counselors-in-training - The Professional Counselor

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

Nov 10, 2018 | Volume 8 - Issue 4

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

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

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

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

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

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

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

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

Empathy in Counseling

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

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

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

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

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

Methods

Participants

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

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

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

Table 1

Participants’ Demographic Characteristics

Characteristic		n	Total %
Age	18–19	460	52.4
	20–21	155	17.9
	22–23	130	15.0
	24–25	58	6.7
	26–27	36	4.1
	28–29	27	3.1
Gender	Female	692	79.7
	Male	167	19.2
	Other	8	0.9
Racial	Caucasian	624	71.9
Background	African American/African/Black	101	11.6
	Biracial/Multiracial	65	7.5
	Asian/Asian American	40	4.6
	Native American	3	0.3
	Other	25	2.9
Ethnicity	Hispanic	172	19.8
	Non-Hispanic	689	79.4
Academic	Undergraduate	709	81.7
Enrollment	Graduate	152	17.5
	Other	5	0.6
Academic Major	Athletic Training/Health Sciences	115	13.2
	Biology/Biomedical Sciences/Preclinical Health Sciences	167	19.2
	Counseling	153	17.6
	Communication	163	18.8
	Nursing	128	14.7
	Psychology	142	16.4

Note. N

= 868.

Procedure

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

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

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

Data Instrumentation

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

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

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

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

Data Screening

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

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

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

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

Table 2

AMES Scores by Academic Major

Scale	Mean (M)	SD	Range
Athletic Training
Affective Empathy	3.20	0.80	4.00
Cognitive Empathy	3.80	0.62	3.33
Sympathy	4.34	0.55	2.67
Biomedical Sciences
Affective Empathy	3.12	0.76	4.00
Cognitive Empathy	3.66	0.59	3.00
Sympathy	4.30	0.61	2.00
Communication
Affective Empathy	3.18	0.87	4.00
Cognitive Empathy	3.80	0.62	2.67
Sympathy	4.27	0.69	3.00
Counseling
Affective Empathy	3.32	0.60	3.33
Cognitive Empathy	3.83	0.48	4.00
Sympathy	4.32	0.54	2.00
Nursing
Affective Empathy	3.37	0.71	3.67
Cognitive Empathy	3.80	0.59	2.67
Sympathy	4.46	0.49	2.00
Psychology
Affective Empathy	3.28	0.78	4.00
Cognitive Empathy	3.86	0.59	2.67
Sympathy	4.35	0.65	2.67

Note. N
= 868.

Results

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

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

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

Discussion

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

Implications for Counselor Educators

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

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

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

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

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

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

Limitations

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

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

Recommendations for Future Research

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

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

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

Conflict of Interest and Funding Disclosure

The authors reported no conflict of interest

or funding contributions for the development

of this manuscript.

References

Badenoch, B. (2008). Being a brain-wise therapist: A practical guide to interpersonal neurobiology. New York, NY:
W. W. Norton & Company, Inc.

Barrett-Lennard, G. T. (1986). The Relationship Inventory now: Issues and advances in theory, method, and use. In L. S. Greenberg & W. M. Pinsof (Eds.), The psychotherapeutic process: A research handbook (pp. 439–476). New York, NY: Guilford Press.

Batson, C. D., & Shaw, L. L. (1991). Evidence for altruism: Toward a pluralism of prosocial motives. Psychological Inquiry, 2(2), 107–122. doi:10.1207/s15327965pli0202_1

Bayne, H. B., & Jangha, A. (2016). Utilizing improvisation to teach empathy skills in counselor education. Counselor Education and Supervision, 55(4), 250–262. doi:10.1002/ceas.12052

Beder, J. (2004). Lessons about bereavement. Journal of Loss & Trauma, 9, 383–387. doi:10.1080/15325020490491014

Bell, H., Hagedorn, W. B., & Robinson, E. H. M. (2016). An exploration of supervisory and therapeutic relationships and client outcomes. Counselor Education and Supervision, 55(3), 182–197. doi:10.1002/ceas.12044

Bloom, Z. D., & Lambie, G. W. (in press). The Adolescent Measure of Empathy and Sympathy in a sample of emerging adults. Measurement and Evaluation in Counseling and Development.

Bohart, A. C., Elliott, R., Greenberg, L. S., & Watson, J. C. (2002). Empathy. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 89–108). New York, NY: Oxford University Press.

Carré, A., Stefaniak, N., D’Ambrosio, F., Bensalah, L., & Besche-Richard, C. (2013). The Basic Empathy Scale in Adults (BES-A): Factor structure of a revised form. Psychological Assessment, 25, 679–691.
doi:10.1037/a0032297

Clark, A. J. (2004). Empathy: Implications of three ways of knowing in counseling. The Journal of Humanistic Counseling, Education & Development, 43, 141–151. doi:10.1002/j.2164-490X.2004.tb00014.x

Clark, A. J. (2010). Empathy and sympathy: Therapeutic distinctions in counseling. Journal of Mental Health Counseling, 32(2), 95–101. doi:10.17744/mehc.32.2.228n116thw397504

Connors, G. J., Carroll, K. M., DiClemente, C. C., Longabaugh, R., & Donovan, D. M. (1997). The therapeutic alliance and its relationship to alcoholism treatment participation and outcome. Journal of Consulting and Clinical Psychology, 65, 588–598. doi:10.1037/0022-006X.65.4.588

Council for Accreditation of Counseling and Related Educational Programs. (2016). 2016 Standards. Alexandria,
VA: Author.

Davis, M. H. (1980). A multidimensional approach to individual differences in empathy. JSAS Catalog of Selected Documents in Psychology, 10, 85.

Davis, M. H. (1983). Measuring individual differences in empathy: Evidence for a multidimensional approach. Journal of Personality and Social Psychology, 44, 113–126. doi:10.1037/0022-3514.44.1.113

Decety, J., & Ickes, W. (Eds.). (2009). The social neuroscience of empathy. Cambridge, MA: MIT Press.

DePue, M. K., & Lambie, G. W. (2014). Impact of a university-based practicum experience on counseling students’ levels of empathy and assessed counseling competences. Counseling Outcome Research and Evaluation, 5(2), 89–101. doi:10.1177/2150137814548509

Dillman, D. A., Smyth, J. D., & Christian, L. M. (2009). Internet, mail, and mixed-mode surveys: The tailored design method (3rd ed.). Hoboken, NJ: Wiley.

Eisenberg, N., Eggum, N. D., & Di Giunta, L. (2010). Empathy-related responding: Associations with prosocial behavior, aggression, and intergroup relations. Social Issues and Policy Review, 4, 143–180.
doi:10.1111/j.1751-2409.2010.01020.x

Elliott, R., Bohart, A. C., Watson, J. C., & Greenberg, L. S. (2011). Empathy. Psychotherapy, 48, 43–49.
doi:10.1037/a0022187

Flasch, P. S., Limberg-Ohrt, D., Fox, J., Ohrt, J., Crunk, E., & Robinson, E. (in press). Experiences of altruistic caring by clients and their counselors in the counseling session. Counseling & Values Journal.

Gall, M. D., Gall, J. P., & Borg, W. R. (2007). Educational research: An introduction (8th ed.). Boston, MA: Allyn & Bacon.

Goleman, D. (1995). Emotional intelligence: Why it can matter more than IQ for character, health and lifelong achievement. New York, NY: Bantam Books.

Hair, J. F., Jr., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate data analysis (7th ed.). Upper Saddle River, NJ: Prentice Hall.

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

Ivey, A. E., Normington, C. J., Miller, C. D., Morrill, W. H., & Haase, R. F. (1968). Microcounseling and attending behavior: An approach to prepracticum counselor training. Journal of Counseling Psychology, 15(5), 1–12.

Jolliffe, D., & Farrington, D. P. (2006). Development and validation of the Basic Empathy Scale. Journal of Adolescence, 29, 589–611. doi:10.1016/j.adolescence.205.08.010

Kirchberg, T. M., Neimeyer, R. A., & James, R. K. (1998). Beginning counselors’ death concerns and empathic responses to client situations involving death and grief. Death Studies, 22(2), 99–120.

Kline, R. B. (2011). Principles and practice of structural equation modeling (3rd ed.). New York, NY: Guilford Press.

Konrath, S. H., O’Brien, E. H., & Hsing, C. (2011). Changes in dispositional empathy in American college
students over time: A meta-analysis. Personality and Social Psychology Review, 15, 180–198. doi:10.1177/1088868310377395

Krupnick, J. L., Sotsky, S. M., Simmens, S., Moyer, J., Elkin, I., Watkins, J., & Pilkonis, P. A. (1996). The role of a therapeutic alliance in psychotherapy and pharmacotherapy outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 64, 532–539.

Lam, T. C. M., Kolomitro, K., & Alamparambil, F. C. (2011). Empathy training: Methods, evaluation practices, and validity. Journal of Multidisciplinary Evaluation, 7(16), 162–200.

Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38, 357–361. doi:10.1037/0033-3204.38.4.357

Lambert, M. J., & Bergin, A. E. (1994). The effectiveness of psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed.; pp. 143–189). Oxford, England: John Wiley & Sons.

McGuire, A. M. (2003). “It was nothing”: Extending evolutionary models of altruism by two social cognitive biases in judgment of the costs and benefits of helping. Social Cognition, 21, 363–394.
doi:10.1521/soco.21.5.363.28685

McWhirter, B. T., Besett-Alesch, T. M., Horibata, J., & Gat, I. (2002). Loneliness in high risk adolescents: The role of coping, self-esteem, and empathy. Journal of Youth Studies, 5, 69–84. doi:10.1080/13676260120111779

Norcross, J. C. (Ed.). (2011). Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.). New York, NY: Oxford University Press.

Norcross, J. C., & Lambert, M. J. (2011). Psychotherapy relationships that work II. Psychotherapy: Theory, Research, Practice, Training, 48, 4–8.

Osborne, J. W. (2013). Best practices in data cleaning: A complete guide to everything you need to do before and after collecting your data. Thousand Oaks, CA: Sage.

Qualtrics. (2013). Qualtrics software (Version 37,892) [Computer software]. Provo, UT: Qualtrics Research Suite.

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

Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 95–103. doi:10.1037/h0045357

Sachse, R., & Elliott, R. (2002). Process–outcome research on humanistic therapy variables. In D. J. Cain & J. Seeman (Eds.), Humanistic psychotherapies: Handbook of research and practice (pp. 83–115). Washington, DC: American Psychological Association.

Siegel, D. J. (2010). Mindsight: The new science of personal transformation. New York: Bantam.

Silva, N. W. (2001). Effect of empathy training on masters-level counseling students. (Unpublished doctoral dissertation). University of Florida, Gainesville, FL.

Spreng, R. N., McKinnon, M. C., Mar, R. A., & Levine, B. (2009). The Toronto Empathy Questionnaire: Scale development and initial validation of a factor-analytic solution to multiple empathy measures. Journal of Personality Assessment, 91, 62–71. doi:10.1080/00223890802484381

Stoltenberg, C. (1981). Approaching supervision from a developmental perspective: The counselor complexity model. Journal of Counseling Psychology, 28, 59–65. doi:10.1037/0022-0167.28.1.59

Stoltenberg, C. D., & McNeill, B. W. (2010). IDM supervision: An integrative developmental model for supervising counselors & therapists (3rd ed.). New York, NY: Routledge.

Szalavitz, M., & Perry, B. D. (2010). Born for love: Why empathy is essential—and endangered. New York, NY: Harper Collins.

Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics (6th ed). Upper Saddle River, NJ: Pearson.

Teding van Berkhout, E., & Malouff, J. M. (2016). The efficacy of empathy training: A meta-analysis of randomized controlled trials. Journal of Counseling Psychology, 63, 32–41. doi:10.1037/cou0000093

Truax, C. B., & Carkhuff, R. R. (1967). Toward effective counseling and psychotherapy: Training and practice. Chicago, IL: Aldine Publishing.

Truax, C. B., & Lister, J. L. (1971). Effects of short-term training upon accurate empathy and non-possessive warmth. Counselor Education and Supervision, 10(2), 120–125. doi:10.1002/j.1556-6978.1971.tb01430.x

Vossen, H. G. M., Piotrowski, J. T., & Valkenburg, P. M. (2015). Development of the Adolescent Measure of Empathy and Sympathy (AMES). Personality and Individual Differences, 74, 66–71.
doi:10.1016/j.paid.2014.09.040

Watson, J. C., Steckley, P. L., & McMullen, E. J. (2014). The role of empathy in promoting change. Psychotherapy Research, 24, 286–298. doi:10.1080/10503307.2013.802823

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

Counselor-in-Training Intentional Nondisclosure in Onsite Supervision: A Content Analysis

Jun 28, 2018 | Volume 8 - Issue 2

Ryan M. Cook, Laura E. Welfare, Devon E. Romero

Studies from allied professions suggest that intentional nondisclosure in clinical supervision is common; however, the types of intentional nondisclosure and reasons for nondisclosure have yet to be examined in an adequate sample of counselors-in-training (CITs). The current study examined intentional nondisclosure by CITs during their onsite supervision experience. We utilized content analysis to examine examples of intentional nondisclosure. Sixty-six participants provided examples of intentionally withholding information from their supervisors they perceived as significant. The most common types of information withheld were negative reactions to supervisors, general client observations, and clinical mistakes. The most common reasons cited were impression management, perceived unimportance, negative feelings, and supervisor incompetence. We offer implications for both supervisees and supervisors on how they might mitigate intentional nondisclosure; for example, we present strategies to address ineffective or harmful supervision, discuss techniques to openly address intentional nondisclosure, and explore ways to integrate training on best practices in clinical supervision.

Keywords: intentional nondisclosure, counselors-in-training, supervision, content analysis, best practices in clinical supervision

Counselors-in-training (CITs) in programs accredited by the Council for Accreditation of Counseling & Related Educational Programs (CACREP) are required to complete two supervised onsite field experiences (i.e., practicum and internship) in their area of interest (e.g., clinical mental health, school, rehabilitation; CACREP, 2015). The purpose of this onsite field experience is for CITs to learn the roles and responsibilities of being a professional counselor by applying what they learn in their training programs to their work in a counseling setting (CACREP, 2015). Given CITs’ limited clinical experience, onsite supervisors provide weekly supervision to aid CITs in their professional development (Borders et al., 2011; Borders et al., 2014). Although supervision is a unique opportunity, CITs receive problematic mixed messages about the expectations of the supervisory process (Borders, 2009). CITs are encouraged to discuss the topics and concerns that are the most important to their professional growth (Bordin, 1983), but the information shared is then used by their supervisors to evaluate their clinical performance (Bernard & Goodyear, 2014). These evaluations have a definitive impact on CITs’ ability to pass a practicum or internship course or graduate (CACREP, 2015) and subsequently secure employment in the counseling field. Thus, it is not surprising that studies in allied professions (e.g., clinical psychology, counseling psychology, social work) have shown that trainees commonly withhold potentially unflattering information from their supervisors (Hess et al., 2008; Ladany, Hill, Corbett, & Nutt, 1996; Mehr, Ladany, & Caskie, 2010, 2015; Pisani, 2005). While CITs’ concern to maintain a favorable image in the eyes of their supervisor is understandable, withholding information can result in missed learning opportunities for CITs and negatively impact their clients (Hess et al., 2008).

To date, only two studies have examined supervisee intentional nondisclosure in a sample of counselor education students (Cook & Welfare, 2018; Lonn & Juhnke, 2017). However, neither study examined specific examples of the types and reasons of CIT nondisclosure during onsite supervision. Counselors submit to a unique training model, with specific requirements and goals for master’s-level counselors (e.g., CACREP, 2015). CITs enrolled in CACREP-accredited programs can specialize in one of seven tracks: (a) addictions counseling; (b) career counseling; (c) clinical mental health counseling; (d) clinical rehabilitation counseling; (e) college counseling and student affairs; (f) marriage, couple, and family counseling; (g) school counseling; and (h) rehabilitation counseling. As a result, CITs work in diverse settings with a wide variety of responsibilities that are unique to the counseling profession (CACREP, 2015; Lawson, 2016). Without a study focused on CITs’ experiences in onsite supervision, CITs and supervisors must rely on findings from allied professions that may or may not reflect the counseling training model. Thus, in the current study we aimed to examine the types of intentional nondisclosure and the reasons for the nondisclosure during CITs’ supervised onsite field experience.

Supervised Onsite Field Experience in CACREP-Accredited Programs

Given the growing importance of attending a CACREP-accredited program as an educational requirement for professional counselors (Lawson, 2016), we chose to specifically target intentional nondisclosure by CITs enrolled in CACREP-accredited training programs. State licensure boards are encouraging or mandating that those pursuing professional licensure as counselors must have a degree from a CACREP-accredited program (Lawson, 2016). Additionally, as of January 1, 2022, those applying to be National Certified Counselors (NCCs) will need to graduate from a CACREP-accredited program (National Board for Certified Counselors, 2014). Thus, the standards for onsite field experiences outlined in the 2016 CACREP Standards provide clear guidelines for counselor training. Furthermore, the activities during the onsite field experience are designed to mimic those of a professional counselor in the field (CACREP, 2015). Exploring CIT intentional nondisclosure within the CACREP educational structure can help to inform best practices in counselor training.

Intentional Nondisclosure in Clinical Supervision

The supervision process is reliant on CITs to self-identify important information to share with their supervisors (Ladany et al., 1996); however, identifying this important information is not always clear to CITs given the intricacies of the client–counselor relationship (Farber, 2006; Knox, 2015). Farber (2006) suggested that some nondisclosure “is normative and unavoidable in supervision” (p. 181). Yet, there are instances in which CITs purposefully withhold information they know is relevant because of concerns for what could happen if they shared the information with their supervisor (Hess et al., 2008; Yourman & Farber, 1996).

So why would CITs, who are held to the same ethical standards as practicing counselors (American Counseling Association [ACA], 2014), knowingly choose to withhold information that could be harmful to their professional development or their clients’ treatment? During an onsite field experience, CITs learn the day-to-day tasks of being a professional counselor (e.g., establishing rapport, planning treatment, managing paperwork), but they also must meet the demands of their graduate training programs. Most CITs want to perform counselor functions at a high level, if not perfectly (Rønnestad & Skovholt, 2003). Avoiding clinical mistakes is a dubious belief that CITs hold for themselves (Knox, 2015). These high expectations create a reasonable desire to present oneself favorably to their supervisors, even though supervisors know that perfection is impossible (Farber, 2006). Moreover, CITs are told to share information that is most salient to their personal and professional development with their supervisors, but disclosing information that may be potentially unflattering or embarrassing can then be used by supervisors to evaluate performance (Borders, 2009).

Types and Reasons for Intentional Nondisclosure

In a seminal study on intentional nondisclosure, Ladany et al. (1996) investigated the types and reasons for nondisclosure in a sample of clinical and counseling psychology trainees. Participants were asked to identify instances in which they withheld information from their supervisors and then provide a rationale for why they failed to share that information. The authors found that 97.2% of the participants withheld information from their supervisors.

Through categorizing the content of the nondisclosures, Ladany et al. identified 13 types of nondisclosure, providing definitions and examples of each type: (a) negative reactions to supervisor (e.g., unfavorable thoughts or feelings about supervisors or their actions); (b) personal issues (e.g., information about an individual’s personal life that may not be relevant); (c) clinical mistakes (e.g., an error made by a counselor); (d) evaluation concerns (e.g., worry about the supervisor’s evaluation);
(e) general client observations (e.g., reactions about the client or client treatment); (f) negative reactions to client (e.g., unfavorable thoughts or feelings about clients or clients’ actions); (g) countertransference (e.g., seeing oneself as similar to the client); (h) client–counselor attraction issues (e.g., sexual attraction between client and counselor); (i) positive reactions to supervisor (e.g., favorable thoughts or feelings about supervisors or their actions); (j) supervision setting concerns (e.g., concerns about the placement or tasks required at placement); (k) supervisor appearance (e.g., reactions to supervisor’s outward appearance); (l) supervisee–supervisor attraction issues (e.g., sexual attraction between supervisee and supervisor); and (m) positive reactions to client (e.g., favorable thoughts or feelings about clients or their actions).

They also identified 11 reasons for intentional nondisclosure: (a) perceived unimportance (e.g., information not worth discussing with supervisor); (b) too personal (e.g., information about one’s personal life that is private); (c) negative feelings (e.g., embarrassment, shame, anxiety); (d) poor alliance with supervisor (e.g., poor working relationship with supervisor); (e) deference (e.g., inappropriate for a counselor to bring up because of their role as intern or supervisee); (f) impression management (e.g., desire to be perceived favorably by supervisor); (g) supervisor agenda (e.g., supervisor’s views, roles, and beliefs that guide supervisor’s actions or reactions to supervisee); (h) political suicide (e.g., fear that the disclosure will be disruptive in the workplace and lead to the supervisee being unwelcome or unsupported); (i) pointlessness (e.g., addressing the issue would not influence change); (j) supervisor not competent (e.g., supervisor is inaccessible or unfit for supervisory role); and (k) unclear (e.g., researchers unable to read participants’ statements). The most common types of intentional nondisclosure in the study by Ladany et al. (1996) were negative reactions to supervisor, CITs’ personal issues, clinical mistakes, and evaluation concerns, while the most common reasons for the nondisclosures were perceived unimportance, too personal, negative feelings, and a poor alliance with the supervisor.

Subsequent studies, also from allied professions (e.g., social work, clinical psychology), have found similar results in regard to the types and reasons for intentional nondisclosure (Hess et al., 2008; Mehr et al., 2010; Pisani, 2005). Mehr and colleagues (2010) found 84.2% of psychology trainees reported withholding information from their supervisors, and the most common types of nondisclosures were negative perception of supervision, personal life concerns, and negative perception of the supervisor, while the most common reasons for nondisclosure were impression management, deference, and fear of negative consequences. Additionally, Pisani (2005) found the most commonly withheld information for social work trainees included supervisor–supervisee attraction issues, negative reactions to supervisor, and supervision setting concerns. Finally, in a qualitative study, Hess et al. (2008) explored the differences in a single example of intentional nondisclosure based on psychology trainees’ perceptions of the quality of the supervisory relationship—for example, good (i.e., only one instance of a problem in the supervisory relationship) versus problematic supervisory relationships (i.e., ongoing issues in the supervisory relationship). They found that supervisees in both good and problematic supervisory relationships withheld information about client-related issues. However, supervisees in problematic relationships more commonly withheld supervision-related concerns (e.g., negative reactions to supervisor) compared to supervisees in good relationships. The findings described above provide empirical evidence that nondisclosure in allied professions is common.

The Current Study

Although there is evidence that supervisees from allied professions withhold information, there is currently a dearth of literature regarding intentional nondisclosure by CITs in the field of counseling. Cook and Welfare (2018) found that the quality of the supervisory working alliance and supervisee avoidant attachment style predicted supervisee nondisclosure. In a qualitative study, Lonn and Juhnke (2017) examined supervisee nondisclosure in triadic supervision. They found that the supervisee’s perception of their relationships, the presence of a peer, and opportunity to share were important to whether supervisees withheld information. However, these studies failed to examine the types of information being withheld by CITs as well as their reason for withholding information. Considering that professional counselors have a unique training model (CACREP, 2015), professional identity (Lawson, 2016), and code of ethics (ACA, 2014), the purpose of the current study was to examine the types and reasons of intentional nondisclosure by CITs during their supervised onsite internship experience.

Method

We utilized content analysis (Hsieh & Shannon, 2005) to examine the examples of intentional nondisclosures provided by CITs that occurred in supervision with their onsite internship supervisors. Hsieh and Shannon (2005) defined qualitative content analysis as “a research method for the subjective interpretation of the content of text data through the systematic classification process of coding and identifying themes or patterns” (p. 1278). Our analysis was guided by the findings from Ladany et al. (1996), which allowed us to compare the findings from the current study with those from allied professions while also examining how the phenomenon of intentional nondisclosure might present uniquely in the counseling profession (Hsieh & Shannon, 2005). The current study was designed to answer two research questions: (a) What are the types of information that CITs intentionally withhold from their supervisors during their internship’s onsite supervision? and (b) What are the reasons for their nondisclosure?

Research Team

Our research team included three members. The first and third authors served as coders while the second author served as a peer reviewer. The first and second authors are counselor educators at different universities in the Southeast United States, and the third author was a doctoral student at the same institution as the first author. We all have experience as professional counselors, supervisees, supervisors, and researchers; consequently, we have experienced all parts of the nondisclosure cycle. Prior to the analysis process, we discussed how our previous experiences might impact the analysis. Likewise, we intentionally discussed and bracketed potential influences of bias throughout the project. We also employed triangulation (e.g., multiple coders), utilized frequent peer debriefs, and employed a peer reviewer (Creswell, 2013). Our items also were reviewed by four consultants with counseling, supervision, and research experience to minimize bias and maximize clarity.

Recruitment Procedure and Participants

After securing IRB approval, we recruited participants currently enrolled in internship for the current study through the assistance of counselor education faculty at CACREP-accredited institutions. Fifteen counselor educators at 14 institutions offered paper-and-pencil instrument packets to CITs during one of their class periods. As indicated by the key informants, 152 of the 173 CITs present in class on the day the packets were offered agreed to participate in the study. This resulted in an in-class response rate of 87.86%.

Participants were CITs currently enrolled in internship in a CACREP-accredited program and receiving supervision at their internship sites. The age of the participants ranged from 22 to 60 years old (M = 28.13, SD = 7.43, n = 107). Eighty-eight participants identified as female (80%), 17 participants identified as male (15.5%), three participants identified as nonbinary (gender identity not male and not female, 2.7%), and two participants indicated that they did not want to disclose their gender (1.8%). Regarding race, the majority of participants identified as White (non-Hispanic; n = 71, 64.5%), while 23 participants identified as African American (20.9%), four participants identified as Asian/Pacific Islander (3.6%), three participants identified as Hispanic/Latinx (2.7%), three participants identified as multiracial (2.7%), one participant identified as Native American (0.9%), one participant responded “none of the above categories” (0.9%), and four participants responded that they preferred not to disclose (3.6%). Regarding CACREP track, 64 participants were enrolled in a clinical mental health counseling track (58.2%), 32 participants were enrolled in a school counseling track (29.1%), nine were enrolled in a college counseling and students affairs track (8.2%), and five were enrolled in a marriage, couples, and family track (4.5%).

Instrument

The instrument was designed to gather information about participants’ experiences with their current onsite internship supervisors. Two items were the focus of this study: (a) “Describe a time when you decided not to share something you thought was significant with your current onsite internship supervisor” and (b) “What brought you to that decision to not share it with your current onsite internship supervisor?” In addition, the questionnaire included 15 items to collect demographic information about the participants and their current onsite internship supervisors. Of the 152 participants who began participation, 42 participants (27.6%) were removed from the analysis as they did not complete the open-ended questions, resulting in a final sample of 110 participants. We utilized the demographic variables to check for evidence of nonresponse bias using Chi-square tests of independence and independent t-tests. We did not find evidence of response bias when comparing those who answered the open-ended questions and those who did not.

Data Analysis

We analyzed participants’ responses to the open-ended questions utilizing content analysis. We categorized the types of intentional nondisclosure and the reasons for nondisclosure into categories as recommended by Hsieh and Shannon (2005). For our analysis, we utilized the types of nondisclosure and the reasons for nondisclosure originally identified by Ladany et al. (1996). To reiterate, Ladany et al. identified 13 types of intentional nondisclosure and 11 reasons for nondisclosure (1996). Also, as recommended by Hsieh and Shannon (2005), we allowed for new categories to emerge that did not fit within the categories from Ladany et al. The rationale for this approach was two-fold. First, we could best understand the phenomenon of intentional nondisclosure by comparing our findings to that of previous research from allied professions, while also generating new knowledge of how nondisclosure might uniquely manifest in the counseling profession (Lawson, 2016). Second, utilizing previous research provided structure to our coding procedures and informed the researchers’ interpretation of participant responses (Hsieh & Shannon, 2005).

Coding process. The first and third authors coded the responses of 110 participants for (a) whether or not the participant identified an incident of intentional nondisclosure and (b) to categorize the participant responses that indicated intentional nondisclosure by the type and reasons for the nondisclosure. Each response was coded into one category of type of nondisclosure and one category of reason for the nondisclosure. First, the two coders selected 10 participant responses and coded them as a team. Next, the two coders selected an additional 10 participant responses and coded them independently of each other. They then came together to reach a consensus on the categorization of participant responses. The remaining 90 participant responses were coded independently, and the two coders regularly engaged in peer debriefings throughout the process to ensure consistency (Creswell, 2013). After all 110 participant responses were analyzed, the first and third authors met to finalize the categorization of participant responses and to generate names for the new categories that emerged during the analysis (Hsieh & Shannon, 2005). Regarding the categorization of participant responses in terms of the participant-identified incident of intentional nondisclosure, the coders’ agreement was 100%. Regarding the types and reasons for the nondisclosure, the coders initially disagreed on 15 types of intentional nondisclosure and 23 reasons for the nondisclosure. The two coders established consensus through discussion, resulting in an agreement of 100% (Creswell, 2013). Finally, the second author, serving as a peer reviewer, evaluated the entire coding process. She was chosen based on her expertise with supervision delivery (e.g., protocol, practice) and the topic of intentional nondisclosure. She did not recommend any changes to the categorization of participant responses; however, she recommended renaming two of the new categories for the types of nondisclosures that emerged from the data to better reflect the content of participant responses. Eleven types of intentional nondisclosure and 13 reasons emerged from our analysis.

Results

Forty-four (40%) participants reported that they had never withheld something significant from their current onsite internship supervisors, while 66 (60%) reported that they had. Examples of responses coded as never having withheld something significant from their onsite supervisors include “N/A,” “At this time, I have not withheld any information that I felt was significant with my supervisor,” and “I don’t think there has been one.” For the responses that included an example of intentional nondisclosure (n = 66), 11 types of intentional nondisclosure and 13 reasons for withholding information emerged from the data. The types of intentional nondisclosure included eight types of nondisclosure that were from Ladany et al.’s (1996) research on nondisclosure and three new types of intentional nondisclosure that emerged in this data set: (a) CIT professional developmental needs, (b) a peer’s significant issue, and
(c) experiencing sexual harassment. Regarding the reasons for the intentional nondisclosures, 10 reasons mirrored the findings from Ladany et al. and three reasons were unique to the current study: (a) did not want to harm client or confidentiality concerns, (b) consulted with another supervisor, and (c) issue with other professional in supervision setting.

The Types and Reasons for Intentional Nondisclosures

The most common type of intentional nondisclosures identified by the researchers in the current study were negative reactions to supervisor (n = 18, 27.3%), general client observations (n = 16, 24.2%), and clinical mistakes (n = 15, 22.7%). The most common reasons for intentional nondisclosures were impression management (n = 12, 18.2%), perceived unimportant (n = 8, 12.1%), negative feelings, (n = 8, 12.1%), and supervisor not competent (n = 8, 12.1%). Complete results of the coding and category frequencies of the types of nondisclosures are presented in Table 1, and the final coding and category frequencies of the reasons for nondisclosure are presented in Table 2.

Table 1 Types of Intentional Nondisclosure
Type of Intentional Nondisclosure	n (%)	Examples
Negative Reactions to Supervisor	18 (27.3%)	When my supervisor asked if there is anything that is hindering our relationship, I lied and said that there wasn’t anything and the relationship is fine. I feel that I am not getting feedback about my counseling from my supervisor in the supervision meetings. Instead I am only getting suggestions of how the supervisor would have handled the client. Made a comment behind my back. My onsite supervisor is new and so I don’t share too much because he’s easily overwhelmed.
General Client Observations	16 (24.2%)	I gave [clients] more chances to skip/miss an appointment than [my supervisor] would allow so sometimes don’t let her know when people cancel or no show. When a client disclosed personal family issues; client’s past trauma.
Clinical Mistakes	15 (22.7%)	I put a client in danger by a lack of knowledge and being new in a position. Too much self-disclosure in a session; getting behind on case notes/paperwork. Having a chronically suicidal client and . . . not assessing for SI in a session and feeling as if when assessed it was not done so well.
Client–Counselor Attraction Issues	4 (6.1%)	I felt attracted to an assessment client. During a session, a client told me that he liked how I looked in my pants. He then told me that he got excited at the sound of my voice.
Countertransference	3 (4.5%)	A client reminded me of my late mother. Early in internship, I had strong countertransference with a client.
Supervision Setting Concerns	3 (4.5%)	I was concerned if I was going to have to find another site to finish hours. Frustration with internship duties.
Personal Issues	2 (3.0%)	I did not tell my supervisor that I chose to cut it off with a potential romantic partner.
CIT Developmental Need	2 (3.0%)	When I was first starting out I had a hard time letting my supervisor know when I needed something extra from them whether it be time or information.
Negative Reactions to Client	1 (1.5%)	Anger toward a student.
A Peer’s Significant Issue	1 (1.5%)	A client wrote a letter to my co-intern about his sexual desires and love for her.
Experiencing Sexual Harassment	1 (1.5%)	When I felt sexually harassed by a colleague.
Note. Not all types of intentional nondisclosure from Ladany et al. (1996) were present in this sample, and three new types emerged: (a) CIT developmental need, (b) a peer’s significant issue, and (c) experiencing sexual harassment.

Table 2 Reasons for Intentional Nondisclosure
Reasons	n (%)	Examples
Impression Management	13 (19.7%)	Concerned about evaluations by those who supervise my supervisors. Fear of looking bad or being perceived as not being a good counselor. [Supervisor] might pass judgment because I can’t possibly know what I’m talking about being only an intern. I worried she will think I’m unprofessional or not trust me with future clients.
Negative Feelings	8 (12.1%)	Poor self-confidence. Fear of rejection. Embarrassment, inferiority felt with supervisor.
Supervisor Not Competent	8 (12.1%)	I see the way she counsels clients and I know she thinks taking time to establish rapport and positive therapeutic relationships is not always necessary. Everyone in the office says she is burnt-out and I want to be more compassionate.
Perceived Unimportant	8 (12.1%)	I did not feel it was necessary. I was running late to class and I didn’t consult with her because she was in a session with a client so I figured I’d tell her the next day.
Deference	6 (9.1%)	I did not feel like it would be taken well, and that I am only an intern and should not correct her. Didn’t want to hurt/upset her or burn a professional relationship.
Poor Alliance with Supervisor	5 (7.6%)	The power differential. She berated me in supervision to the point of tears. I feel unsafe with her and our clinical styles contrast. I knew she would make me feel inferior.
Supervisor Agenda	4 (6.1%)	I thought he would immediately notify people in charge. Knowing my supervisor would want to tell [client’s] mother.
Political Suicide	4 (6.1%)	I want to get hired where I’m working and I don’t feel . . . safe during supervision. It’s a small practice and I have to share a wall with this offender every day.
Did Not Want to Harm Client or Confidentiality Concerns	4 (6.1%)	I didn’t want to put client in a bad situation. That student was not positive of her status and was not in any danger. Revealing her secret at that point would have damaged the relationship. Confidentiality issues.
Too Personal	3 (4.5%)	It was too personal. I didn’t want to talk about my grief.
Pointlessness	1 (1.5%)	Thought that was between student and personal physician.
Consulted with Another Supervisor	1 (1.5%)	Other supervisor suggestions.
Issues with Other Professionals in Supervision Setting	1 (1.5%)	The teacher expressed frustration. Hopes to prevent future conflict.
Note. Not all categories and reasons from Ladany et al. (1996) were present in this sample, and three new reasons emerged: (a) did not want to harm client or confidentiality concerns, (b) consulted with another supervisor, and (c) issues with other professionals in supervision setting.

Specific Examples of the Types and Reasons for Intentional Nondisclosure

To provide a more complete picture of the phenomenon of intentional nondisclosure (Hsieh & Shannon, 2005), this section is presented to highlight specific examples provided by participants for each type of nondisclosure and the reasons they withheld the information. Our coded reason for the type of intentional nondisclosure is included in parentheses below (e.g., deference, impression management, political suicide).

Negative reactions to supervisor. One participant stated that she did not disclose that her supervisor “was not helpful during a time that I needed her to be” because the participant “did not want to . . . upset her or burn a professional relationship” (deference). Another participant did not tell her supervisor at her school internship that she disapproved of the way the supervisor addressed a student: “I felt she was being too harsh on a student and not considering other factors.” This participant did not want her supervisor to perceive her as “being wrong” (impression management). A participant stated that even though her supervisor sits in on all of her sessions at her internship site, she still withheld that she is not satisfied with the quality of their relationship and did not share how she felt “in the relationship with her.” She added that she did not disclose this information because “I am afraid she’ll be angry and it will damage the relationship we do have” (negative feelings). Finally, for a clinical mental health CIT, even her supervisor directly asking if she had concerns about the supervisory relationship was not enough to encourage her disclosure: “When my supervisor asked if there is anything that is hindering our relationships I lied and said that there wasn’t anything and the relationship is fine.” The CIT stated she lied because “the power differential, being videotaped, and concerns with confidentiality . . . stopped me from being completely honest about my comfort with our relationship” (poor alliance with supervisor).

General client observations. General client observations differed from clinical mistakes because participants did not self-identify that they perceived the specific examples they provided to be mistakes. Rather, participants indicated that the examples they provided were relevant; however, they failed to disclose this significant information to their supervisors. One school counseling CIT stated that she did not share with her supervisor that she was having trouble “breaking the ice with a client” because she “knew my [supervisor] would make me feel inferior” (poor alliance with supervisor). Another school counseling CIT shared that she failed to disclose that one of her clients was “drinking alcohol on campus” because she thought her supervisor would “immediately notify people in charge of discipline rather than talking to the student first” (supervisor agenda). Finally, another school counseling CIT stated that a client told her she was pregnant, but she failed to notify her supervisor because “that student was not positive of her status and was not in any danger. Revealing her secret at that point would have damaged the relationship” (did not want to harm client; confidentiality concerns).

Clinical mistakes. Participants reported a range of clinical mistakes, from minor clerical errors to potentially more problematic mistakes such as failure to assess for client risk. One clinical mental health CIT did not share that she was “behind on my case notes” because she “did not feel it was necessary” and she “caught up quickly” (perceived unimportant). A student affairs CIT stated that he did not let his supervisor know that he “lacked confidence in theories” because he felt “inadequate” and “embarrassed” (negative feelings). A clinical mental health CIT shared that she failed to disclose something in supervision that her supervisor had previously told her not to do: “My supervisor had previously verbalized that she would be upset.” She withheld this information because “I didn’t want to seem . . . incompetent and I respected her and want her to think I’m doing my best” (impression management). Multiple participants provided specific examples of intentional nondisclosures related to failing to adequately assess for client risk or failing to notify their supervisors that a client was engaging in risk-related behavior. A school counseling CIT shared that she did not discuss with her supervisor that “a client (minor on a school campus) was engaging in [non-suicidal self-injury] again” because “we discussed before how she is obligated to pass that info to school principal who tells parents” (supervisor agenda). This participant added that she decided not to share this information with her supervisor because she perceived the self-injury to be non–life threatening and she wanted to “save rapport” with the client (did not want to harm client; confidentiality concerns). Finally, a school counseling CIT stated that she withheld from her supervisor that she “put a client in danger by my lack of knowledge and being new in my position.” This CIT did not discuss this with her supervisor because “my supervisor wasn’t available” (supervisor not competent).

Client–counselor attraction issues. One clinical mental health counseling CIT stated that her client “told me that he liked how I looked in my pants. He then told me that he got excited at the sound of my voice.” She stated that she did not disclose this information to her supervisor because “I told myself that I did not understand how he meant the comment and I thought he would stop the flirting if I ignored him” (perceived unimportant). Two participants indicated that they experienced sexual attraction to a client but failed to share it with their supervisor. One student affairs CIT stated that she felt “embarrassed” (negative feelings), while a clinical mental health counseling CIT shared that he “did not want anyone to find out and I felt like I handled it fine” (impression management).

Countertransference. One marriage, couples, and family CIT stated that she did not disclose to her supervisor that a client “reminded me of [my] late mother” because she “did not want to talk about [my] grief” (too personal). A clinical mental health counseling CIT echoed the previous participant’s thinking process. She stated she did not tell her supervisor she was experiencing “countertransference” with a client because “it was too personal” (too personal). Finally, another marriage, couples, and family CIT stated that early in her internship she had “strong countertransference with a client” as a result of a personal grieving process. She shared that she did not tell her supervisor because she wasn’t sure “how much I trusted her with this information as it was only several weeks into internship” (poor alliance with supervisor).

Supervision setting concerns. A clinical mental health counseling CIT stated that she did not express her “frustration with internship duties” to her supervisor because “he was unavailable” (supervisor not competent). Another clinical mental health counseling CIT was concerned that she “would need to find another site to finish [internship] hours,” but did not tell her supervisor because “I did not choose to add to stress [of my] site supervisor by posing my concern” (deference).

Personal issues. One participant enrolled in a clinical mental health counseling program withheld from the supervisor that “sad and depressed” feelings because of a “fear of rejection” (negative feelings) arose during supervision. A school counseling CIT did not disclose to her supervisor that she had recently ended a relationship “with a potential romantic partner” even though it was causing her to “feel drained and emotional during the day at her internship” because “I felt that it would be silly to and I thought I did a good enough job ignoring the feelings while with students” (too personal).

CIT developmental need. One clinical mental health counseling CIT shared that she had a difficult time “letting my supervisor know when I needed something extra from them whether it be time or information” because she “felt nervous about [her] position as ‘just an intern’” (negative feelings). Another clinical mental health counseling CIT stated that she failed to let her supervisor know that she is “concerned about being in an individual session with a male client” because she is fearful that her supervisor would think she is “unprofessional or not trust me with future clients” (impression management).

Negative reactions to client. Only one participant indicated that she failed to disclose a negative reaction to a client with her supervisor. This student affairs CIT stated that she did not disclose her “anger towards a client” because she “did not think it was important enough to share” (perceived unimportant).

A peer’s significant issue. One clinical mental health counseling CIT noted that there was a failure to disclose to the supervisor that “a client wrote a letter to my co-intern about his sexual desires and love for her.” This CIT stated that the co-intern did not want this information shared and that the participant “did not think it was my place” (deference).

Experiencing sexual harassment. A clinical mental health counseling CIT stated that she was “sexually harassed by a colleague,” but failed to disclose to her supervisor because “it’s a small practice and I have to share space with this offender every day” (political suicide).

Discussion

The current investigation was designed to examine the types of and reasons for intentional nondisclosure by CITs during their onsite supervision. Sixty percent of the participants provided an example of withholding something significant from their onsite internship supervisors, suggesting that, similar to allied professions, intentional nondisclosure by counseling CITs is common (Ladany et al., 1996; Pisani, 2005; Yourman & Farber, 1996). Participants also provided detailed examples of the types of intentional nondisclosures as well as the reasons they withheld the information. These findings provide insight into the experiences of CITs at their internship placement. In this section, we will connect our findings to those from previous research as well as offer implications for counselors, supervisors, and counselor training programs.

The Types of Intentional Nondisclosure and Reasons for Nondisclosure

Overall, the types of intentional nondisclosure and the reasons for these nondisclosures are comparable to the findings of previous studies in allied professions. There were four categories of the types of intentional nondisclosure that emerged in the study by Ladany et al. (1996) that were not present in the current study: (a) positive reactions to supervisor, (b) supervisor appearance, (c) supervisee–supervisor attraction issues, and (d) positive reactions to client. The category of “unclear” in regard to the reasons for nondisclosure also was not found in the current study, as all participant responses in the current study were legible. Participants of differing CACREP tracks all provided examples of intentional nondisclosure to their supervisors in regard to their field placement. These findings suggest that despite the differences in training models (CACREP, 2015) and professional identities (Lawson, 2016), CITs experience many of the same situations that result in intentional nondisclosure as those from allied professions. The most commonly withheld information in the current study was negative reactions to supervisor, which also was true for psychology trainees in the study by Ladany et al. Supervisees appear most hesitant to discuss their concerns about their supervisor or supervision experience (Hess et al., 2008; Mehr et al., 2010; Pisani, 2005). In addition, CITs also commonly withheld general observations about clients and clinical mistakes similar to allied professions (Hess et al., 2008; Ladany et al., 1996; Mehr et al., 2010; Pisani, 2005).

The CITs in the current study provided many reasons for their intentional nondisclosure, but some reasons were more commonly reported than others. Like the findings from Mehr et al. (2010), participants in the current study most commonly withheld information in order to make a favorable impression on their supervisors. Others reported they withheld because of negative feelings such as “shame” or “embarrassment.” Farber (2006) suggested that internalized negative feelings are often a reason for nondisclosure. Consistent with findings from allied professions (Hess et al., 2008; Ladany et al., 1996), CITs also withheld because (a) they believed a supervisor was not competent, (b) they believed information was not quite important enough to disclose, and (c) they wanted to perform perfectly in their new roles.

Novel Findings Regarding Types and Reasons for Intentional Nondisclosure

An important aspect of content analysis is discussing findings that may extend existing knowledge of a given phenomenon (Hsieh & Shannon, 2005). The current study is the first to examine the types of intentional nondisclosure and reasons for nondisclosure in a sample of CITs. As such, there are several novel findings that warrant discussion. For example, two participants indicated that they did not discuss their professional development needs with their onsite supervisor. This is particularly interesting, given a central function of clinical supervision is to facilitate CIT professional development (Bernard & Goodyear, 2014). CITs who internalize their professional developmental needs as a flaw or who desire to hide these needs for fear of their supervisors’ reactions also may desire to perform perfectly (Rønnestad & Skovholt, 2003). Discussing opportunities for growth as a CIT can be difficult (Mehr et al., 2010); thus, supervisors may need to prompt their supervisees to discuss their needs more directly.

Another novel finding is that one participant indicated that she withheld from her supervisor about her peer’s ethical dilemma (the client letter revealing romantic interest). This participant explained that she did not feel it was her place to share her peer’s information, but all counselors and CITs share some responsibility to address ethical concerns. Ladany et al. (1996) found that 53% of those who withheld information from their supervisors told a peer in the field about their concern. Therefore, it seems likely that other CITs may be placed in a similar position as the participant in the current study. Knowing one’s ethical responsibility to disclose unethical behavior, as in the situation germane to this study, could be prudent (ACA, 2014). Finally, one participant indicated that she was being sexually harassed by a colleague. This report of intentional nondisclosure is particularly concerning given the increased attention to Title IX and attempts to mitigate sexual harassment and sexual assault in university and workplace settings (Welfare, Wagstaff, & Haynes, 2017). This participant’s willingness to share her trauma through the data collection process in this study presents an opportunity for counselor educators and supervisors to explore strategies to prevent these experiences for future CITs.

Regarding the reasons for intentional nondisclosure, there also were novel findings because three new reasons emerged in the current study. First, five participants did not disclose information to their supervisor because they did not want to harm their clients or violate a client’s confidentiality. However, the sharing of information with a supervisor would never violate client confidentiality (ACA, 2014). Perhaps the supervisees’ confusion about the parameters of confidentiality or misdirected efforts to protect clients from the actions of a supervisor they perceived as incompetent led to this decision. A second novel reason for intentional nondisclosure was evidenced by one participant who reported consulting with a supervisor who was not her site supervisor. Ladany et al. (1996) found that 15% of psychology trainees consulted with “another supervisor” outside their primary supervisor (p. 16). Ladany et al. did not ask their participants to clarify the role of another supervisor; however, this finding is relevant to the current study and the training of CITs. Throughout a CIT’s internship experience, they have two supervisors: one onsite supervisor and one university supervisor (CACREP, 2015). It is unclear if the supervisor with whom the participant discussed their concern was another supervisor at the site or the university supervisor. However, this could be an inherent challenge for CITs to identify who to share information with, particularly if there are issues in one of the two relationships. Finally, one school counseling CIT indicated that she had an issue with a teacher and addressed this issue with the teacher directly. Counselors work in diverse settings (ACA, 2014; CACREP, 2015) and may often work with persons outside the counseling profession. Counseling programs and supervisors may need to better prepare students to work with other professionals in their specific setting.

Implications for CITs

The findings from the current study provide empirical evidence that, when faced with the decision to share in clinical supervision, CITs sometimes chose to withhold information from their supervisors despite knowing its relevance. CITs of all CACREP tracks will likely be faced with this difficult decision. We hope that these findings, which offer insights into the experience of intentional nondisclosure, help to normalize the challenges that CITs face and identify strategies to prevent nondisclosure.

Some of the participants described harmful supervision experiences in which they were berated by their supervisors, feared fallout if they were to disclose illegal sexual harassment by another site employee, were concerned about a supervisor’s clinical competence, or did not feel safe to share even blatantly inappropriate client behaviors. Harmful supervision such as this has also been described by Ellis et al. (2014) and is a major concern for counseling and related professions. CITs who find themselves in harmful supervision situations can consider seeking support from another professional, a peer, or a professional association ethics consultant who might help rectify these issues.

Even for those CITs who are not enduring harmful supervision, there are costs to nondisclosure such as stalled development, safety concerns, and ethical or legal violations. Ultimately, the decision to withhold information from one’s clinical supervisor rests with the CIT (Murphy & Wright, 2005). Advocating for a safe and productive supervisory experience may result in a change that serves as a catalyst for supervisee growth or prevents client harm. No supervisee needs to be concerned about burdening a supervisor with disclosures about training issues or ethics; it is the supervisor’s responsibility to address supervisee needs, no matter how burdensome. Relatedly, supervisees who are reluctant to discuss their observations of clients or clinical mistakes for fear of being evaluated poorly or perceived as unqualified should consider ways to demonstrate quality work in order to balance the areas for growth. Making mistakes is expected for all CITs, but it is important to use supervision to learn from these mistakes (Pearson, 2001). In fact, reflecting on previous experiences—and learning from those experiences—is key to becoming a skilled and seasoned counselor (Rønnestad & Skovholt, 2003). CITs also might find it helpful to pursue their own personal counseling as another strategy to facilitate personal and professional growth (Oden, Miner-Holden, & Balkin, 2009).

Several CITs shared their hesitancy in disclosing information to their supervisor for fear of violating their clients’ confidentiality or harming the therapeutic alliance. Although client confidentially is critical, disclosing information to one’s supervisor would not violate a client’s confidentiality (ACA, 2014). In fact, some of the concerns expressed seemed to be more about the limits of confidentiality in the setting more broadly (e.g., high school rules), rather than with the supervisor specifically. Counselors are encouraged to not tell a client that the information shared during the counseling process will remain absolutely confidential. Rather, counselors are encouraged to include a passage in their informed consent about the boundaries of client confidentiality and discuss this information with their clients (ACA, 2014). Finally, predicting when ethical or legal issues will occur may be impossible. Counselors should regularly consult with supervisors to discuss treatment options and legal and ethical issues (ACA, 2014).

Implications for Supervisors and Counselor Education Training Programs

Supervisors and counselor educators play a central role in reducing CIT intentional nondisclosures. The findings from the current study suggest there is a wide range of topics that CITs are reluctant to discuss with their supervisors and a wide range of reasons for withholding. The varying nature of intentional nondisclosures highlights the necessity of individualized interventions. Broadly speaking, supervisors are encouraged to facilitate an open and safe environment that invites disclosure (Bordin, 1983). This might also mean supervisors must be willing to purposefully solicit feedback from their supervisees (Murphy & Wright, 2005). Additionally, supervisors must be proactive in utilizing the knowledge gained from studies like this one to normalize the experiences of their supervisees. Perhaps by discussing each of the types of nondisclosure described above with CITs, supervisors can reduce the pressures associated with performing perfectly (Rønnestad & Skovholt, 2003) or diminish the negative emotions (e.g., shame, embarrassment) associated with making mistakes (Farber, 2006; Knox, 2015).

Finally, some of the experiences described by the participants in the current study are deeply troubling, as they shared specific examples of ineffective and harmful supervision. The burden of providing evidence and reporting instances of harmful supervision is often placed on the CIT (Ellis, Taylor, Corp, Hutman, & Kangos, 2017). We outlined some strategies for CITs in case they were to experience harmful supervision; however, the findings from the current study suggest that CITs are withholding this information for any number of reasons. The participants in this study are not unlike those from other allied professions who have similar supervision experiences (for specific examples of harmful supervision, see Ellis, 2017). Thus, supervisors and counselor education programs must work to prevent CITs from experiencing the damaging effects of ineffective or harmful supervision. We encourage counselor education programs to be proactive by reviewing the signs of ineffective and harmful supervision practices with students before they begin their internships and to regularly check in with students about the supervision experience. Counselor education programs may find it beneficial to solicit student feedback about their practicum/internship site at the end of each term—specifically targeting concerns related to ineffective and harmful supervision.

Encouraging students to disclose their experiences with ineffective or harmful supervision while they are in the process of graded program work might not be possible because of the reasons described above; however, preventing similar experiences for future students may be. Finally, CACREP (2015) requires that all site supervisors receive supervision training prior to serving in this capacity. Accidental instances of ineffective or harmful supervision may be prevented by adding training for site supervisors in this content area (Ellis et al., 2017).

Limitations and Future Research

The current study has limitations that create opportunities for future research. First, we utilized the categories originally identified in the study conducted by Ladany et al. (1996). Although we allowed for the creation of new categories, it is possible that selecting a different study to guide our investigation would have yielded different findings (Hsieh & Shannon, 2005). Also, prompting for a single example of significant intentional nondisclosure may have influenced the findings. Future studies should include the opportunity to provide multiple examples, which could result in different findings. Finally, participants were asked to provide examples of intentional nondisclosure with their onsite supervisors during their internship. These participants were receiving supervision from a university supervisor (CACREP, 2015), meaning the information withheld from the onsite supervisor may have been discussed with the university supervisor. It is also plausible that supervisees withheld the information from both the onsite and university supervisors. Site supervisors and university supervisors might have conflicting agendas, presenting a burden on supervisees to decide what to disclose to whom. Future studies should examine how supervisees decide what to disclose when they have multiple supervisors at one time. Finally, participants in the current study reported they were most hesitant to disclose their negative reactions about their supervisors. Future research should explore how supervisors can better monitor their supervisees’ reactions to them.

Conclusion

Although previous research from allied professions provides evidence of how nondisclosure manifests within those professions, the findings from this study provide empirical evidence of how CIT intentional nondisclosure presents during onsite supervision. These findings provide valuable insights into the types of information that CITs withhold as well as the reasons for their nondisclosure during their onsite supervision. Given that the counseling profession has a unique training model (CACREP, 2015) and professional identity (Lawson, 2016), these findings can be used by CITs, onsite supervisors, and counselor educators to generate targeted solutions to address this critical issue.

Conflict of Interest and Funding Disclosure

This research was supported by a grant from the Association for Counselor Education and Supervision.

References

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

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

Borders, L. D. (2009). Subtle messages in clinical supervision. The Clinical Supervisor, 28, 200–209. doi:10.1080/07325220903324694

Borders, L. D., DeKruyf, L., Fernando, D. M., Glosoff, H. L., Hays, D. G., Page, B., & Welfare, L. E. (2011). Best practices in clinical supervision. Retrieved from https://www.acesonline.net/sites/default/files/ACES-Best-Practices-in-clinical-supervision-document-FINAL_0_0.pdf

Borders, L. D., Glosoff, H. L., Welfare, L. E., Hays, D. G., DeKruyf, L., Fernando, D. M., & Page, B. (2014). Best practices in clinical supervision: Evolution of a counseling specialty. The Clinical Supervisor, 33, 26–44.

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

Cook, R. M., & Welfare, L. E. (2018). Examining predictors of counselor-in-training intentional nondisclosure. Counselor Education and Supervision, 57, 211–226.

Council for Accreditation of Counseling & Related Educational Programs. (2015). 2016 CACREP standards.
Retrieved from https://www.cacrep.org/for-programs/2016-cacrep-standards

Creswell, J. W. (2013). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). Thousand Oaks, CA: Sage.

Ellis, M. V. (2017). Narratives of harmful clinical supervision. The Clinical Supervisor, 36, 20–87.
doi:10.1080/07325223.2017.1297752

Ellis, M. V., Berger, L., Hanus, A. E., Ayala, E. E., Swords, B. A., & Siembor, M. (2014). Inadequate and harmful clinical supervision: Testing a revised framework and assessing occurrence. The Counseling Psychologist, 42, 434–472. doi:10.1177/0011000013508656

Ellis, M. V., Taylor, E. J., Corp, D. A., Hutman, H., & Kangos, K. A. (2017). Narratives of harmful clinical supervision: Introduction to the special issue. The Clinical Supervisor, 36, 4–19.
doi:10.1080/07325223.2017.1297753

Farber, B. A. (2006). Self-disclosure in psychotherapy (1st ed.).New York, NY: Guilford Press.

Hess, S. A., Knox, S., Schultz, J. M., Hill, C. E., Sloan, L., Brandt, S., . . . Hoffman, M. A. (2008). Predoctoral interns’ nondisclosure in supervision. Psychotherapy Research, 18, 400–411. doi:10.1080/10503300701697505

Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 1277–1288. doi:10.1177/1049732305276687

Knox, S. (2015). Disclosure—and lack thereof—in individual supervision. The Clinical Supervisor, 34, 151–163. doi:10.1080/07325223.2015.1086462

Ladany, N., Hill, C. E., Corbett, M. M., & Nutt, E. A. (1996). Nature, extent, and importance of what psychotherapy trainees do not disclose to their supervisors. Journal of Counseling Psychology, 43, 10–24. doi:10.1037/0022-0167.43.1.10

Lawson, G. (2016). On being a profession: A historical perspective on counselor licensure and accreditation. Journal of Counselor Leadership and Advocacy, 3, 71–84. doi:10.1080/2326716X.2016.1169955

Lonn, M. R., & Juhnke, G. (2017). Nondisclosure in triadic supervision: A phenomenological study of counseling students. Counselor Education and Supervision, 56, 82–97. doi:10.1002/ceas.12064

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

Mehr, K. E., Ladany, N., & Caskie, G. I. L. (2015). Factors influencing trainee willingness to disclose in supervision. Training and Education in Professional Psychology, 9, 44–51. doi:10.1037/tep0000028

Murphy, M. J., & Wright, D. W. (2005). Supervisees’ perspectives of power use in supervision. Journal of Marital and Family Therapy, 31, 283–295. doi:10.1111/j.1752-0606.2005.tb01569.x

National Board for Certified Counselors. (2014). NBCC educational requirements to change in 2022. The National Certified Counselor, 30(3), 1–2.

Oden, K. A., Miner-Holden, J., & Balkin, R. S. (2009). Required counseling for mental health professional trainees: Its perceived effect on self-awareness and other potential benefits. Journal of Mental Health, 18, 441–448. doi:10.3109/09638230902968217

Pearson, Q. M. (2001). A case in clinical supervision: A framework for putting theory into practice. Journal of Mental Health Counseling, 23, 174–183. doi:10.1111/ppc.12003

Pisani, A. (2005). Talk to me: Supervisee disclosure in supervision. Smith College Studies in Social Work, 75, 29–47. doi:10.1300/J497v75n01_03

Rønnestad, M. H., & Skovholt, T. M. (2003). The journey of the counselor and therapist: Research findings and perspectives on professional development. Journal of Career Development, 30, 5–44. doi:10.1177/089484530303000102

Welfare, L. E., Wagstaff, J., & Haynes, J. R. (2017). Counselor education and Title IX: Current perceptions and questions. Counselor Education and Supervision, 56(3), 193–207. doi:10.1002/ceas.12072

Yourman, D. B., & Farber, B. A. (1996). Nondisclosure and distortion in psychotherapy supervision. Psychotherapy: Theory, Research, Practice, Training, 33, 567–575. doi:10.1037/0033-3204.33.4.567

Ryan M. Cook is an assistant professor at The University of Alabama. Laura E. Welfare, NCC, is an associate professor at Virginia Tech. Devon E. Romero, NCC, is an assistant professor at The University of Texas at San Antonio. Correspondence can be addressed to Ryan Cook, 310A Graves Hall, The University of Alabama, Tuscaloosa, AL 35487, rmcook@ua.edu.

Examining the Facilitating Role of Mindfulness on Professional Identity Development Among Counselors-in-Training: A Qualitative Approach

Dec 3, 2017 | Volume 7 - Issue 4

Shengli Dong, Amanda Campbell, Stacy Vance

Professional identity development is crucial for counselors-in-training, as it provides a frame of reference for understanding their chosen field and contributes to a sense of belonging within the professional community. This qualitative study examined the impact of mindfulness on professional identity development among counselors-in-training. Participants reported that mindfulness, along with experiential learning and mentoring, served as a facilitator in completing the transformational tasks in the process of professional identity development. The preliminary results from this qualitative study warrant further research to examine and validate the impact of mindfulness on professional identity development among counselors-in-training.

Keywords: mindfulness, professional identity development, transformational tasks, counselors-in-training, experiential learning

The counseling profession has emphasized the importance of developing healthy professional identity among counselors-in-training (Corey, Corey, & Callanan, 2011; Council for Accreditation of Counseling & Related Educational Programs [CACREP], 2016; Granello & Young, 2011). Gibson, Dollarhide, and Moss (2010) defined professional identity development (PID) as the “successful integration of personal attributes and professional training in the context of a professional community” (pp. 23–24). A strong sense of professional identity provides an individual with a frame of reference for understanding his or her chosen field, contributes to a sense of belonging within the professional community, and helps to develop competency and an allegiance to the profession (Elman, Illfelder-Kaye, & Robiner, 2005; Pistole & Roberts, 2002). Conversely, a lack of professional identity may have negative consequences, such as detriments to the quality of counseling services (Pistole & Roberts, 2002) and role confusion among beginning practitioners (Studer, 2006).

Moss, Gibson, and Dollarhide (2014) and Gibson et al. (2010) proposed a transformational model in describing the development of professional identity across time among counselors-in-training and counselors. Specifically, the researchers reported that counselors passed through several transformational stages, including moving from idealism to realism, burnout to rejuvenation, external validation to internal validation, and separation to integration into the professional community, as they became more advanced. Additionally, counselors developed an internalized definition of counseling over time (Moss et al., 2014).

Developing professional identity can be a daunting task. On one hand, counselors-in-training and new professionals experience a variety of challenges in the course of PID. Some of these challenges include demanding academic and clinical work (Aponte et al., 2009), contradictory or ambiguous experiences triggering self-questioning and identity reshaping (Adams, Hean, Sturgis, & Clark, 2006; Slay & Smith, 2011), and a tendency to be self-critical and evaluate oneself primarily based upon external standards (Skovholt, Grier, & Hanson, 2001). In addition, counselor trainees tend to have an unrealistic view of their roles and capacity as a counselor (Thompson, Frick, & Trice-Black, 2011). These challenges may hinder the process of PID.

On the other hand, PID is a complicated process that involves transformational aspects such as cognition, behavior, and affection. A counselor-in-training or a new counselor develops a sense of oneness with a profession while addressing difficulty in balancing personal identity with professional identity (Goltz & Smith, 2014). Additionally, intense emotional interactions with clients and supervisors, such as constant exposure to professional evaluations, require consistent broadening and review of internal boundaries and perceptions (Birnbaum, 2008). Without successfully balancing these academic and professional requirements and expectations, counselors-in-training may encounter burnout. Thus, it is important for counselor educators and supervisors to assist trainees in the development of their professional identities (Auxier, Hughes, & Kline, 2003; Brott, 2006; Levitt & Jacques, 2005).

Most current approaches to PID focus on cognitive and behavioral aspects through experiential learning, continuing training, and supervision (Limberg et al., 2013; Zakaria, Warren, & Bakar, 2017). However, the aspect of affect also is of great significance. Several researchers have identified the significant impact of an affective component in the development of professional identity (Clouder, 2005; Mayes, Dollarhide, Marshall, & Rae, 2016). For example, Clouder (2005) stressed that affect development, which is highly associated with mindfulness (Schroevers & Brandsma, 2010; Snippe, Nyklíček, Schroevers, & Bos, 2015), should be integrated into PID.

Mindfulness and PID

Mindfulness is instrumental in affective development through emotional regulation (Hill & Updegraff, 2012; Hülsheger, Alberts, Feinholdt, & Lang, 2013). Mindfulness is a complex construct with several definitions. According to Kabat-Zinn (1994), mindfulness is conceptualized as “paying attention in a particular way: on purpose in the present moment, and nonjudgmentally” (Kabat-Zinn, 1994, p.4). Similarly, Bishop et al. (2004) defined mindfulness as a two-component model, involving the “self-regulation of attention” and “a particular orientation towards one’s experiences in the present moment . . . that is characterized by curiosity, openness, and acceptance” (p. 232).

The benefits of mindfulness practices have been found in many areas, such as preventing and reducing burnout (Epstein, 2003; Rothaupt & Morgan, 2007), enhancing counseling competency (Campbell, Vance, & Dong, 2017; Greason & Cashwell, 2009), and fostering acceptance of one’s challenging thoughts and feelings as opposed to encouraging one to alter or control them (Davis & Hayes, 2011). In addition, Snippe et al. (2015) examined the temporal order of changes in mindfulness and affect and found that the changes in mindfulness seemed to predict and precede the changes in affect. The characteristics of mindfulness and its impacts on affect could potentially facilitate the transformational process in PID, which requires not only clinical and cognitive competence, but also affective and reflective capacities.

Although several studies have been conducted in the fields of social work, nursing, and psychology that have supported the relationship between mindfulness and PID (Birnbaum, 2008; Jacobowitz & Rogers, 2014; Martin, 2014), there is a lack of research exploring this relationship in the field of counseling (Beddoe & Murphy, 2004; Birnbaum, 2008; Louchakova, 2005). Furthermore, no study has focused on exploring a possible link between mindfulness and the transformational tasks in the process of PID. The purpose of this qualitative study was to explore how mindfulness may relate to the transformational tasks of PID (idealism to realism, burnout to rejuvenation, external validation to internal validation, and separation to integration) through the perspectives of mental health counselors-in-training.

Method

The qualitative approach for this study was informed by phenomenology and qualitative content analysis (Cho & Lee, 2014). Phenomenology was used as a framework to gain an understanding into participants’ experiences of PID through the potential impact of mindfulness among counselors-in-training. The qualitative content analysis offers a systematic method for identifying key themes among mindfulness and transformational tasks within the PID process among participants.

Participants

The participants in this study were master’s-level counseling students enrolled in two sections of an internship class during the last semester of their mental health counseling program (spring 2015) at a CACREP-accredited program of a Research I university in the southeastern United States. Six out of 16 students in the internship classes participated voluntarily in this study, with a participation rate of 37%. The sample included four Caucasian and two Hispanic participants, with four identified as female. The sample size of a qualitative study should be based upon goals and purpose of the study (Starks & Trinidad, 2007) and the depth of interviews—for more in-depth interviews, fewer participants are needed (Patton, 2015). Starks and Trinidad (2007) stated that the typical number of participants in a phenomenological study range from one to 10.

The participants conducted their internships in various settings, including an inpatient behavioral health center, a university counseling center, local community agencies, youth and family services, and low-income community services.

Procedures

The first author of this manuscript offered the internship course in which mindfulness-based practices and activities were discussed, demonstrated, and practiced. The mindfulness activities included meditation practices, readings regarding mindfulness, and weekly reflections on mindfulness practices for participants at their internship sites (mindfulness instructions and procedures can be obtained by contacting the first author).

The first author informed the students about the availability and voluntary nature of this study. The second and third authors (two doctoral-level students in the counseling program at the same university as the first author) came to the internship class and introduced the study, its purpose, nature and procedure, format, and the voluntary nature of participation. During that time, the course instructor (the first author) left the classroom. The students were informed that they would be invited to participate in this study via emails by the two doctoral-level investigators. Should students in the class agree to participate, the two doctoral-level investigators and the students would schedule a time to conduct interviews. All interviews were conducted by the second and third authors.

Prior to conducting the interviews, the doctoral-level investigators presented the interviewees with an informed consent form and told the interviewees that they could withdraw from the study at any time. Whether interviewees would participate or withdraw from the study would not be known to the course instructor and would not affect their grades for the class. In addition, data analysis was conducted after the end of the semester, when all the participants’ final grades had been submitted through the university’s grade submission system.

Each interview lasted about one hour and took place during the last four weeks of the spring semester of 2015. The interview included four open-ended questions, with two of these questions having additional probing questions. The semi-structured interviews served to better answer the research question. The interview began with questions regarding the participants’ professional development, including questions relating to internship site expectations, capability as an effective counselor, and the relationship between personal and professional identities. Next, the participants were asked questions pertaining to their experience in the internship class and internship sites, including questions about in-class mindfulness activities, internship site expectations, client interactions, and changes in professional identity. In addition, participants were asked about their self-care and mindfulness activities outside of the classroom. The interview concluded with a discussion about the factors that would aid participants to reach the next stage of their PID.

The interviews were audio-recorded and transcribed by the second and third authors. The transcripts were kept in a password-protected file and accessible only to researchers of this study. All identifying information was removed prior to data analysis. The audio recordings were deleted once all of the transcripts were cross-checked by the second and third authors to ensure the accuracy of the audio recordings and transcripts.

Qualitative Content Analyses

We used a qualitative content analysis approach to identify transformational tasks in PID and explore the potential impact of mindfulness on facilitation of completing transformational tasks. According to Cho and Lee (2014), qualitative content analysis is flexible in utilizing inductive or deductive analysis: codes or themes are directly identified from the data in inductive approach, whereas deductive approach starts with preconceived codes or categories derived from prior relevant theory.

We started the coding and data analysis process after all interviews had been completed, as suggested by Seidman (2013). In order to reduce or minimize the effect of our biases and preconceived assumptions on our interpretation of the meaning of the data, we engaged in bracketing (Moustakas, 1994) by reading the transcripts multiple times with the goal of embracing the participants’ perspectives while reducing the researchers’ preconceived notions on the topic (Hycner, 1999). Both the verbal and nonverbal (e.g., fillers and silences) content of the interviews were included in the transcripts.

The content analysis approach requires the researchers to review the data to ensure a thorough and integrative analysis. First, we carefully read each transcript and made notes identifying relevant information related to the research question. Second, we read the notes and listed the types of information found, then categorized interview content and notes in a meaningful manner. Third, we identified if connections between categories could be found or themes could be observed. Finally, we compared and contrasted various major and minor categories. The same process was repeated for each transcript. After analyzing all the transcripts, we identified themes and examined each in detail and considered if they were appropriate. Once all the transcripts were carefully examined and categorized into themes or subthemes, we reviewed the data to ensure that the information was categorized and described appropriately. Finally, we reviewed the transcripts and ensured that all relevant information was examined and categorized (Neuendorf, 2016).

Triangulation is the process through which a researcher gains confidence and assurance that their findings and interpretations of the data are reflecting what is actually occurring in the data (Stake, 2006), and it provides a check on selective perception and illuminates blind spots in an interpretive analysis (Patton, 1990). Content analysis with multiple researchers in this study offered opportunities for cross-checking and analyst triangulation. We each coded the interviews independently, and compared and contrasted categories and comments under each theme. When different opinions occurred, we discussed the discrepancies and brought light to data through multiple perspectives. The first author has research and clinical experiences related to mindfulness and PID, and past experiences in qualitative content analysis. The second and third authors have relevant research experiences in mindfulness and training in qualitative research.

Results

The results section describes the tasks in the transformational model of PID and their relationship to mindfulness based upon the participants’ responses. Under each transformational task, results are presented in two categories: (1) the transformational model of PID tasks, and (2) the impact of mindfulness on the transformational tasks.

Burnout to Rejuvenation

Transformational model of PID task. According to the results of the interviews, participants described being at different points on the burnout–rejuvenation continuum. Most commonly, participants noted multiple sources of burnout that accompanied their training experiences. These sources ranged from the nature of the work itself to an inability to cope with stress and multiple demands. For example, a male participant from a low-income community agency indicated nervousness at the prospect of being adjudicated as the result of a client complaining. In contrast, participants also cited their work as a means of rejuvenation. When given the opportunity to apply the knowledge that trainees had learned in class, participants often cited their practicum experiences as sources of excitement. One female participant from youth and family services and university services stated, “I’m excited and I want to get out there and see more and do more.”

Impact of mindfulness. A common theme emerged illustrating that participants viewed mindfulness as a strategy for reducing burnout and facilitating movement toward rejuvenation while developing their professional identities. Through building awareness of their internal and external experiences, participants noted a transition in the energy that they felt for their work. Specifically, participants noted initially feeling tired, stressed, and overwhelmed by their work. However, attending to these feelings, focusing on the here-and-now, and accepting the experiences nonjudgmentally helped participants manage feelings of burnout and ultimately feel an increased energy for their work. Participants perceived mindfulness as facilitating awareness of their internal and external experiences. One female participant working with an inpatient psychiatric hospital highlighted how mindfulness served as a facilitator for awareness of internal experiences: “I try really hard to focus on myself throughout the day using mindfulness, especially when I became overwhelmed where I could feel my body reacting, and that helped professionally because I could prepare for those situations.” In addition, a female participant from youth and family services noted that mindfulness served as a facilitator for awareness of external experiences, “[being] more mindful about where I was in the situation with a client so [I would not] get attached and bring that [vicarious trauma] home with me.”

Participants also noted mindfulness as facilitating acceptance of their internal experiences when faced with external stressors. For example, one female participant working at an inpatient psychiatric hospital and prison noted, “I mean deep breathing, especially when I’m feeling anxious . . . even when you’re just . . . feeling depressed, is nice to just [say] okay, ‘this is maybe just a phase I’m going through, it’s a normal reaction to everything that is happening.’” Furthermore, bringing awareness to all aspects of the internship through mindfulness activities helped relieve burnout and increase energy for work. For example, one participant working with an inpatient psychiatric hospital stated: “Really stopping and looking at the good times and the energy . . . in (the) workplace . . . and looking at the good things that happen really changed my view.”

Idealism to Realism

Transformational model of PID task. Participant responses revealed a pattern of adopting an idealistic perspective of the counseling process or outcomes, as well as unrealistic expectations of the counseling workplace. Responses demonstrated that some novice counselor trainees believed their roles were to “fix” or “save” their clients. For example, one participant at youth and family services noted, “a lot of the kids I have seen have been raped or sexually abused, neglected, abandoned. . . . I want to save every kid and I want to take every one of them home with me because I can feed them.” Other participants demonstrated having unrealistic expectations about the counseling workplace. Among responses collected, many participants defined counseling as “sitting there and listening to people” and noted beginning their internships with an idealistic perspective. For example, a female participant working with an inpatient psychiatric hospital stated, “Before, you have this idea of a counselor, sitting in a room with books around you and asking, ‘How do you feel about that?’” Many participants began with idealistic perspectives of their clinical skills and transitioned to more realistic expectations. For example, one female participant from a youth and family agency indicated that she had not anticipated the need to develop skills in helping, communicating, and connecting with parents prior to her internship, but had developed a more realistic expectation of her role in working with the parents of her clients.

Impact of mindfulness. Participants’ openness, awareness, and acceptance of experience are instrumental in the facilitation of realism in PID. Through an openness to experience in their internships, these novice counselors began to note a transition in their conception of the profession. Specifically, participants demonstrated attention to the here-and-now while engaging in their clinical experience, thereby allowing their understanding of the profession to be malleable to their therapeutic practice. One female participant from a youth and family agency noted that attending to the moment, rather than overpreparing, allowed her to remain open and flexible in her work with clients. Additionally, the participant stated mindfulness helped her with “being okay with not being okay . . . being more aware of my own feelings, accepting [clients] more, and dealing with [clients] in a better way than I normally would have.”

Furthermore, the participants were open to and accepted their experiences as opposed to rejecting their experiences because they did not fit with their pre-existing perception. Through the acceptance of their experiences, participants were able to begin to broaden their definition of counseling to a more realistic view. For example, a male participant from a low-income community agency noted, “we integrate counseling along with some aspects of basic-level social work case management; sometimes we are doing advocacy, sometimes we are doing a multitude of other things where counseling skills are helpful, but the counseling is not your direct . . . objective.”

Separation to Integration

Transformational model of PID task. With regard to separation to integration, participants at the beginning stages of training often viewed their professional identity as a separate entity from their personal identity. Many participants reported sustained effort in keeping their professional and personal identities separate when beginning their internship. For example, one participant reported “learning that it’s [her] identity as a counselor and not who [she is] as a person,” and further reported concerns about “bringing everything back home with [her] at the end of the day.”

In contrast, participants at the later stages of their training often perceived their professional and personal identity as one and the same. In this study, four of the six participants noted that their personal and professional identities are intertwined. For example, one male participant at a university counseling center stated, “I feel like I identify a lot with that [counselor] role. Sometimes it’s . . . hard to differentiate between taking off my counselor hat and keeping it on, even in some interpersonal . . . relationships.”

Impact of mindfulness. Responses from the participants also revealed that the integration process helped energize them. For example, one female participant at an inpatient psychiatric hospital stated, “Before, when I had jobs, I would separate myself. Because my career is so closely aligned with my personality, I feel like it’s the same. The way I am at my job energizes me; it makes me who I am.”

Additionally, some participants also indicated feeling comforted and integrated into the professional counseling community through accepting who they are and interacting with both peers and supervisors. For example, one female participant at youth and family services noted “knowing other resources to give clients and walking through the process of this is all that we can do with them . . . and then knowing that we did all that [we] could and that was okay.”

Similarly, there was one participant who noted that becoming integrated within the professional community helped with regard to becoming more internally validated. A female participant working in an inpatient psychiatric hospital noted that “things were finally starting to click into place where I was a part of the team . . . that was when my professional identity started to grow—when I see me as a professional instead of an intern.”

External to Internal Validation

Transformational model of PID task. Naturally, novice counselors experience doubt about their skills and capabilities in serving clients in a therapeutic capacity and often look to other more experienced professionals or resources for validation. Participant responses indicated that they were self-critical and looked toward others for validation of their experience. For example, one male participant from low-income community services indicated that when using professional manuals as an ultimate reference at the beginning of their training, “I didn’t trust myself to go off the manual . . . I was so concerned [about], okay did I cover this step, did I cover this step, did I cover this step.”

As the counselors-in-training developed their professional identity, there was a movement from external validation to being able to internally validate themselves. For example, the participant from low-income community services stated, “I am just now starting to trust myself to use the manuals as a base and then apply my own clinical judgment.”

Impact of mindfulness. One’s level of self-acceptance and tendency to not judge oneself is the key to the ability to validate oneself internally. Through nonjudgmentally accepting and evaluating oneself, participants were able to trust and internalize their own strengths and abilities. One male participant from a university counseling center stated, “I learned to accept the current level that I’m at, not being so critical on myself about what I should or shouldn’t be doing, or should and shouldn’t know . . . and that’s been helpful.”

Within this study, mindfulness appears to contribute to one’s willingness to expand the personal comfort zone and explore new and creative approaches, both of which facilitate development toward becoming an effective counselor. A male participant from the university counseling center stated, “It [mindfulness] helped me . . . step out of my comfort zone and try different things with clients, it’s been well received [and] really helpful in terms of feeling more competent [and] confident.”

Mindfulness assisted participants with accepting and trusting themselves, which develops internal confidence and validation. A male participant from low-income community services stated, “The basic concept of stopping yourself, examining in the moment, and saying okay . . . trusting myself that I could find the answer . . . if I allowed myself to relax, it made the client less agitated and less frustrated.”

Discussion

This qualitative study explored how mindfulness facilitates the transformational model of professional development (Gibson et al., 2010; Moss et al., 2014) in master’s-level counselor trainees. Although the extant literature within the field of social work has examined the role of mindfulness in PID (Birnbaum, 2008; Jacobowitz & Rogers, 2014; Martin, 2014), no research to date has examined this relationship within the counselor education field. This study employed a qualitative method, which offers contextual data on the experiences of counselor trainees’ PID. Thus, this exploratory study serves to address gaps in the literature by offering an understanding of how mindfulness may foster growth in counselor trainees’ PID.

The results of the study supported the transformational model of PID proposed by Gibson et al. (2010) and Moss et al. (2014). Indeed, participant responses supported each of the transformational tasks and seemed to hint that this process occurs as a continuum. Although participants were all master’s-level internship students at the completion of their program, each student demonstrated being in various places on the continuum on the four transformational tasks. For example, although some participants indicated a need to keep their professional identity and personal identity separated, others demonstrated beliefs that the professional and personal are intertwined, indicative of separated and integrated identities, respectively. Furthermore, participant responses alluded to change in their professional development over time, further validating the process of growth through the transformational tasks.

The emphasis of the current study was to examine how mindfulness may facilitate growth in PID through the aforementioned transformational tasks. Participant responses seemed to support that some participants found components of mindfulness assisted in their PID. The results showed that specific mindfulness facets associated with acceptance and a here-and-now orientation of internal experiences (e.g., thoughts, emotions, perception of self) and external experiences (e.g., internship experiences) contributed to more sophisticated PID perspectives.

The findings of this study support existing literature on mindfulness in counselor education. Wei, Tsai, Lannin, Du, and Tucker (2015) found that hindering self-focused attention, the antithesis of self-acceptance, led to diminished self-efficacy in counselor trainees. As this relates to the current study, many participants noted experiencing greater internal validation as a result of learning to accept their shortcomings as a counselor trainee. Similarly, participants indicated that self-acceptance yielded a greater propensity for rejuvenation. As suggested by Masicampo and Baumeister (2007), one’s acceptance of difficult thoughts and feelings allows for the development of affect tolerance. However, when counselor trainees are unable to accept their internal experiences (i.e., experiential avoidance), the negative emotional impact may be excessive and garner feelings of exhaustion and result in further manifestation of those avoided internal experiences (Hayes, Strosahl, & Wilson, 1999) or burnout. Indeed, the current research also suggests that self-acceptance played an important role in developing more realistic perspectives of their abilities and the profession. Corroborating evidence for this finding suggests that mindful acceptance and attention to the present moment allows counselor trainees to separate from the need to control themselves and their environment, thereby allowing themselves to be in the here-and-now with their clients and themselves (Christopher & Maris, 2010). In doing so, it is thought that individuals are able to see their abilities and profession as they are, thus developing a more realistic perspective.

In addition to mindfulness, participant responses also indicated a myriad of other experiences that contributed to their PID. Specifically, participants cited sources of growth such as experiential learning and field experiences, research, colleagues, supervisors, and coworkers. This finding is well supported in the literature on mental health counselors’ PID. Specifically, research on PID indicates that experiential learning; faculty, mentor, and supervisor relationships (Limberg et al., 2013); professional peer relationships (Murdock, Stipanovic, & Lucas, 2013); and professional organizations, such as the American Counseling Association (Reiner, Dobmeier, & Hernández, 2013), are all helpful in developing trainees’ professional identities, as they serve to validate shared experiences. Additionally, participant responses indicated that these sources of growth assisted many counselor trainees in becoming more integrated into the professional community.

An unexpected result was the various understandings and opinions regarding mindfulness expressed by participants. It was derived that some participants viewed mindfulness as a set of techniques and strategies (e.g., mindful breathing), whereas others considered mindfulness more as a state of being. For those adopting views related to the latter, responses indicated the acknowledgement of how awareness and acceptance of one’s internal and external experiences initiated progress in their PID. Although most participants adopted a positive view of mindfulness, perhaps because of their voluntary participation in a mindfulness study, a minority indicated that mindfulness was not personally beneficial to them, as they disliked using mindfulness techniques. Although there is a dearth of literature on the topic of those who do not benefit or dislike the use of mindfulness, La Roche and Lustig (2013) posited that the individual and the intervention that is being employed by the individual must match if it is to be effective. Indeed, it is possible that participants who did not find benefits from mindfulness maintain personal assumptions that are inherently distinct from, and perhaps incompatible with, basic tenets of mindfulness. In other words, the participants’ culture must be assessed and considered when attempting to employ mindfulness strategies in counselor trainees (Hyland, Lee, & Mills, 2015).

Limitations

Although this study provides a contextual understanding of how mindfulness may impact the PID of counselor trainees, it is not without limitations. The study implemented a convenience sampling procedure, recruiting counselor trainees from two sections of a course offered at one southeastern university. The final sample size was relatively small, including only six master’s-level trainees out of 16 students in the course, and was predominantly female (66%). The participants’ motivation to apply mindfulness practices and their knowledge of mindfulness could be different from that of their peers who did not attend the study. As such, the findings are limited to the sample used in the study and cannot be generalized to counselor trainees attending other universities or degree programs. Additionally, although the interviewers attempted to create a warm, nonjudgmental, welcoming environment, it is possible that participants may have felt hesitant to share their true experiences. Furthermore, all of the transformative tasks outlined in Moss et al.’s (2014) model were supported by the data; however, the use of a deductive approach may have led to confirmatory bias. Lastly, given the qualitative nature of this study, no causal inferences can be made with regards to the impact of mindfulness on PID.

Implications for Counselor Education and Further Research

The results of the current study indicate that mindfulness may contribute to the PID of counselor trainees through a variety of different mechanisms. As such, counselor educators may better assist counselor trainees in addressing barriers to PID through incorporating mindfulness-based approaches into curriculum and experiential activities. Counselor educators should work collaboratively with site supervisors to incorporate mindfulness into the supervision and field training experiences of counselor trainees, while also gathering feedback on the PID of counselor trainees over time. Furthermore, as some counselor trainees in this study demonstrated a superficial understanding of mindfulness (e.g., mindfulness as purely an intervention technique), students may benefit from the addition of a course focused on mindfulness and the PID process as a means to facilitate a deeper understanding of the philosophy and practice of mindfulness while fostering PID. Overall, counselor trainees may benefit from developing an understanding of the PID process and the benefits of mindfulness in facilitating both professional and personal growth.

Further research should incorporate larger sample sizes, varying degree programs, and multiple universities to develop a more general understanding of mindfulness and PID across counselor trainees. The impact of mindfulness on PID may be further examined using experimental and longitudinal research designs. For example, examining the impact of a mindfulness-based intervention on the PID of counselors-in-training, using pretest and posttest measures, and using a control group for comparison would add to our understanding of these phenomena. In addition, developing an understanding of mindfulness and PID may require moving beyond the self-report measure often used in social science to incorporating the feedback and observations of supervisors overseeing the work of counselor trainees within the clinical setting. Given the parallels between mindfulness and professional development (Beddoe & Murphy, 2004; Birnbaum, 2008; Louchakova, 2005) in other fields, as well as the findings of this study, deriving a mindfulness-based model of PID may prove beneficial for deepening the understanding of the connection between these two processes both in research and practical setting.

The complex and ever-evolving nature of PID is an area ripe for further exploration and discussion, particularly among counselor educators and trainees. The results of this exploratory qualitative study revealed that mindfulness facilitates engagement in the transformational tasks (i.e., burnout to rejuvenation, separation to integration, idealism to realism, and external validation to internal validation) in the process of PID for counselors-in-training. Considering the significance of PID and preliminary results in this study, further research is needed to examine and validate the impact of mindfulness on PID.

Conflict of Interest and Funding Disclosure

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

References

Adams, K., Hean, S., Sturgis, P., & Clark, J. M. (2006). Investigating the factors influencing professional identity of first-year health and social care students. Learning in Health and Social Care, 5(2), 55–68. doi:10.1111/j.1473-6861.2006.00119.x

Aponte, H. J., Powell, F. D., Brooks, S., Watson, M. F., Litzke, C., Lawless, J., & Johnson, E. (2009). Training the person of the therapist in an academic setting. Journal of Marital and Family Therapy, 35, 381–394. doi:10.1111/j.1752-0606.2009.00123.x

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

Beddoe, A. E., & Murphy, S. O. (2004). Does mindfulness decrease stress and foster empathy among nursing students? Journal of Nursing Education, 43, 305–312. doi:10.3928/01484834-20040701-07

Birnbaum, L. (2008). The use of mindfulness training to create an ‘accompanying place’ for social work students. Social Work Education: The International Journal, 27, 837–852. doi:10.1080/02615470701538330

Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J. . . . Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11, 230–241. doi:10.1093/clipsy/bph077

Brott, P. E. (2006). Counselor education accountability: Training the effective professional school counselor. Professional School Counseling, 10, 179–188. doi:10.5330/prsc.10.2.d61g0v3738863652

Campbell, A., Vance, S. R., & Dong, S. (2017). Examining the relationship between mindfulness and multicultural counseling competencies in counselor trainees. Mindfulness. Advance online publication. doi:10.1007/s12671-017-0746-6

Cho, J. Y., & Lee, E.-H. (2014). Reducing confusion about grounded theory and qualitative content analysis: Similarities and differences. The Qualitative Report, 19(32), 1–20.

Christopher, J. C., & Maris, J. A. (2010). Integrating mindfulness as self-care into counselling and psychotherapy training. Counselling and Psychotherapy Research, 10, 114–125. doi:10.1080/14733141003750285

Clouder, L. (2005). Caring as a ‘threshold concept’: Transforming students in higher education into health(care) professionals. Teaching in Higher Education, 10, 505–517. doi:10.1080/13562510500239141

Corey, G., Corey, M. S., & Callanan, P. (2011). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.

Council for Accreditation of Counseling & Related Educational Programs. (2016). 2016 standards for accreditations. Alexandria, VA: Author.

Davis, D. M., & Hayes, J. A. (2011). What are the benefits of mindfulness? A practice review of psychotherapy-related research. Psychotherapy, 48, 198–208. doi:10.1037/a0022062

Elman, N. S., Illfelder-Kaye, J., & Robiner, W. N. (2005). Professional development: Training for professionalism as a foundation for competent practice in psychology. Professional Psychology: Research and Practice, 36, 367–375. doi:10.1037/0735-7028.36.4.367

Epstein, R. M. (2003). Mindful practice in action (II): Cultivating habits of mind. Families, Systems & Health, 21, 11–17. doi:10.1037/h0089495

Gibson, D. M., Dollarhide, C. T., & Moss, J. M. (2010). Professional identity development: A grounded theory of transformational tasks of new counselors. Counselor Education and Supervision, 50, 21–38. doi:10.1002/j.1556-6978.2010.tb00106.x

Goltz, H. H., & Smith, M. L. (2014). Forming and developing your professional identity: Easy as PI. Health Promotion Practice, 15, 785–789. doi:10.1177/1524839914541279

Granello, D. H., & Young, M. E. (2011). Counseling today: Foundations of professional identity. Upper Saddle River, NJ: Pearson Education.

Greason, P. B., & Cashwell, C. S. (2009). Mindfulness and counseling self-efficacy: The mediating role of attention and empathy. Counselor Education and Supervision, 49, 2–19. doi:10.1002/j.1556-6978.2009.tb00083.x

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: The Guilford Press.

Hill, C. L., & Updegraff, J. A. (2012). Mindfulness and its relationship to emotional regulation. Emotion, 12, 81–90. doi:10.1037/a0026355

Hülsheger, U. R., Alberts, H. J., Feinholdt, A., & Lang, J. W. (2013). Benefits of mindfulness at work: The role of mindfulness in emotion regulation, emotional exhaustion, and job satisfaction. Journal of Applied Psychology, 98, 310–325. doi:10.1037/a0031313

Hycner, R. H. (1999). Some guidelines for the phenomenological analysis of interview data. In A. Bryman & R. G. Burgess (Eds.), Qualitative research (Vol. 3, pp. 143–164). London, England: Sage.

Hyland, P. K., Lee, R. A., & Mills, M. J. (2015). Mindfulness at work: A new approach to improving individual and organizational performance. Industrial and Organizational Psychology, 8, 576–602. doi:10.1017/iop.2015.41

Jacobowitz, J. L., & Rogers, S. (2014). Mindful ethics: A pedagogical and practical approach to teaching legal ethics, developing professional identity, and encouraging civility. St. Mary’s Journal on Legal Malpractice & Ethics, 4, 198–240.

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

La Roche, M., & Lustig, K. (2013). Being mindful about the assessment of culture: A cultural analysis of culturally adapted acceptance-based behavior therapy approaches. Cognitive and Behavioral Practice, 20, 60–63. doi:10.1016/j.cbpra.2012.04.002

Levitt, D. H., & Jacques, J. D. (2005). Promoting tolerance for ambiguity in counselor training programs. Journal of Humanistic Counseling, Education and Development, 44, 46–54. doi:10.1002/j.2164-490X.2005.tb00055.x

Limberg, D., Bell, H., Super, J. T., Jacobson, L., Fox, J., DePue, M. K., . . . Lambie, G. W. (2013). Professional identity development of counselor education doctoral students: A qualitative investigation. The Professional Counselor, 3, 40–53. doi:10.15241/dll.3.1.40

Louchakova, O. (2005). On advantages of the clear mind: Spiritual practices in the training of a phenomenological researcher. The Humanistic Psychologist, 33, 87–112. doi:10.1207/s15473333thp3302_2

Martin, N. (2014). Think like a (mindful) lawyer: Incorporating mindfulness, professional identity, and emotional intelligence into the first year law curriculum. University of Arkansas at Little Rock Law Review, 36, 413–451.

Masicampo, E. J., & Baumeister, R. F. (2007). Relating mindfulness and self-regulatory processes. Psychological Inquiry, 18, 255–258. doi:10.1080/10478400701598363

Mayes, R. D., Dollarhide, C. T., Marshall, B., & Rae, A. (2016). Affective and developmental transitions: Qualitative themes in multicultural counseling journals. The International Journal of Information and Learning Technology, 33, 2–16. doi:10.1108/IJILT-10-2015-0031

Moss, J. M., Gibson, D. M., & Dollarhide, C. T. (2014). Professional identity development: A grounded theory of transformational tasks of counselors. Journal of Counseling & Development, 92, 3–12. doi:10.1002/j.1556-6676.2014.00124.x

Moustakas, C. (1994). Phenomenological research methods. Thousand Oaks, CA: Sage.

Murdock, J. L., Stipanovic, N., & Lucas, K. (2013). Fostering connections between graduate students and strengthening professional identity through co-mentoring. British Journal of Guidance & Counselling, 41, 487–503. doi:10.1080/03069885.2012.756972

Neuendorf, K. A. (2016). The content analysis guidebook (2nd ed.). Thousand Oaks, CA: Sage.

Patton, M. Q. (1990). Qualitative evaluation and research methods (2nd ed.). Thousand Oaks, CA: Sage.

Patton, M. Q. (2015). Qualitative research & evaluation methods: Integrating theory and practice (4th ed.). Thousand Oaks, CA: Sage.

Pistole, M. C., & Roberts, A. (2002). Mental health counseling: Toward resolving identity confusions. Journal of Mental Health Counseling, 24, 1–19.

Reiner, S. M., Dobmeier, R. A., & Hernández, T. J. (2013). Perceived impact of professional counselor identity: An exploratory study. Journal of Counseling & Development, 91, 174–183. doi:10.1002/j.1556-6676.2013.00084.x

Rothaupt, J. W., & Morgan, M. M. (2007). Counselors’ and counselor educators’ practice of mindfulness: A qualitative inquiry. Counseling and Values, 52, 40–54. doi:10.1002/j.2161-007X.2007.tb00086.x

Schroevers, M. J., & Brandsma, R. (2010). Is learning mindfulness associated with improved affect after mindfulness-based cognitive therapy? British Journal of Psychology, 101, 95–107. doi:10.1348/000712609X424195

Seidman, I. (2013). Interviewing as qualitative research: A guide for researchers in education and the social sciences (4th ed.). New York, NY: Teachers College Press.

Skovholt, T. M., Grier, T. L., & Hanson, M. R. (2001). Career counseling for longevity: Self-care and burnout prevention strategies for counselor resilience. Journal of Career Development, 27, 167–176. doi:10.1177/089484530102700303

Slay, H. S., & Smith, D. A. (2011). Professional identity construction: Using narrative to understand the negotiation of professional and stigmatized cultural identities. Human Relations, 64, 85–107. doi:10.1177/0018726710384290

Snippe, E., Nyklíček, I., Schroevers, M. J., & Bos, E. H. (2015). The temporal order of change in daily mindfulness and affect during mindfulness-based stress reduction. Journal of Counseling Psychology, 62, 106–114. doi:10.1037/cou0000057

Stake, R. (2006). Multiple case study analysis. New York, NY: The Guilford Press.

Starks, H., & Trinidad, S. B. (2007). Choose your method: A comparison of phenomenology, discourse analysis, and grounded theory. Qualitative Health Research, 17, 1372–1380. doi:10.1177/1049732307307031

Studer, J. R. (2006). Erik Erikson’s psychosocial stages applied to supervision. Guidance & Counseling, 21, 168–173.

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

Wei, M., Tsai, P.-C., Lannin, D. G., Du, Y., & Tucker, J. R. (2015). Mindfulness, psychological flexibility, and counseling self-efficacy: Hindering self-focused attention as a mediator. The Counseling Psychologist, 43, 39–63. doi:10.1177/0011000014560173

Zakaria, N. S., Warren, J., & Bakar, A. R. (2017). Counseling ethics education for enhanced professional identity and development: Guidance and counseling teachers lifelong learning acquisition empowered. In I. H. Amzat, & N. P. Valdez (Eds.), Teacher empowerment toward professional development and practices: Perspectives across borders (pp. 153–166). Singapore: Springer Nature Singapore Pte Ltd.

Shengli Dong, NCC, is an assistant professor at Florida State University. Amanda Campbell and Stacy Vance are doctoral students at Florida State University. Correspondence can be addressed to Shengli Dong, 114 Call Street, Tallahassee, FL 32313, sdong3@fsu.edu.

Exploring Experiential Learning Through an Abstinence Assignment Within an Addictions Counseling Course

Dec 2, 2017 | Volume 7 - Issue 4

Chad M. Yates, Alexia DeLeon, Marisa C. Rapp

Counselors-in-training may struggle in working with addictions populations for various reasons, including limited training, pre-existing stigma toward the population, and low self-efficacy treating substance use disorders. This is concerning because professional counselors have the highest proportion of clients with a primary substance abuse diagnosis. The authors explored the experiential learning approach of an abstinence project within an addictions course in an attempt to give students a genuine experience that parallels what an individual with an addiction may experience. The authors utilized generic qualitative analysis to explore the experience of 17 counseling students completing the abstinence assignment. The emergent themes of (1) concrete experiences, (2) dealing with cravings, (3) student’s self-reflection of learning, and (4) empathetic understanding and challenging attitudes are presented. Finally, future areas of research and implications for counselor educators are discussed.

Keywords: substance use disorders, abstinence assignment, generic qualitative analysis, counselors-in-training, addictions

Counselor educators face considerable challenges in providing comprehensive and effective training for counselors-in-training (CITs) serving persons with substance use disorders (SUDs). These challenges include students’ unfamiliarity with addictions or addicted populations, few opportunities to infuse addictions-related materials into the general curriculum, and no uniform national curriculum standards for addictions-related education (Chasek, Jorgensen, & Maxson, 2012; Salyers, Ritchie, Cochrane, & Roseman, 2006). This is concerning, as addiction remains a consistent issue for the general population. Approximately 21.5 million Americans meet criteria for an SUD (Substance Abuse and Mental Health Services Administration, 2015), reinforcing the need for competent addictions counselors. Professional counselors (excluding specified addictions counselors) have the highest proportion of clients with a primary substance abuse diagnosis, in comparison to social workers, psychologists, and psychiatrists (Harwood, Kowalski, & Ameen, 2004). Additionally, CITs also treat clients with addictions much more frequently during their training. Salyers et al. (2006) found that a high percentage of CITs see clients in their practicum and internship experiences who present with substance abuse concerns. Due to the frequency of addiction concerns counselors and CITs treat, it is imperative that counselor education programs continue to address training necessary to accommodate these concerns.

In response to the growing need to train effective addictions counselors, the Council for Accreditation of Counseling & Related Educational Programs (CACREP; 2016) constructed standards that counselor educators should infuse within the curriculum. The integration of the standards across all CACREP-accredited programs has been slow, but a 2013 survey of programs found that 76.7% of counseling graduates had at least one course related exclusively to substance abuse counseling (Iarussi, Perjessy, & Reed, 2013). This is a substantial increase considering Salyers et al.’s (2006) findings that only 58.2% of counseling graduates had taken at least one course related to substance abuse counseling. Starting in 2009 and continuing within the 2016 standards, CACREP specifically called for counselors to understand the theories and etiology of addictions and addictive behaviors, including strategies for prevention, intervention, and treatment (CACREP, 2016). These changes have provided steps toward greater competency in the treatment of addictions; however, most students still have only one course during their program devoted to addictions (Chasek et al., 2012). As most counseling education programs continue to only have a single course devoted to addictions education, it is critical to investigate the educational experiences of CITs and explore the educational experiences that maximize student learning.

A common concern when educating CITs about addictions is the attitudes and biases they bring with them to an addictions course (Chasek et al., 2012). The pre-existing attitudes and behaviors espoused by CITs are often derived from moralistic notions of addiction (Chasek et al., 2012). Clinicians’ negative attitudes toward persons with addictions often lead to reduced outcomes in treatment (McLellan, Lewis, O’Brien, & Kleber, 2000). Blagen (2007) suggested that negative attitudes need to be addressed during training to help CITs facilitate relationship building with persons with addictions. A common tool utilized in addictions training to foster empathy and understanding of persons with addictions is the abstinence assignment. The abstinence assignment asks students to abstain from a substance or behavior for a set period and journal about the experience. This learning approach has been explored in a pharmaceutical education program (Baldwin, 2008), allowing students to successfully meet all four of the course’s learning objectives: (1) describe feelings and experiences related to the process of withdrawal from habituating or addicting substances or activities; (2) describe the importance of abstinence in the maintenance of recovery from habituating or addicting substances or activities and discuss the implications of relapse to the recovery process; (3) discuss the importance of support systems in recovery from habituating or addicting substances; and (4) describe the process of addiction and recovery (Baldwin, 2008).

Baldwin (2008) found generally favorable opinions of the assignment and strong ties to reflective learning through class surveys conducted before and after the assignment. However, no study to date has explored students’ learning processes during an abstinence assignment. The aim of the current study was to understand the pedagogy behind the abstinence assignment and to explore the experience of students completing the project. It was hoped that the study would reveal if the abstinence assignment could foster empathetic experiences for persons with addiction and if the assignment could enhance understanding of withdrawal, craving, and relapse. Specific research questions included: (a) what, if any, were the empathetic experiences of students concerning clients with addictions; (b) how was the concept of craving experienced and made meaningful by participants; (c) what were the elements of the learning process for participants completing the abstinence assignment; and (d) how did students find ways to deal effectively with cravings and abstinence through the project? This study utilized qualitative data analysis methodology to explore the experiences of 17 CITs who completed an abstinence assignment during their addictions course. A review of pertinent literature follows.

CITs often face considerable difficulty learning addiction-specific tools and skills. These challenges typically arise due to students’ limited exposure to persons who are addicted, limited experiences of cravings and triggers, limited understanding of the lives of those with addictions, and limited self-efficacy of being effective with this population (Harwood et al., 2004). This lack of awareness, coupled with classroom material that is disconnected from the students’ experiences, may lead students to feel unprepared for treating clients with addiction concerns. The infusion of experiential learning activities is one way to counter the above concern. Kolb (1984) stated that learning new concepts involves directly encountering these concepts within real world experiences. In Kolb’s theory, “Learning is the process whereby knowledge is created through the transformation of experience” (Kolb, 1984, p. 38). Effective learning is seen when a person progresses through a cycle of four stages: (1) having a concrete experience, followed by (2) observation of and reflection on that experience, which leads to (3) the formation of abstract concepts (analysis) and generalizations (conclusions), which are then (4) used to test hypotheses in future situations, resulting in new experiences (Kolb, 1984). Experiential learning is a means of acquiring knowledge through action and feelings; it creates an emotional understanding and challenges attitudes (Warren, Hof, McGriff, & Morris, 2012).

Sias and Goodwin (2007) explored an experiential learning approach of CITs attending 12-step meetings and then journaling their experience. Students attending 12-step meetings reported growth and new awareness of the experience of persons with addictions. Students described the fear and uncertainty clients faced when beginning a support group. They also reported challenging their pre-existing stereotypes of persons with addictions, through interacting with those in recovery. Results from studies such as Sias and Goodwin (2007) can help further understanding of the barriers in learning about addictions and also help educators implement experiential learning approaches more intentionally.

Barriers to Learning

In training emerging clinicians to work with persons with addictions, research has revealed that many trainees lack empathy and emotional understanding for this population (Baldwin, 2008; Giordano, Stare, & Clarke, 2015; Sias & Goodwin, 2007). Research has shown the struggles CITs may experience in showing empathy, emotional understanding, and challenging bias toward persons with addictions. These struggles may impact the quality of care toward persons with addictions (Chasek et al., 2012; Giordano et al., 2015). Furthermore, many CITs report poor self-efficacy in being clinically effective with persons struggling with addictions (Harwood et al., 2004). Celluci and Vik (2001) found that approximately 144 mental health providers in Idaho who treated persons with an SUD rated their graduate training as inadequate preparation for treating clients with an SUD. The importance of strong educational experiences is reinforced by Carroll (2000). Carroll reported that CITs with more addictions courses were increasingly likely to treat or refer a client for an SUD and to think of an SUD as a distinct disorder, compared to CITs with less addictions training.

Another potential learning barrier for students is negative stigma toward persons with addictions. Society’s negative portrayal of those battling addictions may play a role in counselor trainees’ perceptions and attitudes regarding this population (McLellan et al., 2000). For instance, the general public is reported as viewing persons with drug addictions negatively, as blameworthy and dangerous (Corrigan, Kuwabara, & O’Shaughnessy, 2009). CITs possess similar negative attitudes, beliefs, and biases regarding addictions and addiction treatment (Chasek et al., 2012). These authors investigated CITs’ attitudes toward persons with addictions and the effectiveness of substance abuse counseling. They concluded that students who had less bias toward persons with addictions were more likely to view treatment for substance abuse as effective.

Counselor educators are charged with the responsibility to ensure that competent counseling professionals are entering the field (CACREP, 2016). As present research shows the struggles that many CITs are facing in relation to persons with addictions, it is vital that further research is conducted to examine how counselor educators can remedy this known lack of empathy and emotional understanding through pedagogical intervention. Although anecdotal evidence from past generations of counselor educators has shown the experiential assignment of abstaining from a substance as useful, to date no counseling literature exists that shows empirical evidence for this assumption. Consequently, we investigated the experience of students utilizing the abstinence assignment and built upon the limited understanding of integrating an abstinence assignment into addictions curriculum.

Qualitative Research Design

Generic qualitative analysis (GQS; Percy, Kostere, & Kostere, 2015) was employed as a qualitative methodology to examine the pedagogical implications of utilizing an abstinence assignment within an addictions course. GQS seeks to understand and discover the perspectives and worldviews of participants and is intended to explore what participants directly experienced, or what the experience was about (Percy et al., 2015). The present study utilized existing abstinence journals and reflection summaries that included descriptions and reflections of students’ experiences of participating in the abstinence assignment; it was deemed appropriate to use a qualitative methodology that would support the analysis of these data resources (Percy et al., 2015).

Participants

The participants selected for the study were master’s-level counseling students enrolled in their second and last year of study. These students were enrolled in an addictions counseling course, and a major course requirement was an abstinence assignment. Students were instructed to select a substance or behavior from which they wished to abstain for 4 weeks. There was a total of 17 participants (14 females and three males). The ages of participants ranged from 24 to 44 years with a mean age of 26. All 17 participants identified as White. Participation in the study was solicited after the participants completed their abstinence journals and reflective summaries, and received grades for the assignment. The participants were informed that participation in the study was completely voluntary and would have no impact on their grade. Data analysis was conducted once the course was completed. Of the 17 participants, the following is a list of the chosen substances or behaviors with the number of students: Soda or Carbonated Beverages (3), Sugar (4), Alcohol (3), Eating Out at Restaurants (2), Social Media or Entertainment Activities (3), Procrastination (1), and Evening Snacking (1).

Abstinence Assignment

This exercise was designed to help students experience some of the feelings/thoughts that addicted individuals experience when they quit their drug or behavior of choice. Students were told: This exercise requires that you give up a substance (e.g., nicotine, caffeine, or alcohol) or a behavior (e.g., eating sweets, playing video and computer games, watching television) for a period of 4 weeks. During this assignment, you will write a goodbye letter to your substance or behavior detailing why you are choosing to give up the substance or behavior and what the substance or behavior means to you, and you will keep an abstinence log of your experiences. This log will describe your feelings and reactions, especially focusing on times you “lapse” or experience cravings (minimum one page log of two entries per week). Finally, you will write a summary paper, which will serve as the conclusion to the 4-week exercise.

Data Analysis and Trustworthiness Procedures

The researchers obtained Institutional Review Board approval prior to the analysis of the data. Data analysis procedures were followed according to the guidelines set forth by Percy et al. (2015). The researchers first familiarized themselves with the study materials—which included a goodbye letter to the substance or behavior, abstinence journals, and reflection summaries—by reading through each item and making notations (highlights) about significant statements that reflected the research questions for the study. The above step was performed independently by the first and second author for all 17 transcripts. The two researchers (authors one and two) met at two different times, once halfway through the initial transcript analysis and again at the end to compare and contrast notes.

After this step was completed, the researchers compared notes to identify common theme listings from the data. The researchers created a definitional agreement for each emergent theme. The goal of this step was to isolate significant themes represented in both researchers’ notes. Each researcher had to agree that there was ample evidence to support this theme and agree on the mutual definition of this theme. To aid the researchers in coding, the work of Kolb’s Experiential Learning Model (Kolb, 1984) was incorporated into the coding procedures to link existing learning theory steps to the process that was being discovered within the transcripts. Once the coding structure was in place, the first author coded each of the 17 participant transcripts. Coding each participant was performed by highlighting significant statements that represented the theme and its definition. For example, the researcher coded a significant statement from Participant 1: I can see why this is so difficult for some people to stay sober; I’m having a hard time and only . . . giving up sugar. This significant statement was coded as empathy. Upon completion of this coding, both researchers independently reviewed the list of significant statements under each theme and noted if the statement was representative of the existing theme definition. If the significant statement was not representative, it was either discarded or represented under a more appropriate theme.

The researchers met upon completion of this step to share the results of the review of significant statements. The researchers then decided if each change to the significant statement was warranted. Following the above step, the researchers organized all themes into similar categories. After this categorization was complete, the researchers utilized an auditor outside of the study who shared a similar background and training in qualitative research to review the significant statements under each theme and identify if they were representational to the existing theme definition and if the themes fit within their designated category. The auditor made notes about significant statements to discard or to move to another theme. Upon completion of the auditor’s review, the category, theme structure, and theme definitions were emailed to each participant of the study for member checking. Each participant was asked to comment on the list of themes and the researchers’ definitions of each theme to ensure that they were credible. Participants with comments for the researchers were contacted again, and category and theme structures were reviewed and revised based on the participants’ input.

Results

Four themes emerged during the data collection process. The first theme was “concrete experiences” of the participants completing the abstinence assignment. This theme contained several subthemes, such as withdrawal cues, cravings, relapse, justifications of relapse, shame after relapse, and triggers. The second theme that emerged was “dealing with cravings.” Within this theme were the subthemes of replacement behaviors and relapse avoidance. The third theme contained elements of “student’s self-reflection of learning.” This theme contained two subthemes: reflective observation and abstract conceptualization. The last theme consisted of statements showcasing students engaging in empathetic understanding and challenging their attitudes or perceptions of persons with addictions.

Theme One: Concrete Experiences

Theme One contained participant descriptions of completing the abstinence assignment. These concrete experiences, cravings, relapse, and shame over relapse are similar to experiences of persons beginning and sustaining recovery. The most often identified statement from participants was craving for their identified substance. Participant 3 journaled, “Sometimes I wish I could just take all of my cravings and put them in a jar and smash the jar so I don’t have to deal with them anymore.” Beginning to deny the use of a substance had begun to produce strong desires often unknown by participants. Participant 15, who abstained from soda, described hearing a soda dispenser and the physical effect she noticed in her body for the first time, “It was odd to note that I had a sensation go through my entire body as I heard it. It made me think and consider Pavlov’s dogs. Truthfully, I thought about Diet Coke the rest of the day.” Cravings were often accompanied by withdrawal in participants who had given up substances they had consumed over long periods. Participant 12 reported, “Today I was run-down and fatigued, and I developed a low-grade headache that stayed with me all day. And even though I ate more than I usually eat in a day, I felt like I was starving.”

Reading through the 17 participants’ journals, researchers found consistent patterns of subthemes often occurring in a sequential order. The subthemes order was descriptive of a trigger or cravings, followed by relapse, justification for the relapse, and finally shame and guilt over the relapse. Upon review of the participants’ transcripts, this pattern was found in 15 of the 17 participants and occurred between one and three times per participant. Participant 13, who abstained from sugar, described a cycle of trigger, craving, relapse, justification of relapse, and shame over relapsing: “Tonight was Superbowl Sunday. My aunt made a gluten free cake with dulce de leche and strawberries on top, and I ate two slices . . . I felt like I deserved it because I was doing so good on this abstinence assignment.” Participant 13 further recalled, “I feel a little bad about it now, but I honestly feel like it was justifiable and I plan on going back to the no sugar and no gluten thing again tomorrow anyway.”

Instances of complete breakdown on the students’ abstinence goals often appeared. These especially occurred with students who chose substances like grains, carbs, or sugar. The defining elements of these complete breakdowns were a sense of low self-efficacy and overwhelming guilt and shame. Participant 10, who abstained from fast food, expressed, “I have eaten at fast food restaurants three times since last Thursday . . . I literally feel disgusted at myself that I haven’t been able to control my cravings or at least have enough self-control to just be mindful about my choices.” The experience of emotional and physical symptoms related to abstaining from a behavior or substance prompted students to begin exploring effective personal strategies for dealing with their cravings.

Theme Two: Dealing With Cravings

Paralleling the experience of individuals in the early stages of recovery, participants actively dealt with cravings in various ways, including healthy and unhealthy coping mechanisms. When participants selected strategies that were unhealthy or unhelpful, the researchers labeled these as replacement behaviors. These behaviors often consisted of replacing their substances with other substances. For example, switching from sugary foods to fatty or salty foods, and avoiding a trigger or cravings by staying overly busy. These behaviors are not new to professionals working with clients with addictions. Below are examples of the participants engaging in these replacement behaviors. Participant 1, who abstained from soda, described noticing her behaviors as, “I ate a lot more . . . than I normally do. Because of how many chips I was eating I realized that I had replaced my drink [soda] with chips and salsa.” Noticing the pattern was a valuable learning experience that helped the participant to confront her substitution later in the assignment.

However, other students were unable to observe the ties connected to these behaviors and future relapse. Participant 5, who abstained from social media, reported, “I was also very busy the last couple of days because I’ve been preparing for my counseling presentation. Maybe I’ve successfully distracted myself from the temptation.” Nearly all participants reported engaging in replacement behaviors at some point in their experience. However, many of these participants discovered more successful ways to cope with triggers and cravings. When participants reported positive craving coping strategies, the researchers labeled these experiences as relapse avoidance strategies. These strategies often involved the elimination of potential triggering events or objects within the participants’ environments, relying on significant others and family members for support, talking to classmates about their cravings, and using healthy substitutions in place of their substance.

Participant 5 reported an instance of a relapse avoidance strategy: “I actually uninstalled and deactivated my Twitter. That way if I go to tweet something, I would have to download the app and activate my account. Two layers of activity would definitely put a damper on impulsivity.” Additionally, Participant 6, who had given up sugar, reported, “I got rid of all the sugar in the house.”

Relying on classmates and family was often described as essential from participants who reported they felt they had successfully abstained. Participant 3, who abstained from sugar, reported, “I talked with one of my friends about how the relapse has impacted my overall motivation and she really helped me get through and process.” Participant 5 added, “I’ve enlisted the help of my husband—(he) agreed to check my Twitter handle to make sure it is deactivated. This keeps me honest. I like the accountability piece because I can’t tweet in secret.” The healthy substitution often resembles behaviors like a step-down program or funneling energy into healthy activities and hobbies such as exercising or spending time with close friends. Participant 3, described replacing sugary sodas with a healthier alternative: “I found this type of soda . . . that is basically naturally flavored water. To say it’s curbed my sugar craving is an understatement.” Others described tending to general wellness to alleviate the stress associated with abstinence. Participant 7, who abstained from alcohol, reported, “I noticed myself going to sleep earlier yesterday . . . which I believe was a coping strategy for dealing with my irritability of trying to relax without allowing myself to have a drink.”

These strategies represent active experimentation and learning about how best to be successful at abstaining from the identified substance or behavior. Reflections on these experiences were essential to the learning goals associated with this project. The next theme explores these reflections and provides insight into the learning that was taking place throughout the assignment.

Theme Three: Student’s Self-Reflection of Learning

Theme Three explored the elements of personal learning the participants reflected upon. The researchers identified learning through Kolb’s Experiential Learning Model (Kolb, 1984). The researchers were interested in participants’ statements that evidenced reflective observations, defined as observations and reflections on what their experience was about and how it resonated with them. The researchers also were interested in participants’ statements that evidenced abstract conceptualization. We defined abstract conceptualization as the reflection upon concepts related to treating persons with addictions followed by generalizations from these reflections to future work with clients.

Examples of reflective observation can be found within Participant 2’s description of her difficulty in remaining abstinent from television for the assignment and how she discovered the difficulty of the change process within herself: “I feel like all I’ve done is replace not thinking because I watch mindless shows on television to not thinking because I play mindless games on my phone. I’ve thought about replacing it with exercise, but I feel myself rebelling against that.”

Many of the participants’ reflections facilitated greater awareness about how difficult it was to change any reinforced behavior or the difficulty of abstaining from a substance or behavior. Many reflected on discovering the difficulty of living without their substance or behavior. Participant 4, who abstained from social media, described, “It was very surprising to me when I realized how automatic my impulses were and how often I gave into them. During this time, my eyes were opened to how much this habit impacted my life.” In addition to discovering how hard it was to live without something they once enjoyed, many participants described experiencing new insight into the minds and behaviors of persons in recovery. Participant 13, who abstained from sugar, described, “It was much more difficult to abstain when I was around people who were consuming around me. I felt a greater social pressure and found myself feeling insecure (and) disconnected in social settings.” Participant 13 reported that pressure to continue was difficult to maintain: “Once I relapsed and we were nearing the end of the four weeks, it was hard for me to remain motivated to continue . . . the craving, the desire to connect with people and fit in, and the unexplainable high I get from eating sugar and gluten had to be outweighed by something else.”

Additionally, participants described the change process as something tangible and less theoretical. Participants could describe and reflect upon where they were within the stages of change and began to appreciate the difficulty of sustaining lasting change. Participant 11, who abstained from alcohol, described her awareness of the change process as, “Change doesn’t just happen overnight; it requires many things, including commitment, energy, the right motivation, and the right timing.” In addition, Participant 3, who abstained from sugar, added, “I talk in my notes at my site all the time about motivation for change and what that looks like for each of my clients, and I couldn’t even apply it to myself.”

The participants began to understand the experience of what counselors were asking clients to do by abstaining from drugs or alcohol. They also began to understand how to apply this learning to clients who were currently struggling with addictions and help with the understanding of the concepts of addiction. Participant 12, who abstained from sugar, reported, “This experience helped me understand how counterproductive it is to tell other people what they need to do to change. People don’t change until they are ready . . . to assume that a person will change just because someone tells them to is a mistake.”

Additionally, participants recalled what was most difficult about abstaining and built stronger conceptualizations about the role of triggers in relapse. Participant 17, who abstained from alcohol, reported, “I went dancing with some friends last night at a bar in town and found myself being asked several times why I wasn’t drinking.” This participant expressed the frustration about the experience as, “It began to get really annoying, and I feel (it) gave me some insight into the role that others play in the process of addiction and becoming sober, and how risky it can be in certain environments.”

The application of the experience of abstinence impacted all of the participants to some degree. Overall, they stated they felt a greater capacity of empathy for persons with addictions based upon how difficult abstinence was. Most participants reflected that the way they viewed a person in recovery was altered based on their experience of abstinence. The assignment generated new learning opportunities and understanding of the concepts of addiction and also enhanced their empathy for clients suffering from addictions. This enhancement of empathy was found within Theme Four, discussed below.

Theme Four: Empathy and Attitudes

The participants all stated that a significant learning outcome of the assignment was empathy for those with addictions. Participant 3, who abstained from sugar, reported, “I can see how people would struggle giving up drugs when their body has such a dependence on their drug of choice. I am struggling and counting down the days and I’m only giving up sugar.” This empathy was often associated with a strong protest that they were only experiencing a small proportion of the suffering that persons in recovery go through. Participant 10, who abstained from fast food, described growing his awareness of persons with addictions as, “I know one of my limitations in counseling is not being able to relate to my clients because I haven’t experienced some of the things that they have, like an addiction.” Participant 10 discussed the benefits from the abstinence assignment as, “by doing something as simple as this, I feel that I am in a much better place to help clients.”

Other participants described that empathy helped them deepen their understanding and care for those in their close family who had gone through addictions. Participant 17 reported, “I have personally observed my father going through his journey in alcohol and opiate addictions. I have felt the pain, suffering, frustration, and struggle as a family member, which makes this assignment very personal for me.” Participants reported these empathetic gains as important because they provided new perspectives on the lives of persons with addictions. Gaining empathy helped move participants closer to understanding persons with addictions as human beings who were attempting to steer themselves away from alcohol and drugs. This helped them to combat previous biased views of persons with addictions and altered previous attitudes and beliefs that are ineffective in helping this population.

Discussion

This study explored the pedagogy behind an abstinence assignment and the experiences of students who participated. Specifically, the researchers wished to discover (1) What, if any, were the empathetic experiences of students concerning clients with addictions; (2) how was the concept of craving experienced and made meaningful by participants; (3) how did students find ways to deal effectively with cravings and abstinence through the project; and (4) what were the elements of the learning process for participants completing the abstinence assignment? A discussion of the research questions, including analysis of the themes, follows.

Empathetic Experiences of Students

Addressing bias and negative stigma associated with persons with addictions is a major aim of most addictions courses, as negative stigma has contributed to lower therapeutic outcomes for clients struggling with addictions (McLellan et al., 2000). This study explored the empathetic understanding of students completing the abstinence assignment and found that participants reported accessing empathy for persons struggling with addictions through experiences of craving, triggers, and relapse. Moreover, students empathized with the pain and suffering that abstaining produced and described the needed patience of treating clients with addictions. This empathy was fostered through an experiential understanding of craving, which is better explored within the second research question of how students found ways to effectively deal with cravings and abstinence via the project.

Experiences of Craving

An essential element of Kolb’s Experiential Learning Model (Kolb, 1984) is concrete experience. A concrete experience is a learning stage that involves having students experience a phenomenon physically, mentally, and psychologically. Although the experiences from the abstinence assignment are only approximations of individuals with addictions, they may still be important, as they provide students insight into withdrawal, craving, triggers, relapse, shame, and justification concerning relapse. This study’s first theme supports the learning objective that students experienced genuine addiction-related experiences. Students were cognizant that their experiences may not have perfectly compared to individuals addicted to drugs and alcohol; however, they stated often that the abstinence assignment produced suffering and uncertainty over their ability to abstain successfully from their chosen substances or behaviors. Students also reflected upon how they learned to cope through effective and ineffective ways with the experiences of craving and relapse. This was encouraging, as it provided students with strategies on how to help future clients during recovery.

Effectively Dealing With Cravings

Students often struggle with understanding where to start treatment with persons entering recovery (Carroll, 2000). This uncertainty may stem from unfamiliarity with the experiences of addictions and from lack of awareness of appropriate therapeutic goals for clients suffering from addictions. Students in this study reported understanding the concepts of triggers and cravings much more tangibly, while often discussing how they would broach these topics more readily with clients after completing the abstinence assignment. The students also reported ways they found to effectively manage their cravings that they felt could be useful to explore with clients in the future. These ways included many of the well-established treatment interventions for addictions that advocate for removal of all substances or substance use–related materials from home; restructuring daily living to replace or avoid triggering things, places, or times; the building of a supportive structure of family and peers; allowing others to hold the person responsible for future substance use; limiting exposure to cross-dependency through the use of other substances; actively discussing current cravings and triggers with family or peer support; and relying on healthy living strategies, like eating and sleeping well, to bolster defenses against triggers. We see from the list above that students were able to extrapolate strategies through abstaining from a substance or behavior to their work with clients. A closer inspection of Theme Three, students’ self-reflection of learning, found further support for the application of this project.

Elements of the Learning Process

In examining the students’ learning process, this study was interested in discovering if Kolb’s model could be an effective explanation of students’ learning during the abstinence assignment. It was discovered that the stage of concrete experiences was experienced during the period of abstaining. The assignment also required a reflection log or journal and a summarization paper. Within these portions of the assignment, the researchers found ample evidence to support that students engaged in reflective observations that helped them assign meaning to their experiences during abstaining, and also provided room for students to actively think through what these experiences meant for their work with clients (i.e., abstract conceptualization). Due to time considerations and inaccessibility to students, the researchers were unable to observe elements of Kolb’s fourth stage (i.e., active experimentation). Future research might build upon the present design to investigate the application of skills with CITs having undergone an abstinence assignment.

Implications for Counselor Education

Madson, Bethea, Daniel, and Necaise (2008) explored current training within counseling psychology and mental health counseling programs and recommended key areas educators should attend to within the realm of addictions. These areas included: (a) thoroughly assess SUD, (b) determine the appropriate level of treatment, and (c) develop treatment plans that include evidence-based substance abuse treatment (Madson et al., 2008). Madson et al. identified key areas that closely aligned with CACREP Standard II.3.D., which calls for counselors to understand the theories and etiology of addictions and addictive behaviors, including strategies for prevention, intervention, and treatment. It is the authors’ belief that the abstinence assignment helps students prepare for the above standards in a way that surpasses traditional didactic content. Speculatively, this may be why the abstinence assignment has been seen as a hallmark of addictions training. Baldwin’s (2008) investigation of abstinence assignments found that 69% of participants felt the abstinence assignment had a major positive effect, and 44% of participants agreed that they better understood the process of addictions recovery as a result of the assignment. This study aimed to build upon Baldwin’s findings; specifically, to explore if the abstinence assignment was found valuable by students; and to discover if it provided a valuable learning experience about the phenomenological experiences of persons with addictions, an understanding of the symptoms of addictions, and an understanding of preliminary treatment approaches to use with clients. The researchers found key themes within the research that supported the assignment meeting the above learning goals. With these findings, the authors believe in the continued infusion of this assignment within counselor education.

The abstinence assignment carries pedagogical considerations for an educator to take into account before including it in the curriculum. These considerations include how an instructor intends to provide feedback and assess the reflection journals. Content of feedback should be considered to help elicit further reflection for the student to deepen the learning experience. Moreover, the instructor will want to consider ethical issues that may arise from the grading of this assignment. If a student is disclosing dangerous or high-risk behaviors or demonstrating signs or behaviors of a process addiction, instructors will need to address their concerns and support the student’s developmental needs.

Future Research

There are several recommendations for future research. First, future research is needed to examine the application of skills with counselors who have completed an abstinence assignment. Qualitative and quantitative inquiry could provide insight as to whether students are translating their learning from this assignment into clinical practice. Secondly, research may expand upon this study by examining students’ prior experience with addictions or persons struggling with addictions to inquire if prior knowledge influenced their learning experience. Finally, continued empirical exploration into additional pedagogical interventions to examine effectiveness in addictions curriculum is needed.

Limitations

Several limitations exist within the current study. A primary limitation known from the beginning of the study was the utilization of a class assignment as the primary means of data collection with all White participants. While other studies have utilized class assignments as means of data collection (Baldwin, 2008; Sias & Goodwin, 2007), it is unknown if participants provided consistently accurate representations of their progress, or if different types of students would have different experiences. This limitation was partially mitigated by encouraging journaling and reflection upon success and failures during abstinence. Another limitation was the inability to monitor the application of the learning material potentially being applied with internship clients.

Conclusion

Researchers investigated the pedagogical advantages of utilizing an abstinence project within an addictions course, along with exploring the empathetic understanding of students completing the abstinence project. Elements of their learning process were identified and results found that students reported increased empathy for persons struggling with addictions through their experience of abstinence. The authors recommend employing the abstinence assignment in an addictions course curriculum in counselor education. Future research is needed to examine the application of skills with counselors having undergone an abstinence assignment.

Conflict of Interest and Funding Disclosure

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

References

Baldwin, J. N. (2008). A guided abstinence experience to illustrate addiction recovery principles. American Journal of Pharmaceutical Education, 72(4), Article 78, 1–9. doi:10.5688/aj720478

Blagen, M. T. (2007). A research-based, experiential model for teaching a required addictive behaviors course to clinical counseling students. Vistas. Retrieved from https://www.counseling.org/Resources/Library/VISTAS/2007-V-online-MSWord-files/Blagen.pdf

Carroll, J. J. (2000). Counseling students’ conceptions of substance dependence and related initial interventions. Journal of Addictions & Offender Counseling, 20, 84–92. doi:10.1002/j.2161-1874.2000.tb00145.x

Cellucci, T., & Vik, P. (2001). Training for substance abuse treatment among psychologists in a rural state. Professional Psychology: Research and Practice, 32, 248–252. doi:10.1037/0735-7028.32.3.248

Chasek, C. L., Jorgensen, M., & Maxson, T. (2012). Assessing counseling students’ attitudes regarding substance abuse and treatment. Journal of Addictions & Offender Counseling, 33, 107–114. doi:10.1002/j.2161-1874.2012.00008.x

Corrigan, P. W, Kuwabara, S. A., & O’Shaughnessy, J. (2009). The public stigma of mental illness and drug addiction: Findings from a stratified random sample. Journal of Social Work, 9, 139–147.

Council for Accreditation of Counseling & Related Educational Programs. (2016). 2016 CACREP standards. Retrieved from http://www.cacrep.org/wp-content/uploads/2017/07/2016-Standards-with-Glossary-7.2017.pdf

Giordano, A. L., Stare, B. G., & Clarke, P. B. (2015). Overcoming obstacles to empathy: The use of experiential learning in addictions counseling courses. Journal of Creativity in Mental Health, 10, 100–113. doi:10.1080/15401383.2014.947011

Harwood, H. J., Kowalski, J., & Ameen, A. (2004). The need for substance abuse training among mental health professionals. Administration and Policy in Mental Health and Mental Health Services Research, 32, 189–205. doi:10.1023/B:APIH.0000042746.79349.64

Iarussi, M. M., Perjessy, C. C., & Reed, S. W. (2013). Addiction-specific CACREP standards in clinical mental health counseling programs: How are they met? Journal of Addictions & Offender Counseling, 34, 99–113. doi:10.1002/j.2161-1874.2013.00018.x

Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Upper Saddle River, NJ: Prentice-Hall.

Madson, M. B., Bethea, A. R., Daniel, S., & Necaise, H. (2008). The state of substance abuse treatment training in counseling and counseling psychology programs: What is and is not happening. Journal of Teaching in the Addictions, 7, 164–178.

McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. Journal of the American Medical Association, 284, 1689–1695.

Percy, W. H., Kostere, K., & Kostere, S. (2015). Generic qualitative research in psychology. The Qualitative Report, 20, 76–85.

Salyers, K. M., Ritchie, M. H., Cochrane, W. S., & Roseman, C. P. (2006). Inclusion of substance abuse training in CACREP-accredited programs. Journal of Addictions & Offender Counseling, 27, 47–58.

Sias, S. M., & Goodwin, L. R., Jr. (2007). Students’ reactions to attending 12-step meetings: Implications for counselor education. Journal of Addictions & Offender Counseling, 27, 113–126. doi:10.1002/j.2161-1874.2007.tb00025.x

Substance Abuse and Mental Health Services Administration. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health. Retrieved from: http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf

Warren, J. A., Hof, K. R., McGriff, D., & Morris, L. B. (2012). Five experiential learning activities in addictions education. Journal of Creativity in Mental Health, 7, 272–288. doi:10.1080/15401383.2012.710172

Chad M. Yates is an assistant professor at Idaho State University. Alexia DeLeon is an assistant professor at Lewis & Clark. Marisa C. Rapp is a doctoral student at Idaho State University. Correspondence can be addressed to Chad Yates, 921 South 8th Ave, Stop 8120, Pocatello, ID 83209-8120, yatechad@isu.edu.

Development of an Integrative Wellness Model: Supervising Counselors-in-Training

Feb 9, 2015 | Article, Volume 5 - Issue 1

Ashley J. Blount, Patrick R. Mullen

Supervision is an integral component of counselor development with the objective of ensuring safe and effective counseling for clients. Wellness also is an important element of counseling and often labeled as the cornerstone of the counseling profession. Literature on supervision contains few models that have a wellness focus or component; however, wellness is fundamental to counseling and the training of counselors, and is primary in developmental, strengths-based counseling. The purpose of this article is to introduce an integrative wellness model for counseling supervision that incorporates existing models of supervision, matching the developmental needs of counselors-in-training and theoretical tenets of wellness.

Keywords: supervision, wellness, counselors-in-training, integrative wellness model, developmental

The practice of counseling is rich with challenges that impact counselor wellness (Kottler, 2010; Maslach, 2003). Consequently, counselors with poor wellness may not produce optimal services for the clients they serve (Lawson, 2007). Furthermore, wellness is regarded as a cornerstone in developmental, strengths-based approaches to counseling (Lawson, 2007; Lawson & Myers, 2011; Myers & Sweeney, 2005, 2008; Witmer, 1985; Witmer & Young, 1996) and is an important consideration when training counselors (Lenz & Smith, 2010; Roach & Young, 2007). Therefore, a focus on methods by which counselor educators can prepare counseling trainees to obtain and maintain wellness is necessary.

Clinical supervision is an integral component of counselor training and involves a relationship in which an expert (e.g., supervisor) facilitates the development of counseling competence in a trainee (Loganbill, Hardy, & Delworth, 1982). Supervision is a requirement of master’s-level counseling training programs and is a part of developing and evaluating counseling students’ skills (Borders, 1992), level of wellness (Lenz, Sangganjanavanich, Balkin, Oliver, & Smith, 2012), readiness for change (Aten, Strain, & Gillespie, 2008; Prochaska & DiClemente, 1982) and overall development into effective counselors (Bernard & Goodyear, 2014). Supervisors use pedagogical methods and theories of supervision to assess and evaluate trainees with the goal of enhancing their counseling competence (American Counseling Association [ACA], 2014; Bernard & Goodyear, 2014). The method or theory of supervision relates to the interaction between counselor educators and counseling trainees and is isomorphic to a counselor using a theory with a client.

The number of supervision theories and methods has increased over recent years. In addition, integrated supervision models have been established with a focus on specific trainee groups (e.g., Carlson & Lambie, 2012; Lambie & Sias, 2009) or specific purposes (e.g., Luke & Bernard, 2006; Ober, Granello, & Henfield, 2009). These integrated models combine the theoretical tenets of key models with the goal of formulating a new perspective for clinical training that adapts to the needs of the supervisee or context. Lenz and Smith (2010) and Roscoe (2009) suggested that the construct of wellness needs further clarification and articulation as a method of supervision. Currently, a single model of supervision with a wellness perspective is available (see Lenz & Smith, 2010). However, it does not specifically apply to master’s-level counselors-in-training (CITs) or focus on the wellness constructs highlighted in the proposed integrative wellness model (IWM). Therefore, this manuscript serves to review relevant literature on supervision and wellness, introduce the IWM, and present implications regarding its implementation and evaluation.

Supervision

ACA (2014), the Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2009), and the Association for Counselor Education and Supervision (ACES; 2011) have articulated standards for best practices in supervision. For example, ACES’ (2011) Standards for Best Practices Guidelines highlights 12 categories as integral components of the supervision process. The categories include responsibilities of supervisors and suggestions for actions to be taken in order to ensure best practices in supervision. The ACA Code of Ethics (2014) states that supervision involves a process of monitoring “client welfare and supervisee performance and professional development” (Standard F.1.a). Furthermore, supervision can be used as a tool to provide supervisees with necessary knowledge, skills and ethical guidelines to provide safe and effective counseling services (Bernard & Goodyear, 2014).

Supervision has two central purposes: to foster supervisees’ personal and professional development and to protect clients (Vespia, Heckman-Stone, & Delworth, 2002). Supervisors work to ensure client welfare by monitoring and evaluating supervisee behavior, which serves as a gatekeeping tool for the counseling profession (Robiner, Fuhrman, Ristvedt, Bobbit, & Schirvar, 1994). Thus, supervisors protect the counseling profession and clients receiving counseling services by providing psychoeducation, modeling appropriate counselor behavior, and evaluating supervisees’ counseling skills and other professional behaviors. In order to do this, supervisors and supervisees must have a strong supervisory relationship that supports positive supervision outcomes (Rønnestad & Skovholt, 2003).

Supervision is a distinct intervention (Borders, 1992) that is separate from teaching, counseling and consultation. Supervision is unique in that it is comprised of multifaceted (e.g., teacher, counselor and consultant) roles that occur at different times throughout the supervision process (Bernard, 1997). Bernard’s (1979, 1997) discrimination model (DM) of supervision is an educational perspective positing that supervisors can match the needs of supervisees with a supervisor role and supervision focus. The DM is situation specific, meaning that supervisors can change roles throughout the supervision session based on their goal for supervisee interaction (Bernard, 1997). Therefore, supervisees require different roles and levels of support from their supervisors at different times throughout the supervision process, which can be determined by a process of assessment and matching of supervisee needs.

According to Worthen and McNeill (1996), supervision varies according to the developmental level of trainees. Beginning supervisees need more support and structure than intermediate or advanced supervisees (Borders, 1990). Additionally, supervisors working with beginning supervisees must pay more attention to student skills and aid in the development of self-awareness. With intermediate supervisees, supervision may focus on personal development, more advanced case conceptualizations of clients and operating within a specific counseling theory (McNeill, Stoltenberg, & Pierce, 1985). Advanced supervisees work on more complex issues of personal development, parallel processes or a replication of the therapeutic relationship in a variety of settings (e.g., counseling, supervision; Ekstein & Wallerstein, 1972), and advanced responses and reactions to clients (Williams, Judge, Hill, & Hoffman, 1997). Consequently, supervision progresses from beginning stages to advanced stages for supervisees, with a developmental framework central to the process. Supervision is tailored to the specific developmental level of a supervisee, and tasks are personalized for needs at specific times throughout the supervision process. Developmental stages in supervision have been identified as key processes that counselor trainees undergo (e.g., Rønnestad & Skovholt, 2003; Stoltenberg & McNeill, 2012), a conceptualization that necessitates a supervision model that aids supervisees in a developmental fashion.

Recent models of supervision represent trends toward integrative and empirically based supervision modalities (e.g., Bernard & Goodyear, 2014; Lambie & Sias, 2009). The current integrated model of supervision draws from the theoretical tenets of the DM (Bernard, 1979, 1997), matching supervisee developmental needs (Lambie & Sias, 2009; Loganbill et al., 1982; Stoltenberg, 1981) and wellness constructs (Lenz et al., 2012; Myers, Sweeney, & Witmer, 1998). Wellness is a conscious, thoughtful process that requires increased awareness of choices that are being made toward optimal human functioning and a more satisfying lifestyle (Johnson, 1986; Swarbrick, 1997). As such, the IWM includes wellness undertones in order to support optimal supervisee functioning. This article presents the IWM’s theoretical tenets, implementation and methods for supervisee evaluation. In addition, a case study is presented to demonstrate the IWM’s application in clinical supervision.

Theoretical Tenets Integrated Into the IWM of Supervision

The DM (Bernard, 1979, 1997) is considered “one of the most accessible models of clinical supervision” (Bernard & Goodyear, 2014, p. 52) and includes the following three supervisor roles: teacher, counselor and consultant. In the teacher role, the supervisor imparts knowledge to the supervisee and serves an educational function. The counselor role involves the supervisor aiding the supervisee in increasing self-awareness, enhancing reflectivity, and working through interpersonal and intrapersonal conflicts. Lastly, the consultant role provides opportunities for supervisors and supervisees to have discussions on a balanced level (Bernard, 1979). The three roles are used throughout the supervision process to promote supervisee learning, growth and development.

The DM of supervision is situation specific in that supervisors enact different roles throughout the supervision session based on the observed need of the supervisee (Bernard & Goodyear, 2014). As needs arise in supervision, the supervisor decides which role is best suited for the issue or concern. This process requires the supervisor to identify or assess a need and to make a decision regarding the appropriate role (i.e., teacher, counselor or consultant) to facilitate appropriate supervision. Furthermore, the use of supervisory roles is fluid, with its ebb and flow contingent upon the supervisee needs or issues. For example, if a supervisee is struggling with how to review informed consent, a supervisor can use the teacher role to educate the student on how to proceed, and then address the supervisee’s anxiety about seeing his or her first client using the counseling role. The DM roles are integrated into the IWM, and supervisors alternate between roles to match supervisee needs throughout the supervision process.

Developmental Tenets

The authors of developmental models have suggested that counseling trainees progress in a structured and sequential fashion through stages of development that increase in complexity and integration (e.g., Blocher, 1983; Loganbill et al., 1982; Stoltenberg, 1981; Stoltenberg & McNeill, 2010). In early experiences, supervisees engage in rigid thinking, have high anxiety and dependence on the supervisor, and express low confidence in their abilities (Borders & Brown, 2005; Rønnestad, & Skovholt, 2003; Stoltenberg & McNeill, 2012). Moreover, supervisees have limited understanding of their own abilities and view their supervisor as an expert (Borders & Brown, 2005; Stoltenberg & McNeill, 2010). Struggles between independency and autonomy, as well as bouts of self-doubt, occur during the middle stages of counselor development (Borders & Brown, 2005; Stoltenberg & McNeill, 2010). In addition, counselors experience decreased anxiety paired with an increase in case conceptualization, skill development and crystallization of theoretical orientation (Stoltenberg & McNeill, 2010). Thinking becomes more flexible and there is an increased understanding of unique client qualities and traits (Borders & Brown, 2005). The later stages of counselor development are marked by increased stability and focus on clinical skill development and professional growth, which promotes a flexibility and adaptability that allows for trainees to overcome setbacks with minimal discouragement (Stoltenberg & McNeill, 1997). Furthermore, supervisees focus on more complex information and diverse perspectives as they learn to conceptualize clients more effectively (Borders & Brown, 2005).

In summary, supervisees’ movement through the developmental stages is marked by individualized supervision needs. Structured, concrete feedback and information are desired in early supervision experiences (Bernard, 1997; Stoltenberg & McNeill, 2010). The middle stages have a general focus on processing the interpersonal reactions in which supervisees engage, and supervisors provide support to help supervisees increase their awareness of transference and countertransference (Borders & Brown, 2005; Stoltenberg, 1981). Toward the later stages of supervision, supervisees seek collaborative relationships with supervisors. This collaboration provides supervisees with more freedom and autonomy, which allows them to progress through the stages as they begin to self-identify the focus of their supervision (Borders & Brown, 2005).

Similar to the IWM, models of supervision that are development-focused derive from Hunt’s (1971) matching model that suggests a person–environment fit (Stoltenberg, McNeill, & Crethar, 1994). The matching model advocates that the developmental level of supervisees should be matched with environmental or contextual structures to enhance the opportunity for learning (Lambie & Sias, 2009). Specifically, the developmental models account for trainees’ needs specific to their experience level and contextual environment, with the goal of matching interventions to support movement into more advanced developmental levels (Bernard & Goodyear, 2014; Stoltenberg & McNeill, 2012). The IWM derives its developmental perspective from the unique levels trainees experience during supervision and the cycling and recycling of stages that occurs (Loganbill et al., 1982).

Wellness and Unwellness

Wellness is a topic that has received much attention in counseling literature (Hattie, Myers, & Sweeney, 2004), including several perspectives on how to define wellness (Keyes, 1998). Dunn (1967) is considered the architect of the wellness crusade and described wellness as an integration of spirit, body and mind. The World Health Organization (1968) defined health as more than the absence of disease and emphasized a wellness quality, which includes mental, social and physical well-being. Cohen (1991) described wellness as an idealistic state that individuals strive to attain, and as something that is situated along a continuum (i.e., people experience bouts of wellness and unwellness). Witmer and Sweeney (1992) depicted wellness as interconnectedness between health characteristics, life tasks (spirituality, love, work, friendship, self), and life forces (family, community, religion, education). Additionally, Roscoe (2009) depicted wellness as a holistic paradigm that includes physical, emotional, social, occupational, spiritual, intellectual and environmental components. Witmer and Granello (2005) stated that the counseling profession is distinctively suited to promoting health and wellness with a developmental approach and, coincidentally, supervision could serve as a tool to promote wellness in supervisees as well as in clients receiving counseling services.

Smith, Robinson, and Young (2007) found that counselor wellness is negatively influenced by increased exposure to psychological distress. Furthermore, research has shown that counselors face stress because of the nature of their job (Cummins, Massey, & Jones, 2007). Increased stress and anxiety associated with counseling may have deleterious effects on counselor wellness, and supervisors and supervisees who are unwell may adversely impact their clients. In addition, Lawson and Myers (2011) suggested that increasing counselors’ wellness could lead to increased compassion satisfaction and aid counselors in avoiding compassion fatigue and burnout. Thus, supervisee and supervisor wellness should be an important component of counselor training and supervision. The IWM makes counselor wellness a focus of the supervision process.

Supervision literature contains few supervision models that include wellness components and/or focus on wellness as a key aspect of the supervision experience (e.g., Lenz et al., 2012; Lenz & Smith, 2010). Nevertheless, the paradigm of wellness has emerged in the field of counseling and is primary in developmental, strengths-based counseling (Lenz & Smith, 2010; Myers & Sweeney, 2005). The CACREP 2009 Standards note the importance of wellness for counseling students and counselor educators by promoting human functioning, wellness and health through advocacy, prevention and education. To illustrate, the CACREP 2009 Standards include suggestions of facilitating optimal development and wellness, incorporating orientations to wellness in counseling goals, and using wellness approaches to work with a plethora of populations. The overall goal of wellness counseling is to support wellness in clients (Granello & Witmer, 2013). However, if supervisees seeing clients are unwell, how efficient are they in promoting wellness in others? In order to support development of wellness in supervisees, the IWM incorporates the five wellness domains of creative, coping, physical, essential and social (Myers, Luecht, & Sweeney, 2004) by implementing the use of the Five Factor Wellness Evaluation of Lifestyle (5F-Wel; Myers et al., 2004). In addition, supervisees can use a starfish template (Echterling et al., 2002) to gauge their own wellness and prioritize the constructs that influence their personal and professional levels of wellness and unwellness, as well as create plans to increase their overall wellness.

Implementing the IWM

The IWM was created to offer an integrative method of supervision that is concise and easy to facilitate. Specifically, the IWM consists of several processes, including supervisory relationship development, evaluation of developmental phase, allocation of supervision need, and assessment and matching of wellness intervention. The following section outlines each process.

Supervisory Relationship Development

Rapport building and relationship development between supervisor and supervisee constitute a critical step in supervision (Hird, Cavalieri, Dulko, Felice, & Ho, 2001). Similar to counseling, establishing a strong, trusting supervisory relationship is essential because the relationship is an integral component of the supervision experience (Borders & Brown, 2005; Rønnestad & Skovholt, 1993). During initial sessions, supervisors describe the process of the IWM to supervisees in order to maintain open, transparent communication and to promote a safe environment for supervisees to learn, share emotions and feelings, and develop counseling skills. It is hoped that modeling appropriate professional behaviors and setting up supervision sessions to promote a trusting environment will aid in the overall development of counseling supervisees and matriculate into their normal routines as professional counselors. As with counseling, supervisors can promote a strong relationship with supervisees by focusing on the core conditions of empathy, genuineness and unconditional positive regard (Rogers, 1957). Open communication and supervisor authenticity are just two examples of processes that help develop a sound supervisor–supervisee relationship.

Evaluation of Developmental Phase

Supervisee development is an important consideration in the IWM. The IWM divides supervisee development into three phases that consist of distinct developmental characteristics. Similar to Stoltenberg and McNeill’s (2010) suggestion and other integrative models (e.g., Carlson & Lambie, 2012; Young, Lambie, Hutchinson, & Thurston-Dyer, 2011), the phases in the IWM are hierarchical in nature, with the highest phase (phase three) being ideal for developed supervisees. In addition, the IWM acknowledges the preclinical experiences (e.g., lay helper; Rønnestad, & Skovholt, 2003) of supervisees as valuable and relevant to their development. In the IWM, it is important to acknowledge and address the experiences that supervisees have had prior to their work as counselors because they may impact perceptions and expectations.

For example, supervisors can facilitate activities to promote awareness of how supervisees influence counseling sessions. To illustrate, supervisees may participate in activities highlighting culture, family-of-origin, character strengths and bias, and evaluate how those factors may influence their counseling skills, views of clients and interactions with clients, peers and supervisors. One example of a technique that can generate conversation on the aforementioned areas is the genogram (Lim & Nakamoto, 2008). Supervisees can use the genogram to map out their family history, life influences and path to becoming a counselor during a supervision session. Ultimately, the genogram can be used as a tool to assess where supervisees are developmentally and what might have contributed to their worldview and presence as counselors. With any technique used during the supervision process, the goal of increasing awareness is emphasized. Furthermore, supervisees can implement these activities for use with their own clients. Ultimately, supervisors work to facilitate supervisee progression toward being more self-actualized, self-aware counselors. Table 1 provides descriptions of awareness of well-being, developmental characteristics, supervisory descriptors and supervision considerations for each developmental phase.

Table 1

IWM Phases of Supervisee Development

	Awareness of Well-being		Developmental Characteristics	Supervisory Descriptors	Supervision Considerations

Phase 1		Low awareness	Low independenceIncreased anxietyFollows the lead of others Low self-efficacy	SupportiveEducationalStructured	Live supervisionFeedbackPsychoeducation Modeling
Phase 2		Pursuit of awareness	Seeking independenceModerate anxietyMakes attempts to lead Modest self-efficacy	Generating awarenessCelebrating successesChallenging	Advanced skill feedbackChallenge awareness
Phase 3		Increased awareness	Mostly independentNominal anxietyLeads others Moderate–high self-efficacy	Increased mutualityCollaborative	Active listeningConsultation

One way supervisors seek to assess supervisees’ developmental phase is through active inquiry. Similar to Young and colleagues’ (2011) recommendations, the assessment of supervisees’ developmental phase is achieved through the use of questioning, reflecting, active listening and challenging incongruences. In addition, direct and intentional questions are used to target specific topics. For example, a supervisor seeking to assess the wellness of a supervisee might ask, “How are you feeling?” and then if there is incongruence, the supervisor might state, “You’re saying that you feel ‘fine,’ but you appear to be anxious tonight.” Based on supervisee reaction, the supervisor can judge the level of awareness the trainee has into his or her own well-being. Additionally, supervisors might want to ask about specific issues such as planned interventions, diagnostic interpretations or theoretical orientation. For example, a supervisor might ask, “How do you plan to assess for suicide?” Then, based on the trainee’s reaction (e.g., asking for help, giving a tentative answer or giving a confident answer) the supervisor can determine his or her developmental phase.

Supervisors also can assess supervisee developmental phase through evaluation. By observing a supervisee in a number of settings (e.g., counseling, triadic supervision, group supervision), supervisors can gauge where he or she is developmentally. Furthermore, observing the supervisee’s counseling skills, professional behaviors and dispositions (Swank, Lambie, & Witta, 2012) can provide increased insight into what phase the supervisee is experiencing at that particular point in time.

Allocation of Supervision Need

The allocation of supervision need is the next process in the IWM of supervision. The supervisor assesses the developmental phase of the supervisee and then provides a supervision intervention (contextual or educational) with the goal of supporting and/or challenging the supervisee (Lambie & Sias, 2009). Phase one of supervisee development is marked by high anxiety, low self-efficacy, decreased awareness of wellness and poor initiative. The supervision environment is one of structure with prescribed activities. Activities to support growth in phase one include live supervision, critical feedback, education on relevant issues, and modeling of behavior and skill.

Gaining insight into trainee wellness also is critical. Supervisors can use insight-oriented activities such as scrapbook journaling, which allows supervisees to gain awareness through the use of multiple media such as photos, music, quotes and poems in the journaling process (Bradley, Whisenhunt, Adamson, & Kress, 2013), or openly discussing the supervisee’s current state of wellness to help foster an increased awareness of it. Supervisees in this developmental phase can be encouraged to explore the five wellness domains (creative self, coping self, social self, essential self, physical self) and begin increasing awareness of their current level of wellness. An example of an activity for assessing supervisee wellness is the starfish technique, which is adapted from Echterling and colleagues’ (2002) sea star balancing exercise. Within this technique, supervisees receive a picture of a five-armed starfish marked with the five wellness constructs (creative, coping, physical, essential, social; Hattie et al., 2004; Myers et al., 2004) and are asked to evaluate the areas that influence or contribute to their overall wellness. Following this, supervisors and supervisees can pursue a discussion regarding the constructs. After the discussion, supervisees redraw the starfish with arm lengths representing the amount of influence that each construct has on their overall wellness or change the constructs into things that they feel better represent their personal wellness. Figure 1 is an example of a supervisee’s initial starfish. Figure 2 is the redrawn wellness starfish based on prioritizing or changing the wellness constructs; this supervisee’s redrawn starfish prioritizes social, physical and creative aspects. In contrast, nutritional and emotional constructs are depicted as smaller arms, indicating areas for growth or a potential imbalance.

Supervisees’ progression to higher levels of development is facilitated through educational and reflective interventions that their supervisors deliver. Phase two of supervisee development is marked by increased autonomy and self-efficacy, decreased anxiety, and attempts to lead or take initiatives. The context of supervision is less concrete and structured but still supportive and encouraging. Supervisees may seek independence, as well as reassurance that they are correct when working through challenges (Borders & Brown, 2005). Supervisors can provide feedback on advanced skills, challenge supervisee awareness and foster opportunities for supervisees to take risks (i.e., challenge, support; Lambie & Sias, 2009). Supervisees in phase two have an increased awareness of their well-being but may be reluctant to integrate support strategies. Therefore, supervisors may integrate activities, assignments or challenges to enhance supervisees’ wellness. For example, supervisors can have supervisees create wellness plans or discuss current wellness plans. Thus, the supervisor can hold the supervisee accountable for personal well-being.

Supervisees in phase three exhibit high autonomy and self-efficacy, low anxiety, and greater efforts to lead (Borders & Brown, 2005). The supervision environment is less structured and the supervisor assumes a consultative role. In addition, the supervisee may serve as a leader by supporting less developed peers. Interventions at this level take the form of consulting on tough cases, working through unresolved issues and providing guidance on advanced skills. Furthermore, supervisees have higher awareness of their wellness and its implications on their work with clients. Finally, supervisees in this phase seek to minimize negative well-being and may need encouragement to overcome this challenge.

Assessment and Matching of Wellness Interventions

Evaluation is a key component of the supervision process (Borders & Brown, 2005) and therefore, wellness, supervisee skill level and supervisor role are assessed in the IWM. A key feature of the IWM is the emphasis on promoting supervisee wellness. Therefore, the IWM emphasizes the evaluation of supervisees and matching of wellness interventions. Furthermore, it is important to assess supervisees’ counseling skills throughout the supervision process to provide formative and summative feedback.

The IWM utilizes the five factors of the indivisible self model (Myers & Sweeney, 2004, 2005) as points of assessment. Furthermore, the development of personal well-being is dependent upon education of wellness, self-assessment, goal planning and progress evaluation (Granello, 2000; Myers, Sweeney, & Witmer, 2000). Therefore, the IWM utilizes these aspects of wellness development as a modality for enhancing supervisee well-being. Supervisees are viewed from a positive, strengths-based perspective in the IWM and thus, activities in supervision should highlight positive attributes, increase understanding of supervisees’ level of wellness and promote knowledge of holistic wellness. Wellness plans (WPs) and the starfish activity are used to assess supervisee wellness by promoting communication and self-awareness in the supervision session. Furthermore, both evaluations are valuable self-assessment measures for supervisees and allow for initial wellness goal setting. WPs should be developed during early supervision sessions and used as a check-in mechanism for formative wellness feedback. Concurrently, the starfish assessment can be used early on to gauge initial wellness and areas for wellness growth.

Progress evaluation is assessed with the 5F-Wel (Myers et al., 2004), a model used to consider factors contributing to healthy lifestyles. The 5F-Wel is a frequently used assessment of wellness and is based on the creative, coping, essential, physical and spiritual self components of the indivisible self model (Myers et al., 2004; Myers & Sweeney, 2005). Supervisees take this assessment during the initial and final sessions to assess their wellness. Myers and Sweeney (2005) have reported the internal consistency of the 5F-Wel as ranging from .89 to .96.

Supervisee counseling skills should be evaluated using a standardized assessment tool. For example, the Counselor Competency Scale (CCS; Swank et al., 2012) can be used as a formative (e.g., midterm or weekly) and summative (e.g., end of semester) assessment of supervisee competencies. In addition, the CCS examines whether supervisees have the knowledge, self-awareness and counseling skills to progress to additional advanced clinical practicum or internship experiences. The CCS assesses supervisee development of skill, professional behavior and professional disposition (Swank et al., 2012). Therefore, supervisors can utilize the CCS to match and support supervisees’ growth by taking on appropriate roles (i.e., teacher, counselor, consultant) to enhance work on specific developmental issues.

Evaluation allows supervisors to monitor supervisee development of career-sustaining mechanisms that enhance well-being, as well as counseling skills, dispositions and professional behaviors. Specifically, the goals of supervisee development are to increase or maintain level of wellness and increase or maintain counseling skills by the end of the supervision process. However, if a supervisee does not improve well-being, the WP should be reevaluated and a remediation plan set so that the supervisee continues to work toward increased wellness. Similarly, if a student does not meet the minimal counseling skill requirements, a remediation plan can be created to support the student’s continued development.

Matching. Supervisors gain a picture of where counseling trainees are developmentally based on the assessment and evaluation process. Then supervisors can match supervisee developmental levels (of skill and wellness) by assuming the appropriate role (i.e., counselor, teacher, consultant) and using the role to provide the appropriate level of support for each trainee. This process allows for individualization of the supervision process and for supervisors to tailor specific events, techniques and learning experiences to the needs of their supervisees. Furthermore, matching supervisee developmental needs and gauging levels of awareness and anxiety allows for appropriate discussions during supervision. Discussing wellness during the latter part of supervision is appropriate for beginning counselors who may be anxious about their skills and work with clients (Borders, 1990) and may not absorb information about their wellness. Each supervisee is an individual, and as a result, it is important to make sure that the supervisee is ready to hear wellness feedback during the supervision session.

IWM: Goals, Strengths and Limitations

The overall goals of the IWM of supervision are for supervisees to increase their wellness, progress through developmental stages and gain counseling skills required to be effective counselors. Additionally, supervisors using the IWM can aid supervisees in increasing wellness awareness via completion of wellness-related assessments (e.g., WPs and starfish technique). Furthermore, supervisors can work to increase supervisees’ self-awareness and professional awareness of counseling issues such as multicultural wellness concerns, the therapeutic alliance, becoming a reflective practitioner, and positive, strengths-based approaches of counseling under the IWM framework.

The IWM is innovative in that it is one of a few supervision models to contain a wellness component. Additionally, the IWM tenets (i.e., wellness, discrimination, development) are empirically supported on individual levels. Furthermore, the IWM includes techniques and assessments for promoting open communication relating to supervisee wellness and counseling skills, and therefore supports supervisory relationships and greater self-awareness, and ultimately allows supervisors to encourage and promote wellness.

As with all models of supervision, the IWM has limitations. Specifically, the IWM may not be applicable to advanced counselors and supervisees. The IWM includes three developmental phases, which are applicable to CITs. In addition, the model may not be as beneficial to supervisees who already have a balanced wellness plan or practice wellness, because the wellness component may be repetitive for such individuals. Additionally, all aspects of the IWM might not be effective or appropriate across all multicultural groups (i.e., races, ethnicities, genders, religions). For example, in relation to wellness, supervisees may not adhere to a holistic paradigm or believe in certain wellness constructs. Lastly, the IWM is in its infancy and empirical evidence directly associated with the integrative prototype does not exist. Nevertheless, supervisors using the IWM can tailor the wellness, developmental and role-matching components to meet specific supervisee needs. The following case study depicts the use of the IWM with a counseling supervisee.

Case Study

Kayla is a 25-year-old female master’s-level counseling student taking her first practicum course. She is excited about the idea of putting the skills she has learned during her program into practice with clients. However, Kayla also is anxious about seeing her first clients and often questions whether she will be able to remember everything she is supposed to do. People tell her she will be fine; however, Kayla questions whether she will actually be able to help her clients.

In addition to the practicum course, Kayla is taking three other graduate courses. She has a full-time job and is in a steady relationship. Family is very important to her, but since beginning her graduate program, she has been unable to find enough time to spend with friends and family. Kayla feels the pull between these areas of her life and struggles to find a balance between family, school, work and her partner.

Kayla is in phase one (i.e., high anxiety); therefore, her supervisor assumes the counselor and teacher roles most often, to match Kayla developmentally. This choice of roles allows Kayla to receive appropriate levels of support and structure to help ease anxiety. During this phase, the supervisor introduces a WP to Kayla and has her complete the 5F-Wel and starfish activity. After discussing the supervisory process and explaining the IWM, Kayla and the supervisor have a conversation about the areas influencing her overall wellness. Based on her starfish results, Kayla is encouraged to develop a WP that coincides with the areas depicted on the starfish, emphasizing those that she wishes to develop further. Additionally, the 5F-Wel provides a baseline of well-being to use in future sessions. Along with the wellness focus, the supervisor explains how imbalance or unwellness influences counselors and, in turn, how it can influence clients.

Initial supervision sessions will continue to provide Kayla with appropriate levels of support and psychoeducation so that she will be able to transition from low awareness to a greater sense of counseling skill awareness and increased mindfulness regarding her overall wellness. If the supervisor and supervisee are able to establish a strong working relationship, it is expected that Kayla will eventually move developmentally into phase two, where she will continue to gain insight into her counseling and wellness, begin to increase her autonomy, and work on increasing self-efficacy.

Implications for Counseling

The IWM integrates developmental and DM supervision tenets with domains of wellness. A supervision model that incorporates wellness is a logical fit in counseling and counselor education, where programs can and should address personal development through wellness strategies for CITs (Roach & Young, 2007). Furthermore, the IWM supports the idea that wellness is important. According to White and Franzoni (1990), CITs often show higher psychological disturbances than the general population. Cummins, Massey, and Jones (2007) highlighted the fact that counselors and CITs often struggle to take their own advice about wellness in their personal lives. Thus, while counseling is theoretically and historically a wellness-oriented field, many counselors are unwell and failing to practice what they preach (Lawson, Venart, Hazler, & Kottler, 2007; Myers & Sweeney, 2005). Implementing the IWM can aid in supporting overall wellness in supervisees as well as educating CITs to practice wellness with their clients and with themselves.

In relation to developmental matching and DM roles, counseling supervisors using the IWM have the following theoretical issues (e.g., Bernard, 1997; Myers et al., 2004; Myers & Sweeney, 2005) to facilitate: supervisee change, skill development, increased self-awareness and increased professional development. The IWM is a holistic, strengths-based model that focuses on supervisee development, matching supervisee needs through supervisor role changing, and wellness to promote knowledgeable, well and effective counseling supervisees.

Conclusion

The IWM is designed to integrate wellness, developmental stages and role matching to allow supervisors to encourage holistic wellness through supervision. Wellness has a positive relationship with counselors’ increased use of career-sustaining mechanisms and increased professional quality of life (Lawson, 2007; Lawson & Myers, 2011). Likewise, increased professional quality of life has been shown to make a positive contribution to counselors’ self-efficacy and counseling service delivery (Mullen, 2014). Therefore, it is logical to promote wellness and career-sustaining behaviors throughout the supervision process.

In summary, the IWM offers a new, integrated model of supervision for use with CITs. Supervisors using the IWM have the unique opportunity to operate from a wellness paradigm, familiarize their supervisees with wellness practices, and monitor supervisees’ wellness and how their wellness influences their client outcomes, while simultaneously supporting supervisee growth, counseling skill development and awareness of professional dispositions.

Conflict of Interest and Funding Disclosure

The authors reported no conflict of

interest or funding contributions for

the development of this manuscript.

References

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

Association for Counselor Education and Supervision. (2011). Best practices in clinical supervision. Retrieved from http://www.acesonline.net/wp-content/uploads/2011/10/ACES-Best-Practices-in-clinical-supervision-document-FINAL.pdf

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

Bernard, J. M. (1979). Supervisor training: A discrimination model. Counselor Education and Supervision, 19, 60–68. doi:10.1002/j.1556-6978.1979.tb00906.x

Bernard, J. M. (1997). The discrimination model. In C. E. Watkins (Ed.), Handbook of psychotherapy supervision (pp. 310–327). New York, NY: Wiley.

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

Blocher, D. H. (1983). Toward a cognitive developmental approach to counseling supervision. The Counseling Psychologist, 11, 27–34. doi:10.1177/0011000083111006

Borders, L. D. (1990). Developmental changes during supervisees’ first practicum. The Clinical Supervisor, 8, 157–167. doi:10.1300/J001v08n02_12

Borders, L. D. (1992). Learning to think like a supervisor. The Clinical Supervisor, 10, 135–148. doi:10.1300/J001v10n02_09

Borders, L. D., & Brown, L. L. (2005). The new handbook of counseling supervision. New York, NY: Routledge.

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

Carlson, R. G., & Lambie, G. W. (2012). Systemic-developmental supervision: A clinical supervisory approach for family counseling student interns. The Family Journal, 20, 29–36. doi:10.1177/1066480711419809

Cohen, E. L. (1991). In pursuit of wellness. American Psychologist, 46, 404–408.

Council for Accreditation of Counseling and Related Educational Programs. (2009). 2009 standards. Retrieved from http://www.cacrep.org/wp-content/uploads/2013/12/2009-Standards.pdf

Cummins, P. N., Massey, L., & Jones, A. (2007). Keeping ourselves well: Strategies for promoting and maintaining counselor wellness. Journal of Humanistic Counseling, Education and Development, 46, 35–49. doi:10.1002/j.2161-1939.2007.tb00024.x

Dunn, H. L. (1967). High-level wellness. Arlington, VA: Beatty.

Echterling, L. G., Cowan, E., Evans, W. F., Staton, A. R., Viere, G., & McKee, J. (2002). Thriving!: A manual for students in the helping professions. Boston, MA: Houghton Mifflin.

Ekstein, R., & Wallerstein, R. S. (1972). The teaching and learning of psychotherapy (2nd ed.). New York, NY: International Universities Press.

Granello, P. (2000). Integrating wellness work into mental health private practice. Journal of Psychotherapy in Independent Practice, 1, 3–16. doi:10.1300/J288v01n01_02

Granello, P. F., & Witmer, J. M. (2013). Theoretical models for wellness counseling. In P. F. Granello (Ed.), Wellness counseling (pp. 29–36). Upper Saddle River, NJ: Pearson.

Hattie, J. A., Myers, J. E., & Sweeney, T. J. (2004). A factor structure of wellness: Theory, assessment, analysis, and practice. Journal of Counseling & Development, 82, 354–364. doi:10.1002/j.1556-6678.2004.tb00321.x

Hird, J. S., Cavalieri, C. E., Dulko, J. P., Felice, A. A. D., & Ho, T. A. (2001). Visions and realities: Supervisee perspectives of multicultural supervision. Journal of Multicultural Counseling and Development, 29, 114–130. doi:10.1002/j.2161-1912.2001.tb00509.x

Hunt, D. E. (1971). Matching models in education: The coordination of teaching methods with student characteristics. Toronto, Canada: Ontario Institute for Studies in Education.

Johnson, J. A. (1986). Wellness: A context for living. Thorofare, NJ: Slack.

Keyes, C. L. M. (1998). Social well-being. Social Psychology Quarterly, 61, 121–140.

Kottler, J. A. (2010). On being a therapist (4th ed.). San Francisco, CA: Jossey-Bass.

Lambie, G. W., & Sias, S. M. (2009). An integrative psychological developmental model of supervision for professional school counselors-in-training. Journal of Counseling & Development, 87, 349–356. doi:10.1002/j.1556-6678.2009.tb00116.x

Lawson, G. (2007). Counselor wellness and impairment: A national survey. The Journal of Humanistic Counseling, Education and Development, 46, 20–34.

Lawson, G., & Myers, J. E. (2011). Wellness, professional quality of life, and career-sustaining behaviors: What keeps us well? Journal of Counseling & Development, 89, 163–171. doi:10.1002/j.1556-6678.2011.tb00074.x

Lawson, G., Venart, E., Hazler, R. J., & Kottler, J. A. (2007). Toward a culture of counselor wellness. The Journal of Humanistic Counseling, Education and Development, 46, 5–19. doi:10.1002/j.2161-1939.2007.tb00022.x

Lenz, A. S., Sangganjanavanich, V. F., Balkin, R. S., Oliver, M., & Smith, R. L. (2012). Wellness model of supervision: A comparative analysis. Counselor Education and Supervision, 51, 207–221. doi:10.1002/j.1556-6978.2012.00015.x

Lenz, A. S., & Smith, R. L. (2010). Integrating wellness concepts within a clinical supervision model. The Clinical Supervisor, 29, 228–245. doi:10.1080/07325223.2020.518511

Lim, S.-L., & Nakamoto, T. (2008). Genograms: Use in therapy with Asian families with diverse cultural heritages. Contemporary Family Therapy: An International Journal, 30, 199–219. doi:10.1007/s10591-008-9070-6

Loganbill, C., Hardy, E., & Delworth, U. (1982). Supervision, a conceptual model. The Counseling Psychologist, 10, 3–42. doi:10.1177/0011000082101002

Luke, M., & Bernard, J. M. (2006). The school counseling supervision model: An extension of the discrimination model. Counselor Education and Supervision, 45, 282–295. doi:10.1002/j.1556-6978.2006.tb00004.x

Maslach, C. (2003). Burnout: The cost of caring. Cambridge, MA: Malor Books.

McNeill, B. W., Stoltenberg, C. D., & Pierce, R. A. (1985). Supervisees’ perceptions of their development: A test of the counselor complexity model. Journal of Counseling Psychology, 32, 630–633. doi:10.1037/0022-0167.32.4.630

Mullen, P. R. (2014). The contribution of practicing school counselors’ self-efficacy and professional quality of life to their programmatic service delivery. (Unpublished doctoral dissertation). University of Central Florida, Orlando, FL.

Myers, J. E., Luecht, R. M., & Sweeney, T. J. (2004). The factor structure of wellness: Reexamining theoretical and empirical models underlying the wellness evaluation of lifestyle (WEL) and the Five-Factor Wel. Measurement and Evaluation in Counseling and Development, 36, 194–208.

Myers, J. E., & Sweeney, T. J. (2004). The indivisible self: An evidence-based model of wellness. The Journal of Individual Psychology, 60, 234–244.

Myers, J. E., & Sweeney, T. J. (2005). The indivisible self: An evidence-based model of wellness. (Reprint.). The Journal of Individual Psychology, 61, 269–279.

Myers, J. E., & Sweeney, T. J. (2008). Wellness counseling: The evidence base for practice. Journal of Counseling & Development, 86, 482–493.

Myers, J. E., Sweeney, T. J., & Witmer, J. M. (1998). The wellness evaluation of lifestyle. Palo Alto, CA: Mind Garden.

Myers, J. E., Sweeney, T. J., & Witmer, J. M. (2000). The wheel of wellness counseling for wellness: A holistic model for treatment planning. Journal of Counseling & Development, 78, 251–266. doi:10.1002/j.1556-6676.2000.tb01906.x

Ober, A. M., Granello, D. H., & Henfield, M. S. (2009). A synergistic model to enhance multicultural competence in supervision. Counselor Education and Supervision, 48, 204–221. doi:10.1002/j.1556-6978.2009.tb00075.x

Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research & Practice, 19, 276–288. doi:10.1037/h0088437

Roach, L. F., & Young, M. E. (2007). Do counselor education programs promote wellness in their students? Counselor Education and Supervision, 47, 29–45. doi:10.1002/j.1556-6978.2007.tb00036.x

Robiner, W. N., Fuhrman, M., Ristvedt, S., Bobbitt, B., & Schirvar, J. (1994). The Minnesota Supervisory Inventory (MSI): Development, psychometric characteristics, and supervisory evaluation issues. The Clinical Psychologist, 47(4), 4–17.

Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 95–103. doi:10.1037/h0045357

Rønnestad, M. H., & Skovholt, T. M. (1993). Supervision of beginning and advanced graduate students of counseling and psychotherapy. Journal of Counseling & Development, 71, 396–405. doi:10.1002/j.1556-6676.1993.tb02655.x

Rønnestad, M. H., & Skovholt, T. M. (2003). The journey of the counselor and therapist: Research findings and perspectives on professional development. Journal of Career Development, 30, 5–44.

Roscoe, L. J. (2009). Wellness: A review of theory and measurement for counselors. Journal of Counseling & Development, 87, 216–226. doi:10.1002/j.1556-6678.2009.tb00570.x

Smith, H. L., Robinson, E. H. M., III, & Young, M. E. (2007). The relationship among wellness, psychological distress, and social desirability of entering master’s-level counselor trainees. Counselor Education and Supervision, 47, 96–109. doi:10.1002/j.1556-6978.2007.tb00041.x

Stoltenberg, C. D. (1981). Approaching supervision from a developmental perspective: The counselor complexity model. Journal of Counseling Psychology, 28, 59–65.

Stoltenberg, C. D., & McNeill, B. W. (1997). Clinical supervision from a developmental perspective: Research and practice. In C. E. Watkins, Jr. (Ed.), Handbook of psychotherapy supervision (pp. 184–202). New York, NY: Wiley.

Stoltenberg, C. D., & McNeill, B. W. (2010). IDM supervision: An integrative developmental model of supervision (3rd ed.). New York, NY: Routledge.

Stoltenberg, C. D., & McNeill, B. W. (2012). Supervision: Research, models, and competence. In N. A. Fouad (Ed.), APA handbook of counseling psychology: Vol. 1. Theories, research, and methods (pp. 295–327). Washington, DC: American Psychological Association.

Stoltenberg, C. D., McNeill, B. W., & Crethar, H. C. (1994). Changes in supervision as counselors and therapists gain experience: A review. Professional Psychology: Research and Practice, 25, 416–449. doi:10.1037/0735-7028.25.4.416

Swank, J. M., Lambie, G. W., & Witta, E. L. (2012). An exploratory investigation of the counseling competencies Scale: A measure of counseling skills, dispositions, and behaviors. Counselor Education and Supervision, 51, 189–206. doi:10.1002/j.1556-6978.2012.00014.x

Swarbrick, M. (1997). A wellness model for clients. Mental Health Special Interest Section Quarterly, 20, 1–4.

Vespia, K. M., Heckman-Stone, C., & Delworth, U. (2002). Describing and facilitating effective supervision behavior in counseling trainees. Psychotherapy: Theory, Research, Practice, Training, 39, 56–65. doi:10.1037/0033-3204.39.1.56

White, P. E., & Franzoni, J. B. (1990). A multidimensional analysis of the mental health of graduate counselors in training. Counselor Education and Supervision, 29, 258–267. doi:10.1002/j.1556-6978.1990.tb01165.x

Williams, E. N., Judge, A. B., Hill, C. E., & Hoffman, M. A. (1997). Experiences of novice therapists in prepracticum: Trainees’, clients’, and supervisors’ perceptions of therapists’ personal reactions and management strategies. Journal of Counseling Psychology, 44, 390–399. doi:10.1037/0022-0167.44.4.390

Witmer, J. M. (1985). Pathways to personal growth. Muncie, IN: Accelerated Development.

Witmer, J. M., & Granello, P. F. (2005). Wellness in counselor education and supervision. In J. E. Myers & T. J. Sweeney (Eds.), Counseling for wellness: Theory, research, and practice (pp. 261–272). Alexandria, VA: American Counseling Association.

Witmer, J. M., & Sweeney, T. J. (1992). A holistic model for wellness and prevention over the life span. Journal of Counseling & Development, 71, 140–148. doi:10.1002/j.1556-6676.1992.tb02189.x

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

World Health Organization. (1968). Constitution of the World Health Organization. Geneva, Switzerland: Author.

Worthen, V., & McNeill, B. W. (1996). A phenomenological investigation of “good” supervision events. Journal of Counseling Psychology, 43, 25–34. doi:10.1037/0022-0167.43.1.25

Young, T. L., Lambie, G. W., Hutchinson, T., & Thurston-Dyer, J. (2011). The integration of reflectivity in developmental supervision: Implications for clinical supervisors. The Clinical Supervisor, 30, 1–18. doi:10.1080/07325223.2011.532019

Ashley J. Blount, NCC, is a doctoral student at the University of Central Florida. Patrick R. Mullen, NCC, is an Assistant Professor at East Carolina University. Correspondence can be addressed to Ashley J. Blount, The Department of Child, Family, and Community Sciences, University of Central Florida, P.O. Box 161250, Orlando, Florida, 32816-1250, ashleyjwindt@gmail.com.

« Older Entries

Next Entries »

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

Counselor-in-Training Intentional Nondisclosure in Onsite Supervision: A Content Analysis

Examining the Facilitating Role of Mindfulness on Professional Identity Development Among Counselors-in-Training: A Qualitative Approach

Exploring Experiential Learning Through an Abstinence Assignment Within an Addictions Counseling Course

Development of an Integrative Wellness Model: Supervising Counselors-in-Training

Recent Publications