The More, the Merrier? A Phenomenological Investigation of Counselor-in-Training Simultaneous Supervision

William B. Lane, Jr., Timothy J. Hakenewerth, Camille D. Frank, Tessa B. Davis-Price, David M. Kleist, Steven J. Moody

 

Interpretative phenomenological analysis was used to explore the simultaneous supervision experiences of counselors-in-training. Simultaneous supervision is when a supervisee receives clinical supervision from multiple supervisors. Sometimes this supervision includes a university supervisor and a site supervisor. Other times this supervision occurs when a student has multiple sites in one semester and receives supervision at each site. Counselors-in-training described their experiences with simultaneous supervision during the course of their education. Four superordinate themes emerged: making sense of multiple perspectives, orchestrating the process, supervisory relationship dynamics, and personal dispositions and characteristics. Results indicated that counselors-in-training experienced compounded benefits and challenges. Implications for supervisors, supervisees, and counselor education programs are provided.

Keywords: clinical supervision, simultaneous supervision, counselors-in-training, interpretative phenomenological analysis, counselor education

     Supervision is a key component of counselor education in programs accredited by the Council for the Accreditation of Counseling and Related Educational Programs (CACREP; 2015) and an ethical requirement in the ACA Code of Ethics (American Counseling Association, 2014). Supervision of counselors-in-training (CITs) serves the purpose of guiding counselor development, gatekeeping, and, ultimately, ensuring competent client care (Borders et al., 2014). For the present study, we defined simultaneous supervision as a pre-licensure CIT receiving weekly individual or triadic supervision from more than one supervisor over the same time period. At the time of the study, the 2016 CACREP standards required that internship and practicum students receive individual and/or triadic supervision averaging 1 hour per week throughout their clinical experience (Standards 3.L. & 3.H.). Some CITs may gain field experience at multiple clinical sites requiring individual site supervision at each site. Many programs require students to engage in faculty advising meetings (Choate & Granello, 2006), which may take a form analogous to formal supervision. Additionally, supervisees may have clinical supervision, focused on supervisee development and client welfare, as well as administrative supervision, focused on functionality and logistics within an agency; these roles may be fulfilled by the same person or at times by two separate supervisors (Kreider, 2014; Tromski-Klingshirn & Davis, 2007). Consequently, although simultaneous supervision is not required in and of itself, it often occurs in counselor education practice.

Supervision Foundations
     Counseling supervision research has increased significantly in the last few decades (Borders et al., 2014). Borders and colleagues (2014) developed best practices for effective supervision, including emphasis on the supervision contract, social justice considerations, ethical guidelines, documentation management, and relational dynamics. Previous research has overwhelmingly demonstrated that a strong supervisory alliance is the bedrock of effective supervision (Bernard & Goodyear, 2019). Sterner (2009) further studied the supervisory relationship as a mediator for supervisee work satisfaction and stress. Lambie and colleagues (2018) developed a CIT clinical evaluation to be used in supervision, with strength in assessing personal dispositions in addition to clinical skills. A review of the supervision literature revealed that a strong supervisory relationship based in goal congruence, empathic rapport, and transparent feedback processes (Bernard & Goodyear, 2019; Borders et al., 2014; Sterner, 2009) generate mutual growth between supervisor and supervisee, enhancing clinical work. Additionally, CACREP mandates that faculty and site supervisors foster CIT professional counselor identity through the supervisory process (Borders, 2006; CACREP, 2015).

Counselor development is also a crucial factor in clinical supervision. An entire category of supervision models centralizes the professional development of supervisees in their approach (Bernard & Goodyear, 2019). One of the most widely known models, the Integrative Developmental Model, plots learning, emotion, and cognitive factors across multiple stages of therapist development (Stoltenberg & McNeill, 2010). By focusing on overarching themes of self–other awareness, autonomy, and motivation, the Integrative Developmental Model (Stoltenberg & McNeill, 2010) illuminates how supervisees fluctuate and grow in their anxiety, self-efficacy, reliance on structure, and independence. All these factors may have substantial impact when considering the complexity that simultaneous supervision brings. Furthermore, professional dispositions of openness to feedback and flexibility and adaptability (Lambie et al., 2018) may have additional developmental implications when considering the complexity of simultaneous supervision.

Ethics similarly serve as a foundation of supervisory experiences. Multiple standards and principles of the ACA Code of Ethics (2014) may be complicated by simultaneous supervision and require special attention. Veracity may be of particular interest given the commonality of supervisee nondisclosure (Kreider, 2014), multiplied by the added number of supervisors in one time period. Furthermore, specific standards in Section D: Relationships With Other Professionals may be implicated by obligations in working with multiple professionals; multiple standards in Section F: Supervision, Training, and Teaching may be indicated because of the convergence of both teaching and clinical supervision in counselor training programs; and, finally, reconciling the additional complexities of simultaneous supervision not explicitly identified elsewhere in the 2014 Code of Ethics may elicit a need to carefully consider Section I: Resolving Ethical Issues. With more parties involved, greater nuance would be expected in ethical decision-making.

Much of the foundational research and reviewed contextual factors have either focused specifically on sole supervision or do not differentiate between sole and simultaneous supervision. When considering best supervision practices, the phenomenon of simultaneous supervision presents distinct practical concerns. Exploration is needed to better understand how supervisees might navigate different but related supervisory relationships, how goals and tasks can be congruent across separate supervisory experiences, and how supervisees would make meaning of multiple sources of feedback. Despite the apparent use of simultaneous supervision in counselor education programs, few researchers have explored these dynamic concerns.

Multiple Supervisors and Multiple Roles
     Early researchers began to conceptualize the challenges and strengths inherent in simultaneous supervision in both counseling (Davis & Arvey, 1978) and clinical psychology (Dodds, 1986; Duryee et al., 1996; Nestler, 1990), with mixed results overall. Nestler (1990) identified the difficulties in receiving contradictory feedback from multiple supervisors, reflective of fundamental differences in the supervisors’ approaches. Dodds (1986) similarly identified multiple potential stressors in having concurrent supervisors at agency and training settings. Dodds argued that although the general goals to teach and serve clients overlapped, each had inherent differences in their primary institutional goals and structures. Duryee and colleagues (1996) described a beneficial view of simultaneous supervision, in which supervisees overcome conflicts with site supervisors via support and empowerment from academic program coordinators. Davis and Arvey (1978) presented a case study in which supervisees, in a raw comparison, more highly favored the dual supervision overall. These findings highlight the dynamics that occur in the context of simultaneous supervision and connect with recent findings.

Recent researchers have focused on dual-role supervision, defined as one individual supervisor serving as both a clinical and administrative supervisor to one or more supervisees (Kreider, 2014). Kreider (2014) investigated supervisee self-disclosure as related to three factors: supervisor role (dual role or single role), supervisor training level, and supervisor disclosure. Level of supervisor disclosure was found to be significant in explaining differences in supervisee self-disclosure and was hypothesized as a mitigating factor in supervisor role differences (Kreider, 2014). Tromski-Klingshirn and Davis (2007) surveyed the challenges and benefits unique to dual-role supervision for post-degree supervisees. Most supervisees reported neutral to positive outcomes from a dual-role supervisor, but a minority of supervisees noted power dynamics and fear of disclosure as primarily problematic (Tromski-Klingshirn & Davis, 2007), similar to the earlier hypotheses of Nestler (1990) and Dodds (1986). The small amount of existing research solidifies the prevalence of simultaneous supervision and the challenges and benefits for the supervisees. A missing link emerges in understanding how CITs come to understand their experience in simultaneous supervision from a qualitative perspective.

The distinct focused phenomenon of simultaneous supervision is limited in counseling literature. The few conceptual examinations of simultaneous supervision in the mental health literature have indicated confusion and role ambiguity (Nestler, 1990), while at other times simultaneous supervision has been noted to improve comprehensive learning (Duryee et al., 1996). Our study addresses the gap in the literature regarding current simultaneous supervision in counselor education utilizing qualitative analysis.

Method

Given the limited research on simultaneous supervision and its prevalence within the profession, we decided to explore this phenomenon qualitatively. Our research question was “What is the experience of CITs receiving simultaneous supervision from multiple supervisors?” We used interpretative phenomenological analysis (IPA) to explore this question because of its utility with counseling research, grounded methods of analysis, and emphasis on both contextual individual experiences with the phenomenon and general themes (Miller et al., 2018).

Research Team
     At the time of the study, the research team consisted of four doctoral students—William B. Lane, Jr., Timothy J. Hakenewerth, Camille D. Frank, and Tessa B. Davis-Price—who each had previous experience with simultaneous supervision as supervisees and supervisors. The team’s perspective of this phenomenon from both roles informed their interest in and analysis of the phenomenon. The fifth member of the team, David M. Kleist, was our doctoral faculty research advisor. The sixth author, Steven J. Moody, provided support in the writing process.

Participants and Procedure
     Our participants were four CITs from CACREP-accredited graduate programs accruing internship hours. Smith et al. (2009) suggested seeking three to six participants for IPA, as this allows researchers to explore the phenomenon with individual participants at a deeper level. All four participants specialized in either addiction, school, or clinical mental health counseling, and identified as White, female CITs ranging from 23 to 37 years old. Additionally, each participant reported receiving supervision from at least two supervisors to include university-affiliated supervisors and site supervisors. Each participant came from a different university representing the Rocky Mountain and North Central regions of the Association for Counselor Education and Supervision. To protect confidentiality, each participant selected a pseudonym for the study.            

After securing approval from our university’s review board, we recruited participants through purposive convenience sampling. We posted a recruitment email to the CESNET listserv, an informational listserv for counselor educators and supervisors. This listserv was selected as an initial step of convenience sampling to increase the potential to reach a broad range of counseling programs. Nine individuals responded to the call to participate in the research by taking a participant screening survey that helped us determine suitability for the study. After removing individuals from research consideration because of potential dual relationships, nonresponse, or not meeting inclusion criteria, four individuals were selected as participants. We further planned to engage in serial interviewing to gain richer details of the phenomenon and achieve greater depth with the four participants (Murray et al., 2009; Read, 2018). Prior to data collection, the researchers completed a brief phone screening with each participant to review the interview protocol and explain the phenomenological approach guiding the questions. A $40 gift card was provided as a research incentive to participants. Our selection criteria included (a) being a master’s student within a CACREP counseling program, (b) currently accruing internship hours, and (c) receiving simultaneous supervision. We selected participants in internship only because homogenous sampling helps produce applicable results for a given demographical experience (Smith et al., 2009).

Data Collection
     Consistent with the recommendations of Smith et al. (2009), we conducted two semi-structured interviews with each participant lasting between 45–90 minutes. We utilized the online videoconferencing platform Zoom to conduct and record the interviews. First-round interviews consisted of four open-ended questions (see Appendix) that allowed participants to explore the experience of simultaneous supervision in detail (Pietkiewicz & Smith, 2014). These questions were open-ended to allow participants to explore the how of the phenomenon (Miller et al., 2018). The final interview questions were developed through initial generation based off research and personal experiences with the phenomenon, refinement in consultation with the research advisor, and interview piloting with volunteer students who did not participate in the study. Research participants were asked about their overall experience with having multiple supervisors, benefits and detriments of simultaneous supervision, and the meaning they made as a result of experiencing simultaneous supervision. Second-round interview questions were developed based on participant responses to first-round interview questions. After two rounds of interviews and analysis, we conducted a final member check to confirm themes. All participants expressed that the developed themes were illustrative of their lived experiences with simultaneous supervision.

Data Analysis
     We followed IPA’s 6-step analysis process as outlined by Smith et al. (2009) and added a seventh step with the use of the U-heuristic analysis for group research teams (Koltz et al., 2010). Our process consisted of first coding and contextualizing the data individually, followed by group analysis, triangulated with the fifth author, Kleist, as research advisor. We completed this process for each participant and then analyzed themes across participants as suggested by Smith et al. We reached consensus that four superordinate themes emerged with 11 subthemes across the two rounds of interviews. All participants endorsed agreement with the themes from their experiences in simultaneous supervision during the member check process.

Trustworthiness
     We integrated Lincoln and Guba’s (1985) framework in conducting multiple procedures for establishing trustworthiness and credibility. We demonstrated prolonged engagement and persistent observation through consistent coding meetings over the span of 1 year. Additionally, we adapted the U-heuristic analysis process during data analysis to analyze data individually and collectively to strengthen the credibility of our findings (Koltz et al., 2010). Finally, after we developed the themes, we triangulated the results with participants via a member check, ensuring the individual and group themes matched their idiographic experiences.

We bridled our personal experiences with simultaneous supervision throughout the research process. Bridling recognizes that researchers have had close personal experiences with the phenomenon and that bias is best managed by recognition rather than elimination (Stutey et al., 2020). The four principal investigators, Lane, Hakenewerth, Frank, and Davis-Price, individually engaged in memo writing, discussed personal reactions to the data, and participated in group discussions regarding meaning-making of the phenomenon with Kleist serving as research advisor.

Results

Our data analysis produced four superordinate themes identified across all cases. These themes were (a) making sense of multiple perspectives, (b) orchestrating the process, (c) supervisory relationship dynamics, and (d) personal dispositions and characteristics. In the sections that follow, each theme is described in further detail and exemplar quotes are given to support their development.

Making Sense of Multiple Perspectives
     Making sense of multiple perspectives was defined as the receipt and conceptualization of supervisory feedback from multiple supervisors during the same academic semester. Supervisees identified their supervisors as having differing professional orientations. At times, these differing backgrounds led to supervisors providing differing opinions for the same client.

Participants used metaphors to make meaning of the distinct offerings of their supervisors’ feedback. An example of capturing multiple perspectives was one participant, Emma, utilizing the ancient Indian parable of “The Blind Men and the Elephant” (Saxe, 1868): “The point of the story is all the world religions might have a piece of the picture of God, you know. And so between all of us [clinicians and supervisors] together, maybe we have a perspective of truth.” Through retelling of the Indian fable, this participant was able to vividly capture her personal perspective of differing viewpoints through an integrative lens as opposed to a conflict of ideas. Within this superordinate theme, the two subthemes of supervisee framing and safety net vs. minefield emerged.

Supervisee Framing
     Supervisee framing focused on the participant’s personal view of hearing multiple perspectives from supervisors within simultaneous supervision. Some participants described hearing varying perspectives as being helpful and valuable, providing support, and increasing confidence. They typically framed the idea of receiving various feedback as a way to gain ideas and then make their own informed decisions. Molly shared this positive perspective when she stated, “I like coming to [my differing supervisors] with different issues I have with different clients because I feel like they both have valuable experience, but in different ways.” In contrast, Hailey identified multiple perspectives as being “really difficult,” and Diana noted they were “more frustrating than beneficial” and confusing. Similarly, Hailey stated, “My supervisors are all very different, so they give me different feedback, and a lot of times it conflicts with what the other one has said.” The supervisee’s framing of discrepant feedback impacted their overall perceptions with simultaneous supervision. Supervisees either valued or were confused by the feedback. Generally, participants spoke of times when multiple perspectives were beneficial and difficult, but it appeared all participants were left with the task of making sense of multiple perspectives while receiving simultaneous supervision.

Safety Net vs. Minefield
     Making sense of multiple perspectives was described as creating a safety net of support, while others found the experience to be a minefield that increased confusion, ambiguity, and isolation. Emma and Molly characterized their experience as providing support in an often overwhelming profession. Molly articulated, “I feel like if I didn’t have that good support, that good foundation, I don’t think I could do it because it’s just so much.” She later added, “I feel like getting those different perspectives, getting that support, getting those encouragers is beneficial because I don’t feel as overwhelmed, even though it’s overwhelming.”

Participants also perceived their simultaneous supervision as a minefield wherein they believed they were in double binds. Hailey reflected on an experience when her supervisors contradicted each other and expressed, “It just sucked because I was doing what my supervisor told me to do and suggested I do, and then I was told everything I did was wrong.” Diana echoed that discrepant feedback felt like a constant dilemma needing to be managed “carefully.” In reflecting on contradicting supervision, Diana said, “It’s hard because everybody has their own thing. . . . You just kind of have to appease everyone.” In the face of conflict, it was easier to placate than resolve. Participants’ cognitive framing was a major element of the phenomenon. Whereas making sense of multiple perspectives focused on the cognitive elements of receiving feedback from different supervisors, the next theme focused on the behavioral elements.

Orchestrating the Process
     Another theme that emerged in our data analysis was that of supervisees orchestrating the process of simultaneous supervision. This theme revolved around action-oriented steps in supervision. The essence of this theme was captured when Hailey acknowledged the need for “checking her motives” on what she shared with different supervisors. She asked herself, “Am I sharing this with this [supervisor] because I feel like they’re going to answer in the way that I feel like . . . they should answer, because it’s easier for me?” Hailey acknowledged the difficulty in this, countering with, “Or am I just going to them because it’s that person that I’m supposed to see?” Hailey recognized that having options when it came to approaching supervisors meant that disclosure needed to be intentional rather than straightforward as it is when CITs only have one choice. Participants were aware of their process as they picked and chose what to share with whom, through seeking out a preferred supervisor and through managing the practical aspects of having multiple supervisors. The subthemes of picking and choosing, seeking a preferred perspective, and managing practical considerations were a part of orchestrating the process.

Picking and Choosing
     The subtheme of picking and choosing emerged in how our participants described what they would share in supervision and the course of action taken in their counseling practice. This subtheme was labeled as an in vivo code, derived from Hailey’s quote: “So I definitely pick and choose what I talk to about each one. Because—this sounds terrible—but I respect the one [supervisor] more.” Hailey also described feelings of vulnerability and self-efficacy from week to week, related to her reactions from feedback: “I knew after having such a hard supervision last week showing tape, I was like, ‘I cannot be super vulnerable right now. I need to choose something that’s more surface level.’” Molly experienced picking and choosing as a means of proactively managing the repetitive nature of supervision: “I think just bringing different things to different supervisors is really helpful, and not constantly talking about the same client or the same situation, because that gets obnoxious and repetitive, and you’re gonna get a hundred different opinions.”

After receiving feedback, participants had varying perspectives on how to integrate and transfer constructs into action. Some participants viewed discrepant feedback as mutually exclusive, whereas others had a more integrative perspective. Molly expressed frustration in choosing between differing feedback from multiple supervisors: “Sometimes I don’t really know which I should go with, which I should choose, and which would be best for the client. . . . It’s like a double-edged sword, like it’s good at some points, but then bad at others.” Diana, who expressed similar frustration in choosing between perspectives, relieved this tension by resolving that, “I have to live with myself at the end of the day, so as long as it’s not unethical, I don’t worry about it too much.  And as far as the stuff that I’m told that needs to be done, I do what I can.” Other participants espoused a much more integrative perspective. Emma stated, “I think the thing I like the best about it is actually when [my supervisors] have different advice . . . because then I feel like between the two, I can kind of find what I really like.” All participants spoke about selecting what to share with supervisors and choosing how to integrate feedback into action.

Seeking a Preferred Perspective
     Coinciding with picking and choosing, participants also sought a preferred perspective in the process of receiving simultaneous supervision and orchestrating the process. Some reported the decision to go to one supervisor over another was situationally based and determined by clinical skill or specialty of the supervisor. Diana captured this as follows, “Well, I can have a conversation with either. I just get very different answers. If it’s the technical stuff of what has to be done—her. If it’s ‘how would you approach the situation?’ I do tend to talk to him.” Diana also likened seeking a preferred perspective to a child searching for a desired answer: “It’s like, who do I want to talk to? It’s almost like, talk to the person you want for the answer you want. It’s like, ‘Well, if Mom doesn’t have the right answer, go talk to Dad.’”

Managing Practical Considerations
     All participants spoke to the practicality of meeting with multiple supervisors. Even though some participants strongly valued having multiple supervisors, all participants spoke to the larger time commitment needed in having simultaneous supervision. Molly captured how simultaneous supervision felt overwhelming, adding to the many other sources of feedback she received: “I already have two group supervisions. I’ve heard opinions about this, and I’m hearing other perspectives of my classmates, of my coworkers. Now I have to have triadic and hear their opinions and have individual. . . . It’s just a lot.” Emma framed this time commitment as detracting from her other obligations: “It just starts adding up. Like, my whole Tuesday evenings are gone, and that’s time I could be seeing clients.” Hailey expressed frustration about the obligatory nature and placating to the program’s requirement to see multiple supervisors: “Honestly, I just give the other supervisor little things because I know I have to talk to him . . . and it’s more, like, checking a box.” Finally, Emma captured how this time commitment was epitomized in documentation: “And the paperwork got exhausting, too, because I had to do everything in triplicate sometimes.” She further talked about the additional mental labor: “And now what are we gonna talk about since I just talked about all of this with [a different supervisor] and feel like I found good solutions, you know?” Supervisees had to manage their time and fit more supervision into their schedules. Simultaneous supervision added complexity, and participants needed to orchestrate this process to manage it efficiently and effectively.

Supervisory Relationship Dynamics
     Supervisory relationship dynamics was determined to be a superordinate theme as it reflected on the connecting and disconnecting elements of the supervisory relationship. This theme was broken into three subthemes. The subthemes of vulnerability, power dynamics, and systems of supervision illustrated the relational dynamics within simultaneous supervision.

Vulnerability
     In supervisory relationships, feelings of safety and vulnerability influenced interactions with different supervisors. To illustrate, Hailey noted:

There are certain supervisors I feel more safe with. And so those are the ones that I share more with . . . versus some of them I feel less safe with . . . I don’t share as much with them that is vulnerable, or that makes me vulnerable.

Participant experiences highlighted how vulnerability dictated what and how elements were shared in simultaneous supervision. 

Power Dynamics
     The determination of safety occurred within power dynamics. Diana commented that multiple supervisors serving as evaluators and gatekeepers can create “this weird relationship where you don’t want to be too vulnerable because this person is also your boss and can decide if you are going to stay in that position or not.” Diana and Hailey noted feeling disempowered and disengaged from supervision, referring to supervisors as “bosses” throughout their interviews. When participants perceived their supervision as a firmly directive process, discrepant directives were especially distressing. Diana rephrased this sentiment: “I guess the best thing to compare it to would be if you have more than one boss, but they all give you a different, ‘I want this, I want this, I want this.’” Emma’s experience was more accordant, and she specifically expressed at one time, “None of [my supervisors] are really super bossy either.” Participants identified power dynamics as salient aspects of how they experienced supervision and with whom they connected. Working with more than one supervisor sometimes resulted in characterization of “good” and “bad” supervisors, making individual supervisory relationship dynamics crucial.

Systems of Supervision
     Participants conceptualized the phenomenon as broader systems of supervision in which individual supervisors were interacting with each other. Emma noted, “The two faculty supervisors work very closely together and I assume talk all the time.” Emma and Molly provided multiple examples of supervisors working together to best serve clients, thus bolstering supervision through their combined expertise. Molly stated, “It was nice because [my two supervisors] were in agreement and I felt comfortable going into session with [my client].” Even negative experiences contributed to systems of supervision. Hailey reported seeking out additional support when her assigned supervisory relationships did not meet her needs, widening the reach of simultaneous supervision even more: “By not being a good supervisor, he helps me seek out other resources and figure it out for myself.” Finally, Molly noted that supervisor coordination was primarily for evaluation at the end of the semester and only if problems arose. However, she imagined what it would be like if they were more collaborative:

They would have had a better understanding of the way I work in a counseling room. . . . Because my site supervisor really understood how I approached things and the way I would interact with my clients, but I feel like my university supervisor didn’t really, like, she had little snippets of what I was like in a counseling room.

Power, vulnerability, and systems in the supervisory relationship impacted supervisees from multiple levels in their clinical journey.

Personal Dispositions and Characteristics
     Personal dispositions and characteristics resulted from participants speaking about the phenomenon as well as what they said about their supervisors. Three dispositions that emerged as relevant were tolerance for ambiguity, curiosity, and availability. The first two subthemes were identified as they spoke about the phenomenon and the third subtheme was a characteristic present because of the nature of simultaneous supervision.

Tolerance for Ambiguity
     Tolerance for ambiguity was found to be a critical disposition. This disposition allowed participants to see differences in opinion as helpful. Emma shared that she “very rarely” saw people as giving her “conflicting information.” She said that she saw it as everybody having their own perspective. This connected to her ability to view multiple perspectives as “pieces of the puzzle,” as she expressed earlier in her retelling of the Indian fable. Although participants sometimes expressed concern about direction, Diana shared, “You can ask questions and you can not know and it’s okay.” This disposition directly related to how they reconciled and then reacted to multiple perspectives of simultaneous supervisors.

Curiosity
     Curiosity also manifested more implicitly with supervisees. Participants showed curiosity by taking interest in what supervisors had to say, seeking more information, or staying open to difficult feedback. Hailey shared that simultaneous supervision “definitely requires a lot of continuing to look inward and examining your motives and yourself and what the supervisors have said.” In speaking more broadly, Emma shared, “So I don’t think I’ll ever give [simultaneous supervision] up now that I’ve kind of experienced how valuable it is to get another professional opinion.” Curiosity manifested itself as a transient characteristic for other participants. Diana experienced transference with one of her supervisors, which was a barrier to her ability to exhibit this helpful disposition. One of her supervisors suggested that she try and work things out with another supervisor she was having difficulty with, to which Diana said, “No. Who is gonna walk into their supervisor and be like, ‘Okay, so my problem with you is you’re a bitch. You remind me of my abusive ex.’ . . . But at the same time, I have to work with her.” This was an example of Diana demonstrating a closing off to feedback. Both tolerance for ambiguity and curiosity manifested and impacted their experience of multiple perspectives.

Availability
     An important disposition was emotional and physical availability. Emma expressed that “there’s always somebody I can get a hold of.” Hailey expressed that she had “more coverage just in general,” but also questioned her supervisors’ true availability: “Do I even need to bring this to supervision or can I work on this on my own? Because sometimes I feel like I annoy them.” All participants expressed that availability was important to their experience, although physical availability did not always translate to being available to discuss what the supervisee wanted. Those participants who identified supervisors within simultaneous supervision as being more available had more positive thoughts regarding simultaneous supervision.

Discussion

All four participants identified the complex position of CITs receiving supervision from more than one supervisor. The results align with the growing body of literature affirming the importance of a positive working relationship between CITs and supervisors (Bernard & Goodyear, 2019; Borders et al., 2014; Sterner, 2009) as well as significant differences between faculty and site supervision (Borders, 2006; Dodds, 1986). The results parallel supervision literature detailing the multiple roles of supervisees (Bernard & Goodyear, 2019) who, unlike supervisors, are not required to have specific education in supervision. The theme of personal dispositions has been studied extensively in counselor education, resulting in prominent placement in clinical assessment instruments (Lambie et al., 2018). The presented themes diverge from the current research base in their construction of a clear model of simultaneous supervision. The subthemes of picking and choosing, seeking a preferred perspective, and systems of supervision illustrate the interpersonal dynamics of simultaneous supervision that is distinct from sole supervision, an underrepresented phenomenon in the supervision literature. Participants in this study reported mixed feelings with simultaneous supervision. Four primary themes emerged from this study: making sense of multiple perspectives, orchestrating the process, supervisory relationship dynamics, and personal dispositions and characteristics. These four themes encompass many areas of the supervisory experience while illuminating guidelines for supervisors engaging in simultaneous supervision.

Implications
     Results from this study reinforce the complex levels of integration CITs experience when receiving supervision from multiple supervisors. This process of integration can lead to confusion, ambiguity, and also deeper understanding. The results indicate that the perceived benefit of simultaneous supervision was often based on the relationship between the supervisor and CIT, ability and support to organize the process, and the personal dispositions of the CIT. The implications for this research target three populations.

Supervisors
     The findings of this study indicate several implications for supervisors working with clinicians receiving simultaneous supervision. First and foremost, the critical importance of the supervisory relationship to supervision in general (Bernard & Goodyear, 2019) was further substantiated as a foundation for effective simultaneous supervision. Questionable supervisee behaviors such as intentional nondisclosure via seeking a preferred perspective or picking and choosing can be avoided through purposefully fostering trust in the relationship. Similarly, supervisors may support the perspective of simultaneous supervision as a safety net if support for vulnerability is established and the relationship is actively attended to. Supervisors should be mindful of their availability to CITs and periodically check in to see if they are meeting the needs of the supervisee.

Supervisors who are aware of the themes developed from this research may be better equipped to capitalize on benefits and mitigate challenges. One benefit was that simultaneous supervision allowed participants to receive multiple synergistic perspectives regarding their work with clients. Depending on the developmental level of the supervisee and the demeanor of the supervisor, however, these multiple perspectives may present challenges. Supervisors can apply their knowledge of developmental models to tailor their interventions. Supervisors might anticipate that CITs earlier in development (e.g., in practicum) may require structured support in simultaneous supervision to avoid performance anxiety and frustration from rigid applications of multiple perspectives consistent with this stage (Stoltenberg & McNeill, 2010). Supervisors may also wish to focus supervision on interventions that actively facilitate development of these dispositions, such as employing constructivism to elicit greater cognitive flexibility (Bernard & Goodyear, 2019).

Some early-stage supervisees may experience challenges when navigating varying perspectives and feedback provided to them by multiple supervisors. Challenges can be mitigated when supervisors broach the topic of simultaneous supervision with supervisees early. Additionally, when supervisors ensure they respect other supervisors and create collaborative relationships, supervisee difficulty with simultaneous supervision may decrease. When a supervisor learns of a differing opinion of another supervisor, it is important that it is broached as a variance in approach rather than an incorrect practice. Supervisees experiencing difficulties with simultaneous supervision may also benefit from supervisors checking in with them regarding the variable feedback they are receiving. A collaborative supervisory system may strengthen supervisee development and integration of counseling constructs. Counseling programs can play a key role in setting systemic expectations for supervisors and supervisees.

Counselor Education Programs
     Accredited counselor education programs have autonomy in how they meet various CACREP (2015) supervision and clinical requirements. Programs may choose to require simultaneous supervision, may require multiple clinical sites, and may utilize faculty advising as supplementary clinical supervision. In unique situations such as students completing two tracks or receiving additional supervision for gatekeeping reasons, how programs manage simultaneous supervision can become complex. Best practice guidelines, policies, and procedures regarding simultaneous supervision can be made clear in clinical handbooks, with clinical coordinators, and in material for site supervisors. This would help to address the supervisee confusion from the programmatic side. Another important implication with simultaneous supervision is to consider the supervisory process through a systemic lens. When simultaneous supervision is utilized, there will be many interactions occurring outside of the dyad or triad apparent to one individual supervisor. When supervisors collaborate and communicate, supervisees may be more likely to receive congruent feedback, understand gatekeeping action, and receive consistent expectations. In particular, communication between academic and clinical supervisors can bridge the gap between idealism and practicality (Bernard & Goodyear, 2019; Choate & Granello, 2006). Programmatically mandated, semesterly site visits and opportunities for regular check-ins could fulfill this purpose.

Supervisees
     Participants often spoke to the challenge of organizing simultaneous supervision effectively in relation to feedback, documentation, and case presentation material. Although a certain level of organizational skill is expected of graduate students, the coordination required in simultaneous supervision often seemed unanticipated and unwieldy for students. Preparing for the supervision experience in another course and/or an orientation in lab supervision may aid in this. All participants discussed, at varying distress levels, how having supervision scheduled too close together (e.g., same day or two days in a row) increased repetitiveness and thus made simultaneous supervision feel less efficacious. Supervisees may want to intentionally schedule supervision sessions spaciously to avoid potential repetition or redundancy. With the steady increase in virtual supervision, scheduling supervision in ideal time frames may be easier with increased access and absent travel time. Programmatic preparation, intentional scheduling, and collaborative supervision notes may aid the simultaneous supervision process.

In the areas of core dispositions, CITs who embraced ambiguity and fostered reflexivity, curiosity, and flexibility tended to navigate simultaneous supervision with more ease. Reflexivity, curiosity, and tolerance for ambiguity seemed to strengthen the ability to receive feedback from multiple sources, integrate feedback appropriately, and maintain strong supervisory relationships. A typical guiding question from participants was, “How can I apply this combined feedback to my particular site and client while still maintaining my own clinical identity?” Necessarily, students will enter a program with differing levels of core strengths, yet any student can be encouraged to strengthen their core dispositions. Supervisees are encouraged to think about simultaneous supervision with the same organization and openness required for other courses such as pre-practicum and multicultural counseling. Correspondingly, supervisors have complex responsibilities maintaining ethical competent care, organizing supervision, and fostering these core dispositions.

Ethical Implications of Simultaneous Supervision
     In addition to recommendations for the three populations above, findings from this study highlight ethical considerations. Worthington et al. (2002) identified “intentional nondisclosure of important information” (p. 326) and “inappropriate methods of managing conflict with supervisors” (p. 329) as two major ethical issues that are unique to supervisees and correlate with some of the participant supervisees’ experiences of triangulating supervisors, seeking outside consultation to circumvent supervisors, or intentionally withholding information. To ensure client welfare, supervisors and supervisees may benefit from explicitly discussing ethical implications and considerations unique to this phenomenon at the outset of supervision and again when conflicts arise. Future research that addresses limitations of this study will further clarify the role of supervisors, supervisees, and programs in simultaneous supervision as well as specific ethical guidelines.

Limitations and Future Directions
     Limited information was gathered about the specific counselor education programs in which our participants were enrolled, restricting the inferences able to be made about simultaneous supervision in context. We also chose a convenience sampling method using CESNET and selected four participants. The choice of indirect sampling, primarily through counselor educators redirecting calls to their students, may have limited participants. Further, all participants of this study identified as the same gender and race, which limits the diversity of experience shared. Future researchers may consider sampling more participants to get a broader exploration of the phenomenon. In doing so, researchers may be able to obtain greater representation in gender and race to increase the transferability of this study.

This study focused on the phenomenon of simultaneous supervision as experienced within individual and triadic supervision. Simultaneous supervision is embedded within the broader experience of supervision, and isolating the phenomenon required vigilance by the researchers. Future researchers would benefit from intentional follow-up questions that better focus participants on simultaneous supervision rather than individual experiences with supervisors. As our study did not explicitly ask participants to distinguish between university-affiliated and site supervisors, future researchers may pursue a qualitative study that highlights the difference. Other research may utilize grounded theory to develop a model of simultaneous supervision for supervisors and supervisees to follow or focus explicitly on supervisors’ perspectives of simultaneous supervision. Quantitative research may illuminate the frequency and use of simultaneous supervision in counselor education programs overall or identify correlations between counselor dispositions such as tolerance for ambiguity and supervision outcomes in simultaneous supervision. Because of the lack of information regarding the phenomenon of simultaneous supervision, many opportunities for research regarding the phenomenon persist.

Conclusion

Overall, the findings from this research indicate CITs valued greater support and thrived when integrating “both/and thinking” in navigating feedback from multiple supervisors. This perspective reinforces the need for systemic communication among counselor educators and supervisors. Additionally, results suggest CITs would benefit from supervisors broaching the topic of simultaneous supervision early in their clinical experience.

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 B. Lane, Jr., PhD, NCC, BC-TMH, LPCC, is an assistant professor at Western New Mexico University. Timothy J. Hakenewerth, PhD, NCC, LPC, is an assistant professor at the University of Illinois Springfield. Camille D. Frank, PhD, NCC, LMHC, LPC, is an assistant professor at Eastern Washington University. Tessa B. Davis-Price, PhD, LMHC, LCPC, is an assistant professor at Saint Martin’s University. David M. Kleist, PhD, LCPC, is a professor and department chair at Idaho State University. Steven J. Moody, PhD, is a clinical professor at Adams State University. Correspondence may be addressed to William B. Lane, Jr., 1000 W College Ave, Silver City, NM 88061, william.lanejr@wnmu.edu.

 

Appendix

Interview Protocol

Interview Questions
Round 1
What has been your experience with having multiple simultaneous supervisors?

In your own experience, how has simultaneous supervision been a strength?

In your own experience, how has simultaneous supervision been challenging?

What have you learned about yourself and the counseling profession as you’ve experienced simultaneous supervision?

Round 2
How has having simultaneous supervision been different from times when you have only had one supervisor?

What has it been like to have your supervisors interact with each other in regard to the supervision that you have received from them?

What personal dispositions (characteristics/qualities) do you think you have that influenced your experience of simultaneous supervision?

How has simultaneous supervision impacted your experience of safety or vulnerability in supervision?

What practical considerations have you needed to consider for having multiple simultaneous supervisors?

 

A Phenomenological Exploration of Counselors-in-Training’s Experiences of Microaggressions from Clients

Corrine R. Sackett, Heather L. Mack, Jyotsana Sharma, Ryan M. Cook, Jardin Dogan-Dixon

Microaggressions can and do occur in the counseling process, yet there is a dearth of literature about how counselors-in-training (CITs) experience this phenomenon from clients or how they may respond to clients who perpetuate microaggressions against them in a therapeutic setting. Therefore, in this constructivist phenomenological study, we explored CITs’ experiences of microaggressions from clients in the counseling process. Two interviews with six participants of various marginalized identities revealed the following themes: (a) internal reactions, (b) attempts to contextualize, (c) prevalence of microaggressions, (d) navigating microaggressions, and (e) seeking support. Findings and implications for CITs and counselor educators and supervisors are discussed.

Keywords: microaggressions, constructivist phenomenology, counseling process, counselors-in-training, counselor educators

Microaggressions have been defined as intentional or unintentional ongoing verbal or nonverbal offensives experienced by individuals of a marginalized group (Ratts et al., 2016) and as “subtle and stunning” daily racial offenses that impact the health and well-being of individuals (Pierce, 1970). Counselors and counselors-in-training (CITs) of marginalized identities are often uncertain of whether or how to respond to microaggressions in counseling sessions while keeping the counseling relationship intact (Branco & Bayne, 2020). As such, counseling researchers have the opportunity and responsibility to explore the experiences of counselors or CITs who are the target of microaggressions from clients. Scholarship around this topic can help the counseling profession, and counselor education specifically, in developing competencies to help guide CITs and counselors in these situations.

Given the reality that there are clients from privileged groups receiving counseling from CITs from marginalized groups (Haskins et al., 2015; Ratts et al., 2016) and that the counseling process is an intersection of cultural identities between the client and CIT (Ratts et al., 2016), there is potential for microaggressions to occur in this relationship. Various studies have explored microaggressions within the counseling setting as experienced by clients who identify as racial/ethnic minorities (Constantine, 2007; Crawford, 2011; Morton, 2011; Owen et al., 2011, 2014); however, much less is known about counselors’ and CITs’ experiences with clients who may perpetuate microaggressions against them (Branco & Bayne, 2020). Given the dearth of literature focusing on how CITs can and do handle microaggressions from clients, we aimed to help fill this gap in the literature by exploring CITs’ experiences of microaggressions from clients.

In the 1970s, Harvard-trained Black psychiatrist Chester M. Pierce coined the term “microaggression” to describe the insults that he witnessed Black Americans encounter daily (Pierce, 1970). His work has been seminal in laying a foundation for understanding the damage that negative interracial interactions have on Black Americans’ health. Decades later, Sue and colleagues (2007) continued Pierce’s research on microaggressions and expanded its definition to include experiences of cultural bias, prejudice, and power imbalance. Literature about microaggressions in the counseling profession highlights the negative impact of counselors being the offender, or the person who perpetuates microaggressions, toward a racially/ethnically marginalized client in session (Constantine, 2007; Owen et al., 2011).

Although racial microaggressions toward racially/ethnically marginalized people have been studied extensively, microaggressions can also target gender, sexual orientation, ability status, class, religion, and other visible and invisible identities (Chan et al., 2018). The consequences of microaggressions on the counselor–client relationship have been studied in the context of gender (Owen et al., 2010) and sexual orientation (Shelton & Delgado-Romero, 2013). As such, there is a need for more research to explore microaggressions as a phenomenon that affects various identities. When individuals identify with multiple salient identities, they are more likely to experience privilege and oppression. For instance, a person can experience White privilege while simultaneously experiencing marginalization from identifying as queer—this person can belong to both oppressive and oppressed groups. Because one identity can be stigmatized while another is privileged, there is complexity in understanding one’s whole identity rather than only its parts. The Multicultural and Social Justice Counseling Competencies (MSJCC) include a quadrant to represent a privileged client and a marginalized counselor (Ratts et al., 2016) that can be used to conceptualize the dynamic of microaggressions experienced by counselors from clients. It is possible, of course, for counselors and clients to identify with being in more than one quadrant simultaneously as members of both privileged and marginalized groups. Further, the intersectionality of race, gender, sexual orientation, and other identities may increase the frequency and impact of microaggressions (Williams et al., 2021). Microaggressions toward intersecting marginalized identities compound their harmful impact (Nadal et al., 2015).

Oppression on an individual level in the form of microaggressions, regardless of whether they are intentional or unintentional, can have a devastating impact on individuals’ physical and mental health (Pierce, 1970; Ratts et al., 2016). Depression, anxiety, and post-traumatic stress have been reported by researchers as being associated with microaggressions (Williams et al., 2021). Thus, it is feasible that CITs would experience these same mental and physical reactions to microaggressions within the counseling relationship (Branco & Bayne, 2020), which in turn seems likely to influence their work with current and future clients.

Purpose of the Study
     Branco and Bayne (2020) asserted that counselor educators are called to provide training for counselors from marginalized identities to work with clients from privileged identities, and the counselor education field is lacking in this area. Because the cultural experiences and backgrounds of clients and counselors impact the counseling relationship (Constantine, 2007; Crawford, 2011; Morton, 2011; Owen et al., 2011, 2014), counseling process, treatment selection, and outcomes, it is critical that counseling researchers expand inquiry in this area (Hays, 2020). Specifically, counseling researchers need to inquire more about counselors’ experiences with social injustice and how those affect the counseling process. As established, the MSJCC framework allows for counselors and clients from many intersecting privileged and marginalized identities (Ratts et al., 2016). Although previous studies have focused exclusively on racial microaggressions from clients, Branco and Bayne (2020) called for a broader examination to include counselors or CITs who identify with a marginalized status outside of race and ethnicity. As such, the purpose of the current study was to explore CITs’ experiences of microaggressions from clients, regardless of the one or more marginalized identities they carried, through van Manen’s (2016) constructivist hermeneutic phenomenological approach. This is a reflective process focused on the lived experiences of participants. By specifically focusing on CITs’ experiences of microaggressions from clients, we gain insight into how to better provide supervision and training in this area. Thus, the research question that guided this investigation was: “What are CITs’ experiences of microaggressions from clients in the counseling process?”

Method

Research Design Overview
     We chose van Manen’s (2016) constructivist hermeneutic phenomenological approach for this inquiry of CITs’ experiences of microaggressions from clients, as it aims to increase thoughtfulness, grasp essential meaning, and come into closer contact with the world while providing thought-provoking data that are ideal for clinical practice (Sackett & Cook, 2021). van Manen described hermeneutic phenomenological research as choosing a phenomenon of serious interest, investigating the lived experience of the phenomenon, reflecting on its essential themes, describing the phenomenon through writing and rewriting, remaining in pedagogical relationship, and balancing the parts of the whole of the research.

Researcher Reflexivity
     Following van Manen’s (2016) advisement that researchers be aware of and transparent about their own experience of the phenomenon under investigation and the influence of their own values, beliefs, and experiences, we describe our positionality here for transparency. At the time of the study, authors Corrine R. Sackett, Jyotsana Sharma, and Ryan M. Cook were faculty members in counselor education programs at research universities—Sackett was an associate professor and Sharma and Cook were assistant professors. Heather L. Mack and Jardin Dogan-Dixon were graduates of a CACREP-accredited program specializing in clinical mental health counseling; Mack was practicing in agency and private practice settings and Dogan-Dixon was a correctional psychologist. Sackett, Mack, Sharma, and Dogan-Dixon identify as heterosexual and cisgender women, and Cook as a heterosexual and cisgender man. Sackett, Mack, and Cook identify as White, Sharma identifies as Asian Indian and international, and Dogan-Dixon identifies as Black and from a Christian background.

Sackett was drawn to this line of inquiry after a supervision session in which a supervisee disclosed a microaggression from a client related to gender. The supervisee’s site supervisor (a male counselor) was in the session as a co-counselor. Following the session, the CIT and site supervisor processed the event. Although the site supervisor was supportive, he advised the CIT not to address the microaggression with the client because it was not related to the client’s counseling goals. The CIT described feeling dismissed by her site supervisor’s response. She also described uncertainty in how to continue a meaningful counseling relationship with the client afterward without addressing the microaggression. This experience led Sackett to seek guidance from the literature on CITs’ or counselors’ handling of microaggressions from clients, but she found limited scholarly resources. Sackett was influenced by this experience in her conceptualization of the current study, and in analyzing and writing the findings. Further, while recognizing her privileged identities, Sackett has experienced gender microaggressions that have impacted her and the way she views this topic area. Mack, while also recognizing her privileged identities, has experienced gender microaggressions from clients and a site supervisor. Sharma identifies as an international scholar of Asian Indian descent. As an international woman of color, Sharma has experienced many microaggressions since moving to the United States. She has experienced microaggressions from clients, colleagues, and supervisors. Cook has wondered how supportive or unintentionally unsupportive he has been as a supervisor and faculty member with CITs’ experiences of microaggressions. Dogan-Dixon has experienced gendered racial microaggressions from clients, peers, and supervisors in various counseling settings across her training. She initially struggled to address microaggressions in the moment because of potential rejection and backlash; with practice, however, she has learned to address microaggressions in multiple ways, including caring confrontation. She now educates others on how to navigate microaggressions in personal and professional settings. In harnessing the interpretive nature of van Manen’s (2016) approach, instead of bracketing these biases, we embraced them as part of the process (Prosek & Gibson, 2021).

Participants
     Participants included six CITs from CACREP-accredited counselor education programs in the United States. Sampling was purposive for the phenomenon under investigation (Prosek & Gibson, 2021), and all participants met the eligibility criteria of being enrolled in a CACREP-accredited master’s program with a specialty in clinical mental health or school counseling, being enrolled in or completed practicum or internship in their program, and having lived experience of microaggressions from clients in the counseling process. Constructivist qualitative studies tend to have smaller sample sizes that allow for more depth of understanding and intriguing findings (Boddy, 2016). Though we recruited from across the United States, our resulting sample consisted of participants from the Southern region of counselor education programs. Participant ages ranged from 26–30 years. Self-named gender identity included one female, two cisgender female, two cisgender male, and one participant who did not specify gender. Self-named sexual orientation included one straight, one lesbian, two bisexual, and two who did not specify. Participants self-identified their racial/ethnic identities as Hispanic (one), Hispanic/Latina (one), Black/Afro Latino (one), Caucasian (one), and White (two). Those who answered the question of other relevant identities named student or partnership status. Participants were entered into a drawing for one of three $15 Starbucks gift cards after completion of the second interview as a token of appreciation for their time.

Participant Recruitment
     Sackett obtained human subjects research approval from her university of employment’s IRB. Sackett then recruited participants by sending two rounds of emails explaining the purpose of the study to contacts from 387 CACREP-accredited master’s programs in the United States with specialty areas in clinical mental health and school counseling. The email requested the faculty member send the recruitment email with the purpose of the study and a note about what participation entailed to their master’s students who were currently enrolled in, or had completed, practicum or internship in their program. Inclusion criteria included the experience of a microaggression from a client, regardless of marginalized identity(ies) of the CIT. The email asked CITs to contact Sackett if interested in participation. When participants contacted Sackett, she completed the informed consent process and referred them to Mack to schedule the first interview. Ten individuals contacted Sackett with interest in participating in the study. However, four of the initial 10 individuals reported not having experiences of microaggressions to share after hearing the definition of a microaggression from Mack (see Data Collection below).

Data Collection
     Mack conducted two interviews over Zoom with each participant. Two interviews per participant allowed for sustained engagement with the phenomenon, and interviews were spaced from 1 to 3 weeks apart per participant to allow time for reflection between the interviews. This resulted in 12 interviews. Each participant answered demographic questions during the first interview that requested gender, age, race/ethnicity, any other relevant identities, and pseudonym. To begin each interview, Mack broached her identities with participants (Day-Vines et al., 2007) and verbally gave participants a definition of microaggressions as intentional or unintentional ongoing verbal or nonverbal offensives experienced by individuals of a marginalized group (Ratts et al., 2016). Interview questions were centered on CITs’ experiences of microaggressions from clients, in line with van Manen’s (2016) recommendation that the interview be strongly oriented to the phenomenon. Interview questions were developed by Sackett, Mack, and Sharma and were informed by extant literature of counselors’ experiences of microaggressions from clients (e.g., Branco & Bayne, 2020), multicultural counseling competencies (e.g., Ratts et al., 2016), and CITs’ prioritization of information for supervision (e.g., Cook & Welfare, 2018), coupled with the authors’ respective expertise and perspectives. Researchers used the same interview protocol for both interviews, which can be found in the Appendix. While being mindful of the differences between counseling and interviewing (Sackett & Lawson, 2016), Mack utilized counseling skills to facilitate discussion and to communicate empathy (Kleist, 2017). Interviews ranged in length from 24 to 62 minutes (M = 46.1; SD = 11.82), except for Lila’s second interview of only approximately 5 minutes, as she indicated she had nothing to add from the previous interview. Interviews were audio-recorded and later transcribed by a graduate assistant.

Analysis
     We used NVivo Version 12 (QSR, 2018) software to manage the data. Operating from van Manen’s (2016) approach, we were concerned with capturing the essential meaning of the phenomenon, which involved seeing the essential meaning of each participant’s experience, reaching a reflective determination, and explaining the experience. In this process, we gave order to the research and writing by considering the phenomenon in themes. Along with van Manen’s hermeneutic phenomenological approach, we employed the First and Second Cycle coding process described by Miles et al. (2020). After listening to all participant interviews, Sackett reviewed the 12 interview transcripts while utilizing a line-by-line approach to coding (van Manen, 2016). She applied in vivo codes in her first review and then went back through the data to apply a combination of descriptive codes, process codes, emotion codes, and value codes in the First Cycle coding (Miles et al., 2020). This allowed for a way to summarize segments of data. Next, Sackett applied Second Cycle coding, or pattern coding, to group the initial codes into themes. van Manen described this theme development as giving shape to the shapeless in the data.

We followed van Manen’s (2016) recommendation that for deeper understanding, a peer may read a draft of the description of the phenomenon and share their insights of whether the description resonates with their own experience of the participants’ descriptions. As such, Mack, who had conducted the interviews, and Sharma, who listened to the recordings of the interviews, read the steps of First and Second Cycle coding Sackett employed and shared their insights of how the description of the findings reflected their experience of the participants’ accounts. Through this iterative process, we were able to examine, reinterpret, and reformulate themes while keeping in mind van Manen’s guiding question for this process of whether the phenomenon would still be the same if we were to change or delete any theme. We followed van Manen’s advisement to be mindful to capture individual experiential differences in our data analysis and writing process of the phenomenon. In this study, that meant considering the unique identities of each participant, including intersecting identities and how those may impact their experience of microaggressions from clients. We chose to structure our writing of the phenomenon thematically, one of van Manen’s suggestions for organizing the portrayal of the data. There is some overlap in the nuances of the meanings of the themes, as describing a phenomenon is bound to have a somewhat forced quality.

Methodological Integrity
     As suggested by van Manen (2016), the researchers engaged with each other throughout the entire process of data collection and analysis in a collaborative way that led to deeper understanding of the phenomenon. This process strengthened our engagement with the phenomenon and transcended the limits of having a sole researcher. In doing this, we had regular phone calls, video meetings, and emails throughout the study. Sackett kept a reflective journal while listening to the interviews and conducting analysis. Further, we kept a log of each step in the process, including interview data, codes, and theme development, to show the culmination of our interpretation of the findings. Finally, we conducted two member checks through email with each participant. Member checks allowed participants to reflect on the transcripts of the interviews for further insight and to review the themes and allow for feedback on if it was an accurate description of what the experience is like (van Manen, 2016). Therefore, we conducted member checks after interviews were transcribed and after theme development. In the second member check, we invited participants into dialogue around whether the themes reflected their experience of the phenomenon.

Findings

Five themes emerged from our exploration of CITs’ experiences of microaggressions from clients in the counseling process: (a) internal reactions, (b) attempts to contextualize, (c) prevalence of microaggressions, (d) navigating microaggressions, and (e) seeking support. The first theme, internal reactions, had three subthemes: caught off guard, discomfort, and imposter phenomenon. The fourth theme, navigating microaggressions, had five subthemes: fear of responding genuinely, letting it go, attempting to redirect, directly responding, and avoiding. The final theme, seeking support, had three subthemes: site, university, and family and peers. Pseudonyms chosen by the participants are used throughout the Findings section to maintain participants’ confidentiality.

Internal Reactions
     The first theme, internal reactions, embodies what was happening internally with CITs as they experienced microaggressions in the counseling process. This theme includes subthemes centered around being caught off guard, feeling discomfort, and experiencing imposter phenomenon.

Caught Off Guard
     The first subtheme of internal reactions CITs experienced, caught off guard, describes the initial reaction from the microaggression and not being sure how to react outwardly. David cautiously described his reaction to a parent in a school counseling setting as “mostly just confusion and not really being sure how to respond in that particular situation to what the parent had said.” Wesley, on the other hand, also in a school counseling setting, carefully described trying to manage being caught off guard with how he responded nonverbally in the moment:

I put on my poker face. Nonverbally, eyes kind of narrow, brows furrow. . . . [if] they catch me off guard, like one eyebrow goes up. But because . . . of the mask [from the pandemic], they can’t really read my facial expression, they can only see my eyes.

Discomfort
     CITs also conveyed feeling discomfort in their internal reactions to microaggressions, including anxiety, fear, hurt, sadness, and anger. Lila solemnly described her surprise and discomfort with a client making assumptions of her based on ethnicity as “not ashamed, but saddened that she made that difference between us. I didn’t think she would have done that.”

Imposter Phenomenon
     The third subtheme that resonated with CITs’ experiences in terms of internal reactions was imposter phenomenon. CITs often felt microaggressions from clients made them question their competency and even confirmed doubts they already had in the counselor role, as David thoughtfully articulated:

I think this goes back a little bit to the imposter syndrome that a lot of interns feel, and that I know that I’ve certainly felt. It’s like someone seeing me for who I am and confirming all the different feelings that I have about myself. About maybe not being fully capable in the role yet. . . . very much like, “oh you’re seeing me for who I am” and feeling . . . “I agree with you. You’re seeing how I see myself in some situations.”

Attempts to Contextualize
     The next theme, attempts to contextualize, captures CITs’ tendency and desire to try to make sense of the client microaggression and to understand where the client was coming from and why they may have felt that way or may have said those things. For instance, Lila rationalized—while not excusing the microaggression from her client—“I guess the moment when she said that she was ill, and she was going through a lot of issues. So, I kind of understand her, but I don’t think there was a need of saying stuff like that.” Riley came from the perspective that it is part of a counselor’s role to seek to understand the microaggression:

I see where individuals come from and . . . my job will be to understand the perspective of the other individual . . . and show that type of unconditional positive regard and that unconditional empathy toward them. And kind of look at things from their view. I try not to take things . . . too hard. Because it was just the way they were raised.

Prevalence of Microaggressions
     The next theme encompasses CITs’ perspectives that microaggressions are part of their lives and ongoing experiences, and in some cases they described feeling a bit numb or resigned to microaggressions. Riley said that she “didn’t feel anything. I was just like, ‘here this guy goes again.’ I wasn’t frustrated because I didn’t feel my face getting hot. . . . Typically when I get frustrated, my ears start to burn.”

Wesley underscored the prevalence of these experiences in his world, too: “At this point, nothing really surprises me. Maybe it’s me putting on a pair of rose-colored glasses and just using the glass to filter through whatever microaggressions come at me at this point.” He expressed feeling like he had experienced enough microaggressions to “kind of become numb to it. . . . it happens, and you don’t even pay it any mind, especially living in the South.”

Navigating Microaggressions
     The next theme speaks to how CITs navigated, or thought about navigating, the microaggressions with clients. These responses ranged broadly from fear of responding genuinely to letting it go, attempting to redirect, directly responding, or avoiding.

Fear of Responding Genuinely
     The first subtheme captures the participants’ fear of responding genuinely to clients, even when in some cases they would have liked to. Some of this fear centered on participants’ awareness that they may be playing into stereotypes held by clients if they were to respond genuinely, as Riley richly articulated:

That really bothers me . . . I tend to find myself taking a moment to myself, and I’ll be like, “okay, you’re good” . . . “that’s okay. It’s just one thing that one person told you and maybe they were having a bad day.” So, I try to be as understanding as I can.

Riley expressed that society and the media often portray Latina women as “feisty” or “spicy,” and that she does not want to “give [someone] that satisfaction” of confirming the stereotype: “I’m not like that, you know? I’m not spicy. I’m not a food.”

Other CITs described fear of the vulnerability involved with responding genuinely to a client’s microaggression. For example, Blake explained her genuine response and surrounding fear:

And I did disclose to the client that I’m bisexual. I said, “Oh I’m, I’m bi.” But I had that like, even knowing that the client was part of LGBTQ community, I had that question of like, “Why is the client asking? Is this appropriate? What should I say? What do I do?”

Letting It Go
     CITs described often letting microaggressions go for the sake of the client, the counseling, and the counseling relationship. Connecting back to the theme of attempting to contextualize the microaggression, Riley felt it was her responsibility to let it go, “because they’re [microaggressions] from clients, I understand the role as . . . as a student counselor, that I have to kind of push it aside, and bracket those feelings.” Wesley was earnest in his feeling that microaggressions from students’ parents should not get in the way of his work as a school CIT:

Yeah it’s going to take the focus off of the kid. And it’s going to make things awkward. So I’m all for teaching people, but there’s a . . . moment in time when it’s appropriate. And at this point . . . I’m just trying to get through what we’re doing so we can move on to the next parent. No . . . hard feelings, I’m not upset. I’m a little disappointed, but I’m not livid . . . let’s just move on.

Attempting to Redirect
     Some CITs chose to navigate the microaggression by redirecting it back to the client or to another topic without directly addressing the microaggression. For instance, Riley spoke to her efforts to connect these incidents back to clients indirectly: “Even if it’s something said toward us, we try to find a window . . . or different backdoor type of thing to redirect whatever they are saying back to them.”

Directly Responding
     There were times in the CITs’ experiences of microaggressions in counseling where there was a direct response, either by themselves, a part of the client system, or their site supervisors. CITs seemed to view these instances as reparative in the rift the microaggression created in the therapeutic relationship. For example, Wesley fondly recalled a time when a student apologized for his parent’s microaggression after the fact:

They felt that I was uncomfortable, and they felt the need to try and repair it by apologizing for their parents. So it was very validating to me as a person. And to me as a Black person, because the kid realize what their parents had [done] was out of pocket . . . I’m assuming the kid didn’t want our relationship to suffer. . . . So we talked about it. “Look it’s cool it happened, you and I are still good,” and we moved on.

In a different vein, Blake said that responding directly to a youth client questioning her sexual identity in a public area of the practice helped build trust with the client:

[If] I had hesitated, or if I had said, “oh, no, like I’m not like [that],” I think you know, I think people are perceptive and I think that would have damaged [the relationship]. Even if I’m not sure that the disclosure was an additive piece to the relationship, I think that not being forthcoming would have detracted from anything in that moment.

Avoiding
     Finally, within the theme of navigating clients’ microaggressions, participants reported engaging in avoidance afterward in response. This avoidance included instances when the CIT dreaded contact with the client (or the client system) and limited contact when possible. Avoidance also showed up on behalf of the client by discontinuing work with the CIT in individual or group settings. M relayed that her site found a way to separate her and the client who microaggressed against her: “They even said . . . ‘We’re going to not put her in groups with you . . . it’s just not safe for either of you guys.’” Wesley, a school counseling CIT, somberly described parents trying to avoid him after microaggressing against him: “I’ve had a few [parents] request a different . . . counselor when they come in, because they may feel like they soured their relationship with me already. These are the parents . . . who have noticed that they . . . micro-assaulted me.”

Seeking Support
     The final theme, seeking support, captures participants’ experiences (or lack thereof) of seeking and finding support from their sites, university supervisors and faculty, and family and peers.

Site
     CITs often found support at their sites after experiencing microaggressions from clients. This was frequently seemingly because of physical proximity. Often CITs’ site supervisors or other counselors at the site may have witnessed the microaggression or CITs were able to debrief with someone nearby after it happened. David indicated having a quick but meaningful moment of support with his site supervisor before moving on to their next meeting. He recalled that “after the meeting my supervisor and I just kind of like gave each other a look like, ‘ooh that was kind of a strange meeting.’” M was able to debrief with her site supervisor regularly following repeated microaggressions from her client and found her guidance helpful and supportive, especially in the realm of not taking things personally. M said her supervisor encouraged her to “process it on my own, to make sure that it’s not affecting me . . . to where I can’t even use my counseling skills. Like she didn’t want me to go home at night thinking that a patient hates me.”

University
     For the most part, CITs described either not taking these instances of microaggressions to university supervisors or faculty or facing unsupportive responses when they did. Blake relayed feeling shut down by a faculty member’s humor in a class discussion when she brought up how she handled a microaggression with self-disclosure:

Yeah it was a moment of . . . playful questioning of like, “Oh, that’s the decision you made?” That kind of has that implication that maybe it wasn’t the best decision without having more context, right? And I know . . . that [humor is] kind of his approach. But it was a moment, where I was . . . like, “well I don’t really feel like going further with this.”

In some cases, CITs did find helpful and supportive responses from their faculty. Riley described her professor normalizing her experience and giving her what she found to be helpful advice:

[He] told me, “Sometimes we get things like that,” and that’s when he gave me that advice of trying to redirect the question or redirect it back to the client, versus falling into the trap. Well, he called it a trap. Into that little trap they could be setting for us.

Many participants described feeling as though the microaggression was handled by themselves, at their sites, or through processing with family; thus, they felt no need to bring it up in university supervision.

Family and Peers
     CITs frequently described seeking out their families, friends, and peers for support after experiencing a microaggression from a client. Lila processed her experience with her husband, who gave her advice to have more boundaries with her client and “to keep it more professional. . . . I would sometimes disclose about my personal life because she would ask. So I just stopped disclosing.” Riley expressed feeling the need to vent to friends about her experience, “like ‘What the hell was this lady thinking like telling me that?’ . . . just letting it out.”

Wesley sought support from his mother and grandmother in processing microaggressions perpetuated by students’ parents in his school counseling role. He relayed their supportive response:

It was more of a, “These things can happen, you handle it appropriately.” . . . they have had experiences with microaggressions themselves. [They] may not have known what to call them but have experienced it. And pretty much just applauded me for staying neutral, not punishing the kid for what their parents said, and not completely blasting the parent in the meeting because . . . of a joke they let out.

Discussion

In the current study, we explored six CITs’ experiences of microaggressions perpetuated by their clients in counseling settings. The findings from this study provide insight into how novice counselors experience microaggressions from their clients and choose to handle it. We hope these findings enrich the understanding of client-based microaggressions and offer important implications for CITs, counselor educators, and supervisors.

The first theme, internal reactions, reflected the ways in which participants internally processed the microaggression from their client, which is consistent with prior literature of counselors of color’s experiences with microaggressions from clients (Branco & Bayne, 2020). Interestingly, the CITs in the current study described being caught off guard—feeling confused and uncertain with how to respond—while the more seasoned counselors of color in Branco and Bayne’s (2020) study described buffering and bracing for the microaggression, as if they were prepared for it. Counselors in Branco and Bayne’s study (2020) described their readiness for microaggressions from clients was informed by their prior and extensive personal and professional experiences. Although the CITs may have experienced microaggressions in their personal lives and were used to them, as evidenced by the theme of prevalence of microaggressions, their being caught off guard may be attributable to their lack of counseling experience, and more specifically, having never experienced microaggressions from clients and having not yet learned how to navigate this issue.

The CITs further described how microaggressions from clients caused feelings of hurt, fear, anger, sadness (subtheme of discomfort), and experiences of imposter phenomenon. CITs commonly experience confusion, doubt, and worry about their own professional competencies and preparedness as counselors—sometimes internalizing issues in counseling as their own failures (Loganbill et al., 1982; McNeil & Stoltenberg, 2016). Ultimately, CITs in this study also tried to understand the microaggression from their clients’ perspectives. CITs seemed to understand that people inherit their biases from their families and ancestors and reinforce them through microaggressions, oftentimes unintentionally (Williams et al., 2021). Counselors of color in Branco and Bayne’s (2020) study expressed that they tried to make sense of the microaggression as well, and considered their clients’ worldview, racial identity development, and experiences as they evaluated how they would handle the microaggression. The degree to which CITs can consider the clients’ worldview and cultural identity development may depend on their level of professional development (McNeil & Stoltenberg, 2016) and their own identity development (Day-Vines et al., 2007; Jones et al., 2019).

The CITs in the current study described microaggressions as an ongoing part of their lives, as captured in the theme of prevalence of microaggressions. Microaggressions have been referred to as everyday racism, as they are routine and chronic for individuals of racially and ethnically marginalized populations (Williams et al., 2021). This finding is consistent with prior literature of racial microaggressions (Branco & Bayne, 2020; Haskins et al., 2015, Pierce, 1970). Our findings also extend the knowledge base about microaggressions from clients, as microaggressions can target not only race and ethnicity, but also gender, sexual orientation, age, socioeconomic class, and religion. This finding is not unexpected; as informed by the MSJCC (Ratts et al., 2016), counselors and clients possess multiple identities, both privileged and marginalized, and visible and invisible.

The CITs in this study employed a variety of strategies in navigating microaggressions from their clients. Many CITs felt discomfort in the moment, but they were fearful of responding with their genuine reactions for various reasons. Some CITs tried to redirect the microaggressive client by concentrating on the client’s presenting issue or by taking the focus of the conversation elsewhere. Some CITs directly addressed perpetrators’ microaggressions and expressed that this action helped the relationship, while others decided to forgo addressing the microaggressions altogether. In some situations, clients and CITs attempted to avoid each other following the microaggressive incident. These varying responses are not unlike those found in prior research (Branco & Bayne, 2020). A unique contribution to this study is that our participants even experienced microaggressions from clients’ parents, reflecting a larger system that may foster and perpetuate biased opinions and perspectives toward individuals with marginalized identities. When counseling children, parents play an important role in the counseling relationship, despite not being the identified client (Sackett & Cook, 2021).

The final theme, seeking support, reflected the participants’ willingness and desire to seek support for their experiences of microaggression and from whom the support was sought. CITs must decide whether to disclose an issue experienced in counseling, including microaggressions (Branco & Bayne, 2020), and with whom they trust to share this information (Cook & Welfare, 2018; Cook et al., 2019). Some counselors in Branco and Bayne’s (2020) study spoke of seeking support (i.e., coworker, friend), while others did not and chose to process the event independently. The response of the CITs in our study was also somewhat mixed in this regard, as some CITs sought guidance from professionals at their site or, less often, from university faculty or supervisors, while others sought support from individuals in their personal lives. Given that our participants were trainees, it is not unexpected that they would seek guidance from someone more experienced, like a supervisor (McNeil & Stoltenberg, 2016), though interestingly many CITs did not choose to bring these situations to a university supervisor or faculty member. Further, the participants’ satisfaction with the support that they received, especially from their university, varied greatly. Although some participants felt validated, others felt unsupported. It remains to be seen how the response of the supervisors might inform participants’ actions in the future, although Cook et al. (2019) found that CITs who disclosed a salient concern to their supervisors and felt unsupported may be less willing or unwilling to bring up similar issues in the future with the same supervisor.

The finding that CITs in this study were discussing the microaggressions with family and peers must be carefully considered, even though this finding is not entirely unexpected. Ladany et al. (1996) found that CITs commonly discussed issues withheld from their supervisors with peers and friends, although these people were most often also in the mental health field. Further, studies have found that counselors with marginalized identities value the support of others with shared identities (Branco & Bayne, 2020; Haskins et al., 2015). However, like other scholars (Ladany et al., 1996), we wonder how a CIT’s professional development or client’s care might be impacted by heeding the advice of or seeking support from someone who does not possess the necessary training or is bound to the same ethical and professional mandates as a clinical supervisor or infield peer.

Limitations
     There are limitations to this study that are important to note. Although researchers recruited participants from CACREP-accredited programs from across the United States, the resulting sample consisted of only those from the Southern region. CITs’ experiences with microaggressions in this region may be different from those in other parts of the country. Next, we did not explicitly ask about participants’ targeted identities; this information was inferred from participants’ experiences. Although a plethora of existing research focuses on racial microaggressions, we acknowledge that our participants also spoke about other marginalized identities that were salient to them. Additionally, although our sample size was congruent with the constructivist philosophical stance and scope of the study (Boddy, 2016), the sample was relatively small. Counselor educators should consider the transferability to CITs with marginalized identities working with clients of privileged identities. Finally, given van Manen’s (2016) recommendation for an interpretive conversation with participants around the identified themes, scheduling a verbal conversation with each participant for the second member check may have allowed for more input from participants on the findings.

Implications for CITs, Counselor Educators, and Supervisors
     Readers will need to determine, along with the researchers’ description, the naturalistic generalizability of these study findings to their contexts (Hays & McKibben, 2021). However, the findings from this study offer several notable implications for CITs. As with the participants in this study, CITs experiencing uncertainty with how to respond to microaggressions from clients should be expected, given that microaggressions can be difficult to identify and rectify because of their nebulous nature (Williams et al., 2021) and given the lack of training CITs receive on how to navigate these complex issues (Haskins et al., 2015). Further, learning how to best attend to cultural issues in the counseling relationship is a learned skill (Ratts et al., 2016) that is gained through curiosity, intentional learning, lived experience, and continued professional development (McNeil & Stoltenberg, 2016). As evidenced by findings from this study, as well as other studies (e.g., Branco & Bayne, 2020), counselors choose to respond to microaggressions from their clients in a multitude of ways, including offering no response at all. How best to respond to microaggressions is ultimately the choice of the CITs themselves, including the degree to which they discuss their experience and with whom. For example, CITs must consider their position of power in the counselor role, the impact of any decision on the counseling relationship, the intentionality of clients’ microaggressions, and their own emotional well-being
(Pierce, 1970). Given the complexity of this decision, there may be some useful strategies to help inform CITs’ decisions in how to best respond (Hernández et al., 2010; Nadal, 2011).

CITs may find it helpful to broach cultural identities with their clients at the beginning of their working relationship (Day-Vines et al., 2007). By inviting and normalizing conversations of cultural differences, it may make it easier for both parties to openly discuss microaggressions when they occur. CITs may also find it helpful to model humility in the counseling relationship by correcting their own assumptions about clients (Marbley, 2004). Broaching is a skill and a form of immediacy, or processing the here and now of the counseling relationship, which has been found meaningful in the counseling relationship and the counseling process to clients (Sackett & Lawson, 2016; Sackett et al., 2012) and CITs (Sackett et al., 2012). We believe CITs can harness the skill of immediacy (i.e., broaching) to address microaggressions with clients when they occur in counseling. But first, they need to be taught skills to disarm and dismantle microaggressions to reduce the harm and distress they may cause (Sue et al., 2019). Although the onus is not on CITs who experience microaggressions to always address them in the moment, developing a clinical skillset to educate clients on how to recognize their biases, challenge erroneous beliefs that undergird microaggressions, and develop empathy with those they have harmed is important to mitigating the risk of burnout among CITs with marginalized identities (Williams, 2020).

The findings from this study also offer important implications for counselor educators and supervisors. Fickling et al. (2019) contended that the MSJCC framework (Ratts et al., 2016) should be explicitly integrated into clinical supervision. These findings might also provide a rationale for counselor educators to consider how to infuse the MSJCC framework into their classrooms to better prepare students for microaggressions from clients. Specifically, counselor educators and supervisors can examine with CITs how a counselor holding a marginalized identity can engage with a client holding a privileged identity in a counseling relationship, including discussing or role-playing various scenarios and ways to manage microaggressions from clients (Branco & Bayne, 2020). Encouraging counselor self-care strategies (Sue et al., 2019) in processing these scenarios is critical.

Haskins and colleagues (2015) found that counselor educators acknowledged their curriculum was tailored for White students to work with White clients, even if unintentionally. Counselor education program faculty may apply critical race theory tenets to their curriculum to challenge the dominant White discourse in counselor education, as advised by Haskins and Singh (2015). Our findings highlight the value of training related to CITs’ other marginalized identities as well (e.g., gender, sexual orientation, religion, first language) when working with clients of various privileged and/or visible identities, a need identified by Branco and Bayne (2020). The absence of education on navigating microaggressions may lay the foundation for marginalized students to feel as though their experiences are misunderstood or unwelcomed by faculty or supervisors. The current study provides counselor educators and supervisors with information from CITs on how they experience the counseling process when the dynamics of clients with privileged identities and counselors with marginalized identities are present and political (Ratts et al., 2016). Our study findings fill a gap in the literature of the experiences of CITs who encounter clients who offend and perpetuate microaggressions against them while in session.

Because CITs and supervisees control what they share in supervision, fostering an environment that promotes supervisee disclosure is critical (Cook & Welfare, 2018). Studies of intentional nondisclosure (i.e., supervisees’ purposeful withholding of salient information in supervision; Cook & Welfare, 2018; Ladany et al., 1996) found that supervisors can best mitigate supervisees withholding information by attending to the supervisory relationship and demonstrating cultural humility (Cook & Welfare, 2018; Cook et al., 2020). When a CIT voices concerns related to their identities (i.e., a microaggression), counselor educators and supervisors have an opportunity to support such disclosure in a way that validates the CIT’s experience and encourages future disclosures (Cook et al., 2019). Jones et al. (2019) provided situational examples and related response prompts to guide counselor educators and supervisors on ways to broach cultural differences with their supervisees at the beginning of the supervisory relationship and appropriately attend to cultural issues throughout the relationship. Further, as multicultural competence is positively correlated to a stronger supervisory relationship from the supervisees’ perspective (Fickling et al., 2019), supervisors who work to incorporate the MSJCC framework into their supervision will benefit in their supervisory relationships, hopefully leading to increased disclosure of experienced microaggressions, and provision of appropriate support in navigating the CIT–client relationship.

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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Appendix
Interview Protocol

Tell me about your experience(s) where a client said something that felt like a microaggression toward you.

  • What feelings came to you when you experienced the microaggression from your client?
  • What thoughts came to you?
  • How did you respond (verbally and/or nonverbally)?
  • How did the client respond to your response?
  • What occurred then?
  • How do you feel this impacted your relationship with the client?

Did you process this experience with anyone? With whom did you share about this experience (peers, supervisors, faculty, friends, family, etc.)?

If you processed this with your supervisor(s), was this a doctoral student supervisor, faculty supervisor, or site supervisor?

  • How did your supervisor(s) respond?
  • How did your supervisor(s) encourage you to respond?
  • How did you feel about that response from your supervisor(s)?
  • How did you proceed after the feedback from your supervisor(s)?

If any further action was taken with your client following supervision:

  • How did your client respond?
  • How do you feel about how it went?
  • How do you feel this impacted your relationship with the client?

Did you seek [additional] supervision following [remedial] interactions you may have had with your client?

  • From whom?
  • What was the feedback from your supervisor(s)?

How do you feel this entire experience impacted your relationship with your supervisor(s)?

Any other experiences?

Corrine R. Sackett, PhD, LMFT, is an associate professor at Clemson University. Heather L. Mack, LPC, works for The Well Center in South Carolina. Jyotsana Sharma, PhD, ACS, LCMHC(NH), is an assistant professor at Oklahoma State University. Ryan M. Cook, PhD, LPC, ACS, is an associate professor at the University of Alabama. Jardin Dogan-Dixon, PhD, is a Correctional Psychologist for the Federal Bureau of Prisons. Correspondence may be addressed to Corrine R. Sackett, 225 S. Pleasantburg Dr., Suite D-1, Greenville, SC 29607, csacket@clemson.edu.

Addressing Anxiety: Practitioners’ Examination of Mindfulness in Constructivist Supervision

Jennifer Scaturo Watkinson, Gayle Cicero, Elizabeth Burton

 

It is widely documented that practicum students experience anxiety as a natural part of their counselor development. Within constructivist supervision, mindfulness exercises are used to help counselors-in-training (CITs) work with their anxiety by having them focus on their internal experiences. To inform and strengthen our practice, we engaged in a practitioner inquiry study to understand how practicum students experienced mindfulness as a central part of supervision. We analyzed 25 sandtray reflections and compared them to transcripts from two focus groups to uncover three major themes related to the student experience: (a) openness to the process, (b) reflection and self-care, and (c) attention to the doing. One key lesson learned was the importance of balancing mindfulness exercises to highlight the internal experiences related to anxiety while providing adequate opportunities for CITs to share stories and hear from peers during group supervision. 

Keywords: supervision, mindfulness, counselors-in-training, anxiety, practitioner inquiry

 

It is widely documented that counselors-in-training (CITs) experience anxiety as part of the developmental process (Auxier et al., 2003; Kuo et al., 2016; Moss et al., 2014). Reasons for anxiety include CITs’ doubts about their ability to perform competently within their professional role (Moss et al., 2014) coupled with perfectionism (Kuo et al., 2016). Additionally, Auxier et al. (2003) noted that CITs’ anxiety also stems from the pressure associated with external evaluation provided by supervisors. Wagner and Hill (2015) added that CITs’ need for external validation from their supervisors, coupled with the belief that there is only one right way to counsel clients, also generates anxiety. This need for external validation creates an overreliance on a supervisor’s judgment that could render a CIT helpless (Wagner & Hill, 2015). Although a moderate amount of anxiety may increase a person’s focus and positively impact productivity, too much anxiety impedes learning and growth (Kuo et al., 2016). Hence, there is a need for supervisors to address anxiety early in a CIT’s development to foster self-reliance and professional growth (Ellis et al., 2015; Mehr et al., 2015).

The two lead authors of this article, Jennifer Scaturo Watkinson and Gayle Cicero, are counselor educators who supervised school counseling practicum students and ascribed to a constructivist approach to supervision. While discussing supervision pedagogy, we shared our observations on how anxious our practicum students were to be evaluated and our belief that their anxiety often limited their professional growth and development as counselors. Within constructivist supervision, mindfulness exercises are used to help CITs work with their anxiety by having them focus on their internal experiences of discomfort (Guiffrida, 2015). Thus, we utilized mindfulness as a central approach to helping our students work with their anxiety associated with the counselor developmental process.

To assist in our planning, we reviewed the supervision literature and found that discussions on mindfulness were largely conceptual (Guiffrida, 2015; Johnson et al., 2020; Schauss et al., 2017; Sturm et al., 2012) or outcome-based (Bohecker et al., 2016; Campbell & Christopher, 2012; Carson & Langer, 2006; Daniel et al., 2015; Dong et al., 2017), with limited focus on supervision pedagogy to guide supervisors on how to integrate mindfulness into their practicum seminars, particularly from the perspective of the practitioner. Further, Barrio Minton et al. (2014) and Brackette (2014) confirmed that there was a scarcity of counselor education literature that focused on teaching pedagogy and argued that more research in this area was needed to improve counselor preparation. To add to the current literature on supervision pedagogy and inform our practice, we engaged in a practitioner inquiry study (Cochran-Smith & Lytle, 2009) and formed a professional learning community to investigate how utilizing mindfulness within our supervision could help school counseling practicum students work with their anxiety.

Literature Review

Constructive Supervision
     Supervisors who utilize constructivist principles help CITs make meaning of their experience by examining how their approach benefits their clients (Guiffrida, 2015). Constructivism is built upon the belief that knowledge is not derived from absolute realities but rather localized to specific contexts and personal experiences. McAuliffe (2011) argued that knowledge is “continually being created through conversations” and is not given to the learner through a one-sided expert account. Constructivists believe that learning is “reflexive and includes a tolerance for ambiguity” (McAuliffe, 2011, p. 4). Constructivist supervisors prioritize CITs’ experiences, encouraging them to examine the intent behind their approach and reach their own conclusions. Hence, constructive supervisors help supervisees deconstruct experiences that have multiple “right” approaches to client care while normalizing the anxiety associated with professional growth. Within a constructivist supervision framework, moderate amounts of anxiety are not viewed as problematic but rather are seen as a catalyst for change (Guiffrida, 2015) and part of the learning process (McAuliffe, 2011). Guiffrida (2015) asserted that the aim of supervision in the early stages of counselor development is not to remove feelings of anxiety but rather to help the CIT acknowledge and live with the anxiety. Utilizing mindfulness, supervisors acknowledge CITs’ internal experiences and guide them through intentional mindfulness practices to generate personal and professional reflection and meaning making.

Within constructivist supervision, mindfulness is a central approach to helping CITs work with their anxiety (Guiffrida, 2015). Kabat-Zinn (2016) defined mindfulness as “paying attention in a sustained and particular way: on purpose, in the present moment and nonjudgmentally” (p. 1). Constructive supervisors facilitate learning experiences that promote introspection and intentionally direct CITs to examine their internal experience, without judgment, during times of disequilibrium. Rather than helping a CIT rid themselves of anxiety, the constructivist supervisor acknowledges that anxiety is a normal response to the uncertainty of doing something for the first time (Guiffrida, 2015). Mindfulness provides a platform for a supervisor to normalize anxiety within the supervisory relationship (Sturm et al., 2012). Hence, supervisors can utilize mindfulness to prioritize the CITs’ internal experiences (e.g., doubt, uncertainty, fear) and foster self-reliance.

Mindfulness as an Approach
     Mindfulness practices are linked to the personal and professional growth of CITs (Bohecker et al., 2016; Campbell & Christopher, 2012). Campbell and Christopher (2012) compared counseling students who participated in a mindfulness-based stress reduction (MBSR) program to a control group and found that those who participated in MBSR reported significant decreases in stress, negative affect, rumination, and state and trait anxiety while noting a significant increase in positive affect and self-compassion when compared to participants in the control group. Additionally, Christopher and Maris (2010) reported that supervisees who were exposed to mindfulness were “more open, aware, self-accepting, and less defensive in supervision” (p. 123). Similarly, Bohecker et al. (2016) discovered that CITs who participated in a mindfulness experiential small group saw the benefits of attending to their emotions (e.g., internal experiences) and acknowledged that mindfulness increased self-awareness and promoted objectivity when attending to their thoughts. Having objectivity allowed them to be in the present, which positively affected their behavioral responses (Bohecker et al., 2016).

CITs also experienced benefits to having mindfulness incorporated into their practicum and internship seminar classes. Dong et al. (2017) examined CITs’ response to mindfulness-based activities and discussions during internship seminar. Results suggested that CITs who engaged in mindfulness practices were more focused on the moment and responded to stressors with acceptance and nonjudgment. As a result, CITs were more likely to be “okay with not being okay” when faced with challenging situations (Dong et al., 2017, p. 311). Additionally, Dong and his colleagues noted that participants were able to validate themselves when they made mistakes and were more accepting of their rough edges. Carson and Langer (2006) agreed and added that CITs who received mindfulness as part of their supervision were better able to examine the thoughts that contributed to their anxiety and were more open to accepting their mistakes as learning opportunities. As a result, CITs minimized the focus they put on self-criticism and were less vulnerable when they made mistakes (Carson & Langer, 2006). These studies highlight how CITs benefited from integrating mindfulness into group supervision, yet there is limited research on how counselor educators might structure their practicum seminars to include mindfulness as an integrated approach to supervision.

Purpose of the Present Study
     The purpose of this practitioner inquiry was to inform Watkinson and Cicero’s practice as supervisors of practicum school counseling students within a CACREP-accredited program. We utilized mindfulness as a central approach to group supervision during practicum seminar and wanted to understand how intentional mindfulness exercises that prioritized the CITs’ internal experiences (e.g., uncertainty, doubt, fear) were perceived by our students. By understanding the student experience, we could make informed decisions about how we might improve upon the way we integrate mindfulness into future seminar meetings. Specifically, we were guided by this research question: How are CITs experiencing mindfulness as part of group supervision provided during practicum seminar?

Method

We engaged in a practitioner inquiry study (Cochran-Smith & Lytle, 2009) to examine the application of mindfulness within the context of our practice. Cochran-Smith and Lytle (2009) argued that the examination of one’s practice privileges practitioner knowledge and adds to the overall discourse on teaching pedagogy, as “deep and significant changes in practice can only be brought about by those closest to the day-to-day work of teaching and learning” (p. 6). Although not intended to generalize knowledge, practitioner inquiry positions the researcher as a participant to uncover tensions and challenges that come from applying theory to practice while enhancing the knowledge of the practitioner doing the investigation (Cochran-Smith & Lytle, 2009). Thus, we intended to reflect upon how we integrated mindfulness into supervision by understanding the experiences of our practicum students.

Participants
     We gained approval from our university’s IRB to conduct the study and invited all 33 CITs enrolled in our practicum sections to participate. Twenty-five (76%) CITs agreed to participate. Of the 25 participants, 24 identified as female (96%) and one identified as male (4%). Sixteen students (64%) self-identified as White/Caucasian, five (20%) as African American, three (12%) as Hispanic, and one (4%) as other. Eighty-four percent of participants were full-time students and 16% identified as part-time. Students were told they could withdraw their participation at any time. All practicum students completed their field experience in public schools.

To safeguard participants from believing they were required to join the study, Watkinson and Cicero were not aware of which students agreed to participate until the end of the semester, when grades were submitted. To protect participant identity until after the semester, we took the following steps: 1) the third author, Elizabeth Burton, was the only one who knew the identity of the participants; 2) Burton recruited participants, stored data (erasing identifying information), and communicated with the participants; 3) the data source labeled sandtray reflections included activities that all CITs completed as part of a required seminar experience; 4) a focus group was held after the semester concluded and grades were submitted; and 5) during data collection, Watkinson and Cicero never discussed the study with any of the CITs enrolled in practicum.

Seminar Context
     The practicum course is the first field experience for CITs enrolled in the school counseling master’s program. As per the CACREP 2016 Standards, the practicum experience is a 100-hour experience in which 40% of those hours are in direct service. In addition to meeting those direct hours by working with several individual clients, practicum students are also required to design and run a small counseling group and deliver several classroom lessons within schools. Further, CACREP-accredited programs must provide practicum students with 1.5 hours on average of group supervision per week throughout the duration of the semester. Thus, our practicum seminars were designed to provide CITs with the required group supervision.

All practicum seminar sessions met in person except for one, which was held synchronously through Zoom, a web conferencing platform. There were three sections of practicum, two taught by Cicero and one taught by Watkinson. Watkinson and Cicero drew upon constructive supervision principles and mindfulness core concepts (e.g., self-compassion, present moment, and nonjudgment) to guide the planning of the practicum seminars. We maintained similar course structures, objectives, and learning outcomes utilizing similar room arrangements, mindfulness exercises, and structured learning experiences. Mindfulness exercises were central to the practicum seminar and were focused on the practicum students’ internal experiences. The 15 weekly practicum seminars were 90 minutes in length, and student-to-faculty ratios were 9:1 for two of the practicum sections and 6:1 for the third. The room arrangement consisted of a circle of chairs for students to use during the opening and closing of the seminar, along with a designated workspace for students to sit at tables to take notes or complete reflective class experiences. Soft meditation music played as students entered the room and was turned off to signal the beginning of class.

Watkinson and Cicero engaged in weekly collaborative planning meetings throughout the 15-week semester to plan their seminar meetings and share insights related to student learning. The instructional design was experiential and incorporated mindfulness exercises during the opening of the seminar to bring attention to the “here and now,” breath, nonjudgment, and self-compassion. Cicero was previously trained in mindfulness and exercises were selected based upon her training; Cicero taught Watkinson how to implement those mindfulness exercises during their weekly meetings. Many of the opening mindfulness exercises can be found through internet searches.

Structure of Seminar Meetings
     The structure and room arrangement for each practicum seminar were consistent across the three sections. Fourteen of the 15 seminar meetings began with the CITs participating in a 5-minute mindfulness opening that transitioned into structured learning experiences and ended with a sharing circle. Seminar Meeting 11 was entirely dedicated to mindfulness, engaging practicum students in several mindfulness activities for the purpose of drawing their attention to breath and reflection.

Mindfulness Openings
     The 5-minute mindfulness openings were scripted and consisted of either a guided meditation (e.g., Calm Still Lake, A River Runs Through It), intentional breathing exercises (e.g., Balloon Breath, Meditative Chimes) or chair yoga (e.g., Mountain Pose, Warrior 2). Each mindfulness opening concluded with reflective questions to increase awareness of the present moment (e.g., What was this experience like for you?). The meditation exercises were varied to introduce CITs to different approaches they might want to try outside of seminar for personal use or in their own practice with K–12 students.

Structured Learning Experiences
     After the mindfulness opening, CITs participated in structured learning experiences that focused on either counselor development, case conceptualization, group counseling leadership, evidence-based planning, or classroom curriculum development and instruction. Guided by constructivist supervision principles, two of the structured learning experiences implemented were metaphorical case drawing (Guiffrida, 2015) and sandtray (Guiffrida, 2015; Saltis et al., 2019).

     Metaphorical Case Drawing. Guiffrida’s (2015) metaphorical case drawing was used to assist CITs in the development of their case conceptualization skills. In Guiffrida’s work, a metaphorical case drawing has three steps. First, CITs reflect upon six items that highlight their internal experiences and perspectives specific to an individual counseling session with one of their clients: 1) identification of the client’s primary concern, 2) description of the client and CIT interaction, 3) CIT’s intention for the session, 4) CIT’s description of how they viewed their performance as a counselor during the session, 5) general assessment of how the session went, and 6) statement on what the CIT thought the client gained from the session. Second, CITs use images and/or metaphors to respond to three of the six items above to create a case drawing. Lastly, utilizing their case drawings, CITs share their cases with the supervisor and other supervisees. Through the presentation of their case, the CITs interpreted their work while the supervisor and other supervisees listened and asked questions to facilitate deeper insight by offering alternative perspectives.

     Sandtray. Although sandtray is typically used in supervision to help CITs develop their case conceptualization skills (Anekstein et al., 2014; Guiffrida, 2015; Guiffrida et al., 2007), we modified our use of sandtray to focus the CITs on their developmental journey as counselors. Like the metaphorical case drawing, the sandtray facilitates an internal examination where CITs get to interpret their own experience (Guiffrida et al., 2007). The sandtray was used in Seminar Meetings 6 and 13 to document how CITs were encountering practicum at two different times in the semester. The written reflections that followed the sandtray were used as a data source for this study and are therefore described in further detail.

Prior to creating an image in the sandtray, CITs were asked to journal about their experience as a practicum student. The prompt was left open so that CITs would have the freedom to focus on the most salient part of their experience. Next, CITs were partnered to create a sandtray image and each pair were given a large box that contained sand and a small baggie filled with a variety of miniature objects. CITs had 5 minutes to create an image in response to this prompt: Create an image that represents your practicum experience thus far. At the conclusion of the 5 minutes, CITs shared their stories with their partners. After everyone created a sandtray image and shared, CITs wrote a reflection in response to this prompt: Drawing from the sandtray exercise and sharing, describe your experience in practicum thus far. Identify and describe the thoughts and feelings you have as you begin your work with students. These written reflections were submitted to the professor at the conclusion of the seminar meeting.

At Seminar Meeting 13, CITs created and shared their sandtray images. Following the same procedure as identified in Seminar Meeting 6, CITs engaged in the sandtray activity again to create a new image in response to a new prompt: Create an image that described your overall experience in practicum. After creating and sharing of their image with a partner, students reflected and responded in writing to a final prompt: Drawing from the sandtray exercise, describe your experience in practicum. Identify and describe your thoughts and feelings now that practicum has come to an end. What have you learned about yourself? Written reflections were completed during the seminar meeting and submitted to the professor when class ended.

Sharing Circle
     After the structured learning experience, each seminar concluded with a 5–10 minute sharing circle where students summarized new insights and identified actions to implement at their practicum site. The sharing circle was guided by two questions: What are some key takeaways from today’s seminar? and How might we use what we have learned today within our own practice?

Structure of Mindfulness Seminar Meeting
     Seminar Meeting 11 was fully dedicated to the practice of mindfulness and did not follow the above seminar format and structure. During this one 90-minute class, CITs identified an intention, created a mindfulness jar, journaled, and walked a labyrinth. Johnson et al. (2020) argued that CITs who receive mindfulness as part of their supervision should start or maintain a mindfulness practice of their own. Yet there is nothing in the research that identifies specific mindfulness exercises as being essential to that practice, only that CITs should be exposed to mindfulness as part of the classroom experience (Johnson et al., 2020). Thus, our intent for this seminar meeting was to engage CITs in mindfulness exercises that would encourage meditation and reflection. For this class we requested a large room to accommodate a small circle arrangement of 10 chairs and three stations: a labyrinth, creating a mindfulness jar, and journaling. During this seminar meeting, the CITs were instructed to visit the three stations at their own pace and to self-select the order in which they participated in those stations. Class opened with a mindfulness exercise that focused on breath and ended with a sharing circle to debrief. An example of a closing question posed by the professors during the sharing circle is: What insights would you like to share about your experience in seminar today?

     Labyrinth. CITs were given a brief description of a labyrinth along with written instructions on how to set an intention and walk the labyrinth. We created a floor labyrinth for use during the seminar. CITs set their intention prior to walking the labyrinth. Some examples of intentions were to be open to the process or to demonstrate self-compassion. Once inside the labyrinth, CITs would follow the path and could walk the labyrinth as many times as they desired.

     Creating Mindfulness Jars. CITs created a mindfulness jar from an empty 8-ounce bottle, fine glitter, clear hand soap, confetti, and water. Directions on how to create a mindfulness jar were provided at the station. CITs were encouraged to use the mindfulness jar during the 90-minute seminar as a focal point to guide their breath during reflection time.

     Journaling. CITs were provided paper, pens, markers, and crayons for journaling at the beginning of the seminar. CITs were provided minimal directions on what they were to journal, outside of selecting a quiet place in the room to write and reflect upon their experience during the session. Journals were private and CITs were not asked to share what they wrote with the professors or other CITs.

Data Sources and Collection
     We used three data sources to understand CITs’ experience with mindfulness as part of supervision: supervisor observations, sandtray reflections from weeks 6 and 13, and focus group transcripts. Watkinson and Cicero captured supervisor observations in their meeting minutes, which also included specific plans for each seminar session along with assumptions and observations about CIT learning. The written sandtray reflections captured CITs’ overall experience in practicum at two different points in the semester. Using a multi-step process, the sandtray served as a structured learning experience completed and collected during the seminar meetings. Data from sandtray reflections taken at the end of the semester (week 13) were analyzed to examine how CITs reflected on their overall practicum experience at the completion of the semester.

All 25 participating CITs were invited to participate in a focus group. Of the 25, nine (36%) attended and two different focus groups were held to accommodate their schedules. Each focus group was held virtually on Zoom, recorded, and transcribed, and took place at the end of the academic semester after grades were issued. Focus groups lasted 60 minutes, were co-led by Watkinson and Cicero, and served as a type of member checking. Guiding questions/prompts were: Describe your experience in practicum this semester, Describe your feelings throughout the semester, and What was it like for you to engage in mindfulness as part of your development as a counselor?

Trustworthiness
     Watkinson and Cicero are both counselor educators at a university located within the Mid-Atlantic region of the United States. Watkinson is a Caucasian middle-aged female with 14 years of experience as a school counselor and over 10 years of experience as a counselor educator. Cicero is a Caucasian middle-aged female with 30 years of experience in a large public school district as a teacher, school counselor, and a district-level administrator of school counseling and student service programs, as well as 3 years of experience as a counselor educator. Watkinson and Cicero are licensed professional counselors, board approved certified supervisors, and certified school counselors. Burton was a first-semester school counseling student and served as Watkinson’s graduate assistant. She is a Caucasian female with no prior experience in schools or as a counselor. At the time of data analysis, she had finished her first year of coursework and offered an additional perspective on how the data could be interpreted.

Watkinson and Cicero held certain biases and assumptions about how mindfulness might be experienced by CITs in their practicum sections. We assumed that mindfulness was beneficial to CIT counselor development yet had no preconceived ideas as to the type of benefit it would have on their professional growth outside of our assumption that mindfulness could help CITs work with their anxiety. Additionally, we found that CITs, particularly at the practicum level, were anxious and worried about their performance and believed that supervision was needed to attend to that anxiety. Lastly, we shared a strong desire to better understand our own practice and were therefore open and expected feedback to strengthen that practice.

Trustworthiness was addressed in a variety of ways. In practitioner research, validation is obtained through a form of peer review, where practitioner researchers collaborate to discuss and reflect upon their experiences through peer feedback (Anderson & Herr, 1999; Cochran-Smith & Lytle, 2009). Thus, Watkinson and Cicero met weekly during the 15-week semester to share observations and obtain feedback related to their own practice. Further, during these meetings we engaged in critical dialogue to disrupt previously held assumptions and biases. For example, we challenged each other to share evidence to support the interpretations we made about how students were experiencing the course, asking the question, How do you know? Observations that included peer feedback were recorded in our meeting minutes.

Second, we engaged in prolonged observation of participants as we worked alongside CITs, acting in the role of both inside and outside observers during the 15-week semester. As Creswell (2013) asserted, validation of findings comes from prolonged engagement and persistent observation of participants. Third, we triangulated data, comparing Seminar Meeting 13 sandtray reflection data across the three practicum sections to the focus group transcripts (Merriam, 2009). Fourth, the focus groups served as a type of member checking (Merriam, 2009) to validate and refine our analysis of the final sandtray reflections to the perceptions that were shared by students in the focus groups.

Data Analysis
     We formed a research team and regularly met to debate and discuss the data during the analysis process. Data from the sandtray reflections taken during Seminar Meeting 13 were organized into a table for analysis so that we could track individual responses and practicum sections. Drawing from Creswell’s (2013) process for analyzing data, we each familiarized ourselves with the data by independently engaging in multiple readings of the final sandtray reflections and focus group transcripts, including memoing to capture initial impressions and key concepts. After familiarizing ourselves with the data, we met as a research team to share initial insights and bracket assumptions. Next, we reviewed each line of the final sandtray reflection data independently to identify initial codes. As a research team, we shared our codes, discussed discrepancies, and reviewed units of data until consensus was reached and a codebook was created. Next, codes from the final sandtray reflections were compared to the focus group transcripts and refined. Lastly, we looked for patterns in the data and organized them into themes.

Findings

To examine our supervision practice, we sought to understand how CITs experienced mindfulness as a supervision approach. Prioritizing mindfulness within our practicum seminar meetings focused our students on the examination and understanding of their internal experiences and meeting uncertainty with nonjudgment and self-compassion. After analyzing the data, three major themes emerged: openness to the process of becoming, reflection and self-care, and attention to the doing.

Openness to the Process of Becoming
     Although CITs acknowledged the challenges associated with their experience, they also expressed an openness to becoming a counselor who generated personal insight, self-compassion, and wisdom. As one participant stated, “It’s natural to feel uncertain when learning new concepts. However, uncertainty should not consume you and cause your thoughts to become negative. Give yourself permission to grow.” Another wrote, “The biggest growth I’ve seen in myself is self-awareness. Regardless of my weaknesses and shortcomings, I am good enough!! The greatest gift I can give to students is to be myself.”

CITs felt hopeful and purposeful in their development as counselors and expressed excitement about their professional growth. As one participant remarked, “In the beginning everything seemed new and scary, but when I look at the end, I see so much growth. I will continue to grow and expand. I look forward to my career.” Another wrote:

At the beginning of practicum, I felt awkward and unsure of myself. I felt self-conscious. At the end of practicum, I can feel the growth I’ve made. I no longer feel awkward or self-conscious. I know who I am and what kind of counselor I am.

     Acknowledging the emotional challenges of their professional journey, CITs highlighted the emotional discomfort they felt at the start of practicum. One student stated: “Anxiety from the beginning—feeling of anxiety and not knowing what to expect.” Another mentioned in her reflection, “I definitely had feelings of inadequacy. I just didn’t think that I was doing what I needed to do.” Some students expressed this discomfort as cyclical:

Understanding everything that was going to be happening and everything that was expected and what it all entails, I definitely started to get more anxious and got comfortable and then getting [anxious] again. So, kind of like back and forth a lot.

Students compared this back and forth feeling to that of a rollercoaster: “I feel like some weeks I’d be on fire, like, yeah, I did really good . . . there would be other days where it’s like my timing is off and I’m uncomfortable in the classrooms . . . it was definitely a rollercoaster feeling.”

Another student agreed, sharing that they “would definitely second the rollercoaster. The beginning was very overwhelming for sure . . . that rollercoaster of like the expectation of learning . . . feeling like you’re doing really bad and then learning what is good.”

There was also a sense of wisdom in how the participants described what they gained from this experience of becoming. One participant mentioned “feeling depressed and anxious. . . . Fast forward 2 months and I had grown so much. I can’t believe in only 60 days my attitude toward practicum changed so dramatically. . . . change and growth take time, but it does happen.” Another CIT stated:

In my first reflection, there seemed to be a lot of low points, but I was hopeful things would get better. In my second reflection, I realized that the things I have done have made an impact and the highs and lows both got me to this point.

     CITs expressed recognition of the highs and lows experienced and within that recognition focused on a greater purpose. As one wrote,

I started out being very unaware and doubtful of myself. I was overwhelmed and wasn’t seeing the beauty in the process of learning who I am as a counselor. I began to see the small and big impacts that I had with my students in 15 weeks. I saw the power that comes with being a counselor and am more mindful of the impact I have and will make.

Another reflected:

The biggest growth I’ve seen in myself is self-awareness. Awareness of my strengths and weaknesses so that I can be mindful of how to be the best I can be for all students. So that I can strive to have a positive impact on others.

Another mentioned:

At this point in the journey, I finally met my passion. I always wanted to have an impact not because I taught a great lesson, but because I helped a student and showed I cared. I grew by knowing how to use my tools to make a difference while finding my style of counseling in the process. The growth hasn’t stopped and needs refinement, but I want each day to be better for myself and the students.

     Additionally, CITs perceived feedback to be essential to their growth process. One CIT reflected that they “learned to be open to change . . . accepting feedback and letting it help me make positive changes throughout this journey. There is always a need for continued growth and development.” Another remarked:

I’ve realized that in order for me to learn and grow I have to be more open [to feedback]. Being closed off means that I am only working with what I know, which is not helpful to me personally, but also what we tell students not to do. Being open has forced me to become a more active participant in my learning and take more risks . . . it will all be worth it in the end.

Another practicum student focused on gratitude:

Feedback and supervision helped to change my perspective and boost my confidence. Things about myself that I thought had nothing to do with being a counselor were highlighted and the areas for improvement were spoken of and tended to with genuine care. I’m grateful to have had the experience of becoming so reflective. I’m grateful for the lows and the moments where I felt as though I was at a standstill. I’m grateful for falling so hard that my only option was to reach out and ask for help. I’m grateful for the hurdles . . . and I’m grateful for the ever-flowing river. I’m grateful for the art and the science of counseling. I’m grateful for who I’m becoming in the process of becoming. I’m grateful for grace and for the realization of how necessary it is. I’m grateful for family and adopted big sisters in the program. I’m grateful to have had the chance to say “I don’t know” and keep learning.

     The theme of openness to the journey was also highlighted in the acknowledgement of not being in control. There was an openness to embracing the unknown and the chaos associated with not having everything figured out, as one CIT concluded:

In the beginning, I was working really hard to try to figure everything out. I saw obstacles everywhere. As I moved on, I started to focus on counseling in a way that didn’t put pressure on me to do all of the right things. I started to grasp the essence of counseling and what makes the profession unique.

Another noted:

One major insight is that it was a chaotic journey. It’s not straightforward, and I don’t always know the path I’ll take, but I am continuously growing and learning about myself as a person and as a school counselor. . . . I am enjoying the unknown. I like what I am doing, and I like moving forward, even if I am unsure at times.

Reflection and Self-Care
     CITs reported that the seminar was very reflective, which gave them a sense of calm and a new appreciation for self-care. As one student commented, “I did, like everyone else, find [the seminar class] to be calming, enjoyable, and reflective.” Reflection generated by the mindfulness exercises gave CITs an opportunity to get to know themselves:

It was definitely a positive experience for sure. I would agree it was very calming and super reflective. I felt like I understood myself as a counselor and also just like as a person on my own personal journey. Even aside from that I felt like I learned a lot.

Further, CITs expressed the importance of reflection and giving themselves the space to be in the present moment as a means of self-care:

I am so wrapped up in everything that is going on in my life and getting everything done. And school takes a lot of everything I’ve got . . . to be reminded and practice [mindfulness] on a regular basis . . . but doing it each week in class, helped me to do it at home. So that was giving me that practice and repetition and it really made a huge difference.

Another mentioned, “There’s just so many things going on in your life . . . to be reflective and just calm my inner self and learn how to breathe . . . this was a life skill class for me,” and a different student elaborated, “I was so grateful for it because I realized how much self-reflection I have to do . . . that I need to keep doing it and making it a priority.”

Attention to the Doing
     Although students valued the priority that we placed upon mindfulness to better understand their internal experiences, some wished that we had provided more time for them to share stories about their practicum sites. As one CIT stated, “I would have liked to have had time each week for all of us to share what was going on and to learn from each other’s situations and to support each other in those situations.” Additionally, CITs desired to know more about what was happening at different practicum sites because of the belief that they were missing an experience. As one CIT explained, “I didn’t have a role model so it was nice to hear everyone else’s role models . . . so I could just learn from pieces I wasn’t getting [at my site].” Another CIT agreed: “I think it definitely would have helped to hear more about other people’s sites just because I wasn’t really getting a ton out of my site. Or I did get things, but differently.” Another mentioned, “I wanted to hear other people’s experiences because I felt like everyone was at such different schools and different levels . . . we’re all experiencing different things.”

Discussion

We sought to understand how practicum students experienced mindfulness exercises within supervision to improve our own practice. To help practicum students work with their anxiety, mindfulness exercises were heavily integrated into the course structure to engage all CITs in weekly reflective exercises that directed their attention toward their internal experiences. Practicum students were invited to acknowledge their anxiety and respond to it with nonjudgment and self-compassion. Mindfulness core concepts (e.g., being present, nonjudgment, self-compassion) served as a framework for how practicum students made meaning of their internal experiences. Although our focus was not to determine the impact mindfulness had on our practicum students, to inform our practice we did seek to gain a descriptive understanding of how our students experienced mindfulness as part of their group supervision.

Open to the Process of Becoming
     Our CITs reported being open to the process of becoming a counselor that included acceptance of where they were in the developmental process. Through acceptance, CITs reported being aware of the uncertainty associated with learning a new skill and leaned into that anxiety with self-compassion and nonjudgment. Further, they were able to acknowledge the ambiguity (e.g., “rollercoaster”) associated with learning something new and the tension that comes with being uncomfortable. Bohecker et al. (2016) found similar results in their qualitative study, acknowledging that CITs who integrated mindfulness practices into their daily lives were better able to handle the ambiguity associated with counselor development. As part of her correlational study, Fulton (2016) found that self-compassion, a core principle of mindfulness, was predictive of a CIT’s tolerance to handle ambiguity. Thus, our findings support and add to the current literature by describing qualitatively how practicum students made meaning of that uncertainty to normalize the tension that was associated with it.

Self-Care
     Participants saw reflection as a form of self-care, finding meditation to be relaxing, and they acknowledged that meditating each week during seminar allowed them to stay in the present moment. Similarly, Duffy and colleagues (2017) found that CITs in their qualitative study who participated in weekly mindfulness exercises as part of a core class described mindfulness as reflective, providing them with a sense of calm and ability to stay within the present. Banker and Goldenson (2021) noted that CITs within their qualitative study also reported personal benefits to utilizing mindfulness within their practicum seminar, including being able to better transition to the present moment. Thus, the experiences our practicum students had connecting reflection as a form of self-care are similar to the experiences of other CITs who practiced regular meditation.

Attention to the Doing
     Although CITs saw value in participating in group supervision that integrated mindfulness as a central approach within their practicum seminars, some CITs wanted more focus on learning about the experiences other practicum students had at their school sites. Specifically, CITs desired to know more about school counselor practice by sharing stories of what their peers were doing, as well as the work being done by the practicing school counselor. Participants sought more understanding on school counselor practice either because of a lack of modeling at their own schools or professional curiosity. Similarly, Watkinson et al. (2018) noted that counselor educators reported discrepancies between how school counseling CITs were being prepared versus what they experienced in the field. For example, counselor educators shared that they often taught content (e.g., implementing a comprehensive school counseling program) that their school counseling CITs did not see modeled at their schools. Thus, it would seem logical that CITs at the practicum level would want to have more exposure to activities that school counselors were doing at other sites, especially if what they were observing was not aligned with their training.

Reflecting on Our Own Practice: Lessons Learned
     Through this practitioner inquiry, we gained some valuable insight into how CITs experienced mindfulness that has informed our practice. First, by analyzing our CITs’ experiences in practicum, we believed that they benefited from the mindfulness exercises as a way to work with their anxiety. Specifically, we were encouraged that practicum students expressed an openness to the process of becoming a counselor, which included self-acceptance. CITs stated they were more open to feedback and less critical of themselves, recognizing they still had much to learn. Second, we learned that although the integration of mindfulness as a central approach to our supervision could be helpful to practicum students, CITs also expressed a desire to have more time dedicated to hearing about the work their peers and other practicing school counselors were doing within schools. This was particularly important if the CIT believed their site was lacking. Hence, as supervisors we needed to create a balance between engaging our CITs in mindfulness practices and the need that our CITs had to share work stories and gain some practical insight into the work of school counselors.

Cochran-Smith and Lytle (2009) highlighted that a benefit to practitioner inquiry was the uncovering of professional dilemmas that naturally occur when you apply a concept to practice. For us, seeking balance challenged us to consider what specific mindfulness exercises were critical to maintain. Watkinson et al. (2018) also found that counselor educators struggled with balancing the amount of content that needs to be covered in a course versus the depth of understanding that is needed for CITs to apply the content learned. Thus, we too needed to decide on depth versus breadth, which boiled down to identifying the frequency with which we had our practicum students participate in mindfulness exercises in each seminar meeting to gain benefit.

Because the recent literature suggested that exposure to weekly mindfulness exercises within core courses and clinical seminars benefited CITs (Campbell & Christopher, 2012; Dong et al., 2017; Fulton, 2016), we decided to keep the opening mindfulness meditative exercises and remove the one seminar session we had dedicated to mindfulness. Further, we increased the time CITs spent in sharing circles to include space for CITs to talk about the work being done by school counselors (or themselves) at practicum sites. Lastly, we looked for opportunities to highlight mindfulness principles in case conceptualization.

To integrate mindfulness principles into case conceptualization, Sturm and colleagues (2012) proposed using metaphors (i.e., Earth, Air, Water, Space and Fire) that represent ancient Buddhist principles when conceptualizing cases. For instance, the Earth metaphor symbolizes grounding, and when applied to case conceptualization enables CITs to consider what grounds them personally and theoretically when treating a client (Sturm et al., 2012). Another example of integrating core mindfulness principles into supervision is through free association (Schauss et al., 2017). Schauss et al. (2017) used free association to help CITs attend to the present by asking questions that focused CITs on the here and now (Schauss et al., 2017). Sample questions include: What are you feeling in this moment? When and in what ways has this feeling surfaced during your counseling experiences at your school site? How does your body respond to this type of feeling and what is the impact on your counseling experiences? By integrating mindfulness principles into skill development (e.g., case conceptualization), our practicum students would be further exposed to core mindfulness principles.

Limitations and Future Research

Our intention of sharing the findings from this study was to offer a practitioner’s perspective on how CITs experienced mindfulness within supervision to contribute to the broader discussions on counselor education pedagogy. Generalization was not the objective, and findings need to be interpreted within the context of practice. Further, this study did not examine the impact that mindfulness had on CIT anxiety, and we are not able to infer such causal relationships. To strengthen our understanding of counselor education pedagogy, future studies could build upon our findings to identify which mindfulness exercises had the greatest impact on helping CITs work with their anxiety. Understanding which mindfulness exercises impact anxiety, counselor educators could be more intentional with the exercises they include, thus making room for other supervision priorities (e.g., CITs hearing about the work of practicing school counselors).

Future research could also investigate how supervisors’ modeling of core mindfulness principles could impact counselor development and the supervisory alliance. Daniel et al. (2015) have called upon researchers to increase understanding of how supervisors’ mindfulness behaviors impact the supervisory relationship. Future research could attend to this deficiency within the literature by looking at the relationship between a supervisor’s mindfulness behaviors and the supervisory relationship through a practitioner lens.

Conclusion

By incorporating a mindfulness approach into supervision, we learned that CITs were open to working with the anxiety associated with becoming a counselor. This openness or self-acceptance gave them the perspective to appreciate the impact this experience had on them and others while also valuing the benefits of reflection through meditation. The intent of this study was not to generalize the experience of these CITs to others; rather, it was to generate conversation and an understanding of how CITs experienced mindfulness to better our practice as supervisors. Although CITs saw benefits of mindfulness within supervision, they also desired more conversations on counselor practice to better their understanding of the role school counselors have in schools. As supervisors, we understand mindfulness should be balanced with the need for CITs to learn about the work of the school counselor through the sharing of experiences at their practicum sites. Beginning each session with a mindfulness exercise and infusing mindfulness core principles into case conceptualization could be a means to achieve such balance.

 

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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Jennifer Scaturo Watkinson, PhD, LCPC, is a certified school counselor and serves as an associate professor and the School Counseling Program Director at Loyola University Maryland. Gayle Cicero, EdD, LCPC, is a certified school counselor and serves as an assistant clinical professor at Loyola University Maryland. Elizabeth Burton is a certified professional school counselor for Baltimore County Public Schools. Correspondence may be addressed to Jennifer Watkinson, Timonium Graduate Center, 2034 Greenspring Dr., Lutherville-Timonium, MD 21093, jswatkinson@loyola.edu.

Vicarious Grief in Supervision: Considerations for Doctoral Students Supervising Counselors-in-Training

Samara G. Richmond, Amber M. Samuels, A. Elizabeth Crunk

 

The COVID-19 pandemic has brought about collective experiences of grief; thus, counselors-in-training (CITs) and their doctoral student supervisors may encounter increases in grief-oriented clinical work. In considering how to support CITs’ work with grieving clients, doctoral supervisors should be prepared to help CITs manage experiences of vicarious grief (VG). Given the ubiquity of loss and the limited amount of grief-specific coursework in counselor training, CITs could benefit from exploring their experiences of VG with their doctoral supervisors in clinical supervision—a core area of training for doctoral students enrolled in counselor education programs accredited by the Council for Accreditation of Counseling and Related Educational Programs. In this manuscript, we (a) provide an overview of the literature on VG, (b) discuss the potential impact of VG on CITs, (c) present a case study illustrating attention to VG in supervision, and (d) provide practical strategies doctoral supervisors can employ when addressing VG in supervision, drawing on Bernard and Goodyear’s discrimination model.

Keywords: vicarious grief, counselors-in-training, doctoral supervisors, clinical supervision, discrimination model

 

     Loss, and the resulting grief response, is a universal human experience that individuals are likely to encounter at multiple points across the life span (Chan & Tin, 2012). As such, grief presents in counseling as a common client concern (Hill et al., 2018) and can stem from the loss of a loved one through death, non-death loss (e.g., relationship loss, loss of lifestyle), or normal life transitions (e.g., retirement, relocating; Sullender, 2010). Given the ubiquity of these experiences, counselors should anticipate working with clients who are facing loss and grief throughout their years of practice (Doughty Horn et al., 2013).

Current events may also elicit collective and global grief responses as we have seen with the COVID-19 pandemic and the unexpected death of professional basketball player Kobe Bryant early in 2020 (Milstein, 2017; Weir, 2020). These bring the pervasiveness of grief to the forefront of our awareness. Counselors, not immune to these events at the macro or micro level, must cope with their own grief responses and be prepared to experience grief through exposure to their clients’ presenting concerns, recognized as a vicarious grief (VG) response (Chan & Tin, 2012; Kirchberg et al., 1998; Rando, 1997). This reality, highlighted by the growing awareness and impact of collective grief in 2020, supports the need for increased loss and grief competencies within the profession of counseling.

Although calls have been made to more purposefully integrate loss and grief competencies into counselor education (Doughty Horn et al., 2013), we aim to highlight the importance of supporting doctoral students in growing loss and grief competencies related to their roles as future counselor educators and supervisors. As the most recent Council for Accreditation of Counseling and Related Educational Programs (CACREP) standards identify supervision as one of the five core areas of doctoral-level student training (CACREP, 2015), we propose that doctoral students should be trained to identify VG observed within counselors-in-training (CITs) and themselves. Further, they should be prepared to facilitate supervisory discussion to explore VG and help CITs learn strategies for effectively managing VG they might experience in response to their clinical work. Drawing on the existing literature on vicarious trauma, loss, and grief in counseling and supervision, as well as Bernard and Goodyear’s (1992, 2019) discrimination model, with this article we (a) provide an overview of the literature on VG, (b) discuss the potential impact of VG on CITs, (c) present a case study illustrating VG in supervision, and (d) provide practical strategies doctoral supervisors can employ when addressing VG in supervision.

Grief in Counseling
     In order to more thoroughly understand counselors’ and supervisors’ experiences of VG, it is necessary to first explore how loss and grief may present within the therapeutic context. Contrary to traditional stage models of bereavement, contemporary research indicates that grief is a more nuanced, nonlinear psychological response to loss that can vary significantly between individuals with respect to duration of grief and the presentation and intensity of symptoms (Crunk et al., 2017; Doughty Horn et al., 2013). For example, although the majority of individuals experience more normative grief responses, about 10% of bereaved individuals experience a protracted, debilitating, and sometimes life-threatening grief response known as complicated grief (Shear, 2012), also referred to as prolonged grief disorder (Prigerson et al., 1995) or persistent complex bereavement disorder (American Psychiatric Association, 2013). As doctoral student supervisors and CITs inevitably encounter clinical presentations of loss and grief, the ability to identify and discuss both common and complicated grief reactions not only serves to support  determination of treatment interventions, but also promotes the introspection necessary to identify, explore, and cope with their own VG responses (Ober et al., 2012), which is the focus of this present article.

Vicarious Grief
     Prior literature within the counseling profession has largely focused on vicarious trauma—the negative emotional or psychological changes and altered view of self, others, or the world experienced by counselors resulting from repeated engagement with clients’ trauma-related stories, memories, pain, and fear (American Counseling Association [ACA], n.d.; Trippany et al., 2004). It is widely recognized by practitioners and counselor educators that vicarious trauma can be personally and professionally disruptive, with counselors experiencing behavior changes, interpersonal issues, shifts in personal values and beliefs, and diminished job performance as a result (ACA, n.d.). However, less attention has been directed toward VG (i.e., bereavement), a phenomenon originally documented by Kastenbaum (1987) that describes “the experience of loss and consequent grief and mourning that occurs following the deaths of others not personally known by the mourner” (Rando, 1997, p. 259). The two types of VG include (a) Type 1, exclusively VG (i.e., the griever feels what it is like to be in the initial griever’s position) and (b) Type 2, the experience of VG for a griever along with feeling reminded of one’s own losses and unfinished grieving (Rando, 1997; Sullender, 2010). Although there is overlap between grief and trauma, there are also important differences for counselors to be aware of and attend to in counselor training, practice, and supervision, particularly given the pervasiveness of loss and grief.

In light of prior literature suggesting that counselors can experience negative outcomes following vicarious traumatization, we propose that issues of loss and grief, too, can elicit unexpected and unwanted grief responses that might impact counselors’ well-being or even their ability to provide client care. CITs and doctoral supervisors would benefit from greater awareness of the potential impacts of VG on themselves and their ability to deliver ethical and effective services to clients. Research has indicated training and experience in grief counseling are among the strongest predictors of grief counseling competence (Ober et al., 2012); thus, counselors who have little or no training in grief and loss may be at risk for being unable to manage clients’ grief presentations. With counselor wellness essential to providing adequate clinical services, and counselors holding an ethical obligation to be prepared to work with a variety of client presentations, including loss and grief, it is suggested that increased attention to VG serves to promote counselor wellness, clinical preparedness, and positive client outcomes (Hill et al., 2018).

Although the long-term effects of our current experiences of collective, widespread grief have yet to be fully identified and understood, the immediate impact brings to the forefront the professional necessity of recognizing reactions to grief within clinical work and supervision. Sufficient evidence exists that counselors who work with clients facing issues of loss and grief are vulnerable to compassion fatigue, burnout, and secondary traumatization. Best practices reflect the necessity for practitioners to attend to their emotional responses to clients presenting with these issues (Chan & Tin, 2012; Gentry, 2002; Kirchberg et al., 1998), but little empirical evidence has been established surrounding how counselors respond to discussion of loss and grief in supervision. Therefore, to promote recognition and understanding of VG, it is beneficial for counselors and counselor educators to consider the separate and distinct impacts of VG on a counselor’s work. This includes how VG can permeate into supervisory relationships—space that has traditionally been used for counselors to process and attend to their emotional reaction to clients’ presenting concerns (Bernard & Goodyear, 2019).

Vicarious Grief in Supervision
     Although supervision is evaluative and hierarchical by nature, it can serve a “simultaneous purpose of enhancing the professional functioning” (Bernard & Goodyear, 2019, p. 9) of the CIT. When applied to loss- and grief-oriented clinical work, it may be understood to include assisting CITs in exploring how their own reactions contribute to their ability to deliver clinical services. For doctoral students in the role of supervisor, this task requires that they not only support the connection of classroom learning to clinical practice, but also promote personal reflection and growth in the service of clients. As such, in cases of clients presenting with issues of loss and grief, doctoral students can utilize supervision and the supervisory working alliance to facilitate identification and understanding of a VG response, ultimately supporting more effective clinical work.

The supervision literature suggests that VG may affect counselors differently depending on their level of clinical experience. For example, more advanced clinicians have been found to experience less distress when faced with death-related client concerns (Terry et al., 1996), whereas beginning counselors, particularly those in a practicum course, rate death and loss as highly uncomfortable clinical topics to handle (Kirchberg & Neimeyer, 1991). In addition, the interplay of personal and contextual factors may exacerbate the distress that students experience when faced with these clinical topics, emphasizing the necessity of not only acquiring appropriate knowledge and skills related to grief work, but also personal awareness and competencies to manage their emotional responses (Chan & Tin, 2012; Kirchberg et al., 1998). Doctoral students must be prepared through their own education and introspective abilities to support this process for their CITs.

As it presents for CITs, sufficient evidence can be derived from the loss and grief and vicarious trauma literature to suggest that client outcomes may be affected when CITs cannot adequately identify or cope with vicarious responses (ACA, n.d.; Hill et al., 2018). When experiencing VG, it may be more difficult for CITs to attend to client presentations during session and engage in pre-session planning or post-session reflection (Lonn & Haiyasoso, 2016). Without standards for grief training or practice in the professional counseling field (Doughty Horn et al., 2013; Ober et al., 2012), much of the responsibility to promote CIT wellness and attention to VG responses falls on doctoral student supervisors engaging with CITs in their practicum experiences. As such, doctoral student supervisors, also ethically charged with promoting client welfare and proficiency of practitioners across presenting concerns, should be prepared to attend to VG and its likelihood to impact CIT ability to lead client sessions effectively.

Given that the vicarious trauma literature suggests that supervisors monitor their own responses to trauma-focused clinical information presented by their CITs, doctoral student supervisors and their supervisors (i.e., counselor educators and supervisors) supporting grief work must also be aware of their own risk for VG (Lonn & Haiyasoso, 2016). Supervisors may also experience emotional reactions to CITs’ disclosures of their own VG reactions in supervision (Bernard & Goodyear, 2019). Through utilizing introspective practices, doctoral student supervisors and their supervising counselor educators and supervisors can attend to this heightened possibility of VG by examining their physical, emotional, and cognitive reactions to their CITs, their workload, and any personal issues pertaining to unresolved grief that may be shaping how they in turn conduct supervision around topics of loss and grief (Ladany et al., 2000; Walker & Gray, 2002, as cited in Bernard & Goodyear, 2019). The following sections outline recommendations for addressing VG in supervision with doctoral-level supervisors and CITs.

Supervision and Vicarious Grief: Leveraging Roles and Relationships

     Clinical supervision is essential to basic counselor training and has become a major emphasis of counseling doctoral training programs (Bernard & Goodyear, 2019; CACREP, 2015). Supervision as a practice has been found to increase counselor objectivity, empathy, and compassion (Trippany et al., 2004), providing an ideal environment for doctoral student supervisors to intervene and address the ripple effects of client grief presentations. Although grief is a common client concern, literature addressing VG in supervision is scarce. Generally recognized standards for addressing VG in supervision do not yet exist. Thus, in the absence of best practices, in this article, we extrapolate from existing supervision literature strategies for effectively fostering CIT growth and adapting our understanding of how these factors may also serve to support CITs and their supervisors as they navigate grief-related content and possible VG experiences in supervision.

Just as it has been studied in psychotherapy research, common factors of supervision can be examined to better conceptualize the supervisor’s role and ability to shift a CIT’s experience of VG. In considering common and specific factors of supervisory models, it has been suggested that the supervisory relationship is paramount to positive clinical outcomes (Crunk & Barden, 2017). Doctoral student supervisors, in being asked to address the intense emotional reactions of VG with their CITs, may benefit from focusing on the quality of the supervisory relationship to encourage openness, honesty, and increased willingness to process feelings of grief that arise in relation to work with their clients.

Per Bernard and Goodyear’s (1992, 2019) discrimination model, it can also be helpful to consider how the supervisory roles of counselor, consultant, and teacher may inform a doctoral student supervisor’s approach to VG with trainees. Often as a new supervisor, it can be difficult to navigate these roles and best determine which to utilize within supervision (Bernard & Goodyear, 2019; Nelson et al., 2006). The counselor role may be most familiar, given previous clinical experience, but the consultant and teacher role hold value in striking an “optimal balance between support and challenge” (Bernard & Goodyear, 2019, p. 106) for the CIT. Purposefully integrating the roles of counselor, consultant, and teacher can support doctoral student supervisors in addressing CIT factors, such as resistance, anxiety, and transference, which inherently contribute to a trainee’s experience of VG (Bernard & Goodyear, 2019; Chan & Tin, 2012; Gentry, 2002; Kirchberg et al., 1998).

To facilitate this integration of roles within the context of supervision, it is also crucial to recognize that doctoral student supervisors, early in their own training as clinical supervisors, may struggle with this task (Bernard & Goodyear, 2019; Nelson et al., 2006). In response to COVID-19 impacts to clinical services, doctoral student supervisors may be asked to provide consultation to CITs regarding navigating a client crisis via teletherapy. Overlapping with the role of consultant is also the necessity for doctoral student supervisors to teach CITs about ethical usage of teletherapy platforms for the delivery of clinical services. Further, doctoral student supervisors may recognize the need to provide counseling support to CITs around anxiety that manifests from the plethora of changes in a short period of time. These examples highlight the complex tasks facing doctoral student supervisors in the context of the current COVID-19 pandemic and draw attention to the support doctoral student supervisors may benefit from in order to remain best equipped to meet their CITs’ needs. Group or individual supervision with faculty members or senior clinic staff members may prove useful to provide an opportunity for doctoral student supervisors to examine their perspectives, emotional reactions, and the challenges of their new professional identity, coupled with the potential parallel process of experiencing their own VG through their work with CITs (Trippany et al., 2004).

As supervision provides opportunities for professional and personal growth critical to the learning experience of CITs, doctoral student supervisors must consider how best to support CITs in both of these domains. The bereavement literature suggests that a larger focus is often placed on the development of professional competencies, knowledge, and skills, as compared to an emphasis on the personal nature, or the role of self, in loss and grief (Balk et al., 2007; Stroebe et al., 2008). Thus, it is common for CITs and supervisors alike, particularly those who have not received formal academic instruction on topics of loss and grief, to be less open to topics of death and loss with clients, have less insight into their own beliefs regarding death, and have a greater fear of death (Doughty Horn et al., 2013).

This suggests that for supervisors to effectively address VG within supervision, they should engage in their own self-study of loss and grief to support their acquisition of knowledge and increased personal understanding of responses to death and loss. Because coursework that focuses specifically on loss and grief is not required by CACREP standards (Doughty Horn et al., 2013), it is unlikely that doctoral students coming from master’s programs in counseling or marriage and family therapy have had substantive training specific to loss and grief (Ober et al., 2012). Seeking out learning opportunities will further prepare doctoral student supervisors to embody the roles of counselor, consultant, and teacher to both educate and process their CITs’ reactions related to loss, grief, and death. Much like vicarious trauma has been approached within supervision, doctoral student supervisors who have engaged in the study and self-reflection of loss and grief can serve in the important role of helping CITs “stay in their own chairs” (Rothschild, 2006, p. 201). They can more effectively support identification of CITs’ gaps in knowledge or reactions to the material presented by the client and utilize supervision as a space for both education and emotional processing.

Doctoral student supervisors working with CITs must recognize the inherent challenges CITs may have in sharing clinical and personal information within supervision (Lonn & Haiyasoso, 2016). New counselors may be less aware of their emotional reactions in session (Dowden et al., 2014), further necessitating attention to VG by supervisors. Doctoral student supervisors, in guiding CITs to gain insight into their own reactions, may find benefit in incorporating discussion of countertransference and VG in an effort to differentiate the experiences for CITs. Countertransference—a counselor’s emotional, cognitive, or behavioral reactions that occur in response to the client or clinical content and are rooted in the counselor’s own life and relational experiences (Bernard & Goodyear, 2019; Hayes et al., 2011)—can be understood as distinct from VG, which, adapted from the vicarious trauma literature, is the response to the loss-oriented client material unrelated to personal experiences (Trippany et al., 2004). Although countertransference may also occur for a CIT as it relates to loss and grief, the literature supports the likelihood that as clients experience existential crises of meaning around loss, professional helpers are likely to share in the existential challenges, including the experience of VG (Chan & Tin, 2012). It is beneficial for doctoral student supervisors to support CITs in making this distinction, as each may require different attention within the supervision process.

The COVID-19 pandemic has elicited a surge of global loss, grief, and trauma, increasing the likelihood of supervisors and CITs encountering VG in supervision. Generally speaking, it is important and necessary for doctoral students to attend to the previously mentioned tasks of supporting CITs who may encounter VG, while recognizing the likelihood of a parallel process between supervision and the trainee’s clinical work (Bernard & Goodyear, 2019). Just as it can be hard for a CIT to manage responses to grief, so too may it be challenging for a new supervisor to cope without thorough discussion of loss and grief topics in supervision. Given the current widespread and collective grief specific to COVID-19, and the ubiquity of loss and grief in general, we recommend that counselor education programs help doctoral student supervisors to become more aware of the potential for VG to emerge in supervision. Strategies may include introducing case studies of VG in supervision to support doctoral students in applying strategies and exploring the impacts for themselves and their CITs.

Implications for Training: Doctoral Student Curricular Preparation

A review of the existing literature revealed that there is both minimal research and limited curricular focus on loss and grief education in the profession of counseling (Doughty Horn et al., 2013). Although this conversation has largely focused on master’s-level curricula, it is important to consider the impact of this lack of focus within doctoral education as well. Counselor education doctoral students, lacking education on clinical competencies in loss and grief from within their master’s programs, are preparing themselves to become educators of the next generation of counselors. Therefore, it is imperative that we rectify this lack of competency around loss and grief in order to best meet the moral and ethical obligation of counselors and counselor educators to promote and facilitate client growth both in their own clinical work and through the instruction and supervision of students’ work (Cicchetti et al., 2016).

Doctoral programs, although held by CACREP (2015) standards to include training in counseling, supervision, teaching, research, and advocacy, currently have no requirement to address topics of loss and grief, including VG within these domains. In order to most effectively implement the strategies discussed above, doctoral student supervisors would benefit from more focused training, both to enhance their supervisory competencies and fill gaps within introductory counselor education. Despite the existence of master’s CACREP standards that address life span development issues, there exist no CACREP standards to date that address topics of loss and grief, including VG. Hence, in this article, we examine how VG can perhaps be incorporated into doctoral supervisory curriculum.

Within counselor education doctoral programs, supervision is a core area of counselor educator education and training (CACREP, 2015). Given the ubiquity and salience of grief (Doughty Horn et al., 2013), VG is an arguably crucial phenomenon to be acknowledged and addressed by both CITs and doctoral supervisors. Hence, it is worthwhile to examine the content of courses that meet this standard. Whether a didactic course prior to direct supervisory experience or an experiential course, CACREP (2015) calls for course material to include a variety of components (e.g., purposes of clinical supervision, skills and modalities, ethical responsibilities, culturally relevant strategies). Despite the likelihood of issues of loss and grief to be present in clinical scenarios, CACREP supervision standards remain broad, meaning important topics, like loss and grief, may be neglected in course development and discussion. Just as students build on their prior knowledge of theory, interventions, cultural competence, and trauma-informed practice, so too can loss and grief be discussed as it relates to growing supervision knowledge, skills, and competencies.

The incorporation of these topics into doctoral courses may need to include foundational instruction related to loss and grief to facilitate basic competencies in addition to more complex applications of loss and grief clinical content to supervision frameworks, ethical issues, and modalities of supervision. Counselor educators and doctoral program coordinators may consider integrating VG both to draw attention to the possibility of one’s own encounter with VG as a counselor and counselor educator, and to provide opportunities for processing and self-reflection. Through purposeful instruction and modeling of strategies for supervision, doctoral student supervisors are better equipped not only to manage their own reactions, but also to recognize and facilitate understanding of their CITs’ reactions, ultimately supporting client well-being (Cicchetti et al., 2016). As such, we suggest that faculty of doctoral programs critically examine clinical topics discussed within courses meeting the CACREP supervision standards and purposefully integrate loss, grief, and VG into course content. Further, the use of case studies as a means of illustrating practical strategies that counselors and supervisors can use is a well-documented practice within the counseling scholarship (Kelly, 2016). Hence, in order to support doctoral students in their preparedness to apply the practical strategies discussed in this article, we present a case study as an example that can be used with doctoral students to support their training around VG in supervision.

Case Study
     The following fictional case study illustrates features of VG (i.e., Type 1 and Type 2; Kastenbaum, 1987; Rando, 1997; Sullender, 2010) evident with Cynthia, a CIT, during clinical supervision with a doctoral supervisor. Doctoral supervisors working with CITs experiencing VG are advised to use the information previously outlined to pay attention to the grief reactions presented in the case. Drawing on Bernard and Goodyear’s (1992, 2019) discrimination model, we discuss interventions that supervisors can use to attend to VG in supervision. Supervisor collaboration with practicum instructors to facilitate the management and potential amelioration of VG is also discussed. The case study highlights the important role supervision plays in facilitating the CIT’s awareness about the process of both leaving and returning to one’s “chair” (Rothschild, 2006, p. 201).

The Case of Cynthia
     Cynthia is a master’s-level CIT who is approaching the end of her practicum experience in the midst of COVID-19. During supervision, Cynthia discusses her clients’ experiences with multiple forms of loss and associated grief resulting from the pandemic, ranging from the deaths of loved ones to COVID-19, to job loss, loss of financial security, loss of special plans, loss of social connection, and an overall loss of “normal life” as they knew it. When Cynthia’s supervisor asks her how it has felt for her to help clients process their feelings of grief, Cynthia shares that when her clients share their grief with her, she becomes simultaneously reminded of her own losses (e.g., loss of social connection, daily routine, and normalcy) resulting from the pandemic, as well as her own associated grief response that she finds becomes activated in and outside of session. Cynthia shares that her own grief has been triggered by hearing her clients’ experiences and that her satisfaction with and sense of personal accomplishment surrounding her clinical work is starting to diminish.

Cynthia shares that she has also begun avoiding talking or thinking about their grief-related experiences in session. In supervision, she shares that since the pandemic, she worries that she is not doing enough for her clients and reports feeling a general sense of hopelessness associated with her work with them. Although she feels as though she is hearing her clients share stories about their loss and grief “constantly,” she also indicates that she is trying to stay motivated to continue to work with her clients and believes in her ability to help them. She also reports, however, that bearing continuous witness to their grief, fear, and overall uncertainty associated with the losses they are enduring because of the pandemic is becoming emotionally difficult to manage.

     A Brief Analysis: Type 1 and Type 2 VG. As illustrated above, the case of Cynthia depicts manifestations of Type 1 and Type 2 VG during supervision. First, Type 2 VG is evidenced by Cynthia’s report of being reminded of her own losses following those of her clients and her resulting grief response. Within this instance of Type 2 VG, in response to the reported grief of her clients, Cynthia is reminded of her own losses as well as her own unfinished grieving. Second, Type 1 VG is evidenced by Cynthia’s report that her own grief response has been triggered after hearing her clients’ experiences of grief. Unlike Cynthia’s experience of Type 2 VG, in which her own unfinished grief was elicited, in this instance, Cynthia exclusively feels what it is like to be in the griever’s (i.e., client’s) position. When using a case study such as this with doctoral students, it may be beneficial to have them identify and discuss the types of VG present and begin to process how they might attend to both within supervision.

     Attending to VG in Supervision. According to Bernard and Goodyear (1992, 2019), the three primary roles that are associated with clinical supervision are: counselor, teacher, and consultant. Given that these roles all fall within the domain of supervision, CITs can be afforded a broad variety of developmentally appropriate interventions throughout supervision. In considering common and specific factors of supervisory models, it has been suggested that the supervisory relationship is paramount to positive clinical outcomes (Crunk & Barden, 2017). Doctoral student supervisors, when addressing the intense emotional reactions of VG with their CITs, may benefit from focusing on the quality of the supervisory relationship to encourage openness, honesty, and increased willingness to process feelings of grief related to client work. When using a case study for experiential purposes, doctoral students can be asked to consider how, along with the use of common factors, the trifecta of roles presented by the discrimination model can be called on by supervisors to offer CITs guidance surrounding the challenging terrain of VG, regardless of the supervisor’s theoretical supervisory orientation.

     Counselor. Although the intent is not to provide therapy, doctoral students can consider how the role of counselor remains constant throughout the supervisory relationship and can facilitate CITs’ understanding of and ability to manage their personal feelings and reactions as they emerge throughout their work with clients (Bernard & Goodyear, 2019). Initially, after the origination of the COVID-19 pandemic and its loss-related effects on Cynthia’s clients, Cynthia exhibited VG as well as hopelessness surrounding her clinical work during supervision. By facilitating Cynthia’s processing through reflecting her feelings of hopelessness and asking her to reflect on how her feelings may be affecting her work with clients, the doctoral student supervisor might guide Cynthia in expressing her underlying emotions that are associated with her VG response and impacting her clinical work. Given the potential for CITs to feel challenged in sharing clinical and personal information within supervision (Lonn & Haiyasoso, 2016), doctoral students examining this case study can consider how as a supervisor they might also use a check-in with Cynthia at the beginning of supervision (Doyle, 2017), in order to normalize her personal grief reactions and encourage her to be proactive about self-care surrounding her VG. Furthermore, in the case of COVID-19, this case study can highlight for doctoral students how a supervisor might attend to their own feelings of grief and demonstrate their willingness to model transparency and vulnerability to Cynthia in order to assist her in acknowledging and managing countertransference and VG. Ultimately, in more closely examining the role of counselor, doctoral students can more clearly imagine how they might be able to help Cynthia examine her feelings and emotions associated with her VG to her clients and her clinical work to reduce the potential for disturbance in her therapeutic relationship.

     Teacher. In the role of teacher, the supervisor assumes the primary responsibility for the CIT’s learning (Bernard & Goodyear, 2019). In the case of Cynthia, as teacher, doctoral students can contemplate and discuss how as a supervisor they might work to help her understand her reactions to her clinical work as VG. In addition to providing education about how counselors are called to attend to their clients’ needs during a crisis, the supervisor might also provide Cynthia with psychoeducation about VG, as well as examples of symptoms and information pertaining to distinguishing it from countertransference, compassion fatigue, or burnout. This knowledge would be provided to Cynthia to help normalize and validate manifestations of indirect grief which makes these reactions easier to manage, with the case study providing opportunity for doctoral students to evaluate their own knowledge of these areas and seek support from peers or faculty to grow their knowledge.

Furthermore, doctoral students examining this case study may also be prompted to examine how they could bolster Cynthia’s learning and enhance her preparedness to work with her grieving clients by bringing Cynthia’s experiences to the attention of her practicum instructor. This provides opportunity for doctoral students to consider how to collaborate with faculty so that instructors might provide additional educational support surrounding the concept of VG during group supervision. Through discussion around how to effectively integrate didactic components into the supervisory process and attend to Cynthia’s learning, doctoral students are able to practice how a supervisor can work toward ameliorating a CIT’s VG.

     Consultant. In the role of consultant, the supervisor might work with Cynthia to identify strategies that minimize the impact of VG and allow her to engage in self-care practices. By examining this case study, doctoral students can consider how to balance the teaching role, in which they adopt the role of the expert, with the consultant role, in which the supervisor works to foster Cynthia’s independence, autonomy, and empowerment (Bernard & Goodyear, 2019). Given that Cynthia demonstrated motivation to engage in supervision and learn more about her VG, as consultant, the supervisor might provide her with structured guidance surrounding how to approach her work with clients. Doctoral students may benefit from discussion around how to promote amelioration of Cynthia’s VG through providing her with resources regarding self-regulation and offering to help her brainstorm ways to be more present with her clients in session during discussions of grief. By examining a case study, doctoral students are provided the opportunity to further consider how, as consultant, they might communicate to Cynthia that she handled this situation ethically and professionally by sharing her feelings of VG with the supervisor. 

Limitations
     Given the dearth of research on grief literacy in counselor education and without sufficient standards around loss and grief training for counselors (Doughty Horn et al., 2013; Ober et al., 2012),
our conceptualizations, discussion, and recommendations for doctoral student supervisors and CITs encountering VG in supervision are inherently limited. Thus, we cannot be certain these recommendations would significantly influence the supervisory experience and its effect on client and counselor well-being. We believe there is sufficient evidence within the current literature suggesting that attention to VG within supervision is warranted, but further research is necessary to more completely understand the role of supervision in identifying and managing VG responses.

Further, our exploration of VG is limited to an academic setting as we believe specific attention to these competencies lies in the inclusion of loss and grief training within counselor education (Doughty Horn et al., 2013). However, given the ubiquity of grief in life and within counseling (Chan & Tin, 2012; Doughty Horn et al., 2013; Hill et al., 2018), it would be remiss for us to not acknowledge that this discussion about doctoral student supervisors is just one of many situations in which a counselor or clinical supervisor may find themselves faced with experiences of VG. Our conceptualization of VG and many of our suggestions may even ring true for clinical supervisors at various stages of their career within that role. Further research must consider how supervision occurs in contexts outside of academia and the impact of VG for counselors and supervisors at more advanced stages of their career.

Future Directions
     Given the continued pervasiveness of the COVID-19 pandemic, it is impossible to understand its long-term effects, but the immediate impacts to the profession of counseling speak to the necessity of recognizing reactions to grief within clinical work and supervision. Although the supervision literature abounds with approaches for supervising counselors, as highlighted by this article, the counseling literature lacks empirical studies on VG in supervision, despite its occurrence and impact on clinicians and supervisors alike. In the absence of such research, we call for VG in supervision to be an emerging area of focus for the profession of counseling, particularly within doctoral counselor education.

However, although the scope of this article is aimed at recognizing and managing VG by doctoral student supervisors, it is our hope that drawing attention to the complexities of this experience brings further conversation to experiences of VG in all types of clinical supervision. It is of benefit to all supervisors, doctoral students, and clinicians both new to the role and with seasoned experience that increased attention is directed toward validating specific supervisory techniques developed to attend to counselors’ experience of VG in supervision. It is our goal that this discussion acknowledges the impact of VG on clinicians and promotes further research and development of best practices for managing VG in supervision, both within counselor education and beyond.

Conclusion

CITs and counselor educators face the possibility of experiencing VG in their respective work with clients and CITs who have experienced loss. Counselor educators in supervisory roles can help CITs mitigate VG through facilitating awareness of the impacts of grief-related clinical content into the supervision process and attending to CITs’ unique needs in the roles of teacher, counselor, and consultant. In light of the COVID-19 pandemic and its resulting landscape of increased loss and related mental health needs, it is especially critical for counselor educators and supervisors to be equipped to attend to the needs of CITs who are experiencing VG. In this article, we aimed to address this need by defining VG, discussing its potential impact on CITs and doctoral supervisors, and presenting a case study illustrating interventions that counselor educators can use when addressing VG in supervision.

 

Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.

 

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Samara G. Richmond, MA, MS, NCC, LGPC, is a doctoral candidate at The George Washington University. Amber M. Samuels, MS, NCC, LGPC, is a doctoral candidate at The George Washington University. A. Elizabeth Crunk, PhD, NCC, LGPC, is an assistant professor at The George Washington University. Correspondence may be addressed to Samara G. Richmond, 2136 G St NW, Washington, D.C. 20052, sgelb@gwmail.gwu.edu.

Individual and Relational Predictors of Compassion Fatigue Among Counselors-in-Training

Nesime Can, Joshua C. Watson

 

Scholars have described compassion fatigue as the result of chronic exposure to clients’ suffering and traumatic stories. Counselors can struggle when they experience compassion fatigue because of various reasons. As such, an exploration of factors predictive of compassion fatigue may help counselors and supervisors buffer adverse effects. Utilizing a hierarchical linear regression analysis, we examined the association between wellness, resilience, supervisory working alliance, empathy, and compassion fatigue among 86 counselors-in-training (CITs). The research findings revealed that resilience and wellness were significant predictors of compassion fatigue among CITs, whereas empathy and supervisory working alliance were not. Based on our findings, counselor educators might consider enhancing their current training programs by including discussion topics about wellness and resilience, while supervisors consider practicing wellness and resilience strategies in supervision and developing interventions designed to prevent compassion fatigue.

 

Keywords: compassion fatigue, counselors-in-training, wellness, resilience, supervisory working alliance

 

 

Balancing self-care and client care can be a challenge for many counselors. When counselors neglect self-care, they can become vulnerable to several issues, including increased anxiety, distress, burnout, and compassion fatigue (Ray, Wong, White, & Heaslip, 2013). Counselors might be especially prone to experiencing compassion fatigue because they repeatedly hear traumatic stories and clients’ suffering in sessions (Skovholt & Trotter-Mathison, 2016). This phenomenon is likely pronounced among counselors-in-training (CITs), as lack of experience, skillset, knowledge, and support can lead to struggles when working with clients (Skovholt & Trotter-Mathison, 2016). Coupled with the increased anxiety, distress, and disappointment, CITs can experience compassion fatigue early in their career development, which can lead to exhaustion, disengagement, and a decline in therapeutic effectiveness (Rønnestad & Skovholt, 2013). At this developmental stage, negative experiences can lead to feelings of doubt and a lack of confidence among CITs and potentially lead to career dissatisfaction. Therefore, it is essential and necessary to better understand the predictive factors of compassion fatigue among CITs to prevent its early onset.

 

Compassion Fatigue in Counseling

 

Counselors listening to their clients’ fear, pain, and suffering can feel similar emotions. Figley (1995) defined this experience as compassion fatigue; it also can be defined as the cost of caring (Figley, 2002). Whether working in mental health agencies, schools, or hospital settings, counselors experience compassion fatigue because of exposure to large caseloads, painful stories, and lack of support and resources (Skovholt & Trotter-Mathison, 2016). Despite this exposure, counselors are expected to place their personal feelings aside and provide the best treatment possible in response to the presenting issues and needs of their clients (Figley, 2002; Ray et al., 2013; Turgoose, Glover, Barker, & Maddox, 2017). Maintaining this sense of detached professionalism has its costs, as a number of counselors find themselves at risk for experiencing physical, mental, and emotional exhaustion, as well as feelings of helplessness, isolation, and confusion—a situation collectively referred to as compassion fatigue (Eastwood & Ecklund, 2008; Thompson, Amatea, & Thompson, 2014).

 

Merriman (2015b) stated that ongoing compassion fatigue negatively impacts counselors’ health as well as their relationships with others. Additionally, compassion fatigue can lead to a lack of empathy toward clients, decrease in motivation, and performance drop in effectiveness, making even the smallest tasks seem overwhelming (Merriman, 2015b). When this occurs, counselors can project their anger on others, develop trust issues, and experience feelings of loneliness (Harr, 2013). Therefore, the demands of the counseling profession can affect many counselors’ wellness and potentially could hurt the quality of client care provided (Lawson, Venart, Hazler, & Kottler, 2007; Merriman, 2015a). Further, counselors experiencing compassion fatigue might have difficulties making effective clinical decisions and potentially be at risk for harming clients (Eastwood & Ecklund, 2008). Consequently, scholars appear to agree that compassion fatigue is an occupational hazard that mental health care professionals need to address (Figley, 2002; Merriman, 2015a).

 

Factors Associated With Compassion Fatigue

 

Many researchers have studied the relationships between compassion fatigue and various constructs, such as empathy, gender, mindfulness, support, and wellness (e.g., Beaumont, Durkin, Martin, & Carson, 2016; Caringi et al., 2016; Ray et al., 2013; Sprang, Clark, & Whitt-Woosley, 2007; Turgoose et al., 2017). Researchers conducted most of these studies among novice and veteran mental health professionals. Scant research among CITs exists. Our research attempts to fill this gap by exploring factors affecting CITs given their unique position as both students and emerging professionals. The following review of the literature supports the inclusion of predictor variables used in this study.

 

Empathy and Compassion Fatigue

One of the most widely studied concepts across various cultures is empathy, as it has been determined to be one of the major precipitants of compassion fatigue (Figley, 1995). However, findings in the literature regarding the association between compassion fatigue and empathy remain mixed (e.g., MacRitchie & Leibowitz, 2010; O’Brien & Haaga, 2015; Wagaman, Geiger, Shockley, & Segal, 2015). For instance, O’Brien and Haaga (2015) compared trait empathy and empathic accuracy with compassion fatigue after showing a videotaped trauma self-disclosure among therapist trainees (a combined group of advanced and novice graduate students) and non-therapists. The results indicated that there was no significant association between participants’ levels of compassion fatigue and empathy scores. However, MacRitchie and Leibowitz (2010) found a significant relationship between compassion fatigue and empathy after exploring the relation of these variables on trauma workers whose clients were survivors of violent crimes. The mixed results of these previous studies suggest further research is needed to understand better the relationship between empathy and compassion fatigue and how this relationship impacts counseling practice.

 

Supervisory Working Alliance and Compassion Fatigue

Although reviewed literature addressed studies suggesting supervision and support are related factors to compassion fatigue, research on this relationship is still insufficient. Kapoulitsas and Corcoran (2015) conducted a study and found that a positive supervisory relationship has a significant role in developing resilience and reducing compassion fatigue among counselors. Knight (2010) also found that students uncomfortable talking with their supervisor reported a higher risk for developing compassion fatigue. Additionally, organizational support appears to reduce compassion fatigue, whereas an absence of support increases practitioners’ and interns’ risk of developing compassion fatigue symptoms (Bride, Jones, & MacMaster, 2007). Given the intense need for support and guidance CITs need during their initial work with clients, it is expected that those students who do not actively work with their supervisors can struggle and be more vulnerable for compassion fatigue.

 

Wellness, Resilience, and Compassion Fatigue

Although counselors are encouraged to practice self-care activities to continue to enhance personal well-being (American Counseling Association [ACA], 2014; Coaston, 2017; H. L. Smith, Robinson, & Young, 2008), not all CITs can balance caring for self and others. When CITs do not receive training in the protective factors for compassion fatigue, they risk becoming more vulnerable to violating the ACA code of ethics (Merriman, 2015a; Merriman, 2015b). Kapoulitsas and Corcoran (2015) and Skovholt and Trotter-Mathison (2016) highlighted the importance of resilience and self-care activities as protective factors for compassion fatigue. Wood et al. (2017) evaluated the effectiveness of a mobile application called Provider Resilience to reduce compassion fatigue scores of mental health professionals. After a month of utilization, the results indicated that the application was effective in reducing compassion fatigue. Additionally, Lawson and Myers (2011) conducted a study with professional counselors to examine counselor wellness about compassion fatigue and found a negative correlation between total wellness scores and compassion fatigue scores. As CITs balance academic, family, and work demands, the probability of decreased wellness and a corresponding increase in compassion fatigue exists.

 

Compassion Fatigue Among CITs

 

Most CITs are often unable to master all counselor competencies (Rønnestad & Skovholt, 2013), and therefore they might not know how to deal with possible stressors and the emotional burden of their work (Star, 2013). Although they are learning counseling skills to provide the best care possible to clients, CITs may find themselves working with seriously troubled or traumatized clients without obtaining quality supervision and support (Skovholt & Trotter-Mathison, 2016). Lack of skills and resources increases the likelihood of CITs developing compassion fatigue (Merriman, 2015b). However, there is a lack of focus in compassion fatigue education on preparing CITs to manage compassion fatigue symptoms (Merriman, 2015a). Although scholars have examined compassion fatigue among counselors, there is still a dearth of studies investigating the level of compassion fatigue among CITs and addressing its protective factors within this population (Beaumont et al., 2016; Blount, Bjornsen, & Moore, 2018; Thompson et al., 2014). Subsequently, further research is needed to understand better potential protective factors that can be enhanced to offset the negative impact of compassion fatigue on CITs and the counseling process. Thus, with this study, we aimed at assessing the relationship between resilience, wellness, supervisory working alliance, empathy, and compassion fatigue among CITs in the United States. To accomplish this goal, we sought to answer the following research questions: (1) What is the prevalence of compassion fatigue among CITs? and (2) Do empathy, supervisory working alliance, resilience, and wellness significantly predict levels of compassion fatigue among CITs?

 

Method

 

Participants

Participants recruited for this study consisted of master’s-level counseling students who are at least 18 years of age and enrolled in an internship course in the United States through mostly professional listservs (e.g., Counselor Education and Supervision Network Listserv [CESNET-L], Texas Association for Counselor Education and Supervision Network Listserv [TACESNET-L], Counseling Graduate Student Network [COUNSGRADS]). Because of the impossibility of knowing how many individuals received the email invitation, we were unable to calculate and determine a response rate. Accordingly, a total of 114 CITs initially agreed to participate in this study. Before data analysis, we inspected the data set for possible entry errors and missing data. After the inspection, we excluded 28 participants from all subsequent data analyses resulting in the reduced sample of 86 CITs used to address our research questions. Overall, the sample consisted of 78 female (90.7%) and eight male (9.3%) participants, and the mean age of the participants was 32.89 years (SD = 9.72) with participants’ ages ranging between 21 and 62 years. Participants were from diverse ethnic and racial backgrounds, with the sample consisting of White (n = 48, 55.8%), Hispanic/Latino (n = 18, 20.9%), Black/African American (n = 12, 14.0%), and Asian (n = 5, 5.8%) CITs. Three participants (3.5%) listed their ethnicities as “other” when providing demographic information. Participants reported their program enrollment as follows: clinical mental health counseling program (n = 47, 54.7%); school counseling program (n = 23, 26.7%); marriage, couple, and family counseling program (n = 4, 4.7%); college counseling and student affairs program (n = 3, 3.5%); addiction counseling program (n = 2, 2.3%); and other programs (n = 7, 8.1%). Additionally, most of the participants (n = 73, 84.9%) reported enrollment in a CACREP-accredited program with the remaining participants (n = 13, 15.1%) enrolled in a non–CACREP-accredited program.

 

Procedure

Upon receiving institutional review board approval, we recruited participants from different institutions with the primary researcher contacting professional colleagues at various departments to disseminate the online survey link to potential participants during the 2017 summer and fall semesters. We also recruited participants through professional listservs (e.g., CESNET-L, TACESNET-L, COUNSGRAD), with listserv participants being provided the same informed consent and survey link through a secure website. The survey completion process took approximately 15–20 minutes.

 

Measures

We used the following self-administered survey questionnaires and a separate demographic data sheet in our data collection.

 

     Professional Quality of Life Scale (ProQOL). This scale is designed to measure the mental and emotional consequences of working with individuals who experienced trauma or painful events (Stamm, 2010). The ProQOL includes two main traits, Compassion Satisfaction (positive) and Compassion Fatigue (negative). Compassion Satisfaction is related to the joy individuals develop when they do their work well (Stamm, 2010). Compassion Fatigue consists of two subscales: Secondary Traumatic Stress (STS) and Burnout. Scholars have defined STS as an emotional state that occurs when an individual becomes upset or traumatized as a result of their exposure to victim experiences (Figley, 2002). The second part of Compassion Fatigue is Burnout, which is a multidimensional syndrome related to the social work environment. Burnout could be related to work overload, lack of control, insufficient rewards, unfairness, and value conflict at a workplace (Skovholt & Trotter-Mathison, 2016).

 

The ProQOL is a 30-item Likert-type self-report assessment with responses of never, rarely, sometimes, often, and very often for each item. A sample item is “I feel depressed because of the traumatic experiences of the people I [help].” This assessment has 10 questions per each of three main scales measuring separate constructs. However, the Compassion Fatigue scale includes two of these constructs, which are the Burnout and the STS scales. According to Stamm (2010), the ProQOL has good construct validity, as researchers have noted its efficacy in over 200 published articles. Finally, alpha coefficient values for the Burnout and STS scales were .75 and .81, respectively (Stamm, 2010), and are similar (.72 and .79) to the Cronbach’s alpha values from the current study presented in Table 1.

 

Table 1

Descriptive Statistics of the Study Variables (N = 86)

Range
Variable M SD Min Max Skew α
Compassion Fatigue 41.48 8.03 22 60    .19
BO 21.34 4.38 12 32 .72
STS 20.14 4.96 10 38 .79
Empathy 21.86 4.12   9 28   -.51 .80
Supervisory Working Alliance   5.82   .97   2.16   7  1.26
CF   6.65 1.30   2.17   8.17 .90
R   5.80   .96   2.33   7 .93
Resilience   3.43   .79   1   4.67   -.74 .89
Wellness 47.58 6.23 27 56 -1.39 .86


Note. BO = Burnout; STS = Secondary Traumatic Stress; CF = Client Focus; R = Rapport

 

 

     Interpersonal Reactivity Index (IRI). Davis (1983) developed the IRI to measure the reactions of a person to other individuals’ observed experiences. The 28-item instrument has four subscales: Empathic Concern, Perspective Taking, Fantasy, and Personal Distress (Davis, 1983). Researchers report separate subscale scores, as a total score for the instrument has not been recommended (Davis, 1983). In this study, we only used the Empathic Concern subscale to collect data regarding empathy scores of CITs.

 

Davis (1983) described empathic concern as an emotional response, such as compassion and sympathy, to someone else in need. The 7-item subscale is a self-report assessment with a 5-point Likert-type scale, ranging from Does not describe me well to Describes me very well. A sample item is “I am often quite touched by things that I see happen.” An alpha coefficient of .77 has been reported for the Empathic Concern subscale (Péloquin & Lafontaine, 2010), while the Cronbach’s alpha value of the IRI in the current study was .80.

 

     Supervisory Working Alliance Inventory: Trainee Form (SWAI-T). Efstation, Patton, and Kardash (1990) developed this inventory to measure supervisees’ perceptions about the effectiveness of the working relationship with their supervisors, and we used the SWAI-T to measure the construct of the supervisory working alliance. With a total of 19 items, the self-report assessment includes a 7-point Likert-type scale with responses ranging from almost never to almost always. A sample item is “When correcting my errors with the client, my supervisor offers alternative ways of intervening with the client.” The SWAI-T has two subscales—Client Focus and Rapport—and the Cronbach alpha coefficients of these scales were .77 and .90, respectively (Efstation et al., 1990). For the current study, we calculated Cronbach alpha values of .90 for the Client Focus subscale and .93 for the Rapport subscale. Because some researchers have found high correlations between these two subscales, they decided to combine them in their studies (e.g., Ganske, 2007; White & Queener, 2003). Therefore, in this study, after conducting a correlation analysis with the subscale scores, we also chose to combine subscales as the results of subscale scores were highly correlated.

 

     Brief Resilience Scale (BRS). The BRS was developed to measure a person’s ability to recover from stress and cope with challenging situations (B. W. Smith et al., 2008). The BRS is used to measure the construct of resilience. As a 6-item self-report assessment, the BRS includes a 5-point Likert-type scale with responses ranging from strongly disagree to strongly agree. A sample item is “I usually come through difficult times with little trouble.” B. W. Smith and colleagues (2008) reported that the Cronbach’s alpha values of the BRS range from .80 to .91, and we calculated a Cronbach alpha of .89 for the current study.

 

     Flourishing Scale (FS). The FS was designed to measure individuals’ self-perceived success in areas like optimism and relationships (Diener et al., 2010) and used to measure the construct of wellness in this study. The FS is an 8-item self-report assessment with a 7-point Likert-type scale with responses ranging from strongly disagree to strongly agree (Diener et al., 2010). A sample item is “I lead a purposeful and meaningful life.” Diener and colleagues (2010) reported moderately high reliability with a .87 Cronbach’s alpha coefficient, and in the current study, the FS had a Cronbach alpha of .86.

 

Data Analysis

     Statistical power analysis. We used an a priori type of the G*Power to set the minimum number of participants needed to detect statistical power for this research design. Based on an alpha of .05, a power level of .90, and four predictors (Faul, Erdfelder, Buchner, & Lang, 2009), the computation results suggested that a minimum of 73 participants was required to detect statistical significance with at least a moderate size effect (.15). We had 86 participants, suggesting adequate power.

 

     Preliminary analyses. We analyzed all data using the Statistical Package for the Social Sciences, Version 20 (SPSS; IBM Corporation, 2011). Before addressing our stated research questions, we cleaned the dataset and addressed missing data. We did not observe any pattern between missing data points. Therefore, the type of missing data was completely random, which was addressed using the series of mean function within the SPSS. Next, we calculated descriptive statistics and alpha coefficients for each scale used in the study (see Table 1). Before performing hierarchical regression analyses, we tested all associated model assumptions. First, we examined study variables based on their types and concluded each utilized a continuous scale. We then assessed normality with the Shapiro-Wilk test of normality (W > .05), indicating data was normally distributed for the dependent variable. To identify outliers, we examined boxplots. Although there were a few mild outliers, no extreme scores were detected. We assessed linearity and homoscedasticity through inspection of standardized residual plots. To assess for the assumption of multicollinearity, we examined the correlation matrix of study variables to determine if any correlated highly. According to Field (2013), correlations above .80 are considered high and may indicate the presence of multicollinearity. In the present study, none of the correlation coefficients were above .50 (see Table 2). Collectively, these findings indicated no evidence suggesting any of the model assumptions had been violated. As a result, the dataset was deemed appropriate for analysis using a hierarchical regression design.

 

     Primary analysis. Descriptive statistics were calculated to organize the data by producing means, mode, median, standard deviations, and minimum and maximum scores for the study variables (Field, 2013). Individually, we reviewed descriptive statistics for the compassion fatigue variable, and results were reported to address the first research question. Next, we performed a three-step hierarchical linear regression to address the second research question.

 

Table 2

 

Intercorrelations for Scores on the Study Variables

Variable 1 2 3 4 5
1. ProQOL-CF
2. SWAIT-T   .04
3. IRI-EC  -.06  .04
4. BRS    -.47** -.09 -.11
5. FS    -.45**  .12    .25* .35**


Note. N = 86; ProQOL = Professional Quality of Life (Compassion Fatigue [CF] subscale score is presented); IRI = Interpersonal Reactivity Index (Empathic Concern [EC] subscale score is presented); SWAI-T = Supervisory Working Alliance Inventory: Trainee Form; BRS = Brief Resilience Scale; FS = Flourishing Scale.

*p < .05.  **p < .01.

 

 

 

Results

 

Compassion fatigue scores of CITs represent the sum of scores of all items on the STS and Burnout subscales. According to the ProQOL administration manual (Stamm, 2010), individuals scoring below 22 may indicate little or no issues with Burnout and STS, while scores between 23 and 41 indicate moderate levels of Burnout and STS, and scores above 42 indicate higher levels of Burnout and STS. For this sample, participants’ Burnout scores ranged from 12 to 32 with a mean of 21.34 (SD = 4.38), and STS scores ranged from 10 to 38 with a mean of 20.14 (SD = 4.96). These results indicated a low risk of both Burnout and STS among CITs.

 

To address the second research question, we performed a three-step hierarchical linear regression analysis. With this analysis, we aimed to assess the association between resilience, wellness, supervisory working alliance, empathy, and compassion fatigue. We chose to implement a hierarchical multiple regression analysis because scholars previously have highlighted the essential relationship between empathy, supervision, and compassion fatigue (Figley, 2002; MacRitchie & Leibowitz, 2010). In the first step, empathy scores entered the model as a predictor variable, as Figley (1995) stated that empathy is one of the main factors contributing to compassion fatigue. However, among this sample, we found that empathy was not a significant predictor of compassion fatigue: F(1, 84) = .2, p = .66 , R2 = .002 (adjusted R2 = -.01). Then, we added supervisory working alliance scores to the model in the second step, as both Knight (2010) and Miller and Sprang (2017) emphasized the importance of supervisory support for mental health practitioners. Results revealed that the supervisory working alliance variable also was not a significant predictor of compassion fatigue: F(2, 83) = .16, p = .85, R2 = .004 (adjusted R2 = -.02). In the third step, resilience and wellness scores were entered into the model to determine whether these variables significantly improved the amount of explained variance in compassion fatigue. Results showed that this combination of variables significantly predicted 26% of the variance in compassion fatigue: F(4, 81) = 8.57, p < .001, R2 = .30. Therefore, it was concluded that CITs with greater wellness and resilience reported developing less compassion fatigue (see Table 3).

 

Table 3

Hierarchical Regression Analysis Results for Variables Predicting Compassion Fatigue

Variables B SEB β R2 ΔR2
Step 1 .002 -.01
Empathy   -.09 .21 -.05
Step 2 .004 -.02
Empathy   -.10 .21 -.05
SWA    .33 .91  .04
Step 3 .30*  .26
Empathy   -.03 .19 -.02
SWA    .36 .78  .04
Wellness   -.39 .14  -.30*
Resilience  -3.66     1.05  -.36*


Note. SWA = Supervisory Working Alliance

*p < .05.

 

 

Discussion

 

In this study, CITs reported having a low risk of compassion fatigue. When we examined the Burnout and STS scores separately, the main contributors of compassion fatigue (Stamm, 2010), both subscale scores indicated participants having a low risk for STS and Burnout. This finding is similar to results found by Beaumont and colleagues (2016) in their study of compassion fatigue, burnout, self-compassion, and well-being relationships among student counselors and student cognitive behavioral psychotherapists. According to their research findings, a total of 54 student participants reported high scores on self-compassion and well-being and reported less compassion fatigue and burnout (Beaumont et al., 2016).

 

One of the goals of this study was to seek understanding of whether wellness and resilience explain a statistically significant amount of variance in compassion fatigue among CITs after accounting for empathy and supervisory working alliance. The results indicated that empathy and supervisory working alliance were not significant predictors of compassion fatigue. Regarding empathy and compassion fatigue relation results, the findings of this study did not support Figley’s (1995) assumption of empathy as one of the main contributors to compassion fatigue. This result also is inconsistent with Wagaman and colleagues’ (2015) results indicating a significant association between empathy and compassion fatigue among social workers. However, current results aligned with those studies that found no correlation between empathy and compassion fatigue (e.g., O’Brien & Haaga, 2015; Thomas & Otis, 2010). An explanation of the variability between this inquiry and previous studies might lie with the difference between participants’ field of study and measurement differences. Also, none of the previous studies used CITs solely as their sample, nor used a similar way to measure the construct of empathy. Additionally, CITs would have less experience working with clients compared to experienced counselors, and thus less time for feelings of compassion fatigue to build.

 

Although scholars addressed the importance of supervision and supervisory working alliance to help prevent compassion fatigue (Kapoulitsas & Corcoran, 2015; Merriman, 2015a), this study’s results indicated supervisory working alliance was not a significant predictor of compassion fatigue among CITs. Like current results, Ivicic and Motta (2017) and Williams, Helm, and Clemens (2012) found no statistically significant association between supervisory working alliance and compassion fatigue among mental health practitioners. It is noteworthy that these studies highlighting the importance of supervision and the supervisory relationship are qualitative in design, and participants did not consist solely of CITs. Additionally, their results emphasized the importance of supervision as support to counter the negative impact of trauma exposure (Kapoulitsas & Corcoran, 2015; Ling, Hunter, & Maple, 2014). According to the current study results, CITs did not report experiencing a high level of compassion fatigue. This finding could be interpreted as CITs not yet feeling the need for supervisory support to help with compassion fatigue.

 

Results also indicated that resilience and wellness were significant predictors of compassion fatigue among CITs. In other words, when reflecting on both the regression and correlation results, CITs with greater resilience and wellness reported lower scores of compassion fatigue and these results were consistent with Tosone, Minami, Bettmann, and Jasperson’s (2010) research findings. Regarding a wellness and compassion fatigue relationship, Beaumont and colleagues (2016) conducted a study with student counselors and student cognitive behavioral psychotherapists. The results of Beaumont et al.’s study revealed that individuals with high scores of self-compassion and well-being reported having less compassion fatigue and burnout. Thomas and Morris (2017) also highlighted the significance of self-care and well-being not only for preventing and helping to manage the potentially damaging impact of practice, but also for facilitating the counselor’s personal and professional growth.

 

Implications for Counselor Educators and Supervisors

 

The research findings provide data-driven results regarding compassion fatigue among CITs that have meaningful implications for counselor educators and supervisors. Present study results revealed that CITs indicated experiencing a low risk of compassion fatigue. However, raising awareness on this issue may still help CITs as a preventative measure to cope with possible compassion fatigue experience in the future. To address this issue, counselor educators may consider raising awareness on this topic by reviewing current counseling program curricula to add discussion questions related to compassion fatigue and its empirically predictive factors—wellness and resilience. Roach and Young (2007) stated that students in counseling programs reported group counseling, counseling techniques, legal and ethical issues, practicum, and wellness courses as contributing most to their knowledge and skills regarding wellness. Therefore, counselor educators might use different assignments, including group discussions, projects, and role-playing exercises, to open a discussion about the compassion fatigue phenomenon and the relation with its predictive factors and these courses. Counselor educators may also use the ProQOL scale as an assignment in an assessment and testing course to inform CITs about how to use this instrument as a self-monitoring aid. For example, professional counselors may feel overwhelmed because of working with trauma survivors after graduation and start noticing compassion fatigue symptoms in themselves. These individuals may self-administer the ProQOL scale to determine whether they have developed compassion fatigue. Additionally, in a practicum or an internship course, CITs may fill out the ProQOL as part of their continuing personal wellness plan by comparing personal results over time and sharing their thoughts and reflections about the results.

 

Supervisors need to find ways to raise awareness of compassion fatigue and its protective factors with CITs. For instance, during internship experience, supervisors may develop a site training including compassion fatigue awareness for CITs, as CITs should be prepared for the possible emotional and psychological consequences in working with trauma survivors. Student counselors also should be encouraged to advocate for themselves when they notice symptoms of compassion fatigue. Supervisors might consider the administration of the ProQOL scale regularly to assess both organizational and individual risks (Newell & MacNeil, 2010). Additionally, supervisors can use the ProQOL scale with their supervisees to start a conversation about compassion fatigue. Although the ProQOL is not a diagnostic test, the 30-item self-report scale can be utilized readily as a conversation starter in supervision sessions.

 

The results suggested that empathy and supervisory working alliance did not predict CITs’ compassion fatigue level. However, wellness and resilience are significantly related to contributing to it. Therefore, both counselor educators and supervisors might consider enhancing CITs’ resilience and wellness a worthwhile endeavor. For example, Miller and Sprang (2017) developed a component-based practice and supervision model to reduce compassion fatigue for use in training, supervision, and clinical practice. A tool like this one can be added to existing training curricula and supervision practice to improve CITs’ resilience and wellness.

 

Limitations

The results of this study aim to provide greater clarity regarding the predictive factors of compassion fatigue among CITs. However, interpretation of results should take into consideration the limitations that emerged because of uncontrollable influences and choices we made. The study was limited in its ability to represent all CITs throughout the United States, as we utilized a convenience sampling approach. Additionally, we gathered data through self-report questionnaires, which introduce the possibility of response bias in the findings. Although we assumed participants answered each question honestly, they might not have been honest in their responses because of the fear of being perceived as weak or less competent. It is important to note that being in an internship class might also increase participants’ interest in the profession as they currently are engaged in the practice of counseling. Therefore, participants might have had a higher level of enthusiasm and reported less compassion fatigue. Also, individuals who suffer from compassion fatigue might have preferred not to respond to these items. Finally, although participants were enrolled in an internship class, each participant may have different numbers of hours of client experience.

 

Future Directions for Research

Additional research should be conducted to expand and clarify the current research findings of compassion fatigue among CITs. A phenomenological study using a qualitative research method is recommended to expand the findings of this current study. Future researchers may use the ProQOL scale to assess CITs’ level of compassion fatigue and then conduct interviews with the volunteer participants reporting a higher level of compassion fatigue to better understand CITs’ experience with compassion fatigue and its contributing factors. The data collected through a qualitative study may provide greater insight into the phenomenon of compassion fatigue among CITs. Additionally, researchers can replicate the present study with early-career counselors who have recently graduated, because of the noted intensity of those first years after graduation (Skovholt & Trotter-Mathison, 2016). Therefore, future researchers exploring novice counselors’ experiences with compassion fatigue will help counselor educators and supervisors better understand when counselors may start developing compassion fatigue symptoms, as well as how they cope with the symptoms.

 

Conclusion

 

CITs may struggle when they continuously hear painful stories of clients because of a lack of experience, skillset, or support (Skovholt & Trotter-Mathison, 2016). Researchers have described this experience as compassion fatigue. With this study, we aimed to provide a better understanding of the predictive factors of compassion fatigue among CITs. Using data-driven research results to determine ways to work with CITs on compassion fatigue and its predictive factors can be beneficial in preventing compassion fatigue symptoms from an early onset. CITs may take precautionary measures to ensure they remain enthusiastic and energized by the work they do. Further, implications of the current study may help CITs start their professional careers better prepared to provide their clients with the optimal care needed throughout the counseling relationship by minimizing compassion fatigue.

 

 

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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Nesime Can is an instructor at Ankara University in Turkey. Joshua C. Watson, NCC, is a professor and department chair at Texas A&M University–Corpus Christi. Correspondence can be addressed to Nesime Can, Ankara University Faculty of Educational Sciences, Department of Educational Sciences, Program of Counseling and Guidance, Office 3111, Çankaya, Ankara, Turkey 06590, nesime.can@ankara.edu.tr.