Neuroscience for Counselors: Recommendations for Developing and Teaching a Graduate Course

Deborah L. Duenyas, Chad Luke

 

In recent decades, professional counselors have increasingly focused on neuroscience to inform their case conceptualization and treatment planning with clients. With the additional lens of neuroscience, both the counselor and client can gain new understandings of the client’s issues and improve the quality of the therapeutic relationship. The benefits of integrating neuroscience into the profession of counseling (i.e., neuroscience-informed counseling) are being documented in the scholarly literature; however, information on integrating neuroscience-informed counseling into the counselor education curriculum is sparse. This article describes one teaching approach for a neuroscience-informed counseling course. The structure of the course, methods for effective instruction, and ethical and cultural considerations are discussed.

 

Keywords: neuroscience, counselor education, teaching, neuroscience-informed, instruction

 

 

Neuroscience-informed counseling is a growing force in the counseling profession (Beeson & Field, 2017). The integration of neuroscience into the profession of counseling has been evident over the past two decades. Examples include the development of neuroscience interest networks by the American Counseling Association (ACA), the American Mental Health Counselors Association (AMHCA), and the Association for Counselor Education and Supervision (ACES). There have been numerous books published that focus on neuroscience for counselors (Field, Jones, & Russell-Chapin, 2017; Luke, 2019) and an increased amount of scholarly literature focused on integrating neuroscience into counseling practice (Beeson & Field, 2017; Lorelle & Michel, 2017; Luke, Redekop, & Jones, 2018; Makinson & Young, 2012; Miller, 2016; Myers & Young, 2012).

 

Neuroscience is the study of the brain and nervous system (Kalat, 2019). Neuroscience-informed counseling involves integrating principles from the structure and function of the brain and nervous system to counseling practice (Russell-Chapin, 2016). This integrative work in counseling is being used to treat behavioral and mental health challenges (Field et al., 2017). According to Beeson and Field (2017), neurocounseling is a

 

specialty within the counseling field, defined as the art and science of integrating neuroscience
principles related to the nervous system and physiological processes underlying all human
functioning into the practice of counseling for the purpose of enhancing clinical effectiveness in the
screening and diagnosis of physiological functioning and mental disorders, treatment planning
and delivery, evaluation of outcomes, and wellness promotion. (p. 74)

 

Three methods for integrating neuroscience into the counseling profession have been identified in the scholarly literature, including neuroeducation (Fishbane, 2013), neurofeedback (Myers & Young, 2012), and the use of a metaphor-based approach (Luke, 2016).

 

The first method, neuroeducation, is defined by Miller (2016) as “a didactic or experiential-based intervention that aims to reduce client distress and improve client outcome by helping clients understand the neurological processes underlying mental functioning” (p. 105). Neuroeducation is essentially psychoeducation about the brain and nervous system. Neuroeducation can be used as an intervention to help clients understand the neurological processes that underlie their symptoms and development (Miller, 2016). Miller described various methods for integrating neuroeducation into counseling practice through the use of information on neuroplasticity, brain structures and functions, and memories.

 

     Plasticity is an object’s or organism’s ability to stretch and to be resilient. As applied to the brain and central nervous system, this is called neuroplasticity or neural plasticity, and involves “changes in the activity and connectivity of the various circuits within the nervous system [that] enable learning, encode memory, and drive behavior” (Li, Park, Zhong, & Chen, 2019, p. 44). Information on neuroplasticity and self-defeating patterns of thought and behavior may help demystify change processes.

 

Informing clients about the various brain structures and functions (e.g., brain stem, limbic, and cortical regions) can help with understanding the brain from a developmental perspective—that the brain is built to change and to be resilient (Luke, 2019). Educating clients about how their memories are encoded, stored, and accessed, drawn from the groundbreaking work of Eric Kandel (1976), can help clients gain a better understanding of their own brain and behavior (Miller, 2016). This knowledge can instill hope that although events of the past cannot be changed, the meaning of the memories associated with those events can be changed (Sweatt, 2016). Furthermore, the relational context in which change takes place can help clients’ brains overwrite rigid rules and threats about relationships learned from earlier dysfunctional relationships (Kandel, Dudai, & Mayford, 2014; Schore, 2010; Siegel, 2015).

 

A second method, neurofeedback, has been recognized as an effective treatment for reducing symptoms of various mental health concerns (Russell-Chapin, 2016). A specialized form of biofeedback, neurofeedback changes brain wave patterns to aid in the treatment of conditions such as attention-deficit/hyperactivity disorder, anxiety, depression, addiction, trauma, autism spectrum disorders, and personality disorders (Russell-Chapin, 2016). Neurofeedback is just one method that counselors can use with clients to help them understand and change the function of their brains. Additional examples include basic biofeedback tools and methods like those found on many “smart” watches and fitness trackers.

 

The third method for integrating neuroscience-informed counseling is described by Michael and Luke (2016) as using a metaphor-based approach to teaching the neuroscience of play therapy. This approach is an extension and application of that described in Luke (2016), wherein neuroscience concepts are used both as metaphors for the human experience, as well as understanding brain function. Tay (2017a) has identified the therapeutic value of metaphor and its utility in understanding language and the body. Relatedly, the practices of mindfulness and meditation often use imagery, a form of metaphor, to engage practitioners in engaging more fully in the experience (Tang, Hölzel, & Posner, 2015). As neuroscience-informed counseling continues to become integrated into the work of professional counselors, counselor educators must adapt in order to keep their coursework relevant.

 

Counselor Education and Neuroscience-Informed Counseling

 

Beeson and Field (2017), along with others (Field et al., 2017; Luke, 2017; Miller, 2016) have called for more training for counselors who seek to integrate neuroscience into their practice. They also have identified the challenges associated with infusing neuroscience into counseling courses. The Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2015) standards now require competency in “the biological, neurological, and physiological factors that affect human development, functioning, and behavior” (p. 10). CACREP standards, along with growing momentum in the field, support the development of a course designed specifically for integrating neuroscience for counselors. The AMHCA clinical training standards include recommendations for competence in understanding and applying the biological bases of behavior. The AMHCA standards outline basic knowledge and skills, which include integrating research into practice, as well as clinical interventions.

 

Field et al. (2017) laid a foundation for incorporating neuroscience-informed counseling across the CACREP curriculum. This approach addresses neuroscience in pre-existent courses, yet there is limited availability of literature on how to teach a graduate content course in neuroscience-informed counseling. In the absence of established models for teaching a course in neuroscience-informed counseling, counselor educators and others can feel at a loss for how to proceed. The purpose of this article is to provide recommendations for developing a neuroscience-informed counseling course designed for graduate students. This includes the course structure (e.g., content and resources), methods for effective instruction (e.g., teaching approach and assignments), and ethical considerations.

 

Course Structure: Content and Resources

 

The Neuroscience for Counselors course builds on prior core counseling courses, including counseling theories and the fundamentals of counseling. As such, it represents an extension of counseling theory and fundamentals and is not intended to be a substitute or replacement. Neuroscience-informed counseling explores how different counseling theories and interventions influence and change neurobiology and help facilitate client wellness.

 

The Neuroscience for Counselors course was offered to master’s students enrolled in a CACREP-accredited counseling program at a mid-size university in the northeast region of the United States. The course was offered as an elective that fulfilled three graduate credits toward degree completion. The course was designed as an introduction to neuroscience research and clinical interventions for counselors. Specific attention was given to reviewing the structures, systems, and functions of the brain. Psychodynamic, behavioral, humanistic, and constructivist counseling theories were explored in relation to neuroscience research. The neuroscience of mental health disorders, such as anxiety, depression, stress, and addictions and substance use, were explored.

 

Course assignments included developing a neuroscience-informed guided metaphor; completing a brain resource book on structures, systems, and functions; dyads to practice using neuroscience-informed counseling interventions; reflection in a neuroscience process analysis log (N-PAL); and activities exploring neuroscience-informed technology. A final paper included a case conceptualization based on the 8-factor meta-model (Luke, 2017, 2019) of case conceptualization to explore their client’s presenting concerns.

 

The assigned textbook for this course was Luke’s (2016) Neuroscience for Counselors and Therapists: Integrating the Sciences of Mind and Brain, which focuses on client conceptualization, brain anatomy, various theoretical approaches, and an array of commonly diagnosed mental health concerns. The text also provides case vignettes highlighting how a student might use neuroscience-informed counseling interventions with a diverse population of clients. The first chapter of the text discusses ethical and philosophical issues related to integration. Chapter 2 presents an overview of the basic brain structures, systems, and functions, including neurons and synapses. Chapters 3 through 6 cover the major categories of counseling theories: psychodynamic, cognitive-behavioral, humanistic-existential, and postmodern and constructivist. Chapters 7 through 10 describe conceptualizing and treating anxiety, depression, stress-related disorders, and substance use disorders. The text is written for counselors and counselors-in-training who have little or no background in the physiological bases of behavioral and mental health concerns.

 

     The course instructor provided supplemental material, including magazine articles, peer-reviewed journal publications, apps, videos, websites, and links to neuroscience interest networks. For example, students were provided a link to the Neuroscience News website, which is an independent science news website that offers free cognitive science research papers, neuroscience resources, and a science social network. Also included were links to the Dana Foundation, an organization that supports brain research via grants, publications, and education, and the ACA’s Neurocounseling Interest Network. The supplemental material was selected as a method to broaden student understanding and support knowledge acquisition in neuroscience.

 

Methods: Teaching Approach and Assignments

 

Experiential education is not a new approach in higher education. Educational psychologists in the past, such as John Dewey (1938), Carl Rogers (1969), and David Kolb (1984), have laid the groundwork for the development of contemporary experiential education. Kolb (1984) defined learning as “the process whereby knowledge is created through the transformation of experience. Knowledge results from the combination of grasping and transforming experience” (p. 41). The Association for Experiential Education (AEE; 2019a) defined experiential education as a teaching philosophy “in which educators purposefully engage with learners in direct experience and focused reflection in order to increase knowledge, develop skills, clarify values, and develop people’s capacity to contribute to their communities” (para. 1). In essence, experiential education is the process of learning through experience and reflection.

 

Methods of instruction in the Neuroscience for Counselors course were consistent with the 12 principles of practice outlined by the AEE (2019b). For example, class assignments provided students with the opportunity for reflection, critical thinking, and personal application. The instructor’s teaching roles included “setting suitable experiences, posing problems, setting boundaries, supporting learners, insuring physical and emotional safety, and facilitating the learning process” (AEE, 2019b, para. 9). Sakofs (2001) cautioned that experiential activities can be misused by educators as a form of entertainment with no real educational value. The following six assignments were designed with the intention to deepen students’ understanding of neuroscience concepts as they relate to the profession of counseling.

 

Six Neuroscience Course Assignments

     Developing a neuroscience-informed guided metaphor. Historically, neuroscience has been considered the realm of the medical professional or psychiatrist who has studied the complex inner workings of the brain. Developing a neuroscience-informed guided metaphor provides counseling students the experiential opportunity of taking an unfamiliar concept or idea (i.e., using neuroscience-informed counseling) and making it more accessible by relating it to ideas they are already familiar with (Jamrozik, McQuire, Cardillo, & Chatterjee, 2016; Lawson, 2005). For this assignment, students were assigned to read the article “The Birth of the Neuro-counselor?” (Montes, 2013), in which the term neurocounselor was first used. The article introduces and encourages students to begin thinking about what it means to use neuroscience-informed counseling in practice and how it influences their professional identity as a counselor.

 

After reading the article, students illustrated a guided metaphor that could be used to inform their model of neuroscience-informed counseling practice. Students were provided with the prompt, “Neuroscience-informed counseling is _________” and then asked to fill in the blank with a noun. Students included a paragraph explaining their choice in metaphor and how they came to make that decision. Students were asked to share their metaphors with their peers in class. A student’s illustration could be a visual representation, in writing, or a combination of both. Metaphor is, simply put, the practice of describing one thing in terms of another (Tay, 2017b). More specifically, the use of metaphor increases understanding of a less well-understood concept or idea by describing it in terms of something that is better understood. In the assignment described above, students generated metaphors such as “neuroscience-informed counseling is the first mission to the moon,” “neuroscience-informed counseling is a penlight in a dark maze,” and “neuroscience-informed counseling is a puzzle” to be solved. Lawson (2005) extolled the virtues of metaphors in counseling, noting that they “can help the counselor connect to the client’s world” (p. 135). The use of neuroscience metaphors, whether generated by the client or the counselor, can aid in promoting empathy and therefore trust (Luke, 2017) and can aid in learning neuroscience concepts (Michael & Luke, 2016). For example, in the wildly popular “I Had a Black Dog, His Name Was Depression” World Health Organization video on YouTube (over 9 million views as of this writing), depression is compared to a black dog that affects every facet of an individual’s life (World Health Organization, 2012). The metaphor works by comparing an abstract concept like depression with something concrete like a black dog. It enables the client to experience their depression as something happening to them, not emerging from their core self. When incorporated with relevant neuroscience information, the metaphor takes on increased significance. This black dog hijacks a person’s will, leaving them with diminished options for meaningful action.

 

Developing metaphors for the counselor’s roles when using neuroscience-informed counseling can clarify and strengthen counselor identity. When introducing this assignment, it is important to note that neuroscience-informed counseling is not its own therapeutic orientation. Whereas many graduate counseling programs have courses focused on advanced therapeutic orientations, such as solution-focused therapy or motivational interviewing, a course in neuroscience for counselors can strengthen a counselor’s current theoretical framework (Luke, 2017). For example, counselors practicing cognitive behavior therapy who learn about Hebb’s rule (1949), which states that “neurons that fire together wire together,” along with the concept of neuroplasticity, have another avenue of support for clients working to make positive behavioral changes. In this example, neuroscience can help the client gain awareness of the neurological structures that reinforce their behavior and also provide hard evidence that change is possible (Li et al., 2019). Neuroscience-informed counseling is one of many tools in the counselor toolbox. In addition to conceptualizing neuroscience-informed counseling as part of their professional identity, students also learn content knowledge of the brain’s structures, systems, and functions.

 

     Brain structures, systems, and functions book. This assignment required students to research the basic structures, systems, and functions of the human brain and design their own book. The instructor provided students black and white images of various structures of the brain discussed in the class textbook. Images included lateral and dorsal views of the brain, the two hemispheres of the brain, the three divisions of the brain (i.e., forebrain, midbrain, and hindbrain), the four lobes of the brain (i.e., frontal, temporal, occipital, and parietal), the anatomy of a neuron, and a stem chart of the nervous system tasks, including the sympathetic and parasympathetic nervous system functions. This approach is supported by works such as the Wammes, Meade, and Fernandes (2016) investigation of the neural processes of storing and retrieving memory. The authors found that drawing important words and phrases improves one’s ability to remember important concepts. Students were asked to use various mediums, including colored pencils, crayons, and markers, to label and highlight the different neuroanatomy. Students also were asked to use their class textbook to write descriptions of the functions of these parts of the brain within their assignment.

 

Mental health diagnoses can be intimidating for clients, as can the symptoms of a disorder. Anchoring a client’s experience in their neurobiology can increase their understanding of what is happening. Basic neuroscience information can empower them to learn more about, and in some ways objectify, their experience. In other words, knowledge of the underlying brain function can encourage clients to reflect on mind and body and how they interact. For example, depression is a result of brain function, but the choices an individual makes in response can be a function of the mind. In practice, clients can be led through the process of identifying brain function and mind function.

 

The brain structures, systems, and functions book assignment helps to empower students by providing them with the language and imagery surrounding neuroanatomy. Once counselors feel confident in their knowledge of basic brain regions and systems they can use it to empower clients by providing them a physiological explanation of their experiences. For example, knowledge about the autonomic nervous system can help a client struggling with generalized anxiety disorder. According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013), generalized anxiety disorder is characterized by excessive anxiety and worry that is difficult to control, with symptoms that might include restlessness, feeling on edge, being easily fatigued, difficulty with concentration, muscle tension, and sleep disruptions. Clients struggling with generalized anxiety disorder can feel as if they are in a constant state of emergency. Understanding how the sympathetic nervous system prepares the body for emergencies can help a client understand what they are experiencing at a physiological level. This can make them more receptive to interventions that activate their parasympathetic nervous system functions and move them from “fight or flight” to “rest and digest.” Once students in the course obtained content knowledge regarding the brain’s structures, systems, and functions, they applied that knowledge in dyads.

 

     Dyads. Experiential learning takes careful planning, structuring of lessons, and intentionality in teaching practices (AEE, 2019). Experiential activities such as dyads can help students learn the material through the act of “doing.” Tollerud and Vernon (2011) described the benefits of experiential learning as “promoting interest in a topic, supporting student retention of the material, and involving students in their education” (p. 285).

 

Luke (2017) outlined neuroscience concepts that can be used as interventions with clients
(e.g., memory systems, Hebb’s rule, left and right brain processing, mirror neurons, attention, and mindfulness). In the neuroscience course, students practiced discussing neuroscience concepts in dyads where they took turns acting as counselor and client. The neuroscience concepts coincided with Chapters 3–10 in the textbook. This provided practice for students using the neuroscience concepts with specific theoretical approaches (e.g., contemporary psychodynamic, behavioral approaches, humanistic approaches, and constructivist approaches), but also could align with a particular mental health diagnosis (e.g., anxiety, depression, stress disorders, and substance use disorders). For example, discussion about Hebb’s rule may apply to counselors working from a behavioral approach or counselors working with clients struggling with specific issues such as substance use.

 

The instructor provided a dyad prompt for students relating to the chapter material for that class session. For instance, the prompt for Chapter 3, Contemporary Psychodynamic Approaches and Neuroscience, was, “Tell me more about your early memories pertaining to key relationships (i.e., parents, siblings, guardians)” and “How do you feel these early memories influence your key relationships today?” The discussion prompt provided the student counselor an avenue to discuss the neuroscience concepts identified in the chapter (i.e., relationships in the brain/interpersonal neurobiology, consciousness, and memory systems) with their mock client. Students were graded on their ability to use the neuro-concepts and attend to their fundamental counseling skills (e.g., unconditional positive regard and empathy).

 

The dyad activities also highlight the positive benefits of right hemisphere to right hemisphere connections validated through neuroscience. According to Badenoch (2008), right hemisphere to right hemisphere connections are at the root of change, as interpersonal connections are rooted in the neural processes of the right hemisphere. Practicing mock counseling sessions provides students the opportunity to develop healthy relationships with their peers in class. This experience can later become a parallel process by which they use the positive experience in class with their future clients.

 

In counseling, two approaches parallel the class experience. In the first, counselors can apply the same material described above with their clients, using process-based psychoeducation. For example, the counselor can present information on the neurobiology and role of early memories, relationships (past and present), and consciousness/unconsciousness in the client’s depression. They can then ask the questions described above directly to the client. The second approach involves a Gestalt technique wherein the client’s depression, their brain, and the client themselves all sit together in the room. The client is guided through a discussion with these constituent parts in order to better understand the role that each plays in the living of the client’s life. As students completed each dyad, a system was created for them to reflect on their experience as described below.

 

     The N-PAL (Neuroscience-Personal Analysis Log). According to Faiver, Brennan, and Britton (2012), the purpose of a personal analysis log (PAL) “is to help students track their progress over the semester in terms of self-awareness and comfort level with the counseling process” (pp. 292–293). Students completed nine neuroscience personal analysis logs (N-PALS) throughout the course. Entries were made in class after each dyad. Students were given the opportunity to analyze and express their feelings in relation to the dyad activities and course material. The purpose of the N-PAL was to help students reflect on their counseling work while integrating neuroscience concepts into the mock counseling sessions with their classmates.

 

N-PALs consisted of five questions: (a) On a scale from 1–10, how confident do you feel applying the assigned theoretical approach for this dyad? (b) On a scale from 1–10, how confident did you feel using neuroscience concepts in this dyad? (c) What were some new areas of growth and development during this dyad? (d) Assess your own performance during this dyad and provide specific examples, and (e) What is your reaction to the course material (i.e., assigned reading, class lecture, videos, discussion)? The N-PAL’s structure is consistent with the experiential education principle, which states that experiences are structured to require the learner to take initiative and make decisions and be accountable for results (AEE, 2019). The questions were developed to encourage students to reflect on their dyadic experiences and think critically about their neuroscience-informed interventions while being held accountable for areas of growth and development.

 

     Exploring neuroscience-informed technology. With the increased focus on neuroscience in popular culture and media, there has been an influx of new neuroscience-informed technology. Students were asked to find three technological tools that could inform their neuroscience-informed clinical work. The tools were to fall into three distinct categories: one app (e.g., mindfulness, anxiety, or brain information app), one video (e.g., YouTube, TedTalk), and one technological application (e.g., pulse oximeter, biofeedback equipment, EEG reader). After identifying the neuroscience-informed technology tools, students posted on an online discussion board describing how they would use their identified tools in a counseling session.

 

There is an abundance of neuroscience-informed technology on the market today. Counselors recommending meditation apps or assorted TedTalks to their clients may be using this technology without awareness of their neuroscientific implications. Counselors do not have to work from memory alone but can take advantage of the growing number of resources available today (e.g., journal articles, books, apps, videos). Counselors who take advantage of resources also must be savvy consumers. For example, prior to recommending apps or videos to clients with neuroscience-related material, counselors should check the source to confirm it is reputable and use the material themselves. Whereas the neuroscience-informed technology discussion post helped to build awareness of technological tools, the final case conceptualization paper served to showcase the content students gained throughout the course.

 

     Case conceptualization. As a summative assignment, students completed a three-part case write-up that demonstrated their ability to conceptualize client issues and apply neuroscience-informed interventions. The instructor provided students with a fictional client case vignette, including biopsychosocial information. The first part of the assignment required students to use an 8-factor meta-model (Luke, 2017, 2019) to conceptualize their client’s case. This 8-factor model is a holistic model identifying eight components that every counselor must consider when working with clients: thoughts, feelings, behaviors, environments, experiences, biology and genetics, relationships, and the socio-cultural context in which the client lives.

 

Students were asked to include neuro-concepts in their discussion of each of the factors. For example, if the student identified that the client was experiencing anxious thoughts, they would include a description of how the amygdala modulates the client’s reactions to events perceived as dangerous or scary. This part of the assignment demonstrated the counseling student’s mastery of case conceptualization in conjunction with their understanding of how neuroscience concepts can influence the client’s symptoms.

 

The second part required students to review their conceptualization and write a phenomenological description of the client across the eight factors of the model. A phenomenological description provides an opportunity for students to consider, beyond the prescribed clinical note, what it might be like to “walk in this client’s shoes.” Writing a phenomenological description uses right-brain processing skills of creativity and intuitiveness. Although the description is the student’s interpretation of the client’s experience, the exercise can strengthen skills in empathic awareness and creative thinking. Thinking about the phenomenology of a client (i.e., what would it be like to walk in the client’s shoes?) can deepen therapeutic rapport, strengthen conceptualization skills, and help build empathy.

 

The third part of the assignment was for students to select a theoretical approach, along with a rationale for their choice, and create a transcript of a session with the client. The transcript had to include a brain-based counseling intervention (e.g., discussion about Hebb’s rule, neuroplasticity, or memory storage). Neuroscience is an essential tool for helping clients understand what is happening to them. For example, a client who has suffered a trauma and is struggling to understand why they cannot remember events clearly may find respite in knowledge regarding how traumatic memories are stored in their brain. Knowledge about neuroscience can help normalize and validate clients’ experiences.

 

In summary, six assignments were described above: neuroscience-informed guided metaphor; brain systems, structures, and functions book; dyads; the N-PAL; exploring neuroscience-informed technology; and a case conceptualization paper. The assignments were developed to build students’ understanding of the material and improve their ability to integrate neuroscience into their case conceptualization, treatment planning, and counseling skills. With the growth of neuroscience integration into the counseling profession, best practice dictates that ethical and cultural considerations are addressed.

 

Ethical Considerations

 

With nascent developments in the counseling profession, such as neuroscience-informed counseling, come potential risks to clients’ well-being. The ACA Code of Ethics (2014) states that “Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience” (Standard C.2.a). Scholarly literature has recognized the need for professional counselors to work within their scope of practice (Luke, 2019). As the counseling profession continues to integrate neuroscience into practice, the boundaries of that practice are not always clear. For instance, at what level of integration must counselors be educated in neuroscience explicitly? Who governs the practice of integration and ensures that counselors are following best practice, especially when best practice has not been established?

 

Each of the three areas described above—neuroeducation, neurofeedback, and metaphor—present distinct ethical challenges. Neuroeducation, like psychoeducation, can become too didactic and place counselors in the role of content expert, as opposed to process expert. It may be easy for counselors to share brain information with their clients, becoming dependent on sharing facts instead of sharing a process. Studies have demonstrated the potential for harm in the helping relationship when clients view helpers as aloof related to neuro-speak, as clients may feel powerless to change their neurobiology (Kim, Ahn, Johnson, & Knobe, 2016; Lebowitz & Ahn, 2014).

 

Neurofeedback can require advanced knowledge in technological interventions. For example, neurofeedback often requires the use of technological equipment to read and equalize brainwave activity. The Biofeedback Certification International Alliance (n.d.) offers a training program specifically for neurofeedback certification. With certification comes a level of oversight and guidance that promotes proper training of practitioners. However, certification is not a legal requirement to use neurofeedback in counseling practice. Therefore, what is a counselor’s ethical responsibility to acquire education in the use of neurofeedback equipment with clients? How much education is enough to be considered competent? Also, in terms of counselor identity, can neurofeedback be considered counseling or is it an adjunct to counseling?

 

Given these concerns, the use of metaphor may be a reasonable middle ground wherein counselors are still integrating neuroscience into counseling, but not to the extent that it becomes something different. The use of metaphor is less about teaching clients and more about coming to a mutual understanding of the client’s experience using terms that make sense and matter to the client (Tay, 2012). However, this approach requires the counselor to understand brain function and to stay current in the literature to ensure that the metaphor is accurate and apropos to the client situation. For example, memory has been likened to a video recording of events, yet the function of memory has been demonstrated as far more constructed than a recording of facts. In this case, memory is more like a movie wherein the recordings have been edited to tell the story based on the movie-maker’s experience and desire. It is imperative for professional counselors to consider standards of ethical practice in order to meet the ethical principles of beneficence and nonmaleficence. Similarly, counselors also have a responsibility to be aware of cultural considerations when integrating neuroscience into their counseling practice.

 

Cultural Considerations

 

There is a power differential in the therapeutic relationship, in part because of the needs and vulnerabilities that can accompany clients when seeking counseling. Clients might feel disempowered in the counseling relationship because of intersections of race, gender, age, spirituality, and social and economic status (Ratts, Singh, Nassar-McMillan, Butler, & McCullough, 2016). In addition, if counselors use language about the brain that may be perceived as intimidating or unsafe by clients, it could harm the therapeutic relationship. Integrating neuroscience into the counseling profession requires counselors to develop self-awareness surrounding neuroscience terminology and power inequalities in the counseling relationship. It is vital for counselor educators to consider the ethical and cultural implications of teaching a neuroscience-informed counseling course in order to help students learn how to facilitate a therapeutic environment where clients feel safe to process their experiences.

 

Conclusion

 

Given the benefits of neuroscience-informed counseling to treat behavioral and mental health concerns, counselor educators must begin to integrate neuroscience-informed counseling into the curriculum. Developing a neuroscience for counselors course using the aforementioned recommendations for course structure and methods for instruction is one approach to meeting this need. Assignments included a neuroscience-informed guided metaphor; development of a brain structures, systems, and functions book; dyads to practice using neuroscience-informed counseling interventions; N-PALs for reflection; a neuroscience-informed technology discussion post; and a summative case conceptualization paper. Integrating neuroscience-informed counseling into the counseling curriculum, while simultaneously addressing ethical and cultural considerations, has the potential to improve graduate students’ case conceptualizations, treatment planning, and counseling skills.

 

 

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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Deborah L. Duenyas is an assistant professor at Kutztown University of Pennsylvania. Chad Luke is an associate professor at Tennessee Technical Institute. Correspondence can be addressed to Deborah Duenyas, OMA Wing – Room 412, P.O. Box 730, Kutztown, PA 19530, duenyas@kutztown.edu.

A Comparison of Empathy and Sympathy Between Counselors-in-Training and Their Non-Counseling Academic Peers

Zachary D. Bloom, Victoria A. McNeil, Paulina Flasch, Faith Sanders

 

Empathy plays an integral role in the facilitation of therapeutic relationships and promotion of positive client outcomes. Researchers and scholars agree that some components of empathy might be dispositional in nature and that empathy can be developed through empathy training. However, although empathy is an essential part of the counseling process, literature reviewing the development of counseling students’ empathy is limited. Thus, we examined empathy and sympathy scores in counselors-in-training (CITs) in comparison to students from other academic disciplines (N = 868) to determine if CITs possess greater levels of empathy than their non-counseling academic peers. We conducted a MANOVA and failed to identify differences in levels of empathy or sympathy across participants regardless of academic discipline, potentially indicating that counselor education programs might be missing opportunities to further develop empathy in their CITs. We call for counselor education training programs to promote empathy development in their CITs.

 

Keywords: empathy, sympathy, counselor education, counselors-in-training, therapeutic relationships

 

Empathy is considered an essential component of the human experience as it relates to how individuals socially and emotionally connect to one another (Goleman, 1995; Szalavitz & Perry, 2010). Although empathy can be difficult to define (Konrath, O’Brien, & Hsing, 2011; Spreng, McKinnon, Mar, & Levine, 2009), within the counseling profession there is agreement that empathy includes both cognitive and affective components (Clark, 2004; Davis, 1980, 1983). When discussing the difference between affective and cognitive empathy, Vossen, Piotrowski, and Valkenburg (2015) described that “whereas the affective component pertains to the experience of another person’s emotional state, the cognitive component refers to the comprehension of another person’s emotions” (p. 66). Regardless of specific nuances among researchers’ definitions of empathy, most appear to agree that “empathy-related responding is believed to influence whether or not, as well as whom, individuals help or hurt” (Eisenberg, Eggum, & Di Giunta, 2010, p. 144). Furthermore, empathy can be viewed as a motivating factor of altruistic behavior (Batson & Shaw, 1991) and is essential to clients’ experiences of care (Flasch et al., in press). As such, empathy is foundational to interpersonal relationships (Siegel, 2010; Szalavitz & Perry, 2010), including the relationships facilitated in a counseling setting (Norcross, 2011; Rogers, 1957).

 

Rogers (1957) intuitively understood the necessity of empathy in a counseling relationship, which has been verified by the understanding of the physiology of the brain (Badenoch, 2008; Decety & Ickes, 2009; Siegel, 2010) and validated in the counseling literature (Elliott, Bohart, Watson, & Greenberg, 2011). In a clinical context, empathy can be described as both a personal characteristic and a clinical skill (Clark, 2010; Elliott et al., 2011; Rogers, 1957) that contributes to positive client outcomes (Norcross, 2011; Watson, Steckley, & McMullen, 2014). For example, empathy has been identified as a factor that leads to changes in clients’ attachment styles, treatment of self (Watson et al., 2014), and self-esteem development (McWhirter, Besett-Alesch, Horibata, & Gat, 2002). Moreover, researchers regularly identify empathy as a fundamental component of helpful responses to clients’ experiences (Beder, 2004; Flasch et al., in press; Kirchberg, Neimeyer, & James, 1998).

 

Although empathy is lauded and encouraged in the counseling profession, empathy development is not necessarily an explicit focus or even a mandated component of clinical training programs. The Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2016) identifies diverse training standards for content knowledge and practice among master’s-level and doctoral-level counselors-in-training (CITs), but does not mention the word empathy in its manual for counseling programs. One of the reasons for this could be that empathy is often understood and taught as a microskill (e.g., reflection of feeling and meaning) rather than as its own construct (Bayne & Jangha, 2016). Yet empathy is more than a component of a skillset, and CITs might benefit from a programmatic development of empathy to enhance their work with future clients (DePue & Lambie, 2014).

 

The application of empathy, or a counselor’s use of empathy-based responses in a therapeutic relationship, requires skill and practice (Barrett-Lennard, 1986; Truax & Carkhuff, 1967). Clark (2010) cautioned, for example, that counselors’ empathic responses need to be congruent with the client’s experience, and that the misapplication of sympathetic responses as empathic responses can interfere in the counseling relationship. In regard to sympathy, Eisenberg and colleagues (2010) explained, “sympathy, like empathy, involves an understanding of another’s emotion and includes an emotional response, but it consists of feelings of sorrow or concern for the distressed or needy other rather than merely feeling the same emotion” (p. 145). Thus, researchers call for counselor educators to do more than increase CITs’ affective or cognitive understanding of another’s experience, and to assist them in differentiating between empathic responses and sympathetic responses in order to better convey empathic understanding and relating (Bloom & Lambie, in press; Clark, 2010).

 

With the understanding that a counselor’s misuse of sympathetic responses might interrupt a therapeutic dialogue and that empathy is vital to the therapeutic alliance, researchers call for counselor educators to promote empathy development in CITs (Bloom & Lambie, in press; DePue & Lambie, 2014). Although there is evidence that some aspects of empathy are dispositional in nature (Badenoch, 2008; Konrath et al., 2011), which might make the counseling profession a strong fit for empathic individuals, empathy training in counseling programs can increase students’ levels of empathy (Ivey, 1971). However, the specific empathy-promoting components of empathy training are less understood (Teding van Berkhout & Malouff, 2016). Overall, empathy is an essential component of the counseling relationship, counselor competency, and the promotion of client outcomes (DePue & Lambie, 2014; Norcross, 2011). However, little is known about the training aspect of empathy and whether or not counselor training programs are effective in enhancing empathy or reducing sympathy among CITs. Thus, the following question guided this research investigation: Are CITs’ levels of empathy or sympathy different from their academic peers? Specifically, do CITs possess greater levels of empathy or sympathy than students from other academic majors?

 

Empathy in Counseling

 

Researchers have established continuous support for the importance of the therapeutic relationship in the facilitation of positive client outcomes (Lambert & Bergin, 1994; Norcross, 2011; Norcross & Lambert, 2011). In fact, the therapeutic relationship is predictive of positive client outcomes (Connors, Carroll, DiClemente, Longabaugh, & Donovan, 1997; Krupnick et al., 1996), accounting for about 30% of the variance (Lambert & Barley, 2001). That is, clients who perceive the counseling relationship to be meaningful will have more positive treatment outcomes (Bell, Hagedorn, & Robinson, 2016; Norcross & Lambert, 2011). One of the key factors in the establishment of a strong therapeutic relationship is a counselor’s ability to experience and communicate empathy. Researchers estimate that empathy alone may account for as much as 7–10% of overall treatment outcomes (Bohart, Elliott, Greenberg, & Watson, 2002; Sachse & Elliott, 2002), making it an important construct to foster in counselors.

 

Despite the importance of empathy in the counseling process, much of the literature on empathy training in counseling is outdated. Thus, little is known about the training aspect of empathy; that is, how is empathy taught to and learned by counselors? Nevertheless, early scholars (Barrett-Lennard, 1986; Ivey, 1971; Ivey, Normington, Miller, Morrill, & Haase, 1968; Truax & Carkhuff, 1967) posited that counselor empathy is a clinical skill that may be practiced and learned, and there is supporting evidence that empathy training may be efficacious.

 

In one seminal study, Truax and Lister (1971) conducted a 40-hour empathy training program with 12 counselor participants and identified statistically significant increases in participants’ levels of empathy. In their investigation, the researchers employed methods in which (a) the facilitator modeled empathy, warmth, and genuineness throughout the training program; (b) therapeutic groups were used to integrate empathy skills with personal values; and (c) researchers coded three of participants’ 4-minute counseling clips using scales of accurate empathy and non-possessive warmth (Truax & Carkhuff, 1967). Despite identifying statistically significant changes in participants’ scores of empathy, it is necessary to note that participants who initially demonstrated low levels of empathy remained lower than participants who initially scored high on the empathy measures. In a later study modeled after the Truax and Lister study, Silva (2001) utilized a combination of didactic, experiential, and practice components in her empathy training program, and found that counselor trainee participants (N = 45) improved their overall empathy scores on Truax’s Accurate Empathy Scale (Truax & Carkhuff, 1967). These findings contribute to the idea that empathy increases as a result of empathy training.

 

More recent researchers (Lam, Kolomitro, & Alamparambil, 2011; Ridley, Kelly, & Mollen, 2011) have identified the most common methods in empathy training programs as experiential training, didactic (lecture), skills training, and other mixed methods such as role play and reflection. In their meta-analysis, Teding van Berkhout and Malouff (2016) examined the effect of empathy training programs across various populations (e.g., university students, health professionals, patients, other adults, teens, and children) using the training methods identified above. The researchers investigated the effect of cognitive, affective, and behavioral empathy training and found a statistically significant medium effect size overall (g ranged from 0.51 to 0.73). The effect size was larger in health professionals and university students compared to other groups such as teenagers and adult community members. Though empathy increased as a result of empathy training studies, the specific mechanisms that facilitated positive outcomes remain largely unknown.

 

Although research indicates that empathy training can be effective, specific empathy-fostering skills are still not fully understood. Programmatically, empathy is taught to counselors within basic counseling skills (Bayne & Jangha, 2016), specifically because empathy is believed to lie in the accurate reflection of feeling and meaning (Truax & Carkhuff, 1967). But scholars argue that there is more to empathy than the verbal communication of understanding (Davis, 1980; Vossen et al., 2015). For example, in a more recent study, DePue and Lambie (2014) reported that counselor trainees’ scores on the Empathic Concern subscale of the Interpersonal Reactivity Index (IRI; Davis, 1980) increased as a result of engaging in counseling practicum experience under live supervision in a university-based clinical counseling and research center. In their study, the researchers did not actively engage in empathy training. Rather, they measured counseling students’ pre- and post-scores on an empathy measure as a result of students’ engagement in supervised counseling work to foster general counseling skills. Implications of these findings mirror those described by Teding van Berkhout and Malouff (2016), namely that it is difficult to identify specific empathy-promoting mechanisms. In other words, it appears that empathy training, when employed, produces successful outcomes in CITs. However, counseling students’ empathy also increases in the absence of specific empathy-promoting programs. This begs the question: Are counseling programs successfully training their counselors to be empathic, and is there a difference between CITs’ empathy or sympathy levels compared to students in other academic majors? Thus, the purpose of the present study was to (a) examine differences in empathy (i.e., affective empathy and cognitive empathy) and sympathy levels among emerging adult college students, and (b) determine whether CITs had different levels of empathy and sympathy when compared to their academic peers.

 

Methods

 

Participants

We identified master’s-level CITs as the population of interest in this investigation. We intended to compare CITs to other graduate and undergraduate college student populations. Thus, we utilized a convenience sample from a larger data set that included emerging adult college students between the ages of 18 and 29 who were enrolled in at least one undergraduate- or graduate-level course at nine colleges and universities throughout the United States. Participants were included regardless of demographic variables (e.g., gender, race, ethnicity).

 

Participants were recruited from three sources: online survey distribution (n = 448; 51.6%), face-to-face data collection (n = 361; 41.6%), and email solicitation (n = 34; 3.9%). In total, 10,157 potential participants had access to participate in the investigation by online survey distribution through the psychology department at a large Southeastern university; however, the automated system limited responses to 999 participants. We and our contacts (i.e., faculty at other institutions) distributed an additional 800 physical data collection packets to potential participants, and 105 additional potential participants were solicited by email. Overall, 1,713 data packets were completed, resulting in a sample of 1,598 participants after data cleaning. However, in order to conduct the analyses for this study, it was necessary to limit our sample to groups of approximately equal sizes (Hair, Black, Babin, & Anderson, 2010). Therefore, we were limited to the use of a subsample of 868 participants. Our sample appeared similar to other samples included in investigations exploring empathy with emerging adult college students (e.g., White, heterosexual, female; Konrath et al., 2011).

 

The participants included in this investigation were enrolled in one of six majors and programs of study, including Athletic Training/Health Sciences (n = 115; 13.2%); Biology/Biomedical Sciences/Preclinical Health Sciences (n = 167; 19.2%); Communication (n = 163; 18.8%); Counseling (n = 153; 17.6%); Nursing (n = 128; 14.7%); and Psychology (n = 142; 16.4%). It is necessary to note that students self-identified their major rather than selecting it from a preexisting prompt. Therefore, the researchers examined responses and categorized similar responses to one uniform title. For example, responses of psych were included with psychology. Further, in order to attain homogeneity among group sizes, we included multiple tracks within one program. For example, counseling included participants enrolled in either clinical mental health counseling (n = 115), marriage and family counseling (n = 24), or school counseling (n = 14) tracks. Table 1 presents additional demographic information (e.g., age, race, ethnicity, graduate-level status). It is necessary to note that, because of the constraints of the dataset, counseling students consisted of master’s-level graduate students, whereas all other groups consisted of undergraduate students.

 

Table 1

Participants’ Demographic Characteristics

 

Characteristic

n

Total %

Age 18–19

460

52.4

20–21

155

17.9

22–23

130

15.0

24–25

58

6.7

26–27

36

4.1

28–29

27

3.1

Gender Female

692

79.7

Male

167

19.2

Other

8

0.9

Racial Caucasian

624

71.9

Background African American/African/Black

101

11.6

Biracial/Multiracial

65

7.5

Asian/Asian American

40

4.6

Native American

3

0.3

Other

25

2.9

Ethnicity Hispanic

172

19.8

Non-Hispanic

689

79.4

Academic Undergraduate

709

81.7

Enrollment Graduate

152

17.5

Other

5

0.6

Academic Major Athletic Training/Health Sciences

115

13.2

Biology/Biomedical Sciences/Preclinical Health Sciences

167

19.2

Counseling

153

17.6

Communication

163

18.8

Nursing

128

14.7

Psychology

142

16.4

Note. N

= 868.

 

 

 

Procedure

The data utilized in this study were collected as part of a larger study that was approved by the authors’ institutional review board (IRB) as well as additional university IRBs where data was collected, as requested. We followed the Tailored Design Method (Dillman, Smyth, & Christian, 2009), a series of recommendations for conducting survey research to increase participant motivation and decrease attrition, throughout the data collection process for both web-based survey and face-to-face administration. Participants received informed consent, assuring potential participants that their responses would be confidential and their anonymity would be protected. We also made the survey convenient and accessible to potential participants by making it available either in person or online, and by avoiding the use of technical language (Dillman et al., 2009).

 

We received approval from the authors of the Adolescent Measure of Empathy and Sympathy (AMES; Vossen et al., 2015; personal communication with H. G. M. Vossen, July 10, 2015) to use the instrument and converted the data collection packet (e.g., demographic questionnaire, AMES) into Qualtrics (2013) for survey distribution. We solicited feedback from 10 colleagues regarding the legibility and parsimony of the physical data collection packets and the accuracy of the survey links. We implemented all recommendations and changes (e.g., clarifying directions on the demographic questionnaire) prior to data collection.

 

All completed data collection packets were assigned a unique ID, and we entered the data into the IBM SPSS software package for Windows, Version 22. No identifying information was collected (e.g., participants’ names). Having collected data both in person and online via web-based survey, we applied rigorous data collection procedures to increase response rates, reduce attrition, and to mitigate the potential influence of external confounding factors that might contribute to measurement error.

 

Data Instrumentation

     Demographics profile. We included a general demographic questionnaire to facilitate a comprehensive understanding of the participants in our study. We included items related to various demographic variables (e.g., age, race, ethnicity). Regarding participants’ identified academic program, participants were prompted to respond to an open-ended question asking “What is your major area of study?”

 

     AMES. Multiple assessments exist to measure empathy (e.g., the IRI, Davis, 1980, 1983; The Basic Empathy Scale [BES], Jolliffe & Farrington, 2006), but each is limited by several shortcomings (Carré, Stefaniak, D’Ambrosio, Bensalah, & Besche-Richard, 2013). First, many scales measure empathy as a single construct without distinguishing cognitive empathy from affective empathy (Vossen et al., 2015). Moreover, the wording used in most scales is ambiguous, such as items from other assessments that use words like “swept up” or “touched by” (Vossen et al., 2015), and few scales differentiate empathy from sympathy. Therefore, Vossen and colleagues designed the AMES as an empathy assessment that addresses problems related to ambiguous wording and differentiates empathy from sympathy.

 

The AMES is a 12-item empathy assessment with three factors: (a) Cognitive Empathy, (b) Affective Empathy, and (c) Sympathy. Each factor consists of four items rated on a 5-point Likert scale with ratings of 1 (never), 2 (almost never), 3 (sometimes), 4 (often), and 5 (always). Higher AMES scores indicate greater levels of cognitive empathy (e.g., “I can tell when someone acts happy, when they actually are not”), affective empathy (e.g., “When my friend is sad, I become sad too”), and sympathy (e.g., “I feel concerned for other people who are sick”). The AMES was developed in two studies with Dutch adolescents (Vossen et al., 2015). The researchers identified a 3-factor model with acceptable to good internal consistency per factor: (a) Cognitive Empathy (α = 0.86), (b) Affective Empathy (α = 0.75), and (c) Sympathy (α = 0.76). Further, Vossen et al. (2015) established evidence of strong test-retest reliability, construct validity, and discriminant validity when using the AMES to measure scores of empathy and sympathy with their samples. Despite being normed with samples of Dutch adolescents, Vossen and colleagues suggested the AMES might be an effective measure of empathy and sympathy with alternate samples as well.

 

Bloom and Lambie (in press) examined the factor structure and internal consistency of the AMES with a sample of emerging adult college students in the United States (N = 1,598) and identified a 3-factor model fitted to nine items that demonstrated strong psychometric properties and accounted for over 60% of the variance explained (Hair et al., 2010). The modified 3-factor model included the same three factors as the original AMES. Therefore, we followed Bloom and Lambie’s modifications for our use of the instrument.

 

Data Screening

Before running the main analysis on the variables of interest, we assessed the data for meeting the assumptions necessary to conduct a one-way between-subjects MANOVA. First, we conducted a series of tests to evaluate the presence of patterns in missing data and determined that data were missing completely at random (MCAR) and ignorable (e.g., < 5%; Kline, 2011). Because of the robust size of these data (e.g., > 20 observations per cell) and the minimal amount of missing data, we determined listwise deletion to be best practice to conduct a MANOVA and to maintain fidelity to the data (Hair et al., 2010; Osborne, 2013).

 

Next, we utilized histograms, Q-Q plots, and boxplots to assess for normality and identified non-normal data patterns. However, MANOVA is considered “robust” to violations of normality with a sample size of at least 20 in each cell (Tabachnick & Fidell, 2013). Thus, with our smallest cell size possessing a sample size of 115, we considered our data robust to this violation. Following this, we assumed our data violated the assumption for multivariate normality. However, Hair et al. (2010) stated “violations of this assumption have little impact with larger sample sizes” (p. 366) and cautioned that our data might have problems achieving a non-significant score for Box’s M Test. Indeed, our data violated the assumption of homogeneity of variance-covariance matrices (p < .01). However, this was not a concern with these data because “a violation of this assumption has minimal impact if the groups are of approximately equal size (i.e., largest group size ÷ smallest group size < 1.5)” (Hair et al., 2010, p. 365).

 

It is necessary to note that MANOVA is sensitive to outlier values. To mitigate against the negative effects of extreme scores, we removed values (n = 3) with standardized z-scores greater than +4 or less than -4 (Hair et al., 2010). This resulted in a final sample size of 868 participants.

 

We also utilized scatterplots to detect the patterns of non-linear relationships between the dependent variables and failed to identify evidence of non-linearity. Therefore, we proceeded with the assumption that our data shared linear relationships. We also evaluated the data for multicollinearity. Participants’ scores of Affective Empathy shared statistically significant and appropriate relationships with their scores of Cognitive Empathy (r = .24) and Sympathy (r = .43). Similarly, participants’ scores of Cognitive Empathy were appropriately related to their scores of Sympathy (r = .36; p < .01). Overall, we determined these data to be appropriate to conduct a MANOVA. Table 2 presents participants’ scores by academic discipline.

 

Table 2

AMES Scores by Academic Major

 

Scale

Mean (M)

SD

Range

Athletic Training

Affective Empathy

3.20

0.80

4.00

Cognitive Empathy

3.80

0.62

3.33

Sympathy

4.34

0.55

2.67
Biomedical Sciences

Affective Empathy

3.12

0.76

4.00

Cognitive Empathy

3.66

0.59

3.00

Sympathy

4.30

0.61

2.00
Communication

Affective Empathy

3.18

0.87

4.00

Cognitive Empathy

3.80

0.62

2.67

Sympathy

4.27

0.69

3.00
Counseling

Affective Empathy

3.32

0.60

3.33

Cognitive Empathy

3.83

0.48

4.00

Sympathy

4.32

0.54

2.00
Nursing

Affective Empathy

3.37

0.71

3.67

Cognitive Empathy

3.80

0.59

2.67

Sympathy

4.46

0.49

2.00
Psychology

Affective Empathy

3.28

0.78

4.00

Cognitive Empathy

3.86

0.59

2.67

Sympathy

4.35

0.65

2.67

Note. N
= 868.

 

 

Results

 

Participants’ scores on the AMES were used to measure participants’ levels of empathy and sympathy. Descriptive statistics were used to compare empathy and sympathy levels between counseling students and emerging college students from other disciplines. CITs recorded the second highest levels of affective empathy (M = 3.32, SD = .60) and cognitive empathy (M = 3.83, SD = 0.48), and the fourth highest levels of sympathy (M = 4.32, SD = 0.54) when compared to students from other disciplines. Nursing students demonstrated the highest levels of affective empathy (M = 3.37, SD = .71) and sympathy (M = 4.46, SD = .49), and psychology students recorded the highest levels of cognitive empathy (M = 3.86, SD = 0.59) when compared to students from other disciplines. The internal consistency values for each empathy and sympathy subscale on the AMES were as follows: Cognitive Empathy (α = 0.86), Affective Empathy (α = 0.75), and Sympathy (α = 0.76).

We performed a MANOVA to examine differences in empathy and sympathy in emerging adult college students by academic major, including counseling. Three dependent variables were included: affective empathy, cognitive empathy, and sympathy. The predictor for the MANOVA was the 6-level categorical “academic major” variable. The criterion variables for the MANOVA were the levels of affective empathy (M = 3.24, SD = .76), cognitive empathy (M = 3.80, SD = .58), and sympathy
(M = 4.34, SD = .60), respectively. The multivariate effect of major was statistically non-significant:
p = .062, Wilks’s lambda = .972, F (15, 2374.483) = 1.615, η2 = .009. Furthermore, the univariate F scores for affective empathy (p = .139), cognitive empathy (p = .074), and sympathy (p = .113) were statistically non-significant. That is, there was no difference in levels of affective empathy, cognitive empathy, or sympathy based on academic major, including counseling. Thus, these data indicated that CITs were no more empathic or sympathetic than students in other majors, as measured by the AMES.

 

We also examined these data for differences in affective empathy, cognitive empathy, and sympathy based on data collection method and educational level. However, we failed to identify a statistically significant difference between groups in empathy or sympathy based on data collection method
(e.g., online survey distribution, face-to-face data collection, email solicitation) or by educational level (e.g., master’s level or undergraduate status). Thus, these data indicate that data collection methods and participants’ educational level did not influence our results.

 

Discussion

 

The purpose of the present study was to (a) examine differences in empathy (i.e., affective empathy and cognitive empathy) and sympathy levels among emerging adult college students, and (b) determine whether CITs demonstrate different levels of empathy and sympathy when compared to their academic peers. We hypothesized that CITs would record greater levels of empathy and lower levels of sympathy when compared to their non-counseling peers, because of either their clinical training from their counselor education program or the possibility that the counseling profession might attract individuals with strong levels of dispositional empathy. Participants’ scores on the AMES were used to measure participants’ levels of empathy and sympathy. We conducted a MANOVA to determine if participants’ levels of empathy and sympathy differed when grouped by academic majors. CITs did not exhibit statistically significant differences in levels of empathy or sympathy when compared to students from other academic programs. In fact, CITs recorded levels of empathy that appeared comparable to students from other academic disciplines. This finding is consistent with literature indicating that even if empathy training is effective, counselor education programs might not be emphasizing empathy development in CITs or employing empathy training sufficiently. We also failed to identify statistically significant differences in participants’ AMES scores when grouping data by collection method or participants’ educational level. Thus, we believe our results were not influenced by our data collection method or by participants’ educational level.

 

Implications for Counselor Educators

The results from this investigation indicated that there was not a statistically significant difference in participants’ levels of cognitive or affective empathy or sympathy regardless of academic program, suggesting that CITs do not possess more or less empathy or sympathy than their academic peers. This was true for students in all majors under investigation (i.e., athletic training/health sciences, biology/biomedical sciences/preclinical health sciences, communication, counseling, nursing, and psychology), regardless of age and whether or not they belonged to professions considered helping professions (i.e., counseling, nursing, psychology). Although students in helping professions tended to have higher scores on the AMES than their peers, these differences were not statistically significant.

One might hypothesize that students in helping professions (especially in professions in which individuals have direct contact with clients or patients, such as counseling) would have significantly higher levels of empathy. However, counseling programs may not attract individuals who possess greater levels of trait empathy, or training programs might not be as effective in training their students as previously thought. Although microskills are taught in counselor preparation programs (e.g., reflection of content, reflection of feeling), microskill training might not overlap with material that is taught as part of an empathy training or enhance such training. Thus, microskill training might not be any more impactful for CITs’ development of empathy and sympathy than material included in training programs of other academic disciplines (e.g., athletic training, nursing).

 

Another potential reason for the lack of recorded differences between CITs and their non-counseling peers could be that counseling students are inherently anxious, skill-focused, self-focused, or have limited self-other awareness (Stoltenberg, 1981; Stoltenberg & McNeill, 2010). We wonder if CITs might not be focused on utilizing relationship-building approaches as much as they are on doing work that promotes introspection and reflection. Another inquiry for consideration is whether CITs potentially possess a greater understanding of empathy as a construct that inadvertently leads CITs to rate themselves lower in empathy than their non-counseling peers. Further, it is possible that CITs potentially minimize their own levels of empathy in an effort to demonstrate modesty, a phenomenon related to altruism and understood as the modesty bias (McGuire, 2003). Future research would be helpful to better understand various mitigating factors. Nevertheless, we suggest that counseling programs might be able to do more to foster empathy-facilitating experiences in counselors by being more proactive and effective in promoting empathy development in CITs. Through a review of the literature, we found support that empathy training is possible, and we wonder if there is a missed opportunity to effectively train counselors if counselor education programs do not intentionally facilitate empathy development in their CITs.

 

Counselor training programs are not charged to develop empathy in CITs; however, given the importance of empathy in the formation and maintenance of a therapeutic relationship, we propose that counseling training programs consider ways in which empathy is or is not being developed in their specific program. As such, we urge counselor educators to consider strategies to emphasize empathy development in their CITs. For example, reviewing developmental aspects of empathy in children, adolescents, and adults might fit well in a human development course, and the subject can be used to facilitate a conversation with CITs regarding their experiences of empathy development.

 

Similarly, because empathy consists of cognitive and affective components, CITs might benefit from work that assists them in gaining insight into areas of strengths and limitations in regard to both cognitive and affective aspects of empathy. Students who appear stronger in one area of empathy might benefit from practicing skills related to the other aspect of empathy. For example, if a student has a strong awareness of a client’s experience (i.e., cognitive empathy) but appears to have limitations in their felt sense of a client’s experience (i.e., affective empathy), a counselor educator might utilize live supervision opportunities to assist the student in recognizing present emotions or sensations in their body when working with the client or in a role play. Alternatively, to assist a student with developing a greater intellectual understanding of their client’s experience, a counselor educator might employ interpersonal process recall when reviewing their clinical work to help the student identify what their client might be experiencing as a result of their lived experience. To echo recommendations made by Bayne and Jangha (2016), we encourage counselor educators to move away from an exclusive focus on microskills for teaching empathy and to provide opportunities to teach CITs how to foster a connecting experience through creative means (e.g., improvisational skills).

Furthermore, the results from this study indicated that CITs possess higher levels of sympathy than of both cognitive and affective components of empathy. We recommend that counselor educators facilitate CITs’ understanding of the differences between empathy and sympathy and bring awareness to their use of sympathetic responses rather than empathic responses. It is our hope that CITs will possess a strong enough understanding between empathy and sympathy to be able to choose to use either response as it fits within a counseling context (Clark, 2010). We also encourage counselor educators to consider recommendations made by Bloom and Lambie (in press) to employ the AMES with CITs. The AMES could be a valuable and accessible tool to assist counselor educators in evaluating CITs’ levels of empathy and sympathy in regard to course assignments, in response to clinical situations, or as a wholesale measure of empathy development. As Bloom and Lambie encouraged, clinical training programs might benefit from using the AMES as a tool to programmatically measure CITs’ levels of empathy throughout their experience in their training program (i.e., transition points) as a way to collect programmatic data.

 

Limitations

     Although this study produced important findings, some limitations exist. It is noted that the majority of participants from this study attended universities located within the Southeastern United States. As a result, the sample might not be representative of students nationwide. Similarly, demographic characteristics of the present study including the race, age, and gender composition of the sample limit the generalizability of the findings.

 

This study also is limited in that the instrument used to assess empathy and sympathy was a self-report measure. Although self-report measures have been shown to be reliable and are widely used within research, these measures might result in the under- or over-reporting of the variables of interest (Gall, Gall, & Borg, 2007). It is necessary to note that we employed the AMES, which was normed with adolescents and not undergraduate or graduate students. Although we recognize that inherent differences exist between adolescent and emerging adult populations, we believed the AMES was an effective choice to measure empathy because of Vossen and colleagues’ (2015) intentional development of the instrument to address existing weaknesses in other empathy assessment instruments. Nonetheless, it is necessary to interpret our results with caution.

 

Recommendations for Future Research

We recommend future researchers address some of the limitations of this study. Specifically, we recommend continuing to compare CITs’ levels of empathy with students from other academic disciplines, but to include a more diverse array of academic backgrounds. Similarly, we suggest future researchers not limit themselves to an emerging adult population, as both undergraduate and graduate populations include individuals over the age of 29. Further, researchers should aim to collect data from students across the country and to include a more demographically diverse sample in their research designs.

 

Additionally, it is necessary to note that limitations exist to using self-report measures (Gall et al., 2007), and measures of empathy are vulnerable to a myriad of complications (Bloom & Lambie, in press; Vossen et al., 2015). Thus, we encourage future researchers to consider using different measures of empathy that move away from a self-report format (e.g., clients’ perceptions of cognitive and affective empathy within a therapeutic relationship; Flasch et al., in press). Another area for future research is to track counseling students’ levels of empathy as they enter the counseling profession after graduation. It is possible that as they become more comfortable and competent as counselors, and as anxiety and self-focus decrease, their ability to empathize increases.

 

There is agreement in the counseling profession that empathy is an important characteristic for counselors to embody in order to facilitate positive client outcomes and to meet counselor competency standards (DePue & Lambie, 2014). Yet scholars have grappled with how to identify the necessary skills to foster empathy in counselor trainees and remain torn on which approaches to use. Although empathy training programs seem effective, little is known about which aspects of such programs are the effective ingredients that promote empathy-building, and we lack understanding about whether such programs are more effective than simply engaging in clinical work or having life experiences. Thus, we encourage researchers to explore if counseling programs are effective at teaching empathy to CITs and to further explore mechanisms that may or may not be valuable in empathy development.

 

 

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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Zachary D. Bloom is an assistant professor at Northeastern Illinois University. Victoria A. McNeil is a doctoral candidate at the University of Florida. Paulina Flasch is an assistant professor at Texas State University. Faith Sanders is a mental health counselor at Neuropeace Wellness Counseling in Orlando, Florida. Correspondence can be addressed to Zachary Bloom, 5500 North St. Louis Avenue, Chicago, IL 60625, z-bloom@neiu.edu.

Current Practices in Online Counselor Education

William H. Snow, Margaret R. Lamar, J. Scott Hinkle, Megan Speciale

 

The Council for Accreditation of Counseling & Related Educational Programs (CACREP) database of institutions revealed that as of March 2018 there were 36 CACREP-accredited institutions offering 64 online degree programs. As the number of online programs with CACREP accreditation continues to grow, there is an expanding body of research supporting best practices in digital remote instruction that refutes the ongoing perception that online or remote instruction is inherently inferior to residential programming. The purpose of this article is to explore the current literature, outline the features of current online programs and report the survey results of 31 online counselor educators describing their distance education experience to include the challenges they face and the methods they use to ensure student success.


Keywords:
online, distance education, remote instruction, counselor education, CACREP

 

Counselor education programs are being increasingly offered via distance education, or what is commonly referred to as distance learning or online education. Growth in online counselor education has followed a similar trend to that in higher education in general (Allen & Seaman, 2016). Adult learners prefer varied methods of obtaining education, which is especially important in counselor education among students who work full-time, have families, and prefer the flexibility of distance learning (Renfro-Michel, O’Halloran, & Delaney, 2010). Students choose online counselor education programs for many reasons, including geographic isolation, student immobility, time-intensive work commitments, childcare responsibilities, and physical limitations (The College Atlas, 2017). Others may choose online learning simply because it fits their learning style (Renfro-Michel, O’Halloran, & Delaney, 2010). Additionally, education and training for underserved and marginalized populations may benefit from the flexibility and accessibility of online counselor education.

The Council for Accreditation of Counseling & Related Educational Programs (CACREP; 2015) accredits online programs and has determined that these programs meet the same standards as residential programs. Consequently, counselor education needs a greater awareness of how online programs deliver instruction and actually meet CACREP standards. Specifically, existing online programs will benefit from the experience of other online programs by learning how to exceed and surpass minimum accreditation expectations by utilizing the newest technologies and pedagogical approaches (Furlonger & Gencic, 2014). The current study provides information regarding the current state of online counselor education in the United States by exploring faculty’s descriptions of their online programs, including their current technologies, student and program community building approaches, and challenges faced.

 

Distance Education Defined

Despite its common usage throughout higher education, the U.S. Department of Education (DOE) does not use the terms distance learning, online learning, or online education; rather, it has adopted the term distance education (DOE, 2012). However, in practice, the terms distance education, distance learning, online learning, and online education are used interchangeably. The DOE has defined distance education as the use of one or more technologies that deliver instruction to students who are separated from the instructor and that supports “regular and substantive interaction between the students and the instructor, either synchronously or asynchronously” (2012, p. 5). The DOE has specified that technologies may include the internet, one-way and two-way transmissions through open broadcast and other communications devices, audioconferencing, videocassettes, DVDs, and CD-ROMs. Programs are considered distance education programs if at least 50% or more of their instruction is via distance learning technologies. Additionally, residential programs may contain distance education elements and still characterize themselves as residential if less than 50% of their instruction is via distance education. Traditional on-ground universities are incorporating online components at increasing rates; in fact, 67% of students in public universities took at least one distance education course in 2014, further reflecting the growth in this teaching modality (Allen & Seaman, 2016).

Enrollment in online education continues to grow, with nearly 6 million students in the United States engaged in distance education courses (Allen & Seaman, 2016). Approximately 2.8 million students are taking online classes exclusively. In a conservative estimate, over 25% of students enrolled in CACREP programs are considered distance learning students. In a March 2018 review of the CACREP database of accredited institutions, there were 36 accredited institutions offering 64 degree programs. Although accurate numbers are not available from any official sources, it is a conservative estimate that over 12,000 students are enrolled in a CACREP-accredited online program. When comparing this estimate to the latest published 2016 CACREP enrollment figure of 45,820 (CACREP, 2017), online students now constitute over 25% of the total. This does not include many other residential counselor education students in hybrid programs who may take one or more classes through distance learning means.

At the time of this writing, an additional three institutions were currently listed as under CACREP review, and soon their students will likely be added to this growing online enrollment. As this trend continues, it is essential for counselor education programs to understand issues, trends, and best practices in online education in order to make informed choices regarding counselor education and training, as well as preparing graduates for employment. It also is important for hiring managers in mental health agencies to understand the nature and quality of the training graduates of these programs have received.

One important factor contributing to the increasing trends in online learning is the accessibility it can bring to diverse populations throughout the world (Sells, Tan, Brogan, Dahlen, & Stupart, 2012). For instance, populations without access to traditional residential, brick-and-mortar classroom experiences can benefit from the greater flexibility and ease of attendance that distance learning has to offer (Bennet-Levy, Cromarty, Hawkins, & Mills, 2012). Remote areas in the United States, including rural and frontier regions, often lack physical access to counselor education programs, which limits the numbers of service providers to remote and traditionally underserved areas of the country. Additionally, the online counselor education environment makes it possible for commuters to take some of their course work remotely, especially in winter when travel can become a safety issue, and in urban areas where travel is lengthy and stressful because of traffic.

 

The Online Counselor Education Environment

The Association for Counselor Education and Supervision (ACES) Technology Interest Network (2017) recently published guidelines for distance education within counselor education that offer useful suggestions to online counselor education programs or to those programs looking to establish online courses. Current research supports that successful distance education programs include active and engaged faculty–student collaboration, frequent communications, sound pedagogical frameworks, and interactive and technically uncomplicated support and resources (Benshoff & Gibbons, 2011; Murdock & Williams, 2011). Physical distance and the associated lack of student–faculty connection has been a concern in the development of online counselor education programs. In its infancy, videoconferencing was unreliable, unaffordable, and often a technological distraction to the learning process. The newest wave of technology—enhanced distance education—has improved interactions using email, e-learning platforms, and threaded discussion boards to make asynchronous messaging virtually instantaneous (Hall, Nielsen, Nelson, & Buchholz, 2010). Today, with the availability of affordable and reliable technical products such as GoToMeeting, Zoom, and Adobe Connect, online counselor educators are holding live, synchronous meetings with students on a regular basis. This includes individual advising, group supervision, and entire class sessions.

It is important to convey that online interactions are different than face-to-face, but they are not inferior to an in-person faculty–student learning relationship (Hickey, McAleer, & Khalili, 2015). Students and faculty prefer one method to the other, often contingent upon their personal belief in the effectiveness of the modality overall and their belief in their own personal fit for this style of teaching and learning (Watson, 2012). In the actual practice of distance education, professors and students are an email, phone call, or videoconference away; thus, communication with peers and instructors is readily accessible (Murdock & Williams, 2011; Trepal, Haberstroh, Duffey, & Evans, 2007). When communicating online, students may feel more relaxed and less inhibited, which may facilitate more self-disclosure, reflexivity, and rapport via increased dialogue (Cummings, Foels, & Chaffin, 2013; Watson, 2012). Subsequently, faculty who are well-organized, technologically proficient, and more responsive to students’ requests may prefer online teaching opportunities and find their online student connections more engaging and satisfying (Meyer, 2015). Upon Institutional Research Board approval, an exploratory survey of online counselor educators was conducted in 2016 and 2017 to better understand the current state of distance counselor education in the United States.

 

Method

Participants

Recruitment of participants was conducted via the ACES Listserv (CESNET). No financial incentive or other reward was offered for participation. The 31 participants comprised a sample of convenience, a common first step in preliminary research efforts (Kerlinger & Lee, 1999). Participants of the study categorized themselves as full-time faculty members (55.6%), part-time faculty members (11.1%), academic chairs and department heads (22.2%), academic administrators (3.7%), and serving in other roles (7.4%).

 

Study Design and Procedure

The survey was written and administered using Qualtrics, a commercial web-based product. The survey contained questions aimed at exploring online counselor education programs, including current technologies utilized, approaches to reducing social distance, development of community among students, major challenges in conducting online counselor education, and current practices in meeting these challenges. The survey was composed of one demographic question, 15 multiple-response questions, and two open-ended survey questions. The demographic question asked about the respondent’s role in the university. The 15 multiple-response questions included items such as: (a) How does online counselor education fit into your department’s educational mission? (b) Do you provide a residential program in which to compare your students? (c) How successful are your online graduates in gaining postgraduate clinical placements and licensure? (d) What is the average size of an online class with one instructor? and (e) How do online students engage with faculty and staff at your university? Two open-ended questions were asked: “What are the top 3 to 5 best practices you believe are most important for the successful online education of counselors?” and “What are the top 3 to 5 lessons learned from your engagement in the online education of counselors?”

Additional questions focused on type of department and its organization, graduates’ acceptance to doctoral programs, amount of time required on the physical campus, e-learning platforms and technologies, online challenges, and best practices for online education and lessons learned. The 18 survey questions were designed for completion in no more than 20 minutes and the survey was active for 10 months, during which time there were three appeals for responses yielding 31 respondents.

 

Procedure

An initial recruiting email and three follow-ups were sent via CESNET. Potential participants were invited to visit a web page that first led to an introductory paragraph and informed consent page. An embedded skip logic system required consent before allowing access to the actual survey questions.

The results were exported from the Qualtrics web-based survey product, and the analysis of the 15 fixed-response questions produced descriptive statistics. Cross tabulations and chi square statistics further compared the perceptions of faculty and those identifying themselves as departmental chairs and administrators.

The two open-ended questions—“What are the top 3 to 5 best practices you believe are most important for the successful online education of counselors?” and “What are the top 3 to 5 lessons learned from your engagement in the online education of counselors?”—yielded 78 statements about lessons learned and 80 statements about best practices for a total of 158 statements. The analysis of the 158 narrative comments initially consisted of individually analyzing each response by identifying and extracting the common words and phrases. It is noted that many responses contained more than one suggestion or comment. Some responses were a paragraph in length and thus more than one key word or phrase could come from a single narrative response. This first step yielded a master list of 18 common words and phrases. The second step was to again review each comment, compare it to this master list, and place a check mark for each category. The third step was to look for similarities in the 18 common words and group them into a smaller number of meaningful categories. These steps were checked among the researchers for fidelity of reporting and trustworthiness.

 

Results

Thirty-one distance learning counselor education faculty, department chairs, and administrators responded to the survey. They reported their maximum class sizes ranged from 10 to 40 with a mean of 20.6 (SD = 6.5), and the average class size was 15.5 (SD = 3.7). When asked how online students are organized within their university, 26% reported that students choose classes on an individual basis, 38% said students are individually assigned classes using an organized schedule, and 32% indicated that students take assigned classes together as a cohort.

Additionally, respondents were asked how online students engage with faculty and staff at their university. Email was the most popular, used by all (100%), and second was phone calls (94%). Synchronous live group discussions using videoconferencing technologies were used by 87%, while individual video calls were reported by 77%. Asynchronous electronic discussion boards were utilized by 87% of the counselor education programs.

Ninety percent of respondents indicated that remote or distance counseling students were required to attend the residential campus at least once during their program, with 13% requiring students to come to campus only once, 52% requiring students to attend twice, and 26% requiring students to come to a physical campus location four or more times during their program.

All participants indicated using some form of online learning platform with Blackboard (65%), Canvas (23%), Pearson E-College (6%), and Moodle (3%) among the ones most often listed. Respondents indicated the satisfaction levels of their current online learning platform as: very dissatisfied (6.5%), dissatisfied (3.2%), somewhat dissatisfied (6.5%), neutral (9.7%), somewhat satisfied (16.1%), satisfied (41.9%), and very satisfied (9.7%). There was no significant relationship between the platform used and the level of satisfaction or dissatisfaction (X2 (18,30) = 11.036, p > .05), with all platforms faring equally well. Ninety-seven percent of respondents indicated using videoconferencing for teaching and individual advising using such programs as Adobe Connect (45%), Zoom (26%), or GoToMeeting (11%), while 19% reported using an assortment of other related technologies.

Participants were asked about their university’s greatest challenges in providing quality online counselor education. They were given five pre-defined options and a sixth option of “other” with a text box for further elaboration, and were allowed to choose more than one category. Responses included making online students feel a sense of connection to the university (62%), changing faculty teaching styles from traditional classroom models to those better suited for online coursework (52%), providing experiential clinical training to online students (48%), supporting quality practicum and internship experiences for online students residing at a distance from the physical campus (38%), convincing faculty that quality outcomes are possible with online programs (31%), and other (10%).

Each participant was asked what their institution did to ensure students could succeed in online counselor education. They were given three pre-defined options and a fourth option of “other” with a text box for further elaboration, and were allowed to choose more than one option. The responses included specific screening through the admissions process (58%), technology and learning platform support for online students (48%), and assessment for online learning aptitude (26%). Twenty-three percent chose the category of other and mentioned small classes, individual meetings with students, providing student feedback, offering tutorials, and ensuring accessibility to faculty and institutional resources.

Two open-ended questions were asked and narrative comments were analyzed, sorted, and grouped into categories. The first open-ended question was: “What are the top 3 to 5 best practices that are the most important for the successful online education of counselors?” This yielded 78 narrative comments that fit into the categories of fostering student engagement (n = 19), building community and facilitating dialogue (n = 14), supporting clinical training and supervision (n = 11), ensuring courses are well planned and organized (n = 10), providing timely and robust feedback (n = 6), ensuring excellent student screening and advising (n = 6), investing in technology (n = 6), ensuring expectations are clear and set at a high standard (n = 5), investing in top-quality learning materials (n = 4), believing that online counselor education works (n = 3), and other miscellaneous comments (n = 4). Some narrative responses contained more than one suggestion or comment that fit multiple categories.

The second open-ended question—“What are the top 3 to 5 lessons learned from the online education of counselors?”—yielded 80 narrative comments that fit into the categories of fostering student engagement (n = 11), ensuring excellent student screening and advising (n = 11), recognizing that online learning has its own unique workload challenges for students and faculty (n = 11), providing timely and robust feedback (n = 8), building community and facilitating dialogue (n = 7), ensuring courses are well planned and organized (n = 7), investing in technology (n = 6), believing that online counselor education works (n = 6), ensuring expectations are clear and set at a high standard (n = 5), investing in top-quality learning materials (n = 3), supporting clinical training and supervision (n = 2), and other miscellaneous comments (n = 8).

Each participant was asked how online counselor education fit into their department’s educational mission and was given three categorical choices. Nineteen percent stated it was a minor focus of their department’s educational mission, 48% stated it was a major focus, and 32% stated it was the primary focus of their department’s educational mission.

The 55% of participants indicating they had both residential and online programs were asked to respond to three follow-up multiple-choice questions gauging the success rates of their online graduates (versus residential graduates) in attaining: (1) postgraduate clinical placements, (2) postgraduate clinical licensure, and (3) acceptance into doctoral programs. Ninety-three percent stated that online graduates were as successful as residential students in gaining postgraduate clinical placements. Ninety-three percent stated online graduates were equally successful in obtaining state licensure. Eighty-five percent stated online graduates were equally successful in getting acceptance into doctoral programs.

There were some small differences in perception that were further analyzed. Upon using a chi square analysis, there were no statistically significant differences in the positive perceptions of online graduates in gaining postgraduate clinical placements (X2 (2, 13) = .709, p > .05), the positive perceptions regarding the relative success of online versus residential graduates in gaining postgraduate clinical licensure (X2 (2, 13) = .701, p > .05), or perceptions of the relative success of online graduates in becoming accepted in doctoral programs (X2 (2, 12) = 1.33, p > .05).

 

Discussion

The respondents reported that their distance learning courses had a mean class size of 15.5. Students in these classes likely benefit from the small class sizes and the relatively low faculty–student ratio. These numbers are lower than many residential classes that can average 25 students or more. It is not clear what the optimal online class size should be, but there is evidence that the challenge of larger classes may introduce burdens difficult for some students to overcome (Chapman & Ludlow, 2010). Beattie and Thiele (2016) found first-generation students in larger classes were less likely to talk to their professor or teaching assistants about class-related ideas. In addition, Black and Latinx students in larger classes were less likely to talk with their professors about their careers and futures (Beattie & Thiele, 2016).

Programs appeared to have no consistent approach to organizing students and scheduling courses. The three dominant models present different balances of flexibility and predictability with advantages and disadvantages for both. Some counselor education programs provide students the utmost flexibility in selecting classes, others assign classes using a more controlled schedule, and others are more rigid and assign students to all classes.

The model for organizing students impacts the social connections students make with one another. In concept, models that provide students with more opportunities to engage each other in a consistent and effective pattern of positive interactions result in students more comfortable working with one another, and requesting and receiving constructive feedback from their peers and instructors.

Cohort models, in which students take all courses together over the life of a degree program, are the least flexible but most predictable and have the greatest potential for fostering strong connections. When effectively implemented, cohort models can foster a supportive learning environment and greater student collaboration and cohesion with higher rates of student retention and ultimately higher graduation rates (Barnett & Muse, 1993; Maher, 2005). Advising loads can decrease as cohort students support one another as informal peer mentors. However, cohorts are not without their disadvantages and can develop problematic interpersonal dynamics, splinter into sub-groups, and lead to students assuming negative roles (Hubbell & Hubbell, 2010; Pemberton & Akkary, 2010). An alternative model in which students make their own schedules and choose their own classes provides greater flexibility but fewer opportunities to build social cohesion with others in their program. At the same time, these students may not demonstrate the negative dynamics regarding interpersonal engagement that can occur with close cohort groups.

 

Faculty–Student Engagement

Remote students want to stay in touch with their faculty advisors, course instructors, and fellow students. Numerous social engagement opportunities exist through technological tools including email, cell phone texts, phone calls, and videoconference advising. These fast and efficient tools provide the same benefits of in-person meetings without the lag time and commute requirements. Faculty and staff obviously need to make this a priority to use these tools and respond to online students in a timely manner.

All technological tools referred to in the survey responses provide excellent connectivity and communication if used appropriately. Students want timely responses, but for a busy faculty or staff member it is easy to allow emails and voicemails to go unattended. Emails not responded to and unanswered voicemail messages can create anxiety for students whose only interaction is through electronic means. This also might reinforce a sense of isolation for students who are just “hanging out there” on their own and having to be resourceful to get their needs met. It is recommended that the term timely needs to be defined and communicated so faculty and students understand response expectations. It is less important that responses are expected in 24, 48, or even 72 hours; what students need to know is when to expect a response.

Survey responses indicated that remote counselor education students are dependent upon technology, including the internet and associated web-based e-learning platforms. When the internet is down, passwords do not work, or computers fail, the remote student’s learning is stalled. Counselor education programs offering online programming must provide administrative services, technology, and learning support for online students in order to quickly remediate technology issues when they occur. It is imperative that standard practice for institutions include the provision of robust technology support to reduce down-time and ensure continuity of operations and connection for remote students.

 

Fostering Program and Institutional Connections

Faculty were asked how often online students were required to come to a physical campus location as part of their program. Programs often refer to short-term campus visits as limited residencies to clarify that students will need to come to the campus. Limited residencies are standard, with 90% responding that students were required to come to campus at least once. Short-term intensive residencies are excellent opportunities for online students to make connections with their faculty and fellow students (Kops, 2014). Residential intensives also provide opportunities for the university student life office, alumni department, business office, financial aid office, registrar, and other university personnel to connect with students and link a human face to an email address.

Distance learning students want to engage with their university, as well as fellow students and faculty. They want to feel a sense of connection in a similar manner as residential students (Murdock & Williams, 2011). Institutions should think creatively about opportunities to include online learners in activities beyond the classroom. An example of promoting inclusiveness is when one university moved the traditional weekday residential town halls to a Sunday evening teleconference webinar. This allowed for greater access, boosted attendance, and served to make online counselor education students feel like a part of the larger institution.

As brick-and-mortar institutions consider how to better engage distance learning students, they need to understand that a majority of students (53%) taking exclusively distance education courses reside in the same state as the university they are attending (Allen & Seaman, 2016). Given that most are within driving distance of the physical campus, students are more open to coming to campus for special events, feel their presence is valued, and know that they are not just part of an electronic platform (Murdock & Williams, 2011).

 

E-Learning Platforms as Critical Online Infrastructure

All participants (100%) reported using an online learning platform. E-learning platforms are standard for sharing syllabi, course organization, schedules, announcements, assignments, discussion boards, homework submissions, tests, and grades. They are foundational in supporting faculty instruction and student success with numerous quality options available. Overall, online faculty were pleased with their technological platforms and there was no clear best platform.

Online learning platforms are rich in technological features. For example, threaded discussions allow for rich, thoughtful dialogue among students and faculty, and they are often valued by less verbally competitive students who might express reluctance to speak up in class but are willing to share their comments in writing. Course examinations and quizzes in a variety of formats can be produced and delivered online through e-learning platforms such as Blackboard, Canvas, and Moodle. Faculty have flexibility for when exams are offered and how much time students have to complete them. When used in conjunction with proctoring services such as Respondus, ProctorU, and B-Virtual, integrity in the examination process can be assured. Once students complete their exam, software can automatically score and grade objective questions, and provide immediate feedback to students.

 

Videoconferencing and Virtual Remote Classrooms

Videoconferencing for teaching and individual advising through Adobe Connect, Zoom, GoToMeeting, and related technologies is now standard practice and changing the nature of remote learning. Distance learning can now employ virtual classroom models with synchronous audio and video communication that closely parallels what occurs in a residential classroom. Videoconferencing platforms provide tools to share PowerPoints, graphics, and videos as might occur in a residential class. Class participants can write on virtual whiteboards with color markers, annotating almost anything on their screen. Group and private chat functionality can provide faculty with real-time feedback during a class session. Newer videoconferencing features now allow faculty to break students into smaller, private discussion groups and move around to each group virtually, just like what often occurs in a residential classroom. With preparation, faculty can execute integrated survey polls during a video class session. Essentially, videoconferencing tools reduce the distance in distance education.

Videoconference platforms allow faculty to teach clinical skills in nearly the same manner as in residential programs. Counselor education faculty can model skills such as active listening in real time to their online class. Faculty can then have students individually demonstrate those skills while being observed. Embedded features allow faculty to record the video and audio features of any conversation for playback and analysis. Videoconference platforms now offer “breakout” rooms to place students in sub-groups for skills practice and debriefing, similar to working in small groups in residential classrooms. Faculty members and teaching assistants can visit each breakout room to ensure students are on task and properly demonstrating counseling skills. Just as in a residential class, students can reconvene and share the challenges and lessons learned from their small group experience.

 

Challenges in Providing Remote Counselor Education

Participants were asked to select one or more of their top challenges in providing quality online counselor education. In order of frequency, they reported the greatest challenges as making online students feel a sense of connection to the university (62%), changing faculty teaching styles from brick-and-mortar classroom models to those better suited for online coursework (52%), providing experiential clinical training to online students (48%), supporting quality practicum and internship experiences for online students residing at a distance from the physical campus (38%), and convincing faculty members that quality outcomes are possible with online programs (31%).

Creating a sense of university connection. Counselor education faculty did not report having major concerns with faculty–student engagement. Faculty seemed confident with student learning outcomes using e-learning platforms and videoconferencing tools that serve to reduce social distance between faculty and students and facilitate quality learning experiences. This confidence could be the result of counselor educators’ focus on fostering relationships as a foundational counseling skill (Kaplan, Tarvydas, & Gladding, 2014).

However, faculty felt challenged to foster a student’s sense of connection with the larger university. For example, remote students not receiving emails and announcements about opportunities available only to residential students can feel left out. Remote students might find it difficult to navigate the university student life office, business department, financial aid office, registration system, and other university systems initially designed for residential students. Highly dependent on their smartphone and computer, remote students can feel neglected as they anxiously wait for responses to email and voicemail inquiries (Milman, Posey, Pintz, Wright, & Zhou, 2015).

In the online environment, there are extracurricular options for participating in town halls, special webinars, and open discussion forums with departmental and university leaders. Ninety percent of the programs require students to come to their physical campus one or more times. These short-term residencies are opportunities for students to meet the faculty, departmental chairs, and university leaders face-to-face and further build a sense of connection.

A majority of online students (53%) reside in the same state as the university they are attending (Allen & Seaman, 2016), with many within commuting distance of their brick-and- mortar campus. These students will appreciate hearing about the same opportunities afforded to residential students, and under the right circumstances and scheduling they will participate.

Changing faculty teaching styles. Not all residential teaching styles and methods, such as authority-based lecture formats, work well with all students (Donche, Maeyer, Coertjens, Van Daal, & Van Petegem, 2013). Distance learning students present their own challenges and preferences. Successful distance education programs require active and engaged faculty who frequently communicate with their students, use sound pedagogical frameworks, and maintain a collaborative and interactive style (Benshoff & Gibbons, 2011; Murdock & Williams, 2011). Discovery orientation, discussion, debriefing, action research, and flipped classrooms where content is delivered outside the classroom and the classroom is used to discuss the material are good examples of more collaborative styles (Brewer & Movahedazarhouligh, 2018; Donche et al., 2013).

Organization is critical for all students, but more so for remote students who often are working adults with busy schedules. They want to integrate their coursework into other life commitments and want a clear, well-organized, and thoughtfully planned course with all the requirements published in advance, including specific assignment due dates. Distance counselor education faculty will find their syllabi growing longer with more detail as they work to integrate traditional assignments with the e-learning and videoconferencing tools in order to create engaging, predictable, and enjoyable interactive learning experiences.

Providing experiential clinical training. Counselor educators ideally provide multimodal learning opportunities for counseling students to understand, internalize, and demonstrate clinical skills for a diverse clientele. In residential classrooms, the knowledge component is usually imparted through textbooks, supplemental readings, course assignments, video demonstration, and instructor-led lecture and discussions. All remote programs provide similar opportunities for students and replicate residential teaching models with their use of asynchronous e-learning platforms and synchronous videoconferencing technologies.

Asynchronous methods are not well suited for modeling, teaching, and assessing interpersonal skills. However, synchronous videoconferencing technologies provide the same opportunity as residential settings to conduct “fishbowl” class exercises, break students into groups to practice clinical skills, conduct role plays, apply procedural learning, and give students immediate, meaningful feedback about their skills development.

The majority of surveyed programs required remote students to come to campus at least once to assess students for clinical potential, impart critical skills, and monitor student progress in achieving prerequisite clinical competencies required to start practicum. Courses that teach and assess clinical interviewing skills are well suited for these intensive experiences and provide an important gatekeeping function. Faculty not only have the opportunity to see and hear students engage in role plays, but also to see them interact with other students.

Supporting quality practicum and internship experiences. Remote counselor educators report that their programs are challenged in supporting quality practicum and internship experiences. Residential students benefit from the relationships universities develop over time with local public and nonprofit mental health agencies in which practicum and internship students may cluster at one or more sites. Although online students living close enough to the residential campus may benefit from the same opportunities, remote students living at a distance typically do not experience this benefit. They often have to seek out, interview, and compete for a clinical position at a site unfamiliar to their academic program’s field placement coordinator. Thus, online counselor education students will need field placement coordination that can help with unique practicum and internship requirements. The placement coordinator will need to know how to review and approve distance sites without a physical assessment. Relationships with placement sites will need to rely upon email, phone, and teleconference meetings. Furthermore, online students can live in a state other than where the university is located, requiring the field placement coordinator to be aware of various state laws and regulations.

Convincing faculty that quality outcomes are possible. Approximately one-third of the surveyed counselor education faculty reported the need to convince other faculty that quality outcomes are possible with remote counselor education. Changing the minds of skeptical colleagues is challenging but naturally subject to improvement over time as online learning increases, matures, and becomes integrated into the fabric of counselor education. In the interim, programs would be wise to invest in assisting faculty skeptics to understand that online counselor education can be managed effectively (Sibley & Whitaker, 2015). First, rather than just telling faculty that online counselor education works, programs should demonstrate high levels of interactivity that are comparable to face-to-face engagement by using state-of-the-art videoconferencing platforms. Second, it is worth sharing positive research outcomes related to remote education. Third, it is best to start small by encouraging residential faculty to first try a hybrid course by holding only one or two of their total class sessions online. Fourth, it is important to provide robust support for reluctant but willing faculty who agree to integrate at least one or two online sessions into their residential coursework. Finally, institutions will find more willing faculty if they offer incentives for those who give online counselor education a chance.

 

Ensuring Online Student Success

Student success is defined by the DOE as related to student retention, graduation rates, time to completion, academic success, and gainful employment (Bailey et al., 2011). Counselor education programs would likely add clinical success in practicum and internship and post-master’s licensure to these critical success outcomes.

The survey respondents reported that student success begins with making sure that the students they accept have the aptitude to learn via online distance education. Students may have unrealistic perceptions that remote distance education is somehow less academically strenuous. Programs need to ensure students are prepared for the unique aspects of online versus residential learning. Fifty-eight percent of the programs engaged in student screening beginning with the admissions process. A quarter of the respondents used a formal assessment tool to assess students for success factors such as motivation, learning style, study habits, access to technology, and technological skills. A commonly used instrument was the Online Readiness Assessment developed by Williams (2017).

 

Lessons Learned and Best Practices

The 158 statements regarding best practices and lessons learned were further refined to yield the top six imperatives for success in online counselor education, namely: (1) fostering student–faculty–community engagement (57.4%); (2) providing high expectations, excellent screening, advising, and feedback (36%); (3) investing in quality instructional materials, course development, and technology support (30.5%); (4) providing excellent support for online clinical training and supervision (14.6%); (5) recognizing the workload requirements and time constraints of online students; (6) working to instill the belief in others that quality outcomes are possible with online counselor education programs (10.1%); and (7) other assorted responses (13.5%).

An indicator of success for many counselor education programs is the rate at which students graduate, obtain clinical placement, and become licensed. There is also an interest in how successful graduates are in becoming admitted into doctoral programs. For online programs, a further benchmark test is to compare online student graduation, licensure, and doctoral admissions rates to those in residential programs. Fifty-five percent of the respondents served in programs with residential as well as online students. These respondents were able to compare their online student outcomes to residential student outcomes. Their perception was that online graduates were as successful as residential students in gaining postgraduate clinical placements (93%), obtaining state licensure (93%), and acceptance into doctoral programs (85%). They generally believed online graduates were competitive with residential graduates.

 

Limitations, Recommendations, and Conclusion

Limitations of the Study

When this study began in 2016, there were 11 CACREP-accredited institutions offering online counselor education programs, and by March 2018, there were 36. This study represents a single snapshot of the online counselor education experience during a time of tremendous growth.

This study focused on the reported experience of faculty, departmental chairs, and administrators who have some commitment and investment in online learning. Some would point out the bias of those who advocate for remote counselor education in relaying their own experiences, anecdotal evidence, and personal comparisons of online and residential teaching.

The exploratory nature of this study was clearly not comprehensive in its inclusion of all the factors associated with online counselor education. Specific details of online counselor education programs were not emphasized and could have offered more information about university and departmental resources for remote education, faculty training for online educational formats, and student evaluations of online courses. The numerous technologies used were identified, but this says nothing about their differential effectiveness. Future studies should include these variables as well as other factors that will provide further information about the successes and challenges of online counselor education.

This survey assessed the informed opinions of counselor education faculty and administrators who responded that they were generally satisfied with the various aspects of their programs, including student outcomes. What was not assessed was the actual quality of the education itself. In order to change the mind of skeptics, more than opinions and testimonies will be needed. Future studies need to objectively compare learning outcomes, demonstrate quality, and delineate how remote counselor education programs are meeting the challenges of training counselors within distance learning modalities.

 

Recommendations

The dynamic nature of the field of online counselor education requires ongoing study. As more programs offer courses and full programs through distance learning modalities, they can contribute their own unique expertise and lessons learned to inform and enrich the broader field.

The challenge of faculty skepticism and possible mixed motives regarding online learning will continue to be problematic. There is a lingering perception by some faculty that online counselor education programs are not equivalent to residential training. An inherent faculty bias might exist in which residential means higher quality and online means lower quality. Some faculty may teach online courses only for additional compensation while privately having reservations. In contrast, departmental chairs and academic administrators might want the same high levels of quality, but may find themselves more driven by the responsibility for meeting enrollment numbers and budgets. In times of scarcity, these individuals may see online counselor education as the answer for new revenue sources (Jones, 2015). For others, online education may present concerns while providing an appeal for its innovative qualities or providing social justice through increasing access to higher education by underserved populations. The best way to clarify the issues and better inform the minds of skeptics is to present them with objective data regarding the nature and positive contributions of remote counselor education learning outcomes.

Aside from the modality of their instructional platform, it is important to understand if effective remote counselor educators are different from equally effective residential course instructors. Remote teaching effectiveness might be associated with some combination of attributes, interests, and motivations, and thus self-selection to teach remote students. Further studies will need to tease out what works, what does not work, and what type of faculty and faculty training make someone best suited for participation in remote counselor education.

Technology is critical to the advances in remote counselor education. Email, smartphones, texting, and e-learning platforms have helped faculty create engaging courses with extensive faculty–student interactions. Videoconferencing in particular has served to reduce the social distance between faculty and remote students. As aforementioned, innovative programs are taking the distance out of distance counselor education, where the virtual remote classroom modality provides similar experiences to those of residential classes. The nature of these technologically facilitated online relationships deserves further study to determine which technologies and related protocols enhance learning and which impede it.

A logical next step is to build on the work that has been accomplished and conduct more head-to-head comparisons of student outcomes among remote and residential programs. This is very feasible, as 34 of the 36 institutions currently offering online counselor education programs also have a residential program with which to make comparisons. These within-institution comparisons will be inherently quasi-experimental. Effective program comparisons of delivery models will require systematically implemented reliable and valid measures of student learning outcomes at strategic points in the counselor training program. The Counselor Competency Scale (Lambie, Mullen, Swank, & Blount, 2018) is a commonly used standardized assessment for graduate students engaged in clinical practicum and internship. The National Counseling Exam scores of current students and recent graduates can provide standardized measures to compare outcomes of graduates across programs.

Finally, although we can learn from institutional best practices and student success stories, we also could benefit from understanding why some programs, faculty, and students struggle. Challenges are certainly faced in remote counselor education and training, but it is likely that one or more programs have developed innovative concepts to surmount these obstacles. The 31 respondents were able to articulate many best practices to manage challenges and believed they were achieving the same learning objectives achieved by residential counseling students. Many faculty members, departmental chairs, and administrators believed that remote counselor education graduates are as successful as those attending residential programs, but this opinion is not universally shared. What is clear is that despite some reservations, a growing number of counselors are trained via a remote modality. It is time to embrace distance counselor education; learn from best practices, successes, and struggles; and continue to improve outcomes for the benefit of programs, the profession of counseling, and the consumers of the services our graduates provide.

 

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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William H. Snow is an associate professor at Palo Alto University. Margaret R. Lamar is an assistant professor at Palo Alto University. J. Scott Hinkle, NCC, is Director of Professional Development at the National Board for Certified Counselors. Megan Speciale, NCC, is an assistant professor at Palo Alto University. Correspondence can be addressed to William Snow, 1791 Arastradero Road, Palo Alto, CA 94304, wsnow@paloaltou.edu.

Becoming a Gatekeeper: Recommendations for Preparing Doctoral Students in Counselor Education

Marisa C. Rapp, Steven J. Moody, Leslie A. Stewart

The Council for Accreditation of Counseling & Related Educational Programs (CACREP) standards call for doctoral preparation programs to graduate students who are competent in gatekeeping functions. Despite these standards, little is understood regarding the development and training of doctoral students in their roles as gatekeepers. We propose a call for further investigation into doctoral student gatekeeper development and training in gatekeeping practices. Additionally, we provide training and programmatic curriculum recommendations derived from current literature for counselor education programs. Finally, we discuss implications of gatekeeping training in counselor education along with future areas of research for the profession.

Keywords: gatekeeping, counselor education, doctoral students, programmatic curriculum, CACREP

 

Gatekeeping practices in counselor education are highly visible in current literature, as counselor impairment continues to be a significant concern for the mental health professions (Brown-Rice & Furr, 2015; Homrich, DeLorenzi, Bloom, & Godbee, 2014; Lumadue & Duffey, 1999; Rapisarda & Britton, 2007; Rust, Raskin, & Hill, 2013; Ziomek-Daigle & Christensen, 2010). V. A. Foster and McAdams (2009) found that counselor educators are frequently faced with counselors-in-training (CITs) whose professional performance fails to meet program standards. Although gatekeeping practices in counselor education have been cursorily examined over the past 40 years (Ziomek-Daigle & Christensen, 2010), more recent literature indicates a need to further address this topic (Brown-Rice & Furr, 2016; Burkholder, Hall, & Burkholder, 2014).

In the past two decades, researchers have examined the following aspects of gatekeeping: student selection; retention; remediation; policies and procedures; and experiences of faculty members, counseling students, and clinical supervisors (Brown-Rice & Furr, 2013, 2015, 2016; V. A. Foster & McAdams, 2009; Gaubatz & Vera, 2002; Homrich et al., 2014; Lumadue & Duffey, 1999; Parker et al., 2014; Rapisarda & Britton, 2007; Ziomek-Daigle & Christensen, 2010). Although the aforementioned areas of study are needed to address the complex facets of the gatekeeping process, there is a noticeable lack of research examining how counselor education programs are preparing and educating future faculty members to begin their role as gatekeepers.

Because doctoral degree programs in counselor education are intended to prepare graduates to work in a variety of roles (Council for Accreditation of Counseling & Related Educational Programs [CACREP], 2015), program faculty must train doctoral students in each of the roles and responsibilities expected of a future faculty member or supervisor. Authors of previous studies have examined constructs of identity, development, practice, and training in the various roles that doctoral students assume, including investigations into a doctoral student’s researcher identity (Lambie & Vaccaro, 2011), supervisor identity (Nelson, Oliver, & Capps, 2006), doctoral professional identity transition (Dollarhide, Gibson, & Moss, 2013), and co-teaching experiences (Baltrinic, Jencius, & McGlothlin, 2016). Studies investigating the various elements of these roles are both timely and necessary (Fernando, 2013; Lambie & Vaccaro, 2011; Nelson et al., 2006); yet, there is a dearth of research examining the complex development of emergent gatekeeper identity. In order to empower counseling programs in training the next generation of competent and ethical professional counselors, the development of doctoral students’ gatekeeping skills and identity must be more fully understood.

 

The Complexity of Gatekeeping in Counselor Education

Gatekeeping is defined as a process to determine suitability for entry into the counseling profession (Brown-Rice & Furr, 2015). When assessing this professional suitability, academic training programs and clinical supervisors actively evaluate CITs during their training as a means to safeguard the integrity of the profession and protect client welfare (Brear, Dorrian, & Luscri, 2008; Homrich et al., 2014). Evaluators who question a CIT’s clinical, academic, and dispositional fitness but fail to intervene with problematic behavior run the risk of endorsing a student who is not ready for the profession. This concept is referred to as gateslipping (Gaubatz & Vera, 2002). Brown-Rice and Furr (2014) found that consequences of gateslipping can impact client care, other CITs, and the entire counseling profession.

Gatekeeping for counselor educators and supervisors is understood as an especially demanding and complex responsibility (Brear & Dorrian, 2010). Potential complications include personal and professional confrontations (Kerl & Eichler, 2005), working through the emotional toll of dismissing a student (Gizara & Forrest, 2004), lack of preparation with facilitating difficult conversations (Jacobs et al., 2011), and fear of legal reprisal when assuming the role of gatekeeper (Homrich et al., 2014). Homrich (2009) found that although counselor educators feel comfortable in evaluating academic and clinical competencies, they often experience difficulty evaluating dispositional competencies that are nebulously and abstractly defined. To complicate the gatekeeping process further, counselor educators are often hesitant to engage in gatekeeping practices, as discerning developmentally appropriate CIT experiences from problematic behavior (Homrich et al., 2014) may be difficult at times. Thus, more clearly defined dispositional competencies and more thorough training in counselor development models may be necessary to assist counselor educators’ self-efficacy in gatekeeping decisions. The proceeding section examines doctoral students in counselor education preparation programs and their involvement in gatekeeping responsibilities and practices.

 

Doctoral Students’ Role in Gatekeeping

Doctoral students pursuing counselor education and supervision degrees are frequently assigned the responsibility of supervisor and co-instructor of master’s-level students. Consequently, doctoral students serve in an evaluative role (Dollarhide et al., 2013; Fernando, 2013) in which they often have specific power and authority (Brown-Rice & Furr, 2015). Power and positional authority inherent in the role of supervisor (Bernard & Goodyear, 2014) and instructor permit doctoral students ample opportunity to appraise CITs’ development and professional disposition during classroom and supervision interaction (Scarborough, Bernard, & Morse, 2006). Doctoral students frequently consult with faculty through the many tasks, roles, and responsibilities they are expected to carry out (Dollarhide et al., 2013). However, relying solely on consultation during gatekeeping responsibilities rather than acquiring formal training can present considerable risks and complications. The gatekeeping process is complex and leaves room for error in following appropriate protocol, understanding CIT behavior and development, supporting CITs, and potentially endorsing CITs with problematic behavior that may have been overlooked.

Despite the importance of doctoral student education in the counseling profession and a substantial body of research on gatekeeping over the past two decades (Brown-Rice & Furr, 2013, 2015, 2016; V. A. Foster & McAdams, 2009; Gaubatz & Vera, 2002; Lumadue & Duffey, 1999; Parker et al., 2014; Rapisarda & Britton, 2007; Ziomek-Daigle & Christensen, 2010), there is an absence in the professional discourse examining the identity, development, practice, and training of doctoral students for their role of gatekeeper. No counseling literature to date has explored how counselor education programs are supporting doctoral students’ transition into the role of gatekeeper, despite the latest accreditation standards calling for doctoral preparation programs to graduate students who are competent in gatekeeping functions relevant to teaching and clinical supervision (CACREP, 2015, Standard 6.B). A lack of specific literature is particularly problematic, as the process of gatekeeping can be difficult for faculty members. It is reasonable to assume that if faculty members struggle to navigate the responsibilities of a gatekeeper, then less experienced doctoral students would struggle in this role as well. Furthermore, most incoming doctoral students have not had an opportunity to formally engage in gatekeeping practices in academic settings as an evaluator (DeDiego & Burgin, 2016).

Although doctoral students have been introduced to the concept of gatekeeping as master’s-level students (e.g., gatekeeping policies), many counselors do not retain or understand gatekeeping information (V. A. Foster & McAdams, 2009; Parker et al., 2014; Rust et al., 2013). These research findings were further examined through an exploratory study in August of 2016. The first two authors of this article assessed beginning doctoral students’ gatekeeping knowledge and self-efficacy prior to doctoral training or formal curricula. Areas of knowledge assessed included general information on the function of gatekeeping, standard practices, and program-specific policies and procedures. Preliminary findings of six participants indicated that incoming doctoral students lacked understanding for their role in gatekeeping. This supports existing research (V. A. Foster & McAdams, 2009; Parker et al., 2014; Rust et al., 2013) and aligns with DeDeigo and Burgin’s (2016) assertion that doctoral students are often unsure of what the role of gatekeeper “even means, let alone how to carry it out” (p. 182). Consequently, attention must be given to preparing doctoral students for their gatekeeping role to meet CACREP standards and, most importantly, prepare them to gatekeep effectively in an effort to prevent gateslippage.

DeDiego and Burgin’s (2016) recommended counselor education programs support doctoral students’ development through specific programmatic training. Despite the established importance of specific training (Brear & Dorrian, 2010), no corresponding guidelines exist for content of material. To address this gap, we provide recommendations of content areas that may assist doctoral students in becoming acquainted with the complex role of gatekeeper. We derived our recommendations from a thorough review of professional literature. Recommendations compiled include current trends related to gatekeeping within the counseling profession, findings from various studies that state what information is deemed important in the realm of gatekeeping, and considerations for educational and professional standards that guide best practices as a counselor educator.

 

Recommendations

Recommendations contain general areas of knowledge that should accompany program-specific material for introductory gatekeeping role information. Providing doctoral students with program-specific policies and procedures related to gatekeeping practices, such as remedial and dismissal procedures, is of utmost importance. This information can be dispersed in a variety of methods such as orientation, gatekeeping-specific training, coursework, and advising. We view these areas of content as foundational in acquainting doctoral students with the role of gatekeeper. We included four general content areas of knowledge pertaining to gatekeeping practices and the role of gatekeeper: current variation of language espoused by the counselor education community; ethics related to gatekeeping; cultural considerations; and legal and due process considerations. Each of these recommended content areas will be briefly discussed with relevant literature supporting the importance of their inclusion.

 

Adopted Language

Current terminology in the field of counselor education describing CITs who struggle to meet professional standards and expectations is broad and lacks a universal language that has been adopted by counselor educators (Brown-Rice & Furr, 2015). Consequently, a plethora of terms and definitions exists in the literature describing CITs who are struggling to meet clinical, academic, and dispositional competencies. As described earlier, the lack of consensus regarding gatekeeping and remediation language may contribute to the lack of clarity, which many counselor educators perceive as a gatekeeping challenge. Terms appearing in gatekeeping literature that describe students of concern include: deficient trainees (Gaubatz & Vera, 2002), problems of professional competence (Elman & Forrest, 2007; Rust et al., 2013), impaired, unsuitable, unqualified, and incompetent (J. M. Foster, Leppma, & Hutchinson, 2014), with varying definitions describing these terms. Duba, Paez, and Kindsvatter (2010) defined counselor impairment as any “emotional, physical, or educational condition that interferes with the quality of one’s professional performance” (p. 155) and defined its counterpart, counselor competency, as an individual demonstrating both clinical skills and psychological health. It is important to emphasize potential complications and implications associated with the term impairment, which can have close association with disability services, rendering a much different meaning for the student, supervisee, or colleague (McAdams & Foster, 2007).

Introducing these terms to doctoral students not only familiarizes them with the definitions, history, and relevance of terms present in the counseling community, it also provides a foundation in which to begin to conceptualize the difference between clinical “impairment” versus emotional distress or developmentally appropriate academic struggle. In upholding responsibilities of gatekeeping, one must be aware of the differentiating aspects of emotional distress and impairment in order to be able to distinguish the two in professionals and students. In further support of this assertion, Rust et al. (2013) stated that counseling programs must be able to distinguish between problems of professional competence and problematic behavior related to normal CIT development. Including a review of relevant terms existing in the counseling literature in the program’s training will allow doctoral students to begin to understand and contextualize the language relevant to their new roles as gatekeepers.

Although it is essential to educate doctoral students on language common to the counseling community, familiarity with language adopted by the department and institution with which they are serving as gatekeepers is vital to training well-informed gatekeepers (Brear & Dorrian, 2010). Having a clear understanding of the terminology surrounding gatekeeping ensures that doctoral students and faculty are able to have an open and consistent dialogue when enforcing gatekeeping practices. Homrich (2009) described consistent implementation of gatekeeping protocol as a best practice for counseling programs and faculty. Additional best practices include the establishment of expectations and communicating them clearly and widely. In the recommendations offered by Homrich (2009), a common language is needed within the department in order to successfully implement these practices to improve and sustain gatekeeping procedures. After doctoral students are situated in the current climate of gatekeeping-related terms and language, an exploration of professional and educational ethics can ensue.

 

Ethics Related to Gatekeeping

Professional and ethical mandates should be identified and discussed to familiarize doctoral students with the corresponding ethical codes that they are expected to uphold. Three sources that guide ethical behavior and educational standards for counselor educators that must be integrated in curricula and training include the American Counseling Association Code of Ethics (2014), the 2016 CACREP Standards (2015), and the National Board for Certified Counselors Code of Ethics (2012). Doctoral preparation programs should draw specific attention to codes related to the function of gatekeeping. These ethical codes and professional standards can be introduced in an orientation and discussed in more depth during advising and formal courses.

Doctoral preparation programs have flexibility in introducing standards and ethical codes during doctoral students’ academic journey. We recommend relevant standards and ethics be introduced early and mentioned often during doctoral training, specifically in terms of gatekeeping. Doctoral students should have prior knowledge of the ethical codes before engaging in gatekeeping or remedial functions with CITs. Moreover, if doctoral students have an understanding of the educational standards that are required of them, they can strive to meet specific standards in a personalized, meaningful manner during their training. Referencing CACREP standards addressed in a course syllabus is required for accreditation and helpful for students; yet, educational standards should be incorporated in training to foster deeper meaning and applicability of standards. As doctoral students are being trained to take leadership positions in the counselor education field, a more thorough understanding of educational principles and ethical codes is vital, particularly in the area of gatekeeping. Faculty members leading doctoral courses are encouraged to speak to standards related to gatekeeping throughout the duration of a course. Faculty intentionally dialoguing about how these standards are being met may allow for doctoral students to provide informal feedback to whether they believe they understand the multifaceted role of gatekeeper. During the review of codes and standards, focused attention should be given to “cultural and developmental sensitivity in interpreting and applying codes and standards” (p. 207) in gatekeeping-related situations (Letourneau, 2016). One option for attending to such sensitivity is the introduction of a case study in which doctoral students participate in open dialogue facilitated by a trainer. The inclusion of a case study aims to engage doctoral students in critical thinking surrounding cultural and diversity implications for gatekeeping practices. The following section will draw further attention to the importance of cultural awareness in gatekeeping practices and responsibilities.

 

Cultural Considerations

It is vital for doctoral students to have an understanding and awareness of the cultural sensitivity that is required of them in making sound gatekeeping-related decisions. Not only do ethical codes and educational mandates expect counselor educators to possess a level of multicultural competency (American Counseling Association, 2014; CACREP, 2015), but recent literature draws attention to cultural considerations in the gatekeeping process (Goodrich & Shin, 2013; Letourneau, 2016). These cultural considerations provide doctoral students with valuable information on conceptualizing and interacting with gatekeeping practices in a more culturally sensitive manner.

Letourneau (2016) described the critical nature of taking into account students’ cultural influences and differences when evaluating their assessment of fitness for the profession, while Goodrich and Shin (2013) called attention to “how cultural values and norms may intersect” (p. 43) with appraisal of CIT counseling competencies. For example, when assessing a CIT’s behavior or performance to determine whether it may be defined as problematic, evaluators may have difficulty establishing if the identified behavior is truly problematic or rather deviating from the cultural norm (Letourneau, 2016). This consideration is essential as culture, diversity, and differing values and beliefs can influence and impact how perceived problematic behaviors emerge and consequently how observed deficiencies in performance are viewed (Goodrich & Shin, 2013; Letourneau, 2016). Examining the cultural values of the counseling profession, counselor education programs, and the community in which the program is embedded can shed light on what behaviors, attitudes, and beliefs are valued and considered norms. This examination can prompt critical awareness of how CITs differing from cultural norms may be assessed and evaluated differently, and even unfairly.

Jacobs et al. (2011) described insufficient support for evaluators in how to facilitate difficult discussions in gatekeeping-related issues, specifically when the issues included attention to diversity components. Doctoral students must be given ample opportunity to identify cultural facets of case examples and talk through their course of action as a means to raise awareness and practice looking through a multicultural lens in gatekeeping-related decisions and processes. Of equal importance is familiarity with legal and due process considerations, which are addressed in the section below.

 

Legal and Due Process Considerations

Three governing regulations that are often discussed in the literature, but left to the reader’s imagination in how faculty members actually understand them, include the Family Educational Rights and Privacy Act (FERPA) of 2000, the Americans with Disabilities Act (ADA) of 1990, and a student’s rights and due process policy within an institution. Presenting these three concepts and their implications to the gatekeeping process is warranted, as doctoral students are assumed only to have the understanding of these concepts from a student perspective. Although FERPA, the ADA, and the due process clause may be covered in new faculty orientation, how these regulations interface with gatekeeping and remediation are generally not reviewed during standard university orientations. It is recommended that training and curricula include general knowledge and institution-specific information related to the regulations. Institution-specific material can include university notification of rights; handbook material directly addressing student rights; remediation policy and procedures; and resources and specific location of campus services such as the disability office. Inclusion of general and program-specific information will help future faculty members in possessing a rounded and well-grounded understanding of how legal considerations will apply to students and inform their gatekeeping practices. Lastly, doctoral students should be informed that the regulations detailed below may limit their access of information due to master’s-level student privacy. To begin, doctoral students should intimately understand FERPA and its application to the CITs they often supervise, teach, and evaluate.

FERPA. General information may consist of the history and evolution of FERPA in higher education and its purpose in protecting students’ confidentiality in relation to educational records. Doctoral students must be introduced to the protocol for ensuring confidentiality in program files. Program files include communication about CIT performance and may be directly related to gatekeeping issues. Doctoral students must recognize that, as evaluators communicating CIT assessment of fitness, including dispositional competencies, they must abide by FERPA regulations, because dispositional competencies are considered educational records.

Educational programs often utilize off-site practicum and internship programs that are independent from the respective university (Gilfoyle, 2008), and this is indeed the case with many CACREP-accredited counselor training programs. Doctoral students must have an understanding of the protocols in place to communicate with site supervisors who are unaffiliated with the university, such as student written-consent forms that are a routine part of paperwork for off-site training placement (Gilfoyle, 2008). Although doctoral students may not be directly corresponding with off-site evaluators, their training should consist of familiarizing them with FERPA regulations that address the disclosure of student records in order to prepare them in serving CITs in a faculty capacity. Understanding how to communicate with entities outside of the university is crucial in the event that they are acting as university supervisors and correspondence is necessary for gatekeeping-related concerns. An additional governmental regulation they are expected to be familiar and interact with is the ADA.

The ADA. Introducing doctoral students to the ADA serves multiple functions. First, similar to FERPA, it would be helpful for doctoral students to be grounded in the history of how the ADA developed and its purpose in protecting students’ rights concerning discrimination. Second, general disability service information, such as physical location on their respective campus, contact information for disability representatives, and protocols for referring a student, provides doctoral students the necessary knowledge in the event that a CIT would inquire about accommodations. If a CIT were to inquire about ADA services during a class in which a doctoral student co-teaches or during a supervision session, it would be appropriate for the doctoral student to disseminate information rather than keeping the CIT waiting until after consultation with a faculty member. Lacking general information relevant to student services may place the doctoral student in a vulnerable position in which the supervisory alliance is undermined, as the doctoral student serving in an evaluative role is not equipped with the information or knowledge to assist the CIT. Finally, presentation of the ADA and its implications for gatekeeping will inform students of the protocols that are necessary when evaluating a CIT who has a record of impairment. For example, if a CIT has registered a disability through the university’s ADA office, appropriate accommodations must be made and their disability must be considered during the gatekeeping process.

 Due Process. The introduction of students’ fundamental right to basic fairness is essential, as many doctoral students may not understand this concept outside of a student perspective because of a lack of experience in instructor and supervisor positions. Examples of such basic fairness can be illustrated for doctoral students through highlighting various components in a counselor training program that should be in place to honor students’ right to fair procedures and protect against arbitrary decision-making. These include but are not limited to access to program requirements, expectations, policies, and practices; opportunity to respond and be heard in a meaningful time in a meaningful way; decisions by faculty members, advisors, or programs to be supported by substantial evidence; option to appeal a decision and to be notified of judicial proceedings; and realistic time to complete remediation (Gilfoyle, 2008; Homrich, 2009). McAdams and Foster (2007) developed a framework to address CIT due process and fundamental fairness considerations in remediation procedures to help guide counselor educators’ implementation of remediation. It is recommended that these guidelines (McAdams & Foster, 2007) be introduced in doctoral student training to generate discussion and included as a resource for future reference. In educating doctoral students about considerations of due process through a faculty lens, formal procedures to address student complaints, concerns, and appeals also should be included in training.

 

Implications for Counselor Education

Doctoral preparation programs are charged with graduating students who will be prepared and competent for the various roles they will assume as a counselor educator and clinical supervisor. The lack of professional literature exploring the development and training of gatekeepers indicates a clear call to the counseling profession to investigate the emergence of counselor educators into their role of gatekeepers. This call is fueled by the need to understand how doctoral preparation programs can support students and ensure competency upon graduation. Generating dialogue related to doctoral student gatekeeper development may consequently continue the conversation of standardization in gatekeeping protocol. Accordingly, this sustained dialogue also would keep the need for more universal gatekeeping nomenclature in the forefront. Continued emphasis on a common gatekeeping language will only strengthen gatekeeping protocol and practices and in return provide an opportunity for training developments that have the potential to be standardized across programs.

The recommended content areas we have offered are intended to prepare doctoral students for their role of gatekeeper and aim to enhance the transition into faculty positions. These recommendations may be limited in their generalizability because gatekeeping practices vary across programs and department cultures, indicating that information and trainings will need to be tailored individually to fit the expectations of each counseling department. These differences hinder the ability to create a standardized training that could be utilized by all departments. As gatekeeping practices continue to receive research attention and the call for more universal language and standardization is answered, standardization of training can be revisited. Nonetheless, general recommendations in training content can serve as groundwork for programs to ensure that students are receiving a foundation of basic knowledge that will allow doctoral students to feel more confident in their role of gatekeeper. The recommended content areas also serve to help incoming doctoral students begin to conceptualize and see through an academic—rather than only a clinical—lens.

Implementation and delivery of recommended content areas may be applied in a flexible manner that meets doctoral preparation programs’ specific needs. The recommendations offered in this article can be applied to enhance existing curricula, infused throughout coursework, or disseminated in a gatekeeping training or general orientation. Faculty creating doctoral curricula should be cognizant of when doctoral students are receiving foundational gatekeeping information. If doctoral students are expected to have interaction with and evaluative power over master’s-level students, recommended gatekeeping content areas should be introduced prior to this interaction.

There are several avenues for future research, as the proposed recommendations for content areas are rich in potential for future scholarly pursuit. The first is the call to the profession for investigations examining training efforts and their effectiveness in preparing future faculty members for the multifaceted role of gatekeeper. The complexity and import of gatekeeping responsibilities and identity development may be a possible reason for the lack of studies to date on this role. Nevertheless, both qualitative and quantitative inquiry could lend insight to gaps in training that lead to potential gateslippage. Quantitative research would be helpful in examining how many programs are currently utilizing trainings and the content of such trainings. In consideration of the number of CACREP-accredited doctoral programs within the United States, a large sample size is feasible to explore trends and capture a full picture. Conducting qualitative analysis would expand and deepen the understanding of how faculty and doctoral students have been trained and their processes and experience in becoming gatekeepers.

In conclusion, doctoral preparation programs can be cognizant to infuse the aforementioned recommended content areas into doctoral curricula to meet CACREP standards and prepare doctoral students for the complex role of gatekeeper. Counselor education and supervision literature indicates that more focused attention on training could be beneficial in improving gatekeeping knowledge for doctoral students. Training recommendations derived from existing literature can be utilized as guidelines to enhance program curriculum and be investigated in future research endeavors. With a scarcity of empirical studies examining gatekeeping training and gatekeeper development, both quantitative and qualitative studies would be beneficial to better understand the role of gatekeeper and strengthen the overall professional identity of counselor educators and clinical supervisors.

 

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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Marisa C. Rapp, NCC, is an assistant professor at the University of Wisconsin–Parkside. Steven J. Moody, NCC, is an associate professor at Idaho State University. Leslie A. Stewart is an assistant professor at Idaho State University. Correspondence can be addressed to Marisa Rapp, 264 Molinaro Hall, 900 Wood Rd., Kenosha, WI 53144-2000, rapp@uwp.edu.