A Q Methodology Study of a Doctoral Counselor Education Teaching Instruction Course

Eric R. Baltrinic, Eric G. Suddeath

Many counselor education and supervision (CES) doctoral programs offer doctoral-level teaching instruction courses as part of their curriculum to help prepare students for future teaching roles, yet little is known about the essential design, delivery, and evaluation components of these courses. Accordingly, the authors investigated instructor and student views on the essential design, delivery, and evaluation components of a doctoral counselor education teaching instruction (CETI) course using Q methodology. Eight first-year CES doctoral students and the course instructor from a large Midwestern university completed Q-sorts, which were factor analyzed. Three factors were revealed, which were named The Course Designer, The Future Educator, and The Empathic Instructor. The authors gathered post–Q-sort qualitative data from participants using a semi-structured questionnaire, and the results from the questionnaires were incorporated into the factor interpretations. Implications for incorporating the findings into CES pedagogy and for designing, delivering, and evaluating CETI courses are presented. Limitations and future research suggestions for CETI course design and delivery are discussed.

Keywords: teaching instruction course, Q methodology, pedagogy, counselor education, doctoral students


Counselor education doctoral students (CEDS) need teaching preparation as part of their doctoral training (Hall & Hulse, 2010; Orr et al., 2008), including the completion of formal courses in pedagogy, adult learning, or teaching (Barrio Minton & Price, 2015; Hunt & Weber Gilmore, 2011; Suddeath et al., 2020). Teaching instruction courses may occur within or outside of the counselor education curriculum. Within counselor education, counselor education teaching instruction (CETI) courses are those doctoral-level seminar or semester-long curricular experiences designed to provide CEDS with the basic foundational knowledge for effective teaching (Association for Counselor Education and Supervision [ACES], 2016). CETI courses are cited as an important foundational training component for preparing CEDS for success in fulfilling future teaching roles (ACES, 2016). Additionally, simply possessing expert knowledge in one’s field (e.g., counseling) is not sufficient to support student learning in the classroom (ACES, 2016; Waalkes et al., 2018), a reality recognized in counselor education some time ago by Lanning (1990).

To increase the attention to and strengthen the rigor of teaching preparation, the Council for Accreditation of Counseling and Related Educational Programs (CACREP) developed standards for fostering students’ knowledge and skills in teaching through curricular and/or experiential training (CACREP, 2015). Specifically, within the CACREP (2015) teaching standards, CEDS need to learn “instructional and curriculum design, delivery, and evaluation methods relevant to counselor education” (Section 6, Standard B.3.d.). Although programs may use teaching internships (Hunt & Weber Gilmore, 2011), structured teaching teams (Orr et al., 2008), coteaching (Baltrinic et al., 2016), and teaching mentorships (Baltrinic et al., 2018) to address standards and train CEDS for their future roles as educators, teaching coursework is cited as the most common preparation practice (Barrio Minton & Price, 2015; Suddeath et al., 2020; Waalkes et al., 2018). Despite our knowledge that teaching coursework is commonly used for teaching preparation (Barrio Minton & Price, 2015; Suddeath et al., 2020), little is known about how counselor educators design and deliver these courses within counselor education. Although a few studies in counselor education and supervision address teaching coursework (e.g., Suddeath et al., 2020; Waalkes et al., 2018), it is in a cursory way or as one part of a broader inquiry into teacher preparation processes.

Perceived Effectiveness of CETI Courses
     Ideally, teaching coursework, whether offered within counselor education specifically or not, should provide doctoral students with a basic framework for effective teaching. Unfortunately, as previously mentioned, little is known about what constitutes a CETI course. Moreover, the few studies that address this training component suggest inconsistency in its perceived value and effectiveness. For example, early research by Tollerud (1990) and Olguin (2004) found no difference in terms of teaching self-efficacy between those with and without coursework, regardless of the number of courses taken. Similarly, in Hall and Hulse’s (2010) study examining counselor educators’ doctoral teaching preparation and perceived preparedness to teach, participants found their teaching coursework least helpful for preparing them to teach. To improve the effectiveness of their coursework, participants in Hall and Hulse’s study indicated a desire for multiple courses with a greater focus on the practical aspects of teaching, approaches for teaching adult learners, and more opportunities to engage in actual teaching during the course.

In a recent study by Waalkes et al. (2018), participants expressed similar sentiments reporting a general lack of emphasis and rigor in teacher preparation as compared to other core areas of development and especially for teaching coursework. Specific deficiencies included a lack of emphasis on pedagogy and teaching strategies and a discrepancy between their teaching coursework and their actual teaching responsibilities as current counselor educators (Waalkes et al., 2018). Given their experience, participants indicated a desire for greater integration of doctoral-level teaching coursework throughout their programs as well as “philosophy and theory, pedagogy/teaching strategies, understanding developmental levels of students, course design, assessment, and setting classroom expectations” (Waalkes et al., 2018, p. 73).

Unlike Tollerud (1990) and Olguin (2004), Suddeath et al. (2020) found that formal teaching coursework significantly predicted increased self-efficacy toward teaching. Furthermore, participants indicated that formal coursework strengthened their self-efficacy toward teaching slightly more than their fieldwork in teaching experiences. However, it is unclear from this study what aspects of the CEDS’ coursework contributed to increased self-efficacy. In a study by Hunt and Weber Gilmore (2011), CEDS identified elements such as the creation of syllabi, exams, rubrics, and a philosophy of teaching and receiving support and feedback from instructors and peers as most helpful in their coursework experiences. Those who did not find the course helpful expressed a desire for more opportunities to engage in actual teaching. Overall, the literature addressing the relative effectiveness of teaching coursework suggests the need to (a) improve teaching courses, (b) connect teaching courses to additional teaching experiences, and (c) make it a meaningful and impactful experience for CEDS.

Instructor Qualities and Course Delivery
     Counselor education research also suggests that instructor qualities and course delivery influence the learning experiences of counseling students (Malott et al., 2014; Moate, Cox, et al., 2017; Moate, Holm, & West, 2017). Regarding instructor qualities, two recent studies examining novice counselors’ instructor preferences within their didactic (Moate, Cox, et al., 2017) and clinical courses (Moate, Holm, & West, 2017) found that, overall, participants preferred instructors who were kind, supportive, empathic, genuine, and passionate about the course. Likewise, Malott et al. (2014) reported that instructors who were caring, which included characteristics such as respect, interest, warmth, and availability, were “essential in motivating learning” (p. 295). Moate and Cox (2015) also emphasized the importance of cultivating a supportive and safe learning environment for increasing students’ active participation and engagement in their learning.

Regarding course delivery, overall participants in didactic and clinical courses preferred instructors who were pragmatic and connected course material to their actual work as counselors (Moate, Cox, et al., 2017; Moate, Holm, & West, 2017). Within didactic courses specifically—which included career counseling, theories, ethics, and diagnosis—Moate, Cox, et al. (2017) emphasized students’ lack of preference for instructors who primarily utilized lecture or PowerPoint for instruction. This relates to the topic of teacher-centered versus learner-centered approaches. Those who use teacher-centered approaches utilize lecture as the primary mode of delivery and focus on the transmission of content through lecture from the experienced expert to the inexperienced novice, which may foster passive learning (Moate & Cox, 2015). In contrast, those who use learner-centered approaches emphasize shared responsibility for learning, which encourages active learning and application of course content through collaborative learning activities to tap into the collective knowledge of the group as well as supporting students’ active engagement and application of course content (Malott et al., 2014; Moate & Cox, 2015).

Although Moate, Cox, et al. (2017) and Moate, Holm, and West (2017) focused on master’s-level versus doctoral-level students, their findings suggested the importance of instructor qualities and approaches as well as student perspectives within course design and delivery. Moate, Cox, et al. (2017) and Moate, Holm, and West (2017) did not link instructor qualities to the training they received within doctoral CETI coursework, but having an understanding of these connections may aid doctoral instructors’ design and delivery of CETI courses to better meet student needs.

Regarding instructor qualities and approaches to course delivery within doctoral CETI courses specifically, our literature search identified two studies that minimally addressed these components. Participants in the studies of both Waalkes et al. (2018) and Hunt and Weber Gilmore (2011) emphasized the importance of feedback from professors and classmates within CETI courses for strengthening their preparedness to teach. Neither study described exactly how this feedback supported their preparedness to teach, the type of feedback received, or the instructor’s approach to delivering feedback.

The Current Study
     Teaching preparation is an essential component of CEDS’ training (ACES, 2016), as teaching and related responsibilities (a) consume a greater proportion of time than any other responsibility of a counselor educator (Davis et al., 2006) and (b) impact CEDS’ confidence and feelings of preparedness to teach (Hall & Hulse, 2010; Suddeath et al., 2020). Still, some findings suggest a lack of rigor concerning teaching preparation compared to other core doctoral training areas (e.g., research and supervision; Waalkes et al., 2018). Although teaching preparation research in general is gaining momentum, there are no findings clarifying what components of formal coursework most support students’ development as teachers. In fact, findings are mixed regarding its effectiveness (e.g., Suddeath et al., 2020; Waalkes et al., 2018). Furthermore, no in-depth research exists on how counselor educators implement formal teaching courses within counselor education or how those teaching courses are designed and delivered by counselor educators and experienced by CEDS. Yet, our experience tells us and research confirms (e.g., Waalkes et al., 2018) that counselor education programs increasingly require CEDS to engage in CETI courses as one way to develop teaching competencies, with some citing it as the most widely utilized way in which programs train CEDS to teach (ACES, 2016; Barrio Minton & Price, 2015; Suddeath et al., 2020).

As variability exists in how respective programs deliver CETI courses (Hunt & Weber Gilmore, 2011), we studied a single CETI course as a way to illustrate an example of common issues and potential discrepancies faced by students and instructors engaged in a doctoral CETI course. We examined this course, taking into account both experienced instructor and novice student views, to (a) reveal common views on ideal course design, delivery, and evaluation components among participants navigating a common curriculum; (b) identify any similar or divergent views between the instructor and students; and (c) determine how to design course content and instruction to meet the future needs of students. The study was guided by the research question: What are instructor and student views on the essential design, delivery, and evaluation elements needed for a CETI course?


     Q methodology is a unique research method containing the depth of qualitative data reduction and the objective rigor of by-person factor analysis (Brown, 1993). Researchers have effectively utilized this method in the classroom setting to facilitate personal discovery and to increase subject matter understanding (Watts & Stenner, 2012). Specifically, students’ self-perspectives are investigated and then related to other students’ views, which are then related to nuances within their own views (Good, 2003). Q methodology has also been effectively used as a pedagogical exercise to examine subjectivity in intensive samples of participants (McKeown & Thomas, 2013). Focusing on intensive samples, and even single cases, allows researchers to retain participants’ frames of reference while concurrently revealing nuances within their views, which may be lost within larger samples (Brown, 2019). Yet, the rigor of findings from intensive samples derived from Q factor analysis remains.

We selected Q methodology for the current study versus a qualitative or case study approach (Stake, 1995) to reveal common and divergent viewpoints in relation to common stimulus items (i.e., a Q sample composed of ideal design, delivery, and evaluation of CETI course components from the literature). We also wanted both the instructor and students participating in the sampled doctoral CETI course to provide their subjective views on the optimal design, delivery, and evaluation components of a doctoral CETI course, while incorporating the rigorous features of quantitative analysis (Brown, 1980).

Concourse and Q Sample
     Specific steps were taken to develop the Q sample, which is the set of statements used to assist participants with expressing their views during the Q-sorting process. The first step is selecting a concourse, which is a collection of opinion statements about any topic (Stephenson, 2014). Many routes of communication contribute to the form and content of a concourse (Brown, 1980). The concourse for this study was composed of statements taken by the authors from select teaching literature and documents (e.g., ACES, 2016; McAuliffe & Erickson, 2011; West et al., 2013).  After carefully searching within these sources, researchers selected statements specifically containing teaching experts’ views on essential components for teaching preparation, in general, and CETI courses in particular. The concourse selection process resulted in over 240 concourse statements, which was too many for the final Q sample (Brown, 1970, 1980).

Second, the concourse of statements was reduced by the first author using a structured deductive Q sample design shown in Table 1 (Brown, 1970). Data reduction using a structured design results in a reduction of concourse statements into a manageable Q sample (McKeown & Thomas, 2013). Accordingly, data reduction proceeded with the removal of unclear, fragmented, duplicate, or unrelated statements until there were eight items for each of the types, resulting in the structured 48-item sample shown in the Appendix.


Table 1

Structured Q Sample

Dimensions Types N
1. Design a. Materials
(Items 4, 5, 10, 13, 14, 23, 28, 39)
b. Experiences

(Items 3, 22, 24, 25, 36, 37, 43, 45)

2. Delivery


c. Content
(Items 2, 15, 17, 18, 26, 27, 35, 38)
d. Process

(Items 6, 8, 12, 30, 32, 41, 44, 46)



3. Evaluation e. Formative
(Items 7, 20, 21, 29, 33, 40, 42, 47)
f. Summative

(Items 1, 9, 11, 16, 19, 31, 34, 48)



*Q-set = D (Criteria) (Replications); D ([1₂] [2₂] [3₂]) (n); D (2) (2) (2); D = 8 combinations;
D (2) (2) (2) (6 replications); D = 48 statements for the Q sample.


Third, the 48-item Q sample was then evaluated by three expert reviewers using a content validity index (Paige & Morin, 2016). Expert reviewers who had a minimum of 10 years of experience as counselor educators, had designed and delivered doctoral CETI courses, had published frequently on teaching and learning, and were familiar with Q methodology were solicited by the first author. Accordingly, expert reviewers rated each of the 48 items on a 4-point scale using three criterion questions: 1) Is the statement clear and unambiguous as read by a counselor educator? 2) Is the statement clear and unambiguous as read by CEDS? and 3) Is the statement distinct from the other statements listed here? Items receiving a score of 3 (“Mostly”) or 4 (“Completely”) were included; items receiving a score of 2 (“Somewhat”) were reviewed and modified by the authors for appropriateness; items receiving a score of 1 (“Not at all”) were discarded from the sample. After the three expert evaluators completed the content validity index, the authors refined the Q sample by rewriting two items to improve clarity, eliminating one duplicate item, and adding an item the reviewers thought important. For the final step, two of the experts completed Q-sorts to assure the final Q sample facilitated the expression of views on supervisee roles. The results of these two pilot Q-sorts were not included in the data analysis.

Participant Sample
     Researchers followed McKeown and Thomas’ (2013) recommendations for selecting an intensive participant sample (i.e., fewer than 20 participants), which included a combination of purposeful and convenience sampling strategies (Patton, 2015) to obtain participants for the study. We purposefully selected the doctoral CETI course and the instructor because it was offered within a reputable, CACREP-accredited doctoral program; developed by a counselor educator known for teaching excellence and professional contributions; and taught and refined in an on-campus, in-person program by that same instructor for over 16 years. Additionally, the participants engaged in the course at the time of investigation constituted a convenience sample of eight first-year CEDS. Participants collectively represented a group of individuals holding similar theoretical interests and the ability to provide insight into the topic of investigation (Brown, 1993).

All nine participants were from a large, top-ranked counselor education program located in the Midwest. Seven of the students identified as White cisgender females, and one as a cisgender Asian male. Four student participants were in the 25 to 30-year-old range, and four were in the 31 to 35-year-old range. The instructor was in the 50 to 55-year-old range, who identified as a White cisgender male. None of the student participants reported having previous teaching experience.

Data Collection
     After obtaining IRB permission, the first author collected the initial consent, demographic, Q-sort, and post–Q-sort written data from the students and instructor using a semi-structured questionnaire. The nine participants (n = 8 students; n = 1 instructor) were each asked to rank-order the 48 items in the Q sample along a forced choice grid from most agree (+4) to most disagree (-4). The conditions of instruction used for the students’ and instructor’s Q-sorts stemmed directly from the research question. After completing this Q-sort, participants were asked by the first author to provide written responses, using a semi-structured questionnaire, for the top three items with which they most (+4) and least (-4) agreed and were asked to comment on any other items of significance.

The first author asked the course instructor to respond in writing to three questions, in addition to those prompts contained in the semi-structured questionnaire. This was done to add nuance and context to the results. The additional questions and highlights from the instructor’s responses are shown in Table 2.

Data Analysis

Nine Q-sorts completed by participants were each entered into the PQMethod software program V. 2.35 (Schmolck, 2014). A correlation matrix was then generated reflecting the “nature and extent of relationships” among all the participants’ Q-sorts in the data set (Watts & Stenner, 2012, p. 111). The correlation matrix served as the basis for factor analysis, which was completed using the centroid method (Brown, 1980). Essentially, factor analysis allows researchers to examine the correlation matrix for patterns of similarity among the participants’ Q-sorts. In the current study, we were interested in similar and divergent patterns among the instructor’s and students’ Q-sorts on essential doctoral CETI course components. In other words, data analysis in Q studies is possible because all participants rank-order a Q sample of similar items, which allows researchers to inter-correlate those Q-sorts for subsequent factor analysis.

Given the low number of participants, we initially extracted five factors from the correlation matrix,  which yielded fewer significant factor loadings (i.e., a correlation coefficient reflecting the degree to which a participant’s Q-sort correlates with the factor). Therefore, we extracted three factors, which yielded a higher number of factor loadings. The three factors were rotated using the varimax method, which we selected because (a) we had no preconceived theoretical notions regarding the findings, (b) we were blind to participant identifying information in the data, and (c) we intended to obtain dominant views among participants within the same course (Watts & Stenner, 2012). The varimax factor rotation method helps researchers to identify individual factor loadings “whose positions closely approximate those of the factor” (Watts & Stenner, 2012, p. 142). In Q methodology, a factor is a composite or ideal Q-sort to which individual participants correlate (Watts & Stenner, 2012). Overall, data analysis steps yielded a 3-factor solution containing at least two significant factor loadings on each factor, which is the minimum suggested number of factor loadings for a factor to hold significance (Brown, 1980). Notably, the final 3-factor solution contained significant factor loadings for all nine of the study participants, which suggests the rigor of the collective viewpoints (i.e., factors) discussed in the results.


Table 2

Summary of Instructor Responses

Interview Question Interview Responses (Factor A Exemplar)
1. What is important for planning, delivering, and evaluating doctoral-level counselor education teaching instruction courses? I think of the different elements that go into teaching and I think these are the things that students need to be exposed to, such as: developing a teaching philosophy, creating a syllabus, evaluating other instructors’ syllabi, making selections on textbooks, looking at equity in the classroom, backwards design of curriculum, having a small group teaching experience, having a large group teaching experience, using experiences in the classroom for developing reflective practice, and reviewing essential readings in the teaching field. I also think it is essential that we teach students how to use online platforms, so they have exposure and, to what degree we can, competency, to online platforms.
2. What are some significant lessons learned over the past 16 years as an instructor of a counselor education teaching instruction course? This course is a change in pace for most students in my program. For that reason, students generally seem excited about this course. Having them excited about taking the course makes teaching the course a pure joy. Along with the excitement, students bring a level of naïveté to the topic. They have been students, but they do not have a lot of exposure to being a teacher. In my field of counseling, students at the doctoral level have exposure to counseling, so they come in with a level of exposure and expertise in that area, but in teaching it seems all new to them. And that makes a course fun for me.


I believe the hardest thing for students to learn is to set aside their own passions and misconceptions about what their students need to know in service of what they must know to be an effective counselor. What their passions are and what students need to know are not always the same thing. I notice students are generally apprehensive about their performance when it comes to teaching. I have to constantly remind myself that it doesn’t come automatically to them as it does to me, having taught many years. So I have to reintroduce myself to the idea of performance anxiety in the classroom. That’s where I think the in-class reflective practice piece fits in nicely for them. They get a chance to think and talk through their anxiety about teaching.

3. What role does a counselor education teaching instruction course serve for preparing doctoral students to teach? I can’t imagine a program that does not have a teaching instruction course, preferably taught within the program, that would be able to adequately prepare students for future faculty roles. Most of my career has been to emphasize the need for good faculty instruction on teaching in the counseling field.



The data analysis revealed three significantly different viewpoints (i.e., Factors A, B, and C) on the essential design, delivery, and evaluation elements needed for a doctoral CETI course. All participants in the study were significantly associated with one of the three factors. Specifically, one student participant and the course instructor were significantly associated with Factor A (i.e., had factor loadings of .37 or higher; .50 and .84, respectively). Five of the eight student participants were significantly associated with Factor B (.72, .70, .66, .78, and .60, respectively). Two of the eight student participants were significantly associated with Factor C (.75 and .87, respectively). Select participant quotes from participants’ post-sort questionnaires were incorporated into the factor interpretations below to provide contextual details for each factor.

Factor A: The Course Designer
     Factor A is most distinguished by the view that CETI courses should result in students having the ability to design their own counseling courses, which differs from Factors B and C (Item 37; +4, 0, 0, respectively). This pervasive opinion is contained in the instructor’s semi-structured questionnaire response to Item 37:

I cannot imagine the purpose of having a course for teaching in counselor education without the purposeful outcome being to create a course. The ability to do course development, to me, is the skillset that doctoral graduates should have from a teaching course.

The student associated with this factor added, “I want this course to help me be successful, which means I have to practice . . . making a syllabus, working with students . . . the basis of the entire course is to learn to teach!” Learning how to design evaluations of the teaching and learning process (Item 48, +2) is also considered an essential CETI course component for Factor A. For Factor A, CETI courses need to include discussions about selecting textbooks (Item 14, +2) and opportunities to learn about classroom management (Item 18, +2). There was even stronger agreement that CETI courses need to include information about designing a syllabus (Item 39, +3) and constructing related course objectives (Item 33, +3), which would culminate in a plan for actual teaching experiences (Item 35, +3). Given the preference for technical and design elements in CETI courses, the authors have named Factor A The Course Designer.

Factor A placed less emphasis on the developmental level (Item 25, -3) and cultural differences (Item 38, -1) of students as essential components of a CETI course. But that does not suggest these elements are unimportant, as one participant illustrated: “All instructors need to be mindful of students’ cultural differences. Learning can only be effective in an environment conducive of understanding students’ differences.” Importantly, the Factor A view was not limited to just design and technical components. In fact, Factor A, like B and C, viewed having some type of teaching experience as an essential element of a CETI course (Item 46; +4, +4, +1, respectively).

Factor B: The Future Educator
     The Factor B viewpoint, which the authors named The Future Educator, placed importance on the use of interactive (Item 6, +4) and experiential (Item 45, +3) activities, more so than course design, as essential elements of a CETI course. In contrast to Factors A (-4) and C (-4), Factor B participants believed in the helpfulness of teaching to their peers (Item 44, +2). However, Factor B was most distinguished from Factors A (+1) and C (-1) in its belief that CETI courses should prepare students for future faculty roles (Item 43, +4). Collectively, individuals on this factor all agreed that the role of a CETI course was to help them be successful as future faculty members, and as one student stated, “Students need to be prepared for future faculty roles including teaching, so students need to be prepared to teach.”

     Factor B differed from Factors A and C on the importance of evaluation of students’ learning (Item 20, -1) and textbook selection (Item 14, -2), but agreed that videotaping students’ experiences is not an essential component of CETI courses (Item 11, -4). Regarding Item 11, participants noted, “Video recordings may not demonstrate the entire experience, including feelings and opinions of students and teachers.” Additionally, CEDS noted that being video-recorded could potentially “make students in the class act differently,” and, “if there is live evaluation” contained in a CETI course, “including guided reflection and time to process feedback, then video isn’t necessary.” This is an interesting finding given that many of the participants were trained in counseling programs that used video work samples as the basis for supervision feedback related to counseling skills development.

Factor C: The Empathic Instructor
     Factor C represented a preference for instructor qualities and intentional communication (i.e., delivery) more so than design issues (Factor A) or future faculty preparation (Factor B). For instance, Factor C participants believed that instructors of CETI courses should be passionate about teaching (Item 30, +4), compared to -1 and 2 for Factors A and B, respectively. As one student put it, “I feel as though passion fuels everything else in the course: effort, preparation, and availability of the instructor. Passion is everything.” According to Factor C, CETI instructors should be approachable (Item 32, +4), model and demonstrate how to provide feedback for future student encounters (Item 26, +3), and check in often with students to determine their level of understanding (Item 21, +3). However, when designing, delivering, and evaluating CETI courses, Factor C participants highlighted the developmental level (Item 25, +2) and cultural differences (Item 38, +4) of students, which contrasts with Factors A and B. Factor C simply placed higher importance on these items compared to the other factors.

Factor C was also distinguished by what is not essential for a CETI course, such as planning for a teaching experience (Item 35, -1), processing fellow classmates’ teaching experiences (Item 29, -3), and being able to design evaluations of teaching and learning (Item 48, -4), which, as one participant stated, are “usually dictated by the institution where you are employed.” Factor C placed less emphasis on specific feedback (i.e., content-oriented) instructors provide to students on their teaching (Item 42, -1) in favor of the instructor’s approachability. As one participant described, “There is not growth without feedback . . . if the instructor is approachable then the student will feel as if they can approach the instructor with any concerns, including any items on this Q sample.” Given the preference for instructor qualities and communication, the authors have named Factor C The Empathic Instructor.

     Despite the distinguishing perspectives contained in each individual factor, significant areas of consensus existed among factors with respect to particular Q sample items. For example, Factors A, B, and C believed that designing a syllabus is an important aspect of a CETI course (Item 39; +3, +3, and +2, respectively). All three factors commonly acknowledged that CETI course instructors ought to consider the pedagogy used for course delivery (Item 10; 0, +1, and +1, respectively), and that CETI courses should prepare doctoral students for teaching internships (Item 22; 0, +1, 0). CETI courses should address classroom management issues as well (Item 18; +2, +1, and 0, respectively). Finally, CETI courses should contain intentional student engagement efforts (Item 3; +2, +1, and +2) with regular and relevant discussions (Item 8; +1, +3, and +2, respectively).

Consensus among factors also existed around the non-essential elements of a CETI course. Specifically, all three factors expressed that midterm (Item 16; -3, -3, and -2, respectively) and final course exams (Item 19; -3, -4, and -3, respectively) were not essential components of a CETI course. One male participant summarized this point: “I think students’ progress can be evaluated by exploring what students think they learn, how much insight they gain, and how they plan to apply what they learn in the class, rather than using exams or pre/post-tests.” Similarly, another female participant cited, “Exams will not show progress in teaching skills. You need real life experiences and discussion.” Overall, participants across factors believed that exams promote memorization of content more so than the fair and commensurate evaluation of teaching knowledge and skills. In other words, they believed that CETI courses should be more experiential in nature.


The purpose of this study was to gain insight into the essential design, delivery, and evaluation elements needed for a CETI course. The results produced three unique views on this topic. In addition, although participants’ views varied, with Factor A emphasizing the technical components of creating a course, Factor B emphasizing experiential components and future faculty roles, and Factor C emphasizing the character and qualities of the instructor, there were several areas of consensus. Specifically, participants across all three factors agreed on the importance of CETI courses for (a) preparing CEDS for teaching internships (Hunt & Weber Gilmore, 2011; Orr et al., 2008; Waalkes et al., 2018); (b) using pedagogy to guide CETI course delivery (ACES, 2016; Waalkes et al., 2018); (c) designing syllabi (Hall & Hulse, 2010; Hunt & Weber Gilmore, 2011); and (d) developing teaching skills such as classroom management, engaging students, and facilitating class discussions (Hall & Hulse, 2010; Hunt & Weber Gilmore, 2011; Waalkes et al., 2018). As indicated above, these points of consensus align with previous counselor education literature, including participants’ desire for CETI courses to prepare them for teaching as counselor educators (Baltrinic et al., 2016).

An expected finding within Factor C is the influence of the instructor’s qualities (e.g., approachability and passion) and delivery (e.g., seminar format) on participants’ views of the CETI course (Moate, Cox, et al., 2017). The instructor delivered the course in a seminar format emphasizing student leadership for content sharing and de-emphasizing the use of lecture, which relates to consensus factor scores on Item 40, “In a teaching course, I should be evaluated on my ability to do a lecture.” However, it is unclear from the data how participants understood the purpose or role of lectures for engaging students in the classroom. It is notable to mention, however, that participants delivered counseling content to master’s-level students as part of their teaching experiences for the course and would thus benefit from feedback on their performance.

Many have suggested that utilizing lecture as the principal mode of delivery fosters passive learning and does not necessarily support students’ engagement in course content or development of decision-making, problem-solving, or critical-thinking skills (e.g., Malott et al., 2014; Moate & Cox, 2015). Participants in Waalkes et al.’s (2018) study indicated that their training primarily equipped them to lecture, which they reported did not fully prepare them for their roles as educators. Although Moate and Cox (2015) do not recommend utilizing lecture as the only method for helping students engage with course content, both they and Brookfield (2015) emphasized the false dichotomy that exists between teacher-centered approaches, which are typically characterized by lecturing, and learner-centered approaches, which often rely on using discussions as a primary mode of teaching.

Rather than dismissing lectures entirely, instructors can utilize lectures to provide a broad overview of the course content, to explain difficult or complex concepts with frequent examples, to generate students’ engagement and interest in a topic, and/or to model the types of skills and dispositions instructors would like to foster in students (Brookfield, 2015; Malott et al., 2014; Moate & Cox, 2015). Thus, lectures can serve as a starting point to model and frame course content for further discussion and application using other teaching methods (Moate & Cox, 2015). Overall, we believe that it is important for students to possess a variety of teaching methods for engaging students with course content and understand when and how to apply various methods effectively, which requires CETI instructor feedback and support.

Surprising results included participants’ low rankings of Item 12 regarding the importance of role-playing, of Item 7 regarding the importance of peer feedback, and of Item 11 regarding the use of video recordings of teaching—this latter finding contrasts with participant responses in Hunt and Weber Gilmore’s (2011) study, who found “sharing and critiquing a video of us teaching” an especially valuable component of their coursework (p. 147). Current counselor education research consistently affirms the importance and reported desire for formal coursework to incorporate practical teaching components related to the actual work of a counselor educator (Hall & Hulse, 2010; Hunt & Weber Gilmore, 2011). Instructors who employ learner-centered approaches often emphasize the role of peers and the use of peer feedback to enhance student learning (Moate & Cox, 2015). It could be that participants assumed that role-plays pertain to practicing counseling-related interventions. As such, it may prove helpful if counselor educators consider situational uses for role-plays, such as a way of managing difficult situations in the classroom (e.g., classroom management), or for addressing sensitive topics related to multicultural concerns, among others (Hunt & Weber Gilmore, 2011). Instructors can model how to facilitate these skills, which can be followed up with dyadic or triadic student role-plays.

Additionally, participants did not place importance on peer feedback over the instructor’s feedback or learning how to provide feedback to their future students in the instructor role. Instead, participants favored feedback from the instructor on their own teaching skills, the proposition here being that instructors can provide feedback from a position of experience, more so than peers who do not have teaching experience. It is plausible that CEDS attending CETI courses need feedback about how to provide feedback and perceive this as an important teaching skill (Hunt & Weber Gilmore, 2011). This is important because students in CETI courses are likely (a) learning the course-related content and (b) learning the pedagogy for delivering counseling-related content in their future classrooms (ACES, 2016).

     Findings support two important implications for counselor educators, the first of which is illustrated by the instructor from this study: “What students’ passions are and what students need to know are not always the same thing.” One can reasonably expect discrepancies between the perceptions of the instructor and those of students as evidenced by some participants’ dissatisfaction with the content and delivery of their CETI courses (e.g., Hall & Hulse, 2010; Waalkes et al., 2018). However, we encourage counselor educators as they teach to consider students’ views (i.e., factors) even if they feel their own views and curriculum support best practice. We also acknowledge that some instructors may have limited autonomy in the construction of CETI course syllabi and assignments because of accreditation requirements.

In thinking about the implications for counselor educators, to the extent possible, tailoring a CETI course to the reported preferences/needs of the students seems essential for preparing them for future teaching (Waalkes et al., 2018) as well as for increasing student engagement (e.g., Moate & Cox, 2015). For example, counselor educators can incorporate technology, curricular, and course design elements into CETI courses (Factor A). Counselor educators can link teaching experiences to future faculty roles by exploring them in the context of accreditation requirements, their impact on tenure and promotion practices (Davis et al., 2006), and managing teaching loads in the context of other duties and institutional demands (Silverman, 2003; Factor B). Finally, counselor educators can incorporate Factor C views into their CETI courses by attending to the instructor qualities, modeling passion, demonstrating approachability, and frequently checking in on students’ progress (Malott et al., 2014). Additionally, the authors suggest that counselor educators incorporate aspects of all three factors into their own teaching practice and link the CETI course to future supervised teaching experiences such as teaching practicum or internships as suggested by Waalkes et al. (2018).

Second, counselor educators should obtain and incorporate CEDS’ perspectives early when designing, delivering, and evaluating CETI courses, which can be helpful for investigating (formally or informally) the impact of those instructional strategies and curriculum on CEDS’ teaching skill development and is recommended as a best practice by Malott et al. (2014). It is common practice to collect student opinions of instruction at the end of the semester, and many instructors collect ongoing data on how students are progressing in the semester. Q methodology could be used in ways similar to this study to help instructors positively influence CEDS’ learning. Additionally, counselor educators could utilize Q methodology to identify factors and use those factors to improve their own performance, to design other teaching-related courses, and to affect CEDS’ classroom experiences and learning outcomes. Counselor educators could also compare their CETI courses with other instructors’ courses to see trends or use Q methodology to identify factors within or between CETI courses over time.

Limitations and Future Research
     Q methodology studies gather and rigorously analyze data to reveal common viewpoints among participants. Factors do not generalize in Q studies the same way as findings from traditional factor analysis (i.e., R methodology; Brown, 1980). Rather, factors are simply collections of opinion, the structure of which may or may not exist in other counselor education settings. However, CETI instructors can test this proposition by having students in other CETI courses complete Q-sorts with the current Q sample or by developing and testing relevant Q samples of their own design. In fact, because the Q sample was used in one class, researchers are encouraged to test propositions with larger samples across programs to see if the factors exist in multiple settings. Finally, because the participants in the current study were a convenience sample from a brick-and-mortar program composed mostly of White females within a single course, participant diversity was lacking. Future studies could examine the views of students of color and international students in larger samples across multiple courses and multiple formats (e.g., online and hybrid programs).

Additional conditions of instruction could be added to expand teaching instruction viewpoints using a single-case design approach (Baltrinic et al., 2018). Supporting Q findings with qualitative information from in-depth interviews from student and instructor factor exemplars would add more nuance to the existing factors as well. Finally, following in our footsteps, researchers could develop and administer their own teaching instruction Q-sorts before beginning a CETI course to tailor the development and delivery of the course to the needs of their students. This would allow CETI instructors to develop studies, which may reveal idiosyncratic and shared experiences (Stephenson, 2014) related to programs’ CETI course design, delivery, and evaluation.

     We proposed in this article that doctoral CETI courses offer a starting point for CEDS’ teaching preparation. We elaborated further that despite accreditation guidelines and the anecdotal experiences of counselor educators in various programs, little is known about what specifically to include in a CETI doctoral course. Counselor educators and CEDS alike can honor course variability, anecdotal experiences, and academic freedoms, while providing some structure to their CETI courses. This goal can be achieved by acknowledging that CETI course design, delivery, and evaluation include professional-level, student, and instructor perspectives. The Q factors in the current study revealed one way to include multiple perspectives and to identify preferred and recognizable CETI course components.


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



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College Teaching Q Sample Statements and Factor Array

# Q Sample Statement A B C
1 Peers should be able to review the courses I develop as part of a teacher training course. -1 -2 -2
2 Teacher training courses should have case examples. -2  0  1
3 Designing student engagement is important for a course on teaching.  2  1  2
4 Courses in teacher training should have relevant technology resources.  1 -2 -2
5 Learning how to assess students’ learning is important in a teaching course.  3  0  2
6 Courses in teacher training should have interactive activities.  0  4  1
7 I should have student feedback for the classes I teach while a student in a teacher
training course.
-2  0  2
8 Teacher training courses should have relevant discussion.  1  3  2
9 Teacher training courses should have student feedback mechanisms for the instructor.  0  0  0
10 A teaching course should consider the pedagogy used for course delivery.  0  1  1
11 I believe that my teaching should be videoed in my teacher training course. -1 -4 -1
12 Having role-plays on teaching is important for a teaching course. -4 -3  0
13 Teaching instruction courses should incorporate adult learning theories.  0 -1  0
14 Selecting a textbook is an important part of learning in a teaching course.  2 -2  1
15 Content in teacher training courses should be up to date. -1  1 -1
16 Teacher training courses should have midterm evaluations of my work in the course. -3 -3 -2
17 Teacher training courses should have breakout groups. -3 -3 -3
18 Teacher training courses should address classroom management.  2  1  0
19 Teacher training courses should have course exams. -3 -4 -3
20 A method to evaluate students’ learning is important to course design.  2 -1  1
21 Instructors of teacher training courses should check in often with students to determine their level of understanding. -1  0  3
22 Teaching instruction courses should prepare students for teaching internships.  0  1  0
23 Teacher training courses should have assigned readings on varied aspects of teaching
and learning.
 1 -2 -1
24 Considering students’ personal and cultural characteristics is important in designing a teaching course.  0  2  1
25 Considering students’ developmental level is important in designing a teaching course. -3 -1  2
26 Learning how to provide feedback to future students is important for a teaching course.  1  0  3
27 In a teacher training course, I should be expected to create a teaching philosophy.  4  1  3
28 Teacher training classes should have supplemental learning materials. -1 -2 -2
29 I should process fellow classmates’ teaching experiences as a part of a teacher
training course.
 1 -1 -3
30 The instructor in a teacher training course should be passionate about teaching. -1  2  4
31 In a teacher training course, I should be able to design a teaching instruction course. -4 -1 -4
32 Instructors of teacher training courses should be approachable.  0  2  4
33 Creating course objectives are important to a teaching course.  3  0  3
34 Teacher training courses should have pre/posttest of students’ learning. -2 -4 -3
35 Planning for a teaching experience is an important part of the course.  3  2 -1
36 Portions of teacher training courses should include lectures. -2 -1 -2
37 In a teacher training course, I should be able to design a counseling course.  4  0  0
38 Instructors of teacher training courses should anticipate students’ cultural differences. -1  2  4
39 Designing a syllabus is an important aspect of a teaching course.  3  3  2
40 In a teaching course I should be evaluated on my ability to do a lecture. -2  1 0
41 Decisions on how you will use media are important in designing a teacher training course.  0 -2 -2
42 Instructors of teacher training courses should provide appropriate feedback to students
on teaching.
 2  3 -1
43 Teaching instruction courses should prepare students for future faculty roles.  1  4 -1
44 In a teaching training course, I should have the opportunity to teach to my peers. -4  2 -4
45 Experiential activities are important in a teaching instruction course.  1  3  0
46 Having a teaching experience is important for a course on teaching.  4  4  1
47 In a teacher training course, I should be able to use technology to collect evaluation data. -2 -3 -2
48 In a teacher training course, I should be able to design evaluations of teaching and learning.  2 -1 -4


Eric R. Baltrinic, PhD, LPCC-S, is an assistant professor at the University of Alabama. Eric G. Suddeath, PhD, LPC, is an assistant professor at Mississippi State University – Meridian. Correspondence can be addressed to Eric Baltrinic, Graves Hall, Box 870231, Tuscaloosa, AL 35487, erbaltrinic@ua.edu.

Online Clinical Training in the Virtual Remote Environment: Challenges, Opportunities, and Solutions

Szu-Yu Chen, Cristen Wathen, Megan Speciale


This article focuses on the clinical training aspects of a distance counselor education program and highlights what clinical courses look like in an online synchronized classroom. Using three courses as examples, including group counseling, child and adolescent counseling, and practicum and internship, the authors share unique challenges they have encountered and solutions they have adopted when training distance students on counseling skills. The authors further discuss pedagogy, teaching strategies, and assessments that have been utilized to engage diverse distance learners in synchronized class meetings in order to maintain equivalent quality and learning outcomes with traditional clinical training methods. Finally, the authors provide recommendations for future research to increase and solidify the reality of distance clinical training in counselor education programs.


Keywords: online clinical training, distance counselor education, virtual environment, synchronized classroom, pedagogy



The rapid development of technology over the past decade has caused significant changes in higher education (Swanger, 2018). According to Allen et al. (2016), in 2015 over 6 million students participated in distance learning courses. Following these national trends, distance learning opportunities in counselor education have grown (Snow et al., 2018), delivery modes for distance counselor education programs have been developed, and attention to distance learning pedagogy has become a critical focus. At the same time, counselor educators have held the belief that counselor education, especially clinical skills training, should be learned and taught in person because of the intricacies related to developing rapport and the complexity of the counselor–client relationship (Benshoff & Gibbons, 2011). As the helping relationship is key to effective counseling (Layne & Hohenshil, 2005), providing clinical training via distance education can be a concern in regard to students’ learning experience and growth, and ultimately their ability to connect and work with clients.


Despite this caution, the Council for Accreditation of Counseling and Related Educational Programs (CACREP) accredited program models have begun to shift the perspective in the counselor education field. Alongside numerous pedagogies specific to the online format, the Association for Counselor Education and Supervision (ACES) Technology Interest Network (2017) has published its own guidelines for online learning, showing its support of this method of counselor training. Additionally, to date, CACREP has accredited a number of fully online counselor education programs, supporting the provision of quality counselor training despite an absence of in-person contact between faculty and students. However, scholarly research around best practices and effectiveness of distance counselor education has not substantially increased. Barrio Minton (2019) reported in a thematic analysis of counselor education and supervision articles published in 2017 that only 4% pertained to distance counselor education.


A benefit of distance learning counselor training programs is that students worldwide have an opportunity to pursue an accredited advanced degree in counseling in the United States. When programs approach this type of training with a culturally competent perspective, qualified faculty, and intentional pedagogy specific to distance learners, they not only allow the profession of counseling to grow nationally and globally, they provide opportunities for individuals whose life circumstances have created a barrier to pursuing a counseling degree. With this responsibility, counselor educators recognize that it is crucial to continuously explore challenges and benefits of facilitating clinical training within the realm of technology. It also is vital for counselor educators to continue examining ways to create safe and student-centered learning communities, maintain meaningful teacher–student relationships, and model counseling relationships and clinical skills in a virtual environment. Thus, research and instruction around sound distance learning pedagogy is imperative (Perry, 2017).


This article focuses on the clinical training aspects of a counselor training program and highlights what clinical courses look like in a remote synchronized classroom. We will share unique challenges and solutions we have encountered when training distance students on counseling skills in group counseling, child and adolescent counseling, and practicum and internship. We discuss pedagogy and teaching strategies that we have utilized to engage diverse distance learners in synchronized class meetings in order to maintain equivalent quality and learning outcomes with traditional counseling programs. Finally, because of a dearth of research concerning distance training in counselor education, this article provides research recommendations to increase and solidify the reality of distance counselor education training programs. In order to ethically provide quality training, counselor educators must know what works and what best practices in distance learning produce quality counselors. In fact, Barrio Minton (2019) argued that “scholarly attention to methods for and effectiveness of distance teaching and supervision is the most neglected area within counselor education and supervision” (p. 12). With the number of online programs increasing, this should no longer be the case.


Review of Clinical Training in Distance Education


The 2016 CACREP Standards (2015) emphasize clinical training regarding general and program-specific knowledge, skills, and practice. Specifically, counselors must have knowledge, skills, and practice in conducting clinical interviewing; diagnostic assessments; case conceptualization; and individual, group, and career counseling. Students are expected to demonstrate ethically, developmentally, and culturally appropriate strategies and techniques for building and maintaining face-to-face (F2F) and technology-assisted therapeutic relationships, as well as prevention and interventions regardless of the context of the training medium (CACREP, 2015).


Although distance learning is not a new phenomenon, online counselor education has been slow to progress. Currently, CACREP (2015) defines an online counseling program as one having 50% or more of the counseling curriculum offered via distance technology. As of 2019, the CACREP database indicated 55 CACREP-accredited institutions offering 72 online master’s degree programs, compared to five CACREP-accredited online counselor education programs in 2012. As the number of CACREP-accredited online programs continues to grow, online clinical training has become a controversial topic given the nature of therapeutic relationship-focused and skills-based education. According to Perry (2017), some major concerns include whether distance students obtain as much knowledge and are able to develop comparable counseling skills as students who attend F2F training programs. To date, limited literature focuses on online clinical training and few researchers have examined the efficacy of teaching counseling practice skills through online courses (Barrio Minton, 2019). There are few studies comparing online and F2F programs’ learning outcomes in counselor education. We consider this a particularly important area to explore given that counselor supervisors and educators must conduct counselor education and clinical training programs in an ethical manner whether in traditional, hybrid, or online formats (American Counseling Association, 2014).


Online Clinical Skills Training

Concerns about the ability to translate clinical skills in an online environment are prevalent among educators (Barrio Minton, 2019; Perry, 2017). There is little research to facilitate changed attitudes around this common mindset. Researchers have examined the efficacy of distance students’ clinical skills development in the mental health professions. Murdock et al. (2012) assessed students’ skill development learning outcomes between online and in-person counseling skills courses based on Ivey and Ivey’s (1999) counseling skills training textbook. Participants included 19 students enrolled online and 18 students enrolled in person. Students were taught by the same instructor and the courses were facilitated similarly. A counselor served as an independent evaluator and 15 transcripts of counseling skills sessions were randomly selected. Results showed no significant difference in basic counseling skills based on the mode of course delivery. Similarly, Murdock et al. (2012) and Ouellette et al. (2006) found no significant differences between online and F2F sections of an interviewing skills course for undergraduate social work students.


Wilke et al. (2016) conducted a quantitative study to compare master’s social work students’ development of clinical assessment and clinical skills of crisis intervention between 74 students enrolled in an in-person class and 78 students in an asynchronous online class. All student participants were taught by the same instructor and were given the same assignments, including an assessment and treatment plan of a fictional case and a digital role-play. The role-play assignment was graded by a doctoral student who was blinded to the course delivery format. The results showed that there was no significant difference for students’ skill development between F2F and online classes. Wilke and colleagues concluded that clinical skills seem to be taught as effectively online as in a traditional classroom within the context of the same instructor.


Bender and Dykeman (2016) explored students’ perceptions of supervision in both online and F2F contexts. Counseling faculty and doctoral students provided supervision to 17 F2F students and 12 synchronous online students. Supervision took place for 90 minutes each week in a 10-week period. A posttest assessment, the Group Supervisor Impact Scale (Getzelman, 2003), was given to all participants to measure supervisee satisfaction, self-efficacy, and the supervisory relationship. The results showed no significant differences in the students’ perceived perspective of supervision effectiveness between the online or traditional supervision students. These articles stand out as starting a base of evidence for the effectiveness of online clinical training in counselor education; however, much more qualitative and quantitative research is necessary regarding a multitude of educational aspects connected to CACREP standards to sufficiently evidence the quality of online clinical training.


Assessment and Evaluation of Online Clinical Training

Reicherzer and colleagues (2012) pointed out challenges for online and hybrid programs in observing and assessing students’ counseling skills and practice because of the potential limits of a distance learning environment. Various counselor educators described similar challenges in providing experiential clinical training in a remote learning community. For example, Snow and colleagues (2018) surveyed 31 online counselor educators to investigate the features of current online counseling programs and educators’ online teaching experience, including the challenges they encountered and the strategies they used to ensure students’ success. The results indicated that some of the major challenges related to clinical training included providing experiential clinical training to distance students and supporting quality practicum and internship experiences for distance students.


Reicherzer and colleagues (2012) recommended that instructors develop program-specific standards and use technology to gather multiple artifacts that measure student learning outcomes associated with knowledge and skills. It is important for the program to determine what learning components must be taught in residencies (Reicherzer et al., 2012). Snow and colleagues (2018) further noted that asynchronous online teaching might not be an effective method for modeling, observing, and assessing students’ interpersonal and counseling skills. However, synchronous videoconferencing technologies may provide distance students and educators the same opportunity to conduct skills demonstration, provide immediate feedback, and practice experiential activities, such as role-plays (Snow et al., 2018). Furthermore, it is critical to include skills-based activities throughout the program and ensure students meet necessary learning outcomes before they advance to clinical field experiences (Reicherzer et al., 2012).


To address an increasing trend of distance counselor education, the ACES Teaching Initiative Taskforce (2016) provided suggestions for delivering a high-quality online educational experience for counseling students. It is proposed that instructors’ presence and engagement with students are key to students’ online learning experience. Thus, Hall et al. (2010) postulated a humanistic practice in distance education. Specifically, the authors proposed that instead of heavily relying on technology, instructors should make efforts to foster teacher–student relationships at the beginning of the class and intentionally maintain relationships throughout the course delivery by considering students’ personal, social, and cultural needs. It seems that with advances in technology, embracing humanistic educational foundations can help to ensure the integrity of the counseling profession.


Challenges and Opportunities of Online Clinical Training


Some educators might consider the integration of technology in the counseling training program as an opportunity for continued development in the counseling profession. Yet, others might question the capability and success of online modalities in meeting learning outcomes and standards (Snow et al., 2018) and view it as a threat given that the profession emphasizes therapeutic relationships as the core of effective counseling (e.g., Layne & Hohenshil, 2005). This argument is founded on the assumption that technology cannot provide students with a productive learning experience compared to F2F experiences (Layne & Hohenshil, 2005). Additionally, some online counselor educators identified changing their teaching style to fit an online classroom to be a major challenge (Snow et al., 2018). As a result, many educators are seeking ways to effectively maintain a focus on interpersonal relationships within a technologically oriented teaching format for some professions, including counseling, that are practiced through personal contact (Hall et al., 2010; Lundberg, 2000).


We have perceived and experienced various challenges and opportunities when providing clinical training in a virtual learning environment. Koehler et al. (2004) indicated that to effectively develop online courses, there are three components that must dynamically interact with each other: content, pedagogy, and technology. When the instructor has expertise in the subject, has skill in teaching effectively in an online environment, and understands and effectively utilizes technology in dynamic ways, students report having a better learning experience. Although there is an increasing focus on general online pedagogy in counselor education, concrete and practical strategies for online clinical training are rarely discussed. Accordingly, we aim to illustrate strategies that counselor educators can consider integrating into various skill-based courses to accommodate diverse learning styles, provide supports for students’ learning, and deliver quality clinical training.


Fostering an Effective Learning Environment for Clinical Skills Training

The element of classroom safety is an important consideration in fostering an effective virtual environment for clinical skills training. Because role-plays and mock counseling assignments often include information that is sensitive in nature, it is essential that students maintain confidentiality during and after class meetings (ACES Technology Interest Network, 2017). Although attending class in a private location is preferred, students in synchronous settings may join the class from a variety of locations in which privacy cannot be guaranteed (e.g., coffee shops, shared living spaces, and libraries), so it is important to establish classroom guidelines that address classroom confidentiality. Example guidelines that ensure a safe and respectful online environment may include: (a) using headphones in class to prevent the accidental sharing of classmates’ private information, (b) limiting background noise, (c) ensuring there is proper lighting so the student’s face is illuminated, (d) closing all other open windows on the computer to increase focus, and (e) avoiding side conversations with other students or outside persons during class.


Synchronous Tools for Clinical Skills Training

With the expansion of technology, instructors have been able to apply numerous synchronized technological tools to enhance students’ engagement and benefit students’ clinical skills development in the virtual space. One of the features of many videoconferencing software programs is breakout rooms, which function similar to small group breakouts in traditional classrooms. With breakout rooms, instructors can assign students to small groups in a virtual classroom where students can conduct case discussions and role-plays. Instructors can join each small group remotely to facilitate observations and assessment of students’ clinical skills, as well as provide feedback on students’ discussion and questions. This allows students to receive individual feedback immediately and to incorporate recommendations into their practice simultaneously.


Online counseling practice systems are another opportunity that can benefit students’ practice of counseling skills in the online realm. Instructors can incorporate this technology tool into the curriculum for students to practice specific counseling skills, such as paraphrasing, reflection of feeling, and question asking. These platforms usually provide a variety of short video clips of diverse mock clients with different presenting issues. Instructors can set up different modules and assign students to practice different skills every week. Students can watch video clips and record their therapeutic responses to mock clients as many times as they deem necessary. After students submit their responses, instructors evaluate their responses online and provide feedback by recording their skills demonstration. Additionally, instructors play mock client video clips during the synchronized class meeting and demonstrate effective therapeutic techniques. These online practice systems also serve as an additional opportunity for students to practice counseling skills in a technology-assisted counseling setting and help them understand the potential of online counseling settings.


Assessment of Clinical Skills

Although synchronous videoconferencing platforms allow counselor educators an opportunity to observe students’ verbal and facial/nonverbal communication, assessment of the full range of counseling microskills involved with facilitating a therapeutic environment is limited. Qualities such as eye contact, body positioning, proximity, and other subtle nonverbals are important markers of students’ therapeutic stance (Lambie et al., 2018); however, there are significant challenges to observing these behaviors over synchronous video. Because of the variations in the placement of student webcams and computer monitors, eye contact and body nonverbals cannot be measured consistently, so educators attempt to capture this behavior using real-time role-plays in class, as well as pre-recorded role-plays of the student performing mock counseling with an outside acquaintance (e.g., friend, family member, or other student). Using multiple points of observation, educators can gain deeper insight into the student’s nonverbal abilities and have multiple opportunities to provide feedback.


As both verbal and nonverbal communication are central to the assessment of students’ conveyance of empathy and non-judgment, limited access of students’ therapeutic presence in a synchronous format also poses challenges to the observation of cultural competency. In a residential classroom, group dialogue provides a critical opportunity for educators to assess student comfort in discussing cultural topics, such as discrimination, power, and privilege (Sue et al., 2009). During these conversations in a synchronous online format, it is difficult to observe the microbehavior associated with discomfort and reactivity, especially in classes with larger enrollment, and students that are struggling with the conversation can elect to remain muted or turn off their camera. As such, educators may find it beneficial to divide the class into smaller breakout groups to facilitate increased student engagement and bolster students’ sense of safety in smaller group settings. In this format, educators are better able to observe when and why students become disengaged or triggered by the dialogue and then intervene accordingly.


Examples of Online Clinical Skills Training in Counseling Courses


The delivery model of distance counselor education at our institution consists of synchronous class meetings via videoconference software and asynchronous learning via a learning management system. Students are required to participate in the synchronized virtual classroom meeting weekly for 1.5 hours. Instructors asynchronously assign weekly readings, facilitate additional discussion board activities, and post video lectures or other video resources.


Students enrolled in the online program are required to attend a one-week intensive basic counseling skills course residentially prior to taking other skills-focused courses online, such as group and child and adolescent counseling. We provide examples of facilitating advanced counseling techniques training in a synchronized format. Specifically, we illustrate how to structure and assess students’ clinical competencies and utilize creative and ethical solutions in group, child and adolescent, and practicum and internship courses in a virtual learning community.


Group Counseling Skills Training

Group counseling is identified by CACREP (2015) as one of the eight core content areas required for all graduates of accredited counseling and related educational programs. It is unique in that, in addition to knowledge and skill learning outcomes, there also is a requirement that educators provide “direct experiences in which students participate as group members in a small group activity, approved by the program, for a minimum of 10 clock hours over the course of one academic term” (CACREP, 2015, p. 12). This experiential component distinguishes the group counseling course as a premier opportunity for clinical skills training; however, to date, there is little research attesting to educational best practices in synchronous online learning environments about group counseling. Thus, in the development of this course, the instructors supplemented the limited existing research with consultation of group work specialists, group counseling instructors, and counselor educators specializing in synchronous online education. Through these dialogues, the following 11-week course structure was established, which is generally revised with each course offering by incorporating student feedback, continued consultation, and updated research.


Course Structure

     The required 10-week experiential component of group counseling in an 11-week online course can be achieved in a variety of ways. Common strategies include: (a) inviting external licensed group counselors (paid or volunteer) to facilitate a group counseling experience for students (without instructor observation), (b) implementing an instructor-led group counseling experience for students, (c) allowing students to serve as both group facilitators and group members in an alternating facilitation schedule (instructor-observed), and (d) requiring all students to locate and participate in an external group of their choosing (Merta et al., 1993; Shumaker et al., 2011). In consideration of the common challenges associated with an externally led and instructor-led group, including ethical concerns regarding potentially harmful dual relationships and problematic professional boundaries between students, as well as limitations imposed by the online training format, instructors chose to implement an alternating student-led structure for the experiential groups. A more thorough review of the benefits and limitations of each approach may be found in Shumaker et al. (2011).


At the beginning of the course, students are assigned to a small group ranging in membership from five to seven students each. Given the online setting, smaller groups may be more manageable for student facilitators and can give student members increased opportunities for engagement. Each group is responsible for determining a facilitation schedule for the 10 experiential groups in which students will choose the week(s) that they wish to lead the group. Students are directed to collaborate with group members to determine a specific focus of the group, falling within the realm of counseling professional development. The group meets in online breakout rooms for 60 minutes in each of the 10 weekly videoconferences. Periodically, instructors will incorporate a group reflecting team that will observe the group session live with their video and microphones off; record displayed group counseling skills, process, and content observations; and provide feedback for the group and group co-leaders based on the current lecture topics.


Ethical Considerations

Because of the potential for dual relationships, the in-class experiential group is not intended to be a therapy group. The group is described as a process group in which members will discuss issues related to professional development, and students are urged to exercise caution and intentionality regarding the nature of their personal disclosure. Students are reminded that the group experience is an assignment for the course in which participation in the group will be evaluated. Cautions regarding the limits of confidentiality and privacy are highlighted and an online practice screening session and example of a group informed consent is utilized.


Clinical Training and Assessment

The clinical skill outcomes determined for this course were developed in line with the 2016 CACREP Standards and the Association for Specialists in Group Work’s Professional Standards for the Training of Group Workers (2000). Group counseling clinical skills are assessed through the instructors’ online observation of: (a) each student leading a group, (b) course role-plays based on working with group roles that clients often take on, and (c) the ability to identify clinical skills when observing the group as a reflecting team member. Finally, the synchronous nature of the online group counseling course allows for dispositional assessment of students, as inappropriate behaviors are discussed throughout the class and are integrated into the group rules by the course instructor. In addition, the group instructor can intervene through synchronous technology when necessary, as they are able to do so in the F2F group counseling classroom.


Challenges, Strengths, and Solutions

     Challenges related to teaching group counseling online include facilitating a humanistic relationship between group members and instructors as well as among small group members in the online environment. Holmes and Kozlowski (2015) compared online counseling group courses with a small group component with a similar in-person group counseling course. The results showed that students assessed the in-person group counseling experience more positively than the online groups. This study signifies that there is more work to be done to improve the delivery of group counseling clinical training in online settings. A challenge that may contribute to this phenomenon is that students are often not trained on the nuances of noticing nonverbals in a videoconference setting. A second challenge is the variability in where students are located while doing group. Although students may be in a confidential setting, it might not be the most helpful setting to participate in a practice group session. For example, instructors have observed students in their cars, lying on their beds, sitting in a beauty salon, and having the television on while participating in group. Clear boundaries and expectations regarding the students’ background are vital, as contexts can be distracting for group members, group leaders, and for the individual. Technological difficulties also can impede the development of group rapport and trust as students’ screens can freeze during a discussion. Similarly, group leaders can have legitimate issues that make it difficult for them to be understood and communicate, and some students may be continuously logging on and off because of internet connection problems. Facilitating a discussion regarding thoughts and emotions around group technology issues is an effective way to normalize frustration and collaboratively brainstorm strategies to facilitate connection despite these realities.


There are, however, notable advantages to teaching group counseling online. These include the ability for the group supervisor to give immediate feedback to group leaders through online chat and video options. With consent, group sessions can be easily recorded for transcription assignments, supervision, real-time classroom discussion, and utilizing a reflecting team. Other supports and areas of importance include group rules about how students will utilize microphones. For instance, will they stay muted throughout the group until they want to share, or will everyone keep their microphones on so they feel freer to talk without having the extra step of turning on their microphone? Another consideration is whether to allow group members access to private chat abilities while in group. Instructors have experienced times when this has been distracting, as student group members may bring up unrelated topics while another person is sharing verbally. However, the chat function also can allow for increased support for individuals sharing, as group members can type in multiple responses. This can be a challenge for group co-leaders as they navigate both the group chat and group work occurring verbally.


Child and Adolescent Counseling Skills Training

Child and adolescent counseling is another clinical skill-focused course in which students are expected to understand and practice a variety of developmentally appropriate approaches to working with diverse youth. According to the 2016 CACREP Standards (2015), this course may assess students’ learning outcomes not only in areas of core content, but also in specialty areas, such as school counseling, clinical mental health counseling, and family counseling. Given the first author’s specialization in play therapy, she aims to provide opportunities for students to practice basic play therapy techniques and other age-appropriate modalities such as expressive arts activities. Therefore, this course is highly experiential.


When teaching play therapy skills in a virtual classroom, some unique challenges include students’ access to toys and art materials, space for play therapy demonstration and role-plays, and limited observations of nonverbal communication. Consequently, the following section focuses on how instructors adapt the virtual classroom environment to strive for maintaining quality clinical training and assessment in child and adolescent counseling competencies.


Course Structure

     To develop child and adolescent counseling competencies, students are expected to practice various play therapy techniques and take turns as counselors and mock clients during weekly synchronized meetings. Over the 11-week class, the instructor usually begins the class with a group discussion about assigned readings and clinical session videos. The instructor also highlights some important materials and demonstrates specific play therapy skills during this time. After the instructor’s modeling, students usually practice skills in small breakout rooms for 40 minutes. The instructor observes students’ role-plays and provides live feedback in the breakout rooms. At the end of the class, the instructor brings students back to the large group to provide overall feedback and allow students to process their role-play experience.


Clinical Training and Assessment

     The instructor utilizes multiple assessments to observe students’ development of child and adolescent counseling skills. Course assignments designed to measure clinical skills outcomes include: (a) in-class participation evaluations based on the student’s level of engagement in the role-plays and case discussions and (b) a recorded play or activity session with a child or adolescent with a session critique. One of the major clinical skills assignments is for students to facilitate a 30-minute play session with a child or an activity session with an adolescent depending on the student’s preferred working population. Students are recommended to find friends’ and relatives’ children for this role-play assignment. Students can also use their own children if they feel comfortable with this option. Students are expected to record the session and provide critiques and personal reflection for their session. This assignment allows students to practice their play therapy skills and language with an actual child or adolescent outside of the classroom and, most importantly, to experience the relationship-building process with a child or adolescent.


Students’ child and adolescent counseling clinical skills are assessed through the instructor’s observation of students’ ability to communicate with children or adolescents through developmentally and culturally appropriate interventions and therapeutic responses. The instructor also assesses students’ knowledge and competencies in areas of ethics, diagnosis, treatment planning, caregiver and teacher consultations, and advocacy. The weekly synchronized meeting also allows the instructor to conduct disposition assessments of students, including how students receive constructive feedback from the instructor and peers.


Challenges, Strengths, and Solutions

     Normally, online instructors are likely to sit in front of a web camera to facilitate the class activities or skills demonstration. However, when working with child clients in a playroom setting, counselors must move around to follow child clients’ play and attend to their play behavior and nonverbal communication. When facilitating creative arts activities with preadolescents or adolescents, counselors sometimes need more space for the activity and need to focus on the client’s process of creation, which involves critical observations of nonverbal communication.


In consideration of these challenges of toys and space, instructors can consider some creative strategies. For instance, when demonstrating skills, the instructor can set up a corner of the room with purposefully selected toys and ensure the camera captures a wide angle of the room so that students are able to observe the instructor’s verbal and nonverbal therapeutic skills. To have students personally experience the power of play and creative arts activities, instructors can facilitate activities involving basic art materials, such as colored pencils and markers, that students have easy access to in their settings. Instructors also encourage students to use any objects that are accessible to students and to be spontaneous when role-playing therapy skills so that students can experience children’s creativity. Students are encouraged to adjust their camera so that their peers can better observe their play behavior and body language during the role-plays.


Although instructors demonstrate various therapeutic responses, it is important to acknowledge the limits of demonstration and role-play experience because of the online environment. It is also imperative to consider ethical issues when assessing students’ clinical skills. For example, when students conduct a play or activity session assignment, instructors need to provide clear guidelines for the purpose of the assignment in that students are not providing therapy for children; instead, students are practicing therapeutic play skills and language. Instructors also want to provide informed consent information for the child’s guardians, including video and audio recording for this assignment and that only the instructor will review the session for the training purpose. Last, instructors want to ensure the privacy of all video materials; therefore, it is recommended that students record videos using HIPAA-compliant software programs and submit them using course platforms.


Online Clinical Skills Training in Practicum and Internship

A major portion of clinical training in a counseling program is group supervision of practicum and internship courses. Although students are most often working F2F with their clients and on-site supervisors, the group supervision experience for distance students takes place in a synchronous format, meeting HIPAA and confidentiality requirements legally and ethically. Jencius and Baltrinic (2016) highlighted the ethical imperative of online supervision competence when faculty are assigned to teach the practicum and internship courses. According to CACREP (2015), practicum and internship group supervision students must meet on average for 1.5 hours per week of group supervision at a 1:12 faculty to student ratio, and qualified supervisors with relevant experience, professional credentials, and counselor supervision training must be a part of the counseling faculty or a student under the supervision of a counseling faculty. While in these courses, counseling students accumulate at least 700 clinical hours, of which 280 must be direct client contact. Through these courses, CACREP standards are met, student learning outcomes assessed, and strengths and challenges are experienced. Following best practices in online learning and CACREP standards, the following online practicum and internship course was designed.


Course Structure

     The courses are designed to evaluate basic clinical skills, facilitate theory-based clinical insights, and advance students’ clinical skills through role-plays, case presentations, course discussions, readings, reflective assignments, and experiential activities. Online courses take place once a week for 1.5 hours during an 11-week quarter. In class, students review and present actual video or audio recordings (if allowed by the practicum and internship site) of clinical work, participate in giving feedback to other students in the course, participate in reflecting teams, and follow ethical and legal considerations for client confidentiality. Weekly, students present a client case presentation based on sessions from their practicum or internship site following a specific outline. If a site allows video presentations of clients, a 5–10-minute clip of a session is presented (with the client’s consent). Students receive feedback from their peers as well as the group supervisor. In the online practicum or internship course, consent is necessary from the site regarding how video and supervision are handled in the online format. It is imperative that a HIPAA-compliant mode of course delivery is utilized for the weekly class meeting and that students presenting videos and cases are instructed on specific expectations of recording, storing, and transferring their video clips and client information that protects their clients’ confidentiality. For example, it would not be appropriate for a student to record, store, and then upload a client session on their cellular phone without proper security compliance in place. At our institution, the ability to utilize the course delivery modality to record sessions is helpful as it provides a HIPAA-compliant way to record and store session clips.


Clinical Training and Assessment

     It is important to note that for practicum and internship courses, the structure, expectations, and assessment of students do not differ substantially from the traditional class. Students in practicum and internship meet the CACREP standards the program has identified for these courses through the Counseling Competencies Scale-Revised (Lambie et al., 2018), whereby instructors and students evaluate and discuss their ratings together through reflective assignments, role-plays, class discussion, and the client case presentation. Group supervisors also are able to monitor students on their dispositions as they participate in giving feedback to their peers, discuss ethical dilemmas and other issues that come up for students during the practicum experience, assess their case presentation and response to peer and supervisor feedback, and review reflective assignments such as journaling or self-care plans.


Challenges, Supports, and Solutions

     Challenges for teaching practicum and internship courses online include discussing informed consent with clients, practicum and internship sites’ buy-in and understanding of how the course works in an online format, the technology limitations of the instructors and students, and technology difficulties that might be encountered during discussions and class presentations. Also, as supervising instructors are rarely in the same location as students in a distance course, there are challenges in knowing and understanding the context of a variety of cultures, regions, and contexts. Legal issues, licensure requirements, and site requirements differ from state to state and can be challenging to navigate. The practicum and internship supervisor also can be in a different time zone from the site supervision, which can make coordinating meetings difficult. Finally, as group supervision is a type of group, there are many similarities with the challenges of teaching group clinical skills (e.g., making sure students are in a confidential location where no one else can see or hear video clips or class discussions regarding clients). Instructors must be clear about the seriousness of violating confidentiality and the expectations they have for the course. Additionally, it can be difficult to give and receive constructive feedback in a setting where nonverbals are more challenging to see and experience. Instructors must work to build rapport and trust and openly discuss with the class the strengths and weaknesses of technology regarding their supervision experience.


Strengths of online practicum and internship delivery include opportunities to develop cultural competency as students from different areas, regions, states, and even countries discuss client cases from their context. Instructors can utilize the chat options of the online format to ask questions while video clips are being shared or point out particulars without stopping the video. Potentially, client information does not have to be transferred as many places when students do not have to come to campus, versus students having client information go from their site, to their home, to their university setting, and back. Also, students are able to have more flexibility in choosing a site that is not region-bound. The availability of this format can be helpful to many sites and ultimately to clients who might not be located near a university with a counselor education program and who would benefit from having practicum and internship students working with them. It also provides opportunities for students that might not otherwise be able to complete a practicum or internship to enroll in a program and successfully complete it without needing to move and leave family or work obligations. With proper training of instructors, clear expectations for students, and legally and ethically appropriate technology, the practicum and internship course in an online format can be an effective modality for counseling students.


Discussion and Recommendations for Future Research


This article has overviewed the current literature regarding master’s-level online clinical training, provided a reference for challenges and opportunities regarding online pedagogy in counselor education courses, and described examples of online clinical course structures. When facilitating online clinical training, instructors must understand the unique nature of counseling and be intentional about maintaining student relationships within the realm of technology. This is especially critical for ensuring that the program strategically integrates the technology to advance the delivery of the program rather than the program heavily relying on the use of technology. In this article, we have identified humanistic approaches and specific strategies to ensure that meaningful teacher–student relationships and rigorous assessments remain the focus of instruction when technology is integrated. Facilitating personal and professional growth in distance counselor education presents many challenges to students and instructors. If instructors can intentionally and creatively use technology to promote distance students’ learning and training, a distance delivery format can reach students who would not have the opportunity to pursue counselor education.


Currently, the online delivery of counselor training skills is outpacing foundational research literature. For attitudes and pedagogy to change around the online academic environment, more research is needed. Future research could best focus on comparing the outcome of students’ counseling skills, including multicultural counseling competencies, between traditional and online courses. Skills needed for building rapport in the online environment may differ from F2F settings. Therefore, research regarding how the instructors’ and students’ use of language online impact the helping relationship and teacher–student relationship in virtual classrooms can be valuable. There also is a need to explore counselor educators’ understanding and experiences in conducting online clinical training, as well as students’ perspectives in receiving online clinical training and supervision. Future studies also might investigate different course structures and delivery methods for specific clinical skills courses so that the best methods for online clinical training could be applied by more counselor education programs.


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




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Szu-Yu Chen, PhD, NCC, LPC, RPT, is an assistant professor at Palo Alto University. Cristen Wathen, PhD, NCC, LCPC, is a core faculty member at Palo Alto University. Megan Speciale, PhD, NCC, LMHC, is an assistant professor at Palo Alto University. Correspondence can be addressed to Szu-Yu Chen, 1791 Arastradero Rd., Palo Alto, CA 94304, dchen@paloaltou.edu.