Preparing Counselors-in-Training for Private Practice: A Course in Clinical Entrepreneurship

Oct 15, 2014 | Article, Volume 3 - Issue 1

Ryan F. Reese, J. Scott Young, Gerald A. Hutchinson

To date, few scholars in counselor education have attended to the processes and impacts of introducing business-related concepts within counseling curricula. The authors describe the development, implementation and evaluation of a graduate-level course titled Entrepreneurship in Clinical Settings wherein students were tasked with producing a business plan for their ideal clinical practice. Implications and recommendations are explored.

Keywords: entrepreneurship, private practice, problem-based learning, clinical settings, counselor education

Recent attention in mainstream professional counseling has brought to light the complexities of establishing and maintaining a successful clinical practice (Shallcross, 2011). Developing and sustaining a caseload through a referral base, deciding whether to buy or rent office space, and identifying a marketable niche are just a few of the many challenges practitioners face in establishing a counseling practice. Despite the complex nature of counseling practice that requires a competent understanding of foundational business concepts, limited literature exists within counselor education to address the importance of preparing counselors to succeed in private practice (Reynolds, 2010). A search for business failure rates for 2012 revealed that only 47.6% of services business, of which a counseling practice is one type, survive for five years (Shane, 2012), meaning that less that one of two counselors who begins a clinical practice will be in business five years hence. Relatedly, researchers within the field have noted that mental health practitioners have been economically naive and must expand conceptualizations of potential applications of psychological treatment, stressing the need for counselors to become more entrepreneurial (Cummings, Cummings, & O’Donohue, 2009). The development of scholarly writing around business-related concepts in counselor education might help counselor educators better prepare counselors to develop competencies related to successfully developing and running a clinical practice. Although there is a dearth of such writing at present in counselor education literature, scholars within related professions (e.g., social work; Green, Baskind, Mustian, Reed, & Taylor, 2007) have highlighted the lack of preparation that students in their fields receive in developing and managing a clinical practice and are taking steps to increase training in business-related practices. In a survey study (N=261) conducted by Green and colleagues with social work graduate stakeholders (e.g., graduate students, graduate-level deans, private and agency-level social workers), nearly 66% of graduate students intended to enter private practice, yet none of the graduate schools surveyed taught content associated with the establishment and management of a clinical practice. A similar lack of literature regarding entrepreneurship in counselor education settings would suggest that a quandary exists in programs preparing counselors for professional private practice enterprises.

Current educational standards within programs accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP) do not require that students complete coursework in the business-related aspects of professional counseling. However, counselor educators who would like to provide students with practice management training cite the CACREP (2009) standards to support the infusion of business-related concepts into current courses or even in the development of a new graduate course. For example, the standards state that upon graduation from a CACREP-accredited program, a student pursuing a clinical mental health counseling track “understands the roles and functions of clinical mental health counselors in various practice settings” (CACREP, 2009, Code A.3; p. 30). That is, students will understand how to function in clinical settings, which includes private practice. In addition, the standards state that a student “understands the management of mental health services and programs, including areas such as administration, finance, and accountability” for their roles in counseling settings (CACREP, 2009, Code A.8; p. 30). Thus, the standards encourage students to gain an understanding of the technical aspects of professional counseling that can include an understanding of developing and maintaining a successful counseling practice. Offering students opportunities to gain practice management skills and competencies within counselor education programs might better prepare them to one day develop their own counseling practices.

Without an exhaustive survey, it is not known how many counselor education programs cover any of the business-related skills of clinical practice. What is certain is that in the United States nearly 20% of all small businesses do not survive past their first year and only 44% of small businesses survive to see their four-year anniversary (Knaup & Piazza, 2007). As of August 1, 2011, of the 42,926 American Counseling Association (ACA) members reporting their work settings, 10.45% described their full-time work setting as private practice and 4.1% described their part-time work setting as private practice. In sum, 14.5% of current ACA members who reported their work setting described themselves as working in private practice (C. Neiman, personal communication, August 15, 2011). Given the high failure rates for small businesses in the service sector and the fact that nearly one in seven counselors describe themselves as conducting private practice, counselor education programs should consider placing a higher emphasis on facilitating the development of knowledge and skills associated with the successful creation and management of a clinical practice.

To address this lack of training, the authors developed and implemented a graduate-level elective course titled Entrepreneurship in Clinical Settings open to both masters and doctoral-level students enrolled in graduate-level helping profession programs (e.g., counselor education, clinical psychology, social work, nursing, kinesiology, etc.) at a university located in the southeast United States. Those actually enrolled in the course included masters and doctoral-level students from counselor education. The course was advertised as an opportunity to obtain the knowledge needed to develop and run a successful private practice. The purpose of developing the course was to advance students’ knowledge and related skills in formulating an individualized business plan for establishing a clinical practice and thereby preparing them to successfully manage a small business.

The purpose of this article is to provide counselor educators and other interested readers with the information needed to adapt or develop a similar course or workshop that fits the needs of their counselor preparation programs. Subsequently, the development, implementation, evaluation and implications of a clinical entrepreneurship course specifically designed to assist students in the acquisition of the knowledge and skills necessary to develop a counseling practice in their desired setting are described.

Entrepreneurial Pedagogy

The semester-long course was co-taught by a counselor educator (second author) and a leadership consultant working in private practice (third author). The course was developed from a pedagogical structure grounded in problem-based learning (PBL) (Albanese & Mitchell, 1993). PBL typically involves the presentation of a set of carefully constructed problems to a small group of students consisting of observable phenomena or events that need explanation. The task of students is to discuss these problems and produce explanations for the phenomena (Norman & Schmidt, 1992). PBL has been implemented in a variety of educational contexts including medical training (Albanese & Mitchell, 1993), teacher preparation (Brocato, 2009) and counselor education (Stewart, 1998). With PBL, the instructor places the ownership of learning directly into the hands of students by posing a problem they must solve prior to the learning of concepts that will assist them in solving the problem (Bouhuijs & Gijselaers, 1993). Subsequently, PBL relies not on didactic instruction but on the provision of resources to aid students in developing practical knowledge needed to solve the problem at hand (Savery, 2006). Within a PBL teaching framework, the instructor is viewed as an expert resource that facilitates critical thinking by asking guided questions and providing feedback as students attempt to solve the problem at hand rather than lecturing about predetermined material (Stewart, 1998). For this course, the instructor (second author) who was a counselor educator also had over 15 years of experience as a part-time private practitioner providing counseling to children, adolescents and adults as well as couple and family counseling. He had successfully established counseling practices in two states treating a wide array of clinical issues, was knowledgeable about billing, insurance panels, marketing, accounting and related issues, had completed training in PBL pedagogy, and had extensive training in business (e.g., a B.A. in business administration). The co-instructor (third author) had obtained a Ph.D. in counselor education and supervision and spent over 15 years as a leadership development consultant to persons in positions of leadership in private industry. He had owned his own successful consulting firm for 12 years, possessing extensive training in executive coaching, consulting and leadership enhancement.

For the Entrepreneurship in Clinical Settings course, students were charged with formulating the specific components of a business plan (see Table 1), which required them to creatively align their own interests with the plan elements while accounting for practical factors that would facilitate or hinder the success of their plan. To meet this goal, each student developed a series of proposals to address the assigned problem, and then worked in small groups to challenge one another through a cyclical feedback process enhanced through the progressive acquisition of relevant knowledge. The PBL cyclical feedback process is hallmarked by the development of multiple iterations of proposals in response to the problem presented by the course instructor (Brocato, 2009). The proposals are presented for peer, self and instructor feedback in a repeating cycle until an end or desired product is developed.

Table 1

Business Plan Outline

The PBL approach was utilized for this particular course because the goal of the course was for students to develop, maintain and enhance a sense of ownership over their visions for a counseling practice they hoped to pursue. Students were challenged to develop their business plan through multiple iterations of their proposal informed by course readings, in-class discussion, guest lectures, and peer and instructor feedback. The course and its structure are described below.

Learning Goals and Objectives

The primary learning goal of the course was to support students as they labored through the PBL approach to develop a detailed business plan relevant to their identified area of focus for a counseling practice (e.g., men in transition, couples and family, children, women’s issues). This goal was addressed by meeting the following objectives taken from the course syllabus, all of which provided students with practical knowledge about the development of a counseling practice:

1. Students will articulate the benefits and problems associated with starting a counseling practice and/or provide                        self-employed private services as an adjunct to other employment.

2. Students will think critically about entrepreneurship and the role of business in society.

3. Students will establish a coherent counseling practice value-proposition and a profitable value-delivery model.

4. Students will analyze the options for financing a counseling practice (e.g., grants, public monies, private funds).

5. Students will analyze the importance of marketing and its role in a successful business.

6. Students will understand the basics of business budgeting, bookkeeping and third-party payments.

Course Structure

The course utilized two textbooks that served as foundation for class discussion and weekly reading assignments. Grodzki’s (2000) Building Your Ideal Private Practice is a self-help book directed toward practitioners in the helping professions who wish to improve upon or develop their own counseling practices. Readings also were assigned from the textbook Entrepreneurial Small Business (Katz & Green II, 2011), which was written for students taking a course in entrepreneurship. These texts served as key resources to students in developing their business plans.

The instructors approached class time from the PBL framework, affording students the opportunity to critically think alone and within group settings about the feasibility of their individual counseling business-related ideas. Prior to each class students worked on one aspect of their business plan (e.g., vision statements, feasibility assessment, value proposition); these assignments served as the focus of class activities. Class time was structured to include substantial peer and instructor feedback, occasional guest speakers, mini-lectures by instructors on topics related to an aspect of the business plan, and student presentations. The instructors approached the class from a Socratic rather than a didactic style in order to provide students with the opportunity to take full ownership over their business ideas and plans. Because the course content could be covered efficiently and because the PBL design allowed for students to work independently, the class met two to three times each month for two hours each session; there were a total of ten sessions across the semester for the two–semester hour course.

Elements of class included brief, interactive PowerPoint presentations with handouts as a way for the instructors to bridge the gap between students’ lack of knowledge of business-related concepts and their developing business plans. In order to add an out-of-class component to student interaction, students used a classroom online forum (Blackboard Learning Technologies) where they posted 500- to 800-word reflections about assigned readings. In addition, students were required to provide feedback regarding the postings of two peers in order to provoke additional intellectual challenge to the reading-learning assignments. Beginning in the second class session, students provided one another in-class feedback about each assignment leading up to the final business plan; this feedback was transmitted in the form of peer reviews in pairs or in triads. Near the end of the course, students provided written feedback to a peer on a draft of their partner’s business plan, which was composed of all of the assignments up to that point. In the final class meeting each student presented his or her completed business plan and responded to comments and questions by fellow course participants from the perspective of “would you invest start-up money in this practice/ business concept?” The idea was that a well-developed and clearly articulated business plan could be used to seek startup investment if needed (Grodzki, 2000). Such an environment was facilitated to help students present clear and concise descriptions of their hypothetical counseling practices. Finally, guest speakers joined class discussions on two different occasions. One speaker was a counselor who had founded and ran a successful counseling practice that provided an array of clinical services including individual, group, and family counseling; in-home counseling; trauma-focused CBT; child-parent psychotherapy; grant-funded parent skills and development; mental health consultation to Head Start; safe touch programs; school-based counseling; as well as traditional insurance-based fee-for-service outpatient counseling. This practice employed multiple counselors, and the speaker provided students a rich sense of entrepreneurial possibilities that exist with a clinical practice. The other speaker ran a successful coaching and business development practice designed to assist mental health practitioners in developing or expanding their own clinical practice.

Class Assignments

Students developed their full business plans by completing a series of related subcomponent assignments outside of class that were discussed and critiqued in class. A brief overview of assignments regarding the development of the business plan is described in Table 1. The first two weeks of the course were dedicated to students thinking about and sharing their broad counseling practice ideas and narrowing these ideas into vision and mission statements that required the development of clarity as to the nature and scope of their proposed practice, including constituents served and market niche. Students were encouraged to contact and interview clinicians in private practice in their community of interest to provide greater clarity into their potential market niche and ask different questions related to the practitioners’ business structures. Students completed several iterations of their vision and mission statements and shared these in pairs and with the class. Students were then assigned a task from the Grodzki text to develop an “elevator pitch” for the practice, which was a brief, one- to two-sentence statement regarding the nature of the practice that an uninformed person could understand. The intention of developing such a statement was, according to Grodzki, to help students describe their practices in plain, nontechnical language that the potential consumer could easily grasp (i.e., “I work with couples and families who are tired of being tired and looking for a new way of doing their relationships”). Students shared, critiqued and modified these statements several times following the PBL model. Another assignment asked students to identify their perceived level of business-related competencies through completion of a business and technical skills self-assessment (e.g., sales, accounting, industry expertise, market knowledge) (Katz & Green, 2011, p. 61). This self-assessment served as an important foundation for a discussion that allowed students to share and normalize comforts and discomforts associated with their own self-efficacy in regard to business- and counseling-related competencies.

The feasibility assessment assignment challenged students to think critically about the viability of their proposed vision and mission statements by identifying their market niche, conducting an industry profile (i.e., identifying competitors), forecasting their one- and two-year expected revenues and examining market conditions in the location of their intended practice. Students found this assignment challenging because it forced them to achieve specific clarity about their mission and vision statements. The instructors responded to student needs in the development of the fundamental vision for their business by allowing students to progress on their assignments at a somewhat different pacing. Given the high-stakes nature of business feasibility, it was important not to arbitrarily rush this step to completion.

After students had developed clear mission statements and conducted feasibility assessments, the assignments flowed more cohesively. The subsequent assignment directed students to ascertain risk management strategies by identifying appropriate professional credentials, professional liability insurance, legal structure for their practice and a financial strategy for the business (e.g., self-pay, private insurance, grants, Medicaid). Students then were challenged to articulate a value proposition for their business by indicating how aspects of their practice would add value for their clients (i.e., what a client could expect to receive for the time and resources invested). Next, students developed marketing strategies, modeled how they would deliver value, and identified the time, logistical, regulatory, economic and expertise constraints that their practices would operate under. They also specified particular support that would be necessary to make their businesses thrive, including accounting, legal and any other relevant services to position their practice for success.

In week eight students developed a budget and financial plan to determine how much capital they would need to sustain the business to profitability over a two-year span. During the final two weeks of the course, students completed their business plans and provided one another detailed feedback about those plans. In the final iteration of their business plan, students identified critical success factors, including their strengths and areas for growth to help them succeed in implementing their plans.

Use of Class Time

Typically, the first 10–15 minutes of class were utilized to discuss students’ questions about business plan components that were the topic during that class. All students presented to the class a progress update on their business plans. This allowed students to provide one another with rich feedback and suggestions in tackling components of the plan. The instructors often placed students into dyads or triads for 20–30 minutes and asked students to provide thoughtful, yet honest feedback on their partners’ work. As this occurred, the instructors would listen in and provide strategic feedback in attempts to promote group interaction and group problem-solving. The class would reconvene and present overlying concerns that ran across business plans and consider how these concerns might be addressed in the next iteration of the plan. In the latter weeks of the course, the instructors invited several guest speakers to talk about their experiences in private practice. Class generally ended with a discussion of the upcoming aspect of the business plan, how students might approach this exercise, and brainstorming of resources that might assist students in answering questions.

Course Effectiveness: A Qualitative Exploration

Because the material in the course as well as the PBL pedagogy is likely unfamiliar to many counselor educators, below we provide readers what we consider to be key learnings for instructors as well as important feedback from students. Following the conclusion of the course, 12 qualitative interview questions were developed to collect feedback associated with the beneficial and/or challenging aspects of the course, fulfillment of course purposes, the utility of course activities, the evaluation of readings, the impact of the course on students ability to develop a business plan, and recommendations for improvements. A counselor educator with experience in developing qualitative interview questions provided feedback on the questions prior to data collection. The primary author completed semi-structured interviews with all students lasting from 15–30 minutes. Interviews were audio-recorded and later reviewed to capture general themes.

Collectively, students articulated that they benefited from the conversational and practical tone of the class, profited from developing a business plan in their interest area regardless of whether the student was a second-year master’s student or a seasoned counselor and desired a more robust bridge to connect business-related information to their plans. If one is considering teaching such a course, the points below may provide clarity and guidance for making decisions as to the structure of the course and how to facilitate student learning in this rather nontraditional approach to education.

It’s simple, but it isn’t easy. The challenge in teaching this course was not assisting students in gaining mastery over the content; rather, the difficulty lies in helping students apply the content to their unique situation. Much like providing clinical supervision or leading groups, this graduate course was as much about the process as about skill mastery. Although students expressed anxiety about the business-related terminology and concepts, terms introduced in the course were kept basic and easy to understand. However, students did struggle with gaining personal clarity about the type of clinical practice they hoped to create and then matching that clarity to a method of providing services. Overall, students felt confident in their abilities to implement their business plans by the end of the course. One student stated, “I have developed a clearer understanding on what my practice will look like and confidence in what it will look like to get there.”

Students further commented on how learning and applying business concepts were less familiar to them compared to counseling concepts. Students found the Grodzki (2000) text to be written in accessible language and characterized as inspirational in the way business concepts were clearly translated. Students further described Grodzki’s writing as inspiring, provoking them to “dream big,” and a text that one “would have picked up in the bookstore.” Conversely, students (and instructors) described the Katz and Green II (2011) reading as more challenging as it was written as a textbook for business school majors. One student indicated her preference for an “entrepreneurship for dummies kind of book” that would allow her to access and understand business concepts more readily. Such feedback suggested to the instructors that in future offerings of the course reader-friendly texts that are related to counseling and fostering students’ confidence are important. Less technical information may be a better fit for counseling students who are often at an early stage of business knowledge. For example, a very accessible text targeted toward an owner-operated entrepreneurial startup such as The Big Book of Small Business (Gegax, 2007) appears ideal.

Group counseling skills are useful. The class began with many of the issues that are present in a newly formed counseling group, including heightened anxiety and uncertainty about performance and expectations. For counseling students, thinking about the business aspects of their career was like learning a foreign language and subsequently there was self-doubt about articulating their fledgling ideas to their peers and the instructors for scrutiny.

Nevertheless, students reported that verbalizing their thoughts and anxieties assisted them in clarifying their future business intentions. By sharing their ideas, they gained clarity and could evaluate the feasibility of their business plan. Students suggested that although they initially felt uncomfortable sharing their ideas to the group because they took the feedback personally, it was an important aspect of developing a well-crafted plan.

Over the course of the semester, students reported feeling more comfortable in sharing their work. Initially, one student recalled that she felt like she and her peers were “just being kind of nice to each other.” By the class’s final session, however, students reported feeling relaxed while delivering their business plan and receiving feedback. In fact, several students reported the final presentation as the highlight of the class experience. As one student stated, “people were comfortable enough to throw out honest feedback.” As a result of sharing their business plans throughout the semester in an informal atmosphere, students reported gaining more perspective and clearer visions in developing a high quality business proposal.

Expect anxiety. As is often reported in the PBL literature, students reported that they wanted more concrete answers and structure than could be provided with a PBL approach and this ambiguity caused anxiety. They often wanted to know whether something was “right” or “wrong.” Feelings of frustration and uncertainty escalated as they confronted roadblocks in their planning, but these would subside as clarity was achieved. It became clear to students that the task of the instructors was to provide appropriate support as anxiety was encountered, with the full awareness that fears could not be completely alleviated; that was the students’ work. Providing the opportunity to struggle with the implications of their business plans allowed students to overcome self-doubts as they owned their decisions; this appeared to increase self-efficacy and optimism in the development of the business plan. Students overcame challenges they previously thought were implausible. As one student recalled, “I didn’t think I would have a final business plan at the end of the class, and I did.”

You can’t teach someone to have a good idea. Students had to labor with their ideas to reach their own conviction about the feasibility of the clinical practice they hoped to create. Therefore, the instructors’ evaluation of student ideas as solid or weak proved less important than the students’ exertion through the steps of developing the business plan. Students had to reach clarity for themselves and this did not appear to come from the instructors. One student said:

When a person is developing a plan, it’s their baby and they get really invested in it and you better not criticize the baby…but you need that [criticism], you need a fresh set of eyes to look at it and say, “Did you think about that? You know, that won’t work.” And they might be wrong. It’s okay. If they’re bringing it to your attention, then that’s really good.

Students in a course such as this will be excited about and protective of their ideas, yet need assistance in challenging their ideas so that more mature thinking can emerge.

It is best to hear about “the real world” from an expert. It was important to bring in outsiders (e.g., counselors in private practice, a business coach) to discuss the process of developing a counseling practice. Even though the instructors had similar insights to share, the reality of starting and managing a clinical practice gained credibility when students heard it from “the horse’s mouth.” The instructors invited guests who ran successful clinical practices who spoke with students about their experiences in establishing and managing their business. Hearing from someone actively engaged in the day-to-day struggles of running a clinical practice was extremely valuable both in terms of offering encouragement and in modeling success.

As mentioned earlier, one speaker ran a coaching and business development practice designed to assist mental health practitioners in establishing and/or maximizing the effectiveness of their clinical practice. This speaker has worked with hundreds of counselors and therapists across the U.S. and was able to address many of the anxieties (e.g., Will I make enough money? How long will it take to get established? What sort of overhead might I expect?) Students found this practical yet highly motivating speaker to be particularly beneficial.

Course Improvements

The more experts the better. The instructors invited several guest speakers who were successful helping professionals and students consistently found these talks to be helpful. The opportunity to hear from a person who had expertise in running a clinical practice gave the students confidence that they too could learn the skills needed to run their own practice. Experts from areas outside of the helping professions were not included (e.g., business management, accounting, law) although several students commented that the opportunity to hear from experts in such specialties may have been helpful in shaping their business plans. Such experts may have made some assignments “less nebulous” as one student put it. Having guests that represent support services such as attorneys or insurance agents might have helped students better understand how to address such issues in business plans. For example, “Do I need to call law firms or call insurance companies or do I just need to be thinking what are my expenses going to be? More clarity would have been helpful,” stated one student. From the post-course perspective, the instructors concluded that the more multidisciplinary the experts the better in order to add specialist insights to the course.

Struggle is the way forward. Unlike a course in which students are asked to read, digest, and repeat material on papers or tests, this material was much more personally connected to their deeper hopes and dreams; while the building of an actual plan to manifest those dreams was the principal outcome. Subsequently, the material held significant salience for the students; thus, being patient with their struggle was crucial. Instructor gentleness was particularly salient as students were forced to struggle to match their vision with the practical reality of developing and running a small business. In the words of one student:

In other [counseling] courses we start out with a broad topic and then you narrow it down and we didn’t have that natural progression (in this class). Instead, we immediately began talking about our ideas, our vision for our careers and the uncertainty as to whether this was something we could make a reality. So from the very beginning this material was more challenging because it was personal.

Indeed, it was clear that the personal nature of the material added to the challenge of course assignments, yet it was equally apparent that the material facilitated student creativity, drive and determination to develop a plan that captured their truest vision for their clinical practice.

Sometimes the instructor needs to get out of the way of the students. The challenge for the instructors was to provide feedback that helped students move deeper into the practical reality of their ideas without discouraging vision and aspirations or taking the idea in a direction that lacked interest. For example, questions like, “Have you considered who else in the area is providing services similar to the ones you hope to offer?” is much more facilitative than, “I doubt there is a market for that.” All students commented on the importance of both instructor and student feedback. For example, one student stated, “I didn’t always feel comfortable with the feedback, but it was necessary to help with the planning process.” Another student commented on how she would have preferred more peer feedback as opposed to relying on the instructors for the expansion of her ideas. She stated:

Sometimes when we presented ideas the instructors would run with ideas of their own. This helped to create a lot of energy, which was nice, but a balance between staying true to the person’s vision versus expanding it would have been helpful.

This comment demonstrates the student’s ownership of their ideas. The instructors found it an imperative challenge to remain true to the core of students’ ideas and ask critical guiding questions while minimizing the instructor’s own contributions. The instructors had to constantly remind themselves; while they may have many years of experience, it does not always translate into expert knowledge in the areas of students’ passions.

The answer isn’t in the book. Students struggled to accept that ultimately their practice vision was not found in any of the materials they read; they had to find it in themselves. Needless to say, this was harder for some students than for others. Like many courses within counselor preparation programs, this course required students to engage in an internal process of self-examination and introspection. Students were given the additional challenge of educating themselves about business aspects of clinical practice through reading, interviews with private practitioners in their communities of interest, market research and seeking feedback. The level of self-examination required was more difficult for some as the business plans were a documentation of crystallized ideas about their hopes for entering the field. Confronting the reality of an actual plan for their future livelihood, as opposed to simply hoping to help others was not always easy. Well-considered plans to make a counseling practice successful are often difficult to come by.

Regardless of their prior counseling or business experience, all students indicated that they benefited from the course and envisioned themselves implementing their business plans. A concern the instructors initially had in developing the course was whether entry-level graduate students or those several years away from developing a counseling practice could fully benefit from such a course. Some students shared these same concerns in their interviews. One master’s student had her doubts initially, but ended up feeling accomplished at the end of the course. Another entry-level graduate student nearing the end of her program of study shared confidently that she had gained tremendously from taking the course and that it had helped her clarify the populations she would like to serve. She stated that, “Other [counseling] classes prepare you to be a generalist…this class really helped me to get the specificity and the passion that I needed behind what I wanted.” Students emphasized that the course helped them clarify their goals not just for establishing a clinical practice, but also in regards to who they wanted to be as practitioners. One student said, “Once you are clear, then you know what to ask for and when you can ask for it; then you are open to getting that.” In a similar way, another student noted, “Because of the course I was able to strip away all the extraneous things and focus on kind of the core of what I want my business to be.” This course impacted students’ level of confidence and clarity in not only the kinds of practices they wanted to develop, but also what they wanted their identities to be as professional counselors. Students at all levels of counseling and business-related experience reported gaining professionally from taking the course. Students indicated that they appreciated and were challenged by the seminar style that provided a process for facilitated student and instructor feedback. Even though at times they wanted more guidance on assignments, students gained clarity about the types of clients they intended to work with, the practices they hoped to develop and the professionals they aspired to be.

Discussion

Both student and instructor reflections identified the strengths as well as the challenges of implementing the course, Entrepreneurship in Clinical Settings. Students reported benefiting from their experience as the development of the business plan forced them to narrow their focus and develop a feasible strategy for implementing their small business ideas. Students went from having broad and poorly formed ideas to a tangible focus for their practice that allowed them to explore the feasibility of their business model. Although some students were several years away from developing a clinical practice, at the conclusion of the course all reported clarity about their proposed business ideas and a sense of confidence in both themselves and the plans they believed would help shape a more specific counselor identity.

The idea of teaching business concepts may be intimidating to some counselor educators, especially those lacking experience running a counseling practice. While counselor educators with experience running a clinical practice are likely more prepared to instruct this course, this may not always be a possibility. Subsequently, for counselor educators who lack experience with a private clinical practice, consider recruiting a co-instructor with practice experience to assist with discussions of business-related concepts and the structuring of a practice. Another option is to consult closely with local counselors who run clinical practices and who can serve as guest speakers to provide students with the foundation needed to integrate business concepts into their practice plans.

One approach that could prove fruitful to teach foundational business concepts is to analyze an existing clinical practice as a case study to examine how networking, marketing, budgeting, operations, risk management, accounting and training are implemented. Analyzing a counseling practice with objectivity early in the course might enhance student relationship building and allow time to transition into a more highly interactive approach in the course’s remaining activities. The instructors learned from conversations with students that including a practice case study in the first portion of the course could be beneficial. Future iterations of the course will include a case study assignment to help students’ transition into developing their own business plans in the latter part of the course.

The class assignments and activities described help students think through and solve the problem of developing their own business plan. However, delaying the start of the PBL approach until after the initial concept-building stage may be a wise consideration. With the increased comfort caused by greater familiarity and higher competence in speaking the language of business with the knowledge accrued in the first segment of the course, students could better engage in lively and productive discussions as “roundtable advisors” about others’ clinical practice ideas and businesses. Students will have a greater ownership of the outcome of the course, if they see a strong link between course-content and outcomes that benefit them directly.

Overall, students enjoyed the seminar structure of the course and PBL pedagogy. They found the classroom environment to be a comfortable, conversational process as opposed to a top-down lecture-based method. Through this structure and the PBL pedagogy, equal responsibility was placed on all classroom participants to facilitate the learning process rather than relying on the instructors to provide information. Despite this freedom and overall satisfaction, students wanted to know in greater detail what the instructors expected from each assignment. When PowerPoint mini-lectures were included, students reported feeling better able to predict the knowledge and skills the instructors expected them to obtain.

Following the completion of the course an unsolicited email was received that described the impact of the course for a particular student. Although the statement’s generalizability is limited, it captures the instructors’ intention of teaching the course:

I cannot express to you how valuable and impactful your course has already been on me in my professional journey as a counselor, but I want to try. Throughout the course of graduate school, I was on the very necessary track of opening my understanding and competence in new areas. Every time I took a class, I could envision myself doing that kind of work: children, families, assessments, adults, adolescents, career, substance abuse, you get the idea. What that gave me in the end was the feeling that I could do anything – I could accept any entry-level counseling job and be successful. What I was lacking, however, was direction. What was my passion in all of this – beyond my desire to be a helper, to be a counselor? Through the progression of Entrepreneurship in Clinical Settings, I was forced to think about not just what I could do, but what I wanted to do and that idea kept refining itself until I became very clear about the fact that I want to work with pregnant women and women parenting young children. Getting clear about this gave me energy and purpose in my job search. Instead of looking on job boards for what was being advertised, I was able to look for agencies that offered the services I wanted to provide. I was able to put out the message into the universe that this was the type of job I wanted. Three days after graduation I was offered a job as an in-home therapist. I am working with pregnant women and women who are parenting children under the age of five who are working with a caseworker on child development issues, but have also requested a therapist to work on their own mental health issues. Not only do I have a job, I can honestly say I have my dream job, and I credit your class. I still plan to start a counseling practice after licensure, but until then I am getting invaluable experience and training working with my ‘ideal clients.’

References

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Bouhuijs, P. A. J., & Gijselaers, W. H. (1993). Course construction in problem-based learning. In P. A. J. Bouhuijs, H. G. Schmidt & H. J. M. van Berkel (Eds.), Problem-based learning as an educational strategy (pp. 79–90). Maastricht: Network Publications.

Brocato, K. (2009). Studio based learning: Proposing, critiquing, iterating our way to person-centeredness for better classroom management. Theory Into Practice, 48, 138–146. doi:10.1080/00405840902776459

Council for Accreditation of Counseling and Related Educational Programs. (2009). 2009 CACREP Standards. Retrieved from http://www. cacrep.org.

Cummings, N. A., Cummings, J. L., & O’Donohue, W. (2009). We are not a healthcare business: Our inadvertent vow of poverty. Journal                 of Contemporary                 Psychotherapy 39, 7–15.

Gegax, T. (2007). The big book of small business: You don’t have to run your business by the seat of your pants. New York, NY: Harper Collins.

Green, R. G., Baskind, F. R., Mustian, B. E., Reed, L. N., & Taylor, H. R. (2007). Professional education and private practice: Is there a disconnect? Social Work, 52, 151–159.

Grodzki, L. (2000). Building your ideal private practice. New York, NY:  W. W. Norton.

Katz, J. A., & Green II, R. P. (2011). Entrepreneurial small business (3rd ed.). New York, NY: McGraw-Hill/Irwin.

Knaup, A., & Piazza, M. (2007). Business employment dynamics data: Survival and longevity, II. Monthly Labor Review, 130, 3–10. Retrieved from http://stats.bls.gov/opub/mlr/mlrhome.htm.

Norman, N. R., & Schmidt, H. G., (1992). The psychological basis of problem-based learning: A review of the evidence. Academic Medicine, 67, 557–565. Retrieved from http://journals.lww.com/academicmedicine/pages/default.aspx.

Reynolds, G. P. (2010). Private practice: Business considerations. Retrieved from http://counselingoutfitters.com/vistas/vistas10 Article_36.pdf.

Savery, J. R. (2006). Overview of problem-based learning: Definitions and distinctions. Interdisciplinary Journal of Problem-based Learning, 1, 9–20. Retrieved from http://www.mendeley.com/research/overview-problembased-learning-definitions-distinctions/.

Shallcross, L. (2011, March). Breaking away from the pack. Counseling Today. Retrieved from http://www.counseling.org/Publications/CounselingTodayArticles.aspx?AGuid=0dc6886d-24d8-48b7-bb69-74712df6ea71.

Shane, S. (2012). Failure rates by sector: The real numbers. Small Business Trends. Retrieved from http://smallbiztrends.com/2012/09/failure-rates-by-sector-the-real-numbers.html.

Stewart, J. B. (1998). Problem-based learning in counsellor education. Canadian Journal of Counselling, 32, 37–49.

Ryan F. Reese, NCC, is an Instructor at Oregon State University-Cascades. J. Scott Young, NCC, is Professor and Department Chair of Counseling and Educational Development at the University of North Carolina at Greensboro. Gerald A. Hutchinson is President of AnovaLogic Management and Leadership, LLC in Greensboro, NC. Correspondence can be addressed to Ryan F. Reese, 2600 NW College Way, Bend, OR 97701, rfr1202@gmail.com.

Standardizing the Pre-Licensure Supervision Process: A Commentary on Advocating for Direct Observation of Skills

Oct 15, 2014 | Article, Volume 3 - Issue 1

Neal D. Gray, Paul Erickson

The present paper advocates for standardized regulations and laws for supervision of pre-licensed counselors in the United States, particularly for direct observation of clinical skills. A review of regulations by the American Counseling Association (ACA) Office of Professional Affairs (2012) reveals that only two states (Arizona and North Carolina) specify requiring supervision interventions that include the use of reviewing audio or videotapes, or live supervision modalities, to help evaluate pre-licensed counselors’ competence. Literature on the current state of regulations, extant research on supervision practices, and effects on satisfaction with supervision and self-efficacy are presented and framed in terms of standardized policy.

Keywords:  pre-licensed counselors, regulations, laws, satisfaction with supervision, self-efficacy, direct observation

A review of regulations by the American Counseling Association (ACA) Office of Professional Affairs (2012) reveals that all 50 states require the practice of counseling under supervision for two or more years after the completion of the master’s degree prior to licensure. However, there are no unified national standards that govern post-master’s degree supervision (e.g., ACA, 2012; Borders & Cashwell, 1992). Supervised counseling experience range from 1000 to 4500 hours (ACA, 2012), with the amount of face-to-face clinical supervision occurring either in an individual or group setting varying greatly (ACA, 2007). Furthermore, only two states (Arizona and North Carolina) specify requiring supervision interventions that include the use of reviewing audio or videotapes, or live supervision modalities, to help evaluate pre-licensed counselor competence (ACA, 2012). Some studies have investigated supervision in this counselor pre-licensure stage, including factors related to counselor effectiveness such as self-efficacy and satisfaction (e.g., Bernard & Goodyear, 2004; Fall & Sutton, 2004; Magnuson, Norem, & Wilcoxon, 2002). The use of direct observation of skills in supervision is noted to lead to more positive effects in terms of counseling performance and outcomes. Standardization of required direct observation of clinical skills is especially necessary. The literature indicates that observation of skills is crucial to counselor professional development and practice (Herbert & Trusty, 2006). Moreover, standardization of required direct observation of clinical skills is a key factor in licensure policy. The following review calls for such standardization, with a summary of current regulations, extant research in counseling outcomes and supervision practice, and recommendations and advocacy for regulation.

Supervision Background and Standards

ACA, the Association for Counselor Education and Supervision (ACES), and the American Association of State Counseling Licensure Boards (AASCB) have all attempted to define best practices in counselor supervision. The ACA Code of Ethics standard F.1.a discusses a primary obligation of supervisors in the role of monitoring services of counselors-in-training. This consists of monitoring case notes, samples of clinical work or live observation of the trainee (Herlihy & Corey, 2006). In 1990, model legislation for licensed professional counselors was developed by the American Counseling Association to promote acceptable professional standards within the realm of counseling. This proposed licensure bill recommended state licensure boards consider “what is the nature of the supervision co-therapy, direct observation, audio and/or videotaping” (Bloom et al., p. 520). ACES also addressed this issue in two different documents. First, the Ethical Guidelines for Counseling Supervisors states that supervisors are responsible for “actual work samples via audio or videotape or live observation . . .” which “should be reviewed by the supervisor as a regular part of the ongoing supervisory process” (ACES, 1995, p. 272). Secondly, the document titled Standards for Counseling Supervisors outlines eleven core competencies necessary for successful supervision. This document recommends that effective supervisors are skilled in using appropriate methods and techniques to promote counselor development; included are the review of video and audio tapes and live supervision (ACA, 1990). Lastly, the AASCB’s Approved Supervision Model (2007) recommends “some type of actual counseling session reviewed on a regular basis (i.e., videotaped session at least once a month)” (p. 2).

Methods of Supervision

Utilizing direct observation of counseling skills in supervision is recommended by various counseling associations. Numerous studies have shown the most common method of supervision during graduate-level training and the pre-licensure stage is self-report (e.g., Amerikaner & Rose, 2012; Bernard & Goodyear, 2014; Borders, Cashwell, & Rotter, 1995; Borders & Cashwell, 1992; Borders & Usher, 1992; Coll, 1995; Culbreth, Woodford, Levitt, & May 2004; Fall & Sutton, 2004; Herbert & Trusty, 2006). The information about the content of counseling sessions is based exclusively on the pre-licensed counselor’s subjective beliefs (Noelle, 2003). A limitation of this method may involve a supervisor’s lack of observable information about the pre-licensed counselor’s session, preventing accurate evaluation of the counselor’s effectiveness (Bernard & Goodyear, 2004). Rogers and McDonald (1995) found that when social work instructors in the field practicum experience used student self-evaluation as the primary content focus of supervision, they more often rated students as prepared for professional practice. However, when instructors employed direct observation of skills as the primary focus of their teaching and discussion surrounding the supervision session, they were less likely to assess the students as being prepared for clinical work. Similarly, Amerikaner and Rose (2012) state that direct knowledge of pre-licensed individuals’ work allows more precise evaluation of clinical skill demonstration. Furthermore, Herbert and Trusty (2006) state that without direct observation “the supervisor can neither affirm nor refute counselor impressions concerning the client-counselor relationship” (p. 76).

Extant literature also suggests supervision beyond self-report may enhance the supervision experience. Anderson, Schlossberg, and Rigazio-DiGilio (2000), in a study of family therapy trainees’ experiences in supervision, found that live supervision and videotape review were related to an enhanced supervision experience. Ellis (2010) states that thorough feedback helps supervisees develop new skills and hone existing skills needed to be successful. Although highly recommended, possible reasons the direct observation of clinical skills in supervision is not more commonly utilized could be due to a lack of time clinical supervisors have to provide adequate supervision due to other job-related duties (e.g., administrative), limited contact between the supervisor and the pre-licensed counselor (Borders & Usher, 1992; Magnuson, Norem, & Wilcoxen, 2000; Rogers & McDonald, 1995), difficulty in obtaining informed consent permission to tape or view counseling sessions (Herbert & Trusty, 2006), or the unavailability of apparatus necessary to directly observe skills such as video-recording technology and one-way mirrors (Amerikaner & Rose, 2012).

Counselor effectiveness also has been linked to self-efficacy and satisfaction, which are important components of therapeutic skill. Some work has investigated these variables in the context of the pre-licensed counselors’ supervisory experience, particularly related to the method of supervision (Gray, Erickson, & Kahsheena, 2009).

Satisfaction with Supervision

Ramos-Sanchez et al. (2002) found that the supervisory relationship was a critical factor in supervisee development. Patton and Kivlighan (1997) found that the bond between supervisee and supervisor affected the quality of the rapport in the supervisees’ relationship with clients. Larson (1998) stated that supervisor support and encouragement (in addition to structured learning situations such as direct observation of skills) would affect supervisee self-efficacy. Learning occurs through both skill practice and within a supportive, satisfactory relationship (Frymier & Houser, 2000). Thus, if the supervisee and supervisor have a satisfactory supervisory relationship, the supervisee is more likely to gain competency in clinical skills, and further, the production of self-efficacy through direct observation of skills within that relationship is likely to lead to a greater satisfaction with supervision.

Self-Efficacy

Assisting the pre-licensed counselor in producing efficacious actions with clients is a primary goal of the supervisor (Larson & Daniels, 1998). Cormier and Bernard (1982) state that the most important goal of supervision is the protection of clients’ welfare and that directly observing the pre-licensed counselor’s skills is useful in meeting this goal. Abbott and Lyter (1999) posit that supervisor observation of the supervisee during field supervision, whether by direct observation or via audio or videotaped recordings, is an essential for professional growth. Lent et al. (2006) state that one function of effective supervisors is that of building efficacy, through support, encouragement and observation of skills. Direct observation of skills is related to confidence in skills, or self-efficacy.

Self-efficacy is a component of social cognitive theory, which partially is a theory of learning through observation. In terms of counseling, the theory posits that to successfully conduct therapy, counselors must believe they are capable of providing successful treatment and be able to master techniques and interventions (Bandura, 1986; Larson, 1998). Mastery is one of four factors that contribute to the development of self-efficacy (Carruth & Woodside, 2010). If pre-licensed counselors have experienced previous success with an intervention, they are more likely to engage in that behavior again. It appears as if direct observation of skills better determines the effectiveness of interventions than case conceptualization does (Bandura, 1986; Bandura, 1997; Larson, 1998).

Direct observation of skills helps more with gaining self-efficacy than more widely-used methods of training in medical settings, such as through paper and pencil testing (du Pre, 2010). For instance, in a study of supervisory observation of medical trainees’ clinical skills by Kogan, Holmboe, and Hauer (2009), the authors found that direct observation of skills is related to quicker attainment of clinical skills and more effective client care. Most importantly, confidence and the ability to apply clinical skills in practice directly influences quality of services provided (Bradley & Fiorini, 1999). Gray et al. (2009) found that pre-licensed counselors’ self-efficacy is affected by more frequent direct observation of clinical skills. Self-efficacy is thus an important component of clinical skill-building in counseling. Given the evidence for this and other elements of supervisory practice and positive outcomes in supervisees, standards for effectiveness in practice are warranted.

Discussion

Currently there are no unified national standards that govern the post-master’s degree supervision experience (e.g., ACA Office of Professional Affairs, 2012; Borders & Cashwell, 1992). Additionally, only a small minority of states require direct observation of pre-licensed counselors’ skills during the supervisory process (ACA Office of Professional Affairs, 2012). Direct observation and practice of skills are linked to self-efficacy (Bandura, 1986). Gray, et al. (2009) found higher levels of counselor self-efficacy in those receiving greater amounts of direct supervision. Thus, it is likely that increased levels of direct observation during supervision are related to both counselors’ self-efficacy and satisfaction with the supervisory experience.

Counselor performance also has been found to be related to self-efficacy and the supervisory environment (Larson  & Daniels 1998); counselors who feel confident in their skills and have had adequate supervision have been shown to perform better clinically. Further, Kanno, and Koeske (2010) found social work interns who rated the supervisory experience as positive (i.e., helpful, receiving positive feedback) felt more empowered and reported higher levels of self-efficacy, linking positive supervisory experiences to self-efficacy and confidence. This work should directly translate to changes in supervision standards. Standards requiring practices that lead to such outcomes across states are necessary to provide a vehicle for optimal performance in counselor practice (Herbert & Trusty, 2006). Supervisees and educators should consider direct obervation of counseling practices to optimize the experience of supervision and counselor performance.

Implications for Supervisors

Observation of skills is clearly relevant to many aspects of supervisor-supervisee interaction. While numerous studies indicate that the most common form of conducting supervision is by self-report (e.g., Amerikaner & Rose, 2012; Bernard & Goodyear, 2014; Borders et al., 1995; Borders & Cashwell, 1992; Borders & Usher, 1992; Coll, 1995; Culbreth et al., 2004; Fall & Sutton, 2004; Herbert & Trusty; 2006), research indicates that observing counselors through the use of audio or video tapes or live supervision is beneficial to supervisee growth. Research further suggests that even minimal amounts of observation of skills has a significantly greater effect on the pre-licensed counselor’s skill development than no observation at all, and that observing the pre-licensed counselor’s skills at least half of the time in supervision is related to greater supervisee self-efficacy than less amounts of clinical skill observation (Gray et al., 2009). Self-efficacy is associated with counselor effectiveness and thus, if direct observation of skills contributes to greater self-efficacy, such observation may be linked to more effective counselor performance. Supervisee observation of supervisors performing counseling, or co-counseling between supervisor and supervisee, is another possible pathway to skill building and self-efficacy (Baird, 2011). It is recommended that supervisees take the initiative in requesting to directly observe supervisors counsel, as it has been found there can be resistance of supervisors to tape sessions for teaching purposes (Levenson & Evans, 2000).

It is paramount during discussions of expectations, roles and responsibilities in the supervisory relationship that supervisors emphasize to counselors that their skills will be observed during the pre-licensure stage (Remley & Herlihy, 2010). If not mandated by supervisors, it is doubtful that pre-licensed counselor’s will solicit direct observation of their skills. Borders and Usher (1992), in a study conducted to determine preferred supervision modalities of pre-licensed counselors, found that they  preferred self-report over observation of skills. The authors state “respondents may have considered other methods (e.g., live observation, videotaping) to be too inconvenient, intrusive or threatening” (Borders & Usher, 1992, p. 598). Furthermore, at the conclusion of the pre-licensure experience, supervisors will be required to formally report to state licensure boards a judgment of the supervisees’ competence to practice independently as a counselor (Cobia & Boes, 2000). Observing skills on a regular basis throughout the relationship can aid in this decision. Lastly, it is recommended that if supervisors are not trained in using these methods of direct observation, they should consider completing continuing education training, workshops or graduate courses (Borders et al., 1995; Culbreth et al., 2004).

Implications for Counselor Educators

The Council for Accreditation of Counseling and Related Educational Programs (CACREP) requires supervisors in master’s and doctoral practicum experiences to include during the experience “the development of program-appropriate audio/video recordings for use in supervision or live supervision of the student’s interactions with clients” (CACREP, 2009, p. 17). It also is common that evaluation for course success utilizes audio/videotapes or live observation of clinical sessions in practicum and internship. However, at the post-master’s degree level this is usually not a requirement, but a recommendation. As previously noted, research studies point out that the observation of clinical work is a rarity and that self-report of clinical sessions is the norm (Amerikaner & Rose, 2012; Bernard & Goodyear, 2014; Borders et al., 1995; Borders & Cashwell, 1992; Borders & Usher, 1992; Coll, 1995; Culbreth et al., 2004; Fall & Sutton, 2004; Herbert & Trusty, 2006). Extant work has found that during the pre-licensure phase of supervision, counseling skills are usually never or rarely observed, but that viewing supervisees’ skills significantly affects their beliefs positively concerning their levels of self-efficacy (Gray et al. 2009).

It is recommended that counselor educators in master’s and doctoral degree programs discuss the post-master’s degree process with students during their graduate school experience, specifically recommending that when selecting a supervisor, pre-licensed counselors broach the issue of how their counseling skills will be evaluated. It also is necessary that counselor educators encourage future counselors to choose supervisors committed to using direct observation as a method to enhance counselee growth, following CACREP requirements that mandate direct observation of skills in graduate practicum and internship experiences. Research such as that cited here can demonstrate to future pre-licensure counselors that despite the possible feelings of anxiety associated with having their clinical skills examined, requesting this observation will benefit their growth as counselors greatly (Borders & Usher, 1992; Overholser, 2004).

Since counselor educators have experience and skill in using these methods of direct observation, it also is recommended that they provide supervision trainings or continuing education opportunities for supervisors in their communities to enhance their competence in supervision (Coll, 1995). Furthermore, as more states call for supervisors to become board certified, counselor educators should advocate for state licensure boards to require supervisory training in methods of clinical skill observation. In addition, it is also recommended that counselor educators support licensure boards mandating a certain percentage of time that counselors’ skills are directly observed. Herbert and Trusty (2006) state that “given the clearly expressed preference for counselors to provide verbal reports of counseling sessions, it is unlikely that other, more direct methods, such as those available through audiotape, videotape, one-way mirror, will evolve without policy changes” (p. 76).

Conclusion

The post-master’s degree supervision experience is critically important in the development of competent counselors, and some research has been conducted to determine which factors in supervision produce more satisfied or capable counselors. However, individual state licensure boards in the United States lack specific requirements concerning methods of supervision (e.g., verbal exchange, direct observation). While the case consultation method is the most directly utilized method of supervision, it should not be the only approach utilized in the supervisory environment. Direct observation of skills by supervisors is a necessary component in the pre-licensed counselors’ professional development. Furthermore, direct observation of skill development will enhance counselor performance, possibly leading to more successful clinical outcomes (Herbert & Trusty, 2006). Given extant work in supervision outcomes, observational learning, and instructive relationships, standard policy regarding supervision of direct skills must be mandated across state licensure boards.

References

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Baird, B. N. (2011). The internship, practicum, and field placement handbook (6th ed.). Boston, MA:  Allyn & Bacon.

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Bernard, J. M., & Goodyear, R. K. (2004). Fundamentals of clinical supervision (3rd ed.). Boston, MA: Allyn and Bacon.

Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th ed.). Columbus, OH: Pearson.

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Borders, L. D., & Cashwell, C., S. (1992). Supervision regulations in counselor licensure legislation.Counselor Education and Supervision, 31, 209–218.

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Borders, L. D., & Usher, C. H. (1992). Post degree supervision: Existing and preferred practices. Journal of Counseling and Development, 70, 594–599.

Bradley, C., & Fiorini, J. (1999). Evaluation of counseling practicum: National study of programs accredited by CACREP. Counselor Education and Supervision, 39, 110–119.

Carruth, E. K., & Woodside, M. (2010). The development of counseling self-efficacy: A case study. North Carolina Perspectives, 3, 4–17.

Cobia, D. C., & Boes, S. R. (2000). Professional disclosure statements and formal plans for supervision: Two strategies for minimizing the risk of ethical conflicts in post-master’s supervision. Journal of Counseling and Development, 78, 293–296.

Coll, K. M. (1995). Clinical supervision of community college counselors: Current and preferred practices. Counselor Education and Supervision, 35, 111–117.

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Culbreth, J. R., Woodford, M. S., Levitt, D. H., & May, K. M. (2004). Current and preferred clinical supervision experiences of home based treatment providers. The Clinical Supervisor, 23(1), 83–99. doi:10.1300/J001v23n0106

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Ellis, M. V. (2010). Bridging the science and practice of clinical supervision: Some discoveries, some misconceptions. The Clinical Supervisor, 29(1), 95–116.

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Ramos-Sanchez, L., Esnil, E., Goodwin, A., Riggs, S., Touster, L. O., Wright, L. K., Ratanasiripong, P., & Rodolfa, E. (2002). Negative supervisory events: Effects on supervision satisfaction and supervisory alliance. Professional Psychology, Research and Practice, 33, 197–203.

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Neal D. Gray is the Chairperson of the Counselor Education program at Lenoir-Rhyne University. Paul Erickson is an Associate Professor and Director of Educational Research Assessment and Technology at Eastern Kentucky University. Correspondence can be addressed to Neal D. Gray, 625 7th Avenue NE, Hickory, NC 28601, neal.gray@lr.edu.                                                                                                                                                                              

Professional Identity Development of Counselor Education Doctoral Students: A Qualitative Investigation

Oct 15, 2014 | Article, Volume 3 - Issue 1

Dodie Limberg, Hope Bell, John T. Super, Lamerial Jacobson, Jesse Fox, M. Kristina DePue, Chris Christmas, Mark E. Young, Glenn W. Lambie

The professional identity of a counselor educator develops primarily during the individual’s doctoral preparation program. This study employed consensual qualitative research methodology to examine the phenomenon of professional identity development in counselor education doctoral students (CEDS) in a cohort model. Cross-sectional focus groups were conducted with three cohorts of doctoral students in counselor education (N = 18) to identify the experiences that contributed to their professional identity development. The findings identified that (a) programmatic goals to develop professional identity align with the experiences most influential to CEDS, (b) experiential learning opportunities enhanced CEDS professional identity development, (c) the relationships with mentors and faculty contribute to their identity as counselor educators, and (d) being perceived as a counselor educator by faculty influences professional identity development. Implications for counselor education and the counseling profession are discussed.

Keywords: consensual qualitative research, counseling, counselor education and supervision, doctoral student development, professional identity development

Professional identity development is central to counseling professionals’ ethical practice (Corey, Corey, & Callanan, 2010; Granello & Young, 2012). The process of professional identity development is defined as the “successful integration of personal attributes and professional training in the context of a professional community” (Gibson, Dollarhide, & Moss, 2010, pp. 23–24). Counselor education doctoral students (CEDS) develop their identity as counselor educators primarily during their doctoral preparation program (Calley & Hawley, 2008; Carlson, Portman, & Bartlett, 2006; Zimpfer, Cox, West, Bubenzer, & Brooks, 1997). Specifically, intentional experiences designed by faculty and/or initiated by CEDS during their doctoral preparation program promote their professional identity development as counselor educators, supporting an effective transition into academia (Carlson et al., 2006). Counselor education doctoral programs employ diverse pedagogical strategies to promote their students’ identity development (e.g., Zimpfer et al., 1997). However, the impact that the experiences and strategies developed within programs has on students and their professional identity has not been examined in previous research. Therefore, an increased understanding of CEDS’ professional identity development might offer insight into pedagogical experiences that enhance doctoral students’ transition from counseling practitioners to faculty members in higher education (Calley & Hawley, 2008; Magnuson et al., 2003).

Professional identity development within counselor education can be described as both an intrapersonal and interpersonal process (Gibson et al., 2010). The intrapersonal process is an internalization of knowledge shared by faculty members and supervisors (e.g., recognizing personal strengths; areas of growth in academic roles). The interpersonal process develops during immersion into the norms of the professional community (e.g., submitting manuscripts for publication, presenting papers at conferences, teaching courses). These two developmental processes co-occur while counselor education trainees are conceptualizing their specific roles and tasks within academia.

Within counselor educators’ professional identity development, three primary roles emerge: (a) teaching and supervision, (b) research and scholarship, and (c) service (Calley & Hawley, 2008). An exploration of the tasks and/or experiences that facilitate doctoral students’ understanding of their future roles as counselor educators is needed (Calley & Hawley, 2008; Gibson et al., 2010). Carlson and colleagues (2006) developed a conceptual model of professional identity development in counselor education consisting of eight roles or tasks: (a) program expectations, (b) teaching and supervision, (c) research, (d) publications, (e) grants and funding, (f) service and conferences, (g) networking, and (h) professional development. Doctoral preparation programs are tasked with guiding future counselor educators’ understanding of these eight roles. Within doctoral preparation programs, three programmatic structure models are employed: (a) independent, (b) part-time, or (c) cohort (Walker, Golde, Jones, Bueschel, & Hutchings, 2008). For the purposes of this manuscript, we focus on the doctoral preparation cohort model. A doctoral preparation cohort model is defined as a group of students entering their preparation program together (same semester), taking the majority of coursework together, and moving through the program concurrently (Paisley, Bailey, Hayes, McMahon, & Grimmett, 2010).

In doctoral counselor education and supervision preparation programs, professional identity development is crucial as students move from their roles as counseling practitioners to counselor educators: making the paradigm shift from thinking like a counselor to thinking like an educator, supervisor, researcher, and leader (e.g., Carlson et al., 2006; Hall & Burns, 2009). In addition, the Council for Accreditation of Counseling and Related Education Programs (CACREP, 2009) Standards state that doctoral preparation program facilitate experiences for doctoral students to collaborate “with program faculty in teaching, supervision, research, professional writing, and service to the profession and the public” (p. 54). Furthermore, the American Counseling Association (ACA) and the Association for Counselor Education and Supervision (ACES) provide professional development opportunities (e.g., conferences, publications) for CEDS to develop their professional identity as future counselor educators. Nevertheless, limited research has investigated professional identity development of CEDS during their cohort model doctoral preparation program.

The shift of identity for CEDS may be from a counselor identity, a student identity, or other professional identity, depending on vocation before entering a counselor education doctoral program. Development of identity as a counselor educator requires a sometimes-difficult shift from previous occupational foci to that of counselor education. Regardless of previous identity, the counselor educator identity is unique in its focus on scholarship, service, and teaching. Without investing oneself in these qualities of counselor education, CEDS risk making a full transition from their previous identity to that of the counselor educator, thus shorting themselves and future students and employers the benefits of an invested counselor educator, such as being student-centered, contributing to the field through research, and giving back to the counseling community. Given the importance of professional identity development in CEDS, the purpose of the present study was to (a) gain a better understanding of the professional identity development process of CEDS during their cohort model doctoral preparation program and (b) identify the specific experiences of CEDS that influenced their professional identity development. The research question guiding the investigation was: How do CEDS develop their professional identities as counselor educators during their cohort model doctoral preparation program?

Method

We utilized consensual qualitative research (CQR; Hill, Thompson, & Williams, 1997; Hill, Knox, Thompson, Williams, & Hess, 2005) for this study. By definition, CQR combines elements of phenomenological, comprehensive analysis, and grounded theory approach to focus on the subjective experiences of humans in their sociological context (Heppner, Wampold, & Kivlighan, 2008). CQR was selected for this study due to (a) the intention of analyzing the comprehensive, subjective experiences of professional identity development among CEDS; (b) its collaborative nature; and (c) data consistency through consensus (Hays & Wood, 2011). Hill and colleagues (2005) identified four main aspects of CQR: (a) the use of open-ended questions, (b) consensual judgment of meaning in the data, (c) the use of an auditor throughout data analysis, and (d) identifying domains and core ideas through cross-analysis. All four of these research aspects were utilized in our investigation. In addition, our study was initiated as an assignment for a first semester doctoral counselor education class and evolved into a genuine interest in understanding professional identity development processes. As a result, we adhered to all protocol for a research study (e.g., approval of university’s institutional review board).

Research Team

We (the research team and authors) consisted of: seven first-year CEDS within a counselor education and supervision doctorate of philosophy (Ph.D.) program at a large southeastern university, a professor within the counselor education and supervision program who assumed the role of the internal auditor and facilitated the focus group for the first-year cohort (i.e., the research team), and an associate professor, in counselor education and supervision, who fulfilled the role of the external auditor and was not involved in data collection and analysis. We ranged in age from mid 20s to late 50s and consisted of four female students, three male students and two male faculty members, and we are all Caucasian. Five members of the research team conducted focus groups, while all members contributed to analyzing the data with the exception of the external auditor. A master’s-level student, not associated with the data collection or analysis, transcribed the focus group data from an audio format.

Positionality and Trustworthiness

We attempted to separate or bracket our biases and judgments regarding the phenomenon under investigation to understand CEDS professional identity development processes with as much objectivity as possible (Creswell, 2007; Hays & Wood, 2011). Therefore, we recorded our biases and expectations in a meeting prior to data collection (Hill et al., 1997). Additionally, we discussed researcher biases and expectations throughout the duration of the study in order to promote awareness of the influence we, as researchers, may have on data analysis (Creswell, 2007). Our biases included the belief that professional identity development is an important aspect of our doctoral program design and that results from this investigation would exemplify specific experiences, in our program, that highlight the areas of teaching, supervision, research, and service in counselor education. The personal knowledge of the participants may have created bias and higher value in particular participant voices in the data analysis; however, this knowledge also added richness to the data collected through prolonged engagement (Creswell, 2007). Additionally, the power dynamic between a professor leading a focus group or a first-year cohort member leading a focus group may create bias in participant responses. Our expectations were that data would vary by cohort years based on the participants’ time in the program and their level of experience, and experiences in (a) teaching and supervision, (b) participating and publishing research, and (c) presenting at conferences would be more powerful than other experiences due to their emphasis in our doctoral program.

To reduce the effects of bias when coding data and to support trustworthiness for our investigation, we used investigator triangulation and an internal and external auditor to evaluate each step of data analysis (Glesne, 2011; Hays & Wood, 2011; Hill et al., 1997). Both auditors were part of the counselor education program in which the study was conducted; therefore, this internal knowledge of the program may have influenced their review of the data analysis. In addition, we used member checking to support trustworthiness, asking participants to review transcripts, preliminary findings and near-finished writings. Furthermore, we sought to be transparent in revealing unforeseen barriers that presented in the research process, supporting the credibility of the research findings. These barriers included various levels of participation in cohorts, the challenge of coding and analyzing data that the research team itself produced through the first-year cohort focus group, and the ability to identify certain participants through personal knowledge of doctoral students in the program. We sent the raw data and the analysis to external and internal auditors to review the consistency and integrity of the data. The external auditor, whose perspective was not influenced by the research team, may have been influenced from being in the same program. This auditor supported the identified themes and findings. The internal auditor confirmed that the raw data were accurately represented under the domains, core ideas and categories.

Participants

The participants were first-, second- and third-year CEDS enrolled in a counselor education and supervision Ph.D. program at a large research university in the southeastern United States. They were recruited and selected to participate based on purposive criteria (i.e., enrolled as a doctoral student in the counselor education program) through campus email. The doctoral program in counselor education and supervision from which the participants were recruited is a fulltime, three-year program that employs a cohort model and awards Ph.D. degrees (Paisley et al., 2010). Criterion-based selection was utilized to ensure participants had similar experiences and commonalities within their doctoral program and to capture the variety of research interests, skill levels and clinical experience among the three years (Creswell, 2007). Although CQR is a qualitative analysis focused on producing results that illustrate the participants’ life experience related to the phenomenon investigated, CQR methodology does suggest a sample size of at least three cases in order to perform the cross-analysis during the data analysis process. A total of 18 CEDS agreed to participate with fellow cohort members in a focus group designated by year, which was an appropriate sample size for CQR (Hays & Wood, 2011). The first-year cohort included seven focus group participants (100% of the first-year CEDS population at this university) consisting of four Caucasian females and three Caucasian males. The second-year cohort included eight focus group participants (78% of the second-year population) with two Caucasian females, one African-American female, one Asian male, and four Caucasian males. Finally, the third-year CEDS cohort included four focus group participants (67% of the third-year population) comprised of two African-American females, one Asian female, and one Caucasian male.

In this study, we acted as both participants and researchers (i.e., the first-year cohort). In qualitative research, the observers can range from complete observers to complete participants (Creswell, 2013), and while traditional research design encourages impartiality, qualitative research varies. Researchers participating in a study offers greater depth of what the participants are experiencing, helps establish greater rapport with the participants and provides an understanding of the context better than would be understood by nonparticipant observers (Creswell, 2013; Heppner et al., 2008). There were several drawbacks that emerged from engaging in the dual roles of researcher and participant. The primary challenge occurred in analyzing the data for the first-year cohort (our cohort). In the dual roles, a level of familiarity was added, as we knew the underlying meanings of statements that might have appeared unclear to outside researchers. While this dual role also was a strength in that the true meaning of the data was able to be analyzed, the same level and depth of understanding could not be given to coding the second-year and third-year cohort data, as they were not part of the research team.

Data Collection

Data collection consisted of facilitators(s), who were members of the research team, conducting focus groups for each CEDS cohort. The focus groups were semi-structured with five open-ended questions asked in sequential order to promote consistency across groups and allow for rich data collection and in-depth responses (Bell et al., 2012; Heppner et al., 2008). Focus groups were conducted, as opposed to individual interviews, to maximize group dynamics that contribute to richer data collection, with the responses of each cohort being observed and recorded. The questions used to facilitate the focus group were created by the research team based on the literature of doctoral student identity.

The open-ended questions were: (a) Describe your experience of transitioning from counselor to counselor-educator-in-training? (b) I am going to name several different experiences you have had so far during your doctoral program (i.e., clinical work with clients, conducting research, teaching, supervising students, service to the profession, attending or presenting at conferences, interviews with faculty members in your initial doctoral class, cohort membership). Please identify or talk about things that happened in any of these arenas that helped you think of yourself as a counselor educator. (c) What other experiences have you had that resonated with you that affected your development as a counselor educator? (d) What pivotal moments (or critical incidents such as important conversations or successes) have you experienced that have helped to form your identity as a counselor educator? and, (e) Can you talk about any experiences that have created doubts about adopting the identity of a counselor educator?

Focus groups lasted one to two hours, varying by the discussion duration. All participants were assured that answers would be kept confidential to protect relationships within the program and promote honest answers. Although confidentiality was explained as part of the consent process, participants were also reminded that researchers could not guarantee confidentiality of other participants within the focus group. While the focus group design offered an environment rich for discussion, it is possible that participants may have held back on full disclosure due to the close nature of the program and personal knowledge of other participants. A faculty member of the research team facilitated the first-year CEDS focus group in order to preserve group facilitator impartiality and allow the first-year cohort, serving dual roles of research members and participants, to fully participate in the focus group process. The second-year and third-year CEDS focus groups were facilitated by first-year CEDS from the research team. Following each focus group, facilitators were asked to debrief by reflecting on three structured open-ended questions: (1) What experiences did participants mention most frequently and with the most emotional intensity? (2) Were there questions that seemed to elicit more or less response? and (3) Anything else that was relevant or noticeable (to you) during this focus group? The purpose of the debriefing was to acknowledge bias from the focus group leaders and to ensure that each leader could express the experience and understanding of the focus group. All the focus groups and debriefing sessions were audiotaped and subsequently transcribed.

Data Analysis

When using CQR, data analysis is a three-step process of (a) clustering data and identifying domains, (b) summarizing core ideas from the domains with shorter descriptions, and (c) developing categories that classify the common themes in the core ideas that exist across cases (Hill et al., 2005). Figure 1 visually explains the data analysis process. We analyzed the data by focus group, and each focus group participant’s contribution was analyzed independently. The data were analyzed to identify domains that were common themes from members of the cohorts. From the domains we recognized core ideas developing within the domain and from the core ideas we recognized categories that developed that crossed the focus groups. Of the eight final domains identified, five domains have more than one category. The process for coding used several methods, using names from the social sciences and in vivo coding where exact words or phrases were used to identify the code.

Figure 1. Data analysis flow chart of the process of analyzing each domain.

Domains. Before collecting and analyzing the data, we collectively created a 12-item start list of domains to guide our data investigation, which is a suggested step of CQR (Hill et al., 2005; Miles & Huberman, 1994). Table 1 presents the start list of domains (bolded), in addition to domains that emerged during data analysis. The start list domains were based on our expectations, as well as the three areas of (a) teaching and supervision, (b) research, and (c) service within counselor education (CACREP, 2009; Calley & Hawley, 2008). A domain start list created by the research team through consensus and in accordance with previous literature related to the phenomenon studied serves several purposes. The start list familiarized the research team with previous findings and allowed for comparison of new emergent themes, and themes found in previous research that was not identified in the current study. Additionally, the start list acquainted the research team with the process of reaching consensus in data analysis. While domain start lists may serve to skew data analysis if not properly and carefully analyzed, all domains required support from the data to be kept or added. Thus, in viewing Table 1, one can see that the original start list did have domains that were dropped due to lack of support from within the data. In accordance with CQR, we analyzed the first-year CEDS data independently, then met as a consortium and evaluated the same data together until consensus was met and domains adjusted. The second-year and third-year CEDS focus groups’ data were then analyzed through us breaking into dyads and triads. Domains were added to the master list as they appeared in the data and were agreed upon by the entire research team. In addition, we collapsed or deleted any domains that were found to be redundant, insignificant, or not present.

Table 1

Domain List Used to Analyze Data

When analyzing the second-year and third-year focus group data, if a difference of opinion arose concerning the meaning of a response, we added subjective insight from the perspective of the group facilitator and how they interpreted the participants’ response in the greater context of the focus group. Additionally, if consensus was not met, we reviewed the original transcript to clarify and meet consensus of the meaning of the data (Hill et al., 2005).

Core ideas and categories. After categorizing the data by cohort year under domains, we continued to work in dyads and triads to formulate core ideas from the raw data (grouped by domain and not by cohort year). We then determined categories that each core idea fell under. Each core idea was assigned a category, and similar core ideas were collapsed under a category to best represent the data. The categories served an overall purpose to classify and determine frequency in the responses from participants within each domain. Categories were clarified through a cross-analysis (Hill et al., 2005) of the participants’ year in the program, and if more than one member of the cohorts identified a domain as an important task or experience. Figure 1 shows the process of categorizing the data from domains to core ideas and then to categories. In CQR, the number of cases in each category determines the frequency label (Hill et al., 2005). General frequency constitutes all, or almost all, cases; typical constitutes more than half of the cases; and variant for less than half of the cases. For this investigation, each focus group represented one case, so frequency labels were defined as general if the category was present in all three cohort groups, typical if the category was present in two groups and variant if the category only emerged in one cohort’s focus group. We reevaluated the domains based on the frequency of the categories within the domain and the relevance to the research question, resulting in the final domain list (see Table 1) that was agreed on through consensus with the entire research team. Finally, we asked the participants to review the preliminary findings (member check), supporting trustworthiness. Participants supported the findings and did not dispute them.

Results

The findings of the investigation are described using domains (i.e., topics used to group data; Hill et al., 2005) and categories used to conduct a cross-analysis to support the findings and connect the findings to the research question. Originally, we developed a start list (Miles & Huberman, 1994) of 12 domains based on previous literature and personal experiences (bolded in Table 1). The start list was expanded to 19 domains through the data analysis (not bolded in column 2 of Table 1). Through further examination, a cross-analysis of the core ideas and categories within each domain was conducted (as presented in Figure 1). After the cross-analysis, the auditors reviewed the data and provided feedback. We revisited the 19 domains, identifying eight domains as strong due to their relevance to the research question and the domain being supported through the clarification of categories (as described in the methods section). The eight domains identified as strong were: (a) teaching, (b) supervision of students, (c) conducting research, (d) attending or presenting at a conference, (e) cohort membership, (f) program design, (g) mentoring, and (h) perceived as a counselor educator by faculty (Column 3 of Table 1; Bell et al., 2012). The eight domains and cross-analysis results are presented in Table 2, which exemplifies the frequency of categories created to increase the level of abstraction in the data analysis (Hill et al., 2005). Not all domains had categories (e.g., cohort membership, program design, and being perceived as a counselor educator by others) because the data within these domains was not diverse enough to create separate categories.

Domain I: Teaching

The teaching domain generated a significant amount of data from the CEDS groups in creating and strengthening their identities as counselor educators. Additionally, the teaching domain produced three contributing categories. Teaching is a core component of a doctoral counselor education program (CACREP, 2009). For this particular university’s program, teaching begins in the first year and peaks in the second year. Teaching was defined as didactic instruction of master’s-level students by doctoral students and occurred in the form of teaching classes, facilitating psycho-educational groups and clinical instruction. The teaching domain was present throughout the first-year, second-year and third-year focus groups with varying emphasis in the categories of (a) teaching experience, (b) contributing factors, and (c) critical interactions with students (see Table 2 for the breakdown and frequencies of the categories within the teaching domain). Therefore, teaching experience during the doctoral program assisted the CEDS in developing their professional identity, specifically their role as counselor educators.

Table 2

Cross-Analysis Findings: Final Domain and Category List

Category 1: Teaching experience. Data generated on the teaching experience category originated from the second-year and third-year CEDS cohorts, designating it as a typical category. Some participants discussed previous teaching experience as vital, while others identified the learning of teaching theories as important. The data revealed the second year as the period in which teaching becomes relevant in this particular counselor education doctoral program. Additionally, first-hand teaching experiences were identified by the third-year cohort as important in counselor educator identity formation. The teaching experience provided doctoral students a way to practice and apply their teaching and learning theory, and an opportunity to build their confidence as teachers. One third-year CEDS stated, “I recognized myself as a counselor educator when I had to assign grades, especially those below a B.”

Category 2: Contributing factors. The category of contributing factors was a general category, present in all three CEDS cohorts. The first-year CEDS felt mandatory programmatic activities such as facilitating psycho-educational groups contributed to their counselor educator identity development in teaching. The second-year students noted the interrelation of teaching and supervision, in that using these skills in a classroom improved their efficacy and contributed to adopting a counselor educator persona. The interrelation is indicated in one student stating, “The second year allows you the opportunity to do everything, including teaching, that you will be doing as a counselor educator.” In addition, evaluating students’ knowledge and skills acquisition helped in developing teaching as a core component of the counselor educator identity. A second-year CEDS supported the importance of student evaluation by stating that teaching and grading were not skills used as a counselor, but differentiated the CEDS as a counselor educator.

Category 3: Critical interactions with students. Though a variant category, third-year cohort members found interactions with students to be influential in adopting the identity of a counselor educator. The third-year group discussed important moments with students that created an impact on them such as: (a) receiving teacher evaluations, (b) grading students, (c) managing student concerns, and (d) feeling pride at student accomplishments. One student stated:

In terms specifically of my teaching I remember grading and being, okay this is where I have to be a big boy, this is where I have to be the counselor educator. It falls to me to decide to pass evaluation and not just a verbal feedback, but a grade… it was a moment, a specific moment where I was like okay now I’m a counselor educator.

Domain II: Supervision of Students

Supervision was the second largest domain present in the CEDS focus groups that was relevant in the participants’ development of a counselor educator identity, which was not surprising due to the emphasis on supervision within counselor education. Data within the supervision domain yielded two categories: (a) supervision teaches future counselor educators about the development of counselors and (b) supervision profoundly affects CEDS’ professional identity transition from counselor to counselor educator (see Table 2 for frequency breakdown). One participant stated, “Supervision brings teaching and counseling skills together to see what students are grasping.”

Category 1: Development of counselors. Supervision as a critical part of counselor development was a general category within the supervision domain and included theoretical aspects of supervision (e.g., applying theories of supervision and adjusting those theories to the development of students), as well as the practical aspects within supervision (e.g., focusing on what students need to know in order to proceed in the field of counseling and in their own growth and development). One CEDS summarized the importance of observing and enhancing development of counselors-in-training as follows:

I would say…supervising students for me has been counselor education in its purest form. Because when you’re in front of a class you’re teaching counselor concepts to people you are wondering are they grasping it, how are they understanding it and when you’re sitting down one-on-one and really supervising a student while they’re counseling someone else over a year or a semester, it gives us an opportunity to be intimately aware of what they’re learning and for me it’s been one of the most energizing and rewarding elements of a counselor educator.

Category 2: Professional identity transition. The doctoral students represented in these focus groups begin their education and practice of supervision during the second year of their doctoral program. Aligning with program sequencing, the majority of responses in the professional identity transition category came from the second-year cohort with support from the third-year CEDS, designating it as a typical category. Second-year students noted that the introduction of supervising students during the second year of the program facilitated their role transition from counselor to counselor educator. A second-year CEDS stated, “I think really what solidified it for me was the supervision class… having two of those before teaching even. That’s when I remember making that shift into thinking as an educator and supervisor rather than a counselor.” Another second-year CEDS stated, “Supervising students has been helpful to be me, sitting on the other side of the table instead of me counseling the client; I’m supervising the counselor (who is) counseling the client.” The third-year CEDS also identified supervision as one of the most significant experiences in solidifying their counselor educator identity.

Domain III: Conducting Research

The domain of conducting research as an important identity-forming experience was present across all the CEDS cohorts. Although the importance of conducting research was present in first through third years, it appears to peak in the second year of the program where research is emphasized through coursework. CEDS in the second-year cohort reported an increased interest in research and awareness of the relevance of research in counselor education and identifying as a counselor educator. A second-year CEDS stated:

One thing that really clicked for me this year was speaking in terms of research and that was a new way of thinking for me. It was a struggle between wearing my counselor hat versus my counselor educator hat and was sort of manifested in my research ideas. I was doing a lot of counselor practitioner kind of thinking in terms of research and I switched that into thinking of counselor educator research and that helped my identity transition.

Two categories were identified within the conducting research domain: (a) research is a responsibility and (b) development of the researcher role (see Table 2 for category and frequency breakdown).

Category 1: Research is a responsibility. The theme that research inquiry is not just a duty of a counselor educator, but also a responsibility to the profession presented as a typical category. The third-year cohort focused on the feeling of responsibility toward conducting research. The second-year CEDS contributed the majority of data in the research is a responsibility category and focused on the responsibility of research, writing and contributing to the professional knowledge base. During the second-year CEDS focus group, a conversation thread emerged focused on intentionality of contributing to the field of literature with quality research. All second-year cohort members agreed that the responsibility of conducting research was an area that substantially helped in their transition from thinking like a counseling practitioner to thinking like a counselor educator.

Category 2: Development of the researcher role. Data assigned to the research category was fairly distributed between all three cohorts, designating it as a general category. The first-year CEDS focused on their initial experiences, including the process of writing the first manuscript and the first Institutional Review Board (IRB) submission and approval. A major theme of second-year CEDS was identifying and developing research interests. Third-year CEDS focused more on the products of conducting research, such as presenting research results at conferences and conducting follow-up research. These research themes appeared to be developmentally appropriate as they matched the educational structure of this particular doctoral counselor education program.

Domain IV: Conferences

Although the domain of conferences produced broad responses from participants, it was clear that conference attendance contributed to identity development. Data centered around two categories contributing to CEDS’ identity development as counselor educators: (a) attending and presenting papers at conferences and (b) networking with other professionals in counselor education.

Category 1: Presenting papers at conferences. Conference presentation was a general category, present across all three years of CEDS. First-year students discussed the importance of presenting papers in developing professional identity. One reason identified for the importance of presenting papers was that other professionals at conferences expressed interest in their work and this professional attention was affirming. Second-year CEDS felt conference presentations solidified their role as a counselor educator, making it “more real.” Third-year CEDS stated that presenting papers at conferences gave a feeling of “professional weightiness,” in that they felt respected when other professionals valued their contributions and recruited them for potential faculty positions.

Category 2: Networking with professionals at conferences. The category of networking with professionals at conferences was a typical category, present in the first and second-year cohort responses. First-year students felt conversations with counselor educators outside of their program that occurred during conferences were helpful in the formation of their counselor educator identity. A second-year CEDS emphasized:

Attending the conferences is really good… I’m able to see other professionals that have been successful going through what I’m in now. And to get advice from them, to hear some tips that they have about research or teaching…umm and just getting inspired and motivated and saying that “you know I can see myself in their positioning in another year and a half or so.”

Domain V: Cohort Membership

The university at which our research was conducted employs a cohort model for the doctoral program in counselor education. As noted, a cohort model is defined by a group of students entering the program together, taking the majority of coursework together and moving through the program concurrently (Paisley et al., 2010). In participants’ responses, we found cohort membership was valuable in both first-year and second-year students. First-year CEDS expressed that being a part of the cohort helped create a vision of the future as a counselor educator. The students also recognized cohort members as future colleagues. Second-year CEDS focused on learning from cohort members, such as relying on cohort members’ expertise in understanding new situations and how sharing experiences with cohort members helps support them through the doctoral preparation process. It was not surprising that cohort membership did not emerge in the third-year students, as course work ends in the second year so third-year students can focus on dissertations. The lack of coursework contributes to less time the CEDS are together, and thus less of an emphasis on cohort membership and dynamics.

Domain VI: Program Design

The program design domain appeared often, but only in the second-year cohort data. The data reflected the second-year CEDS’ beliefs that the program was intentionally designed to develop skills and knowledge incrementally bringing all the roles of a counselor educator together in the second year of the doctoral program. For example, evaluation by faculty and classroom assignments helped students understand their roles as counselor educators. A second-year student stated, “In the second year, the program is set up to do everything we will be doing in the profession.” While program design domain does not contain categories, it was one of three domains added to the final list that was not associated with the original start list of domains (see Table 1). As the focus groups were conducted in the beginning of the academic year, first-year students may not have recognized the program design as an asset in their identity development as counselor educators due to their newness to the program. We were somewhat surprised that the program design domain did not come up in the third-year focus group; however, as previously mentioned, the third year is centered on dissertation. Therefore, program design may seem less clear during the third year in the program, as the CEDS are working independently.

Domain VII: Mentoring

The data in the mentoring domain crossed all three CEDS cohorts emphasizing the importance of mentoring across the doctoral program. From the mentoring domain, two categories emerged: (a) the importance of mentoring on the student’s professional identity development and (b) the value of conversations with faculty members on their development. A mentoring relationship was beneficial in the CEDS’ professional identify development, which was identified in the data, but was not part of the original start list of domains (see Table 1).

Category 1: Importance of mentoring. The importance of mentoring was present in both first-year and second-year cohort CEDS focus groups, designating it a typical category. First-year CEDS recognized the mentor relationship as an integral part of doctoral education. Second-year CEDS focused on the modeling of teaching by faculty members and faculty assisting in the development of research interests and writing. One student stated, “just being taken under some faculty member’s wing and having them take an invested interest in me and having me connect what my interests are in the community…has been mentally helpful for me.”

Category 2: Value of conversations with faculty. The value of conversations with faculty was a general category. First-year CEDS discussed conversations such as professors checking in on their progress and expressing pride in their work. One student stated, “Talking with a professor who has been successful and is similar to me has validated me in many ways.” Second-year and third-year CEDS focused on encouragement from faculty in terms of honing research interests and consulting with faculty about students, as exhibited in this statement:

A professor told me that my paper could be a manuscript and I didn’t view it like that. I didn’t understand what that meant (to write a manuscript) until the professor said that and I’m like, really? And I didn’t really have the self-efficacy to believe that until he started working with me and I realized the accuracy of his statement. Because I didn’t  believe that of all the people out there making contributions (to the scholarly body of research) that I could actually be one of those people making contributions. It is due to the mentorship and support and somebody highlighting the opportunity.

Domain VIII: Perceived as Counselor Educator by Faculty

The domain of being perceived as counselor educator by faculty crossed all three CEDS cohorts and reflected the professors’ belief and vision of students as future counselor educators. The perceived belief of the faculty members was then reflected in the self-confidence of the CEDS. Students across cohorts gave examples of professors believing in their research, asking for recommendations, and being addressed by professors as counselor educators. One student said, “The professors seeing me as an educator helps me see myself that way.” In addition, one CEDS identified a defining moment while networking at a conference when a professor from an outside university asked for an opinion regarding which textbook to use. The professor’s request validated the student’s identity as a counselor educator and gave the perception of being accepted in the field. Being perceived as a counselor educator by faculty emerged as a domin through data analysis and was not part of the original domain start list (see Table 1).

Discussion

Previous research supports three primary counselor educator roles (teaching and supervision, research, and service; Calley & Hawley, 2008; Carlson et al., 2006). The teaching domain (subcategories: teaching experience, contributing factors, and critical interactions with students) and the supervision domain (subcategories: development of counselors and how it impacted counselor identity) generated the most data from our CEDS participants. Thus, teaching and supervision may serve as distinguishing factors of the transition from counseling practitioner to counselor educator. The perspective that the counselor educators’ researcher role develops during the beginning of this preparation program, and conducting and developing research interests are established through participation on research teams and presenting research results was consistent with previous findings (e.g., Calley & Hawley, 2008; Carlson et al., 2006). However, the responsibility and application of conducting research is important to emphasize throughout a doctoral program to enhance professional identity development. The role of service in counselor education (e.g., Calley & Hawley, 2008) was not supported in our data. The CEDS in our investigation may not have been aware of the opportunities to provide service to the counseling profession, or they may not view service as a priority. Therefore, the counselor educator role of service may be an area of growth for some doctoral programs to expand opportunities for CEDS to provide service in the field.

In addition, our findings support the premise that the development of CEDS professional identity as counselor educators is intimately linked to the students’ doctoral preparation program which was consistent with previous findings (e.g., Carlson, et al.,1997). Built within the participants’ program were opportunities for CEDS to take on the roles of counselor educator, including teaching, research, supervision, and participation in the greater community of counselor educators through conference participation. What is noticeably absent from our results is the lack of influence that the curriculum (e.g., attending class meetings, reading, writing papers, listening to lectures) played in the professional identity development of the CEDS. Although each participant was enrolled as a fulltime CEDS through the duration of their education, the influence of “learning by doing” seemed to develop the identity of each participant more than traditional didactic learning methods. Thus, it is important for counselor education doctoral programs to consider practical experiences for their students (e.g., opportunities’ for teaching, research and supervision).

The influence of faculty and networking (e.g., mentoring, being perceived by faculty as counselor educators, and attending and presenting at conferences) is crucial to CEDS’ professional identity development, and was a unique finding. However, it was noted that counselor education faculty members influenced their students primarily outside of the classroom setting. Faculty (including those outside of one’s program) helped their students grow into the identity of counselor educator through (a) consultation, (b) developing research interests, (c) believing in and treating the students as counselor educators, (d) encouraging students to present at conferences, and (e) mentorship. Our findings affirm the importance of counselor education faculty members’ influence on the development of future counselor educators and professional counselors.

Lessons Learned

As this investigation was our first time conducting qualitative research, specifically CQR, we reflected on lessons learned through this process. Three overarching lessons emerged: (a) coding qualitative data using CQR methodology is a lengthy process that requires significant and honest discussion, (b) the consensual aspect of CQR seemed to balance personal bias, and (c) applying a new research methodology while concurrently learning the process of the methodology presents many challenges. While the focus groups were an expedient method of collecting the data, we found coding the data required a significant amount of time to ensure the data were represented in the codes. Correct categorization of the data was somewhat remedied by dividing up the second-year and third-year CEDS data; however, each smaller team continued spending significant time with their respective data. Additionally, balancing the thoughts and opinions of seven of us was challenging; however, the guidelines for CQR methodology delineated that consensus must be reached in coding the data (Hill et al., 2005). Although a lengthy process, it appeared to balance bias allowing the data to speak for itself in producing new domains. Finally, we served as both researchers and participants, which we recognize as a limitation. However, the active learning process of conceptualizing and applying CQR simultaneously while serving as participants provided us an opportunity to develop our own professional identity as counselor educators, specifically in the area of research.

Limitations and Implications for Future Research

As in all research, limitations were apparent in our investigation. At the time the focus groups were facilitated, we were in the first year of the program, and all of us were from the same university. Our study involved only students in a single doctoral program, which is a cohort design; therefore, the results emphasize the specific goals and curriculum design of one cohort model in counselor education. In addition, we served as participants in representing the first-year doctoral student perspective. Though facilitated by a faculty member, we did have previous knowledge of the research questions and analyzed the data resulting from the focus group.

Although CQR is an emerging methodology that has not been used extensively in counselor education, we followed Hill et al.’s (1997; 2005) CQR guidelines and other scholarly writing guidelines (e.g., Hays & Wood, 2011; Lambie, Sias, Davis, Lawson, & Akos, 2008). After reviewing several CQR methodologies in various studies, Hill et al. (2005) found many advantages and disadvantages to the consensual process of qualitative data collection; one of the advantages may be the rigorous cross-analysis embedded within the CQR method. Our qualitative investigation used a meticulous cross-sectional approach to identify key components of professional identity development among CEDS. A limitation to CQR is researcher bias, which should be safeguarded by considering and reporting all biases (Hill et al., 2005). We spent a significant amount of time considering and discussing potential biases. Finally, we listed all potential biases and through consensus identified actual biases as reported earlier.

A recommendation for future research, based on our investigation, is to expand the sample to include other doctoral counselor education programs, specifically different models (e.g., part-time, independent), allowing domain consistency to be explored, as well as identifying similarities and differences across counselor education doctoral programs. In addition, future research may benefit from the exploration of pre-tenured faculty members’ experiences of professional identify development in comparison to CEDS. Furthermore, a quantitative design may be employed to examine significant relationships of specific domains and productivity of doctoral counselor education students.

In summary, our study examined CEDS’ experiences that helped build their professional identity as counselor educators. The data were collected from three cohorts representing different stages in their doctoral preparation program and analyzed using CQR methodology. The findings suggested that: (a) programmatic goals align with the experiences critical to CEDS professional identity development, (b) experiential learning opportunities (e.g., teaching courses under supervision, participating on a research team, and supervising students) appeared more influential than traditional content learning, and (c) the relationships with mentors and faculty members contribute to both the CEDS efficacy and development of their identity as counselor educators. Therefore, counselor education doctoral programs may want to evaluate current curricula to ensure their students have experiential learning opportunities, if they wish to promote the professional identity of counselor educators.

References

Bell, H., Limberg, D., Young, M. E., Robinson, E.H., Robinson, S., Hayes, G., . . . Christmas, C. (2012). Professional identity development of counselor education doctoral students. Paper presented at the British Association for Counselling & Psychotherapy, Scotland.

Calley, N. G., & Hawley, L. D. (2008). The professional identity of counselor educators. The Clinical Supervisor, 27, 3–16.

Carlson, L. A., Portman, T. A., & Bartlett, J. R. (2006). Self-management of career development: Intentionally for counselor educators in training. Journal of Humanistic Counseling, Education and Development, 45, 126–137.

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Gibson, D. M., Dollarhide, C. T., & Moss, J. M. (2010). Professional identity development: A grounded theory of transformational tasks of new counselors. Counselor Education and Supervision, 50, 21–38.

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Hays, D. G., & Wood, C. (2011). Infusing qualitative traditions in counseling research designs. Journal of Counseling & Development, 89, 288–295.

Heppner, P. P., Wampold, B. E., & Kivlighan, D. M. (2008). Research design in counseling. (3rd ed.). Belmont, CA: Thomson.

Hill, C. E., Knox, S., Thompson, B. J., Williams, E., Hess, S. A., & Ladany, N. (2005).Consensual qualitative research: An update. Journal of Counseling Psychology, 52, 196–205.

Hill, C. E., Thompson, B. J., & Nutt Williams, E. (1997). A guide to conducting consensual qualitative research. The Counseling Psychologist, 25, 517–572.

Knox, S., Burkard, A. W., Janecek, J., Pruitt, N. T., Fuller, S. L., & Hill, C. E. (2012). Positive and problematic dissertation experiences: The faculty perspective. Counseling Psychology Quarterly, 24, 55–69.

Lambie, G. W., Sias, S. M., Davis, K. M., Lawson, G., & Akos, P. (2008). A scholarly writing resource for counselor educators and their students. Journal of Counseling & Development, 86, 18–25.

Magnuson, S., Davis, K. M., Christensen, T. M., Duys, D. Y., Glass, J. S., Portman, T., . . . Veach, L.J. (2003). How entry-level assistant professors master the art and science of successful scholarship. Journal of Humanistic Counseling, Education and Development, 42, 209–222.

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Paisley, P. O., Bailey, D. F., Hayes, R. L., McMahon, H., & Grimmett, M. A. (2010). Using a cohort model for school counselor preparation to enhance commitment to social justice. Journal for Specialists in Group Work, 35, 262–270.

Walker, G. E., Golde, C. M., Jones, L., Bueschel, A. C., & Hutchings, P. (2008). The formation of scholars: Rethinking doctoral education for the twenty-first century. San Francisco, CA: Jossey-Bass.

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Dodie Limberg is an Assistant Professor at Texas A&M-Commerce. Hope Bell is a doctoral candidate at the University of Central Florida. John T. Super, NCC, and Lamerial Jacobson are doctoral graduates of the University of Central Florida. Jesse Fox, NCC, is a doctoral candidate at the University of Central Florida. M. Kristina DePue, NCC, is an Assistant Professor at the University of Florida. Chris Christmas is a doctoral candidate at the University of Central Florida. Mark E. Young is a Professor and Glenn W. Lambie, NCC, is an Associate Professor at the University of Central Florida. Correspondence regarding this article can be addressed to Dodie Limberg, University of Central Florida, College of Education, Department of Education and Human Services, P. O. Box 161250, Orlando, FL 32816-1250, dlimberg@knights.ucf.edu.

Using Two Different Self-Directed Search (SDS) Interpretive Materials: Implications for Career Assessment

Oct 15, 2014 | Article, Volume 3 - Issue 2

V. Casey Dozier, James P. Sampson, Robert C. Reardon

John Holland’s Self-Directed Search (SDS) is a career assessment that consists of several booklets designed to be self-scored and self-administered. It simulates what a practitioner and an individual might do together in a career counseling session (e.g., review preferred activities and occupations; review competencies, abilities and possible career course; and consider RIASEC theory). This study examined how individuals used two different interpretive materials with the SDS assessment: (1) two paper booklets and (2) the computer-generated SDS Interpretive Report (SDS:IR). Participants receiving the SDS:IR were more likely to recall their SDS summary codes and expand their options than those receiving the two paper booklets.

Keywords: Self-Directed Search, SDS Interpretive Report, RIASEC theory, career course, John Holland, career assessment

The Self-Directed Search (SDS; Holland, 1994a) is a career intervention based on John Holland’s (1997) RIASEC theory (Realistic, Investigative, Artistic, Social, Enterprising, Conventional). The basic form of the SDS consists of several booklets designed to be self-scored and self-administered. It simulates what a practitioner and an individual might do together in a counseling session (e.g., review preferred activities and occupations, and review competencies and abilities). In this study, all students in two sections of a college career course completed the paper version of the SDS Form R Assessment booklet (Holland, 1994a) using the paper Occupations Finder (OF; Holland, 2000). Students in one section of the course received the SDS:IR generated by the SDS software system (IR; Reardon & PAR, 2001). Those in the other section received two paper booklets, You and Your Career (YYC; Holland, 1994b) and the Educational Opportunities Finder (EOF; Rosen, Holmberg, & Holland, 1997). These interpretive materials were both designed to answer common questions about the SDS assessment results and about how the findings might be used to improve college students’ career decision-making.

The YYC reusable booklet gives the practitioner a tool for interpreting the results of the SDS assessment activity, and for providing a more complete career intervention (Reardon & Lenz, 1998). Although the YYC booklet was designed to make the SDS a more self-directed activity and support the practitioner’s work, little research has investigated the usefulness of this booklet (Holland, Fritzsche, & Powell, 1994). The EOF is a listing of more than 700 educational programs at three degree levels according to three-letter Holland summary codes. The computer-generated interpretive report uses the SDS assessment results and includes content materials from the OF, YYC, and EOF booklets to produce a customized report based on an individual’s scores from the assessment booklet.

Holland’s work has been referenced in more than 1,600 citations, and the SDS is reported in hundreds of studies (Ruff, Reardon, & Bertoch, 2008). For example, Holland (1997) reported more than two dozen SDS studies with high school students, college students, and adults that demonstrated the psychometric properties of the inventory, examined the efficacy of the RIASEC typology, and investigated the relationship between the Big Five personality factors and RIASEC theory. Despite the popularity of the SDS, we were unable to locate any studies investigating the efficacy of the interpretive materials that support the SDS or the varied ways it might be used (e.g., in-person, booklet alone, personalized computer-generated report).

Whiston and James (2013) concluded that although Brown and Ryan Krane (2000) found that individualized interpretations and feedback were one of five key ingredients in successful career interventions, “there is little outcome research related to precisely how practitioners should interpret the results of career assessments” (p. 571). Moreover, they noted that in analyzing studies published between 1983 and 1995, no treatment/control comparison studies addressed individual test interpretation (Whiston, Sexton, & Lasoff, 1998). We sought to address this gap in the literature with this study.

The authors wanted to learn more about the impact of these two different interpretive materials on SDS users. Did users remember their SDS results or codes? How much time did they spend with each of the materials? Did the materials help users expand their career options? Did users prefer one method over the other?

Method

Participants

The sample consisted of 51 undergraduate students enrolled in two sections of a college career course. Common reasons for enrolling in the course were to explore career options and learn more about career decision-making. Participant ages ranged from 18 to 26 years (M = 21.14, SD = 1.16). The demographic breakdown of the sample was 52.9% Caucasian, 31.4% African-American, 9.8% Hispanic/Latino, 3.9% other, and 2% Asian. Academic class was 62.7% seniors, 19.6% juniors, 15.7% sophomores, and 2% freshmen.

Procedures

After the university institutional review board (IRB) approved this study, each student in the course was given a folder during the first week of class containing an informed consent document, a demographic form, the paper-and-pencil version of the SDS Form R Assessment booklet, and the OF. Completion of the SDS was a basic course assignment, whereas participation in the study was optional. Those completing the forms were given five points of extra credit toward their grade for participating, which was 1% of the total points available in the course.

After the first week of classes, students in each section of the course were randomly assigned to receive either the client interpretive report (Group 1) generated by the SDS software portfolio computer system or the YYC and EOF booklets (Group 2). The Interpretive Reports were given after the SDS summary scores from each completed paper SDS assessment booklet were manually entered into the computer. Five days after students received the SDS results and interpretive materials, the SDS Feedback Form was administered to gather information about students’ satisfaction with the materials and their effectiveness.

Instruments

The Self-Directed Search Form R. The original paper form of the SDS was first published in 1970 and revised in 1977, 1985, and 1994 (Reardon & Lenz, 1998). The assessment is based on Holland’s RIASEC theory, is self-administered, and takes 35–45 minutes to complete. The cost per administration (Assessment booklet, OF, YYC booklet) is about $4.04 (PAR, 2009). The SDS Assessment booklet includes a measure of expressed interests or vocational aspirations (the Daydreams Section) and a measure of assessed interests. The latter is obtained when users respond to SDS items in four sections: Activities (66 items endorsed like or dislike); Competencies (66 items endorsed yes or no to assess skills assess); Occupations (84 occupations that are endorsed yes or no to assess those of interest); and Self-Estimates (12 scale ratings [1 is low and 7 is high] to indicate self-estimates of skills and abilities as compared to those of a similar age across each RIASEC type). A three-letter summary code is derived by totaling the number of “yes” or “like” responses from the three sections (Activities, Competencies, Occupations) and two Self-Estimates ratings in the Assessment booklet.

Intercorrelations among the SDS: Form R and measures of vocational aspiration and college major indicate concurrent validity for male and female college students ranging from .32 to .39 (Holland et al., 1994). Substantial reliability for the summary scales on the SDS are indicated by the internal consistency coefficients (KR-20) ranging from .90 to .94, and test-retest reliability coefficients ranged from .76 to .89 (Holland et al., 1994). Overall, support exists for both the reliability and validity of the SDS.

You and Your Career. YYC is a seven-page booklet developed for use in conjunction with the SDS Form R Assessment booklet. YYC includes descriptions of the Holland codes and personality types, suggestions for engaging in career planning, and information on how to use Holland codes. This reusable booklet gives the practitioner a tool for interpreting the results of the SDS assessment activity, and for providing a more complete career intervention (Reardon & Lenz, 1998). Although the YYC booklet was designed to make the SDS a more self-directed activity and support the practitioner’s work, little research has investigated the usefulness of this booklet (Holland et al., 1994). The YYC costs about $1.28 per copy (PAR, 2009).

Educational Opportunities Finder. The EOF was first published in 1987 as the College Majors Finder and lists more than 750 technical and college-level fields of study, alphabetically and by three-letter Holland code and degree level (2 year, 4 year, and postgraduate). It is designed to help individuals connect Holland codes to varied educational and training options. It costs about $2.16 and may be reused (PAR, 2009).

SDS Interpretive Report. The SDS: IR produces a 10- to 12-page single-spaced Interpretive Report based on an individual’s SDS summary scores and provides a personalized list of occupations using five SDS Summary codes. Each occupation listed includes the DOT number, estimated education needed, and on-the-job training required. The IR also includes major fields of study and leisure options. The Interpretive Report is produced by the software portfolio system that costs $525 for unlimited use (PAR, 2009).

SDS Feedback Form. The items on the SDS Feedback Form were adapted from the Computer-Assisted Career Guidance (CACG) Evaluation Form (Peterson, Ryan-Jones, Sampson, & Reardon, 1988) used in studies of computer-based guidance systems (e.g., Discover, SIGI). The original CACG Evaluation Form had alpha reliabilities ranging from .77 to .87. The SDS Feedback Form included open-ended questions assessing how much time participants spent reading their materials, whether they accurately recalled their three-letter summary code, and the information learned by reading the materials. Four specific items from the Feedback Form were used to assess participants’ ability to expand or narrow their options.

Occupational Alternatives Question. The Occupational Alternatives Question (OAQ; Zener & Schnuelle, 1972, 1976; modified by Slaney, 1980) is a measure of occupational decidedness that asks respondents to list the number of occupations they are considering and the level of decidedness pertaining to these occupations. The OAQ includes two parts: (a) “List all of the occupations you are considering right now” and (b) “Which occupation is your first choice? If undecided, write undecided.” The OAQ is scored on a scale from one to four and is rated as follows: 1 = a first choice is given with no alternatives; 2 = a first choice is given with alternatives listed as well; 3 = no first choice is given, only alternatives; and, 4 = no choices or alternatives are given. The higher the OAQ score, the less decided the individual. The OAQ has been found to have convergent validity with other measures of career indecision, including the Satisfaction with Career Scale, the Vocational Decision Making Difficulties Scale, and the Career Decision Scale (Slaney, Stafford, & Russell, 1981; Walker & Peterson, 2012).

Satisfaction with Choice Question. The Satisfaction with Choice Question (SCQ; Zener & Schnuelle, 1972, 1976; modified by Holland, Gottfredson, & Nafziger, 1975) asks a single question, “How well satisfied are you with your first choice?” and is used to assess one’s level of satisfaction with career choice. This item is rated on a scale from one to six, and is scored as follows: 1 = well satisfied with choice; 2 = satisfied, but have a few doubts; 3 = not sure; 4 = dissatisfied and intend to remain; 5 = very dissatisfied and intend to change; and, 6 = undecided about my future career. Higher scores on the SCQ indicate greater dissatisfaction with career choice. Slaney et al. (1981) reported average correlations of .43, .53 and .44 between the SCQ and other measures of career decidedness, including the OAQ, Vocational Decision Making Difficulty Scale, and the Career Decision Scale.

Student Data Sheet. A demographic form was used to collect basic information on each participant, including gender, age, ethnicity, major, grade level, and career decision state. The latter was measured with the OAQ and SCQ as measures of participants’ career decision state according to the level of career decidedness and satisfaction assessment. Preliminary t-tests indicated that the groups did not vary across age or gender, but Group 2, which received the YYC and EOF booklets, included more seniors and ethnic diversity.

Results

Several analyses were conducted to investigate participants’ ability to recall their SDS summary codes. For example, both 4 x 2 chi-square analyses and several 2 x 2 chi-square analyses were used to compare participants’ actual summary code and their recall of their summary code. Participants in Group 1 who received the computer-generated, individualized interpretive report were significantly more likely to accurately recall their overall summary code (84%), as compared with participants in Group 2 (YYC/EOF booklets) (61.5%, p < .05). Participants in Group 1 were significantly more likely to recall the first and third letters of their summary codes (84% and 88%), compared with participants in Group 2 (61.5% and 50%, p < .017), but there were no significant differences between the groups on the ability to recall the second letter of the summary code.

Using items from the SDS Feedback Form, a series of 3 x 2 chi-square analyses were conducted to determine participants’ ability to expand, elaborate, narrow or confirm their occupational alternatives. Participants in Group 1 (interpretive report) were significantly more likely to expand their career options than those in Group 2 (72% vs. 57.6%, p < .05). However, participants in the two groups showed no significant differences in their ability to elaborate, confirm or narrow their options.

A one-way multivariate analysis of variance (MANOVA) was performed to investigate group differences between two aspects of career decision state. The independent variable was treatment (Groups 1 and 2), and the dependent variable was career decision state, as measured by the OAQ level of decidedness and the response to the SCQ. There were no statistically significant differences noted between treatment groups with respect to career decision state (decidedness and satisfaction) following use of the SDS.

Finally, two independent-sampled t-test analyses were conducted to compare the impact of receiving different SDS:IR materials on the amount of time (calculated in minutes) participants spent with the interpretive materials and the number of times participants picked up the materials to review them. There were no significant differences between groups regarding either the amount of time or number of times spent reading the SDS interpretive materials. Although there were no differences between the two groups on the amount of time spent reading the interpretive materials, participants in both groups spent about 30 minutes reviewing the materials, with a range of 5 to 90 minutes and a standard deviation of nearly 20 minutes. The variability in the amount of time that participants spent examining the SDS interpretive materials is noteworthy and merits further research.

Discussion

The findings in this study indicate that individuals receiving the SDS:IR generated by the SDS software portfolio computer system were more likely to recall their SDS overall three-letter summary code, as well as the first and third letters of their code, than those receiving the YYC and the EOF booklets. Because the SDS software portfolio generates a more customized and individualized interpretive report, the findings of this study are consistent with Brown and Ryan Krane’s (2000) recommendations for providing individualized interpretations and feedback regarding career development interventions. These results are also consistent with previous research, which demonstrated that the SDS increases self-understanding (Zener & Schuelle, 1976). In addition, Tinsley and Chu (1999) indicated that the recall of test results is one method of assessing the effects of a test interpretation.

Findings reveal that the interpretive materials used in this study enabled students to expand their options, but no significant relationships (p < .05) were found regarding their ability to narrow or confirm their options. The SDS results examine matches between the users’ three-letter code and the codes of more than 1,300 occupations in the OF, so it is reasonable that the SDS helped individuals expand their options (Holland, 1997).

Several limitations in this study may affect the generalizability of these findings. First, the sample was small (n = 51) and limited to two sections of an undergraduate career class in one university. The sample was dominated by Social and Enterprising types (64%). Another study with a sample composed of more varied RIASEC types might produce different results. Finally, t-tests were conducted to investigate the homogeneity of groups, and differences were found between class level and ethnicity, with Group 2 (OF/EOF printed booklets) having more seniors and more ethnic diversity. Given that members of this group were less likely to recall their code, it is possible that some seniors were not as focused on exploring their occupational interests and may have been primarily focused on resume writing and job searching.

These limitations notwithstanding, this study adds to the very limited research literature reported by Whiston and James (2013) regarding how practitioners might best interpret the results of career assessments. This study used two different interpretation materials for the SDS, two printed booklets and a computer-based individualized report. The computer-based interpretive report enabled users to recall their results more accurately in a follow-up survey after completing the SDS, and it led users to consider a more expanded list of career options for further consideration. Future studies might examine the efficacy of new interpretive materials now being developed for the SDS, as well as interpretive materials in varied media formats for other career assessments. Such studies would alleviate the paucity of research in this area noted by Whiston and James (2013).

References

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V. Casey Dozier, NCC, is a post-doctoral fellow at the About Family and Youth Institute in Thomasville, Georgia. James P. Sampson, NCC, NCCC, is the Mode L. Stone Distinguished Professor of Counseling and Career Development, Associate Dean for Faculty Development and Administration, and Co-Director, Center for the Study of Technology in Counseling and Career Development, College of Education, Florida State University. Robert C. Reardon, NCC, is Professor Emeritus at Florida State University. Correspondence can be addressed to Robert C. Reardon, FSU Career Center, P.O. Box 3064162, 100 South Woodward Avenue, Tallahassee, FL 32306-4162,

rreardon@fsu.edu.

Author Note: Robert C. Reardon is an author of the SDS software report used in this research.

Using Pair Counseling to Improve the Cost-Effectiveness of College Career Counseling

Oct 15, 2014 | Article, Volume 3 - Issue 2

Mary-Catherine McClain, James P. Sampson

As the demand for career counseling services grows, the need for accountability rises, and the availability of funding decreases, it becomes more critical that practitioners utilize cost-effective interventions and alternative forms of treatment. One option for improving access to all clients while concurrently reducing costs involves using approaches based on collaboration between clients. Pair counseling, a brief intervention based on pairing two individuals of opposing orientations, can be implemented to improve access, promote social justice, and enhance the overall delivery of career services. This article further examines how career theory can be translated into actual practice. Implications for program development and future research are addressed.

Keywords: career counseling, pair counseling, cost-effective interventions, alternative treatments, brief intervention, social justice, program development

Career counselors are struggling to find more cost-effective, accessible interventions while simultaneously dealing with budget cuts and demands for accountability. As noted by Sampson, Dozier, and Colvin (2011), the nature of interventions (e.g., group counseling, workshops) and practitioners (e.g., teachers, counselors) are two key factors associated with cost. While specialized resources and individual counseling may be necessary for clients lacking readiness for decision-making, it is important to consider alternatives when assisting clients with higher levels of readiness or proficient decision-making skills. When level of client readiness is assessed and the appropriate service delivery option identified (e.g., individual, group, self-help), accessibility will be maximized, costs will be minimized, and practitioners will be better prepared to meet the heightened demand for services.

The purpose of this article is to provide a rationale for implementing pair counseling to maximize the number of individuals who can receive career assistance, while concurrently enhancing the cost-effectiveness and overall quality of career service delivery. This article examines career counseling and how career theory has been translated into practice, the effectiveness and relative costs of interventions utilized in career counseling, and suggestions for using pair counseling and evaluating its efficacy.

Career Development, Theory and Practice

Career counseling provides individuals with critical tools for improving self-understanding, occupational knowledge and career exploration behavior in order to set appropriate vocational goals. It also helps individuals meet their aspirations by identifying a sense of life purpose and direction. The practice of career counseling includes a unique history of more than 90 years, which incorporates principles related to counseling and career theory (Super, 1992).

Career theory plays an important role in improving the overall practice of career counseling. For example, the theory provides a basis for selecting interventions and information to effectively deliver services (Brown, 2002). Research conducted by Parsons (1909) during his work with adolescents serves as one factor that increased support for career development and interventions among school educators. Parsons emphasized the importance of self-knowledge (e.g., abilities) and knowledge about the world of work. Similarly, Strong (1927) highlighted the importance of connecting student interests to occupations, and Holland (1973) advocated finding occupational environments that were congruent with individual personality types.

Since the early 1980s, career theories and counseling roles have expanded from a strictly vocational emphasis toward a more holistic picture to meet the diverse and cultural needs of all clientele (Lee & Johnston, 2001; Parmer & Rush, 2003). Due to the rapid transformation of social and economic structures in the 21st century, career counselors have recognized the importance of utilizing dynamic interventions and new service delivery models that have emerged in response to this challenging context (Amundson, 2006). While the field of career theory has experienced considerable growth, research suggests the translation of theory into practice remains inadequate and inconsistent (Miller & Brown, 2005). Pair counseling (discussed in depth later in this article) represents one dynamic, holistic and brief-service delivery approach that could be used to help college students make more effective career decisions through the development of enhanced self-knowledge and occupational knowledge.

Interventions, Efficacy and Costs

In light of recent accountability requirements and reductions in state funding, practitioners are experiencing increased pressure to demonstrate the effectiveness of their services on client outcomes (Wampold, Lichtenberg, & Waehler, 2002). Furthermore, continued funding is highly associated with providing data on the efficacy of career interventions. The current literature suggests that career counseling interventions are effective and promote career development in clients receiving services (Whiston, 2002). Similarly, a meta-analysis performed by Hughes and Gration (2006) found that career decision-making behaviors, career-related knowledge and career maturity improved following exposure to career services. To continue examining the effectiveness of career counseling interventions, it is critical that policies are implemented in which practitioners are allocated adequate financial resources and time for evaluation purposes. Equally important is developing and testing more cost-effective models of service delivery, which ultimately promotes social justice.

Social Justice

Common themes within social justice include advocating for equal access and distribution of resources in society for both underprivileged and more fortunate individuals (Sampson et al., 2011). As mentioned above, the costs related to providing interventions may serve as one factor limiting the accessibility of services—making such costs a social justice issue. For example, individual counseling is more expensive and time consuming than other modalities, yet it appears to be the most widely accepted and used practice (Sampson et al., 2011). As the demand for services grows and the need for accountability rises, it becomes even more critical that practitioners are proactive and utilize alternative forms of treatment. One option for improving access while concurrently reducing costs involves using approaches based on collaboration between clients (Sampson et al., 2011). The following section explores the effectiveness of utilizing two nontraditional forms of counseling within the field of higher education as well as the advantages and disadvantages of the approach.

Counseling Modalities

Some career counselors have shifted focus to helping clients through collaborative techniques rather than implementing interventions that assist individuals independently (Thrift & Amundson, 2005). For instance, Lee and Johnston (2001) argued that the future success of career services and work performance is dependent upon effective collaboration, interdependence and relationships skills in which clients function as co-learners. In order to create more flexible interpersonal arrangements and reduced time constraints when providing support, guidance and information to clients, researchers in a variety of fields have developed creative treatment alternatives.

Peer Tutoring

Over the past two decades, research (Jekielek, Moore, & Hair, 2002) in peer tutoring has increased dramatically due to the method’s economic advantages (e.g., teaching larger numbers of students), political benefits (e.g., facilitating egalitarian thinking), social gains (e.g., improving interpersonal skills), and positive outcomes (e.g., promoting empowerment). Furthermore, students become active learners, receive immediate feedback, achieve greater commitment, and experience increased motivation (Schunk, 1987). For example, Maxwell (1990) showed that peer tutoring and counseling improved academic achievement, increased confidence, and lowered student anxiety levels among tutees. Likewise, Topping, Watson, Jarvis, and Hill (1996) found that students in dyadic reciprocal tutoring groups reported less stress, higher learning and more positive self-concepts when compared to a randomly assigned control group. The mentoring or tutoring relationship also allows for direct assistance with career and professional development, while it concurrently supports emotional and psychological growth (Jacobi, 1991). On the other hand, peer tutoring does have disadvantages: training students to serve as teachers consumes extensive time, and the quality of interaction may be poor if students are not matched appropriately (McDonnell, 1994). Additionally, students may give incorrect information when not under the supervision of a professional.

Collaborative Learning

One form of instructional design typically utilized within university contexts is collaborative learning (Yang, 2006). Specifically, students actively work together in groups of two or more to complete learning tasks and solve problems. More recently, dyads or pairs of students have served as the primary functional unit for collaborative learning. Slavin (1996) advocated that individuals learn better as other peers prompt metacognition, facilitate participation in cognitive activities, and provide validation. Additionally, diffusion of responsibility is minimized because only two students are working together. Improving access to interventions and reducing costs are further benefits of implementing collaborative-based approaches. On the other hand, without the role of a more advanced facilitator, students may experience difficulty completing complex tasks or have insufficient resources to solve problems.

In summary, peer tutoring and collaborative learning represent different modalities with similar underlying theoretical foundations that can be applied when assisting college students with career decisions. However, one must consider a number of significant limitations prior to use. For example, one shortcoming of each approach is the failure to directly consider developmental levels and cognitive abilities of respective clients (Horton, 2008). Pair counseling could be considered as a more cost-effective approach that incorporates strengths found in the above two modalities as well as includes interventions fostering developmental and cognitive growth under the supervision of a trained practitioner.

Pair Counseling

Pair counseling is a structured, short-term developmental intervention in which two persons of opposing intrapersonal orientations (e.g., shy versus aggressive) are matched in a counseling relationship and experience dyadic interactions within a secure environment, guided by a trained practitioner (Karcher, 2002). Pair counseling also incorporates principles of developmental psychology, play therapy and social psychology. Additionally, it is holistic, contextual, and serves as a potential preventive framework for college students seeking career counseling services and resources. Finally, it includes assumptions found in the above modalities (e.g., learning is active, depends on rich contexts, and is inherently social) and allows pairs to function under the guidance, structure and supervision of a trained counselor. However, pair counseling has not been empirically tested within a career center setting or with college/adult populations. Instead, the majority of research investigating the effectiveness of pair counseling has been conducted using children and adolescents in residential or juvenile settings (e.g., middle schools, prisons) (Selman & Schultz, 1990). In the subsequent paragraphs, the theoretical foundation and respective evaluation outcomes are addressed followed by a description of core techniques, roles of the counselor, and assessment measures used in practice. It also should be noted that this article first examines pair counseling with children, and later explores how it can be used when serving adult populations seeking career services.

Theoretical Orientation       

The mechanisms of change by which pair counseling occurs can be broken down into three theoretical categories: social perspective taking, interpersonal negotiation and interpersonal orientation. More than 50 years ago, Piaget (1965) proposed that peers and supportive relationships are critical for appropriate development. Additionally, researchers suggest that parents, educators and professionals cannot provide these friendships in the same manner or quality that peers are able to achieve (Selman, Levitt, & Schultz, 1997). Selman (1980) and his colleagues developed a model of interpersonal understanding based on the above rationale, defined as the ability to “understand social situations in terms of the multiple perspectives of the individuals involved” (Selman, 1980, p. 302). Egocentric thinking, second-person perspective, perspective coordination (e.g., capacity for abstraction) and negotiation strategies represent the four levels described in Selman’s perspective-taking development model. Persons develop this sequence of social perspective-taking over time. Successful resolution of all levels suggests that individuals can identify and understand what is best for the overall social relationship as well as resolve relationship conflict (Selman, 1980).

Each of the above perspective-taking abilities further correlates with a specific type of interpersonal negotiation strategy (often utilized to resolve interpersonal conflicts). Additionally, these strategies can be described in terms of orientation and maturity (Selman & Schultz, 1990).  For example, individuals who vaguely identify perspectives different from their own and focus only on their own wants are likely engaging in unilateral (level 1) actions while individuals operating at a second-person perspective use reciprocal (level 2) negotiation strategies (e.g., cooperation, deal making). A third-person perspective relates to demonstrating collaborative actions (level 3) that accommodate one’s own needs as well as the partner’s (Karcher, 2002). A final component of Selman’s (1980) model relates to specific interpersonal orientations, or how individuals approach relationships. Specifically, some students “give in” during peer interactions (other-transforming) while others manipulate and threaten peers to meet their own needs (self-transforming).

Research suggests that aggressive and withdrawn individuals have immature negotiation strategies and poor perspective-taking abilities when compared to age-related peers (Selman, 1980). As a result, one purpose of pair counseling is helping persons adaptively use both self- and other-transforming strategies to create perspectives that satisfy each student’s needs. Related goals include increasing social-cognitive skills (e.g., perspective taking and problem solving), promoting interpersonal understanding and fostering social maturity (Schultz & Selman, 1998). Finally, working in collaborative pairs can significantly enhance student learning while simultaneously increasing the opportunity for corrective/constructive feedback (Slavin, 1996). For example, students working in dyads can increase the opportunity for cognitive disequilibrium—with the ultimate outcome of promoting perspective-taking ability, intellectual growth, deeper perspectives and reasoning.

Previous Findings and Outcomes

How does an individual benefit from pair counseling, and to what extent can this approach facilitate psychological, social, emotional, vocational and overall well-being? Over the past two decades, several researchers have explored these questions in residential and outpatient contexts, and most recently in academic settings. Qualitative reports—largely based on case studies and quantitative research typically using empirical designs—demonstrate pair counseling as a powerful intervention that significantly contributes to positive youth outcomes (Schultz, 1997).

Youth exhibiting severe aggression, withdrawal or other disruptive behavioral patterns (e.g., ADHD) are commonly referred for treatment, whether in outpatient or residential settings.  Research also suggests that troubled children experience difficulty interacting with peers, exhibit low social competence, and lack psychological resilience (McCullough, Wilkins, & Selman, 1997).  Based on this premise, Karcher & Lewis (2002) conducted a pilot study examining the effects of pair counseling with patients receiving inpatient hospitalization services. Results demonstrated significant reductions in aggressive and delinquent behaviors as well as increases in cognitive development.  In essence, persons diagnosed with externalizing disorders (e.g., oppositional defiant disorder) learned how to make better decisions, resolve conflicts, and achieve higher interpersonal understanding when treated within a pair counseling context because it provided an avenue for self-reflection and peer interaction. Advantages of pair counseling also are effective for individuals experiencing internalizing symptoms such as depression, immaturity or social anxiety.

Schultz (1997) investigated the use of pair counseling among two adolescent girls—one more dominating and forceful, and the other more withdrawn and shy. The context of pair counseling appeared to enable the girls to identify, share and normalize feelings for one another. Furthermore, pair counseling served as a primary vehicle for allowing these youth to develop assertiveness and feel acceptance. Pairing also facilitated the acquisition of appropriate social skills among children diagnosed with ADHD as it promoted goal setting and a context in which self-control could be established. Finally, research indicates that pair counseling fosters understanding between individuals from diverse cultural or ethnic backgrounds.

Schneider, Karcher, and Schlapkohl (1999) published a case study that illustrated the benefits of implementing pair counseling when treating individuals from two different racial backgrounds. Specifically, this modality was utilized when two students of varying ethnic backgrounds were referred for counseling due to awkward and immature social skills. Over the course of treatment, the pair reflected and discussed shared experiences—eventually leading to decreased social isolation and stress experienced at school. It also was reported that the benefits extended beyond the school setting and further enhanced the students’ relationships with their respective families. Although the current research supports the use of pair counseling to treat externalizing and internalizing symptoms, no research has empirically investigated the use of pair counseling as an intervention for college students seeking career services. A potentially promising approach would be to adapt the technique of pair counseling for college students engaging in the career decision-making process.

Matching in Pair Counseling

How does one optimally match persons in pair counseling? For counseling to be most effective, individuals with opposing interpersonal orientations and developmental needs should be matched (Kane, Raya, & Ayoub, 2002). It also becomes easier to facilitate problem solving when persons exhibit divergent styles. Base pairs are typically matched in terms of different negotiation preferences—one student who is forceful or demanding may be matched with another student who expresses timid or shy behavior. Research further suggests that the weaknesses and strengths of each individual can complement the other person’s area of strength or weakness (Karcher, 2002). For example, a college student who is easily distracted may learn to relate and work better with others after being matched with a student who is attentive and detailed oriented; or, a more cautious student could be matched with an impulsive individual. Based on these examples, it seems that incorporating pair counseling and matching pairs can foster collaboration, active learning, and new ways of thinking about resolving career concerns. Also, from a social justice perspective, this type of counseling allows more clients to receive services.

Pair Counseling Techniques

While matching students serves as the foundation for progress and relationship formation, a secure environment must be established for these relationships to flourish. To improve the accuracy and overall effectiveness of pair counseling, Karcher (2002) prepared a comprehensive manual to standardize specific pair techniques and procedures. For example, counseling sessions should be conducted in the same place and at the same time each week—for 50 minutes. Equally important is establishing rules, discussing goals and describing the outline of each session (Barr, Karcher, & Selman, 1997). It also is common for pair partners to choose which activities to perform during the session using negotiation strategies.

In the beginning of each session, the practitioner reviews successes and failures of previous meetings in order to foster reflections and improve session discussions. Next, matched pairs engage in the agreed upon activity or game while the counselor remains nondirective, purposely focusing on the interaction between the pair. Throughout this time, the counselor also helps negotiate conflicts, encourages the articulation of different points of view, and assists in developing solutions to problems. During the last 15 minutes of the session, the counselor becomes more directive to facilitate reflections and to discuss how conflicts could be handled differently in the future (Karcher, 2002). Finally, examples of cooperation and assertiveness occurring within the meeting are described and pairs are typically asked to discuss feelings, thoughts or behaviors that contributed to the success of the session.

In order to promote perspective-taking and foster developmental maturity for both individuals in the pair, the practitioner can employ empowering, linking and enabling during specific interactions, as conflict arises or at the conclusion of each session (Karcher, 2002). Empowering is often utilized for impulsive persons who experience difficulty articulating feelings or identifying beliefs, goals and desires. A person gains a sense of self-efficacy as the counselor reflects needs and subsequently empowers the person to achieve a more differentiated point of view. After a person recognizes and acknowledges personal interests, linking helps the pair coordinate different social perspectives. Additionally, the counselor may need to model or break down the conflict into smaller pieces so that a goal is identified and subsequently agreed upon. Next, the pair strives to generate alternative solutions with the ultimate goal of implementing a mutual strategy. In essence, the pair works together to solve a conflict that is satisfying for both parties. Enabling serves as a final intervention that encourages the matched pair to recognize long-term consequences of individual actions on their mutual relationship. For example, reviewing disagreements, processing interactions, and resolving differences serves as one technique for increasing collaboration, support and respect between the pairs.

Pair Counselor Roles

Fostering relationship development between two individuals and maintaining relationship functions such as autonomy and intimacy represent important counselor roles (Karcher, 2002). Another role relates to enhancing social skills. In other words, a pair counselor offers support during peer interactions and uses opportunities occurring within the session, peer play and guided reflection to promote perspective taking, encourage negotiation, resolve conflict, and enhance social skills.

After establishing a secure atmosphere and explaining the specific goals of pair counseling to each partner, the counselor devotes significant effort to promoting perspective taking and interpersonal understanding. Counselors employ specific techniques in order to accomplish this goal, such as empowering, linking and enabling, as discussed previously. It should be noted that each technique corresponds to levels of perspective taking that are just above the pair’s current social and maturity level (Selman & Schultz, 1990). Other guidelines for ensuring a successful session include incorporating directive and nondirective techniques, accentuating positive interactions, and promoting connectedness between sessions.

Assessment in Pair Counseling

Assessing and evaluating pairs serves as a final function for pair counselors. A variety of evaluation measures have been developed and tested to determine the efficacy of pair counseling. Furthermore, researchers and practitioners recognize that assessment should be comprehensive, incorporating multiple points of view and several measures (Schultz, 1997). Commonly used measures to assess social skill competence and interpersonal understanding include self-reports, interviews, observational checklists, school performance data and empirically-based questionnaires. For example, the Friends’ Dilemma Interview (Selman, 1980) measures perspective-taking ability, conflict resolution and interpersonal understanding, while the Interpersonal Negotiation Strategies Interview (INS; Schultz, Yeates, & Selman, 1989) measures interpersonal autonomy. In terms of questionnaires, the Relationship Questionnaire (Schultz & Selman, 1998) presents 12 scenarios that assess personal meaning of relationships and self-reported action, while the Persons-in-Pairs Questionnaire (Schultz, 1997) explores the experience of pair counseling, feelings about being a pair partner, and things learned as a result of participating in pair counseling. Other scales include the Pair Therapy Process Scale (Selman, Watts, & Schultz, 1997) and the Community-Oriented Programs Environment Scale (Moos, 1996).

An Application of Pair Counseling in College Career Counseling

As noted by Karcher (1997), specific goals of pair counseling are a function of the context in which treatment is employed. Pair counseling has demonstrated its effectiveness with children, and the present authors propose that pair counseling could similarly be employed and be equally effective within a college career center to support freshmen and upperclassmen coping with academic or psychosocial transitions.

A Proposal for Adapting Pair Counseling at the University Level

Pair counseling serves as one intervention tool career counselors can utilize when assisting college students during stressful transitions, whether for the purpose of decreasing commitment anxiety and decision-making confusion when choosing a major, researching jobs, or applying to graduate programs. As research suggests that psychosocial development is necessary for successful performance in academic and vocational contexts, it seems that one advantage of pair counseling is fostering psychosocial development in college students (Deptula & Cohen, 2004; Hinkelman & Luzzo, 2007). For example, relationships formed during the pair counseling process are likely to result in students learning how to share feelings, resolve differences, develop identities, gain feelings of autonomy, and manage thoughts on a deeper level. Likewise, based on Schultheiss’s (2000) relational career counseling model, the facilitative nature of attachment relationships between students can be used for connecting personal, career and social domains—ultimately enhancing adjustment and overall development. This technique also fits well with more recent career theories that have emphasized a more holistic perspective when serving clients. Pair counseling further represents an avenue for translating theory into practice.

A second strength of pair counseling is its ability to help college students identify and learn the perspective of other college students from all cultural, ethnic, social, academic, class and religious backgrounds. As a result, students are likely to receive exposure to alternative points of view, develop diverse problem-solving strategies, and exhibit advanced decision-making skills. However, differences exist between pair counseling and approaches based on individual and group counseling.

Although individual counseling is effective for treating numerous problems and disorders, it does not provide students with direct social functioning with peers. This serves as one limitation for career counselors assisting students seeking interviewing tips or guidelines for resume writing. For example, students working in pairs on these tasks are likely to benefit because of the increased opportunity for reflection and development of interpersonal competence. Similarly, group counseling may not provide students with a direct opportunity to learn or interact with one another. For example, conflicts or disagreements may affect an entire group, but not a specific relationship. Alternatively, the structure of pair counseling protects against the opportunity for students to become overwhelmed or overstimulated by group processes while simultaneously providing clients with resources for support and coping (Karcher, 1997). Third, the approach of pair counseling addresses the developmental level of each pair member and has specific interventions to further facilitate cognitive growth. A final rationale for implementing pair counseling within a college career setting relates to cost-effectiveness. Specifically, as the number of students seeking career services continues to grow and as the number of staff and other resources remains the same or declines, it becomes critical to implement interventions that meet or fulfill this need.

Matching Pairs, Sessions and Techniques

Several factors should be considered when determining pairs. Based on the current literature, the most effective pairing typically occurs among same-gender partners and individuals sharing similar academic or cognitive abilities. These similarities likely increase collaboration, communication and comfort between individuals because the individuals are seen as equal partners. Furthermore, clients are often matched according to opposing interpersonal orientations as it fosters more effective problem solving and discussion. Similarly, clients sharing similar interests, work experiences and occupational goals are generally appropriate pairs. Pairing also is a function of the career service requested; clients selecting a college major have different needs than clients applying for employment or creating a portfolio. It should be noted that the above represent hypotheses, and because no research has empirically investigated pair counseling in a career setting or used content related to vocational decision-making, these suggestions should be experimentally tested. Furthermore, researchers should consider alternative pairings (e.g., cross-age pairs) to identify which factors are most important when matching clients. Following the matching process, how are sessions conducted, techniques implemented and goals achieved?

Increased attention and research efforts are needed for answering the above questions because minimal research has examined pair counseling using brief interventions or drop-in advising services for career counseling. As the majority of clients seeking career services rarely “drop by” more than three or four times in a semester, and often spend less than one hour per session, it seems that one option is intervening early and specifically targeting students who are at-risk for dropping out of college early (e.g., undecided major, first-time-in-college students) or who are already experiencing difficulty in their academic programs. After identifying at-risk students, similar techniques of empowering, linking and enabling should be employed.

Stumbling Blocks and Potential Ethical Issues

While pair counseling has demonstrated efficacy in treating a variety of disorders and across a range of clinical settings, several potential problems have been noted within the literature. First, mismatching among partners may decrease treatment effectiveness; opportunities for conflict increase when interpersonal orientations, levels of maturity and perspective-taking abilities differ significantly between partners (Karcher, 1997). Furthermore, without an adequate level of rapport and security, pairs may find it difficult to communicate, interact and be honest with one another. Based on these findings, it becomes critical that career counselors develop strategies for matching pairs. For example, the Career Thoughts Inventory (CTI; Sampson, Peterson, Lenz, Reardon, & Saunders, 1996) could be utilized to match students of varying levels of anxiety, decision-making confusion and external conflict, or it may be more appropriate to match pairs based on Myers-Briggs Type Indicator (MBTI) personality types. The CTI could also be used as an outcome measure to evaluate the effectiveness of pair counseling. Similarly, educators and researchers should consider how they might pair students who are enrolled in an undergraduate career development course and thus already have pre-existing relationships. Alternatively, how might it work for two members of an organization (e.g., Greeks) to engage in pair counseling?

Disclosing too much information (e.g., making the other partner uncomfortable), breaking confidentiality, and prematurely terminating the sessions represent additional concerns. For example, if an individual shares information outside of the counseling relationship, the other individual may develop mistrust issues or be reluctant to reveal feelings or opinions in future sessions. In order to reduce the likelihood of these ethical problems occurring, it is important for counselors to maintain structure, develop rules, and take notes following each session. When facing complex situations, counselors should consult with others, seek supervision, and use resources.

Future Directions

An important first step for researchers is to conduct studies beyond externalizing disorders and internalizing problems to more cognitively advanced and psychosocial issues encountered by college students and young adults. For example, the influence and potentially positive impact pair counseling has when assisting clients making career decisions and selecting educational options based on vocational goals represents a cognitive example that could be explored more closely by future researchers. Alternatively, researchers could examine how social support between pairs fosters career readiness and autonomy; would an individual feeling discriminated against or afraid to “come out” experience more comfort in making decisions when involved in a positive social relationship? Similarly, the literature and methodology of collaborative learning can be incorporated when assisting clients under a pair counseling approach. Whether pairs work together to explore a significant question (e.g., what college major should I choose?), resolve a problem (e.g., how to write a resume) or complete an activity on the Internet (e.g., research occupations) to make a more informed career choice, the principle components and methodology used for collaborative learning will be essential as researchers move forward in better understanding and implementing pair counseling. As with collaborative learning, these activities should be clearly defined, and individuals must feel supported and validated, but also challenged (Yang, 2006).

Another area for future research concerns the issue of social justice. Researchers could evaluate the cost-effectiveness of pair counseling over an academic year by comparing the number of clients served, the duration of each session, and specific outcomes associated with participating in the pair counseling process (e.g., career satisfaction, career readiness, reduction in dysfunctional thoughts).

Formal quantitative and qualitative research designs are needed to evaluate the effectiveness of pair counseling (Horton, 2008). Specifically, researchers should focus on employing true experiments or at least quasi-experimental designs that incorporate random assignment and comparison groups. Similarly, it is important to collect information over a longer intervention period that includes multiple data collection dates and assessment instruments measuring self-esteem, career readiness, and anxiety. In addition to these areas for future research, it would be beneficial to have a larger number of pairs across a variety of ethnicities, genders, academic levels (freshman through graduate student), and college majors (Horton, 2008). Third, it would be beneficial to explore outcomes of pair counseling for different disorders and across different levels of perspective taking/negotiation to determine which pairings are most effective. Finally, it is important to explore the effectiveness of pair counseling using a variety of total sessions. Researchers could evaluate whether paired students benefit from 1–3 sessions, which is typical practice at career centers advocating brief-staff assisted services, or whether a more traditional 10–13 sessions is necessary for positive treatment results.

Conclusion

Pair counseling could assume an important role in the area of career intervention, as it represents an approach that facilitates dyadic, positive social interactions between two clients. Through collaborative discussions among matched pairs, and under the guidance of a professional counselor, students could identify transferrable skills, select majors, and learn how to make more effective career decisions. Similarly, pairs could provide emotional support to one another while implementing career choices and/or discussing options for reducing career barriers and feelings of anxiety. In addition to bridging the gap between theory and practice, pair counseling represents a cost-effective approach that would enable more college students seeking career services to be served. Future research is needed to determine what types of clients benefit the most and for what career problems this approach is most effective.

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Mary-Catherine McClain is a predoctoral intern at Johns Hopkins University Counseling Center. James P. Sampson, NCC, NCCC, is the Mode L. Stone Distinguished Professor of Counseling and Career Development, Associate Dean for Faculty Development and Administration, and Co-Director, Center for the Study of Technology in Counseling and Career Development, College of Education at Florida State University. Correspondence can be addressed to Mary-Catherine McClain, 3003 North Charles Street, Suite S-200, Baltimore, MD 21218, mcmmcclain@gmail.com.

Millennial Counselors and the Ethical Use of Facebook

Oct 15, 2014 | Article, Volume 3 - Issue 2

Leah Brew, Joseph M. Cervantes, David Shepard

The use of social networking sites (SNS), and Facebook in particular, seems to be on the rise (Salaway, Nelson, & Ellison, 2008). The majority of users tend to be from the millennial generation (Hazlett, 2008), as are the majority of graduate counseling students. This discussion explores several areas regarding the use of Facebook. First, we review the literature on why students from the millennial generation are such avid users of Facebook. Second, we explore privacy settings: how Millennials establish privacy settings and what demographic factors may be correlated with the level of privacy settings they establish. Results from an online descriptive survey of counseling students are compared with and found in many ways to be inconsistent with the literature on the risk factors associated with limited use of privacy settings. Implications of and recommendations for using Facebook for counselors and counselor educators are provided.

Keywords: millennial generation, Generation Y, social networking sites, Facebook, ethics, boundaries

The use of social networking sites (SNS) is increasing in popularity with college students (Hazlett, 2008), and Facebook is one of the most popular sites (Salaway, Nelson, & Ellison, 2008; Fogel & Nehmad, 2009; Hazlett, 2008; Lehavot, Barnett, & Powers, 2010; MacDonald, Sohn, & Ellis, 2010). As of March 2013, Facebook had over 1.11 billion users overall (Facebook, 2013), but the more relevant statistic for this article is the evidence of the site’s widespread use by college students. Data collected in 2006 and 2007 from several studies found that about 60–65% of college students were using Facebook (Fogel & Nehmad, 2009; Lehavot et al., 2010; MacDonald et al., 2010). Recent research conducted on college students found that more than 85% of students who responded to the survey use SNS, and 89% of those who used SNS had a Facebook page (Salaway et al., 2008). Thus, the use of SNS and Facebook is officially part of the college student culture. The fact that so many college students have incorporated Facebook into their lives is highly relevant to the field of counselor education. The majority of students in both masters and doctoral level training programs will have come from this culture, with a strong likelihood that they enter college programs with an existing Facebook page, and anticipate a continued interaction with friends, families and classmates via Facebook. Yet, the use of Facebook raises challenging ethical and clinical issues for both students and counselor educators. These include boundary issues: most importantly, the risks associated with a student’s private information being accessible to clients; issues related to enhancing the integrity of the profession; and the ethical responsibilities of counselor preparation programs in admitting and preparing students for counseling careers. The purpose of this article is to examine the relevant literature on Facebook as it pertains to counselor education, and specifically literature that deepens an understanding of both why students use Facebook and how they use Facebook. Additionally, we will describe the results of a survey of Facebook use at our own master’s in counseling program at California State University, Fullerton (CSUF), which has a large student body, most of whom are members of the millennial generation. The nature of this survey is purely exploratory, with the goal of assessing whether Facebook use in one program supports or challenges the findings in the extant literature. The degree to which those findings are challenged will help clarify the need for and direction of future research. Finally, we will discuss the ethical dilemmas posed by Facebook, make recommendations on how counselor educators can prepare students to use Facebook ethically, and ensure that programmatic use of Facebook maintains the highest ethical standards.

Privacy Settings on Facebook

Before examining the literature, it is important to review the concept of privacy and privacy settings in Facebook, since the way Facebook users deal with privacy is critical to ethically-sound counseling practice. Personal information can be displayed on Facebook including name, address, e-mail, phone number, alma mater (high school and college), current employer and marital status (Facebook, 2013). In addition, questions about spiritual and political beliefs, interests and hobbies can be shared. Finally, the wall, a kind of virtual poster board, offers an opportunity to display any comments one wants to make about a particular topic (such as current events and topics, or a personal story) and has a platform to upload pictures. With each of these primary areas, users can determine whether the public, friends-of-friends, or friends only can see the information. Establishing privacy is usually done at one of these three levels, and Facebook defaults to public; so if a user does not know how to set privacy, most everything will be available for the public to view. This last point is especially salient for counseling students, since their familiarity with the technology of privacy settings directly bears on protecting their boundaries of privacy and keeping clients from accessing personal information.

Why Counseling Students Use Facebook: The Millennial Generation

Within the business profession, the concept of each generation holding its own sets of values is well documented (see Bergman, Fearrington, Davenport, & Bergman, 2011; Howe & Strauss, 2003; Mehdizadeh, 2010; Reith, 2005; Sandfort & Haworth, 2002; Steward & Bernhardt, 2010; Twenge, 2010; Twenge, Campbell, Hoffman, & Lance, 2010). For instance, several comparisons are made between the Silent Generation, baby boomers, Generation Xers, and Millennials comparing work values, school values, and marketing strategies (Twenge, 2010).

A starting point for understanding why the millennial generation of counseling students would be frequent users of Facebook is the role technology has played throughout these students’ development. As Reith (2005) has observed, the millennial generation is more technologically savvy than previous generations. The term researchers used to describe a generation born into the world of current technology is digital natives, as opposed to previous generations, termed digital immigrants, because they developed familiarity with technology as the technology emerged (Prensky, 2001). Additionally, the millennial generation came of age at a time when digital communication was crucial to maintain ties. Reith (2005) observed that many Millennials had parents who involved them in a variety of organized activities, which required highly structured schedules. He proposed that because of limited free time to socialize with friends, perhaps using technology such as texting and social networking provided them with an avenue to informally connect with others in their otherwise busy schedules. Ultimately, the use of SNS and especially Facebook became an integral part of millennial culture (Hazlett, 2008; Salaway et al., 2008).

Howe and Strauss (2003) and Reith (2005) reported that the millennial generation is more conventional than previous generations. They tend to have positive experiences with their parents who enforce rules and, consequently, seem to be trusting of authority and institutions. Perhaps this perception of trusting institutions such as Facebook increases the perception of Millennials that their information is private and safe.

Another possible cultural characteristic is related to the frequent description of Millennials as being narcissistic. One study, using a national sample of 15,000 high school seniors, was able to link narcissism with this generation (Twenge, 2010). Twenge deduced that the experiences of being wanted and therefore feeling special, and of being overprotected and given less responsibility, all may contribute to the higher scores on narcissism by Millennials (Twenge, 2010). Stewart and Bernhardt (2010), after administering the California Psychological Inventories (CPI) to 588 undergraduate students, also found that Millennials scored high on narcissism compared to students from previous generations. They suspected that one possible explanation for these results might be that Millennials are launched into adulthood much later as compared to previous generations. Mehdizadeh (2010) used the Narcissism Personality Inventory (NPI)-16 to assess the level of narcissism of 100 students who were Facebook users at York University. Strong correlations were found between higher scores on narcissism and self-promotional information displayed on the wall. The author asserted that the venue used to post one’s status on Facebook established an acceptable culture of boasting in this forum, which was a criterion used to establish the level of self-promotion.

Thus, the research suggests that Millennials may use Facebook more than previous generations (Hazlett, 2008; Salaway et al., 2008) because of several factors such as the experience of being digital natives; the convenience of connecting with friends through SNS to compensate for busy schedules; trust in institutions; and the correlations found between Millennials and higher scores on narcissism. At the same time, the research is limited, and it would be prudent not to stereotype a generation as narcissistic without more compelling evidence. It also is important to note that the measures used in the above-cited students did not ascribe pathological value to the construct of narcissism, as opposed to how clinicians tend to use the term.

How Millennials use Facebook: The Issue of Privacy Settings

While there is no literature on privacy settings and counseling students or novice counselors, a number of studies have looked at how the millennial generation tends to use privacy settings on Facebook. For the purpose of this article, the most important research involves Millennials involved in health care of some form. MacDonald et al. (2010) looked at the Facebook pages of young doctors in Australia and found that just over a third did not use any privacy options at all. Most of the doctors’ Facebook pages revealed personal information like spiritual or political beliefs, but withheld information such as home address and phone number. Very few of these pages demonstrated inappropriate behaviors such as drinking or using foul language when posting on the wall. However, many doctors had photos that were revealing and perhaps inappropriate for patients to view.

Lehavot et al. (2010) surveyed psychology students and found that about 60% allowed only friends to view their page, while 34% allowed the public to have full access to their Facebook page. The remaining 6% were unsure about privacy settings. Despite the high percentage of users who limited access to friends, they still posted questionable information or photos. When asked, about 3% of respondents had photos and 6% had information that they would not want classmates to see. Those percentages increased when asked about information or photos they did not want faculty (11%) and clients (29%) to see. Taylor, McMinn, Bufford, and Chang (2010) surveyed psychology students and psychologists and found that 85% of those with a Facebook page used at least some level of privacy. However, it is possible that this figure is so high because the sample included licensed psychologists, who may be older than Millennials and more conscientious of potentially crossing boundaries with clients who might gain access.

Other studies, not with health providers, but with Millennials in general, seem to indicate who among this generation would be most likely to disclose personal information; these findings may be relevant to counselor educators if they help identify which students are most likely to need instruction on protecting their Facebook privacy. What the literature suggests is that those individuals who are most likely to allow personal information to be seen are male and people not involved in romantic relationships (Fogel & Nehmad, 2009; Mehdizadeh, 2010; Nosko, Wood, & Molema, 2010; Salaway et al., 2008). The fact that young men tend to use Facebook for self-disclosure may relate to findings in other studies that Facebook disclosure is associated with the trait of risk-taking (Fogel & Nehmad, 2009). The one exception to the finding that men tend to disclose more than women relate to the display of photos, which appears to be a behavior associated with female Millennials (Mehdizadeh, 2010; Salaway et al., 2008).

Consequently, since the research found that about 15%–30% of users in the health professions do not use any privacy settings at all in Facebook, counselors-in-training also may be at risk (Lehavot et al., 2010; MacDonald et al., 2010; Taylor et al., 2010). For individuals who did establish some level of privacy, many men posted information and women posted photos that they would not want clients, professors, or supervisors to see (Fogel & Nehmad, 2009; Lehavot et al., 2010; Mehdizadeh, 2010; Nosko et al., 2010; Salaway et al., 2008). In addition, individuals who posted their relationship status as single seemed to reveal more information, and many Millennials in counseling programs are likely to be single (Nosko et al., 2010). However, no research has been conducted to determine if these results resonate with the counseling profession.

Graduate Student Assessment of Facebook Use

Given the growing awareness of the graduate counseling student population at CSUF and the characteristically large number of students classified as Millennials, we, the authors, wanted to evaluate the level of disclosure with our own sample of students. The purpose of this survey was to evaluate whether millennial students in our graduate program used Facebook more than older generations. Secondly, we wanted to explore the risk factors associated with decreased use of privacy settings, such as being male, single and from the millennial generation as the literature seemed to indicate. Finally, we wanted to assess the impact of discussing the ethical challenges and uses of Facebook in each section of our law and ethics classes on privacy settings given the results obtained from the survey. This survey was meant to provide a descriptive understanding of our students to compare with the extant research.

Social Networking Survey

A brief survey was created based upon questions that arose from the literature regarding usage and privacy settings. The survey was approved by the Institutional Review Board at our university and was organized into four distinct areas that could be easily completed online. These areas included student consent to complete the survey, demographic information, social networking information and Facebook questions. The social networking information dimension asked questions about student involvement in SNS and knowledge about privacy settings. The Facebook questions addressed issues related to one’s profile and the public or private display of personal information.

The online survey was completed at two time intervals: late January 2012 (admin. 1) and early November 2012 (admin. 2). Prior to disseminating the survey in January 2012, the faculty had not yet incorporated any discussion about social networking or Facebook with students. During spring, summer and fall all sections of the law and ethics class included at least some discussion about social networking, using Facebook as an example. Each faculty member presented the information informally and without uniformity. Despite the differences in addressing this area in class with each of the instructors, who also are authors of this paper, the possibility of clients making friend requests on Facebook was presented, and students were encouraged to brainstorm ways in which they might handle this situation.

Participants

Students for this online survey were recruited from approximately 220 current matriculating students in the graduate program in counseling at a public university on the West Coast. They were invited via e-mail to participate, were guaranteed confidentiality, and had no negative consequences for refusing to participate. However, in both administrations they were provided with an incentive in a random drawing to win a $25 gift card from iTunes.

In late January 2012, we obtained 56 responses, and in early November 2012, we received 63 responses (24% and 29% of the students, respectively). In the initial administration, 92.9% of respondents reported using SNS, and 100% of those who used sites participated on Facebook. The second administration indicated that 90.3% of the respondents used SNS with 98.2% of this group participating on Facebook. These results are consistent with the literature about the popularity of Facebook among SNS (Salaway et al., 2008). Primary demographic information on each respective survey is found in Table 1. Note that slightly more than half of the respondents in both administrations were from the millennial generation.

Table 1

Demographic Information

Results

First Administration

The first set of results extrapolated from the survey included a review of risk factors for using few or no privacy settings on Facebook including being male (Fogel & Nehmad, 2009), having a relationship status of single (Nosko et al., 2010), and being from the millennial generation (Nosko et al., 2010). The first survey supported the literature with regard to gender. In our initial survey, 50% of the male students (4 of 8 men) used privacy settings for less than half of their information whereas only 14.6% of the female students (6 of 41 women) used privacy settings for less than half of their information. Regarding photos or videos that students would not want clients to see, 50% of men and women surveyed had such photos or videos. However, nearly all male students (6 out of 7) had information they would not want clients to see; the eighth male student did not specify. In contrast, 50% of female students had information they would not want a client to see.

The trends Nosko et al. (2010) found regarding the relationship between being single and using lower privacy settings did not hold true in our first sample of students. Of the fifteen students who identified as being single on the first survey, only one student did not have the highest levels of privacy established. In contrast, 9 of the 38 students who reported being in a relationship had set less than 50% of their information with some level of privacy. Therefore, in our graduate counseling student population, being single did not seem to correlate with lower levels of established privacy.

Finally, Nosko et al. (2010) found that younger individuals tended to have more information displayed on their Facebook page. When evaluating the reported levels of privacy established by our students in the first survey, this trend did not hold. The majority (86%) of students from the millennial generation reported establishing privacy settings for at least 50% of their information. Students from older generations were slightly less likely to establish privacy for at least 50% of their information. In our sample, 71% reported establishing this level of privacy. Therefore, our data did not support the trends found in the literature for establishing levels of privacy relating to age or relationship status, but we did find that male students seemed to display more information.

Differences Between Administrations

Next, we had a comparison made between the first and second administrations of the survey to determine if teaching about the ethical challenges of using Facebook would impact privacy settings. In the first administration, about 48% reported establishing the maximum privacy allowed, and another 30.8% reported that more than half their information was private. The second administration showed an increase in the maximum privacy allowed at 63.2%. Another 26.3% of students reported having over half their information private. These results indicated an increase in privacy settings from the first to the second administration.

We wanted to explore some possible explanations for this change. First, we had a third party compare the two lists of names and found that 11 students completed the survey a second time: seven already had the highest level of privacy set in the first survey and did not change their settings; three increased their level of privacy; and one did not have the highest level and did not increase the level of privacy. Some students made comments in the first survey stating that participating in the survey made them more aware of privacy settings, and consequently they wanted to establish more rigorous privacy settings; it appears that three students did, in fact, make this change. These results imply that at least part of the increase may have simply been due to completing the initial survey. Next, we had a third party review the names of all students who were currently in or had taken the ethics course between the two administration times. The results indicated that 10 students who took the second survey had completed an ethics course between administrations, and we know that during this time all instructors who taught ethics discussed the ethical challenges of using Facebook. In reviewing the results of the second administration, we found six had established the highest level of privacy; two had 50% or more of their information set as private; and two had less than 50% of their information set as private despite having been exposed to the risks associated with limited privacy. We hope that these students are simply less active users of Facebook and therefore do not feel the need to establish more rigorous settings, but we do not know for certain.

Several articles noted that a few individuals seem to establish some privacy settings, but still had photos that can be seen by the public (Lehavot et al., 2010; MacDonald et al., 2010; Salaway et al., 2008). Much like the rigor of privacy settings, the results of photos displayed to the public shifted between each administration (see Table 2).

Table 2

Photo Visibility Privacy Level on Facebook

Lehavot et al. (2010) found that 3% of respondents had photos and 6% had information they would not want their classmates to see. These numbers increased when asked about faculty (11%) and clients (29%). Our results showed this same trend with both administrations of the survey. Table 3 shows the trend for pictures or videos that students would not want classmates, professors, supervisors or clients to see. Table 4 reveals a similar trend about information posted that students would not want others to see. These trends did not change substantially between administrations as we had hoped. We suspect that even though some students increased their levels of privacy, they did not remove information or photos assuming that the improved privacy settings would protect them. This may be explained by the assertion from Howe and Strauss (2003) and Reith (2005), who believe the millennial generation is more trusting of institutions since they had positive experiences with their parents.

Table 3

Picture and Video Visibility Privacy Level

Table 4

Information Posted Privacy Level

We wanted to examine the implications for the current generation of counseling students, as well as for counselor educators on the use of SNS, and specifically Facebook. The potential ethical minefields Facebook presents for students at every level of counselor development persuaded us that both a perusal of the literature and a survey of our own students’ Facebook use would yield important information. In particular, we looked at the prevalence of Facebook use, its possible roots in the culture of Millennials, and the extent to which Millennials expose their private lives on this particular SNS. The results of our two surveys helped us understand Facebook use in our own program, informing us as faculty about retooling ethics education for our students. The surveys also lent support to previous research findings in some areas and raised questions regarding the generalizability of others. However, our survey results are only descriptive and may not be representative of all of our students or of counseling students across the country.

Facebook Risks for Counselors-in-Training

Millennials are the most prolific generation of users of social networking sites (Hazlett, 2008) and therefore, compared to previous generations, have been found in the literature to be more likely to have posted personal information on a SNS. Our data did not support this assertion; the reasons for this phenomenon remain unclear and require further research. It has been suggested that this generation is particularly self-absorbed, and there is some empirical evidence supporting this notion (Mehdizadeh, 2010; Steward & Bernhardt, 2010; and Twenge, 2010), but a less pathologically-tinged explanation may be that self-disclosure on Facebook and other SNS is a cultural norm for them. Regardless, the critical issue is the extent to which counseling students are employing Facebook privacy settings. If, indeed, Millennials tend to use fewer privacy options and are likely to post more information on the wall as compared to other generations (Nosko et al., 2010), their increased use of SNS places this group at a higher risk for crossing boundaries between their personal and professional lives as they enter the counseling profession (Allen & Roberts, 2011). Our survey of students supported the concern that counseling students had created boundary issues for themselves with Facebook use previous to entering the program, and continued to place themselves at risk for further crossings while in the program. Over 90% of our students who responded to our survey used Facebook, and over half had posted information they would not want clients to see. It should be noted that almost half of the students in our first sample and a somewhat higher percentage in the second survey had established maximum levels of Facebook privacy. But that still meant a significant number of our counseling students had recently posted photos, videos and personal information that might compromise a professional relationship if clients were to discover them, and many of these students were using less than maximum privacy settings. Even those using maximum settings continued to post revealing personal information, but with the expectation that no client could access it.

In fact, even with the use of privacy options, counseling students may not be aware of the challenges of controlling access to their Facebook content. Privacy settings do not guarantee that information will remain private. For instance, when using the friend-of-a-friend level of privacy, it is possible that students have unknown common acquaintances with professors or clients; this might inadvertently give a client or faculty access to their information. Consequently, the unintentional dissemination of information remains a possibility and an ethical dilemma. Furthermore, Facebook friends may not use privacy settings, and they may pull an inappropriate picture from a user’s wall and “tag” it, making it available for clients or faculty to view. Consequently, the unintentional dissemination of information remains both a possibility and an ethical dilemma, and requires further study to have a clearer understanding of these risks.

What are the actual ethical consequences raised by Facebook use? Initially, potential damage to clients if they discover revealing information about their counselors could be a serious risk. The credibility of the counselor can be impaired, clients may become tantalized by the counselors’ personal life, and the counselor’s often challenging efforts to maintain clinically helpful boundaries in sessions may be compromised. For psychologically fragile clients who need to temporarily perceive their counselors as authority figures while they recover and develop new coping skills, the discovery of their counselors’ private life might undermine their recovery.

A related issue, as described in The American Counseling Association’s code of ethics, is the counselor’s ethical role in making a distinction between one’s roles personally and professionally (ACA, 2005). Using SNS is where the line between one’s professional world and private world could mingle (Birky & Collins, 2011). Judd and Johnston (2012), addressing related issues for social work training programs, make observations that seem equally relevant to the counseling profession. For example, they note the importance of impression management and the development of an identity that reflects a level of professional dignity consonant with the mission and ethics codes of the particular mental health discipline. When personal information such as a student’s romantic life or photographs of a student in informal situations becomes available, dignity can be compromised, affecting not only the student-counselor, but the profession itself. If that material is seen by a client, the counseling relationship may be damaged, and if seen by a fieldwork agency clinical director or potential employer, the student risks losing a work opportunity.

Myers, Endres, Ruddy, and Zelikovsky (2012) noted an additional concern when they raised the issue of what happens when a client may want to befriend the counselor on Facebook. Agreeing to the request may expose the counselor’s private life, while refusing the request risks wounding the client. In either case, handling the issue requires careful ethical decision-making and skilled intervention with the client. Perhaps one of the most troubling risks associated with self-disclosure on Facebook or other SNS is the increased risk of counselors-in-training being stalked by psychologically disturbed clients (MacDonald et al., 2010). These potential boundary consequences are assertions, though, and merit the need for further research.

Some have argued that Facebook boundary crossings could be therapeutic and appropriate under the right circumstances. Taylor et al. (2010) asserted that younger clients and professional counselors may believe that the use of SNS is an appropriate method of communication or even a therapeutic tool. The millennial generation and perhaps even the current zeitgeist values transparency more than ever before (as seen on television shows such as Oprah or Dr. Phil), which intentionally blurs the boundaries between personal and professional roles in the interest of a more authentic relationship (Zur, Williams, Lehavot, & Knapp, 2009). Birky and Collins (2011) considered context when using SNS between counselor and client. They suggested that the use of SNS might be appropriate under certain circumstances such as theoretical orientation, length of relationship, and both the client’s and counselor’s culture. Nevertheless, while there might be therapeutically valuable uses of SNS in some cases, the risks of Facebook exposure resulting in negative consequences for both counseling students and clients may be high.

Facebook Risks with Admissions and Advising

Prospective and current counseling students may not realize their risks of participating on SNS (Harris & Younggren, 2011) with regard to their education and training. Lehavot (2009) published an article exploring the ethical use of doing Internet searches by faculty members in admissions and advising capacities. Many individuals reported a belief that their blogs or what they posted on SNS was private (Lehavot, 2009). However, Lehavot (2009) argued that in some ways, the Internet is seen as a public domain; therefore, providing an informed consent to prospective students or students entering into a counseling program may be a way to ameliorate the perception by students that this information is private. Even with informed consent, there may be complications. Faculty members may risk discovering information that negatively biases them if they conducted Internet searches on problem students. Students may feel betrayed by this course of action, and documentation could be complicated if they would need to be counseled out of the program. Finally, Lehavot (2009) asserted that completing Internet searches may inadvertently be discriminatory because not all students have equal access. In the admissions process, for instance, one student may have significant positive information on the Internet, while another does not because of lack of resources, despite having similar accomplishments. In contrast, one student may have made a poor judgment in which a photo was taken and subsequently posted online unbeknownst to him or her, while another student may not have had the misfortune of a photo being posted despite making the same poor decisions. Prospective and current students may not consider how much information could be available to faculty or others when using SNS, which could be problematic. More research is needed to assess the desire of counselor education programs seeking to utilize Internet searches for admissions and advising and how this might impact the admissions and advising process.

Recommendations

To recommend that one avoid the use of Facebook or SNS in general would certainly eliminate any ethical hazards of boundary crossings in counseling, supervision and counselor education. However, this solution is unrealistic, if not impossible. SNS are increasingly becoming embedded in the culture as a way to connect with others, both near and far (Reith, 2005). Therefore, the counseling field should aspire to identify methods to reduce rather than eliminate risks associated with using Facebook. Since the Internet is an integral part of students’ and faculty members’ lives, discussing the impact of using Facebook or other SNS is imperative (Lehavot, 2009). Students should be informed as soon as they begin the program about how social networking culture tends to blur personal, social and professional boundaries. Consequently, counseling students should be made aware of the impact that using Facebook could have on socializing with each other and on the development of professional behavior, especially as they begin seeing clients. Students also can be advised to do an Internet search on their own name to discover what personal information is available online to clients (Zur et al., 2009).

Counselor educators can encourage students to make better decisions about their use of Facebook. For instance, privacy settings on Facebook are dynamic and have become increasingly complex. Students should become educated about this complexity and the risks associated with each level. Students should be aware of risky behavior online, such as publishing photos of themselves in compromising situations. In addition, students should refrain from making inappropriate YouTube videos or communicating in ways that display unprofessional behavior. Counseling students should be advised to maintain all client discussions or references of client information within a context of face-to-face clinical supervision meetings, meetings with peer counselors, or prescribed dialogues with faculty members, and should not reference anything related to clients on Facebook. Furthermore, communicating with clients on Facebook, or any other social media outlet, should be discouraged in most cases; professional boundaries can be too easily crossed.

One encouraging implication that emerged from the administration of both surveys in our graduate counseling program was that it might be fairly easy to change students’ attitudes about Facebook privacy. Discussion of Facebook issues in an ethics class that occurred between the two surveys may explain why more students were using maximum privacy settings in the second administration sample. It also is possible that some students increased their privacy as a result of having participated in the first administration, suggesting that just making students aware of these issues impacts their Facebook practices. Students in the second administration increased privacy levels for photos, videos and information. Moreover, their primary goal was in preventing access by clients, suggesting their chief concern was in accordance of the ethical principle of “do no harm.” Further research is needed to determine how much exposure to Facebook issues, both ethical and technological, is necessary to help students ensure maximum privacy protection. Introducing discussion into a program’s ethics class and, as noted above, addressing the issue at the beginning of the program, would seem to be natural methods for achieving this goal. However, graduate counseling program leaders may choose a variety of learning experiences to help students deal with the Facebook privacy dilemmas, including ethics classes, introductory courses, practicums or special workshops, or they may infuse options throughout the curriculum.

One way to start enhancing student self-awareness is by exploring the meaning of transparency and how this language may be interpreted among the millennial generation as compared with other generations. Dialogues about the levels of self-disclosure revealed on Facebook as compared with face-to-face interactions could enhance students’ awareness. Students can brainstorm potential dilemmas that may emerge when participating on Facebook that may cross boundaries with other students, faculty or clients. Developing a proactive strategy when private information becomes unfortunately disclosed is another important topic to discuss with counseling students to enhance awareness. As Levahot (2009) has noted, the discovery by a student trainee that a client has accessed the trainee’s personal information can lead to a therapeutically valuable conversation with the client during treatment.

Counseling program leaders should carefully evaluate and establish a policy about investigating clients on Facebook without their informed consent. Viewing this information can place counseling students in very difficult dilemmas about appropriate professional behavior, particularly if a search reveals the potential or expectation of clients to cause harm to self or others. Students should be advised to remain up-to-date with emerging technologies their clients may use.

Counselor educators should be literate about Facebook and other technological advances that students may be using. Students are often more competent in these areas, and learning about how students engage on Facebook may open more productive communication about how to maintain appropriate professional boundaries. Counselor education program leaders have an additional responsibility of training agency supervisors on the potential benefits and risks of using SNS. Lehavot et al. (2010) and Taylor et al. (2010) noted that if supervisors seem dated and technologically challenged to supervisees, then supervisees will be less inclined to bring up the conversation when challenges arise. Consequently, supervisees may make poor decisions leading to unintentional boundary crossings with clients. Therefore, it is critical for supervisors to also be prepared to initiate a conversation about the use of Facebook.

Finally, counselor educator program leaders should develop policies regarding investigation of students’ Facebook pages by instructors, supervisors and admissions committees. Instructors and supervisors should initiate conversations with students about mutually participating on SNS such as Facebook. SNS sharing may lead to inappropriate disclosures of personal information that could compromise the faculty-student or supervisor-supervisee relationship. If admission committees intend to look at applicants’ Facebook pages, this policy must be included in departmental Web pages and printed materials describing admissions criteria. The most desirable approach is probably that admissions committees should refrain from using the Internet in general to examine a student’s fitness for a program.

The use of SNS has increased in the last three years, even among the baby-boom generation and Generation X (Hazlett, 2008). Counselor educators have an opportunity and responsibility to become familiar with this technology to protect counselors-in-training and the clients they serve. Additional research should be conducted on the current use of both SNS and privacy settings by counseling students. Our survey suggested that most of our millennial generation counseling students used Facebook; posted photos, videos and information they would not want clients to see; used various levels of privacy settings; and readily increased their privacy settings once exposed to information about Facebook risks. However, this was preliminary information with two small samples; more thorough research is needed in assessing the extent of Facebook use among counseling students, their familiarity and use of privacy settings, and best practices for teaching appropriate use of Facebook for counselors. In addition, determining the types of students who are less likely to establish appropriate privacy settings could be evaluated in order to target those students and reduce negative outcomes. Research could be conducted to evaluate the efficacy and inherent risks of using SNS in counselor education programs and in counseling as well.

Though the basic foundation of counseling has not changed drastically in recent years, current technologies have the potential to enhance or diminish therapy. The setting of counselor education programs is an excellent environment to explore benefits and risks associated with integrating new technologies. By doing so, counselors can remain informed about evolving technology to enhance their work with clients.

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Leah Brew, NCC, is Chair and Associate Professor in the Department of Counseling at California State University, Fullerton (CSUF). Joseph M. Cervantes is a Professor and David Shepard is an Associate Professor, both in the Department of Counseling at CSUF. Correspondence can be addressed to Leah Brew, Department of Counseling, P.O. Box 6868, Fullerton, CA 92834-6868, lbrew@fullerton.edu.

A Therapeutic Approach for Treating Chronic Illness and Disability Among College Students

Oct 15, 2014 | Article, Volume 3 - Issue 3

Katie L. Haemmelmann, Mary-Catherine McClain

Research in chronic illness and disability (CID) in college students has demonstrated that students with disabilities encounter more difficulties psychosocially than their nondisabled counterparts. Subsequently, these difficulties impact the ability of these students to successfully adapt. Using the illness intrusiveness model in combination with cognitive behavioral therapy (CBT), the authors propose therapeutic interventions that could be taken with these students to enhance their overall well-being, adaptation and academic success. The authors also provide final thoughts with directions for future research and application.

Keywords: chronic illness, disability, illness intrusiveness model, cognitive behavioral therapy, college students with disabilities

Chronic illness and disability (CID) impact more than 35 million Americans, often interfering with their everyday life (Livneh & Antonak, 1997). The condition is typically accompanied by a prolonged course of treatment, an often uncertain prognosis, constant and intense psychosocial stress, increasing interference with the performance of daily activities and life roles, and conflict with family and friends (Livneh & Antonak, 1997). Approximately 11% of undergraduate students reported having a disability in 2008 (National Center for Education Statistics, 2011) and 88% of colleges are continuing to enroll students with disabilities (The Princeton Review, 2011). In addition to adjusting to the presence of a disability, adjustment to independent living and beginning academic courses at an undergraduate institution can be challenging for someone with a chronic illness or disability.

The severity of the disability and its functional limitations do not always correlate in a uniform pattern with coping and adjustment (Lustig, Rosenthal, Strauser, & Haynes, 2000). Similarly, disability may include permanent and significant changes in an individual’s body appearance, functional capacities, body image and self-concept (Lustig et al., 2000). This variable, typically referred to as psychosocial adaptation, becomes compounded among college students and deserves further investigation. In order to better understand the adaptation process, conceptualize cases, and provide the most effective services to college students with disabilities, it is important for researchers to test comprehensive models specifically designed to aid in the interpretation of illness-induced interference. Similarly, counselors need to understand and implement empirically supported interventions, techniques and related strategies to assist individuals with disabilities in the transition to higher education.

Currently, there is a dearth of information pertaining to the adjustment of young people that can be applied to college students with chronic illness and disabilities. Additionally, theories within the rehabilitation, quality of life, and counseling literature are used to translate theory into practice. After describing the nature of transitions individuals face upon entering college, discussing current legislative policies, and examining identity formation, this article provides an overview of the illness intrusiveness model and theoretical framework for CBT. Next, the article offers strategies for implementing an integrated model, including elements of illness intrusiveness and CBT, with the college population. Treatment strategies and intervention techniques are also described. Finally, accommodations, the importance of social support, and future directions are addressed.

Identity Formation and College Transition

     Identity formation typically continues during the late teens and early 20s (Luyckx, Schwartz, Soenens, Vansteenkiste, & Goossens, 2010), which also is the time when youth attend or transition to higher education. During this time, the individual is still a child on one hand, yet an adult on the other hand. According to Wright (1983), this creates an overlapping situation in which the adolescent with the disability is not only struggling with the problematic overlap of “child” and “adult,” but also that of “normal” and “disabled.” This is a complex time filled with instability and uncertainty regarding the years ahead. A synthesized sense of identity can provide beneficial effects on an individual’s adjustment (Luyckx et al., 2010), and a comprehensive sense of self can be facilitated through psychotherapeutic interventions. Also, the process of adaptation is multidimensional, complex and subjective (Smart, 2001). Consequently, a comprehensive framework for assessing and intervening is critical for fostering positive counseling outcomes.

Preparing someone for a career is a task that should not be taken lightly, but given the utmost attention. Career can be defined as the “time extended working out of a purposeful life pattern through work undertaken by the person” (Sampson, Reardon, Peterson, & Lenz, 2004, p. 6).This definition helps clarify the idea that a career is an activity people engage in regularly through a lifetime. Employment opportunities for this population are already limited by job choice (variability), available hours, and reduced salary (Schmidt & Smith, 2007). Also, enhancing potential job opportunities for individuals with disabilities is beneficial, as research has shown that the onset of a disability can negatively influence one’s vocational identity—potentially leading to poor adjustment, limited self-direction and goal setting, and lower career development (Enright, Conyers, & Szymanski, 1996; Skorikov & Vondracek, 2007; Yanchak, Lease, & Strauser, 2005).

According to Kirsh et al. (2009), with the economy becoming increasingly knowledge-based, and as the forces of globalization transform to eliminate entry-level positions, people with limitations in cognitive function may become increasingly marginalized. This is not to say that this population can maintain only entry-level positions, but to reiterate that as there is an increase in students with disabilities attending universities, there is an increase in job requirements, qualifications and performance levels required by all populations. Enhancing education and overall college experience with counseling will assist these students as they acquire new skills to use for the rest of their lives.

Need for Psychotherapeutic Interventions

In the past 20 years, there has been a trend of more persons with disabilities pursing higher education. Based on the National Organization on Disability Harris Survey of Americans with Disabilities conducted in 2000, there was a marked increase in persons with disabilities having graduated from high school (77%) compared to those in 1986 (61%). Based on several legislative and social policies implemented in the 1980s (Canadian Human Rights Act, 1985) and 1990s (Individuals with Disabilities Education Act, 1997 [IDEA]), an estimated 8–18% of students in higher education are students with disabilities (Sachs & Schreuer, 2011). Furthermore, persons with disabilities entering postsecondary education are making significant progress toward successful completion of their program of studies (Stodden & Whelley, 2004). This is why educators, administrators, and policymakers are working to improve services while also providing accommodations, interventions, and support services in postsecondary settings (Barazandeh, 2005; Brinckerhoff, Shaw, & McGuire, 1992; Dowrick, Anderson, Heyer, & Acosta, 2005;  Dutta, Kundu, & Schiro-Geist, 2009; Johnson, 2006; Swanson & Hoskyn, 1998; West et al., 1993). Examples of such accommodations include transportation, separate locations for test taking, access to private study rooms, and extended time on exams.

With the reauthorization of the IDEA in 1997 (PL 94-142), there was an increase of higher expectations upon quality preparation to postsecondary education and employment for persons with intellectual disabilities. The Americans with Disabilities Act (ADA) sought to provide reasonable accommodations to ensure equal access to learning and work environments (Jacob & Hartshorne, 2007). The vocational rehabilitation system exists to provide assistance to individuals with disabilities seeking employment. This can be a good support system for those interested in higher education, but only supports eligible consumers (Gilmore & Bose, 2005). While these recent pieces of legislation have been incredibly beneficial and have encouraged individuals and professionals alike to actively engage in advocacy, they do not specifically address the access or right to counseling as an appropriate accommodation.

As students transition to postsecondary education, fear of the unknown affects not only those transitioning, but the people around them (e.g., professors, administrators or counselors) as they experience a change in roles. Parents, for instance, may want to protect their child from the risks of the larger world, and limit them by choosing self-contained and protected programs (Stodden & Whelley, 2004). This approach may deprive students of the opportunity for further education. With optional counseling specifically designed for those individuals with disabilities transitioning into the next phase of life, this may be reassuring not only for the student, but also for the student’s primary support system. One counseling model to implement in such situations is the illness intrusiveness model.

Illness Intrusiveness Model: Theoretical Framework

The illness intrusiveness model was developed based on the idea that illness-induced interference, in addition to interests and valued activities, compromises one’s psychological well-being—ultimately contributing to emotional distress. It is derived from a variety of sources such as functional losses, treatment side effects, disease and treatment-related lifestyle disruptions, and disease-related anatomical changes (Devins, 2010). The model postulates that when there is a decrease in positively reinforcing outcomes from valued activities and limited personal control (e.g., mood level) to obtain positive outcomes and avoid negative ones, significant adaptive changes and coping demands occur (Devins, 2010).

By examining the five factors of disease—that is (1) treatment requirements, (2) personal control, (3) nature of life outcomes, (4) psychological factors, and (5) social factors—one can inspect the level of participation in valued activities, also known as illness intrusiveness. Illness intrusiveness may serve or act as a mediating variable by which unbiased circumstances of disease and treatment influence psychosocial well-being and emotional distress. Specifically, illness intrusiveness is based not only on the experience of the person, but also the psychological characteristics based on objective and subjective concepts (Roessler, 2004).

This model posits that social and psychological factors have a direct effect on life outcomes. Time spent transitioning into college is heavily influenced by social factors, which can create positive or negative experiences in the individual. If the social factors weigh heavily on the individual’s psychological factors in a maladaptive way, the person’s coping abilities and adaptation skills may be compromised and lead to undesirable outcomes. The model also encompasses the idea of locus of control, presented as personal control of self-efficacy (similar to what was described earlier in this article), the idea being that low levels of personal control result in learned helplessness (Roessler, 2004). Furthermore, the theoretical framework hypothesizes that intrusiveness mediates the psychosocial effect of chronic conditions. Indirectly through the effects on intrusiveness, illness and treatment variables are believed to impact subjective well-being (Bettazzonie, Zipursky, Friedland, & Devins, 2008). Incorporation of the illness intrusiveness model can assist professional counselors and clients alike in laying out a clear path of focus (i.e., the five factors of disease; Roessler, 2004) while simultaneously increasing one’s coping and adaptation skills, as well as external allocation of self-efficacy. After describing an assessment tool and following a review of ways in which the illness intrusiveness model has been applied to specific illnesses and populations, the authors provide a rationale for implementing this model among college students with disabilities.

Application of the Illness Intrusiveness Model

Previous research suggests that applying various components of the illness intrusiveness model (e.g., examination of domains) in end-of-stage renal disease clients is effective in objectively measuring varying modes of treatment (e.g., transplantation, dialysis; Devins, et al., 1983). Furthermore, the levels of illness intrusiveness directly affected the psychosocial impact of the condition. Additionally, it was noted that severity levels of hyperhidrosis shared a significant positive correlation with scores on the Illness Intrusiveness Rating Scale (IIRS) (Devins et al., 1983). Intrusiveness scores were weakly related to efforts to control the condition (i.e., medications and ointments), which is indicative of the value of knowledge of self-care techniques and action-based knowledge (Roessler, 2004). Empirical support also has pointed to illness intrusiveness as a precipitant for depression and for feeling a loss of control. This has been observed in persons with arthritis, cancer, diabetes and multiple sclerosis (Roessler, 2004). Furthermore, Devins (2010) notes that levels of illness intrusiveness vary according to illness severity, and weigh in differently for valued activities. This is of particular importance when collaborating therapeutically with college students with disabilities, since there are a wide range of disabilities (e.g., learning disabilities, physical disabilities, mental illness) and they vary in severity (e.g., psychiatric symptoms, functional ability). Subsequently, even among college students with disabilities, there is a wide array of differences; one would expect a shift in valued activities based on transitioning (e.g., social support, school involvement) and disability interference.

The illness intrusiveness model is ideal for working with college students with disabilities because it focuses on improving psychosocial adaptation outcomes. Specifically, it stresses the effect of psychological, social and environmental variables on the interpretation of the disease (Roessler, 2004). This is essential knowledge for implementing effective therapeutic interventions for this population, because often the transition into the college atmosphere impacts the interpretation of the individual and the disability. Additionally, the theoretical framework helps to estimate the effect of disease interpretation and the intrusiveness of treatment factors (Roessler, 2004).

As mentioned previously, the college student population typically struggles to form self-identity in terms of a developmental framework, and intrusiveness is presented in this model as both an objective and subjective concept. This is noteworthy since these individuals are still processing their identity, their life goals, and their viewpoints. With a helping professional, they can work collaboratively to change perspectives that may be distorted or need reframing. Finally, the illness intrusiveness model implies that intrusiveness has a direct effect on both personal control and life outcomes (Roessler, 2004). Through prevention or early intervention, college students with disabilities will realize and begin to feel empowered as they recognize their ability to take control of their lives. This can further be reinforced by seeing positive outcomes almost immediately when collaborating with the practitioner. Before discussing how the illness intrusiveness model can be integrated with other treatment approaches and how it can be applied to college students with disabilities, it is useful to provide a brief history of general psychotherapy with disabled persons and core principles of CBT with this population.

History of Counseling with Persons with Disabilities

Over the past several decades, four basic approaches to adjustment services (e.g., work acclimation) have emerged in disability literature. While the approaches are not mutually exclusive, each offers a new viewpoint on adjustment for persons with disabilities and sheds perspective on both the client and practitioner.

The work acclimation approach utilizes the psychological principle that the greater degree to which a current environment resembles a future environment, the more likely an individual would behave in the same manner in the future environmental setting. Programs utilized almost exclusively in work centers were pay incentives, peer and supervisory work pressure, production rate feedback, lead workers, and status-promotion incentives.

The problem-solving approach to adjustment services represents the second model. It begins by obtaining baseline measures of the problem and delineates adjustment services to any treatment and training modalities necessary to ameliorate the problem, thus allowing the student to succeed academically and vocationally. It is within this model that the approach employs behavioral counseling and behavioral modification techniques that can be applied in multiple settings or situations (Couch, 1984). For example, in a university setting, students with disabilities can be seen for brief or extended psychological services, in which baseline and outcome data are used to encourage behavioral modification and monitor intrusiveness.

In the developmental approach, clients are viewed as capable, problem-solving individuals, fully qualified to accept responsibility for life and determine personal direction. They are taught self-responsibility and self-potency, as well as beliefs, values, and skills, all of which will enable them to solve problems, maintain a sense of self-worth, and enhance personal identity.

Finally, the education approach takes on a different perspective and focuses on skill deficits. This helps the client to engage in remedial education, learn about available resources, and conquer tasks. Examples of such tasks include acquiring a driver’s license or earning a college degree (Couch, 1984). A focus on skill deficits blends well with the theoretical origins of CBT. The following section briefly describes the framework of CBT.

Theoretical Framework for CBT

Three main goals set forth in the field of rehabilitation counseling pertain to affective goals, cognitive goals, and behavioral goals (Parker, Szymanski, & Patterson, 2005). This is similar to taking a holistic or ecological approach in the field of counseling. It is important to treat not just specific aspects of individuals, but to treat the individuals as humans in their entirety. Thus, when addressing college students with disabilities, it could be important to integrate the illness intrusiveness model with that of CBT. The model itself enables the counselor to apply cognitive and behavioral interventions in order to reduce illness intrusiveness strategically, which could encourage the client to participate in valued activities, redefine personal goals, and restructure irrational beliefs related to intrusiveness (Roessler, 2004).

Furthermore, the counselor is able to provide knowledge of self-management and self-care skills, which is facilitated by task-focused coping and problem-solving skills, both of which are central constructs from CBT and can lead to a positive impact on illness intrusiveness. Finally, by including personal control or self-efficacy as critical variables in the illness intrusiveness model, and as a way to better understand life outcomes, individuals are supported in impacting their perceived self-control on life outcomes related to educational achievement and overall well-being (Roessler, 2004).

Integrating the Illness Intrusiveness Model and CBT

Prior to discussing techniques and skills that can be utilized within this framework and among this population, the present article discusses the importance of incorporating specific concepts or tasks within the realm of a client’s goals. Examining client outcomes of counseling interventions is necessary in the field of mental health and other related fields to acquire knowledge on effective treatments, obtain financial funds, establish accountability, and achieve long-term positive results. In addition to cognitive behavioral techniques, client variables with this population may impact the outcome of therapy. For example, Ju (1982) discovered that clients having 12 years of education do not seem to benefit from receiving information and exploring feelings. Rather, they tend to benefit from counselors who predominantly listen attentively and focus on the facilitation of client expression and concern. Additionally, clients with more than 12 years of education tend to reap the most benefits from counselors who not only emphasize the processing of information, but also share personal values, opinions and experiences with the client. This has potential treatment implications from the start of counseling, because to be a viable candidate for collegiate studies, the individual has to successfully complete 12 years of prior education (either formally or in an alternative manner). As students attending school will always vary widely in age, this factor should be kept in the forefront of the counselor’s mind.

Rehabilitation counseling has a history of being goal directed and behaviorally oriented as opposed to a psychodynamically oriented treatment (Ju, 1982). Similarly, a defining characteristic of CBT is the proposal that symptoms and dysfunctional behaviors are often cognitively mediated; thus, modifying dysfunctional thinking and beliefs can lead to improvement (Butler, Chapman, Forman, & Beck, 2006). By following a psychoeducational model, emphasizing therapy as a learning process that includes acquiring and practicing new skills, learning new ways of thinking, and obtaining more effective ways of coping (Corey, 2005), students with disabilities can benefit from improved adjustment to the college atmosphere.

A central role in CBT is the treatment rationale, which provides clients and counselors with a model of etiology and treatment (Addis & Carpenter, 2000). It is within this framework that the counselor teaches the client to identify, evaluate and change dysfunctional thinking patterns so therapeutic changes in mood and behavior can occur (Padesky & Greenberger, 1995). Additionally, it is imperative to address an individual’s metacognitions, or understanding of self-knowledge, in order to grasp the process of cognition and its outcomes (Hresko & Reid, 1988).

Thomas and Parker (1984) remark on the need for effective counseling with persons with disabilities, identifying the following two main focuses: career and psychosocial issues. This only reiterates the need for therapeutic intervention for this specific population who is trying to further education in order to obtain chosen careers while simultaneously adapting to a new lifestyle and appropriately managing the disabilities. It is by weaving together the major tenets presented in CBT (e.g., thoughts, moods, behaviors, biology, and environment; Padesky & Greenberger, 1995), with the five factors of disease (Roessler, 2004) in the illness intrusiveness model that practitioners will be better able to serve this population. This is not to say that all ten areas will need to be remedied or addressed for each individual seeking treatment. Rather, counselors need to be aware that each individual will have different needs to meet or areas to improve.

Akridge (1981) stated that psychological adjustment is an ongoing process of evaluating the self-in-situation to adaptation. A comprehensive self-assessment in the psychosocial domain is the process of summarizing one’s satisfactions and dissatisfactions within the self and the personally relevant aspects of one’s situation. This could be undertaken within the realm of the therapeutic alliance as the client and counselor are working collaboratively toward agreed-upon goals and a focus on improvement. One could suggest the completion of a prescribed homework assignment addressing the area needing further investigation. The client could then experience an increase in self-confidence through exploring each domain, thus decreasing the impact of intrusiveness.

To begin treatment successfully, the counselor and client need to establish a positive, collaborative working relationship. Aaron Beck emphasized the quality of the therapeutic relationship as basic to the application of cognitive therapy (Corey, 2005). The core therapeutic conditions described by Carl Rogers in his person-centered approach are viewed by cognitive therapists as being necessary, but not sufficient, in producing optimal therapeutic effects (Corey, 2005).

The collaborative relationship is essential because it conveys to clients that they possess important information that must be shared to solve problems. Counselors employ general strategies and treatment models while clients are keepers of all the information about unique experiences—only clients can describe thoughts and moods (Padesky & Greenberger, 1995). This again enables clients to build self-esteem and feelings of self-worth so they begin to feel confident in skills and abilities in areas they may doubt. This in turn impacts the domains of career choice, personal control, life outcomes, and psychological and social factors.

In order to be successful at the collegiate level, one must possess sufficient organizational skills. When working with students with disabilities, it is important to address this topic and readdress it throughout the psychotherapeutic process. This approach is key to assist clients in learning to control the things they can in regards to homework assignments, readings, and note-taking, so that if something unexpected or overwhelming becomes more pertinent in unpreventable circumstances, clients will be able to recognize that they have done what they can to contain circumstances within their personal control.

This also relates back to the topic of increasing awareness of metacognition and the cognitive processes. For example, a student may begin to recognize trouble learning a particular topic or realize that there is a need to double-check written work. Similarly, a student may know to review all potential answers before choosing one as the correct option and understand the need to write a task down in order to remember it—essentially working to improve study skills (Hresko & Reid, 1988). Another concept or task that needs to be addressed with this population is that of appropriate accommodations within the university.

Accommodations

The Americans with Disabilities Act states that a disability is “a physical or mental impairment that substantially limits the individual in one or more major life activities” (Jacob & Hartshorne, 2007, p. 209). In such instances, in order for the students to receive and begin using the resources available within the setting and circumstances of the disability, they most likely will need to provide appropriate documentation. This may be an instance in which the therapist needs to take on a more pragmatic role and point the students to the designated resources so they can begin partaking in services. In addition, this simple task models advocacy for the individual. Once the client has taken the required steps to establish services, the practitioner will need to discuss with the client what kinds of services or accommodations may be needed, not only in the classroom, but also for transportation, living, studying, or choosing a career path. A client may need extra time taking tests, to meet with a class note-taker, or require special transportation or access within living space. Addressing organizational skills, as stated previously, may be a way to lead into the topic of study habits or assistance required in completing homework. Clients with mobility limitations or attention deficits may need instruction in specialized computer programs when required to write their thoughts on paper.

Altering Social Factors

Another task or concept that could be discussed within the counseling sessions is social support outside of the therapeutic alliance. Counselors should discuss with the client what types of support have been used in the past, what has worked, what did not work, and what could be modified. In some cases, clients may rely solely on their family for social support while others may rely on both family and friends. It would be beneficial to discuss the client’s preferred approach, to lay out the necessary steps, and to discuss the practicality of accomplishing the support. Some students may find it helpful to join various clubs or organizations, while others may wish to take part in a support group for persons with disabilities who are experiencing similar struggles. One option may be attending a counseling group offered at a university counseling center in which aspects of CBT and illness intrusiveness are addressed. Regardless of the outlet clients require to reach the most beneficial level of social support, they need a realistic understanding of the work required to reach the goal, a picture of what that process looks like, and a comprehensive understanding of why a good support system is necessary. This process will most likely be an ongoing learning experience for both the counselor and client as appropriate adjustments are made and learning and growth are facilitated.

Corey (2005) stated that the goal of CBT is to challenge the client to confront faulty beliefs with contradictory evidence that is gathered and can be evaluated (e.g., thought record). Another important aspect of CBT is goal setting. Padesky and Greenberger (1995) identified five key points about the importance of goal setting. First, setting goals helps identify what clients want to change, and provides guideposts to track progress. Charting such changes within the realm of the illness intrusiveness model can be done by utilizing the IIRS. This method helps the counselor gather baseline data at the onset of therapy, as well as monitor progress and present problems and symptoms.

Second, breaking general goals into specific goals simplifies the process into step-by-step plans for achieving general goals. Third, prioritizing goals helps the client and practitioner to decide which goals should be addressed first to provide the most beneficial outcome from therapy. Fourth, charting emotional changes helps monitor progress toward reaching goals. One can track changes based on emotional intensity and frequency, as well as specific mood-related symptoms. Finally, if the client is not making progress toward the goals, the counselor should consider breaking goals into even smaller steps, thus addressing the impediment to progress and considering changes in the treatment plan (Padesky & Greenberger, 1995).

One of the many reasons that agreement and clarity in goal setting is important is that regardless of individual differences, therapeutic outcomes are more apt to be positive when the counselor and client move toward the same goals (Ju, 1982). It is important that, when a client with specific disabilities makes progress toward and ultimately accomplishes each goal, reinforcement is applied by the practitioner. Reinforcement should be put into practice with intentionality and only when it promotes the attainment of skills and behaviors that the client needs to meet objectives. This skill needs to be used systematically rather than randomly (Thomas & Parker, 1984).

Other techniques that can be employed during the therapeutic process are that of Socratic questioning and activity scheduling. The first occurs by having the practitioner facilitate the telling and retelling of the story until opportunities for new meaning and story content develop (Corey, 2005). The use of Socratic questioning with students with disabilities enables these clients to realize they possess an understanding of their problems and preconceived notions, thoughts, or beliefs, and can alter them by elaborating and discussing matters further. In sum, the use of one simple technique could have a profound impact on illness intrusiveness factors such as personal control, social and psychological factors, and life outcomes.

Activity scheduling is not only another important aspect of CBT, but also an effective tool for decreasing illness intrusiveness. By engaging the client in planned activities, the client is encouraged to take an active role in life, as well as rediscover activities that may have previously been enjoyed. By discerning likes and dislikes, the client is able to increase personal insight and lower levels of depression. Activity scheduling also enables clients to see that they are capable of not just choosing the level and type of daily activities, but also seeing the big picture in choosing the direction of life outcomes. By realizing that they are able to control these tasks, the clients will also begin to reframe their locus of control from external to internal.

Finally, cognitive behavioral counselors aim to teach clients how to be their own therapist (Corey, 2005). As with any case, the hope is that the client can walk away from counseling and make use of skills acquired throughout the therapy process, applying them in daily living without therapeutic assistance. Whether treatment is permanently terminated or titrated down, the outcome will directly impact illness intrusiveness through treatment factors, feelings of personal control, life outcomes, and psychological and social factors.

While research within this specific population is lacking, the application of CBT among persons with intellectual disabilities has shown varied results. For example, Gustafsson et al. (2009) found weak correlations between behavioral therapy, CBT, and other forms of integrated support, while others (Oathamshaw & Haddock, 2006) showed that persons with intellectual disabilities and psychosis could link events and emotions, and differentiate feelings from behaviors—all skills necessary to engage in CBT. While effectiveness among those with intellectual disabilities may or may not be applicable to other types of disabilities, it is worthy to note that evidence exists. It would be beneficial to add to this evidence by supporting the use of CBT in combination with the illness intrusiveness model among students with disabilities transitioning into postsecondary education. Furthermore, by implementing this treatment modality among all college students with disabilities, researchers and counselors would be able to establish whether this model is effective with specific disabilities, cases in which it may not be as useful, and ways treatment can be modified or enhanced. Utilizing the authors’ presented model, future research could aim to investigate treatment of different types of college students with disabilities (e.g., learning disabilities, psychiatric disabilities, attention deficit hyperactivity disorder [ADHD]) and examine the effectiveness, similarities, differences, or any future directions. Treatment may be implemented in both the individual and group setting, and individual changes should be monitored by means of the IIRS.

Summary

The use of CBT among college students with disabilities transitioning into the college atmosphere could have a vast impact on illness intrusiveness. While, to the current authors’ knowledge, no recent studies have looked at implementing this model and mode of treatment, it would be an area worth investigating. The convergence of an empirically supported model such as the illness intrusiveness model, as well as a theory having a preponderance of empirical evidence such as CBT, would be a solid foundation to begin implementation of therapeutic intervention.

The college student population will have to face many potentially problematic situations when transitioning into the world of continued education. Some struggles that may be encountered when assisting college students in transition who also have disabilities may relate to homework completion, organizational stills, appropriate accommodations (e.g., extended test taking time, use of a note-taker, use of assistive computer technology), transportation and living accommodations, and reliable social support systems. By addressing the above areas of concern, an efficacious treatment could be set into practice in order to adhere to professional and personal standards.

Kirsh et al. (2009) found that “disabled adults are twice as likely to be in a household with lower

incomes, and disabled people of working age are more than twice as likely as nondisabled people to have no employment-related qualifications” (p. 392). This is an essential point when discussing the importance of secondary schooling and continued education for persons with disabilities. If the statistics show that disabled persons are twice as likely as those without disabilities to have no employment-related qualifications, then accommodating them in the transition to the college environment seems appropriate. It makes sense to aid others in engaging and succeeding at their endeavors rather than waiting for them to fail or not assisting in the process at all. Counseling intervention and prevention could benefit those who may be struggling to persevere on their own, and implementation of the illness intrusiveness model in combination with CBT may provide to incoming college students with disabilities the appropriate coping skills to transition adaptively to the next phase of their life.

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Katie L. Haemmelmann, NCC, is a predoctoral intern at All Children’s Hospital and the Rothman Center for Pediatric Neuropsychiatry in St. Petersburg, FL. Mary-Catherine McClain is a predoctoral intern at Johns Hopkins University Counseling Center in Baltimore, MD. Correspondence can be addressed to Katie L. Haemmelmann, 3210 Stone Building, 1114 West Call Street, Tallahassee, FL 32306, klh08d@my.fsu.edu.