Apr 1, 2021 | Volume 11 - Issue 2
Samara G. Richmond, Amber M. Samuels, A. Elizabeth Crunk
The COVID-19 pandemic has brought about collective experiences of grief; thus, counselors-in-training (CITs) and their doctoral student supervisors may encounter increases in grief-oriented clinical work. In considering how to support CITs’ work with grieving clients, doctoral supervisors should be prepared to help CITs manage experiences of vicarious grief (VG). Given the ubiquity of loss and the limited amount of grief-specific coursework in counselor training, CITs could benefit from exploring their experiences of VG with their doctoral supervisors in clinical supervision—a core area of training for doctoral students enrolled in counselor education programs accredited by the Council for Accreditation of Counseling and Related Educational Programs. In this manuscript, we (a) provide an overview of the literature on VG, (b) discuss the potential impact of VG on CITs, (c) present a case study illustrating attention to VG in supervision, and (d) provide practical strategies doctoral supervisors can employ when addressing VG in supervision, drawing on Bernard and Goodyear’s discrimination model.
Keywords: vicarious grief, counselors-in-training, doctoral supervisors, clinical supervision, discrimination model
Loss, and the resulting grief response, is a universal human experience that individuals are likely to encounter at multiple points across the life span (Chan & Tin, 2012). As such, grief presents in counseling as a common client concern (Hill et al., 2018) and can stem from the loss of a loved one through death, non-death loss (e.g., relationship loss, loss of lifestyle), or normal life transitions (e.g., retirement, relocating; Sullender, 2010). Given the ubiquity of these experiences, counselors should anticipate working with clients who are facing loss and grief throughout their years of practice (Doughty Horn et al., 2013).
Current events may also elicit collective and global grief responses as we have seen with the COVID-19 pandemic and the unexpected death of professional basketball player Kobe Bryant early in 2020 (Milstein, 2017; Weir, 2020). These bring the pervasiveness of grief to the forefront of our awareness. Counselors, not immune to these events at the macro or micro level, must cope with their own grief responses and be prepared to experience grief through exposure to their clients’ presenting concerns, recognized as a vicarious grief (VG) response (Chan & Tin, 2012; Kirchberg et al., 1998; Rando, 1997). This reality, highlighted by the growing awareness and impact of collective grief in 2020, supports the need for increased loss and grief competencies within the profession of counseling.
Although calls have been made to more purposefully integrate loss and grief competencies into counselor education (Doughty Horn et al., 2013), we aim to highlight the importance of supporting doctoral students in growing loss and grief competencies related to their roles as future counselor educators and supervisors. As the most recent Council for Accreditation of Counseling and Related Educational Programs (CACREP) standards identify supervision as one of the five core areas of doctoral-level student training (CACREP, 2015), we propose that doctoral students should be trained to identify VG observed within counselors-in-training (CITs) and themselves. Further, they should be prepared to facilitate supervisory discussion to explore VG and help CITs learn strategies for effectively managing VG they might experience in response to their clinical work. Drawing on the existing literature on vicarious trauma, loss, and grief in counseling and supervision, as well as Bernard and Goodyear’s (1992, 2019) discrimination model, with this article we (a) provide an overview of the literature on VG, (b) discuss the potential impact of VG on CITs, (c) present a case study illustrating VG in supervision, and (d) provide practical strategies doctoral supervisors can employ when addressing VG in supervision.
Grief in Counseling
In order to more thoroughly understand counselors’ and supervisors’ experiences of VG, it is necessary to first explore how loss and grief may present within the therapeutic context. Contrary to traditional stage models of bereavement, contemporary research indicates that grief is a more nuanced, nonlinear psychological response to loss that can vary significantly between individuals with respect to duration of grief and the presentation and intensity of symptoms (Crunk et al., 2017; Doughty Horn et al., 2013). For example, although the majority of individuals experience more normative grief responses, about 10% of bereaved individuals experience a protracted, debilitating, and sometimes life-threatening grief response known as complicated grief (Shear, 2012), also referred to as prolonged grief disorder (Prigerson et al., 1995) or persistent complex bereavement disorder (American Psychiatric Association, 2013). As doctoral student supervisors and CITs inevitably encounter clinical presentations of loss and grief, the ability to identify and discuss both common and complicated grief reactions not only serves to support determination of treatment interventions, but also promotes the introspection necessary to identify, explore, and cope with their own VG responses (Ober et al., 2012), which is the focus of this present article.
Prior literature within the counseling profession has largely focused on vicarious trauma—the negative emotional or psychological changes and altered view of self, others, or the world experienced by counselors resulting from repeated engagement with clients’ trauma-related stories, memories, pain, and fear (American Counseling Association [ACA], n.d.; Trippany et al., 2004). It is widely recognized by practitioners and counselor educators that vicarious trauma can be personally and professionally disruptive, with counselors experiencing behavior changes, interpersonal issues, shifts in personal values and beliefs, and diminished job performance as a result (ACA, n.d.). However, less attention has been directed toward VG (i.e., bereavement), a phenomenon originally documented by Kastenbaum (1987) that describes “the experience of loss and consequent grief and mourning that occurs following the deaths of others not personally known by the mourner” (Rando, 1997, p. 259). The two types of VG include (a) Type 1, exclusively VG (i.e., the griever feels what it is like to be in the initial griever’s position) and (b) Type 2, the experience of VG for a griever along with feeling reminded of one’s own losses and unfinished grieving (Rando, 1997; Sullender, 2010). Although there is overlap between grief and trauma, there are also important differences for counselors to be aware of and attend to in counselor training, practice, and supervision, particularly given the pervasiveness of loss and grief.
In light of prior literature suggesting that counselors can experience negative outcomes following vicarious traumatization, we propose that issues of loss and grief, too, can elicit unexpected and unwanted grief responses that might impact counselors’ well-being or even their ability to provide client care. CITs and doctoral supervisors would benefit from greater awareness of the potential impacts of VG on themselves and their ability to deliver ethical and effective services to clients. Research has indicated training and experience in grief counseling are among the strongest predictors of grief counseling competence (Ober et al., 2012); thus, counselors who have little or no training in grief and loss may be at risk for being unable to manage clients’ grief presentations. With counselor wellness essential to providing adequate clinical services, and counselors holding an ethical obligation to be prepared to work with a variety of client presentations, including loss and grief, it is suggested that increased attention to VG serves to promote counselor wellness, clinical preparedness, and positive client outcomes (Hill et al., 2018).
Although the long-term effects of our current experiences of collective, widespread grief have yet to be fully identified and understood, the immediate impact brings to the forefront the professional necessity of recognizing reactions to grief within clinical work and supervision. Sufficient evidence exists that counselors who work with clients facing issues of loss and grief are vulnerable to compassion fatigue, burnout, and secondary traumatization. Best practices reflect the necessity for practitioners to attend to their emotional responses to clients presenting with these issues (Chan & Tin, 2012; Gentry, 2002; Kirchberg et al., 1998), but little empirical evidence has been established surrounding how counselors respond to discussion of loss and grief in supervision. Therefore, to promote recognition and understanding of VG, it is beneficial for counselors and counselor educators to consider the separate and distinct impacts of VG on a counselor’s work. This includes how VG can permeate into supervisory relationships—space that has traditionally been used for counselors to process and attend to their emotional reaction to clients’ presenting concerns (Bernard & Goodyear, 2019).
Vicarious Grief in Supervision
Although supervision is evaluative and hierarchical by nature, it can serve a “simultaneous purpose of enhancing the professional functioning” (Bernard & Goodyear, 2019, p. 9) of the CIT. When applied to loss- and grief-oriented clinical work, it may be understood to include assisting CITs in exploring how their own reactions contribute to their ability to deliver clinical services. For doctoral students in the role of supervisor, this task requires that they not only support the connection of classroom learning to clinical practice, but also promote personal reflection and growth in the service of clients. As such, in cases of clients presenting with issues of loss and grief, doctoral students can utilize supervision and the supervisory working alliance to facilitate identification and understanding of a VG response, ultimately supporting more effective clinical work.
The supervision literature suggests that VG may affect counselors differently depending on their level of clinical experience. For example, more advanced clinicians have been found to experience less distress when faced with death-related client concerns (Terry et al., 1996), whereas beginning counselors, particularly those in a practicum course, rate death and loss as highly uncomfortable clinical topics to handle (Kirchberg & Neimeyer, 1991). In addition, the interplay of personal and contextual factors may exacerbate the distress that students experience when faced with these clinical topics, emphasizing the necessity of not only acquiring appropriate knowledge and skills related to grief work, but also personal awareness and competencies to manage their emotional responses (Chan & Tin, 2012; Kirchberg et al., 1998). Doctoral students must be prepared through their own education and introspective abilities to support this process for their CITs.
As it presents for CITs, sufficient evidence can be derived from the loss and grief and vicarious trauma literature to suggest that client outcomes may be affected when CITs cannot adequately identify or cope with vicarious responses (ACA, n.d.; Hill et al., 2018). When experiencing VG, it may be more difficult for CITs to attend to client presentations during session and engage in pre-session planning or post-session reflection (Lonn & Haiyasoso, 2016). Without standards for grief training or practice in the professional counseling field (Doughty Horn et al., 2013; Ober et al., 2012), much of the responsibility to promote CIT wellness and attention to VG responses falls on doctoral student supervisors engaging with CITs in their practicum experiences. As such, doctoral student supervisors, also ethically charged with promoting client welfare and proficiency of practitioners across presenting concerns, should be prepared to attend to VG and its likelihood to impact CIT ability to lead client sessions effectively.
Given that the vicarious trauma literature suggests that supervisors monitor their own responses to trauma-focused clinical information presented by their CITs, doctoral student supervisors and their supervisors (i.e., counselor educators and supervisors) supporting grief work must also be aware of their own risk for VG (Lonn & Haiyasoso, 2016). Supervisors may also experience emotional reactions to CITs’ disclosures of their own VG reactions in supervision (Bernard & Goodyear, 2019). Through utilizing introspective practices, doctoral student supervisors and their supervising counselor educators and supervisors can attend to this heightened possibility of VG by examining their physical, emotional, and cognitive reactions to their CITs, their workload, and any personal issues pertaining to unresolved grief that may be shaping how they in turn conduct supervision around topics of loss and grief (Ladany et al., 2000; Walker & Gray, 2002, as cited in Bernard & Goodyear, 2019). The following sections outline recommendations for addressing VG in supervision with doctoral-level supervisors and CITs.
Supervision and Vicarious Grief: Leveraging Roles and Relationships
Clinical supervision is essential to basic counselor training and has become a major emphasis of counseling doctoral training programs (Bernard & Goodyear, 2019; CACREP, 2015). Supervision as a practice has been found to increase counselor objectivity, empathy, and compassion (Trippany et al., 2004), providing an ideal environment for doctoral student supervisors to intervene and address the ripple effects of client grief presentations. Although grief is a common client concern, literature addressing VG in supervision is scarce. Generally recognized standards for addressing VG in supervision do not yet exist. Thus, in the absence of best practices, in this article, we extrapolate from existing supervision literature strategies for effectively fostering CIT growth and adapting our understanding of how these factors may also serve to support CITs and their supervisors as they navigate grief-related content and possible VG experiences in supervision.
Just as it has been studied in psychotherapy research, common factors of supervision can be examined to better conceptualize the supervisor’s role and ability to shift a CIT’s experience of VG. In considering common and specific factors of supervisory models, it has been suggested that the supervisory relationship is paramount to positive clinical outcomes (Crunk & Barden, 2017). Doctoral student supervisors, in being asked to address the intense emotional reactions of VG with their CITs, may benefit from focusing on the quality of the supervisory relationship to encourage openness, honesty, and increased willingness to process feelings of grief that arise in relation to work with their clients.
Per Bernard and Goodyear’s (1992, 2019) discrimination model, it can also be helpful to consider how the supervisory roles of counselor, consultant, and teacher may inform a doctoral student supervisor’s approach to VG with trainees. Often as a new supervisor, it can be difficult to navigate these roles and best determine which to utilize within supervision (Bernard & Goodyear, 2019; Nelson et al., 2006). The counselor role may be most familiar, given previous clinical experience, but the consultant and teacher role hold value in striking an “optimal balance between support and challenge” (Bernard & Goodyear, 2019, p. 106) for the CIT. Purposefully integrating the roles of counselor, consultant, and teacher can support doctoral student supervisors in addressing CIT factors, such as resistance, anxiety, and transference, which inherently contribute to a trainee’s experience of VG (Bernard & Goodyear, 2019; Chan & Tin, 2012; Gentry, 2002; Kirchberg et al., 1998).
To facilitate this integration of roles within the context of supervision, it is also crucial to recognize that doctoral student supervisors, early in their own training as clinical supervisors, may struggle with this task (Bernard & Goodyear, 2019; Nelson et al., 2006). In response to COVID-19 impacts to clinical services, doctoral student supervisors may be asked to provide consultation to CITs regarding navigating a client crisis via teletherapy. Overlapping with the role of consultant is also the necessity for doctoral student supervisors to teach CITs about ethical usage of teletherapy platforms for the delivery of clinical services. Further, doctoral student supervisors may recognize the need to provide counseling support to CITs around anxiety that manifests from the plethora of changes in a short period of time. These examples highlight the complex tasks facing doctoral student supervisors in the context of the current COVID-19 pandemic and draw attention to the support doctoral student supervisors may benefit from in order to remain best equipped to meet their CITs’ needs. Group or individual supervision with faculty members or senior clinic staff members may prove useful to provide an opportunity for doctoral student supervisors to examine their perspectives, emotional reactions, and the challenges of their new professional identity, coupled with the potential parallel process of experiencing their own VG through their work with CITs (Trippany et al., 2004).
As supervision provides opportunities for professional and personal growth critical to the learning experience of CITs, doctoral student supervisors must consider how best to support CITs in both of these domains. The bereavement literature suggests that a larger focus is often placed on the development of professional competencies, knowledge, and skills, as compared to an emphasis on the personal nature, or the role of self, in loss and grief (Balk et al., 2007; Stroebe et al., 2008). Thus, it is common for CITs and supervisors alike, particularly those who have not received formal academic instruction on topics of loss and grief, to be less open to topics of death and loss with clients, have less insight into their own beliefs regarding death, and have a greater fear of death (Doughty Horn et al., 2013).
This suggests that for supervisors to effectively address VG within supervision, they should engage in their own self-study of loss and grief to support their acquisition of knowledge and increased personal understanding of responses to death and loss. Because coursework that focuses specifically on loss and grief is not required by CACREP standards (Doughty Horn et al., 2013), it is unlikely that doctoral students coming from master’s programs in counseling or marriage and family therapy have had substantive training specific to loss and grief (Ober et al., 2012). Seeking out learning opportunities will further prepare doctoral student supervisors to embody the roles of counselor, consultant, and teacher to both educate and process their CITs’ reactions related to loss, grief, and death. Much like vicarious trauma has been approached within supervision, doctoral student supervisors who have engaged in the study and self-reflection of loss and grief can serve in the important role of helping CITs “stay in their own chairs” (Rothschild, 2006, p. 201). They can more effectively support identification of CITs’ gaps in knowledge or reactions to the material presented by the client and utilize supervision as a space for both education and emotional processing.
Doctoral student supervisors working with CITs must recognize the inherent challenges CITs may have in sharing clinical and personal information within supervision (Lonn & Haiyasoso, 2016). New counselors may be less aware of their emotional reactions in session (Dowden et al., 2014), further necessitating attention to VG by supervisors. Doctoral student supervisors, in guiding CITs to gain insight into their own reactions, may find benefit in incorporating discussion of countertransference and VG in an effort to differentiate the experiences for CITs. Countertransference—a counselor’s emotional, cognitive, or behavioral reactions that occur in response to the client or clinical content and are rooted in the counselor’s own life and relational experiences (Bernard & Goodyear, 2019; Hayes et al., 2011)—can be understood as distinct from VG, which, adapted from the vicarious trauma literature, is the response to the loss-oriented client material unrelated to personal experiences (Trippany et al., 2004). Although countertransference may also occur for a CIT as it relates to loss and grief, the literature supports the likelihood that as clients experience existential crises of meaning around loss, professional helpers are likely to share in the existential challenges, including the experience of VG (Chan & Tin, 2012). It is beneficial for doctoral student supervisors to support CITs in making this distinction, as each may require different attention within the supervision process.
The COVID-19 pandemic has elicited a surge of global loss, grief, and trauma, increasing the likelihood of supervisors and CITs encountering VG in supervision. Generally speaking, it is important and necessary for doctoral students to attend to the previously mentioned tasks of supporting CITs who may encounter VG, while recognizing the likelihood of a parallel process between supervision and the trainee’s clinical work (Bernard & Goodyear, 2019). Just as it can be hard for a CIT to manage responses to grief, so too may it be challenging for a new supervisor to cope without thorough discussion of loss and grief topics in supervision. Given the current widespread and collective grief specific to COVID-19, and the ubiquity of loss and grief in general, we recommend that counselor education programs help doctoral student supervisors to become more aware of the potential for VG to emerge in supervision. Strategies may include introducing case studies of VG in supervision to support doctoral students in applying strategies and exploring the impacts for themselves and their CITs.
Implications for Training: Doctoral Student Curricular Preparation
A review of the existing literature revealed that there is both minimal research and limited curricular focus on loss and grief education in the profession of counseling (Doughty Horn et al., 2013). Although this conversation has largely focused on master’s-level curricula, it is important to consider the impact of this lack of focus within doctoral education as well. Counselor education doctoral students, lacking education on clinical competencies in loss and grief from within their master’s programs, are preparing themselves to become educators of the next generation of counselors. Therefore, it is imperative that we rectify this lack of competency around loss and grief in order to best meet the moral and ethical obligation of counselors and counselor educators to promote and facilitate client growth both in their own clinical work and through the instruction and supervision of students’ work (Cicchetti et al., 2016).
Doctoral programs, although held by CACREP (2015) standards to include training in counseling, supervision, teaching, research, and advocacy, currently have no requirement to address topics of loss and grief, including VG within these domains. In order to most effectively implement the strategies discussed above, doctoral student supervisors would benefit from more focused training, both to enhance their supervisory competencies and fill gaps within introductory counselor education. Despite the existence of master’s CACREP standards that address life span development issues, there exist no CACREP standards to date that address topics of loss and grief, including VG. Hence, in this article, we examine how VG can perhaps be incorporated into doctoral supervisory curriculum.
Within counselor education doctoral programs, supervision is a core area of counselor educator education and training (CACREP, 2015). Given the ubiquity and salience of grief (Doughty Horn et al., 2013), VG is an arguably crucial phenomenon to be acknowledged and addressed by both CITs and doctoral supervisors. Hence, it is worthwhile to examine the content of courses that meet this standard. Whether a didactic course prior to direct supervisory experience or an experiential course, CACREP (2015) calls for course material to include a variety of components (e.g., purposes of clinical supervision, skills and modalities, ethical responsibilities, culturally relevant strategies). Despite the likelihood of issues of loss and grief to be present in clinical scenarios, CACREP supervision standards remain broad, meaning important topics, like loss and grief, may be neglected in course development and discussion. Just as students build on their prior knowledge of theory, interventions, cultural competence, and trauma-informed practice, so too can loss and grief be discussed as it relates to growing supervision knowledge, skills, and competencies.
The incorporation of these topics into doctoral courses may need to include foundational instruction related to loss and grief to facilitate basic competencies in addition to more complex applications of loss and grief clinical content to supervision frameworks, ethical issues, and modalities of supervision. Counselor educators and doctoral program coordinators may consider integrating VG both to draw attention to the possibility of one’s own encounter with VG as a counselor and counselor educator, and to provide opportunities for processing and self-reflection. Through purposeful instruction and modeling of strategies for supervision, doctoral student supervisors are better equipped not only to manage their own reactions, but also to recognize and facilitate understanding of their CITs’ reactions, ultimately supporting client well-being (Cicchetti et al., 2016). As such, we suggest that faculty of doctoral programs critically examine clinical topics discussed within courses meeting the CACREP supervision standards and purposefully integrate loss, grief, and VG into course content. Further, the use of case studies as a means of illustrating practical strategies that counselors and supervisors can use is a well-documented practice within the counseling scholarship (Kelly, 2016). Hence, in order to support doctoral students in their preparedness to apply the practical strategies discussed in this article, we present a case study as an example that can be used with doctoral students to support their training around VG in supervision.
The following fictional case study illustrates features of VG (i.e., Type 1 and Type 2; Kastenbaum, 1987; Rando, 1997; Sullender, 2010) evident with Cynthia, a CIT, during clinical supervision with a doctoral supervisor. Doctoral supervisors working with CITs experiencing VG are advised to use the information previously outlined to pay attention to the grief reactions presented in the case. Drawing on Bernard and Goodyear’s (1992, 2019) discrimination model, we discuss interventions that supervisors can use to attend to VG in supervision. Supervisor collaboration with practicum instructors to facilitate the management and potential amelioration of VG is also discussed. The case study highlights the important role supervision plays in facilitating the CIT’s awareness about the process of both leaving and returning to one’s “chair” (Rothschild, 2006, p. 201).
The Case of Cynthia
Cynthia is a master’s-level CIT who is approaching the end of her practicum experience in the midst of COVID-19. During supervision, Cynthia discusses her clients’ experiences with multiple forms of loss and associated grief resulting from the pandemic, ranging from the deaths of loved ones to COVID-19, to job loss, loss of financial security, loss of special plans, loss of social connection, and an overall loss of “normal life” as they knew it. When Cynthia’s supervisor asks her how it has felt for her to help clients process their feelings of grief, Cynthia shares that when her clients share their grief with her, she becomes simultaneously reminded of her own losses (e.g., loss of social connection, daily routine, and normalcy) resulting from the pandemic, as well as her own associated grief response that she finds becomes activated in and outside of session. Cynthia shares that her own grief has been triggered by hearing her clients’ experiences and that her satisfaction with and sense of personal accomplishment surrounding her clinical work is starting to diminish.
Cynthia shares that she has also begun avoiding talking or thinking about their grief-related experiences in session. In supervision, she shares that since the pandemic, she worries that she is not doing enough for her clients and reports feeling a general sense of hopelessness associated with her work with them. Although she feels as though she is hearing her clients share stories about their loss and grief “constantly,” she also indicates that she is trying to stay motivated to continue to work with her clients and believes in her ability to help them. She also reports, however, that bearing continuous witness to their grief, fear, and overall uncertainty associated with the losses they are enduring because of the pandemic is becoming emotionally difficult to manage.
A Brief Analysis: Type 1 and Type 2 VG. As illustrated above, the case of Cynthia depicts manifestations of Type 1 and Type 2 VG during supervision. First, Type 2 VG is evidenced by Cynthia’s report of being reminded of her own losses following those of her clients and her resulting grief response. Within this instance of Type 2 VG, in response to the reported grief of her clients, Cynthia is reminded of her own losses as well as her own unfinished grieving. Second, Type 1 VG is evidenced by Cynthia’s report that her own grief response has been triggered after hearing her clients’ experiences of grief. Unlike Cynthia’s experience of Type 2 VG, in which her own unfinished grief was elicited, in this instance, Cynthia exclusively feels what it is like to be in the griever’s (i.e., client’s) position. When using a case study such as this with doctoral students, it may be beneficial to have them identify and discuss the types of VG present and begin to process how they might attend to both within supervision.
Attending to VG in Supervision. According to Bernard and Goodyear (1992, 2019), the three primary roles that are associated with clinical supervision are: counselor, teacher, and consultant. Given that these roles all fall within the domain of supervision, CITs can be afforded a broad variety of developmentally appropriate interventions throughout supervision. In considering common and specific factors of supervisory models, it has been suggested that the supervisory relationship is paramount to positive clinical outcomes (Crunk & Barden, 2017). Doctoral student supervisors, when addressing the intense emotional reactions of VG with their CITs, may benefit from focusing on the quality of the supervisory relationship to encourage openness, honesty, and increased willingness to process feelings of grief related to client work. When using a case study for experiential purposes, doctoral students can be asked to consider how, along with the use of common factors, the trifecta of roles presented by the discrimination model can be called on by supervisors to offer CITs guidance surrounding the challenging terrain of VG, regardless of the supervisor’s theoretical supervisory orientation.
Counselor. Although the intent is not to provide therapy, doctoral students can consider how the role of counselor remains constant throughout the supervisory relationship and can facilitate CITs’ understanding of and ability to manage their personal feelings and reactions as they emerge throughout their work with clients (Bernard & Goodyear, 2019). Initially, after the origination of the COVID-19 pandemic and its loss-related effects on Cynthia’s clients, Cynthia exhibited VG as well as hopelessness surrounding her clinical work during supervision. By facilitating Cynthia’s processing through reflecting her feelings of hopelessness and asking her to reflect on how her feelings may be affecting her work with clients, the doctoral student supervisor might guide Cynthia in expressing her underlying emotions that are associated with her VG response and impacting her clinical work. Given the potential for CITs to feel challenged in sharing clinical and personal information within supervision (Lonn & Haiyasoso, 2016), doctoral students examining this case study can consider how as a supervisor they might also use a check-in with Cynthia at the beginning of supervision (Doyle, 2017), in order to normalize her personal grief reactions and encourage her to be proactive about self-care surrounding her VG. Furthermore, in the case of COVID-19, this case study can highlight for doctoral students how a supervisor might attend to their own feelings of grief and demonstrate their willingness to model transparency and vulnerability to Cynthia in order to assist her in acknowledging and managing countertransference and VG. Ultimately, in more closely examining the role of counselor, doctoral students can more clearly imagine how they might be able to help Cynthia examine her feelings and emotions associated with her VG to her clients and her clinical work to reduce the potential for disturbance in her therapeutic relationship.
Teacher. In the role of teacher, the supervisor assumes the primary responsibility for the CIT’s learning (Bernard & Goodyear, 2019). In the case of Cynthia, as teacher, doctoral students can contemplate and discuss how as a supervisor they might work to help her understand her reactions to her clinical work as VG. In addition to providing education about how counselors are called to attend to their clients’ needs during a crisis, the supervisor might also provide Cynthia with psychoeducation about VG, as well as examples of symptoms and information pertaining to distinguishing it from countertransference, compassion fatigue, or burnout. This knowledge would be provided to Cynthia to help normalize and validate manifestations of indirect grief which makes these reactions easier to manage, with the case study providing opportunity for doctoral students to evaluate their own knowledge of these areas and seek support from peers or faculty to grow their knowledge.
Furthermore, doctoral students examining this case study may also be prompted to examine how they could bolster Cynthia’s learning and enhance her preparedness to work with her grieving clients by bringing Cynthia’s experiences to the attention of her practicum instructor. This provides opportunity for doctoral students to consider how to collaborate with faculty so that instructors might provide additional educational support surrounding the concept of VG during group supervision. Through discussion around how to effectively integrate didactic components into the supervisory process and attend to Cynthia’s learning, doctoral students are able to practice how a supervisor can work toward ameliorating a CIT’s VG.
Consultant. In the role of consultant, the supervisor might work with Cynthia to identify strategies that minimize the impact of VG and allow her to engage in self-care practices. By examining this case study, doctoral students can consider how to balance the teaching role, in which they adopt the role of the expert, with the consultant role, in which the supervisor works to foster Cynthia’s independence, autonomy, and empowerment (Bernard & Goodyear, 2019). Given that Cynthia demonstrated motivation to engage in supervision and learn more about her VG, as consultant, the supervisor might provide her with structured guidance surrounding how to approach her work with clients. Doctoral students may benefit from discussion around how to promote amelioration of Cynthia’s VG through providing her with resources regarding self-regulation and offering to help her brainstorm ways to be more present with her clients in session during discussions of grief. By examining a case study, doctoral students are provided the opportunity to further consider how, as consultant, they might communicate to Cynthia that she handled this situation ethically and professionally by sharing her feelings of VG with the supervisor.
Given the dearth of research on grief literacy in counselor education and without sufficient standards around loss and grief training for counselors (Doughty Horn et al., 2013; Ober et al., 2012),
our conceptualizations, discussion, and recommendations for doctoral student supervisors and CITs encountering VG in supervision are inherently limited. Thus, we cannot be certain these recommendations would significantly influence the supervisory experience and its effect on client and counselor well-being. We believe there is sufficient evidence within the current literature suggesting that attention to VG within supervision is warranted, but further research is necessary to more completely understand the role of supervision in identifying and managing VG responses.
Further, our exploration of VG is limited to an academic setting as we believe specific attention to these competencies lies in the inclusion of loss and grief training within counselor education (Doughty Horn et al., 2013). However, given the ubiquity of grief in life and within counseling (Chan & Tin, 2012; Doughty Horn et al., 2013; Hill et al., 2018), it would be remiss for us to not acknowledge that this discussion about doctoral student supervisors is just one of many situations in which a counselor or clinical supervisor may find themselves faced with experiences of VG. Our conceptualization of VG and many of our suggestions may even ring true for clinical supervisors at various stages of their career within that role. Further research must consider how supervision occurs in contexts outside of academia and the impact of VG for counselors and supervisors at more advanced stages of their career.
Given the continued pervasiveness of the COVID-19 pandemic, it is impossible to understand its long-term effects, but the immediate impacts to the profession of counseling speak to the necessity of recognizing reactions to grief within clinical work and supervision. Although the supervision literature abounds with approaches for supervising counselors, as highlighted by this article, the counseling literature lacks empirical studies on VG in supervision, despite its occurrence and impact on clinicians and supervisors alike. In the absence of such research, we call for VG in supervision to be an emerging area of focus for the profession of counseling, particularly within doctoral counselor education.
However, although the scope of this article is aimed at recognizing and managing VG by doctoral student supervisors, it is our hope that drawing attention to the complexities of this experience brings further conversation to experiences of VG in all types of clinical supervision. It is of benefit to all supervisors, doctoral students, and clinicians both new to the role and with seasoned experience that increased attention is directed toward validating specific supervisory techniques developed to attend to counselors’ experience of VG in supervision. It is our goal that this discussion acknowledges the impact of VG on clinicians and promotes further research and development of best practices for managing VG in supervision, both within counselor education and beyond.
CITs and counselor educators face the possibility of experiencing VG in their respective work with clients and CITs who have experienced loss. Counselor educators in supervisory roles can help CITs mitigate VG through facilitating awareness of the impacts of grief-related clinical content into the supervision process and attending to CITs’ unique needs in the roles of teacher, counselor, and consultant. In light of the COVID-19 pandemic and its resulting landscape of increased loss and related mental health needs, it is especially critical for counselor educators and supervisors to be equipped to attend to the needs of CITs who are experiencing VG. In this article, we aimed to address this need by defining VG, discussing its potential impact on CITs and doctoral supervisors, and presenting a case study illustrating interventions that counselor educators can use when addressing VG in supervision.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
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Samara G. Richmond, MA, MS, NCC, LGPC, is a doctoral candidate at The George Washington University. Amber M. Samuels, MS, NCC, LGPC, is a doctoral candidate at The George Washington University. A. Elizabeth Crunk, PhD, NCC, LGPC, is an assistant professor at The George Washington University. Correspondence may be addressed to Samara G. Richmond, 2136 G St NW, Washington, D.C. 20052, firstname.lastname@example.org.
Mar 9, 2020 | Volume 10 - Issue 1
Ryan M. Cook, Laura E. Welfare, Connie T. Jones
This study examined the incidence of intentional nondisclosure by postgraduate, prelicensed counselors receiving supervision as they pursue licensure, which has not been previously examined. Examining the responses of 107 prelicensed counselors, we found that 95.3% reported withholding some degree of information from their supervisors, and 53.3% completely withheld a concern from their supervisors. Participants completely withheld supervision-related incidents (e.g., negative reactions to supervisor, questioning supervisor’s competency) more frequently than they withheld client-related incidents (e.g., clinical mistakes, personal issues). We offer strategies for prelicensed counselors, supervisors, counselor educators, and counselor credentialing bodies to reduce intentional nondisclosure. These strategies include creating a collaborative environment, developing supervision contracts, and attending to power differentials in supervision.
Keywords: intentional nondisclosure, clinical supervision, prelicensed counselors, supervisors, counselor educators
Counselors who desire licensure as full, independent professional counselors must complete a postgraduate supervised field experience (Henriksen et al., 2019). The primary purpose of postgraduate supervision is to ensure that prelicensed counselors provide counseling services that are in accordance with legal, ethical, and professional standards as they begin their professional careers (Borders et al., 2011; Magnuson et al., 2000). Unlike university-based supervision, to which prelicensed counselors are more accustomed (Magnuson et al., 2000), postgraduate supervision requires prelicensed counselors to regularly self-direct their supervision experience. That is, in postgraduate supervision, prelicensed counselors are called to more autonomously self-identify their clinical concerns and developmental needs, and to convey this information to their supervisors (Cook & Sackett, 2018).
Although supervisees’ self-reports can enrich the supervision process (Noelle, 2002), relying on prelicensed counselors to self-select information to share with their supervisor may be problematic (Ladany et al., 1996). While supervision is intended to facilitate supervisees’ professional development, there also is an evaluative component inherent in the supervisory relationship (Borders et al., 2011). The supervisor’s evaluations of the supervisee’s clinical performance are tied to their professional progress (i.e., obtaining full, independent licensure; Magnuson et al., 2000). As such, it benefits supervisees to present themselves in a manner that will yield positive evaluations from their supervisors and to withhold information that could result in their supervisors developing a negative perception of their clinical competencies (Cook, Welfare, & Romero, 2018; Ladany et al., 1996).
Supervisees withholding information from their supervisors is a well-established phenomenon in supervision literature (Cook, Welfare, & Romero, 2018; Gibson, et al., 2019; Hess et al., 2008; Ladany et al., 1996). Termed supervisee nondisclosure, researchers have shown that the frequency of supervisee nondisclosure in clinical supervision is high—ranging from 60% to 97.2% (Cook, Welfare, & Romero, 2018; Ladany et al., 1996; Mehr et al., 2010). But these studies were based on samples of counselors-in-training (CITs) or trainees in allied professions such as psychology. To date, only one qualitative study has examined the phenomenon of nondisclosure in a sample of postgraduate supervisees. Sweeney and Creaner (2014) found that counseling psychology graduates in Ireland (N = 6), like supervisees in mental health training programs (Cook, Welfare, & Romero, 2018; Ladany et al., 1996), commonly withhold information from their supervisors.
What seems most problematic are the instances in which a supervisee identifies a concern or perceives an issue and decides to withhold it from their supervisors anyway (Cook & Welfare, 2018; Yourman & Farber, 1996). These instances are known as supervisee intentional nondisclosure. Ladany and colleagues (1996) suggested that the information being intentionally withheld by supervisees is likely to be the most important information to their clinical and professional development. As such, supervisees who withhold information may inadvertently undermine their own professional growth.
Supervision scholars (Cook, Welfare, & Romero, 2018; Gibson et al., 2019; Hess et al., 2008; Ladany et al., 1996) have found that the types of information withheld by supervisees can be broadly categorized into supervision-related incidents (e.g., negative reactions to a supervisor, evaluation concerns, fears of correcting a supervisor, concerns about the process of supervision) and client-related incidents (e.g., clinical mistakes, general reactions to clients, concerns about lack of professional competencies). The reasons for these intentional nondisclosures most often point to issues in the supervisory relationship (e.g., supervisory working alliance; Cook & Welfare, 2018; Hess et al., 2008), supervisee personality traits (e.g., attachment styles; Cook & Welfare, 2018), and supervisor–supervisee power differentials (e.g., fear of negative evaluation concerns, desire to present oneself favorably to the supervisor; Hess et al., 2008; Ladany et al., 1996). In total, the types of information being intentionally withheld by supervisees, as well as the reasons for their nondisclosures, reflect issues that are inherent in a hierarchal and evaluative relationship such as the supervisory relationship (Hess et al., 2008; Mehr et al., 2010; Sweeney & Creaner, 2014).
Prelicensed counselors, like CITs and supervisees from allied professions, experience similarly high stakes in clinical supervision. However, as described in detail below, postgraduate supervision differs from university-based supervision (Magnuson et al., 2000), and prelicensed counselors are more advanced in their professional development as compared to CITs (Rønnestad & Skovholt, 2003). For these reasons, the salient issues that prelicensed counselors are hesitant or unwilling to discuss with their supervisors might differ from those of CITs. Relatedly, the degree to which they fail to disclose information might also differ. Thus, in our investigation we examined the types of information being withheld in postgraduate supervision by 107 prelicensed counselors and the degree to which they were unwilling to discuss their concerns with their supervisors.
Postgraduate Supervision for Licensure
Postgraduate supervision is required for counselors who desire licensure as full and independent professional counselors in all 50 states in the United States as well as Guam, Puerto Rico, and the District of Columbia. The specific requirements of postgraduate supervision differ in each licensing jurisdiction (e.g., frequency of supervision, hours of required supervision; Henriksen et al., 2019). Although prelicensed counselors often are more self-aware of their client needs and developmental concerns than CITs (Loganbill et al., 1982; Rønnestad & Skovholt, 2003; Stoltenberg & McNeill, 2010), prelicensed counselors also are facing new challenges as counselors such as managing more complex caseloads (Freadling & Foss-Kelly, 2014) and possibly questioning their own clinical competencies (Rønnestad & Skovholt, 2003). Thus, a supervised field experience is critical to helping prelicensed counselors transition from CITs to professional counselors (Henriksen et al., 2019).
As compared to university-based supervision, there are unique features of postgraduate supervision for prelicensed counselors (Magnuson et al., 2000). Namely, prelicensed counselors engaged in postgraduate supervision are tasked to self-direct their supervision experience (Cook & Sackett, 2018) more than they were during university-based supervision. For example, prelicensed counselors may have less access to their supervisors than they did during their graduate training. Henriksen et al. (2019) conducted a content analysis of supervision requirements for postgraduate supervision. Based on their findings, no jurisdiction required supervisors and supervisees engaging in postgraduate supervision to meet at a frequency that equaled the Council for Accreditation of Counseling and Related Educational Programs’ (CACREP) required averages of an hour of individual supervision or 1.5 hours of group supervision per week. It is important to note that it is certainly possible for prelicensed counselors to meet with their supervisors more than is required, but these standards provide a useful benchmark. Prelicensed counselors also may have fewer opportunities than CITs for their clinical work to be directly observed by their supervisors (Magnuson et al., 2000), which could perpetuate the supervisors’ reliance on supervisees’ self-report in supervision (Cook & Sackett, 2018) and unintentionally encourage supervisee nondisclosure (Ladany et al., 1996). For example, Fall and Sutton (2004) found that prelicensed counselors used self-report in their supervision sessions 80% of the time. Comparatively, other methods to monitor supervisees’ work, such as direct observation of a counseling session, audio and video recording, or live supervision, were used far less often (each used 10% of the time).
In addition, the interpersonal dynamics between supervisor and supervisee in postgraduate supervision may differ from those experienced during university-based supervision. Unlike the development-oriented process of university-based supervision, Magnuson et al. (2000) poignantly described postgraduate supervision as a “business relationship” (p. 177). Some prelicensed counselors pay for supervision from someone who does not work at their place of employment, while other prelicensed counselors work with a supervisor at their place of employment (Magnuson et al., 2000). In the latter situation, the supervisors providing clinical supervision also can be evaluating the prelicensed counselor as an administrative supervisor. Although the dual roles may be logistically advantageous for agencies, having combined clinical and administrative supervision could be problematic (Borders et al., 2011; Magnuson et al., 2000). In sum, as compared to university-based supervision, the businesslike nature of postgraduate supervision as well as the heavy reliance on prelicensed counselors to self-direct their supervision experience can change how these counselors utilize intentional nondisclosure in postgraduate supervision.
The degree to which prelicensed counselors are willing to disclose information to their supervisors has implications for clinical supervisors as well. Clinical supervisors assume legal responsibility for the quality of services rendered to their supervisees’ clients (Magnuson et al. 2000). With the dependence on prelicensed counselors to self-report information in clinical supervision (Fall & Sutton, 2004) and the potential absence of regular direct observation (Gray & Erickson, 2013; Magnuson et al., 2000), supervisors are reliant on prelicensed counselors to accurately recall details of their counseling work and to honestly discuss their developmental needs. If prelicensed counselors, like CITs, were to feel unsure about presenting themselves honestly to their supervisors, their decision could unintentionally undermine the work of their clinical supervisors, who have a legal duty to their supervisees and the supervisees’ clients (Magnuson et al., 2000).
No study has examined what prelicensed counselors perceive as salient in their clinical supervision experience and the degree to which they are willing to discuss concerns with their supervisors. Postgraduate supervision is critically important to a counselor’s developmental growth (Henriksen et al., 2019). Prelicensed counselors are mandated to receive clinical supervision (Henriksen et al., 2019), which means that supervisee intentional nondisclosure is a relevant issue. As such, an investigation of supervisee intentional nondisclosure in a sample of postgraduate, prelicensed counselors is needed. Therefore, the aim of our study was to examine prelicensed counselors’ self-reported incidents of intentional nondisclosure in clinical supervision. Specifically, our investigation was guided by two research questions: (a) What is the frequency of intentional nondisclosure in clinical supervision as reported by prelicensed counselors, and (b) Which concerns do prelicensed counselors find most difficult to discuss with clinical supervisors?
Participants and Procedures
Participants in the current study were prelicensed counselors pursuing full, independent licensure as professional counselors. We aimed to recruit a nationally representative sample, so we obtained mailing addresses for persons pursuing licensure in two states in each of the five Association for Counselor Education and Supervision (ACES) regions. Specifically, we solicited participation from prelicensed counselors in Arkansas, Colorado, Idaho, Iowa, Oklahoma, Oregon, Rhode Island, Texas, Vermont, and Washington. We randomly selected up to 150 names from each state. After eliminating and replacing unverifiable mailing addresses, we identified 1,347 potential participants. We first received IRB approval and then solicited participation by mailing paper-and-pencil survey packets to the potential participants. We asked participants to anonymously respond about their current, licensed clinical supervisor. Participants returned the surveys to the authors using a prepaid envelope. Of the 1,347 mailed packets, 330 packets (24.5%) were “returned to sender” and never received by the potential participants. Of the remaining 1,017 packets distributed to potential participants, 109 survey packets were returned. However, two participants’ responses were incomplete and subsequently removed. The number of usable packets was 107, resulting in a response rate of 10.5%. This response rate, although low, is consistent with previous survey research employing a mailing recruitment strategy (Barden et al., 2017). Because data collection was anonymous, we are unable to identify the state of origin for participants included in our sample.
The age of participants ranged from 24 to 67 (M = 38.79, SD = 11.20). The majority of participants identified as White (83.2%), while eight participants identified as Hispanic (7.5%), five participants identified as African American/Black (4.7%), two participants identified as Asian (1.9%), two participants identified as Multiracial (1.9%), and one participant did not respond to this item (0.9%). Eighty-five participants identified as female (79.4%), 21 participants identified as male (19.6%), and one participant identified as non-binary (0.9%). The demographic characteristics of the participants in the current study are comparable to counseling professionals in general (CACREP, 2018). On average, the participants received 64.73 (SD = 29.79) minutes of clinical supervision per week. Finally, 56 participants were assigned a supervisor at their job (51.4%), 28 paid for supervision from someone who did not work at their employment site (26.4%), 17 chose a supervisor at their place of employment (15.9%), and six participants indicated other (5.6%; e.g., free supervision from someone outside their job).
Supervisee Nondisclosure Scale (SNDS)
The SNDS is an instrument designed to capture the degree to which participants disclosed or withheld information to their supervisors (Ellis & Colvin, 2016; Siembor, 2012). Siembor (2012) developed a pool of 30 items, informed by prior research on nondisclosure (Hess et al., 2008; Ladany et al., 1996). Participants indicate their level of disclosure using a 7-point Likert scale with three defined levels: (1 = fully disclosed, 4 = sometimes disclosed, 7 = decided not to disclose). Higher scores indicate higher levels of nondisclosure. Participants are given the option to select not applicable for items describing incidents that have not occurred during their supervision experiences. The items include information related to the supervision experience (e.g., “Negative reactions that I had about my supervisor’s behavior or attitudes”) and items related to the supervisee’s clinical work (e.g., “Clinical mistakes that I did make”). Abbreviated item stems for all 30 SNDS items are presented in Table 1. The internal reliability of all 30 items was strong (α = .88, n = 107) and consistent with prior research (α = .84; McKibben et al., 2018).
We created a survey to collect self-report demographic data for both the supervisee and supervisor (e.g., gender, race). We also asked participants to share about the details of their supervision experience (e.g., time in supervision, administrative versus clinical supervision, selecting a supervisor).
Across all 30 SNDS items, 95.3% of the participants reported some degree of intentional nondisclosure (i.e., partially or fully withheld) for at least one item. The number of incidents of intentional nondisclosure endorsed by participants ranged from 0 to 26 (M = 10.68; SD = 6.62). Also, 53.3% indicated that they fully withheld information from their clinical supervisor for at least one item. The range of incidents completely withheld by participants was 0 to 14 (M = 1.73, SD = 2.6). This finding suggests that intentional nondisclosure by prelicensed counselors in clinical supervision is quite common.
The Frequency of Intentional Nondisclosure in Clinical Supervision
To address the first research question, we examined the frequency of participants who responded that they utilized intentional nondisclosure on each item (i.e., what percent withheld information?). To do so, we analyzed the self-reported responses on each item using the four groups: not applicable, fully disclosed, sometimes disclosed, and decided not to disclose (see Table 1). For each item, participant responses of not applicable were categorized in the not applicable group, responses of 1 were categorized in the fully disclosed group, responses of 2 to 6 were categorized in the sometimes disclosed group, and responses of 7 were categorized in the decided not to disclose group. The incidence of partial or complete nondisclosure per item ranged from 69.2% (“disagreement with one’s supervisor”) to 1.9% (“supervisor attraction issue”), and the average incidence across the items was 35.6% (SD = 15.8%). After “disagreement with one’s supervisor,” the items with the highest incidence rates were “negative reaction to supervisors’ behavior or attitudes” (66.3%), “perceived that my supervisor is wrong” (60.7%), “personal issue” (49.6%), and “personally identifying with a client” (e.g., countertransference; 48.6%). In addition to revealing what supervisees chose to withhold, the results indicated issues that did not emerge in supervision and those that emerged but were fully disclosed. For example, items frequently marked not applicable were “supervisor attraction issue” (97.2%), “client attraction issue” (86.9%), “unsafe in supervision” (86.0%), and “supervisors’ attire and/or appearance” (84.1%). In contrast, “client information” and “clinical mistake” came up often and were fully disclosed.
Incidence of Intentional Nondisclosure by Prelicensed Counselors in Clinical Supervision for State Licensure as Professional Counselors
|Incident of Potential Intentional Nondisclosure
|Decided Not to Disclose
|Negative reaction to supervisors’ behavior or attitudes SRI
|Supervisors’ competence SRI
|Needs not being met in supervision SRI
|Supervisors’ display of stereotypes or bias SRI
|Supervisors’ attire and/or appearance SRI
|Consult with peer and/or another supervisor SRI
|Supervision process concerns SRI
|Power differentials SRI
|Focus of supervision SRI
|Unsafe in supervision SRI
|Perceived that my supervisor
is wrong SRI
|Disagreement with one’s supervisor SRI
|Supervision format issues SRI
|Personal issue CRI
|Personally identify with client (e.g., countertransference) CRI
|Evaluation concern SRI
|Client attraction issue CRI
|Client attracted to counselor CRI
|Positive reaction to supervisor SRI
|Issues with colleague SRI
|Positive reaction to client CRI
|Feeling inadequate CRI
|Clinic setting concerns CRI
|Supervisor attraction issue SRI
|Unprofessional behavior with client CRI
|Future clinical mistake CRI
|Clinical mistake CRI
|Client information CRI
|Negative reaction to client CRI
Note. Percentages may not equal 100% for each item because of rounding.
SRI = Supervision-Related Incident
CRI = Client-Related Incident
a = Items are ranked based on incidence of total nondisclosure (i.e., score of 7).
The Most Difficult to Discuss Items
In addition to the per-item incidence rates, we also calculated which concerns were most often totally withheld from supervisors. We hoped to understand what items participants might be completely unwilling to discuss in supervision. Interestingly, we ranked all 30 SNDS items by the number of participants who reported using total nondisclosure, and this revealed that the 13 items with the highest endorsement were all supervision-related incidents. There were 24 participants (22.4%) who reported completely withholding their negative reaction to their supervisors’ behavior or attitudes. Relatedly, 18 participants (16.8%) did not discuss their concerns about their supervisors’ competence, and 16 participants (15.0%) did not tell their supervisors that they believed they were not getting enough out of supervision. Regarding client-related incidents, the highest-rated total nondisclosure was personal issues related to work with clients, which was reported by five participants (4.7%). The full results regarding the most difficult to discuss items are presented in Table 1.
Our study examined the incidence of intentional nondisclosure by prelicensed counselors receiving postgraduate supervision for licensure as professional counselors. We found that 95.3% of prelicensed counselors in this study reported they withheld some degree of information from their clinical supervisors. This was comparable to the rates of intentional nondisclosure by trainees from allied professions (Ladany et al., 1996; Mehr et al., 2010). On average, participants reported 10.68 of 30 (SD = 6.62) intentional nondisclosures in clinical supervision, which also is comparable to the 8.06 nondisclosures reported by psychology trainees in the study by Ladany et al. (1996), although we should acknowledge that Ladany et al. used a different measure to capture incidents of nondisclosure in their study. Like allied professions, intentional nondisclosure by postgraduate, prelicensed counselors appears to be routine in clinical supervision. Further, we surmise that even though postgraduate, prelicensed counselors are more developmentally advanced than CITs (e.g., self-aware, motivated; Stoltenberg & McNeill, 2010), in a hierarchical and evaluative relationship such as clinical supervision, they too will withhold information. This suggests that prelicensed counselors, who are empowered to self-direct their postgraduate supervision experience, are doing just that—they are self-directing their supervision experience, including editing or concealing concerns about their clients and supervision experience from their supervisors. As such, supervisors who are reliant on supervisee self-report may not be getting a full picture of supervisee concerns or needs. This finding reveals implications for prelicensed counselors and supervisors alike. Delving further into the types of incidents being withheld in postgraduate supervision, as well as the frequency of these incidents, can help tell a more complete story of supervisee intentional nondisclosure by prelicensed counselors.
Overall, we found that participants were more willing to discuss commonly occurring client-related incidents than they were to disclose supervision-related incidents. However, the participants still reported hesitancy in disclosing many of their client-related concerns. This is evidenced by participants identifying client-related issues as salient issues to their supervision experience, and although they withheld some degree of this information from their clinical supervisors, they did not completely withhold the information. Although prior research has found that supervisees are less apprehensive to discuss client-related issues with their clinical supervisors (Ladany et al., 1996; Mehr et al., 2010; Yourman & Farber, 1996), there may be unique differences for prelicensed counselors that help to explain the findings from the current study. Notably, it is possible that as theorized (Loganbill et al., 1982; Stoltenberg & McNeill, 2010), prelicensed counselors are better able to self-monitor their own needs. As prelicensed counselors gain more clinical experience, they are able to autonomously address their client-related concerns (Rønnestad & Skovholt, 2003) and do not need to fully elaborate on their client-related concerns to their supervisors. However, when prompted by a survey such as this one, they recognize that there is more information to share about the incident (i.e., some degree of nondisclosure). Also, given the limited time in supervision for licensure, prelicensed counselors appear to need to prioritize specific information about their clinical work and seek guidance about their most pressing clinical needs (Cook & Sackett, 2018). Thus, at times they are unable to fully discuss the intricacies of their client caseloads.
We also found that prelicensed counselors are most hesitant and sometimes unwilling to discuss supervision-related concerns with their clinical supervisors. In the current study, the most common nondisclosures included disagreements with one’s supervisor, negative perceptions of one’s supervisor, and believing one’s supervisor was wrong, all directly pertaining to the supervisor. High levels of nondisclosure in relation to these types of incidents have been reported in prior research with psychology trainees (Mehr et al., 2010). Prelicensed counselors are likely to have started to develop their own counseling style (Rønnestad & Skovholt, 2003), which may or may not align with their supervisors’ approach to counseling. As such, it is likely that supervisees sometimes disagree with their supervisors or believe that their supervisor handled a situation poorly (Magnuson et al., 2002). It is possible that supervisees’ concerns about voicing dissent to their supervisors could reflect a weak or insecure supervisory relationship, which has been found to be a significant predictor of nondisclosure (Cook & Welfare, 2018; Mehr et al., 2010).
A little more than half of the participants (53.3%) reported that they completely withheld information from their supervisors. That is, these participants recognized something as being salient in their clinical supervision but refrained from disclosing any information about their concern with their supervisor. Perhaps most startling, the top 13 items (out of 30 items total) were all supervision-related incidents and some of these incidents occurred with staggering frequency. For example, a number of participants completely withheld their negative reactions to their supervisor’s behavior or attitudes (22.4%), never disclosed that they questioned their supervisor’s competence (16.8%), and declined to discuss that their needs were not being met in supervision (15.0%). These findings underscore the inherent power imbalance between supervisees and supervisors (Cook, McKibben, & Wind, 2018; De Stefano et al., 2017; Ladany et al., 1996). Although prelicensed counselors perceive concerns about their supervisor or their supervision experience, they are unwilling to broach these topics with their evaluative supervisors (Gibson et al., 2019).
It is difficult to say why the participants in the current study felt unfulfilled by their supervision experience or wondered about their supervisors’ competencies. We must exercise judgment before assuming that the supervisors of the participants in the current study were providing substandard supervision (Ellis et al., 2014). However, it also seems important that supervisees perceive their postgraduate supervision experience as a meaningful one, given the stakes associated with clinical supervision (Magnuson et al., 2000). For example, many prelicensed counselors pay for supervision, which can be a substantial financial investment for new prelicensed counselors. Relatedly, in situations in which prelicensed counselors’ clinical supervisors also are their administrative supervisors, sustained employment may depend on the supervisor’s favorable review. Regardless, these findings highlight the importance of outlining clear expectations of clinical supervision for supervisees (Magnuson et al., 2002) and developing a quality supervisory relationship in order to mitigate supervisee nondisclosure (Cook & Welfare, 2018; Mehr et al., 2010). In sum, these findings offer insight into the experiences of prelicensed counselors in postgraduate supervision, which can yield lessons for prelicensed counselors, supervisors, counselor educators, and counselor credentialing bodies in order to mitigate the occurrence of intentional nondisclosure in the future.
Implications for Prelicensed Counselors
Prelicensed counselors need to take an active role in their postgraduate supervision experience. Learning to navigate the nuances of supervision in addition to learning to be a practicing counselor early in one’s career is a daunting task (Freadling & Foss-Kelly, 2014). Prelicensed counselors who are contemplating withholding information from their clinical supervisors should consider their ethical and professional responsibilities to clients (American Counseling Association, 2014). Counselors who are starting postgraduate supervision may find it helpful to consult resources to help acculturate them to the specifics of postgraduate supervision and to explore strategies other than nondisclosure for addressing their concerns in supervision (Cook & Sackett, 2018; Magnuson et al., 2000; Pearson 2001, 2004).
Also, prelicensed counselors should consider which of the incidents described herein could be most relevant to their postgraduate supervision experience. Specifically, our prelicensed counselor participants were most apprehensive to discuss supervision-related concerns with their clinical supervisors. Unlike clients, who have the freedom to choose a different counselor if they are dissatisfied with their counseling services, supervisees likely have limited options when it comes to changing supervisors (De Stefano et al., 2017). Many of the concerns expressed by our participants reflect the inherent power differential between supervisors and supervisees. As such, prelicensed counselors who are dissatisfied with their supervision experience can find it helpful to broach some of these commonly reported issues with their clinical supervisors (Cook, McKibben, & Wind, 2018). The Power Dynamics in Supervision Scale was designed to operationalize supervisees’ perceptions of power and to aid in the discussion of power dynamics in clinical supervision (Cook, McKibben, & Wind, 2018). Prelicensed counselors may find such an instrument a helpful way to invite these discussions in an objective and nonthreatening manner with their supervisors. Such discussion between supervisors and supervisees can make it easier for supervisees to disclose more honestly if that issue arises (Knox, 2015).
Finally, some participants perceived their supervision experience as substandard, while a few more participants reported feeling unsafe in supervision or recognized power differentials between themselves and their supervisors. Although uncommon, our study is not the first one in which supervisees in the counseling profession report substandard or harmful experiences (Cook, Welfare, & Romero, 2018). Furthermore, no one should endure supervision that they perceive to be inadequate or harmful (Ellis et al., 2014). Supervisees can find it helpful to consult with a trusted colleague or another supervisor. For more egregious issues, prelicensed counselors may seek help from a professional association ethics consultant or a representative from their state licensing board (Cook, Welfare, & Romero, 2018). For those supervisees who are paying for supervision (26.4% in the current study), finding another supervisor may be the most viable solution.
Implications for Supervisors, Counselor Educators, and Counselor Credentialing Bodies
Addressing supervisee intentional nondisclosure must be a priority for clinical supervisors who are providing postgraduate supervision. If supervisors are to rely on supervisee self-report (Fall & Sutton, 2004), it will benefit supervisors to create a safe and open supervision environment that invites supervisee disclosure (Cook & Welfare, 2018; Gibson et al., 2019; Mehr et al., 2010). Encouragingly, prelicensed counselors appear more apt to discuss client-related incidents than supervision-related incidents; however, it also seems that clinical supervisors are not getting the full picture of their supervisees’ clinical work because there is some degree of nondisclosure. Notably, prelicensed counselors reported hesitancy in fully discussing their personal issues related to their work with clients, clinical mistakes, and reactions to clients. As prelicensed counselors continue their professional development, they can desire to try new interventions in their counseling work or have novel insights into how their personal experiences are impacting their clinical work (Rønnestad & Skovholt, 2003). Understandably, they might be apprehensive about discussing these issues with their evaluative supervisors. Supervisors will find it helpful to facilitate a discussion with their supervisees about the lifelong journey of being a professional counselor (Rønnestad & Skovholt, 2003) and the normality of sometimes feeling stuck in one’s clinical work with clients (Cook & Sackett, 2018) or going through stages of feeling stagnation, confusion, and integration, as discussed in the foundational model of Loganbill et al. (1982).
Prelicensed counselors’ unwillingness to discuss their supervision-related concerns, particularly those incidents that are commonly occurring such as negative impressions of one’s supervisor, negative reactions to a supervisor’s competence, and the belief that one’s needs are not being met in clinical supervision, seems to be most problematic. There are infrequently occurring issues that supervisees are completely unwilling to discuss (e.g., romantic attraction to one’s supervisor) that can lead to ruptures in the supervisory relationship (Nelson et al., 2008). Prior research suggests that supervisees who possess a favorable impression of their supervisory relationship are less likely to withhold information from their supervisors (Cook & Welfare, 2018; Gibson et al., 2019; Mehr et al., 2010). As such, supervisors need to take steps during formation of the supervisory relationship and throughout the supervision experience to create a safe and open environment that invites supervisee disclosure. Supervisors will find it helpful to specifically attend to the issues identified in our study such as how to professionally address disagreements between supervisors and supervisees, and to discuss supervisees’ personal expectations of clinical supervision.
Counselor educators can play a critical role in helping CITs learn strategies to navigate postgraduate supervision and understand the concept of intentional nondisclosure. For example, counselor educators can better prepare CITs for some of the nuanced differences of postgraduate supervision (Magnuson et al., 2002) versus the supervision they receive in their training programs. Counselor education programs can share resources (Cook & Sackett, 2018; Magnuson et al., 2002; Pearson, 2001, 2004) with CITs before they graduate to teach them about postgraduate supervision and help them learn about the experiences of prelicensed counselors. Further, counselor educators can teach CITs to be their own advocates in postgraduate supervision because they will be expected to self-direct their supervision experience (Magnuson et al., 2000). Advocacy in this context can include teaching soon-to-be graduates the importance of utilizing supervision contracts and training them to prepare their own supervision contracts to use with their postgraduate supervisors. These supervision contracts should outline key information to conducting adequate supervision (Ellis et al., 2014), including but not limited to (a) the frequency of clinical supervision (e.g., weekly individual or triadic supervision sessions), (b) the modalities to be utilized in supervision (e.g., self-report, audio or video recording), (c) the relevant ethical and professional guidelines that will guide the supervision experience, and (d) the roles and responsibilities for both the supervisor and supervisee. Preparing these documents prior to graduation can ensure that supervisees are well-informed of their rights as supervisees (Munson, 2002) and help easily identify signs of substandard postgraduate supervision (Ellis et al., 2014).
Counselor educators might also share the findings from this study with their CITs and facilitate a discussion about the concerns identified by the participants. Educating CITs on the concept of intentional nondisclosure is important, as it can aid CITs in identifying what influences their own intentional nondisclosure. With greater self-awareness, they may be able to identify the temptation if it ever presents itself. Counselor educators also can teach CITs about the potential harm to clients when supervisees choose to engage in intentional nondisclosure. For example, if supervisees purposefully withhold about the triggers they experience when working with a client, they run the risk of not providing effective counseling services and, even worse, harming the client (Hess et al., 2008; Ladany et al., 1996).
Finally, given that our study was the first study to examine supervisee intentional nondisclosure in a sample of prelicensed counselors, it is important to offer recommendations for state licensure boards and nationwide credentialing bodies that may improve the supervision experience for supervisees and supervisors. These prelicensed counselors withheld specific supervision-related concerns, including the belief that their expectations of clinical supervision were not being met and that they disapproved of their supervisors’ behaviors. Unlike university-based supervision in which supervision requirements and supervisors’ training and credentials (e.g., time in supervision, required supervision training, direct observation) are clearly outlined by accreditation bodies (CACREP, 2015), the supervision requirements for those pursuing state licensure vary from state to state (Field et al., 2019; Gray & Erickson, 2013; Henriksen et al., 2019). Some scholars have questioned if the supervision being provided is minimally adequate, or if supervisors are aware that they are providing inadequate or harmful supervision (Ellis et al., 2014). It is unclear how many supervisors in our study had received clinical supervision training or were providing supervision in accordance with professional standards (i.e., Borders et al., 2011). For example, only six of the 10 states that we sampled had licensure board requirements for clinical supervisors to have completed supervision training (Field et al., 2019), and none required a supervision credential such as the Approved Clinical Supervisor (issued by the National Board for Certified Counselors). It is important for all state licensure boards to require supervision training in order to best position supervisors to provide quality supervision. Relatedly, Field et al. (2019) found that only 47.1% of states require supervisors to complete a supervision contract or supervision philosophy prior to conducting postgraduate supervision. At a minimum, all licensure jurisdictions should require these documents as a part of the application packet for prelicensed counselors when they register their supervisor with their licensing board. By requiring these documents, state licensure boards and credentialing bodies can encourage a dialogue between supervisors and supervisees about some of the concerns identified in our study.
Limitations and Opportunities for Future Research
Like in all studies, there are limitations that need discussion. We aimed to collect data from a nationally representative sample; however, our findings could have been impacted by the varying licensure regulations in each state. As such, future research could benefit from a retest of the incidence of nondisclosure by prelicensed counselors in other states. Relatedly, although our response rate was consistent with prior counseling research that collected data via mailings (Barden et al., 2017), future researchers could explore other data collection methods (e.g., electronic survey) to increase participants’ responsiveness. Also, it is possible that the topic of nondisclosure was acutely salient to the persons who chose to participate in the current study, which could have influenced our findings. Future scholars are urged to examine more demonstrable factors of the supervisory relationship that may help to explain intentional nondisclosure by prelicensed counselors such as the incidents of inadequate and harmful supervision, which appear to influence supervisees’ willingness to disclose in supervision. Finally, future researchers should explore if nondisclosure occurs less frequently in supervision dyads that regularly use one of a number of supervisory relationship inventories (Tangen & Borders, 2016) to assess the perceived quality of their supervisory relationship.
In sum, postgraduate supervision has important implications for prelicensed counselors and supervisors alike. Thus, it behooves both prelicensed counselors and clinical supervisors to mitigate supervisee intentional nondisclosure. The findings presented in this study provide insight into the type of information being withheld by supervisees and the degree to which they are hesitant to discuss certain concerns. Clinical supervisors who hope to create an environment that promotes supervisee disclosure will benefit from specifically targeting some of the issues identified herein.
Conflict of Interest and Funding Disclosure
This research was funded by the Southern
Association for Counselor Education and Supervision.
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Ryan M. Cook, PhD, ACS, LPC, is an assistant professor at the University of Alabama. Laura E. Welfare, PhD, NCC, ACS, LPC, is an associate professor at Virginia Tech. Connie T. Jones, PhD, NCC, ACS, LPCA, LCAS, is an assistant professor at the University of North Carolina at Greensboro. Correspondence can be addressed to Ryan Cook, 310 Graves Hall, Box 870231, Tuscaloosa, AL 35487, email@example.com.