventions for the Body

Many self-care plans begin and end with a strong concentration on physical self-care, typically involving making nutritional changes and increasing physical activity (Bradley et al., 2013; E. Thompson et al., 2011). These therapeutic lifestyle changes (TLCs) can have a huge impact on health and well-being (Walsh, 2011). Although the mental health benefits of these types of changes are well documented (Walsh, 2011), a myopic focus on physiological wellness may be limiting, and self-care should include a broader range of ways to cope (E. Thompson et al., 2011). For individuals wishing to focus specifically on such changes, using the imagery of caring for oneself as one does a plant may increase self-awareness of bodily self-care needs (Bradley et al., 2013). Considering one’s needs in this metaphorical way may help counselors increase their own self-compassion by considering their unique needs and the changes they are ready and willing to make. A counselor may indicate they require shade from the sun, which could represent reducing over-stimulating environments; good spacing from other plants, indicating healthy boundaries or alone time; and water and nutrients, which may remind the counselor to keep a pitcher of water on the desk and a bag of almonds in a drawer. Externalizing in this way can be particularly helpful when learning self-compassion because often counselors find it easier to care for others than themselves (Patsiopoulos & Buchanan, 2011).

Although exercise has clear mental health benefits (Callaghan, 2004), for some the concept of exercise may lack appeal or may prove difficult to prioritize within a daily work schedule. The use of stretching, walking, or yoga for a short amount of time may be more easily integrated into a hectic schedule. Yoga has been found to be equivalent to exercise in many mental and physical health domains, but not all types of yoga have been found to improve overall physical fitness as compared to more rigorous exercise (Ross & Thomas, 2010). The practice of yoga has been found to increase acceptance of self and others and reduce self-criticism (Valente & Marotta, 2005). Further, the regular practice of yoga can “provide therapists with a discipline capable of fostering a greater sense of self-awareness and helping to develop a lifestyle that is conducive to their own personal growth and the goals of their profession” (Valente & Marotta, 2005, p. 79).

The benefits of movement go beyond improvements in cardiac and musculoskeletal health, while serving to benefit the mind and the spirit. Dance has been used for centuries as a healing practice (Koch, Kunz, Lykou, & Cruz, 2014) and reduces stress, increases stress tolerance, and improves well-being (Bräuninger, 2012). Marich and Howell (2015) developed the practice of dancing mindfulness, which utilizes dance as the medium for practicing meditation. Dancing mindfulness participants report improvement in emotional and spiritual domains, greater acceptance of self, and an increased ability to use mindfulness in everyday life (Marich & Howell, 2015). However, caring for oneself requires more than just nutrition and movement; self-care plans should metaphorically consider the environment.

Skovholt et al. (2001; Skovholt, 2012) uses the concept of a greenhouse to describe the characteristics for a healthy work environment. Plants flourish within a nurturing greenhouse environment. Likewise, counselors thrive within a work environment that is characterized by a sense of autonomy and fairness; growth-promoting and meaningful work; reasonable expectations and remuneration; and trust, support, and respect among colleagues (Skovholt, 2012). The metaphorical work “greenhouse” contains individualized supports and resources that allow for growth and rejuvenation, but can protect the counselor from the harshness that could characterize their work. Examining and adjusting factors that may be under the counselor’s control, such as breaks between clients; scheduling of clients engaged in trauma work; number of assessments, intakes, or group sessions in one day; or other malleable elements can help create a work day that best meets the needs of the counselor. Strategic planning and focused intentionality allows the counselor to engage fully in each client encounter.

Interventions for the Spirit

Religion and spirituality are important factors within the lives of many clients (Cashwell, Bentley, & Bigbee, 2007). Within the United States, 77% of adults identify with some religious faith (Masci & Lipka, 2016). However, the United States is growing in those who identify as spiritual, with 59% of adults reporting a regular “deep sense of ‘spiritual peace and well-being’” (Masci & Lipka, 2016, para. 2). To attend appropriately and fully to clients’ religious and spiritual needs, counselors also need to care for their own spiritual selves.

Humanistic counselors engage fully with clients to create a genuine connection and are most effective as helpers in areas in which they themselves are stronger and more grounded (Baldwin, 2013). Therefore, when addressing the spiritual concerns of a client, counselors need to be aware of where they are on their own spiritual path. Otherwise, there is no assurance their own religious or spiritual concerns will not create an obstacle for their client’s growth (Sori, Biank, & Helmeke, 2006). A counselor’s spiritual concerns can influence the therapeutic alliance in many ways. Influences can include increased reactivity to the spiritual concerns of the client, decreased recognition of how the client values personal spirituality, or inattention to how the client’s spirituality may be a therapeutic resource or contributing factor to distress (Sori et al., 2006). Sori and colleagues (2006) concluded that failure to be aware of spirituality as an aspect of the human condition can create potential boundary issues, limit a counselor’s understanding of the client due to unexamined beliefs rooted in one’s own spiritual background, and result in difficulty managing the emotional uncertainty and pain of clients due to the counselor’s own struggles with faith. Therefore, engaging in reflection, exploration, or a regular spiritual practice can benefit both the counselor and the client.

Spirituality in counseling has been defined as “the capacity and tendency present in all human beings to find and construct meaning about life and existence and to move toward personal growth, responsibility, and relationship with others” (Myers & Williard, 2003, p. 149). This definition conceptualizes spirituality as a central component of wellness that shapes one’s functioning physically, psychologically, and emotionally, not as separate parts of the whole being (Myers & Williard, 2003). Valente and Marotta (2005) asserted that a healthy spiritual life can be emotionally nourishing and keep burnout at bay. Further, greater self-awareness of one’s spirituality may allow practitioners to be more present with their own suffering and that of their clients. Chandler, Miner Holden, and Kolander (1992) stated that attending to spiritual health when making personal change toward wellness will increase the likelihood of self-transformation and greater balance in life. Because there are many expressions of spirituality, individuals wishing to incorporate spirituality into their self-care plan should consider choosing activities that align with personal goals and are consistent with their values (Cashwell et al., 2007).

A spiritual self-care practice can create an inner refuge (Linder et al., 2000) that can offer sanctuary for a counselor when overwhelmed by personal or professional suffering (Sori et al., 2006). Particularly for those in the exploration phase of their own spirituality, but beneficial for all, conducting a moral inventory can assess how individuals are living in accordance with personal beliefs and values (Sori, et al., 2006). Following the moral inventory, a counselor may create a short list of principles to live by (i.e., a distilled list of values consistent with religious and spiritual ideas that are particularly personally valuable; V. Pope, personal communication, August, 2016). Individual research or joining a spiritual community can be helpful for education, support, and guidance in learning more about a particular religious or spiritual tradition (Cashwell et al., 2007). Some religious traditions, such as Seventh-Day Adventists, offer guidelines for physical and mental exercises, as well as nutritional advice that can be translated into intentional counselor self-care practices. Seventh-Day Adventists have a strong focus on wellness and advocate a vegetarian diet and avoidance of tobacco, alcohol, and mind-altering substances (General Conference of Seventh-Day Adventist World Church, 2016). Further, self-reflection may be regularly incorporated into rituals associated with an important time of year such as Lent or the Days of Awe.

For many, prayer can be a powerful practice for connecting with a higher power. Prayer is an integral part of a variety of spiritual traditions and has been associated with a variety of improvements in health and well-being (Granello, 2013). Spending time in communion with a higher power can be integrated into a regular routine for the purpose of self-care. Meditation also can be a spiritual practice and has a long history of applications and associations with health improvement (Granello, 2013). Broadly speaking, there are two types of meditation: concentration, which involves focusing attention (e.g., repeating a mantra, counting, or attending to one’s breath), and mindfulness, which non-judgmentally expands attention to thoughts, sensations, or emotions present at the time (Ivanovski & Malhi, 2007). These quiet practices can allow the participant moments of silence to achieve various ends, such as relaxation, acceptance, or centering.

Connecting with the earth or nature also can be a practice of spiritual self-care. Grounding exercises such as massage, Tai Chi, or gardening can be helpful to encourage a reconnection with the body and the earth (Chandler, et al., 1992). Furthermore, spending time in nature has been found to be rejuvenating both mentally and spiritually (Reese & Myers, 2012).

Engaging in a creative, expressive art activity for the purposes of spiritual practice and healing can be incredibly powerful to heal mind, body, and soul (Lane, 2005). Novelist John Updike has said, “What art offers is space—a certain breathing room for the spirit” (Demakis, 2012, p. 23). Art can come in many forms. Expressive arts can be a powerful tool of self-expression (Snyder, 1997; Wikström, 2005) and provide many options that can easily be used as self-care interventions. Sometimes the inner critic, need for approval, fear of failure, or a fear of the unknown can create barriers to exploring one’s creative energy (N. Rogers, 1993). Maintaining a self-compassionate attitude can allow counselors to create a safe environment to practice self-care free of judgment.

Use of dance, music, art, photography, and other media can be used intentionally for holistic healing. Through the use of clay, paint, charcoal, or other media, the creator can become in touch with feelings, gain insight, release energy, and discover alternative spiritual dimensions of the self, as well as experience another level of consciousness (N. Rogers, 1993). Music has been found to be both therapeutic and transcendental (Knight & Rickard, 2001; Lipe, 2002; Yob, 2010). There are various ways to incorporate music into a self-care plan depending on interest, access, and preference. In many cultures, music and spirituality are integrally linked (Frame & Williams, 1996). Listening to a favorite hymn, gospel music, or other type of liturgical music can be one way to revitalize the spirit during the workday. Relaxing music has been found to prevent physiological responses to stress and subjective experience of anxiety in one study of undergraduates (Knight & Rickard, 2001). Singing is another way of expressing thoughts and feelings, and for some it can provide a vehicle for self-actualization, connection to a higher power, and self-expression (Chong, 2010). After a long day, singing in the office, in the car, or while cooking dinner can be particularly cathartic.

Conclusion

Counselors are routinely exposed to painful situations, traumatic circumstances, and overwhelming emotions. Consequently, they could benefit from creating a safe place for vulnerability, especially when emotionally overwrought after a long day or a particularly difficult counseling session. To thrive as a counselor, self-care is essential, yet many struggle to care for themselves as they care for their clients. To best achieve holistic wellness, counselors must incorporate interventions for the body, mind, and spirit. Counselors can apply self-compassion principles to the creation of an individualized self-care plan, one that functions to rejuvenate flagging professional commitment and soothe potentially debilitating stress. By cultivating an attitude of self-compassion, counselors may be more attentive to their own needs, reducing the risk of developing burnout and benefitting both clients and themselves. These counselors also may be more effective in assisting clients with overcoming their own barriers to self-care. Similarly, counselors who serve as educators or supervisors can model such principles and routinely ask students and supervisees, “What do you need now?” to increase awareness and the practice of tuning in. Consequently, the self-compassionate counselor learns to create a self-care plan that becomes a balm for burnout.

Conflict of Interest and Funding Disclosure

The authors reported no conflict of interest or funding contributions for the development of this manuscript.

References

American Counseling Association. (2010). American Counseling Association’s Task Force on Counselor Wellness and Impairment. Retrieved from http://www.creating-joy.com/taskforce/tf_history.htm

American Counseling Association. (2014). 2014 ACA code of ethics. Alexandria, VA: Author. Retrieved from https://www.counseling.org/resources/aca-code-of-ethics.pdf

Baldwin, M. (2013). Interview with Carl Rogers on the use of the self in therapy. In M. Baldwin (Ed.), The use of self in therapy (3rd ed., pp. 28–35). New York, NY: Routledge.

Barnard, L. K., & Curry, J. F. (2011). Self-compassion: Conceptualizations, correlates, & interventions. Review of General Psychology, 15, 289–303. doi:10.1007/s11089-011-0377-0

Barnett, J. E., Baker, E. K., Elman, N. S., & Schoener, G. R. (2007). In pursuit of wellness: The self-care imperative. Professional Psychology: Research and Practice, 38, 603–612. doi:10.1037/0735-7028.38.6.603

Bradley, N., Whisenhunt, J., Adamson, N., & Kress, V. E. (2013). Creative approaches for promoting counselor self-care. Journal of Creativity in Mental Health, 8, 456–469. doi:10.1080/15401383.2013.844656

Bräuninger, I. (2012). Dance movement therapy group intervention in stress treatment: A randomized controlled trial (RCT). The Arts in Psychotherapy, 39, 443–450. doi:10.1016/j.aip.2012.07.002

Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychological Inquiry, 18, 211–237. doi:10.1080/10478400701598298

Bullet Journal. (2017). Getting started. Retrieved from http://bulletjournal.com/get-started/

Callaghan, P. (2004). Exercise: A neglected intervention in mental health care? Journal of Psychiatric and Mental Health Nursing, 11, 476–483. doi:10.1111/j.1365-2850.2004.00751.x

Carney, J. V. (2007). Humanistic wellness services for community mental health providers. The Journal of Humanistic Counseling, 46, 154–171. doi:10.1002/j.2161-1939.2007.tb00033.x

Cashwell, C. S., Bentley, D. P., & Bigbee, A. (2007). Spirituality and counselor wellness. The Journal of Humanistic Counseling, 46, 66–81. doi:10.1002/j.2161-1939.2007.tb00026.x

Chandler, C. K., Holden, J. M., & Kolander, C. A. (1992). Counseling for spiritual wellness: Theory and practice. Journal of Counseling & Development, 71, 168–175. doi:10.1002/j.1556-6676.1992.tb02193.x

Chong, H. J. (2010). Do we all enjoy singing? A content analysis of non-vocalists’ attitudes toward singing. The Arts in Psychotherapy, 37, 120–124. doi:10.1016/j.aip.2010.01.001

Christopher, J. C., Christopher, S. E., Dunnagan, T., & Schure, M. (2006). Teaching self-care through mindfulness practices: The application of yoga, meditation, and qigong to counselor training. Journal of Humanistic Psychology, 46, 494–509. doi:10.1177/0022167806290215

Connolly Baker, K., & Mazza, N. (2004). The healing power of writing: Applying the expressive/creative component of poetry therapy. Journal of Poetry Therapy, 17, 141–154. doi:10.1080/08893670412331311352

Council for Accreditation of Counseling & Related Educational Programs. (2016). 2016 CACREP standards. Alexandria, VA: Author. Retrieved from http://www.cacrep.org/for-programs/2016-cacrep-standards

Covey, S. R. (2010). Foreword. In A. Pattakos (Ed.), Prisoners of our thoughts: Viktor Frankl’s principles for discovering meaning in life and work (2nd ed., pp. V–XI). Oakland, CA: Berrett-Koehler Publishers.

Cushman, P., & Gilford, P. (2000). Will managed care change our way of being? American Psychologist, 55, 985–996. doi:10.1037//0003-066X.55.9.985

Demakis, J. (2012). The ultimate book of quotations. Seattle, WA: CreateSpace.

Figley, C. R. (2002). Compassion fatigue: Psychotherapists’ chronic lack of self-care. Journal of Clinical Psychology, 58, 1433–1441. doi:10.1002/jclp.10090

Frame, M. W., & Stevens-Smith, P. (1995). Out of harm’s way: Enhancing monitoring and dismissal processes in counselor education programs. Counselor Education and Supervision, 35, 118–129. doi:10.1002/j.1556-6978.1995.tb00216.x

Frame, M. W., & Williams, C. B. (1996). Counseling African Americans: Integrating spirituality in therapy. Counseling and Values, 41, 16–28. doi:10.1002/j.2161-007X.1996.tb00859.x

Franco, G. E. (2016). Productivity standards: Do they result in less productive and satisfied therapists? The Psychologist-Manager Journal, 19, 91–106. doi:10.1037/mgr0000041

Freadling, A. H., & Foss-Kelly, L. L. (2014). New counselors’ experiences of community health centers. Counselor Education and Supervision, 53, 219–232. doi:10.1002/j.1556-6978.2014.00059.x

General Conference of Seventh-Day Adventist World Church. (2016). Living a healthful life. Retrieved from https://www.adventist.org/en/vitality/health

Gentry, J. E. (2002). Compassion fatigue: A crucible of transformation. Journal of Trauma Practice, 1(3–4), 37–61. doi:10.1300/J189v01n03_03

Germer, C. K., & Neff, K. D. (2015). Cultivating self-compassion in trauma survivors. In V. M. Follette, J. Briere, D. Rozelle, J. W. Hopper, & D. I. Rome (Eds.), Mindfulness-oriented interventions for trauma: Integrating contemplative practices (pp. 43–58). New York, NY: The Guilford Press.

Graff, G. (2008). Shame in supervision. Issues in Psychoanalytic Psychology, 30, 79–94.

Granello, P. F. (2013). Wellness counseling. Upper Saddle River, NJ: Pearson Education.

Grosch, W. N. & Olsen, D. C. (1994). When helping starts to hurt: A new look at burnout among psychotherapists. New York, NY: W. W. Norton.

Ivanovski, B., & Malhi, G. S. (2007). The psychological and neurophysiological concomitants of mindfulness forms of meditation. Acta Neuropsychiatrica, 19, 76–91. doi:10.1111/j.1601-5215.2007.00175.x

Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York, NY: Hyperion.

Killian, K. D. (2008). Helping till it hurts? A multimethod study of compassion fatigue, burnout, and self-care in clinicians working with trauma survivors. Traumatology, 14(2), 32–44. doi:10.1177/1534765608319083

Knight, W. E., & Rickard, N. S. (2001). Relaxing music prevents stress-induced increases in subjective anxiety, systolic blood pressure, and heart rate in healthy males and females. Journal of Music Therapy, 38, 254–272. doi:10.1093/jmt/38.4.254

Koch, S., Kunz, T., Lykou, S., & Cruz, R. (2014). Effects of dance movement therapy and dance on health-related psychological outcomes: A meta-analysis. The Arts in Psychotherapy, 41, 46–64.

doi:10.1016/j.aip.2013.10.004

Kress, V. E., & Paylo, M. J. (2015). Treating those with mental disorders: A comprehensive approach to case conceptualization and treatment. Upper Saddle River, NJ: Pearson Education.

Lane, M. R. (2005). Creativity and spirituality in nursing: Implementing art in healing. Holistic Nursing Practice, 19, 122–125.

Lent, J. (2009). Journaling enters the 21st century: The use of therapeutic blogs in counseling. Journal of Creativity in Mental Health, 4, 67–73. doi:10.1080/15401380802705391

Linder, S., Miller, G., & Johnson, P. (2000, March). Counseling and spirituality: The use of emptiness and the importance of timing. Paper presented at the meeting of the American Counseling Association, Washington, DC.

Lindholm, J. A. (2003). Perceived organizational fit: Nurturing the minds, hearts, and personal ambitions of university faculty. The Review of Higher Education, 27, 125–149. doi:10.1353/rhe.2003.0040

Lipe, A. W. (2002). Beyond therapy: Music, spirituality, and health in human experience: A review of literature. Journal of Music Therapy, 39, 209–240. doi:10.1093/jmt/39.3.209

Marich, J., & Howell, T. (2015). Dancing mindfulness: A phenomenological investigation of the emerging practice. EXPLORE: The Journal of Science and Healing, 11, 346–356. doi:10.1016/j.explore.2015.07.001

Masci, D., & Lipka, M. (2016, January 21). Americans may be getting less religious, but feelings of spirituality are on the rise. Washington, DC: Pew Research Center. Retrieved from http://www.pewresearch.org/fact-tank/2016/01/21/americans-spirituality

Maslach, C., Leiter, M. P., & Jackson, S. E. (2012). Making a significant difference with burnout interventions: Researcher and practitioner collaboration. Journal of Organizational Behavior, 33, 296–300. doi:10.1002/job.784

Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual Review of Psychology, 52, 397–422. doi:10.1146/annurev.psych.52.1.397

Matthes, W. A. (1992). Induction of counselors into the profession. The School Counselor, 39, 245–250.

Mellin, E. A., Hunt, B., & Nichols, L. M. (2011). Counselor professional identity: Findings and implications for counseling and interprofessional collaboration. Journal of Counseling & Development, 89, 140–147. doi:10.1002/j.1556-6678.2011.tb00071.x

Myers, J. E., Sweeney, T. J., & Witmer, J. M. (2001). Optimization of behavior: Promotion of wellness. In D. C. Locke, J. E. Myers, & E. L. Herr (Eds.), The handbook of counseling (pp. 641–652). Thousand Oaks, CA: Sage.

Myers, J. E., & Williard, K. (2003). Integrating spirituality into counselor preparation: A developmental, wellness approach. Counseling and Values, 47, 142–155. doi:10.1002/j.2161-007X.2003.tb00231.x

Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2, 85–101. doi:10.1080/15298860390129863

Neff, K. D., & Costigan, A. P. (2014). Self-compassion, wellbeing, and happiness. Psychologie in Österreich, 2(3), 114–119. Retrieved from http://self-compassion.org/wp-content/uploads/publications/Neff&Costigan.pdf

Neff, K. D., Kirkpatrick, K. L., & Rude, S. S. (2007). Self-compassion and adaptive psychological functioning.

Journal of Research in Personality, 41, 139–154. doi:10.1016/j.jrp.2006.03.004

Newsome, S., Waldo, M., & Gruszka, C. (2012). Mindfulness group work: Preventing stress and increasing self-compassion among helping professionals in training. The Journal for Specialists in Group Work, 37, 297–311. doi:10.1080/01933922.2012.690832

Nielsen, L. A. (1988). Substance abuse, shame and professional boundaries and ethics: Disentangling the issues. Alcoholism Treatment Quarterly, 4, 109–137. doi:10.1300/J020v04n02_08

O’Halloran, T. M., & Linton, J. M. (2000). Stress on the job: Self-care resources for counselors. Journal of Mental Health Counseling, 22, 354–364.

Ohrt, J. H., Prosek, E. A., Ener, E., & Lindo, N. (2015). The effects of a group supervision intervention to promote wellness and prevent burnout. The Journal of Humanistic Counseling, 54, 41–58.

doi:10.1002/j.2161-1939.2015.00063.x

Patsiopoulos, A. T., & Buchanan, M. J. (2011). The practice of self-compassion in counseling: A narrative inquiry. Professional Psychology: Research and Practice, 42, 301–307. doi:10.1037/a0024482

Pennebaker, J. W., & Seagal, J. D. (1999). Forming a story: The health benefits of narrative. Journal of Clinical Psychology, 55, 1243–1254. doi:10.1002/(SICI)1097-4679(199910)55:10<1243::AID-JCLP6>3.0.CO;2-N

Pollack, S. M., Pedulla, T., & Siegel, R. D. (2014). Sitting together: Essential skills for mindfulness-based psychotherapy. New York, NY: The Guilford Press.

Reese, R. F., & Myers, J. E. (2012). EcoWellness: The missing factor in holistic wellness models. Journal of Counseling & Development, 90, 400–406. doi:10.1002/j.1556-6676.2012.00050.x

Riordan, R. J. (1996). Scriptotherapy: Therapeutic writing as a counseling adjunct. Journal of Counseling and Development, 74, 263–269. doi:10.1002/j.1556-6676.1996.tb01863.x

Rogers, C. R. (1961). On becoming a person: A therapist’s view of psychotherapy. Boston, MA: Houghton Mifflin.

Rogers, C. R. (1980). A way of being. New York, NY: Houghton Mifflin Harcourt.

Rogers, N. (1993). The creative connection: Expressive arts as healing. Palo Alto, CA: Science and Behavior Books.

Ross, A., & Thomas, S. (2010). The health benefits of yoga and exercise: A review of comparison studies. The Journal of Alternative and Complementary Medicine, 16, 3–12. doi:10.1089=acm.2009.0044

Rust, J. P., Raskin, J. D., & Hill, M. S. (2013). Problems of professional competence among counselor trainees: Programmatic issues and guidelines. Counselor Education and Supervision, 52, 30–42.
doi:10.1002/j.1556-6978.2013.00026.x

Ruysschaert, N. (2009). (Self) hypnosis in the prevention of burnout and compassion fatigue for caregivers: Theory and induction. Contemporary Hypnosis, 26, 159–172. doi:10.1002/ch.382

Schanche, E., Stiles, T. C., McCullough, L., Svartberg, M., & Nielsen, G. H. (2011). The relationship between activating affects, inhibitory affects, and self-compassion in patients with Cluster C personality disorders. Psychotherapy, 48, 293–303. doi:10.1037/a0022012

Schaufeli, W., & Enzmann, D. (1998). The burnout companion to study & practice: A critical analysis. Philadelphia, PA: Taylor and Francis.

Skovholt, T. M. (2012). The counselor’s resilient self. Turkish Psychological Counseling and Guidance Journal, 4(38), 137–146. Retrieved from http://www.pegem.net/dosyalar/dokuman/138861-20140125102831-1.pdf

Skovholt, T. M., Grier, T. L., & Hanson, M. R. (2001). Career counseling for longevity: Self-care and burnout prevention strategies for counselor resilience. Journal of Career Development, 27, 167–176. doi:10.1023/A:1007830908587

Smallwood, J., & Schooler, J. W. (2015). The science of mind wandering. Annual Review of Psychology, 66, 487–518. doi:10.1146/annurev-psych-010814-015331

Snyder, B. A. (1997). Expressive art therapy techniques: Healing the soul through creativity. Journal of Humanistic Education & Development, 36, 74–82. doi:10.1002/j.2164-4683.1997.tb00375.x

Sori, C. F., Biank, N., & Helmeke, K. B. (2006). Spiritual self-care of the therapist. In K. B. Helmeke & C. F. Sori (Eds.), The therapist’s notebook for integrating spirituality in counseling: Homework, handouts, and activities for use in psychotherapy (Vol. 1, pp. 3–18). Binghamton, NY: The Haworth Press.

Thompson, E. H., Frick, M. H., & Trice-Black, S. (2011). Counselor-in-training perceptions of supervision practices related to self-care and burnout. The Professional Counselor, 1, 152–162. doi:10.15241/eht.1.3.152

Thompson, I., Amatea, E., & Thompson, E. (2014). Personal and contextual predictors of mental health counselors’ compassion fatigue and burnout. Journal of Mental Health Counseling, 36, 58–77. doi:10.17744/mehc.36.1.p61m73373m4617r3

Utley, A., & Garza, Y. (2011). The therapeutic use of journaling with adolescents. Journal of Creativity in Mental Health, 6, 29–41. doi:10.1080/15401383.2011.557312

Valente, V., & Marotta, A. (2005). The impact of yoga on the professional and personal life of the psychotherapist. Contemporary Family Therapy, 27, 65–80. doi:10.1007/s10591-004-1971-4

Walsh, R. (2011). Lifestyle and mental health. American Psychologist, 66, 579–592. doi:10.1037/a0021769

Warren, J., Morgan, M. M., Morris, L.-N. B., & Morris, T. M. (2010). Breathing words slowly: Creative writing and counselor self-care—The writing workout. Journal of Creativity in Mental Health, 5, 109–124.
doi:10.1080/15401383.2010.485074

Wikström, B. M. (2005). Communicating via expressive arts: The natural medium of self-expression for hospitalized children. Pediatric Nursing, 31, 480–485.

Witmer, J. M., & Young, M. E. (1996). Preventing counselor impairment: A wellness approach. The Journal of Humanistic Counseling, 34, 141–155. doi:10.1002/j.2164-4683.1996.tb00338.x

Wright, J. K. (2003). Writing for protection: Reflective practice as a counsellor. Journal of Poetry Therapy, 16, 191–198. doi:10.1080/0889367042000197376

Yager, G. G., & Tovar-Blank, Z. G. (2007). Wellness and counselor education. The Journal of Humanistic Counseling, 46, 142–153. doi:10.1002/j.2161-1939.2007.tb00032.x

Yob, I. M. (2010). Why is music a language of spirituality? Philosophy of Music Education Review, 18, 145–151. doi:10.2979/pme.2010.18.2.145

Susannah C. Coaston is an assistant professor at Northern Kentucky University. Correspondence can be addressed to Susannah Coaston, 1 Nunn Drive, MEP 203C, Highland Heights, KY 41099, coastons1@nku.edu.

Metaphor in Professional Counseling

Apr 2, 2017 | Volume 7 - Issue 2

Alwin E. Wagener

Metaphors are linked to how individuals process information and emotions, and they are important to understand and utilize in counseling. A description of the structure of metaphors and metaphor theory is provided. The role of metaphors in emotional processing is explained, and the process of counseling is tied to the therapeutic usage of metaphors. Building from that information, approaches to using metaphors in counseling are described, and metaphors are divided into client-generated and counselor-generated categories, with corresponding information on how metaphors can be used in the counseling process. The counseling process is then separated into categories of exploration, insight and action, and descriptions of metaphor usage along with composite case examples are provided for each category to show how incorporating metaphors in clinical practice can be therapeutically beneficial in supporting positive client changes.

Keywords: metaphor, exploration, insight, action, emotional processing

Metaphorical language occurs commonly in communication, with a study by Steen, Dorst, Herrmann, Kaal, and Krennmayr (2010) finding that metaphoric language is used 18.6% of the time in academic writing, 11.8% in fiction and 7.7% in conversation. Examples of types of metaphoric language that may commonly appear in conversation are: she rushed to his defense (in the context of arguing on his behalf), she broke down and cried and when I walked into the house, she attacked me for not calling to say I would be late (in this case meaning that she was upset and spoke in a harsh manner). In these examples, the metaphors are rushed to his defense, broke down, and attacked. These words are not literal descriptions but instead use descriptions of physical processes to metaphorically describe emotional and verbal activities. These metaphors might appear in clients’ normal speech and may be commonly overlooked as being metaphoric. The frequency of these metaphors in language provides opportunities for greater exploration and understanding of clients. Research findings also support metaphors occurring at a higher rate when describing emotions and discussing emotional experiences, making metaphors even more important for counselors to recognize and address (Fainsilber & Ortony, 1987; Lubart & Getz, 1997; Samur, Lai, Hagoort, & Willems, 2015; Smollan, 2014).

Metaphors are not simply a linguistic or literary device; they play an important role in learning and cognitively organizing an understanding of the world (Aragno, 2009; Evans, 2010; Lakoff & Johnson, 1980). The importance of metaphors for learning and understanding is a prime reason for counselors to be conversant in metaphors and their uses in counseling. Counseling involves supporting clients in learning and understanding so they can make changes that enable them to reach their goals. Recognizing and working with client metaphors can be beneficial for professional counselors, as there is research supporting metaphor frequency and types varying in relation to emotional changes (Gelo & Mergenthaler, 2012; Tay, 2012; Wickman, Daniels, White, & Fesmire, 1999). Therefore, clients’ metaphors can provide insight into their emotional states and how they are conceptualizing their situations. In addition, metaphors can be used in treatment interventions and for monitoring changes in client conceptualizations and emotions over the course of treatment (Gelo & Mergenthaler, 2012; Kopp & Eckstein, 2004; Lakoff & Johnson, 1980; Sims, 2003; Tay, 2012). However, to effectively use metaphors in counseling practice, it is helpful to understand the basic terminology and structure of metaphors, as this allows the counselor to recognize metaphor types associated with increased emotional processing and the integration of new awareness (Gelo & Mergenthaler, 2012; Lakoff & Johnson, 1980; Tay, 2012). Therefore, this manuscript begins with a brief description of metaphor structure and forms so that the later sections linking metaphors to emotional states and changes and providing approaches for working with metaphors in counseling are more understandable and useful.

Metaphor Structure

Metaphors are a symbolic approach for implying similarity between experiences, thoughts, emotions, actions or objects (Evans, 2010; Seitz, 1998). The structure of a metaphor can be broken down into two domains, the target domain and the source domain. The target domain refers to the concept the metaphor is being used to explain. The source domain is the concrete topic to which the target domain is being linked. By combining the two domains in a metaphoric expression, an understanding of the target domain’s properties is established. The description of properties through the relationship between domains is referred to as conceptual mapping (Tay, 2012). For example, within the metaphor, she is on fire, she is the target domain and fire is the source domain. Through the linkage of these domains, the she referred to is understood to have qualities like that of a fire—in this case, an intense energy.

Metaphors are further classified as having forms that are either simple or complex and either conventional or unconventional. Simple metaphors have one target and one source domain, and complex metaphors have one target with more than one source domain (Lakoff & Johnson, 1980). Conventional metaphors are those that are commonly used within a culture, and unconventional metaphors are those that are not commonly used (Lakoff & Johnson, 1980).

Metaphors and Emotional Change

The process of counseling requires a focus on the emotional experience of clients. Clients’ emotions guide the counselor to what is most affecting and important to clients, so the counseling process often involves developing clients’ recognition of emotional patterns and needs, as well as the generation of new emotional perspectives. Because emotions are at the heart of counseling, the specific connection between emotions and metaphors needs exploration. Research has shown that metaphor usage is connected to emotional change, and specifically, there is support for an increased occurrence of metaphors when talking about emotions, especially intense emotions (Crawford, 2009; Fainsilber & Ortony, 1987). Lakoff and Johnson (1980) described metaphor as an approach for conceptualizing the experience of emotion in a form that is relatable to other individuals. Metaphor is viewed as a way to cognitively organize the emotional experience (Crawford, 2009; Lakoff & Johnson, 1980). It is possible that intense emotions are an experience not directly relatable to other individuals without references, and this may explain research evidence supporting an increased use of metaphor when describing intense emotional experiences (Crawford, 2009; Smollan, 2014). In addition to the possible need for source domains as references to describe intense emotions, metaphors may be ideal for relating emotional experiences because of their ability to encapsulate specific and content-rich information in a concise and broadly understandable manner (Fainsilber & Ortony, 1987).

The link between metaphor and emotion is supported by a number of studies showing that when comparing literal and metaphoric language with the same intended meaning and emotional valence, metaphoric language is related to greater activation of brain regions (particularly the left amygdala) associated with emotion (Bohrn, Altmann, & Jacobs, 2012; Citron & Goldberg, 2014; Citron, Güsten, Michaelis, & Goldberg, 2016) along with higher participant ratings of the emotion contained in metaphor (Fetterman, Bair, Werth, Landkammer, & Robinson, 2016; Mohammad, Shutova, & Turney, 2016). Connecting these findings more directly with counseling practice, Fetterman et al. (2016) found that having participants write metaphorically about personal experiences significantly reduced negative affect in comparison to a control condition in which participants were writing literally about personal experiences. For those participants who wrote metaphorically, there was an increased preference for metaphor usage. These findings support the theory that metaphors are linked to emotional processing and provide more backing for counselors addressing and working with metaphors in counseling.

One additional study that provides a lens into metaphors in counseling practice was conducted by Gelo and Mergenthaler (2012). They performed single-subject research investigating whether the type of metaphor (unconventional or conventional) and frequency of metaphor use were related to client change in counseling. This research was based on previous studies suggesting that unconventional metaphors occur more frequently when clients are involved in emotional and cognitive change processes (Gelo & Mergenthaler, 2012). Gelo and Mergenthaler found that client metaphor usage was associated with periods of emotional and cognitive change, and the client used more unconventional metaphors when reflecting on emotional change, but not while experiencing emotional change. Though it is hard to generalize from a small study, this is an important observation that supports the conceptual idea that metaphors are used to organize emotional experiences and integrate the experiences with the cognitive domain (Crawford, 2009; Lakoff & Johnson, 1980).

Taken in combination, studies examining the relationship between metaphor and emotion indicate that metaphors are linked to processing and communicating emotion, which makes metaphors important for counselors to understand, address and utilize. These studies also suggest that metaphors may have an important role for counselors who are supporting emotional change in clients. Therefore, these research findings inform recommendations for integrating metaphors into counseling.

Metaphor Sources and Approaches

Metaphors in counseling come from two sources, the client and the counselor. The source of the metaphor is important to consider when describing approaches to working with metaphors in clinical practice; thus, client-generated and counselor-generated metaphors will be discussed separately.

Client-Generated Metaphors

The nature of client-generated metaphors can allow for assessment of clients (Gelo & Mergenthaler, 2012; Stewart & Barnes-Holmes, 2001; Wickman et al., 1999). This assessment may only consist of recognizing how clients are conceptualizing experiences, but it also may involve working directly with metaphors to better understand relationships. Noticing the increased usage of complex and unconventional metaphors may be helpful for recognizing when clients may benefit from greater support and conceptual assistance to integrate new concepts or behaviors and explore emotions (Gelo & Mergenthaler, 2012).

To work directly with metaphors in counseling, several approaches are helpful. Kopp and Craw (1998) and Sims (2003) offered similar models with steps to facilitate insight using client-generated metaphors. Both models begin by having the counselor ask the client to elaborate on the metaphor and then follow up by asking the client questions to provide more detail, including emotions connected to the metaphor. Following client elaboration, additional questions and reflections from the counselor support the generation of client insight. To reinforce insight and apply it to the current situation, Kopp and Craw’s model has the client imagine changes in the metaphor that support counseling goals, whereas Sims’ model directs the client to connect the metaphor with past experiences and future goals. Both models describe the use of basic counseling skills to address client metaphors and are easily incorporated into counseling work. An important takeaway regarding client metaphors is that metaphors have significance for the client and are appropriate for exploration in counseling (Tay, 2012; Wickman et al., 1999).

Another approach for working with metaphors in counseling practice was described by Tay (2012), who identified two types of metaphor processing in counseling that can be selectively used based on the purpose of the metaphor exploration. The first type is correspondence processing. Correspondence processing requires exploring the entailments of metaphors. The term entailments refers to a layering and transfer of meaning in the relationship between the symbols in the metaphor. The entailments are the associations and properties of the domains in the metaphor that are not specifically used in the metaphor (Lakoff & Johnson, 1980). For instance, she is on fire might be used to indicate that she is energetically accomplishing a lot, but could also have entailments of meaning related to fire being culturally associated with destruction and being difficult to control.

Correspondence processing describes the cognitive combining of properties between target and source domains as a conceptual mapping that equates the entailments of both domains to facilitate thinking about and using the metaphor in a variety of forms. An exploration of the entailments of those metaphors is often necessary for correspondence mapping and is accomplished by expanding upon the metaphor. To expand on the metaphor, additional descriptions of content related to the metaphor are generated. For example, if the metaphor, love is a journey, is used for correspondence processing, then the expansion might include asking the client for descriptions of journeys that may elicit information such as: there are rough roads in the journey, there are fellow travelers and sometimes it is necessary to find shelter. These descriptions could map back to love to indicate that, respectively, relationships can be emotionally difficult, two people come together when in love, and breaks from relationships are sometimes necessary.

The second type of cognitive processing is class inclusion. Class inclusion refers to a linking of the target and source domain through the core conceptual properties of the domains without expanding the metaphor to understand entailments (Tay, 2012). For instance, in the metaphor example used above, love is a journey, a class inclusion processing would involve asking the client what is important about a journey. Those responses might include needing time to get to a destination and the acceptance of risk in moving toward the destination, and then those responses would be applied to love. This would indicate that love requires an acceptance of risk and a willingness to put in the time in order to achieve love. In this process, the linking of each entailment of the source domain to the target domain is not necessary; instead, broader concepts that connect the domains are the focus.

Counseling use of these approaches is based on client and therapeutic needs. For complex concepts that need to be better understood, metaphors may be shaped in a manner consistent with correspondence and processed as such, whereas for communicating core messages and principles, class inclusion may be preferable (Tay, 2012). These two approaches are both important for metaphor-based interventions because they provide two directions for exploration—understanding core messages or increasing understandings of the relationships and context surrounding the concept being described in metaphor (Tay, 2012). Exploring client metaphors using counseling skills and guided by the conceptual frameworks described above can increase understanding and awareness in both clients and counselors.

Counselor-Generated Metaphors

Counselor-generated metaphors involve the use of metaphors to intentionally support the therapeutic process. The application of metaphors by counselors can occur through the reintroduction of metaphors first generated by clients but with changes to support therapeutic growth, or the sharing of new metaphors as a way to help clients recognize thoughts, feelings and behaviors, or understand and integrate new concepts and behaviors (Millikin & Johnson, 2000; Tay, 2012; Wickman et al., 1999). The metaphors may be short and involve a very clear target and source domain, or they can be as long and complex as stories. In addition, depending on a client’s ability to understand and recognize metaphor and the purpose for which the metaphor is intended, the exploration of the metaphor may be brief or more involved (Millikin & Johnson, 2000; Tay, 2012; Wickman et al., 1999).

One specific type of introduced metaphor is the disquisition, a narrative form of metaphor (Millikin & Johnson, 2000). Disquisitions are stories that involve similar interactions and concerns as those of clients because they are developed or adopted specifically for the therapeutic needs of the client. These stories take many forms, including fictional stories of other clients in counseling and fairy tale-type stories, though the stories need to closely relate to the client’s issue. The purpose of these stories is to normalize the client’s experience, increase insight, deepen emotions and facilitate new perspectives (Millikin & Johnson, 2000). This is a very deliberate therapeutic usage of metaphor that generally requires a reservoir of stories to draw from for particular situations or the very adaptive and creative generation of appropriate stories.

Another approach is to use client-generated metaphors as a starting place for generating therapeutic, counselor-adapted metaphors. The appeal to this approach is the direct connection of client conceptualizations, represented within their metaphors, to new concepts through metaphoric imagery. With the introduction of this type of metaphor, it is often necessary to help clients reformulate relationships from the original metaphor to the new metaphor. This reformulation may be used in support of change that has occurred or as a tool to help clients generate new concepts and behaviors (Gelo & Mergenthaler, 2012; Tay, 2012; Wickman et al., 1999). As with disquisitions, this is also a very deliberate use of metaphor for specific therapeutic effect.

Metaphors and Contraindications

Before transitioning from approaches to using metaphors in counseling to the application of those approaches, it is important to briefly discuss whether metaphor-based approaches should be avoided with some types of clients or situations. A review of research produces no clear contraindications for using metaphors in client interventions, even with those experiencing psychotic disorders. In fact, a recent systematic review by Mould, Oades, and Crowe (2010) of 28 studies of clients with psychotic disorders found support for metaphors as a useful intervention with psychotic clients and describes metaphors as a tool for reorganizing clients’ cognitive understanding in a way that is grounded in reality. In addition, though metaphors seem to present a challenge for some individuals with learning disabilities and autism, interventions to help them understand metaphors have been successfully introduced into counseling (Mashal & Kasirer, 2011). It would be advisable to use caution when introducing metaphors in counseling and to tailor metaphor work to clients’ cognitive abilities and ability to evaluate reality, but with that said, there is no clear evidentiary reason precluding metaphor interventions across mental health diagnoses and therapies. In fact, metaphors are considered a ubiquitous and foundational aspect of cognitive and emotional processing and communication (Blasko, 1999; Evans, 2010; Steen et al., 2010; Tay, 2012).

Therapeutic Metaphors

To create a clearer sense of the use of metaphor in counseling, the three-part model of counseling described by Hill (2009) will be used. The model describes counseling as involving the self-explanatory stages of exploration, insight and action, with the recognition that these stages are not linear, the stages may overlap and not all stages will be incorporated in all counseling approaches. In the following sections corresponding to the three stages, there are descriptions of metaphor usage appropriate to the purpose of those stages.

Exploration

In counseling, the development of a therapeutic alliance is paramount (Baldwin, Wampold, & Imel, 2007; Del Re, Flückiger, Horvath, Symonds, & Wampold, 2012; Flückiger, Del Re, Wampold, Symonds, & Horvath, 2012). The generation of an effective therapeutic alliance is achieved by communicating to clients that they are safe, heard and understood and by establishing a shared purpose for counseling (Flückiger et al., 2012). One approach is through empathic reflection. With research and theoretical support for metaphors being used to communicate emotions (Crawford, 2009), the reflection and exploration of metaphors and emotions connected to metaphors is appropriate (Tay, 2012; Witztum, van der Hart, & Friedman, 1988). Understanding the client-generated metaphors in this step also may become useful later in the therapeutic process, as the metaphors can then be transformed and reintroduced to support positive changes.

In exploring client-generated metaphors, the counselor will want to be aware of the type of metaphor being used and how it relates to what the client is working to address. Particular attention should be paid to the complex and unconventional metaphors of clients, as those metaphors may be indicative of areas that are challenging, confusing or emotionally difficult for the client. If the counselor recognizes that the client may be seeking to better understand a concept for which the client provided a metaphor, the correspondence mapping approach to exploring the metaphor may be particularly useful. For clients who seem to be using metaphor to describe beliefs or rules, class inclusion may be the more appropriate approach (Tay, 2012).

The choice between class inclusion and correspondence mapping will be influenced by the content of the metaphor and client willingness to engage in the exploration. If the client is willing and able to explore the metaphor and it seems therapeutically appropriate to expand understanding related to the target domain, then the correspondence approach can facilitate that exploration. For example, if a client says about her partner, he is a turtle hiding in his shell, responses based on a correspondence approach could be what makes a turtle go into its shell and what makes up your partner’s shell? Depending on the response to the questions, it may be possible to make more connections between the metaphor and specific aspects of the client’s situation. One way to strengthen the use of this approach in counseling is to reflect back client-generated elaborations in a form that links elements of the metaphor with clients’ emotions and concerns (Greenberg, 2010; Johnson, 2004; Kopp & Craw, 1998; Sims, 2003; Tay, 2012). The correspondence approach can be very helpful as a way to explore important aspects of the client’s situation and challenges.

In a class inclusion approach, the process might look a little different. Rather than discussing specific elements of the imagery, the theme or message of the metaphor is the focus. Taking the same metaphor of the turtle, the message that she cannot reach her partner and believes he is avoiding her becomes the focus. Responses to this message might be: you feel you can’t reach him; how do you feel when you can’t reach him; and what would it look like if he didn’t hide in his shell? This is an approach addressed to the primary message of the metaphor, but it moves away from the metaphor itself to access other metaphors and understandings related to the message. The class inclusion approach allows for an exploration of core messages, emotional reactions and beliefs.

Insight

The insight stage of counseling involves expanding a client’s awareness to recognize patterns, effects of thoughts, emotions, behaviors and possibilities. Unconventional metaphors, complex metaphors or metaphor clusters may occur more frequently during the insight stage as the client develops new awareness (Crawford, 2009; Gelo & Mergenthaler, 2012; Lakoff & Johnson, 1980). It also is important to note that during the experiencing of emotion, it is likely that there will be less metaphor usage than when clients are working to explain and integrate emotions (Gelo & Mergenthaler, 2012). The client-generated metaphors, particularly the unconventional and complex metaphors, in addition to indicating expanding perspectives, can be a tool for furthering clients’ insights and integrating those insights in a way consistent with their counseling goals.

Working with metaphors in this stage expands on the metaphor work in the exploration stage by

focusing on metaphors in relation to goals and patterns related to clients’ situations (Tay, 2012). Reflections and questions are often helpful to use in response to clients’ complex and unconventional metaphors, as reflections and questions may encourage the continued development of new awareness and incorporation of new awareness into different aspects of clients’ lives (Hill, 2004; Kopp & Craw, 1998; Tay, 2012). In addition, clients can be encouraged to develop new insights by having the counselor ask the client to change the metaphor to how he or she would like it to appear and then exploring the new metaphor through class inclusion, correspondence mapping or both (Hill, 2004; Kopp & Craw, 1998). The changed metaphor can be used to deepen feelings, clarify goals and recognize patterns (Tay, 2012). To illustrate this process, a composite dialogue from a case example is provided.

Client (Cl): I’m caught in a whirlwind that’s spinning my head in a circle.

Counselor (Co): Say more about being caught in a whirlwind that’s spinning your head in a circle.

Cl: I just do not know what to do, the relationship still is not changing.

Co: So you’re afraid that the whirlwind will carry you away?

Cl: Not exactly, more that I’ll just stay right where I am.

Co: The whirlwind blocks everyone else from getting to you.

Cl: Yes, I’m all alone in it.

Co: Could you describe how this metaphor might change if you didn’t feel alone?

Cl: Well, I guess I would be holding my partner’s hand in the eye of the whirlwind where we are safe and together.

Co: How does that feel?

Cl: It feels really good.

Co: You really want that connection, but right now you feel scared, alone and trapped in the cycle.

In this example, a complex and unconventional metaphor, composed of two combined metaphors, that the client spontaneously introduced into the session became a tool to deepen and expand awareness concerning the challenges experienced in her current relationship. In the first part of the metaphor, the target domain is the client’s current situation and the source domain is a whirlwind. In the second part of the metaphor, the target domain is the client’s head and the source domain is spinning in a circle. In the example, the client was first asked questions following a class inclusion approach, which allowed for the identification of the important concepts with which the client is struggling—namely, feeling stuck in her current situation and alone in her relationship. Then, by asking the client to change the metaphor based on changing the feelings she identified as particularly concerning, a clearer awareness of her goal to be connected and feel safe with her partner was identified. The utility of this approach is made clear in this example, and it is also important to emphasize that this approach, by changing the context of clients’ descriptions from their everyday life to the imagined, may enable clients to provide descriptions that are outside what they currently view as possible. In the above example, it may have been difficult, given the client’s current frustrations and challenges, to clearly describe what she wanted in her relationship, but in relation to the metaphor of the whirlwind, she could directly and simply state a transformation in the metaphor that spoke to her goal. The insight from this metaphor exploration provides a focus for future therapeutic counseling work.

Another way of promoting client insight is through counselor-generated metaphors. Disquisitions, as described above, are a narrative form of metaphor introduced by the counselor. The use of disquisitions may be particularly appropriate when there are fewer metaphors being used, perhaps indicating either active emotional experiencing or a lack of cognitive and emotional change, because the disquisitions can both highlight the need for change and direct the form it takes (Gelo & Mergenthaler, 2012; Millikin & Johnson, 2000). The way these metaphors are processed with clients depends on therapeutic needs. A composite case example of a class inclusion approach to a disquisition about relationship interactions in couples counseling follows. (It is important to note that in this example, male and female genders were assigned to match with the genders of the couple, but these genders can be changed to fit the situation.)

Co: This reminds me of a story. There once was a lonely skunk. He lived all alone in the forest and desperately wanted a friend. One day he came upon a solitary porcupine. The porcupine also was lonely and looking for a friend. The skunk started walking up to the porcupine softly grunting his hello. The porcupine backed away in terror, showing her teeth. The skunk thought this was a friendly greeting, so he kept approaching. The porcupine was backed against a rock and kept showing her teeth in warning. The skunk came close and just out of reach sat down, prepared to make a new friend. As soon as he sat, the porcupine shoved her way past, fleeing into the forest and leaving quills stuck in the skunk, who out of instinct sprayed the porcupine. The skunk was left lonely, confused and in pain, and the porcupine was terrified and alone, with her eyes burning in pain. Now why do you think I told this story?

Client 1 (Cl1): Because we don’t communicate well.

Client 2 (Cl2): And because we hurt each other when we try to connect.

Co: Yes, but that’s not what either of you want. In fact, I suspect that just like in the story, you both want a close friend and partner.

Cl1 and Cl2: Yes.

Co: So, it sounds like the real problem for you two isn’t that you both want something different. It’s that, like the skunk and porcupine, the interaction between you and your interpretation of that interaction keeps you both from getting what you want—a loving, connected partner.

The disquisition provides a powerful image that represents the interaction cycle of the couple. The message of the story is discussed, and through this discussion there is recognition and awareness of a problem in the relationship that has similarities with the story. However, to bring out the specifics of the relationship interaction cycle, it is necessary to go into more detail. To do that, the metaphor can be left at this point to focus on the specifics of how each partner contributes to the interaction cycle in the relationship, but another option is to take a correspondence approach and tie specific behaviors to specific parts of the story. There are several positive benefits of the correspondence approach. First, there is already agreement that the story is related to what is happening in their relation-ship, so it provides an agreed-upon story with which details can be linked. It also gives a strong image that can be used throughout counseling to reinforce awareness and contrast change. Finally, it can create a feeling of more safety because details of interactions that are uncomfortable to acknowledge can first be discussed based on the imagery (Romig & Gruenke, 1991). The correspondence approach can facilitate going into more detail and emotion more quickly with resistant clients than would otherwise be possible, and through that more detailed exploration it can then be used to generate shared insight into patterns of thoughts, emotions and behaviors that are problematic for the couple.

Action

The action stage is focused on behavioral change and is often based on what has been learned in the exploration and insight stages. It is likely that client-generated metaphors at this stage may become more simple and conventional, though their metaphors also are likely to be changed from those at the beginning of counseling. Metaphors are likely to become less common and take simpler forms at this stage, which may be an indication that the client is incorporating a new awareness of his or her situation (Crawford, 2009; Gelo & Mergenthaler, 2012). At this point in the counseling process, metaphors may be useful for clarifying behavioral changes to be implemented and considerations for their implementation. As an aside, it is important to pay attention to the types of client metaphors at this point, and if the counselor observes unconventional metaphors and complex metaphors, it may be appropriate to work on exploration and insight rather than action. This is because unconventional and complex metaphors are more likely to occur when the client is struggling through emotional and cognitive change (Crawford, 2009; Gelo & Mergenthaler, 2012; Lakoff & Johnson, 1980), which would indicate that the client may not have developed the perspective necessary to implement changes.

In generating action plans, a helpful approach is to use metaphors to provide a different perspective related directly to the client’s experience. If a client has been using a metaphor related to an issue that is the focus of behavioral planning, then asking the client what change they would make to the metaphor and then linking that change back to the client’s life can generate new ideas. The following is a composite case example of that approach.

Co: You are saying that your goal is to not fight with your mother anymore. As we focus on how that might happen, I am reminded of the metaphor you gave earlier about the conflict with your mother. You said that your mother is smothering you. That she holds you so close that you can’t breathe. Did I say that right?

Cl: That’s what it feels like.

Co: Well I am wondering what would you change in that metaphor?

Cl: I would have my mother not hold me so tight that I can’t breathe.

Co: So having a little more room to breathe would really change things. (Client nods)

Co: I also notice that you are not saying that you want your mother far away from you or to ignore you; you just want her to give you a little more space.

Cl: Yes.

Co: So, what you are looking for is a way to not feel controlled by her and still feel connected to her. (Client nods)

Co: How might you do that?

Cl: Well I guess I could move out of the basement of her house.

In the example above, it would have been possible to generate an action plan without using a metaphor, but it can be observed that the metaphor added a strong connection to the emotional experience of the client and helped to open the client to identifying a change that made sense based on his goal. The ability to generate a greater connection with clients through the use of clients’ metaphors can empower clients to make changes directly connected to what is most affecting them. There also are times when clients have difficulty making changes because of fear, and in those situations, providing a path to identifying potential changes indirectly through metaphor can be very beneficial and can allow ideas to be discussed in a manner that may provoke less fear in the client.

Conclusion

Metaphors often seem simple, but they have a deeper conceptual role, and through observing metaphor usage in clients, actively exploring metaphors with clients and generating metaphors to address therapeutic goals for clients, metaphors can become a valuable tool in counseling. The above descriptions and examples provide some practical ways that understanding and using metaphors can positively impact counseling work. Client-generated metaphors provide a lens into the internal world of clients that combines their emotional reactions and experiences in an understandable manner and creates a bridge so clients’ internal worlds can be shared with the counselor. Counselor-generated metaphors provide a tool to further guide and support clients in the pursuit of their goals. Through both client-generated and counselor-generated metaphors, the inner experience of clients can be more directly accessed and positive change can be facilitated. Therefore, the recognition and incorporation of metaphors can be an incredibly valuable tool for counselors. It is hoped that the information provided in this manuscript will serve as a foundation for incorporating metaphor awareness and usage into counseling practice and will stimulate counselors to seek out additional training and information and develop research on the application and effectiveness of using metaphors in counseling.

Conflict of Interest and Funding Disclosure

The authors reported no conflict of interest or funding contributions for the development of this manuscript.

References

Aragno, A. (2009). Meaning’s vessel: A metapsychological understanding of metaphor. Psychoanalytic Inquiry, 29, 30–47. doi:10.1080/07351690802247021

Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75, 842–852. doi:10.1037/0022-006X.75.6.842

Blasko, D. G. (1999). Only the tip of the iceberg: Who understands what about metaphor? Journal of Pragmatics, 31, 1675–1683.

Bohrn, I. C., Altmann, U., & Jacobs, A. M. (2012). Looking at the brains behind figurative language—A quanti-tative meta-analysis of neuroimaging studies on metaphor, idiom, and irony processing. Neuropsychologia, 50, 2669–2683. doi:10.1016/j.neuropsychologia.2012.07.021

Citron, F. M. M., & Goldberg, A. E. (2014). Metaphorical sentences are more emotionally engaging than their literal counterparts. Journal of Cognitive Neuroscience, 26, 2585–2595. doi:10.1162/jocn_a_00654

Citron, F. M. M., Güsten, J., Michaelis, N., & Goldberg, A. E. (2016). Conventional metaphors in longer passages evoke affective brain response. NeuroImage, 139, 218–230. doi:10.1016/j.neuroimage.2016.06.020

Crawford, L. E. (2009). Conceptual metaphors of affect. Emotion Review, 1, 129–139. doi:10.1177/1754073908100438

Del Re, A. C., Flückiger, C., Horvath, A. O., Symonds, D., & Wampold, B. E. (2012). Therapist effects in the thera-peutic alliance-outcome relationship: A restricted-maximum likelihood meta-analysis. Clinical Psychology Review, 32, 642–649. doi:10.1016/j.cpr.2012.07.002

Evans, V. (2010). Figurative language understanding in LCCM theory. Cognitive Linguistics, 21, 601–662. doi:10.1515/COGL.2010.020

Fainsilber, L., & Ortony, A. (1987). Metaphorical uses of language in the expression of emotions. Metaphor and Symbolic Activity, 2, 239–250.

Fetterman, A. K., Bair, J. L., Werth, M., Landkammer, F., & Robinson, M. D. (2016). The scope and consequences of metaphoric thinking: Using individual differences in metaphor usage to understand how metaphor functions. Journal of Personality and Social Psychology, 110, 458–476. doi:10.1037/pspp0000067

Flückiger, C., Del Re, A. C., Wampold, B. E., Symonds, D., & Horvath, A. O. (2012). How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis. Journal of Counseling Psychology, 59, 10–17. doi:10.1037/a0025749

Gelo, O. C. G., & Mergenthaler, E. (2012). Unconventional metaphors and emotional-cognitive regulation in a metacognitive interpersonal therapy. Psychotherapy Research, 22, 159–75. doi:10.1080/10503307.2011.629636

Greenberg, L. S. (2010). Emotion-focused therapy: An overview. Turkish Psychological Counseling and Guidance Journal, 4, 1–12.

Hill, C. E. (Ed.). (2004). Dream work in therapy. Washington, DC: American Psychological Association.

Hill, C. E. (2009). Helping skills: Facilitating exploration, insight, and action (3rd ed.). Washington, DC: American Psychological Association.

Johnson, S. M. (2004). The practice of emotionally focused couple therapy (2nd ed.). New York, NY: Taylor and Francis Group.

Kopp, R. R., & Craw, M. J. (1998). Metaphoric language, metaphoric cognition, and cognitive therapy. Psycho-therapy: Theory, Research, Practice, Training, 35, 306–311.

Kopp, R. R., & Eckstein, D. (2004). Using early memory metaphors and client-generated metaphors in Adlerian therapy. Journal of Individual Psychology, 60, 163–174.

Lakoff, G., & Johnson, M. (1980). The metaphorical structure of the human conceptual system. Cognitive Science, 4, 195–208. doi:10.1207/s15516709cog0402_4

Lubart, T. I., & Getz, I. (1997). Emotion, metaphor, and the creative process. Creativity Research Journal, 10, 285–301.

Mashal, N., & Kasirer, A. (2011). Thinking maps enhance metaphoric competence in children with autism and learning disabilities. Research in Developmental Disabilities, 32, 2045–2054. doi:10.1016/j.ridd.2011.08.012

Millikin, J. W., & Johnson, S. M. (2000). Telling tales: Disquisitions in emotionally focused therapy. Journal of Family Psychotherapy, 11, 73–79.

Mohammad, S. M., Shutova, E., & Turney, P. D. (2016). Metaphor as a medium for emotion: An empirical study. In Proceedings of the Fifth Joint Conference on Lexical and Computational Semantics (pp. 23–33). Berlin, Germany.

Mould, T. J., Oades, L. G., & Crowe, T. P. (2010). The use of metaphor for understanding and managing psychotic experiences: A systematic review. Journal of Mental Health, 19, 282–93. doi:10.3109/09638231003728091

Romig, C. A., & Gruenke, C. (1991). The use of metaphor to overcome inmate resistance to mental health counseling. Journal of Counseling & Development, 69, 414–418.

Samur, D., Lai, V. T., Hagoort, P., & Willems, R. M. (2015). Emotional context modulates embodied metaphor comprehension. Neuropsychologia, 78, 108–114. doi:10.1016/j.neuropsychologia.2015.10.003

Seitz, J. A. (1998). Nonverbal metaphor: A review of theories and evidence. Genetic, Social & General Psychology Monographs, 124, 95–119.

Sims, P. A. (2003). Working with metaphor. American Journal of Psychotherapy, 57, 528–536.

Smollan, R. K. (2014). The emotional dimensions of metaphors of change. Journal of Managerial Psychology, 29, 794–807. doi:10.1108/JMP-04-2012-0107

Steen, G., Dorst, A., Herrmann, J., Kaal, A., & Krennmayr, T. (2010). Metaphor in usage. Cognitive Linguistics, 4, 765–796. doi:10.1515/COGL.2010.024

Stewart, I., & Barnes-Holmes, D. (2001). Understanding metaphor: A relational frame perspective. The Behavior Analyst, 24, 191–199.

Tay, D. (2012). Applying the notion of metaphor types to enhance counseling protocols. Journal of Counseling & Development, 90, 142–149.

Wickman, S. A., Daniels, M. H., White, L. J., & Fesmire, S. A. (1999). A “primer” in conceptual metaphor for counselors. Journal of Counseling & Development, 77, 389–394.

Witztum, E., van der Hart, O., & Friedman, B. (1988). The use of metaphors in psychotherapy. Journal of Contemporary Psychotherapy, 18, 270–290.

Alwin E. Wagener, NCC, is an Adjunct Professor at the University of North Carolina – Charlotte. Correspondence can be addressed to Alwin Wagener, P.O. Box 1443, Black Mountain, NC 28711, alwinwagener@gmail.com.

Perceived Helpfulness of Teachers in Clinical Courses

Mar 23, 2017 | Volume 7 - Issue 2

Randall M. Moate, Jessica M. Holm, Erin M. West

Clinical courses are important in the development of students pursuing a master’s degree in clinical mental health counseling (CMHC). Despite the importance of clinical courses, little is known about what CMHC students perceive as being helpful about their teachers of clinical courses. To investigate this, we sought the viewpoints of beginning counselors who were in their first four years of working as licensed counselors post-graduation. Thirty-two beginning-level counselors completed a Q sort that assessed the perceived helpfulness of their teachers of clinical courses in their CMHC master’s degree program. Three different learning preferences—application-oriented learners, intrinsically motivated learners, and affective-oriented learners—were observed among participants in the study.

Keywords: clinical courses, beginning counselors, Q sort, learning preferences, learners

Counselor educators who teach in clinical mental health counseling (CMHC) master’s degree programs are responsible for preparing counselors-in-training to acquire important content knowledge and develop competent clinical skills (Schwitzer, Gonzalez, & Curl, 2001). Didactic-oriented courses in CMHC curricula (e.g., ethics, diagnosis, cultural diversity, career counseling) tend to emphasize the acquisition of important content knowledge and are often associated with larger class sizes (Sperry, 2012). Clinical courses (e.g., skills, practicum, internship) emphasize development of clinical skills through experiential and applied learning opportunities and are typically associated with smaller class sizes. Although experiential and applied learning can be infused into didactic-oriented courses, they are fundamental to the pedagogy of clinical courses.

For students, engagement in clinical courses requires a shift from passive to active learning, with an increased emphasis on putting what they have learned into action (Auxier, Hughes, & Kline, 2003; Skovholt & Ronnestad, 1992). Clinical courses require students to engage in activities such as role plays, case formulizations and skill demonstrations (Young & Hundley, 2013). Although these types of learning experiences tend to be impactful for students (Furr & Carrol, 2003), they can also pose new emotional and cognitive challenges. Students in clinical courses are frequently observed by peers and instructors demonstrating skills, techniques and clinical thinking, which may be anxiety-provoking for students who are unsure of themselves as counselors-in-training.

We believe counselor educators encounter different types of pedagogical challenges teaching clinical courses when compared to didactic courses. For example, teachers interact closely with students in clinical courses on account of classroom dynamics that are more up close and personal. Additionally, there is an increased need for teachers to help students overcome emotional (e.g., feeling anxious about being observed by peers during a counseling demonstration) and physical (e.g., difficulty demonstrating a basic skill) challenges that arise through curricula focused on skill development. Further, teachers of clinical courses are challenged to evaluate students and provide feedback based on their direct observation of trainees’ ability to perform basic skills, advanced techniques and clinical-thinking abilities.

Unfortunately, little empirical research is available to counselor educators to inform their pedagogical choices in clinical courses (Barrio Minton, Wachter Morris, & Yaites, 2014). We believe that better understanding students’ viewpoints of their teachers in clinical courses and what they perceive as beneficial for their clinical practice could provide counselor educators with valuable information to inform their pedagogy in these courses. The current study was designed to contribute in this regard by exploring what aspects of teachers of clinical courses were perceived as helpful by recent graduates of CMHC programs who were working as beginning counselors.

Teaching in Higher Education

Higher education researchers have focused on personal characteristics of teachers as a way to explore what students perceive as effective teaching; results of such research suggest that students attribute several different characteristics to their teachers’ effectiveness. Examples include perceptions of teacher warmth (Best & Addison, 2000), compassion and interest in students (Sprinkle, 2008), rapport with students, effective delivery of information, focus on interpersonal relationships with students in the classroom (Goldstein & Benassi, 2006), and effective course organization and usefulness (Young & Shaw, 1999). Students additionally believed that effective teachers sparked interest in the course material and were accessible for support as needed (Feldman, 1988). From this research, it appears students value and perceive teacher effectiveness through both teachers’ relational abilities and their effective delivery of course material.

In addition to studying personal characteristics of teachers, some higher education researchers have conceptualized different models of teaching styles. One notable model of teaching styles was created by Grasha (1994) through analysis of interviews with higher education faculty members. Grasha identified five teaching styles among faculty members: expert, formal authority, personal model, facilitator and delegator. An expert style refers to the direct transfer of knowledge to students through teaching modalities such as lecture. The formal authority style refers to defining clear expectations and learning objectives for students, which are based on an instructor’s perceived authority on a subject, and providing direct feedback. A personal style refers to instructors teaching by personal example and encouraging students to learn appropriate behaviors through observation. The facilitator style refers to teachers serving as a guide and consultant, encouraging students to move toward independent learning. Finally, the delegator style refers to a hands-off approach in which students are given freedom to function independently. Rather than the teaching styles being exclusive, Grasha noted that teachers display varying degrees of each of the styles within their classrooms. Consequently, different combinations of teaching styles create a unique learning experience for students.

Another stylistic aspect of teaching that has been categorized in higher education literature is teacher-centered and learner-centered pedagogy. Instructors who use teacher-centered approaches are characterized by working in an expert role to disseminate knowledge to students. Conversely, teachers who utilize learner-centered approaches take the role of facilitator and aim to create an active learning environment (Smart, Witt, & Scott, 2012). Research on the effectiveness of these two approaches remains inconclusive, and some researchers have suggested that a teaching approach that utilizes both teacher- and learner-centered styles is probably ideal (Baeten, Dochy, & Struyven, 2012).

Teaching in Counselor Education

Little research exists that examines pedagogy within counselor education programs. Barrio Minton et al. (2014) completed a content analysis of published articles related to teaching and learning within counseling and found a clear focus on techniques and content rather than pedagogical practices and students’ learning experiences. Further, only a third of the articles were empirically based, and less than 15% had clear pedagogical foundations, indicating that the majority of the literature available on teaching in counselor education is conceptual in nature. Among these conceptual pieces, Malott, Hall, Sheely-Moore, Krell, and Cardaciotto (2014) aimed to bridge evidence-based practices of teaching in higher education with best practices in counselor education. Malott and colleagues affirmed that although counselor-based characteristics (e.g., empathy, positive regard) are essential for effectiveness in teaching counseling courses, they are not sufficient. They suggested that counselor educators should create effective learning environments characterized by creating strong rapport with students, engaging students in active learning (e.g., case studies, role plays) and providing opportunities for feedback throughout the course. Pietrzak, Duncan, and Korcuska (2008) examined factors that impacted counseling students’ perceptions of teaching effectiveness and found that students rated an entertaining delivery style and perceived knowledge of the teacher as the most influential factors.

An examination of the limited literature that exists on pedagogy within counselor education programs identified three important theoretical perspectives: developmental, constructivist and contextual teaching. The developmental approach to teaching suggests that teachers should alter their teaching style and techniques to meet the changing developmental needs of students, progressing from a content-oriented and highly structured emphasis to facilitating active learning experiences (Granello & Hazler, 1998). According to the constructivist perspective, it is important for counselor educators to facilitate students’ engagement in reflective thinking and the personal construction of knowledge (McAuliffe & Eriksen, 2010; Nelson & Neufeldt, 1998). Similarly, the emphasis on contextual teaching is to help students find personal meaning in what they are learning by placing information within a context of how it is relevant to them (Granello, 2000). Although the reviewed literature adds important context to the area of teaching in counselor education, none of the research specifically examines the unique nature of teaching in clinical courses.

Purpose of the Study

The current study is the first to explore beginning counselors’ perceptions of helpful aspects of teachers of clinical courses in CMHC. Clinical courses were selected as a focus in this study because of their key role in student development of skills needed for professional practice and the lack of information on teaching clinical courses within the counselor education literature. We believed exploring the perspectives of beginning professional counselors, rather than students, was valuable for two important reasons: (a) beginning counselors are close enough to their master’s degree program experiences to be reflective about their teachers and (b) beginning counselors are able to consider helpful aspects of their teachers in light of their real-world experiences as professional counselors.

Method

We used a Q methodology to investigate aspects of counselor educators of clinical courses in CMHC that were perceived to be helpful by beginning-level counselors. Q methodology embraces both the analytic rigor of quantitative methodologies and the richness and depth of qualitative methodologies (Watts & Stenner, 2012). We selected Q methodology for this study because it was designed for systematic exploration of subjective human phenomena (i.e., people’s preferences) on topics such as teaching (Ramlo, 2016).

Phase 1: Concourse Development

This study was completed in two phases. The first phase involved developing the concourse. In Q methodology a concourse represents a collection of ideas that is composed around a topic (Stephenson, 1978). The concourse for this study was generated in two ways. First, we conducted a literature review and selected important themes for inclusion in the concourse. Second, after obtaining Institutional Review Board approval, we conducted interviews with five participants and then included statements from the participant interviews into the concourse. Five beginning-level professional counselors were interviewed and asked the following question: “What was it about teachers of your clinical classes during your program that was most helpful in becoming the professional counselor you are today?” To ensure a diverse range of viewpoints would be represented in the second phase of the study, we interviewed different gendered individuals (i.e., two male counselors, three female counselors) who worked in a variety of professional settings (i.e., two counselors worked in a private practice, one counselor worked in a community agency, and two counselors worked in a hospital setting) and who had differing racial identities (i.e., two Caucasian counselors, one African American counselor, one Asian American counselor, one Hispanic counselor).

The lead researcher then analyzed all of the statements in the concourse (from the literature and participant interviews) and began identifying unique statements, grouping similar statements together. Groups of similar statements were further analyzed by the lead researcher, and one statement was selected from each group. Participant statements selected for inclusion were edited to abbreviate long statements or to change the tense of statements. The co-researchers then reviewed the lead researcher’s analysis to ensure that each remaining statement was distinct from other statements and relevant to the study. This process culminated in a 34-item instrument that would be used in the Q sample (see Table 1).

Phase 2: Q Sample and Q Sort

The second phase of this study entailed constructing a Q sample and administering Q sorts to participants. A Q sample is a composite of stimulus items administered to participants for rank-ordering during the Q sorting process (Stenner, Watts, & Worrell, 2008). Thirty-two participants were given the Q sample and were asked to rank order 34 items in the Q sample on a 9-point scale in the shape of a normal distribution. Prior to rank ordering statements for the Q sort, participants were prompted to reflect on teachers they had in clinical courses during their master’s degree programs and then to reflect on what it was about those teachers that had been most helpful to them in becoming the counselors they are today. Participants were then directed to read all statements and rank order them on a response grid that ranged from +4 (most helpful) to -4 (most unhelpful). After rank ordering the statements, participants were asked to provide written responses to several post-Q sort questions designed to elicit qualitative data about why certain items were important to them. Two examples of post-Q sort response questions were as follows: (a) “describe how the two items you ranked at 4 (most helpful) were helpful to the counselor you have become,” and (b) “describe how the two items you ranked at -4 (most unhelpful) were not helpful to the counselor you have become.”

P Sample

The P sample refers to the participants sampled for the Q sort, which in the case of this study were beginning-level professional counselors. Participants were required to meet the following criteria in order to be eligible for this study: (a) were a graduate of a counselor education master’s degree program in CMHC, (b) accrued at least 400 direct hours of post-master’s clinical service working with clients as a licensed counselor and (c) were no more than four years removed from graduating with their degree. After obtaining a second IRB approval to collect data using the Q sort, participants were recruited in several ways. The researchers called on the telephone and sent general recruitment e-mails to supervisors and directors of counseling agencies, private practices and in-patient

Table 1
34-Item Q Sample and Factor Arrays

Item	Statements	Factor 1 2 3
1	A professor created opportunities for me to get feedback from my peers.	-3	1	0
2	A professor encouraged group discussions about relevant topics.	0	0	-2
3	A professor modeled behaviors that I could use with clients.	4	2	0
4	A professor used role plays in class to explain things.	3	2	-1
5	A professor created a safe classroom environment where it felt OK to make mistakes.	3	-1	1
6	A professor required me to self-critique my counseling skills by observing video/audio tape of myself.	-1	3	2
7	A professor required me to show video/audio tape of my counseling skills to my classmates for feedback.	-4	4	0
8	A professor challenged me in uncomfortable, yet helpful ways.	0	0	-2
9	A professor helped me to make connections between counseling theories and my clinical practice.	0	3	-1
10	A professor helped me to develop my ability to conceptualize clients.	2	4	1
11	A professor demonstrated that he/she was open-minded.	1	-2	1
12	A professor discussed ethical issues that related to students’ clinical experiences working with clients.	1	0	-1
13	A professor who I knew was currently working with clients, or had significant experience as a practicing counselor.	1	2	2
14	A professor helped students in the class cultivate close relationships with one another.	-2	-4	-3
15	A professor was open, empathetic, and authentic in their interactions with students.	4	-2	4
16	A professor shared “in the moment” struggles they faced as a counselor.	2	0	-1
17	A professor gave me direct feedback where they made it clear what I was doing well, and what I was not doing well.	1	3	0
18	A professor gave me strength-based feedback.	2	0	1
19	A professor incorporated multiculturalism and issues of diversity into class.	0	-1	0
20	A professor encouraged students to share differing viewpoints on a topic/discussion.	-1	1	0
21	A professor helped me to see the purpose in what I was learning by explaining “how” and “why” it would be useful to me in the future.	2	1	-3
22	A professor I could sense was passionate about what they were teaching.	0	-1	2
23	A professor expected a high standard of performance from me.	-3	1	-1
24	A professor was readily accessible to give me extra help when I needed it (e.g., office hours, e-mail, phone).	-1	-3	-2
25	A professor I could sense was fully present during my interactions with them.	0	-2	1
26	A professor created in-class activities that helped me to become a more reflective thinker.	1	2	-2
27	A professor streamlined course readings and assignments down into what was essential.	-2	-3	-4
28	A professor held me and other students accountable for our actions.	-3	-1	-3
29	A professor had an engaging personality.	-1	-2	3
30	A professor used technology to enhance my learning experience.	-4	-4	-4
31	A professor I believed was probably a good clinician.	-1	0	4
32	A professor who I liked as a person.	-2	-3	3
33	A professor I sensed was an expert on what they were teaching.	-2	-1	2
34	A professor used examples from their clinical experiences to explain things.	3	1	3

hospitalization units in Ohio and Texas, requesting that they forward recruitment information for the study to potential subjects. Snowball sampling was also used to recruit participants when participants who had completed the study recommended colleagues who might be willing to participate in the research. Data were collected from participants by sending packets in the mail that consisted of an informed consent, demographic questionnaire, Q sort, post-Q sort questions and a postage prepaid return envelope.

Thirty-two participants met the criteria for inclusion in the study and completed the Q sorting process. In Q methodology a sample size only needs to be large enough for factors (i.e., groups of shared viewpoints) to emerge and is typically 20 and 60 participants (Brown, 1980). Seventy-two percent (n = 23) of the participants in the study were 20–30 years old; 28% (n = 9) were between 31–40 years old. Seventy-two percent (n = 23) of the participants identified as female and 28% (n = 9) of the participants identified as male. Fifty-nine percent (n = 19) of the participants reported they worked in a community counseling agency; 22% (n = 7) reported they worked in a private practice; and 19% (n = 6) reported they worked in a hospital setting. Thirty-eight percent (n = 12) of the participants indicated they had accrued 400–1,000 direct clinical hours working with clients; 22% (n = 7) indicated they had accrued 1,001–1,500 direct clinical hours working with clients; 3% (n = 1) indicated they accrued 1,501–2,000 direct clinical hours working with clients; 9% (n = 3) indicated they accrued 2,001–2,500 direct clinical hours working with clients; and 28% (n = 9) indicated they had accrued more than 2500 direct clinical hours working with clients. Eighty-two percent (n = 26) of participants identified as Caucasian, 9% (n = 3) of participants identified as African American, and 9% (n = 3) of participants identified as Hispanic.

Data Analysis

Data were entered into the PQMethod software program (Schmolck, 2014) and were factor analyzed using principle components analysis (PCA). After the PCA was initiated, a varimax rotation was used to determine reliability, scores and factor loadings. A 3-factor solution was selected for the data because it accounted for each participant loading onto at least one factor. Due to each participant being accounted for by a 3-factor solution, it was unnecessary to search for a fourth factor.

In Q methodology, factor scores are used for interpretation rather than factor loadings. The factor narratives presented in the results section were created through a factor interpretation method developed by Watts and Stenner (2012). This method was designed to consistently approach each factor in the context of all other factors and to provide a holistic factor interpretation by taking into consideration all differences between factors. First, a worksheet was created from the factor array for each individual factor. The worksheet contained the highest (+4) and lowest (-4) ranked items within the factor (note: items of consensus were not included and were analyzed separately) and those items ranked higher or lower within the factor compared to the other two factors. Second, items in the worksheet were compared to participants’ demographic information and qualitative responses associated with that factor to add depth and detail before the final step. Finally, the finished worksheet was used to construct the factor narratives, which were written as stories that reflected the shared viewpoint of each factor.

Results

Of the three factors produced by the PCA of the 32 Q sorts, Factor 1 contained 12 of the participants and accounted for 17% of the variance; Factor 2 contained nine participants and accounted for 13% of the variance; and Factor 3 contained nine participants and accounted for 14% of the variance. There were two Q sorts that were mixed cases (i.e., they had significant loadings on more than one factor) and were removed from the study.

Factor 1: Application-Oriented Learners

A total of 12 participants loaded onto Factor 1, accounting for 17% of the variance, and their demographic traits were unremarkable when compared to the other two factors. Participants of Factor 1 were application-oriented learners who preferred their professors to be pragmatic, supportive and active leaders during class.

Factor 1 individuals preferred it when their professors demonstrated specific techniques or skills they could envision directly applying to their counseling practice. As one participant noted: “I am a visual learner, so seeing helpful behaviors and how I could act with a client helped me visualize what a therapy technique could be like [in session]. I feel like I was used to seeing good counseling behaviors so it felt more natural to do them myself.” When introducing a new concept in class, individuals of Factor 1 perceived it as more helpful when their teachers provided context of why and how it would be useful to them as a professional counselor (item 21). Individuals of Factor 1 also perceived it as helpful when they were able to hear relevant clinical anecdotes from their teachers (items 12, 16), as they served as a practical way of remembering important lessons that applied to real-world counseling situations. This was described by a Factor 1 participant: “Learning by hearing about my professors’ experiences is the easiest way for me to apply information and the easiest way for me to remember it.” Another participant broadly stated, “Real life examples were the biggest influence on my education.”

Persons of Factor 1 preferred it when their teachers were active leaders in the classroom and used their knowledge and experience to efficiently instruct students. They perceived teachers as having a more credible viewpoint than themselves or their classmates because of their advanced training and experience in counseling. Factor 1 individuals did not perceive it as important that their teachers be experts (item 33) or skilled clinicians (item 31), so long as they could effectively lead class by teaching practical information, demonstrating relevant clinical skills and providing them with strength-based feedback. This preference was evident in a desire for receiving strength-based feedback from their instructors (item 18) rather than engaging in self-critique (item 6) and receiving feedback from their peers (items 1, 7). A Factor 1 participant elucidated, “Getting feedback from peers is not effective, mostly because they didn’t know any more than I did about the subject matter and I don’t value their opinion as much as the professors.”

In addition to the belief that peer feedback was unhelpful, persons of Factor 1 also expressed concern about being critiqued by their peers: “I hated showing my video/audio tapes to others because I felt like I was being judged by peers and not being provided helpful suggestions.” Factor 1 individuals also expressed that high expectations from their teachers (item 23) provoked worries of “not being able to measure up” and were perceived as less helpful. One participant narrated, “The words ‘high expectation’ really struck me as negative. I feel afraid that I won’t be able to meet those expectations. I want my professor to be hopeful about my development as a counselor and not have high expectations.” Teachers who created a safe space for mistakes (item 5) through having a person-centered way of being (item 15), were transparent about their own difficulties as a counselor (item 16) and used strength-based feedback (item 18) were perceived as being more helpful, as they helped mitigate worries present in the Factor 1 viewpoint. Describing this viewpoint, one participant responded:

I appreciated knowing that making mistakes was part of the class and that any expectation to be perfect was unreasonable. Also, it felt safe to grow and take risks when I feel empathy and authenticity from my instructors. This allowed me to be vulnerable and share my thoughts and feelings.

Overall, representatives of Factor 1 perceived it as important that their teachers provide them with a safe and encouraging environment in clinical courses.

Factor 2: Intrinsically Motivated Learners

A total of nine participants loaded onto Factor 2, accounting for 13% of the variance, and demographic traits were unremarkable when compared to the other two factors. Participants of Factor 2 were independent, intrinsically motivated and reflective learners who preferred to learn through considering different points of view about a topic.

In contrast to Factor 1 individuals’ preference for concrete and specific practical knowledge, Factor 2 individuals preferred to learn about conceptual topics that were more abstract and through activities that stimulated reflective thinking. This is evident in the Factor 2 participants’ preference for teachers who helped them hone their ability to conceptualize clients (item 10) and who helped facilitate connections between theoretical concepts and clinical practice (item 9). One participant remarked about item 9, “My theoretical orientation is the biggest part of my counseling identity. Having those initial connections made for me helped solidify my understanding of clients.” Individuals of Factor 2 perceived it as helpful when their teachers created activities that prompted reflective thinking (item 26), as this is a foundational component of how they work with clients. One participant noted, “I feel as though I have to reflect 100% of the time in my job. It helps me take a step back to think of what the client is really trying to say.” Persons of Factor 2 also perceived it as helpful when their instructors prompted them to self-reflect through critiquing their counseling skill. As one participant described, “The self-critique of my video tapes was by far my most memorable learning experience. Watching video of myself challenged my self-concept and gave me opportunities to see what I could do to improve.”

Receiving frequent and direct feedback from teachers and peers was perceived as particularly helpful to representatives of Factor 2. Unlike Factor 1, Factor 2 individuals preferred it when their professors held them to high standards (item 23) and provided them with feedback that was clear and direct (item 17) rather than strength-based. A participant elaborated on their preference for direct feedback: “I liked knowing where I stood, so I could try to improve in areas where I was weak. It was refreshing when professors offered this instead of sugar coating things.” Individuals of Factor 2 indicated a strong preference for teachers who required them to show tapes of their clinical work to classmates (item 7). This activity gave them the opportunity to consider a “broad base of opinions,” which they found to be important to their learning; as one participant explained, “I learned the most when I heard different ideas. Then I had to figure out what I thought was true.”

Persons of the Factor 2 viewpoint were independent learners in clinical courses and preferred when their teachers assumed more facilitative roles on the periphery of the learning environment. Their teachers’ personality characteristics (items 11, 15, 25, 29, 32), enthusiasm for teaching (item 22) and ability to create a safe learning environment (item 5) were perceived as less important than their propensity for facilitating dialog among students. This can be seen in the Factor 2 preference for teachers that facilitated group discussions (item 20) and created ample opportunities for peer feedback (item 1). Although Factor 2 individuals valued their teachers’ forthright feedback, they did not place the high level of importance on the teacher’s perspective that Factor 1 did. Instead, Factor 2 representatives regarded their teachers’ perspectives as one of many useful perspectives present in the classroom. One participant seemed to capture the essence of the Factor 2 viewpoint, remarking: “I learned just as much from my interactions with peers in clinical classes as I did from instructors. I believe in these classes teachers can act as facilitators and help students that way, just as much as they can interacting [with students] or lecturing.”

Factor 3: Affective-Oriented Learners

A total of nine participants loaded onto Factor 3, accounting for 13% of the variance, and demographic traits were unremarkable when compared to the other two factors. Participants of Factor 3 were oriented toward affective and relational qualities of their teachers and were inspired to learn through their admiration and respect for their teachers.

It was paramount for Factor 3 individuals to have a positive appraisal of their teachers as human beings so that they could develop an affinity for them. When Factor 3 individuals liked their teachers (item 32), they were able to form strong relationships with them, and these relationships acted as a catalyst for their learning. As one participant explained, “I am much more likely to grow and learn from someone I like.” Another participant shared a similar sentiment in regards to item 32: “I think my relationship with the professors and how I perceived them were just as important, if not more important, than what they taught me or the feedback they gave me.” Persons of Factor 3 strongly preferred when their teachers had a person-centered way of being (item 15), as this helped them feel like their teachers were good people who cared about them: “Having a kind and understanding professor is key! That is a huge make-it-or-break-it thing for me. I wanted my professors to be people I liked, respected and enjoyed being around, and who I sensed cared about me.” Further, Factor 3 representatives perceived it as helpful when they could sense their teachers were fully present with them (item 25), as this indicated to them that their teachers cared for them and were invested in their learning.

In addition to the importance of having a positive appraisal of their teachers as human beings, it was also important for representatives of Factor 3 to believe that their instructors were skilled teachers and counselors. Factor 3 individuals perceived it as helpful when they could sense that their teachers were skilled clinicians (item 31) and were experts on what they were teaching (item 33) in clinical courses. When persons of Factor 3 held positive beliefs about their instructors as human beings, teachers and counselors, it inspired them to emulate their instructors as clinicians. Elucidating this notion, one participant remarked, “It [item 31] gave me greater respect and admiration for them, which motivated me to be influenced by them.” Similarly, another participant stated, “I remember feeling inspired and wanting to ‘just be like’ certain professors as I entered practicum.” After teachers earned Factor 3 individuals’ respect and admiration they were ascribed credibility, which made it less important for them to provide context for what was being taught (item 21) or to streamline assigned readings (item 27). That is, when a teacher they valued taught something in class or assigned reading, those things were immediately assumed to be important.

It was important to persons of Factor 3 that their teachers had charisma during class, which captivated their attention and motivated them to learn. As such, Factor 3 individuals preferred when their teachers were the active figures in the classroom and led class through having an engaging personality (item 29). Elaborating on the importance of this perspective, one participant explained, “It [item 29] helped me to get excited about what I was doing and learning and helped me to get engaged in discussions and activities.” Representatives of Factor 3 also perceived it as helpful when they could sense their teachers were passionate about what they were teaching (item 22). As one participated remarked, “I experienced several professors who loved what they were teaching. This attitude ignited my excitement for counseling and inspired me.” Summarizing Factor 3 representatives’ emphasis on relational characteristics of their teachers, one participant noted, “My relationships with professors had the greatest impact on my growth; more so than any technique they used or material they covered.”

Consensus Statements

There were two items of consensus on which all three factors agreed. It was of moderate importance to all three factors that their teachers were currently working with clients or possessed significant experience working with clients (item 13). Qualitative data seemed to suggest this item enhanced a counselor educator’s credibility when teaching students in clinical courses, providing them with experiences to draw on when demonstrating a technique. One participant explained: “I felt I received more honest and pragmatic lessons from professors that had recent stories, feedback and teachings from being up-to-date and current with everyday practice. Their knowledge meant more to me and left a longer-lasting impression.”

Representatives of the three factors also perceived it as particularly unimportant that counselor educators incorporate technology into clinical courses to enhance learning (item 30). Qualitative feedback from respondents seemed to focus on two different themes in regards to item 30. One, respondents considered technology unnecessary in clinical courses, as they did not perceive that it was relevant to their work as professional counselors: “Technology does not affect how I practice as a counselor. I actually felt that I wasted much time in fighting with technology during my education that could have been better spent further developing my skills.” Two, respondents suggested that technology was perceived as less helpful when it came at the expense of clinical learning occurring in the classroom: “Technology is nice and all, but I appreciated clinical moments in the classroom with my professor and peers.”

Discussion

An important finding of this study was that three different shared viewpoints (i.e., application-oriented learners, intrinsically motivated learners, affective-oriented learners) exist among beginning-level clinical mental health counselors about helpful aspects of teachers in clinical courses. When considering the different teaching preferences that emerged in this study, it may be helpful for counselor educators to conceptualize each factor as a student-learner archetype present in CMHC clinical courses. An example of the Factor 1 application-oriented archetypal student is as follows: a student focused on becoming a competent professional counselor who is apprehensive about his or her lack of knowledge and experience. This student’s ideal teacher explicitly articulates and demonstrates what he or she needs to do to become a competent professional counselor, while providing supportive feedback as he or she tries to achieve that goal. An example of the Factor 2 intrinsically motivated archetypal student is as follows: a student who is a reflective thinker with a broad enjoyment of learning, motivated to become an excellent counselor. His or her ideal teacher helps to develop deeper personal understandings and wisdom through creating opportunities to hear diverse opinions and feedback. An example of the Factor 3 affective-oriented archetypal student is as follows: a student who wants to feel cared for and valued by a teacher as a means of developing a transformational relationship with him or her. His or her ideal teacher is a person he or she admires who inspires the student to want to become a professional counselor.

The preferences of the Factor 1 student-learner archetype are congruent with counselor educators of clinical courses who use developmental (Granello, 2000) and teacher-centered (Baeten et al., 2012) pedagogies. Students from the Factor 1 archetype are unsure of themselves because of their lack of knowledge and experience in counseling. Thus, it may be helpful when counselor educators use their advanced knowledge and experiences as formal authorities to disseminate essential foundational knowledge and skills (Grasha, 1994). These Factor 1 students also may find it helpful when counselor educators use a personal model of teaching to demonstrate how something should be done, which has the dual benefit of helping students learn through observation and creating a clear objective for which to strive (Grasha, 1994). Additionally, the Factor 1 archetype prefers teachers who introduce new information and skills using a contextual approach (Granello & Hazler, 1998) in which they take time to explain how and why what is being taught is relevant to the goal of becoming a competent professional counselor. These approaches to teaching may quell developmental anxieties experienced by Factor 1 students, and counselor educators can encourage further growth through providing strength-based feedback as students perform clinical learning tasks.

The preferences of the Factor 2 student-learner archetype are closely aligned with counselor educators who use constructivist (Nelson & Neufeldt, 1998) and learner-centered pedagogies (Baeten et al., 2012) while teaching clinical courses. The Factor 2 archetype prefers for minimal class time to be used for teacher-led instruction and the majority of class time to be used for reflective learning activities, discussion and exchanging feedback. These Factor 2 students prefer for counselor educators to operate on the periphery of the classroom in the style of a facilitator and delegator, acting as a catalyst who orchestrates a rich learning environment (Grasha, 1994). A rich learning environment from the Factor 2 perspective is a classroom with many active voices openly sharing different points of view, providing one another with candid feedback about their clinical work. An important task then is for counselor educators to create relevant learning activities in class that provoke discussion and reflection. One example of this could be requiring the Factor 2 archetype to present videos or case vignettes of their clinical work with clients in which they are required to conceptualize the client with their classmates. During such an activity, counselor educators may be helpful to Factor 2 students by offering candid feedback, sharing (potentially) alternative viewpoints and prompting them to justify clinical interventions based on their theoretical orientation(s).

The preferences of the Factor 3 student-learner archetype are focused on the personality and relational qualities of counselor educators. This orientation toward the personality qualities of the teacher is congruent with research from undergraduate populations that found instructors with warmth-inducing behaviors (Best & Addison, 2000) and who demonstrated enthusiasm about course content (Feldman, 1988) were associated with effective teaching. Similarly, it is important to the Factor 3 archetype that they perceive their instructors as kind, genuine and passionate about what they are teaching because these personal qualities kindle their interest for learning. Factor 3 students are further motivated to learn when they develop respect and admiration for counselor educators, which can be achieved through expert and formal authority styles of teaching (Grasha, 1994). Factor 3 prefers for counselor educators to lead class in a teacher-centered fashion so that their teachers’ personal qualities are at the forefront of the learning environment. However, dissimilar to teacher-centered approaches that emphasize the importance of mastering course content, the Factor 3 archetype learns primarily through the relationship developed with counselor educators. Their ideal teacher is affable, demonstrates charisma in the classroom and is an exemplar of personality qualities they perceive as important for a counselor to possess. Observing and experiencing these desirable characteristics in counselor educators inspires Factor 3 students to emulate them in their clinical work. Several examples of how counselor educators can engage Factor 3 students are as follows: (a) ethically sharing candid anecdotes that may directly or tangentially relate to course material; (b) asking students how they are feeling about their experiences in the class or in clinical situations; and (c) using humor as a pedagogical tool.

It is interesting to consider results from this study in light of a similar Q study that explored what beginning professional counselors perceived as helpful about teachers from didactic courses (Moate, Cox, Brown, & West, in press). In both studies, three factors emerged from the data that bear great similarities to one another, despite each study being comprised of different participants and Q sort items. This may suggest that to some degree a commonality exists between CMHC students’ perceptions of what is helpful about teachers in both clinical and didactic courses. However, unlike the previous study that found a high level of agreement among the three factors about the helpfulness of counselor educators of didactic courses, the factors in this study demonstrated three distinct viewpoints about their preferences. This may suggest that it is more challenging for counselor educators in clinical courses to find a pedagogical middle ground that is mutually pleasing to each student-learner archetype. Thus, counselor educators may need to spend more time in clinical courses considering how they can accommodate the different learning perspectives present in their classroom.

Limitations and Future Research

This study used Q methodology to explore different shared viewpoints that exist among beginning-level counselors about their perceptions of helpful aspects of counselor educators teaching clinical courses in CMHC. Although we believe that student learning preferences are an important perspective for counselor educators to consider, we also recognize that this represents only one side of a coin. It would be helpful for future research to explore what counselor educators perceive as being important for CMHC students to learn in clinical courses to prepare them for the rigors of being professional counselors. This added perspective could elucidate important pedagogical items that were not accounted for in this study.

Implications for Teaching Practice

Because of the three distinctive teaching preferences among CMHC students in clinical courses, counselor educators may need to spend more time considering how they can accommodate diverse student learning needs when teaching clinical courses. An important first step may be for counselor educators to reflect on their teaching and learning bias by considering the following questions: (a) with which student-learner archetype did they most closely identify as a student; (b) which student-learner archetype’s teaching preferences most closely align with their style of teaching; and (c) to which student-learner archetype do they prefer to teach? Counselor educators who possess self-awareness of their teaching and learning biases in relation to the student-learner archetypes presented in this study may be better able to make pedagogical adjustments that are beneficial to students who are most unlike their preferences. For example, a counselor educator who identifies as having a pedagogical style that they believe aligns with the Factor 1 (application-oriented) preferences might consider ways to better engage Factor 2 and Factor 3 learners. This could entail structural considerations when designing the course and lesson planning for each class or being intentional about emphasizing or de-emphasizing certain personality characteristics during class.

We also believe that counselor educators can use the findings of this study as a tool to conceptualize students with whom they work in clinical courses. Having such a conceptualization tool may help counselor educators modify their pedagogical approach when working with students individually in a classroom setting. Smaller class sizes and interactive environments in clinical courses provide counselor educators with greater opportunities to communicate directly with students. Consequently, counselor educators have greater potential in clinical courses to make adjustments based on the perceived needs of the individual students. For example, rather than working in the same way with all students (e.g., providing strength-based feedback), a counselor educator who notices that a student has traits of the Factor 2 archetype may consider providing feedback that is corrective in nature.

The findings from this study highlight different teaching preferences that exist among beginning counselors about helpful aspects of teachers in clinical courses. It is probably unrealistic and unnecessary for counselor educators to make drastic changes to their pedagogy in pursuit of perfectly meeting the learning preferences of all CMHC students in a clinical class. Rather, we broadly suggest that counselor educators should be reflective of their own teaching characteristics and biases and consider making small modifications to their pedagogical approach that will be more inclusive for students with preferences different than their own.

Conflict of Interest and Funding Disclosure

The authors reported no conflict of interest or funding contributions for the development of this manuscript.

References

Auxier, C. R., Hughes, F. R., & Kline, W. B. (2003). Identity development in counselors-in-training. Counselor Education and Supervision, 43, 25–38. doi:10.1002/j.1556-6978.2003.tb01827.x

Baeten, M., Dochy, F., & Struyven, K. (2012). Using students’ motivational and learning profiles in investigating their perceptions and achievement in case-based and lecture-based learning environments. Educational Studies, 38, 491–506. doi:10.1080/03055698.2011.643113

Barrio Minton, C. A., Wachter Morris, C. A., & Yaites, L. D. (2014). Pedagogy in counselor education: A 10-year content analysis of journals. Counselor Education and Supervision, 53, 162–177.
doi:10.1002/j.1556-6978.2014.00055.x

Best, J. B., & Addison, W. E. (2000). A preliminary study of perceived warmth of professor and student evaluations. Teaching of Psychology, 27, 60–62.

Brown, S. R. (1980). Political subjectivity: Applications of Q methodology in political science. New Haven, CT: Yale University Press.

Feldman, K. A. (1988). Effective college teaching from the students’ and faculty’s view: Matched or mismatched priorities. Research in Higher Education, 28, 291–329.

Furr, S. R., & Carroll, J. J. (2003). Critical incidents in student counselor development. Journal of Counseling & Development, 81, 483–489. doi:10.1002/j.1556-6678.2003.tb00275.x

Goldstein, G. S., & Benassi, V. A. (2006). Students’ and instructors’ beliefs about excellent lecturers and discussion leaders. Research in Higher Education, 47, 685–707. doi:10.1007/s11162-006-9011-x

Granello, D. H. (2000). Contextual teaching and learning in counselor education. Counselor Education and Super-vision, 39, 270–283. doi:10.1002/j.1556-6978.2000.tb01237.x

Granello, D. H., & Hazler, R. J. (1998). A developmental rationale for curriculum order and teaching styles in counselor education programs. Counselor Education and Supervision, 38(2), 89–105. doi:10.1002/j.1556-6978.1998.tb00561.x

Grasha, A. F. (1994). A matter of style: The teacher as expert, formal authority, personal model, facilitator, and delegator. College Teaching, 42(4), 142–149.

Malott, K. M., Hall, K. H., Sheely-Moore, A., Krell, M. M., & Cardaciotto, L. (2014). Evidence-based teaching in higher education: Application to counselor education. Counselor Education and Supervision, 53, 294–305. doi:10.1002/j.1556-6978.2014.00064.x

McAuliffe, G., & Eriksen, K. (2010). Handbook of counselor preparation: Constructivist, developmental, and experiential approaches. Thousand Oaks, CA: Sage.

Moate, R., Cox, J., Brown, S., & West, E. (in press). Helpfulness of teachers in didactic courses. Counselor Education and Supervision.

Nelson, M. L., & Neufeldt, S. A. (1998). The pedagogy of counseling: A critical examination. Counselor Education and Supervision, 38(2), 70–88. doi:10.1002/j.1556-6978.1998.tb00560.x

Pietrzak, D., Duncan, K., & Korcuska, J. S. (2008). Counseling students’ decision making regarding teaching effectiveness: A conjoint analysis. Counselor Education and Supervision, 48(2), 114–132. doi:10.1002/j.1556-6978.2008.tb00067.x

Ramlo, S. (2016). Mixed method lessons learned from 80 years of Q methodology. Journal of Mixed Methods Research, 10, 28–45. doi:10.1177/1558689815610998

Schmolck, P. (2014). PQMethod (Version 2.35). [Computer Software]. Retrieved from http://schmolck.userweb.mwn.de/qmethod

Schwitzer, A. M., Gonzalez, T., & Curl, J. (2001). Preparing students for professional roles by simulating work settings in counselor education courses. Counselor Education & Supervision, 40, 308–319. doi:10.1002/j.1556-6978.2001.tb01262.x

Skovholt, T. M., & Ronnestad, M. H. (1992). Themes in therapist and counselor development. Journal of Counseling & Development, 70, 505–515. doi:10.1002/j.1556-6676.1992.tb01646.x

Smart, K. L., Witt, C., & Scott, J. P. (2012). Toward learner-centered teaching: An inductive approach. Business Communication Quarterly, 75, 392–403. doi:10.1177/1080569912459752

Sperry, L. (2012). Training counselors to work competently with individuals and families with health and mental health issues. The Family Journal: Counseling and Therapy for Couples and Families, 20, 196–199. doi:10.1177/1066480712438527

Sprinkle, J. E. (2008). Student perceptions of effectiveness: An examination of the influence of student biases. College Student Journal, 42, 276–293.

Stephenson, W. (1978). Concourse theory of communication. Communication, 3, 21–40.

Stenner, P., Watts, S., & Worrell, M. (2008). Q-methodology. In C. Willig & W. Stainton-Rogers (Eds.), The Sage handbook of qualitative research in psychology (pp. 215–239). London, UK: Sage.

Watts, S., & Stenner, P. (2012). Doing Q methodological research. London, UK: Sage.

Young, M. E., & Hundley, G. (2013). Connecting experiential education and reflection in the counselor education classroom. In J. D. West, D. L. Bubenzer, J. A. Cox, & J. M. McGlothlin (Eds.), Teaching in counselor education: Engaging students in learning (pp. 51–66). Alexandria, VA: Association for Counselor Education and Supervision.

Young, S., & Shaw, D. G. (1999). Profiles of effective college and university teachers. The Journal of Higher
Education, 70, 670–686.

Randall M. Moate is an Assistant Professor at the University of Texas at Tyler. Jessica M. Holm is an Assistant Professor at the University of Texas at Tyler. Erin M. West is a Lecturer at the University of Texas at Tyler. Correspondence can be addressed to Randall Moate, The Department of Psychology and Counseling, University of Texas at Tyler, 3900 University Blvd., Tyler, TX 75799, rmoate@uttyler.edu.

The Adolescent Substance Use Risk Continuum: A Cultural, Strengths-Based Approach to Case Conceptualization

Feb 28, 2017 | Volume 7 - Issue 1

Alexis Miller, Jennifer M. Cook

Many theories are used to conceptualize adolescent substance use, yet none adequately assist mental health professionals in assessing adolescents’ strengths and risk factors while incorporating cultural factors. The authors reviewed common adolescent substance abuse theories and their strengths and limitations, and offer a new model to conceptualize adolescent substance use: The Adolescent Substance Use Risk Continuum. We posit that this strengths-based continuum enables clinicians to decrease stigma and offer hope to adolescents and their caregivers, as it integrates relevant factors to strengthen families and minimize risk. This model is a tool for counselors to use as they conceptualize client cases, plan treatment and focus counseling interventions. A case study illustrates the model and future research is suggested.

Keywords: adolescents, substance use, case conceptualization, cultural factors, strengths-based

For decades, theorists have worked to understand adolescent behaviors and conceptualize adolescent substance use. These theories have provided a strong base to conceptualize adolescent substance use, yet none integrate important counseling-focused concepts such as strengths and cultural factors. The Adolescent Substance Use Risk Continuum (ASURC) expands upon previous theoretical models and is designed to enhance counselors’ ability to conceptualize adolescent substance use from a strengths-based, stigma-reducing, and culturally sensitive perspective. The ASURC adds to counselors’ abilities to conceptualize adolescent substance use and enhances their abilities to create comprehensive treatment plans and interventions.

Theoretical Underpinnings

The theory of planned behavior (TPB; Ajzen, 1985), social learning theory (SLT; Akers, 1973), social control theory (SCT; Elliott, Huizinga, & Ageton, 1985), and social development theory (SDT; Hawkins & Weis, 1985) are four theories that have been applied to adolescent substance use. The TPB was developed to describe an individual’s behavior in a general sense, while the other three theories were developed to explain deviant and delinquent behavior. Even though these four theories were developed in the 1970s and 1980s and were not developed specifically for adolescent substance use, researchers have applied these theories to predict substance use within this population (Corrigan, Loneck, Videka, & Brown, 2007; Malmberg et al., 2012; Schroeder & Ford, 2012).

The TPB was developed as an expansion of the theory of reasoned action, which describes behavior as contingent upon an individual’s beliefs about a certain behavior and the perceived social pressure on the individual to perform that behavior (Ajzen, 1985). In addition to individual beliefs and perceived social pressure, the TPB adds an additional element to describe behavioral intention: self-efficacy. Self-efficacy refers to one’s perception of control to complete certain behaviors (Ajzen, 1985). Petraitis, Flay, and Miller (1995) introduced two types of self-efficacy related to adolescent substance use: use self-efficacy and refusal self-efficacy. Use self-efficacy consists of adolescents’ beliefs about their ability to obtain alcohol or other drugs, whereas refusal self-efficacy is indicative of adolescents’ beliefs about their abilities to refuse social pressure to use substances (Petraitis et al., 1995).

SLT was developed to explain so-called deviant behavior, and it is heavily influenced by behavioral theories, particularly operant conditioning and reinforcement. Therefore, behavior is learned when it is reinforced (Akers, 1973). The anticipation of either reinforcement or punishment can lead to behavioral increase or decrease, depending on who has the most influence on the adolescent, and who controls the reinforcement or punishment. Delinquent behavior can be influenced and maintained by a variety of sources, including parents, family, peers and school (Petraitis et al., 1995).

Similar to SLT, SCT emphasizes the importance of rewards and punishments in terms of deviant or delinquent behavior (Elliott et al., 1985). The result of either punishment or reinforcement is influenced mainly by an individual’s socialization into what the authors described as conventional society (Elliott et al., 1985). Conventional society points to general societal norms, largely congruent with dominant cultural norms. Therefore, according to SCT, an adolescent with a strong attachment to conventional society would have stronger internal and external controls and would be less motivated to choose delinquent behaviors. Inversely, an adolescent with a weak attachment to conventional society would have weaker internal and external controls and be more likely to engage in deviant behaviors (Elliot et al., 1985).

Hawkins and Weis (1985) integrated SLT and SCT to develop the SDT. The SDT is a developmental model of delinquent behavior that focuses on how adolescents are socialized through family, peers and school. Delinquent behaviors develop when adolescents are not socialized into conventional society appropriately. Opportunities for involvement with conventional individuals are seen as necessary but not sufficient for an individual to develop positive social bonds (Hawkins & Weis, 1985). There are two mediating factors associated with this socialization process toward positive social bonds: skills possessed by an adolescent and reinforcement of the opportunities for involvement (Hawkins & Weis, 1985). Skills that enhance an adolescent’s ability toward social bonds include adolescents’ social skills, or skills needed to interact and form social bonds with others (Hawkins & Weis, 1985). Similar to SLT and SCT, the SDT stresses the need for reinforcement, where behavior must be reinforced to continue (Hawkins & Weis, 1985).

Strengths and Limitations of Theoretical Underpinnings

The aforementioned models have made significant contributions to how counselors conceptualize adolescent substance use. Particularly, these models highlight the role social influences play in adolescent substance use and, accordingly, how social influences impact behavioral factors like reinforcement, punishment and reward (Akers, 1973; Elliot et al., 1985; Hawkins & Weis, 1985; Petraitis et al., 1995). Additionally, all models have been validated empirically to be predictive of adolescent substance use (Corrigan et al., 2007; Malmberg et al., 2012; Schroeder & Ford, 2012). Although these studies provide empirical support for predicting adolescent substance use and highlight social influences and behavioral factors, limitations exist, namely a lack of specificity related to social influences, the use of problematic language, and failure to incorporate cultural factors and contexts. Below, we detail the strengths and limitations of the aforementioned models to provide a rationale for a more encompassing, strengths-based approach to conceptualizing adolescent substance use.

Social Influences

Research has shown that social factors, such as family and peer group, play a mediating role in adolescent substance use in both positive and negative ways (Piko & Kovács, 2010; Van Ryzin, Fosco, & Dishion, 2012). Also, research highlights how important social influences are on adolescents’ substance use. The TPB suggests that substance use is dependent upon the adolescent’s individual attitudes of substance use and perceived social pressure to use substances (Petraitis et al., 1995). SLT and SCT emphasize how behavior, including substance use, is learned through reinforcement or punishment (Akers, 1973 Elliott et al., 1985). Someone in the adolescent’s life has to reward or punish the adolescent’s substance use for it to continue or cease.

Further, the SDT emphasizes the socialization process in regards to deviant behavior in adolescents. According to the SDT, socialization begins within the family unit, where a child has variable opportunities to develop social, cognitive and behavioral skills (Hawkins & Weis, 1985). As a child grows older, ostensibly these skills are reinforced positively within the school setting and peer group (Hawkins & Weis, 1985). However, if children are not socialized appropriately in the family system, children may not develop socially, cognitively and behaviorally as expected. In turn, they may turn to substance use to cope with stressful life events. Further, if adolescents were not socialized appropriately in early childhood, they may be at greater risk to become involved with adolescents who use substances.

While the four theories emphasize social influences as a factor in adolescent substance use, the TPB, SLT and SCT used the term social influences in a general sense only, and do not differentiate between the different types of social influences. There are a variety of social influences, including family, peers, school, sports teams, clubs and religious organizations, and each can have a varied impact on adolescents’ substance use. For example, involvement in religious organizations can protect some adolescents from substance use (Steinman & Zimmerman, 2004), while engagement with sports teams may increase adolescent substance use for others (Farb & Matjasko, 2012). The SDT was the only model discussed that divides socialization into three units: family, peer and school; however, the SDT suggests that family, peer, and school units all go through the same development process, seemingly at the same rate. Presumably, an adolescent is given the same opportunity for involvement with all three units toward the goal of creating healthy social bonds, and these opportunities are influenced by an adolescent’s current social skills and reinforcement from others (Hawkins & Weis, 1985). This adolescent substance use conceptualization can be problematic because it suggests the family, peer group and school all go through the same developmental process simultaneously and fails to recognize that different units can have different influences (some positive, some negative) on an adolescent, and these influences may develop asymmetrically. Further, the SDT proposes that a “social bond” (Hawkins & Weis, 1985, p. 80) to conventional society is a common goal and that adolescents have the social skills in place to create these bonds. Although it is hoped that adolescents will have strong social skills and that their support systems will endeavor to create healthy social bonds, this may not be the case for all adolescents. Further, some adolescents who have strong social skills may use them to procure substances and influence others to use.

Problematic Language

The developers of SLT, SCT, and SDT used the terms deviant behavior, delinquent behavior, and conventional society to describe aspects contained in their theories. In juvenile justice literature, the terms deviant and delinquent point to adolescent behaviors considered to be age-inappropriate and destructive to self and family, as well as illegal (Pope, 1999). However, these terms are not used to simply describe behaviors as they were intended—they have become labels used to classify and marginalize adolescents who have made poor choices and acted in ways incongruent with conventional society (Constantine, 1999). Often, these terms are applied to adolescents who encompass non-dominant cultural identities (e.g., race, social class), which can serve to further oppress and marginalize adolescents who may experience societal and structural inequality. At the very least, these terms define adolescents by choices they have made and may lead to assumptions about who they are, adding additional stigma and shame to worthy individuals who can learn to make different choices, which is incongruent with a strengths-based perspective.

Conventional society is a term used to describe societal norms, determined most often by dominant U.S. cultural groups (Duncan, 1999). Similar to the issues with the terms deviant and delinquent, the term conventional society may not account accurately for cultural nuances and differences that vary from dominant culture expectations, furthering societal and structural oppression, discrimination and inequality clients experience (Constantine, 1999). For example, according to SCT, weak attachment to conventional society contributes to weaker internal and external controls, and an adolescent can develop a weak attachment to conventional society when she experiences a strain between her aspirations and her perceptions of the opportunity to actualize such aspirations. Therefore, through an SCT lens, if this adolescent lives in a low-income neighborhood where crime and unemployment are prevalent, she may be perceived to have a weak attachment to conventional society (Petraitis et al., 1995), without taking into account that her environment is out of sync with conventional society and cultural norms as defined by the dominant culture.

Cultural Factors

The final common limitation of the aforementioned models is the lack of inclusion of cultural influences on adolescents’ substance use. As mentioned previously, these four models highlight the importance of social influences on adolescents’ substance use yet do not specifically take cultural factors into consideration. The TPB discusses social influences in regard to an adolescent’s beliefs and perceived social pressure (Ajzen, 1985); however, there is no mention that these beliefs might be influenced by cultural values and experiences. Similarly, SLT suggests that an adolescent’s deviant behavior is influenced by positive or negative reinforcement received within the social context (Akers, 1973), yet fails to acknowledge that these positive or negative reinforcements are most likely influenced by cultural factors. The SDT outlines the socialization process through three different units (Hawkins & Weis, 1985), all of which exist within cultural contexts that influence adolescents’ substance use, yet the authors do not cite this as a possibility. Similarly, SCT discusses social influences on a systemic level, focusing on adolescent academic and occupational goals (Elliott et al., 1985). Adolescents’ cultural factors can influence their academic and occupational goals, as well as their perception of the likelihood of obtaining these goals. The theme among these four models is that they include factors influenced by culture without specifically mentioning or addressing culture or cultural variations.

We suggest a conceptual model for adolescent substance use that addresses specific social influences, uses inclusive and strengths-based language, and integrates cultural factors. We propose the ASURC as a model to meet this need. The ASURC asserts that while different social contexts are intertwined with one another, they all influence adolescent substance use in distinct ways. Further, the ASURC model uses strengths-based terms to reduce stigma and shame, and empowers clients and their caregivers to make person-affirmative choices. Finally, the ASURC integrates cultural components into all aspects of the model in order to provide appropriate context, acknowledging that adolescent substance use develops in a cultural context.

The Adolescent Substance Use Risk Continuum

The aforementioned theoretical models contain strengths and limitations and influenced the development of the ASURC model. Prior models emphasized social influence on adolescent substance use, and we emphasize social influences in our model as well. However, we believe that different social systems will have different influences on each adolescent, and each social system develops at its own rate. Further, the included areas are not meant to be predictive of substance use, and can serve both as strengths and risk factors, depending on the individual’s circumstances. The areas featured in our model include: parental and caregiver engagement, relationship between parents and caregivers and adolescent, family history of substance use, biological factors, level of susceptibility to peer pressure, childhood adversity, and academic engagement. While we believe the areas in our model have distinct impacts on adolescents, all areas interact and influence one another, and all areas are influenced by singular and intersecting cultural identities.

The ASURC emphasizes the importance of cultural considerations when conceptualizing adolescent substance use. We used Hays’ (1996) “ADDRESSING” model as a foundation. The included cultural factors are by no means exhaustive; counselors are encouraged to expand this list to work with their clients appropriately. Cultural factors should be considered in terms of the individual, family, community and societal contexts when applied to the ASURC areas. Further, it is important to consider ways in which cultural identities can serve as protective or risk factors, depending on the individual’s dominant and non-dominant cultural identities, and the identities most salient to the client. Client cultural influences are subjective experiences, and counselors should take great care and time to determine their relevance for each client.

Further, the ASURC is a strengths-based approach to conceptualizing adolescent substance use. Previous theories contain the use of problematic language, such as conventional society, deviant behavior, and delinquent behavior, when describing adolescent substance use. We feel the use of this language can lead to stigma and instill a sense of shame for this population. Focusing on strengths while using the ASURC will aid clinicians in fostering a sense of hope while working with this population. Strengths are not a separate component of the model, but rather are incorporated in each aspect of the model.

As the name suggests, the ASURC (Adolescent Substance Use Risk Continuum) is a continuum, ranging from minimal risk to high risk. The continuum starts at minimal risk instead of no risk because substance use and addiction can occur in anyone. Further, a continuum suggests that an adolescent can move bi-directionally along the continuum depending on changes. This potential for movement can instill hope and serve to reduce shame associated with adolescent substance use. To use the ASURC model (see Figure 1), one starts at the bottom of the model and considers how the areas listed serve as adolescent protective or risk factors. When working through these areas, cultural identities are incorporated. These identities are represented above the entire model to indicate how they influence everything underneath them. Cultural factors should be considered from the perspective of the individual, family, community and society as a whole, because their influence could be different in each area. Finally, the counselor determines where the adolescent falls on the risk continuum. Because multiple aspects influence an individual’s location on the continuum, it is important to note the protective and risk factors associated with each of the model’s areas for any specific client. This assessment can assist counselors in developing holistic treatment plans that address not only adolescents’ substance use, but also their strengths and areas that could be enhanced as they strive to eliminate substance use.

Model Components

Cultural Influences

There are many cultural factors to consider when conceptualizing adolescent substance use. The ASURC is based on Hays’ (1996) ADDRESSING model. There are nine overlapping cultural influences included in the ADDRESSING model: age, disability status, religion, ethnicity, socioeconomic status, sexual orientation, indigenous heritage, national origin and gender (Hays, 1996). To these we added race and language. This list is not exhaustive but rather a starting point to consider how culture can be a protective or risk factor for adolescents.

When clinicians consider adolescents’ cultural identities, it is important to do so within individual, family, community and societal contexts. To consider only one context diminishes the multiplicity of adolescents’ experiences, and it can negate the impact these contexts have on them. For example, it is common for societal context to be overlooked in favor of individual experiences due to the importance placed on individualism by the dominant culture (Johnson, 2006). When societal context is neglected, structural inequality may be ignored. Structural inequality denotes the oppression or restrictions non-dominant groups experience when they attempt to access resources, including mental health treatment, which are available without hindrance to dominant culture groups. Structural inequality can impact adolescents’ beliefs about their ability to choose not to use substances and their ability to achieve success and access resources, and can reduce hope about their life circumstances (Hancock, Waites, & Kledaras, 2012).

Religion and spirituality. Religion and spirituality can be a protective factor for adolescents. Higher levels of religious involvement tend to correlate with lower levels of substance use (Mason, Schmidt, & Mennis, 2012). Mason et al. (2012) identified two specific aspects of religiosity associated with lower levels of alcohol and drug use: social religiosity and perceived religious support. Social religiosity refers to public displays of religious behavior, such as church attendance and participation in religious activities; perceived religious support encompasses emotional support one receives from a religious institution as well as tangible support like materials or money donated by a religious organization (Mason et al., 2012). Private religiosity, such as personal importance of religion and individual prayer, was not found to be a protective factor (Mason et al., 2012), suggesting the more social aspects of religion are more beneficial for preventing adolescent substance use. Similarly, religion may be a risk factor when adolescents, such as lesbian, gay, or bisexual (LGB) youth, feel judged, shamed, or shunned by their religious community, which may increase the likelihood of substance use (Barnes & Meyer, 2012).

Ethnicity. Ethnicity is significant because reported substance abuse and dependence rates are higher for people of color than for White people in the population (Substance Abuse and Mental Health Services Administration, 2012). Of the total population of people of color, who represent only 38.5% of the U.S. population, 9,319,277 people reported substance abuse and dependence. This number is particularly staggering when compared to White people, who represent 61.5% of the population, 15,713,373 of whom reported substance abuse and dependence (Substance Abuse and Mental Health Services Administration, 2012). These statistics demonstrate that adolescents of color are more likely to develop substance abuse issues than their White counterparts. However, these statistics do not incorporate issues related to structural inequality, nor do they speak to restricted treatment access or racial groups’ protective factors that could be bolstered. For example, Native Americans, who have the highest statistical rate of substance use, also emphasize spirituality and the importance of the extended family (Sue & Sue, 2013). These factors can serve as protective factors for Native American adolescents. Similarly, researchers have found religious engagement among African American adolescents to be a protective factor (Steinman & Zimmerman, 2004). African American adolescents who attended religious services regularly had lower substance use rates than their peers who did not.

Socioeconomic status. Socioeconomic status (SES), particularly education level, influences substance use in adolescents, and subsequently intersects with race and ethnicity. Adolescents who drop out of high school are more likely to engage in substance use, and lower levels of education are associated with higher prevalence of substance-related diagnoses (Henry, Knight, & Thornberry, 2012). American Indian, Latino, and African American adolescents’ math and reading proficiency rates are less than half of White adolescents, most likely due to structural inequality in low-income schools. Students in these groups are less likely to graduate from high school than their White peers (Henry et al., 2012). Furthermore, living in poverty or low SES are associated with higher risks of substance use, and adolescents from racial minority groups are at a higher risk for living in poverty and low-SES families (Van Wormer & Davis, 2013).

Sexual orientation. Sexual orientation is another cultural factor to consider. The LGB community is at greater risk for substance use compared to heterosexual individuals (Brooks & McHenry, 2009). One explanation for the increased risk in the LGB community may be due to homophobia and heterosexual superiority and internalized homophobia, which can lead individuals in the LGB community to turn to substances as a way to cope (Brooks & McHenry, 2009). Further, gay bars are a mainstay of the LGB community, and even though adolescents may not be allowed to drink legally, bar environments may be integral during adolescents’ coming out process (Brooks & McHenry, 2009). Socialization in a bar environment can lead to adolescent substance use as a way to fit in and cope.

Caregiver Engagement and Adolescent–Caregiver Relationship

Family environment can serve as a protective or risk factor for adolescent substance use. A key factor associated with family environment is parental or caregiver supervision. Strong caregiver supervision has been shown to minimize an adolescent’s risk-taking behavior, such as substance use (Van Ryzin et al., 2012). While caregiver supervision is an important protective factor for adolescents, it also is important for adolescents to be able to experience a sense of autonomy within their family of origin. Allen, Chango, Szwedo, Schad, & Marston (2012) defined autonomy within the family of origin as adolescents’ ability to have opinions and beliefs that differ from their caregiver(s) and can be fostered through a supportive adolescent–caregiver relationship. Positive relationships between caregivers and adolescents can increase self-esteem and healthy coping skills, leading to a decrease in risk-taking behaviors (Piko & Kovács, 2010). According to Piko and Kovács (2010), high levels of both satisfaction and caregiver support perceived by the adolescent define this positive relationship. Further, positive relations within the family can lead to higher levels of family obligation perceived by the adolescent. Family obligation is the perceived importance of spending time together, family unity and family social support; higher levels have been found to deter adolescents from unhealthy risk taking, including the use of alcohol and drugs (Telzer, Fuligni, Lieberman, & Galván, 2013).

Conversely, low caregiver involvement can be a risk factor for adolescent substance use. Adolescents who have low caregiver supervision are more likely to engage with peers who use substances and, subsequently, use substances as a way to find social support (Van Ryzin et al., 2012). Additionally, adolescents who do not have positive relationships with their caregivers have a more difficult time self-regulating their behaviors and increased risk for using substances as a way to cope with stress (Hummel, Shelton, Heron, Moore, & van den Bree, 2013).

Family Substance Abuse History and Biological Risks

Family history of substance use is an additional risk factor for adolescents. Children of parents and caregivers who abuse alcohol are four times more likely to develop an addiction (Van Wormer & Davis, 2013). This risk may be partly due to biological predisposition, and part may be environmental. Scientists have begun to better understand how genes affect substance use disorder development and posit that 40–60% of alcohol use disorders can be explained by genes (Van Wormer & Davis, 2013). It can be difficult to determine whether an individual’s addiction is inherited through genetic composition or is learned via the family environment, or a combination of both. Genetics can include predisposition to impulsivity, and some scientists believe individuals at risk for substance use disorders may be biologically predisposed to overreact to stressful situations and life events. Individuals predisposed genetically to engage in sensation-seeking and impulsive behaviors are more likely to experiment with alcohol and other substances (Van Wormer & Davis, 2013). While biological risk can increase adolescents’ predisposition to develop addiction, it does not necessarily lead to addiction (Van Wormer & Davis, 2013). This message can instill hope and infuse self-efficacy in families who may have a history of substance abuse.

Adolescence is marked by an increase in risk-taking behaviors, which may be associated with developmental biology (Telzer et al., 2013). Adolescents show a heightened response in the ventral striatal, which is part of the brain’s reward system. This heightened response in the ventral striatal can cause adolescents to engage in more reward-seeking behaviors compared to children and adults. Further, adolescents show less activation in pre-frontal regions of the brain, the part of the brain in charge of executive functioning, which can lead to increased risk-taking behaviors (Telzer et al., 2013). Research has shown that an increase in family obligation can lead to decreased sensitivity in the ventral striatal and increased activity in the pre-frontal region of the brain (Telzer et al., 2013). These findings suggest that improved quality in the adolescent–caregiver relationship can jettison substance abuse. Specifically, increased family obligation can help buffer some adolescent biological risks for substance use.

Susceptibility to Peer Influences

Peer relationships can play a role in the development of adolescent substance use. During adolescence, individuals start to spend more time with peer groups than with their families (Piko & Kovács, 2010). Additionally, adolescence is marked by a heightened sense of reward. This focus on reward can lead to an increased desire for adolescents to please their peers, making it more difficult for them to resist peer pressure (Van Ryzin et al., 2012). If adolescents associate with peers who use alcohol and drugs, they are more likely to begin using substances as a way to be accepted by their peer group (Van Ryzin et al., 2012).

Inversely, if adolescents are associated with peers who are not involved in substance use, they are less likely to use substances (Van Ryzin et al., 2012). Moreover, there is a negative correlation between adolescents who are involved in supervised extracurricular activities and substance use (Farb & Matjasko, 2012). Specifically, involvement in school-based activities such as performing arts, leadership groups and clubs is associated with lower rates of substance use (Darling, Caldwell, & Smith, 2005). However, there is a positive correlation between athletics and substance abuse, meaning adolescents involved in athletics are more likely to engage in substance use (Farb & Matjasko, 2012). Researchers believe this positive correlation is due to the subculture of high school athletics that promotes alcohol and drug use (Denault, Poulin, & Pedersen, 2009).

Childhood Adversity

Adolescents who experienced childhood adversity are at greater risk for developing substance use disorders (Benjet, Borges, Medina-Mora, & Méndez, 2013). Childhood adversity refers to family instability such as parental and caregiver mental illness, substance use, and criminal behavior, witnessing domestic violence, and experiencing abuse, neglect, interpersonal loss, and socioeconomic disadvantage. Researchers have suggested that this relationship is due to the self-medication hypothesis, in that adolescents who experience childhood adversity may turn to alcohol and drugs in order to alleviate the pain they encounter as a result of such experiences (Benjet et al., 2013).

Not only are adverse childhood experiences a risk factor for developing substance use disorders, but also for substance use opportunities (Benjet et al., 2013). One possible explanation for such opportunities is the presence of substances in the family environment. For adolescents who experienced child abuse or neglect or who witnessed domestic violence, there is an increased chance that substances were present in their household, making it easier for them to gain access to substances (Benjet et al., 2013).

The absence of childhood adversity can be a protective factor against adolescent substance use (Benjet et al., 2013). Another protective factor in terms of childhood adversity is early intervention (Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011). Early intervention can help children develop healthy coping skills to manage stress. Healthy coping strategies can be implemented to replace more negative coping strategies like substance use (Durlak et al., 2011).

Academic Engagement

Academic engagement can have positive and negative effects on adolescents’ potential substance use. Adolescents who drop out of high school are more likely than their counterparts to engage in substance use (Henry, Knight, & Thornberry, 2012). Further, early school disengagement can be a warning sign to predict high school dropout (Henry et al., 2012). For some adolescents, school engagement can be a protective factor. Particularly, adolescents who experience a positive school climate and have strong school engagement are less likely to use substances (Piko & Kovács, 2010). A positive relationship between adolescents and their teachers can be another protective factor. Previous studies have shown that adolescents who have a positive relationship with their teachers and have a high level of perceived support from teachers are less likely to engage in substance use (Demanet & Van Houtte, 2012).

The case study below provides an example of how clinicians can use the ASURC to conceptualize and plan interventions when working with this population.

Case Study

John is a 14-year-old, biracial male and high school freshman. He lives with his mother and grandmother, both of whom are African American, and they reside in a low socioeconomic neighborhood. Both John’s mother and grandmother work full-time, and his mother works a second job, leaving John unsupervised after school and on the weekends. John’s father, a 38-year-old Puerto Rican male, left the home when John was 4 years old. Prior to his father’s departure, John witnessed domestic violence between his parents. During a fight, John intervened on his mother’s behalf and his father hit him. After this event, John’s mother forbade her husband from living in their home and sought counseling services for her son. After his father left, John had only sporadic visits with him, mainly due to his father’s alcohol use. In addition to John’s father’s alcohol use, there is family history of substance use on his mother’s side. His maternal great-aunts use alcohol, and his maternal uncle uses marijuana daily.

This year, John made the varsity football team and has been spending time with the senior football players after practice during the week and on weekends. In addition to being involved with the football team, John is involved with his church community. At school, John is an average student, earning mostly Bs and Cs, and he reports that he enjoys learning.

John started drinking and smoking cigarettes shortly after joining the football team in order to impress the junior and senior football players. Initially, John was hesitant to drink or smoke; however, after using more frequently, he started to enjoy it and reported feeling more relaxed. Currently, John drinks with his friends on the football team two to three times a week and smokes with them daily. John drinks only when he is with this group of peers, yet he has started to smoke when he is alone.

Over the past two months, John’s grandmother has caught him sneaking back into the house at night smelling like alcohol and cigarettes. The first two times this occurred, John’s grandmother decided not to tell his mother because she believed John when he said it would not happen again. When John’s grandmother caught him a third time, she told his mother. John’s mother was surprised when she heard this news because she believed she and John had a close and honest relationship. Distraught, John’s mother brought him to counseling.

Case Analysis Using the ASURC Model

Conceptualizing this case using the ASURC model reveals that John has both protective and risk factors related to his substance use. In terms of his family environment, John’s mother reports that she and John have a close and honest relationship. This close relationship serves as a protective factor for John because a positive relationship between adolescents and their parents is associated with a decreased risk of adolescent substance use (Piko & Kovács, 2010). Yet, John has minimal supervision at night and on the weekends due to his mother and grandmother’s work schedules. Low caregiver supervision is a risk factor for John because research shows that it is associated with an increased risk of adolescent substance use (Van Ryzin et al., 2012). The family’s low SES impacts John’s low caregiver supervision, and low SES can be associated with a higher risk of substance use (Von Wormer & Davis, 2013).

This year, John joined the football team, and previous research has shown that involvement in athletics in high school can be a risk factor for substance use (Farb & Matjasko, 2012), and adolescents who become associated with peers who use are at an increased likelihood to use (Van Ryzin et al., 2012). Furthermore, adolescence is a period characterized by a heightened sense of reward (Van Ryzin et al., 2012), suggesting that John may have an increased desire to please his peers and difficulty resisting peer pressure. At this point in time, John is drinking only when he is with his friends on the football team, suggesting this peer group is influencing John, yet he has begun smoking alone. Additionally, John is involved in his church community, which serves as a protective factor because being involved in a faith community lowers the risk for substance use in adolescents (Mason et al., 2012). Religious engagement, particularly among African American adolescents, can be a protective factor (Steinman & Zimmerman, 2004), which may be true for John if he identifies with this part of his racial identity as a biracial youth.

The next area of risk and protective factors in the ASURC model is childhood adversity. John witnessed domestic violence between his parents when he was younger, and as a result of attempting to intervene on behalf of his mother, John was hit by his father, a risk factor for adolescent substance use (Benjet et al., 2013). Fortunately, John’s mother sought counseling services for her son after the incident occurred. Early intervention can help offset the negative effects of these experiences (Durlak et al., 2011), and it is possible counseling provided John with healthy coping strategies.

According to the ASURC model, biological factors can impact adolescent substance use. John has a family history of substance use on both his maternal and paternal sides, and genes can play a role in the development of substance use disorders (Van Wormer & Davis, 2013). Further, adolescents experience an increase in risk-taking behaviors due to biological changes associated with adolescence (Telzer et al, 2013), and these changes may cause John to engage in increased risk-taking and pleasure-seeking behaviors.

Higher levels of academic engagement correlate with lower levels of substance use (Henry et al., 2012). John reported that he enjoys learning, suggesting he could have a high level of academic engagement. Nonetheless, John is currently earning Bs and Cs at school, pointing to a disconnection between his motivation to learn and his current grades. This disconnect could be due to associated cultural factors. John is biracial and living in a low socioeconomic neighborhood, and adolescents who live in such neighborhoods and are racial minorities can be at a disadvantage due to structural inequality (Henry et al., 2012).

Case Discussion

When taking all of the risk and protective factors into account, we placed John on the low end of moderate risk using the ASURC model. While John does have various risk factors contributing to his substance use, he also has protective factors that can help to buffer these factors. Further, John’s cultural identities impact him in various areas of the model. In particular, John’s biracial identity and living in a low socioeconomic neighborhood could be risk factors for substance use, while being involved in his church community is a protective factor. It would be important to explore with John how he views his race, SES, and religion, and if he sees them as protective or not. Further, it would be helpful to understand how John views his gender and sexual orientation, and how these identities affect his worldview.

Using the ASURC model to conceptualize John’s case can assist counselors with their interventions with John and his family. While using the model, a counselor is able to assist John and his family to identify current strengths such as positive family relationships, involvement in his church community, and potential for high academic engagement. Identifying these strengths allows John and his caregivers to concretize what is helpful in their situation and allows the counselor to encourage more of these behaviors as tools to strengthen weaker areas. For example, because there are strong family relationships, John’s mother and grandmother can increase their engagement with John when they are away from home via texts or phone calls. Increasing parental engagement will be beneficial for the family, particularly John’s mother and grandmother knowing who John is spending time with because his substance use is heavily influenced by his friendships on the football team. Similarly, because John likes to learn yet is not achieving high grades in school, tutoring programs can be sought to bolster his academic performance and solidify his academic engagement, as well as fill his time with positive activities that may decrease his desire to use. Additionally, it may be helpful to educate John and his caregivers about biological predispositions and risk factors in adolescence. This information can empower John to make positive choices when he understands both that he is not destined to develop an addiction and that he is experiencing normal physical changes. Additionally, it could prove helpful to talk with John and his family about how they might be experiencing structural inequality due to their race and SES. Engaging them in this conversation can normalize their experiences and serve to determine points where advocacy with and on behalf of the family may alleviate some of the strain they experience. Finally, because John’s risk level is on the low end of moderate, structured substance abuse treatment may not be warranted at this time. Interventions could include assessing John’s readiness to stop using and working through a change commitment while strengthening John’s protective factors in an effort to decrease his risk factors.

Future Research

Currently, the ASURC is a conceptual framework yet to be evaluated for efficacy with adolescent populations. Empirical research is needed to determine the model’s viability, validity and efficacy. Further, qualitative research would inform clinicians about the ways in which adolescents and their families felt stronger and more empowered by engaging in counseling practices that use this model’s approach.

Further research can be conducted to evaluate the degree of influence different components of the model have on adolescents with substance use concerns. Also, future research could investigate the relationship the model components have with one another, particularly the interplay of different cultural identities. Research is warranted to determine additional ways in which cultural factors can be used to strengthen clients and their families to mitigate deficit-based research and the pervasive negative cultural messages about non-dominant cultural groups and their struggles with substance use.

Conclusion

The ASURC is a strengths-based approach focused on identifying protective and risk factors as counselors conceptualize adolescent substance use. While previous theories conceptualized adolescent substance use using strengths, they had limitations, including only discussing social influences in a general sense, use of problematic language, and lack of cultural influences. The ASURC builds upon the strengths of previous models while addressing their limitations. The ASURC model emphasizes the need for a strengths-based approach while working with adolescent populations and focuses on the importance of the consideration of cultural influences during the conceptualization process.

Finally, this model serves as a tool to help guide interventions that best serve adolescents and their families. Using the ASURC model for case conceptualization can help counselors determine the most salient factors of the model to the particular case, which will in turn assist in the treatment planning process. Future research is warranted to determine the viability of the ASURC model as an evidence-based practice.

Conflict of Interest and Funding Disclosure

The authors reported no conflict of interest

or funding contributions for the development

of this manuscript.

References

Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl & J. Beckmann (Eds.), Action-control: From cognition to behavior (pp. 11−39). New York, NY: Springer.

Akers, R. L. (1973). Deviant behavior: A social learning approach (2nd ed.). Belmont, CA: Wadsworth.

Allen, J. P., Chango, J., Szwedo, D., Schad, M., & Marston, E. (2012). Predictors of susceptibility to peer influence regarding substance use in adolescence. Child Development, 83, 337−350.
doi:10.1111/j.1467-8624.2011.01682.x

Barnes, D. M., & Meyer, I. H. (2012). Religious affiliation, internalized homophobia, and mental health in lesbians, gay men, and bisexuals. American Journal of Orthopsychiatry, 82, 505−515.
doi:10.1111/j.1939-0025.2012.01185.x

Benjet, C., Borges, G., Medina-Mora, M. E., & Méndez, E. (2013). Chronic childhood adversity and stages of substance use involvement in adolescents. Drug and Alcohol Dependence, 131, 85−91.
doi:10.1016/j.drugalcdep.2012.12.002

Brooks, F., & McHenry, B. (2009). A contemporary approach to substance abuse and addiction counseling: A counselor’s guide to application and understanding. Alexandria, VA: American Counseling Association.

Constantine, M. G. (1999). Labeling theory. In J. S. Mio, J. E. Trimble, P. Arredondo, H. E. Cheatham, & D. Sue (Eds.), Key words in multicultural interventions: A dictionary (pp. 169−170). Westport, CT: Greenwood Press.

Corrigan, M. J., Loneck, B., Videka, L., & Brown, M. C. (2007). Moving the risk and protective factor framework toward individualized assessment in adolescent substance abuse prevention. Journal of Child & Adolescent Substance Abuse, 16(3), 17−34. doi:10.1300/J029v16n03_02

Darling, N., Caldwell, L. L., & Smith, R. (2005). Participation in school-based extracurricular activities and adolescent adjustment. Journal of Leisure Research, 37, 51−76.

Demanet, J., & Van Houtte, M. (2012). School belonging and school misconduct: The differing role of teacher and peer attachment. Journal of Youth and Adolescence, 41, 499−514. doi:10.1007/s10964-011-9674-2

Denault, A.-S., Poulin, F., & Pedersen, S. (2009). Intensity of participation in organized youth activities during the high school years: Longitudinal associations with adjustment. Applied Developmental Science, 13(2), 74−87. doi:10.1080/10888690902801459

Duncan, L. (1999). Social norms. In J. S. Mio, J. E. Trimble, P. Arredondo, H. E. Cheatham, & D. Sue (Eds.), Key words in multicultural interventions: A dictionary (pp. 239−240). Westport, CT: Greenwood Press.

Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor, R. D., & Schellinger, K. B. (2011). The impact of enhancing students’ social and emotional learning: A meta-analysis of school-based universal interventions. Child Development, 82, 405−432. doi:10.1111/j.1467-8624.2010.01564.x

Elliott, D. S., Huizinga, D., & Ageton, S. S. (1985). Explaining delinquency and drug use. Beverly Hills, CA: Sage.

Farb, A. F., & Matjasko, J. L. (2012). Recent advances in research on school-based extracurricular activities and adolescent development. Developmental Review, 32, 1−48. doi:10.1016/j.dr.2011.10.001

Hancock, T. U., Waites, C., & Kledaras, C. G. (2012). Facing structure inequality: Students’ orientation to oppression and practice with oppressed groups. Journal of Social Work Education, 48, 5−25.
doi:10.5175/JSWE.2012.201000078

Hawkins, J. D., & Weis, J. G. (1985). The social development model: An integrated approach to delinquency prevention. Journal of Primary Prevention, 6, 73−97. doi:10.1007/BF01325432

Hays, P. A. (1996). Addressing the complexities of culture and gender in counseling. Journal of Counseling & Development, 74, 332−338. doi:10.1002/j.1556-6676.1996.tb01876.x

Henry, K. L., Knight, K. E., & Thornberry, T. P. (2012). School disengagement as a predictor of dropout, delin-quency, and problem substance use during adolescence and early adulthood. Journal of Youth and Adolescence, 41(2), 156−166. doi:10.1007/s10964-011-9665-3

Hummel, A., Shelton, K. H., Heron, J., Moore, L., & van den Bree, M. (2013). A systematic review of the relation-ships between family functioning, pubertal timing and adolescent substance use. Addiction, 108, 487−496. doi:10.1111/add.12055

Johnson, A. G. (2006). Privilege, power, and difference (2nd ed.). New York, NY: McGraw-Hill.

Malmberg, M., Overbeek, G., Vermulst, A. A., Monshouwer, K., Vollebergh, W. A., & Engels, R. C. (2012). The

theory of planned behavior: Precursors of marijuana use in early adolescence? Drug and Alcohol Dependence, 123, 22−28. doi:10.1016/j.drugalcdep.2011.10.011

Mason, M. J., Schmidt, C., & Mennis, J. (2012). Dimensions of religiosity and access to religious social capital: Correlates with substance use among urban adolescents. The Journal of Primary Prevention, 33, 229−237. doi:10.1007/s10935-012-0283-y

Petraitis, J., Flay, B. R., & Miller, T. Q. (1995). Reviewing theories of adolescent substance use: Organizing pieces in the puzzle. Psychological Bulletin, 117, 67–86. doi:10.1037/0033-2909.117.1.67

Piko, B. F., & Kovács, E. (2010). Do parents and school matter? Protective factors for adolescent substance use. Addictive Behaviors, 35, 53−56. doi:10.1016/j.addbeh.2009.08.004

Pope, R. L. (1999). Deviance. In J. S. Mio, J. E. Trimble, P. Arredondo, H. E. Cheatham, & D. Sue (Eds.), Key words in multicultural interventions: A dictionary (pp. 92−93). Westport, CT: Greenwood Press.

Schroeder, R. D., & Ford, J. A. (2012). Prescription drug misuse: A test of three competing criminological theories. Journal of Drug Issues, 42, 4−27. doi:10.1177/0022042612436654

Substance Abuse and Mental Health Services Administration. (2012). Results from the 2011 national survey on drug use and health: Summary of national findings. NSDUH, H-44(12−4713). Rockville, MD: Author.

Steinman, K. J., & Zimmerman, M. A. (2004). Religious activity and risk behavior among African American adolescents: Concurrent and developmental effects. American Journal of Community Psychology, 33(3), 151−161. doi:10.1023/B:AJCP.0000027002.93526.bb

Sue, D. W., & Sue, D. (2013). Counseling the culturally diverse: Theory and practice (6th ed.). New York, NY: John Wiley & Sons, Inc.

Telzer, E. H., Fuligni, A. J., Lieberman, M. D., & Galván, A. (2013). Meaningful family relationships: Neuro-cognitive buffers of adolescent risk taking. Journal of Cognitive Neuroscience, 25, 374−387.
doi:10.1162/jocn_a_00331

Van Ryzin, M. J., Fosco, G. M., & Dishion, T. J. (2012). Family and peer predictors of substance use from early adolescence to early adulthood: An 11-year prospective analysis. Addictive Behaviors, 37, 1314−1324. doi:10.1016/j.addbeh.2012.06.020

Van Wormer, K., & Davis, D. R. (2013). Addiction treatment: A strengths perspective (3rd ed.). Belmont, CA:
Brooks/Cole.

Alexis Miller, NCC, is a professional counselor for the Dual Diagnosis Partial Hospitalization Program at Rogers Memorial Hospital in Madison, WI. Jennifer M. Cook, NCC, is an Assistant Professor at Marquette University. Correspondence can be addressed to Rogers Memorial Hospital, Attn: Alexis Miller, 406 Science Dr., Suite 110, Madison, WI 53711, alexis.miller626@gmail.com.

« Older Entries

Next Entries »

Recent Publications