Clare Merlin-Knoblich, Jenna L. Taylor, Benjamin Newman
Social justice is a paramount concept in counseling and supervision, yet limited research exists examining this idea in practice. To fill this research gap, we conducted a qualitative case study exploring supervisee experiences in social justice supervision and identified three themes from the participants’ experiences: intersection of supervision experiences and external factors, feelings about social justice, and personal and professional growth. Two subthemes were also identified: increased understanding of privilege and increased understanding of clients. Given these findings, we present practical applications for supervisors to incorporate social justice into supervision.
Keywords: social justice, supervision, case study, personal growth, practical applications
Social justice is fundamental to the counseling profession, and, as such, scholars have called for an increase in social justice supervision (Ceballos et al., 2012; Chang et al., 2009; Collins et al., 2015; Dollarhide et al., 2018, 2021; Fickling et al., 2019; Glosoff & Durham, 2010). Although researchers have studied multicultural supervision in the counseling profession, to date, minimal research has been conducted on implementing social justice supervision in practice (Dollarhide et al., 2021; Fickling et al., 2019; Gentile et al., 2009; Glosoff & Durham, 2010). In this study, we sought to address this research gap with an exploration of master’s students’ experiences with social justice supervision.
Social Justice in Counseling Counseling leaders have developed standards that reflect the profession’s commitment to social justice principles (Chang et al., 2009; Dollarhide et al., 2021; Fickling et al., 2019; Glosoff & Durham, 2010). For instance, the American Counseling Association’s ACA Code of Ethics (2014) highlights the need for multicultural and diversity competence in six of its nine sections, including Section F, Supervision, Training, and Teaching. Additionally, in 2015, the ACA Governing Council endorsed the Multicultural and Social Justice Counseling Competencies (MSJCC), which provide a framework for counselors to use to implement multicultural and social justice competencies in practice (Fickling et al., 2019; Ratts et al., 2015). All of these standards reflect the importance of social justice in the counseling profession (Greene & Flasch, 2019).
Social Justice Supervision Although much of the counseling profession’s focus on social justice emphasizes counseling practice, social justice principles benefit supervisors, counselors, and clients when they are also incorporated into clinical supervision. In social justice supervision, supervisors address levels of change that can occur through one’s community using organized interventions, modeling social justice in action, and employing community collaboration (Chang et al., 2009; Dollarhide et al., 2021; Fickling et al., 2019). These strategies introduce an exploration of culture, power, and privilege to challenge oppressive and dehumanizing political, economic, and social systems (Dollarhide et al., 2021; Fickling et al., 2019; Garcia et al., 2009; Glosoff & Durham, 2010; Pester et al., 2020). Moreover, participating in social justice supervision can assist counselors in developing empathy for clients and conceptualizing them from a systemic perspective (Ceballos et al., 2012; Fickling et al., 2019; Kiselica & Robinson, 2001). When a supervisory alliance addresses cultural issues, oppression, and privilege, supervisees are better able to do the same with clients (Chang et al., 2009; Dollarhide et al., 2021; Fickling et al., 2019; Glosoff & Durham, 2010). Thus, counselors become advocates for clients and the profession (Chang et al., 2009; Dollarhide et al., 2021; Gentile et al., 2009; Glosoff & Durham, 2010).
Chang and colleagues (2009) defined social justice counseling as considering “the impact of oppression, privilege, and discrimination on the mental health of the individual with the goal of establishing equitable distribution of power and resources” (p. 22). In this way, social justice supervision considers the impact of oppression, privilege, and discrimination on the supervisee and supervisor. Dollarhide and colleagues (2021) further simplified the definition of social justice supervision, stating that it is “supervision in which social justice is practiced, modeled, coached, and used as a metric throughout supervision” (p. 104). Supervision that incorporates a focus on intersectionality can further support supervisees’ growth in developing social justice competencies (Greene & Flasch, 2019).
Literature about social justice supervision often includes an emphasis on two concepts: structural change and individual care (Gentile et al., 2009; Lewis et al., 2003; Toporek & Daniels, 2018). Structural change is the process of examining, understanding, and addressing systemic factors in clients’ and counselors’ lives, such as identity markers and systems within family, community, school, work, and elsewhere. Individual care acknowledges each person within the counseling setting independent of their environment (Gentile et al., 2009; Roffman, 2002). Scholars advise incorporating both concepts to address power, privilege, and systemic factors through social justice supervision (Chang et al., 2009; Gentile et al., 2009; Glosoff & Durham, 2010; Greene & Flasch, 2019; Pester et al., 2020).
It is necessary to distinguish social justice supervision from previous literature on multicultural supervision. Although similar, these concepts are different in that multicultural supervision emphasizes cultural awareness and competence, whereas social justice supervision brings attention to sociocultural and systemic factors and advocacy (Dollarhide et al., 2021; Fickling et al., 2019; E. Lee & Kealy, 2018; Peters, 2017; Ratts et al., 2015). For instance, a supervisor practicing multicultural supervision would be aware of a supervisee’s identity markers, such as race, ethnicity, and culture, and address those components throughout the supervisory experience, whereas a supervisor practicing social justice supervision would also consider systemic factors that impact a supervisee, in addition to being culturally competent. The supervisor would use that knowledge in the supervisory alliance and act as a change agent at individual and community levels (Chang et al., 2009; Dollarhide et al., 2021; Fickling et al., 2019; Gentile et al., 2009; Glosoff & Durham, 2010; E. Lee & Kealy, 2018; Lewis et al., 2003; Peters, 2017; Ratts et al., 2015; Toporek & Daniels, 2018).
Researchers have found that multicultural supervision contributes to more positive outcomes than supervision without consideration for multicultural factors (Chopra, 2013; Inman, 2006; Ladany et al., 2005). For example, supervisees who participated in multicultural supervision reported that supervisors were more likely to engage in multicultural dialogue, show genuine disclosure of personal culture, and demonstrate knowledge of multiculturalism than supervisors who did not consider multicultural concepts in supervision (Ancis & Ladany, 2001; Ancis & Marshall, 2010; Chopra, 2013). Supervisees also reported that multicultural considerations led them to feel more comfortable, increased their self-awareness, and spurred them on to discuss multiculturalism with clients (Ancis & Ladany, 2001; Ancis & Marshall, 2010). Although parallel research on social justice supervision is lacking, findings on multicultural supervision are a promising indicator of the potential of social justice supervision.
Models In recent years, scholars have called for social justice supervision models to integrate social justice into supervision (Baggerly, 2006; Ceballos et al., 2012; Chang et al., 2009; Collins et al., 2015; Glosoff & Durham, 2010; O’Connor, 2005). However, to date, only three formal models of social justice supervision have been published. Most recently, Dollarhide and colleagues (2021) recommended a social justice supervision model that can be used with any supervisory theory, developmental model, and process model. In this model, the MSJCC are integrated using four components. First, the intersectionality of identity constructs (i.e., gender, race/ethnicity, socioeconomic status, sexual orientation, abilities, etc.) is identified as integral in the supervisory triad between supervisor, counselor, and client. Second, systemic perspectives of oppression and agency for each person in the supervisory triad are at the forefront. Third, supervision is transformed to facilitate the supervisee’s culturally informed counseling practices. Lastly, the supervisee and client experience validation and empowerment through the mutuality of influence and growth (Dollarhide et al., 2021).
Prior to Dollarhide and colleagues’ (2021) model for social justice supervision, Gentile and colleagues (2009) proposed a feminist ecological framework for social justice supervision. This model encouraged the understanding of a person at the individual level through interactions within the ecological system (Ballou et al., 2002; Gentile et al., 2009). The supervisor’s role is to model socially just thinking and behavior, create a climate of equality, and implement critical thinking about social justice (Gentile et al., 2009; Roffman, 2002).
Lastly, Chang and colleagues (2009) suggested a social constructivist framework to incorporate social justice issues in supervision via three delineated tiers (Chang et al., 2009; Lewis et al., 2003; Toporek & Daniels, 2018). In the first tier, self-awareness, supervisors assist supervisees to recognize privileges, understand oppression, and gain commitment to social justice action (Chang et al., 2009; C. C. Lee, 2007). In the second tier, client services, the supervisor understands the clients’ worldviews and recognizes the role of sociopolitical factors that can impact the developmental, emotional, and cognitive meaning-making system of the client (Chang et al., 2009). In the third tier, community collaboration, the supervisor guides the supervisee to advocate for changes on the group, organizational, and institutional levels. Supervisors can facilitate and model community collaboration interventions, such as providing clients easier access to resources, participating in lobbying efforts, and developing programs in communities (Chang et al., 2009; Dinsmore et al., 2002; Kiselica & Robinson, 2001).
Each of these supervision models serves as a relevant, accessible tool for counseling supervisors to use to incorporate social justice into supervision (Chang et al., 2009, Dollarhide et al., 2021; Gentile et al., 2009). However, researchers lack an empirical examination of any of the models. To address this research gap and begin understanding social justice supervision in practice, the present qualitative case study exploring master’s students’ experiences with social justice supervision was undertaken.
We selected Chang and colleagues’ (2009) three-tier social constructivist framework in supervision for several reasons. First, the social constructivist framework incorporates a tiered approach similar to the MSJCC (Ratts et al., 2015) and reflects social justice goals in the profession of counseling (Ceballos et al., 2012; Chang et al., 2009; Collins et al., 2015; Glosoff & Durham, 2010). Second, the model is comprehensive. In using three tiers to address social justice (self, client, and community), the model captures multiple layers of social justice influence for counselors. Finally, the model is simple and meets the developmental needs of novice counselors. By identifying three tiers of social justice work, Chang and colleagues (2009) crafted an accessible tool to help new and practicing school counselors infuse social justice into their practice. This high level of structure matches the initial developmental levels of new counselors, who typically benefit from high amounts of structure and low amounts of challenge in supervision (Foster & McAdams, 1998).
Method
The research question guiding this study was: What are the experiences of master’s counseling students in individual social justice supervision? We used a social constructivist theoretical framework and presumed that knowledge would be gained about the participants’ experiences based on their social constructs (Hays & Singh, 2012). The ontological perspective reflected realism, or the belief that constructs exist in the world even if they cannot be fully measured (Yin, 2017).
We selected a qualitative case study methodology because it was the most appropriate approach to explore the experiences of a single group of supervisees supervised by the same supervisor in the same semester. In this approach, researchers examine one identified unit bounded by space, time, and persons (Hancock et al., 2021; Hays & Singh, 2012; Yin, 2017). Qualitative case study research allows researchers to deeply explore a single case, such as a group, person, or experience, and gain an in-depth understanding of that identified situation, as well as meaning for the people involved in it (Hancock et al., 2021; Prosek & Gibson, 2021).
In this study, we selected a case study methodology because the study’s participants engaged in the same supervisory experience at the same counseling program in the same semester, thus forming a case to be studied (Hancock et al., 2021). Given the research question, we specifically used a descriptive case study design, which reflected the study goals to describe participants’ experiences in a specific social justice supervision experience. Case study scholars (Hancock et al., 2021; Yin, 2017) have noted that identifying the boundaries of a case is an essential step in the study process. Thus, the boundaries for this study were: master’s-level school counseling students receiving social justice supervision from the same supervisor (persons) at a medium-sized public university on the East Coast (place) over the course of a 14-week semester (time).
Research Team Our research team for this study consisted of our first and third authors, Clare Merlin-Knoblich and Benjamin Newman, both of whom received training and had experience in qualitative research. Merlin-Knoblich and Newman both identify as White, heterosexual, cisgender, middle-class, and trained counselor educators/supervisors. Merlin-Knoblich is a woman (pronouns: she/her/hers) and former school counselor, who completed master’s and doctoral coursework on social justice counseling and studied social justice supervision in a doctoral program. Newman is a man (pronouns: he/him/his) and clinical mental health/addictions counselor, who completed social justice counseling coursework in a master’s counseling program before completing a doctorate in counselor education and supervision. Our second author, Jenna L. Taylor, was not a part of the research team, but rather was a counseling student unaffiliated with the research participants who assisted in the preparation of the manuscript. Taylor identifies as a White, heterosexual, cisgender, and middle-class woman (pronouns: she/her/hers) with prior experience in research courses and on qualitative research teams. Merlin-Knoblich was familiar with all three participants given her role as the practicum supervisor. Taylor and Newman did not know the study participants beyond Newman’s interactions while recruiting and interviewing them for this study.
Participants and Context Although some scholars of some qualitative research methodologies call for requisite minimum numbers of participants, in case study research, there is no minimum number of participants sufficient to study (Hays & Singh, 2012). Rather, in case study research, researchers are expected to study the number of participants needed to reflect the phenomenon being studied (Hancock et al., 2021). There were three participants in this study because the supervisory experience that comprised the case studied included three supervisees. Adding additional participants outside of the case would have conflicted with the boundaries of the case and potentially interfered with an understanding of the single, designated case in this study.
All study participants identified as White, heterosexual, cisgender, middle-class, and English-speaking women (pronouns: she/her/hers). Participants were 23, 24, and 26 years old. All the participants were students in the same CACREP-accredited school counseling program at a public liberal arts university on the East Coast of the United States. Prior to the study, the participants completed courses in techniques, group counseling, school counseling, ethics, and theories. While being supervised, participants also completed a practicum experience and coursework in multicultural counseling and career development.
All participants completed practicum at high schools near their university. One high school was urban, one was suburban, and one was rural. During the practicum experience, participants met with Merlin-Knoblich, their supervisor, for face-to-face individual supervision for 1 hour each week. They also submitted weekly journals to Merlin-Knoblich, written either freely or in response to a prompt, depending on their preference. Merlin-Knoblich then provided weekly written feedback to each participant’s journal entry, and, if relevant, the journal content was discussed during face-to-face supervision. Simultaneously, a university faculty member provided weekly face-to-face supervision-of-supervision to Merlin-Knoblich to monitor supervision skills and ensure adherence to the identified supervision model. The faculty member possessed more than 15 years of experience in supervision and was familiar with social justice supervision models.
Merlin-Knoblich applied Chang and colleagues’ (2009) social constructivist social justice supervision model in deliberate ways throughout the supervisees’ 14-week practicum experience. For example, in the initial supervision sessions, Merlin-Knoblich introduced the supervision model and explained how they would collaboratively explore ideas of social justice in counseling related to their practicum experiences. This included defining social justice, discussing supervisees’ previous background knowledge, and exploring their openness to the idea.
Throughout the first 5 weeks of supervision, Merlin-Knoblich used exploratory questions to build participants’ self-awareness (the first tier), particularly around their experiences with privilege and oppression. During the next 5 weeks of supervision, Merlin-Knoblich focused on the second tier, understanding clients’ worldviews. They discussed sociopolitical factors and examined how a client’s worldview impacts their experiences. For example, Merlin-Knoblich discussed how a client’s age, race/ethnicity, socioeconomic status, family structure, language, immigrant status, gender identity, sexual orientation, and other factors can influence their experiences. Lastly, in the final 4 weeks of supervision, Merlin-Knoblich focused on the third tier of social justice implications at the institutional level. For instance, Merlin-Knoblich initiated discussions about policies at participants’ practicum sites that hindered equity. Merlin-Knoblich also explored the role that participants could take in making resources available to clients, advocating in the community, and using leadership to support social justice. Table 1 summarizes how Merlin-Knoblich implemented Chang and colleagues’ (2009) social justice model.
Table 1
Social Justice Supervision in Practice
Merlin-Knoblich addressed fidelity to the supervision model in two ways. First, in weekly supervision-of-supervision meetings with the faculty advisor, they discussed the supervision model and its use in sessions with participants. The faculty advisor regularly asked about the supervision model and how it manifested in sessions in an attempt to ensure that the model was being implemented recurrently. Secondly, engagement with Newman occurred in regular peer debriefing discussions about the use of the supervision model. Through these discussions, Newman monitored Merlin-Knoblich’s use of the social justice model throughout the 14-week supervisory experience.
Data Collection We obtained IRB approval prior to initiating data collection. One month after the end of the semester and practicum supervision, Newman approached Merlin-Knoblich’s three supervisees about participation in the study. He explained that participation was an exploration of the supervisees’ experiences in supervision and not an evaluation of the supervisees or the supervisor. Newman also emphasized that participation in the study was confidential, entirely voluntary, and would not affect participants’ evaluations or grades in the practicum course, which ended before the study took place. All supervisees agreed to participate.
Case study research is “grounded in deep and varied sources of information” (Hancock et al., 2021) and thus often incorporates multiple data sources (Prosek & Gibson, 2021). In the present study, we identified two data sources to reflect the need for varied information sources (Hancock et al., 2021). The first data source came from semistructured interviews with participants, a frequent data collection tool in case study research (Hancock et al., 2021). One month after the participants’ practicum experiences ended, Newman conducted and audio-recorded 45-minute individual in-person interviews with each participant using a prescribed interview protocol that explored participants’ experiences in social justice supervision. Newman exercised flexibility and asked follow-up questions as needed (Merriam, 1998).
The interview protocol contained 12 questions identified to gain insights into the case being studied (Hancock et al., 2021). Merlin-Knoblich and Newman designed the interview protocol by drafting questions and reflecting on three influences: (a) the overall research question guiding the study, (b) the social constructivist framework of the study, and (c) Chang and colleagues’ (2009) three-tier supervision model. Questions included “In what ways, if any, has the social justice emphasis in your supervision last semester influenced you as a counselor?” Questions also addressed whether or not the emphasis on social justice at each tier (i.e., self, client, institution) affected participants. Appendix A contains a list of all interview questions.
The second data source was participants’ practicum journals. In addition to interviewing the participants about experiences in supervision, we also asked participants if their practicum journals could be used for the study’s data analysis. The journals served as a valuable form of data to answer the research question, given their informative and non-prescriptive nature. That is to say, although participants knew during the study interviews that the interview data would be used for analysis for the present study, they wrote and submitted their journals before the study was conceptualized. Thus, the journals reflected in-the-moment ideas about participants’ practicum and social justice supervision. Furthermore, this emphasis on participant experiences during the supervisory experience aligned with the methodological emphasis on studying a case in its natural context (Hancock et al., 2021). All participants consented for their 14 practicum journal entries (each 1–2 pages in length) to be analyzed in the study, and they were added to the interview data to be analyzed together. Such convergent analysis of data is typical in case study research (Prosek & Gibson, 2021).
Data Analysis We followed Yin’s (2017) case study research guidelines throughout the data analysis process. We transcribed all interviews, replaced participants’ names with pseudonyms, and sent participants the transcripts for member checking. Two participants approved their interview transcripts without objection. One participant approved the transcript but chose to share additional ideas about the supervisory experience via a brief email. This email was added to the data. The case study database was then formed with the compiled participants’ journal entries, the additional email, and the interview data (Yin, 2017).
Next, we read each interview transcript and journal entry twice in an attempt to become immersed in the data (Yin, 2017). We then independently open coded transcripts by identifying common words and phrases while maintaining a strong focus on the research question and codes that answered the question (Hancock et al., 2021). We compared initial codes and then collaboratively narrowed codes into cohesive categories representing participants’ experiences. This process generated a list of tentative categories across data sources (Yin, 2017). Throughout these initial processes, we attended to two of Yin’s (2017) four principles of high-quality data analysis: attend to all data and focus on the most significant elements of the case.
We then independently contrasted the tentative categories with the data to verify that they aligned accurately. We discussed the verifications until consensus was met on all categories. Lastly, we classified the categories into three themes and two subthemes found across all participants (Stake, 2005). During these later processes, we were mindful of Yin’s (2017) remaining two principles of high-quality data analysis: consider rival interpretations of data and use previous expertise when interpreting the case. Accordingly, we reflected on possible contrary explanations of the themes and considered the findings in light of previous literature on the topic.
Trustworthiness We addressed trustworthiness in three ways in this study. First, before data collection, we engaged in reflexivity through acknowledging personal biases and assumptions with one another (Hays & Singh, 2012; Yin, 2017). For example, Merlin-Knoblich acknowledged that her lived experience supervising the participants might impact the interpretation of data during analysis and noted that these perceptions could potentially serve as biases during the study. Merlin-Knoblich perceived that the supervisees grew in their understanding of social justice, but also acknowledged doubt over whether the social justice supervision model impacted participants’ advocacy skills. She also noted her role as a supervisor evaluating the three participants prior to the study taking place. These power dynamics may have influenced her interpretations in the analysis process. Newman shared that his lack of familiarity with social justice supervision might impact perceptions and biases to question whether or not supervisees grew in their understanding of social justice. We agreed to challenge one another’s potential biases during data analysis in an attempt to prevent one another’s experiences from interfering with interpretations of the findings.
In addition, we acknowledged that our identities as White, English-speaking, educated, heterosexual, cisgender, middle-class researchers studying social justice inevitably was informing personal perceptions of the supervisees’ experiences. These privileged identities were likely blinding us to experiences with oppression that participants and their clients encountered and that we are not burdened with facing. Throughout the study, we discussed the complexity of studying social justice in light of such privileged identities. We spoke further about our identities and potential biases when interpreting the data.
Second, investigator triangulation was addressed by collaboratively analyzing the study’s data (Hays & Singh, 2012). Because data included both interview transcripts and journals, we confirmed that study findings were reflected in both data sources, rather than just one information source (Hancock et al., 2021). This process helped prevent real or potential biases from informing the analysis without constraint. We also were mindful of saturation of themes while comparing data across participants and sources during the analysis process. Lastly, an audit trail was created to further address credibility. The study recruitment, data collection, and data analysis were documented so that the research can be replicated (Hays & Singh, 2012; Roulston, 2010).
Findings
In case study research, researchers use key quotes and descriptions from participants to illuminate the case studied (Hancock et al., 2021). As such, we next describe the themes and subthemes identified in study data using participants’ journal and interview quotes to illustrate the findings. Three overarching themes were identified in the data: 1) intersection of supervision experiences and external factors, 2) feelings about social justice, and 3) personal and professional growth. Two subthemes, 3a) increased understanding of privilege and 3b) increased understanding of clients, further expand the third theme.
Intersection of Supervision Experiences and External Factors One theme evident across the data was that participants’ experiences in social justice supervision did not occur in isolation from other experiences they encountered as counseling students. Coursework, overall program emphasis, and previous work experiences were external factors that created a compound influence on participants’ counselor development and intersected with their experiences of growth in supervision. Thus, external factors influenced participants’ understanding of and openness to a social justice framework. For example, concurrent with their practicum and supervision experiences, participants completed the course Theory and Practice of Multicultural Counseling. While discussing their experiences in supervision, all participants referenced this course. For example, Casey explained that exposure to social justice in the multicultural counseling course while discussing the topic in supervision made her more open and eager to learning about social justice overall.
Participants’ experiences prior to the counseling program also appeared to intersect with and influence their experiences in social justice supervision. Kallie, for instance, previously worked with African American and Latin American adolescents as a camp counselor at an urban Boys and Girls Club. She explained that social justice captured the essence of viewpoints formed in these experiences, saying, “I really like social justice because it kind of is like the title for the way I was looking at things already.” Casey grew up in California and reported that growing up on the West Coast also exposed her to a mindset parallel to social justice. Esther described that though she was not previously exposed to the term “social justice,” studying U.S., women’s, and African American history in college influenced her pursuit of a counseling career. This influence is evident in Esther’s third journal entry, in which she described noticing issues of power and oppression:
My own attention to an “arbitrarily awarded power” and personal questioning as to what to do with this consciousness has been at the forefront of my mind over the past two years. Ultimately this self-exploration led me to school counseling as a vehicle to advocate and raise consciousness in potentially disenfranchised groups.
This quote highlights how Esther’s previous studies in college may have primed her for the content she was exposed to in social justice supervision.
Feelings About Social Justice The second theme was a change in participants’ feelings toward social justice over the course of the semester. Two of the participants expressed that their feelings toward social justice changed from intimidation and fear to comfort and enthusiasm. Initially, Casey explained that social justice supervision created feelings of intimidation. Casey felt fear that the supervisor would instruct her to be an advocate at the practicum site, and that in doing so, Casey would upset others. However, Casey reported that she realized during supervision that social justice advocacy does not necessarily look one specific way. Casey said, “I think a lot of that intimidation went away as I realized that I could have my own style integrated into social justice.” Kallie expressed a similar pattern of emotions, particularly regarding examining clients from a social justice perspective. When asked to explore clients through this lens in supervision, an initial uncomfortable feeling emerged, but over the course of practicum, Kallie reported an attitude change. In the sixth journal entry, Kallie explained that she was focusing on examining all clients through a social justice lens, and “found it to be significantly easier this week than last week.”
Esther also shared evidence of changed emotions during social justice supervision. Initially, Esther reported feeling excited, but later, she was confused as to how counselors could use social justice practically. Despite this confusion, Esther shared that she gained new awareness that social justice advocacy is not only found in individual situations with clients, but also in an overall mindset:
Something I will take from it [supervision] . . . is you incorporate that sort of thinking into your overall [approach]. You don’t necessarily wait for a specific event to happen, but once you know the culture of a place, you have lessons geared towards whatever the problem is there.
Despite these mixed feelings, Esther’s experience aligns with Casey’s and Kallie’s, as all reported experiencing a change in emotions toward social justice over the course of supervision.
Personal and Professional Growth Participants also demonstrated changes in professional and personal growth throughout the supervision experiences, the third theme identified. In early journal entries, they reported nervousness, doubt, and insecurity regarding their counseling skills and knowledge. Over time, the tone shifted to increased comfort and confidence. This improvement appeared not only related to overall counseling abilities, but specifically to participants’ understanding of social justice in counseling. For example, in Esther’s second journal entry, she noted the influence that social justice supervision had on the ability to recognize oppression and bring awareness to it at practicum. Esther wrote, “Just having this concept be explicitly laid out in our plan has already caused me to be more attentive to such issues.”
Similarly, professional growth was evident in Kallie’s journal entries over time. In the fourth journal entry, Kallie described discomfort and nervousness when reflecting on clients’ sociopolitical contexts. However, in the ninth journal entry, Kallie described an experience in which she adapted her counseling to be more sensitive to the client’s multicultural background. Casey also highlighted growth with an anecdote about a small group she led. Casey explained that the group was for high-achieving, low-income juniors intending to go to college:
In the very beginning, I remember thinking—this sounds terrible now, but—“It’s kind of unfair to the other students that these kids get special privileges in that they get to meet with us and walk through the college planning process.” ’Cause I was thinking, “Wow, even kids who are high-achieving but are middle-class or upper-class, they could use this information, also. And it’s not really fair that just ’cause they’re lower class, they get their hand held during this.” But, throughout the semester, realizing that that’s not necessarily a bad thing for an institution to give another one a little extra help because they’re gonna have a deficit of help somewhere else in their life, and it really is fair. It’s more fair to give them more help ’cause they likely aren’t going to be getting it at home. . . . So, by having that group, it actually is making a greater degree of equity . . . through supervision and through processing all of that, [I learned] it was actually evening the board out more.
Participants also expressed that their professional growth in social justice competencies was intertwined with personal growth. Casey reported that supervision increased her comfort when talking about social justice issues and led to the reevaluation of personal opinions. Similarly, Kallie summarized:
I am very thankful that I had that social justice–infused model because it changed the way I think about people. . . . It kinda opened my eyes in a way I had not anticipated practicum opening my eyes. I didn’t expect that—social justice. I didn’t realize how big of an impact it would actually have.
Increased Understanding of Privilege Participants reported that understanding their privilege was one area of growth. During practicum, participants considered their areas of privilege and how these aligned or contrasted with those of clients. For example, in Esther’s third journal entry, she noted that interactions with clients made her more aware of personal privileges, which led her to create a list regarding gender identity, socioeconomic background, and sexual orientation. Casey and Kallie further described initially feeling resistant to the idea of White privilege. Casey explained:
I was a little resistant to the idea of White privilege originally, which I’ve since learned is a normal reaction. ’Cause I’ve kind of had the thought of “No! It’s America! All of us pull ourselves up by our bootstraps and everyone has the same opportunity,” which just isn’t the case. And so that definitely had a huge influence on me—realizing that I have huge privileges and powers that I did not, maybe didn’t want to, recognize before.
After initial resistance, participants reported that they transitioned from feeling shame about White privilege to an increased understanding and excitement to use privilege to create change.
Increased Understanding of Clients Lastly, participants also reported specific growth in their understanding of the clients whom they counseled. Participants believed they were better able to understand clients’ backgrounds and experiences because of social justice supervision. Kallie described how reflecting on clients’ sociopolitical contexts helped her better understand clients. She noted that the practice became a habit, saying, “It just kinda invaded the way I look at different people and see their backgrounds.” Casey also described an increased understanding of clients by sharing an example of a client who was highly intelligent, low-income, and Mexican American. Casey learned that the client intended to go to trade school to become a mechanic and was not previously exposed to other postsecondary education options like college. Casey described this realization as “a big moment” and said, “My interaction with him, for sure, was influenced by recognizing that there was social injustice there.”
Discussion
The purpose of this study was to explore counseling students’ experiences in social justice supervision. Findings indicated that participants had meaningful experiences in social justice supervision that impacted them as future counselors. Topics of privilege, oppression, clients’ sociopolitical contexts, and advocacy were reportedly prominent in the participants’ supervision and influenced their experiences.
Despite many calls for social justice supervision in the counseling profession (Baggerly, 2006; Ceballos et al., 2012; Chang et al., 2009; Collins et al., 2015; Glosoff & Durham, 2010; O’Connor, 2005), this is the first known study about supervisees’ experiences with social justice supervision. It represents a new line of inquiry to understand what social justice supervision may be like for supervisees. Findings indicate that participants wrestled with understanding social justice and viewed it as a complex topic. They also suggest that participants found value in making sense of social justice and using it as a tool to better support clients individually and systemically. Similar to research on multicultural supervision, participants indicated that receiving social justice supervision was a positive experience and impacted personal and professional growth (Ancis & Ladany, 2001; Ancis & Marshall, 2010; Chopra, 2013; Inman, 2006; Ladany et al., 2005).
Notably, findings align with some, though not all, of Chang and colleagues’ (2009) delineated tiers in the social justice supervision model. Some of the themes reflect the first tier, self-awareness. For example, participants’ feelings about social justice (Theme 2) and increased understanding of privilege (Theme 3a) highlight how the supervisory experience enhanced their self-awareness as counselors. As their feelings changed and knowledge of privilege grew, their self-awareness improved, a critical task in becoming a social justice–minded counselor (Chang et al., 2009; Dollarhide et al., 2021; Fickling et al., 2019; Glosoff & Durham, 2010). Participants’ increased understanding of clients (Theme 3b) reflects the second tier in Chang and colleagues’ (2009) model, client services. In demonstrating an enhanced understanding of clients and their world experiences, the participants reported thinking beyond themselves and into how power, privilege, and oppression affected those they counseled.
The final tier of the social justice supervision model, community collaboration, was not evident in participant data about their experiences. Despite the supervisor’s intent to address this tier through analyses of school and district policies, as well as community advocacy opportunities, themes about this topic did not manifest in the data. This theme’s absence may suggest that the supervisor’s efforts to address the third tier were not strong enough to impact participants. Alternatively, the absence may suggest that participants were not developmentally prepared to make sense of social justice at a systemic, community level. Instead, their development matched best with social justice ideas at the self and client levels.
Participant findings did align with previous research about supervision. For example, Collins and colleagues (2015) studied master’s-level counseling students and found that their lack of experience in social justice supervision led them to feel unprepared to meet the needs of diverse clients. In this study, the presence of social justice supervision helped participants feel more prepared to support clients, as evidenced in the subtheme of increased understanding of clients. Furthermore, this study reflects similar findings from multicultural supervision research. We found that multicultural supervision was associated with positive outcomes of being prepared to work with diverse clients and engaging in effective supervision (Chopra, 2013; Inman, 2006; Ladany et al., 2005). This pattern is reflected in the current study, as participants reported positive experiences in social justice supervision. Ancis and Ladany (2001) and Ancis and Marshall (2010) found that incorporating multicultural considerations into supervision increases supervisees’ self-awareness and encourages them to engage clients in multicultural discussions. These same results were evident in the present study, with participants reporting personal and professional growth, such as stronger awareness of White privilege and greater willingness to examine clients’ sociopolitical contexts. Findings also reflect general research on supervision, which indicates that supervisees typically experience personal and professional growth in the process (Association for Counselor Education and Supervision, 2011; Watkins et al., 2015; Young et al., 2011).
Furthermore, study findings also align with assertions from supervision scholars regarding the value of social justice supervision. They support Chang and colleagues’ (2009) claim that social justice supervision can increase counselor self-awareness and build an understanding of oppression. Additionally, the findings also reflect Glosoff and Durham’s (2010) assertion that social justice in supervision helps supervisees gain awareness of power differentials. Finally, Ceballos and colleagues (2012) posited that social justice supervision will help counselors develop empathy for clients as counselors conceptualize clients in a systemic perspective. The participants’ enhanced understanding of White privilege and their clients’ contexts supports each of these ideas. Though findings are not generalizable, they appear to confirm scholars’ ideas about social justice supervision and suggest that the approach can be a positive, beneficial experience for counselors-in-training.
Limitations Study findings ought to be considered in light of the study’s limitations. First, although case study research focuses on a single identified case by definition and is not designed for generalization (Hays & Singh, 2012), the case in this study consisted of a demographically homogenous population of only three participants lacking racial, gender, and age diversity. This lack of diversity influenced participants’ experiences and study findings. Second, although the supervisor in this study did not conduct the semistructured interviews with participants in an attempt to prevent bias, participants were aware that Merlin-Knoblich was collaborating on the study, and this knowledge may have influenced their reported experiences. Merlin-Knoblich and Newman also began the study with acknowledged biases toward and against social justice supervision, and although they engaged in reflexivity and dialogue to prevent these biases from interfering with data analysis, there is no way to verify that this positionality did not influence the interpretation of findings. Lastly, our privileged identities served as a potential limitation while studying a topic like social justice supervision. Our racial, educational, class, language, and sexual identity privileges continually blind us to the experiences of oppression that others, including supervisees and clients, face. Seeking to know these perspectives better can increase our understanding of the implications of social injustices in society.
Implications for Counselor Educators and Supervisors The positive participant experiences illuminated through this study suggest that supervision based on this model may yield positive experiences for counselors-in-training, such as supporting students in developing self-awareness, understanding of clients’ sociopolitical contexts, and advocacy skills (Chang et al., 2009). Although the supervisor in this study used social justice supervision in individual sessions with participants, counselor educators may choose to apply social justice supervision models to group or triadic supervision. Counseling supervisors in agency, private practice, and school settings may also want to consider using social justice supervision to support counselors and subsequently clients (Baggerly, 2006; Ceballos et al., 2012; O’Connor, 2005). Furthermore, counselor educators teaching doctoral students may want to incorporate social justice supervision models into introductory supervision courses. Including these models into course content may in itself increase student interest in social justice (Swartz et al., 2018).
Regardless of the setting in which supervisors implement social justice supervision, the findings suggest practical implications that supervisors can consider. First, supervisors appear to benefit from considering social justice supervision models in their work (Chang et al., 2009; Dollarhide et al., 2021; Gentile et al., 2009). The findings in this study, plus previous research indicating positive outcomes for multicultural supervision (Chopra, 2013; Inman, 2006; Ladany et al., 2005), suggest that social justice supervision may potentially benefit counseling. Second, supervisors using social justice supervision may encounter supervisee confusion, discomfort, and/or enthusiasm when introduced to social justice supervision. These feelings also may change over the course of the supervisory relationship when learning about social justice. Third, supervisors ought to be mindful of all three tiers of Chang and colleagues’ (2009) social justice supervision model and a supervisee’s developmental match with each tier. As seen in this study, supervisees may be best matched for the first and second tiers of the model (self-awareness and client services), but not the third tier (community collaboration). Supervisors would benefit from assessing a supervisee’s potential for understanding community collaboration before deciding to infuse its focus in supervision.
More research is needed to understand social justice supervision. A variety of future studies, including different models, methods, and settings, would benefit the counseling profession. For example, a study implementing the social justice supervision model proposed by Dollarhide and colleagues (2021) can add to the needed research in this field. Additional qualitative studies with diverse supervisees in different counseling settings would be helpful in understanding if the experiences participants reported encountering in this study are common in social justice supervision. Quantitative studies on social justice supervision interventions would also add to the profession’s knowledge on the value of social justice supervision. Lastly, studies on supervisees’ experiences in social justice supervision compared to other models would highlight benefits and drawbacks of multiple supervision models (Baggerly, 2006; Chang et al., 2009; Glosoff & Durham, 2010).
Conclusion
In this article, we explored master’s-level counseling students’ experiences in social justice supervision via a qualitative case study. Through this exploration, we identified three themes reflecting participants’ experiences in social justice supervision: intersection of supervision experiences and external factors, feelings about social justice, and personal and professional growth, as well as two subthemes: increased understanding of privilege and increased understanding of clients. Findings suggest that social justice supervision may be a beneficial practice for supervisors and counselor educators to consider integrating in their work (Chang et al., 2009; Dollarhide et al., 2021; Gentile et al., 2009; Pester et al., 2020). Further research across contexts and with a range of methodologies is needed to better understand social justice supervision in practice.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
References
American Counseling Association. (2014). ACAcode of ethics. https://www.counseling.org/resources/aca-code-of-ethics.pdf
Ancis, J. R., & Ladany, N. (2001). A multicultural framework for counselor supervision. In L. J. Bradley & N. Ladany (Eds.), Counselor supervision: Principles, process, and practice (3rd ed., pp. 63–90). Brunner-Routledge.
Ancis, J. R., & Marshall, D. S. (2010). Using a multicultural framework to assess supervisees’ perceptions of culturally competent supervision. Journal of Counseling & Development, 88(3), 277–284.
https://doi.org/10.1002/j.1556-6678.2010.tb00023.x
Association for Counselor Education and Supervision. (2011). Best practices in clinical supervision. https://acesonline.net/wp-content/uploads/2018/11/ACES-Best-Practices-in-Clinical-Supervision-2011.pdf
Baggerly, J. (2006). Service learning with children affected by poverty: Facilitating multicultural competence in counseling education students. Journal of Multicultural Counseling and Development, 34(4), 244–255. https://doi.org/10.1002/j.2161-1912.2006.tb00043.x
Ballou, M., Matsumoto, A., & Wagner, M. (2002). Toward a feminist ecological theory of human nature: Theory building in response to real-world dynamics. In M. Ballou & L. S. Brown (Eds.), Rethinking mental health and disorder: Feminist perspectives (pp. 99–141). Guilford.
Ceballos, P. L., Parikh, S., & Post, P. B. (2012). Examining social justice attitudes among play therapists: Implications for multicultural supervision and training. International Journal of Play Therapy, 21(4), 232–243. https://doi.org/10.1037/a0028540
Chang, C. Y., Hays, D. G., & Milliken, T. F. (2009). Addressing social justice issues in supervision: A call for client and professional advocacy. The Clinical Supervisor, 28(1), 20–35. https://doi.org/10.1080/07325220902855144
Chopra, T. (2013). All supervision is multicultural: A review of literature on the need for multicultural supervision in counseling. Psychological Studies, 58, 335–338. https://doi.org/10.1007/s12646-013-0206-x
Collins, S., Arthur, N., Brown, C., & Kennedy, B. (2015). Student perspectives: Graduate education facilitation of multicultural counseling and social justice competency. Training and Education in Professional Psychology, 9(2), 153–160. https://doi.org/10.1037/tep0000070
Dinsmore, J. A., Chapman, A., & McCollum, V. J. C. (2002). Client advocacy and social justice: Strategies for developing trainee competence. Paper presented at the Annual Conference of the American Counseling Association, Washington, DC.
Dollarhide, C. T., Hale, S. C., & Stone-Sabali, S. (2021). A new model for social justice supervision. Journal of Counseling & Development, 99(1), 104–113. https://doi.org/10.1002/jcad.12358
Dollarhide, C. T., Mayes, R. D., Dogan, S., Aras, Y., Edwards, K., Oehrtman, J. P., & Clevenger, A. (2018). Social justice and resilience for African American male counselor educators: A phenomenological study. Counselor Education and Supervision, 57(1), 2–17. https://doi.org/10.1002/ceas.12090
Fickling, M. J., Tangen, J. L., Graden, M. W., & Grays, D. (2019). Multicultural and social justice competence in clinical supervision. Counselor Education and Supervision, 58(4), 309–316. https://doi.org/10.1002.ceas.12159
Foster, V. A., & McAdams, C. R., III. (1998). Supervising the child care counselor: A cognitive developmental model. Child and Youth Care Forum, 27(1), 5–19. https://doi.org/10.1007/BF02589525
Garcia, M., Kosutic, I., McDowell, T., & Anderson, S. A. (2009). Raising critical consciousness in family therapy supervision. Journal of Feminist Family Therapy, 21(1), 18–38. https://doi.org/10.1080/08952830802683673
Gentile, L., Ballou, M., Roffman, E., & Ritchie, J. (2009). Supervision for social change: A feminist ecological perspective. Women & Therapy, 33(1–2), 140–151. https://doi.org/10.1080/02703140903404929
Glosoff, H. L., & Durham, J. C. (2010). Using supervision to prepare social justice counseling advocates. Counselor Education and Supervision, 50(2), 116–129. https://doi.org/10.1002/j.1556-6978.2010.tb00113.x
Greene, J. H., & Flasch, P. S. (2019). Integrating intersectionality into clinical supervision: A developmental model addressing broader definitions of multicultural competence. The Journal of Counselor Preparation and Supervision, 12(4). https://digitalcommons.sacredheart.edu/jcps/vol12/iss4/14
Hancock, D. R., Algozzine, B., & Lim, J. H. (2021). Doing case study research: A practical guide for beginning researchers (4th ed.). Teachers College Press.
Hays, D. G., & Singh, A. A. (2012). Qualitative inquiry in clinical and educational settings. Guilford.
Inman, A. G. (2006). Supervisor multicultural competence and its relation to supervisory process and outcome. Journal of Marital and Family Therapy, 32(1), 73–85. https://doi.org/10.1111/j.1752-0606.2006.tb01589.x
Kiselica, M. S., & Robinson, M. (2001). Bringing advocacy counseling to life: The history, issues, and human dramas of social justice work in counseling. Journal of Counseling & Development, 79(4), 387–397.
https://doi.org/10.1002/j.1556-6676.2001.tb01985.x
Ladany, N., Friedlander, M. L., & Nelson, M. L. (2005). Critical events in psychotherapy supervision: An interpersonal approach. American Psychological Association.
Lee, C. C. (2007). Counseling for social justice (2nd ed.). American Counseling Association.
Lee, E., & Kealy, D. (2018). Developing a working model of cross-cultural supervision: A competence- and alliance-based framework. Clinical Social Work Journal, 46, 310–320. https://doi.org/10.1007/s10615-018-0683-4
Lewis, J. A., Arnold, M. S., House, R., & Toporek, R. L. (2003). Advocacy competencies. www.counseling.org/resources/competencies/advocacy_competencies.pdf
Merriam, S. B. (1998). Qualitative research and case study applications in education. Jossey-Bass.
O’Connor, K. (2005). Assessing diversity issues in play therapy. Professional Psychology: Research and Practice, 36(5), 566–573. https://doi.org/10.1037/0735-7028.36.5.566
Pester, D. A., Lenz, A. S., & Watson, J. C. (2020). The development and evaluation of the Intersectional Privilege Screening Inventory for use with counselors-in-training. Counselor Education and Supervision, 59(2), 112–128. https://doi.org/10.1002/ceas.12170
Peters, H. C. (2017). Multicultural complexity: An intersectional lens for clinical supervision. International Journal for the Advancement of Counselling, 39, 176–187. https://doi.org/10.1007/s10447-017-9290-2
Prosek, E. A., & Gibson, D. M. (2021). Promoting rigorous research by examining lived experiences: A review of four qualitative traditions. Journal of Counseling & Development, 99(2), 167–177. https://doi.org/10.1002/jcad.12364
Ratts, M. J., Singh, A. A., Nassar-McMillan, S., Butler, S. K., & McCullough, J. R. (2015). Multicultural and social justice counseling competencies. www.counseling.org/docs/default-source/competencies/multicultural-and-social-justice-counseling-competencies.pdf
Roffman, E. (2002). Just supervision. Multicultural Perspectives on Social Justice and Clinical Supervision Conference, Cambridge, MA, United States.
Roulston, K. (2010). Reflective interviewing: A guide to theory and practice. SAGE.
Stake, R. E. (2005). Qualitative case studies. In N. K. Denzin & Y. S. Lincoln (Eds.), The SAGE handbook of qualitative research (3rd ed., pp. 433–466). SAGE.
Swartz, M. R., Limberg, D., & Gold, J. (2018). How exemplar counselor advocates develop social justice interest: A qualitative investigation. Counselor Education and Supervision, 57(1), 18–33. https://doi.org/10.1002/ceas.12091
Toporek, R. L., & Daniels, J. (2018). ACA advocacy competencies. https://www.counseling.org/docs/default-source
/competencies/aca-advocacy-competencies-updated-may-2020.pdf?sfvrsn=f410212c_4
Watkins, C. E., Jr., Budge, S. L., & Callahan, J. L. (2015). Common and specific factors converging in psychotherapy supervision: A supervisory extrapolation of the Wampold/Budge Psychotherapy Relationship Model. Journal of Psychotherapy Integration, 25(3), 214–235. http://doi.org/10.1037/a0039561
Yin, R. K. (2017). Case study research and applications: Designs and methods (6th ed.). SAGE.
Young, T. L., Lambie, G. W., Hutchinson, T., & Thurston-Dyer, J. (2011). The integration of reflectivity in developmental supervision: Implications for clinical supervisors. The Clinical Supervisor, 30(1), 1–18. https://doi.org/10.1080/07325223.2011.532019
Appendix A
Semistructured Interview Questions
What brought you to this counseling program?
Overall, how would you describe your practicum experience last semester?
Where did you complete your practicum?
How would you describe the population you worked with at your practicum?
What previous experience, if any, did you have with social justice prior to individual practicum supervision?
During individual practicum supervision on campus last semester, what were some of your initial thoughts and feelings about a social justice–infused supervision model?
In what ways, if any, did those thoughts and feelings about social justice change throughout your
supervision experience?
These next three questions address three areas of social justice that were incorporated into your individual practicum supervision model: self, students (clients), and institution (school or school districts).
6. Do you think that the emphasis on social justice related to self (i.e., your power, privileges, and experience with oppression) in individual practicum supervision on campus had any influence on you?
If yes, what influence did this emphasis have on you?
If no, why do you think that’s the case?
7. Do you think that the emphasis on social justice related to others (i.e., the sociopolitical context of students, staff, etc.) in individual practicum supervision on campus had any influence on you?
If yes, what influence did this emphasis have on you?
If no, why do you think that’s the case?
8. Do you think that the emphasis on social justice related to institution (i.e., your practicum site, school district) in individual practicum supervision on campus had any influence on you?
If yes, what influence did this emphasis have on you?
If no, why do you think that’s the case?
In what ways, if any, has the social justice emphasis in your individual practicum supervision influenced you as a counselor?
In what ways, if any, has the social justice emphasis in your individual practicum supervision influenced your development as a person?
How would you define social justice?
Is there anything else you would like to add regarding your experience in a social justice–infused model of supervision last semester?
Is there anything else you’d like to share?
Clare Merlin-Knoblich, PhD, NCC, is an associate professor at the University of North Carolina at Charlotte. Jenna L. Taylor, MA, NCC, LPC-A, is a doctoral student at the University of North Texas. Benjamin Newman, PhD, MAC, ACS, LPC, CSAC, CSOTP, is a professional counselor at Artisan Counseling in Newport News, VA. Correspondence may be addressed to Clare Merlin-Knoblich, 9201 University City Blvd., Charlotte, NC 28211, cmerlin1@uncc.edu.
Jennifer Scaturo Watkinson, Gayle Cicero, Elizabeth Burton
It is widely documented that practicum students experience anxiety as a natural part of their counselor development. Within constructivist supervision, mindfulness exercises are used to help counselors-in-training (CITs) work with their anxiety by having them focus on their internal experiences. To inform and strengthen our practice, we engaged in a practitioner inquiry study to understand how practicum students experienced mindfulness as a central part of supervision. We analyzed 25 sandtray reflections and compared them to transcripts from two focus groups to uncover three major themes related to the student experience: (a) openness to the process, (b) reflection and self-care, and (c) attention to the doing. One key lesson learned was the importance of balancing mindfulness exercises to highlight the internal experiences related to anxiety while providing adequate opportunities for CITs to share stories and hear from peers during group supervision.
It is widely documented that counselors-in-training (CITs) experience anxiety as part of the developmental process (Auxier et al., 2003; Kuo et al., 2016; Moss et al., 2014). Reasons for anxiety include CITs’ doubts about their ability to perform competently within their professional role (Moss et al., 2014) coupled with perfectionism (Kuo et al., 2016). Additionally, Auxier et al. (2003) noted that CITs’ anxiety also stems from the pressure associated with external evaluation provided by supervisors. Wagner and Hill (2015) added that CITs’ need for external validation from their supervisors, coupled with the belief that there is only one right way to counsel clients, also generates anxiety. This need for external validation creates an overreliance on a supervisor’s judgment that could render a CIT helpless (Wagner & Hill, 2015). Although a moderate amount of anxiety may increase a person’s focus and positively impact productivity, too much anxiety impedes learning and growth (Kuo et al., 2016). Hence, there is a need for supervisors to address anxiety early in a CIT’s development to foster self-reliance and professional growth (Ellis et al., 2015; Mehr et al., 2015).
The two lead authors of this article, Jennifer Scaturo Watkinson and Gayle Cicero, are counselor educators who supervised school counseling practicum students and ascribed to a constructivist approach to supervision. While discussing supervision pedagogy, we shared our observations on how anxious our practicum students were to be evaluated and our belief that their anxiety often limited their professional growth and development as counselors. Within constructivist supervision, mindfulness exercises are used to help CITs work with their anxiety by having them focus on their internal experiences of discomfort (Guiffrida, 2015). Thus, we utilized mindfulness as a central approach to helping our students work with their anxiety associated with the counselor developmental process.
To assist in our planning, we reviewed the supervision literature and found that discussions on mindfulness were largely conceptual (Guiffrida, 2015; Johnson et al., 2020; Schauss et al., 2017; Sturm et al., 2012) or outcome-based (Bohecker et al., 2016; Campbell & Christopher, 2012; Carson & Langer, 2006; Daniel et al., 2015; Dong et al., 2017), with limited focus on supervision pedagogy to guide supervisors on how to integrate mindfulness into their practicum seminars, particularly from the perspective of the practitioner. Further, Barrio Minton et al. (2014) and Brackette (2014) confirmed that there was a scarcity of counselor education literature that focused on teaching pedagogy and argued that more research in this area was needed to improve counselor preparation. To add to the current literature on supervision pedagogy and inform our practice, we engaged in a practitioner inquiry study (Cochran-Smith & Lytle, 2009) and formed a professional learning community to investigate how utilizing mindfulness within our supervision could help school counseling practicum students work with their anxiety.
Literature Review
Constructive Supervision Supervisors who utilize constructivist principles help CITs make meaning of their experience by examining how their approach benefits their clients (Guiffrida, 2015). Constructivism is built upon the belief that knowledge is not derived from absolute realities but rather localized to specific contexts and personal experiences. McAuliffe (2011) argued that knowledge is “continually being created through conversations” and is not given to the learner through a one-sided expert account. Constructivists believe that learning is “reflexive and includes a tolerance for ambiguity” (McAuliffe, 2011, p. 4). Constructivist supervisors prioritize CITs’ experiences, encouraging them to examine the intent behind their approach and reach their own conclusions. Hence, constructive supervisors help supervisees deconstruct experiences that have multiple “right” approaches to client care while normalizing the anxiety associated with professional growth. Within a constructivist supervision framework, moderate amounts of anxiety are not viewed as problematic but rather are seen as a catalyst for change (Guiffrida, 2015) and part of the learning process (McAuliffe, 2011). Guiffrida (2015) asserted that the aim of supervision in the early stages of counselor development is not to remove feelings of anxiety but rather to help the CIT acknowledge and live with the anxiety. Utilizing mindfulness, supervisors acknowledge CITs’ internal experiences and guide them through intentional mindfulness practices to generate personal and professional reflection and meaning making.
Within constructivist supervision, mindfulness is a central approach to helping CITs work with their anxiety (Guiffrida, 2015). Kabat-Zinn (2016) defined mindfulness as “paying attention in a sustained and particular way: on purpose, in the present moment and nonjudgmentally” (p. 1). Constructive supervisors facilitate learning experiences that promote introspection and intentionally direct CITs to examine their internal experience, without judgment, during times of disequilibrium. Rather than helping a CIT rid themselves of anxiety, the constructivist supervisor acknowledges that anxiety is a normal response to the uncertainty of doing something for the first time (Guiffrida, 2015). Mindfulness provides a platform for a supervisor to normalize anxiety within the supervisory relationship (Sturm et al., 2012). Hence, supervisors can utilize mindfulness to prioritize the CITs’ internal experiences (e.g., doubt, uncertainty, fear) and foster self-reliance.
Mindfulness as an Approach Mindfulness practices are linked to the personal and professional growth of CITs (Bohecker et al., 2016; Campbell & Christopher, 2012). Campbell and Christopher (2012) compared counseling students who participated in a mindfulness-based stress reduction (MBSR) program to a control group and found that those who participated in MBSR reported significant decreases in stress, negative affect, rumination, and state and trait anxiety while noting a significant increase in positive affect and self-compassion when compared to participants in the control group. Additionally, Christopher and Maris (2010) reported that supervisees who were exposed to mindfulness were “more open, aware, self-accepting, and less defensive in supervision” (p. 123). Similarly, Bohecker et al. (2016) discovered that CITs who participated in a mindfulness experiential small group saw the benefits of attending to their emotions (e.g., internal experiences) and acknowledged that mindfulness increased self-awareness and promoted objectivity when attending to their thoughts. Having objectivity allowed them to be in the present, which positively affected their behavioral responses (Bohecker et al., 2016).
CITs also experienced benefits to having mindfulness incorporated into their practicum and internship seminar classes. Dong et al. (2017) examined CITs’ response to mindfulness-based activities and discussions during internship seminar. Results suggested that CITs who engaged in mindfulness practices were more focused on the moment and responded to stressors with acceptance and nonjudgment. As a result, CITs were more likely to be “okay with not being okay” when faced with challenging situations (Dong et al., 2017, p. 311). Additionally, Dong and his colleagues noted that participants were able to validate themselves when they made mistakes and were more accepting of their rough edges. Carson and Langer (2006) agreed and added that CITs who received mindfulness as part of their supervision were better able to examine the thoughts that contributed to their anxiety and were more open to accepting their mistakes as learning opportunities. As a result, CITs minimized the focus they put on self-criticism and were less vulnerable when they made mistakes (Carson & Langer, 2006). These studies highlight how CITs benefited from integrating mindfulness into group supervision, yet there is limited research on how counselor educators might structure their practicum seminars to include mindfulness as an integrated approach to supervision.
Purpose of the Present Study The purpose of this practitioner inquiry was to inform Watkinson and Cicero’s practice as supervisors of practicum school counseling students within a CACREP-accredited program. We utilized mindfulness as a central approach to group supervision during practicum seminar and wanted to understand how intentional mindfulness exercises that prioritized the CITs’ internal experiences (e.g., uncertainty, doubt, fear) were perceived by our students. By understanding the student experience, we could make informed decisions about how we might improve upon the way we integrate mindfulness into future seminar meetings. Specifically, we were guided by this research question: How are CITs experiencing mindfulness as part of group supervision provided during practicum seminar?
Method
We engaged in a practitioner inquiry study (Cochran-Smith & Lytle, 2009) to examine the application of mindfulness within the context of our practice. Cochran-Smith and Lytle (2009) argued that the examination of one’s practice privileges practitioner knowledge and adds to the overall discourse on teaching pedagogy, as “deep and significant changes in practice can only be brought about by those closest to the day-to-day work of teaching and learning” (p. 6). Although not intended to generalize knowledge, practitioner inquiry positions the researcher as a participant to uncover tensions and challenges that come from applying theory to practice while enhancing the knowledge of the practitioner doing the investigation (Cochran-Smith & Lytle, 2009). Thus, we intended to reflect upon how we integrated mindfulness into supervision by understanding the experiences of our practicum students.
Participants We gained approval from our university’s IRB to conduct the study and invited all 33 CITs enrolled in our practicum sections to participate. Twenty-five (76%) CITs agreed to participate. Of the 25 participants, 24 identified as female (96%) and one identified as male (4%). Sixteen students (64%) self-identified as White/Caucasian, five (20%) as African American, three (12%) as Hispanic, and one (4%) as other. Eighty-four percent of participants were full-time students and 16% identified as part-time. Students were told they could withdraw their participation at any time. All practicum students completed their field experience in public schools.
To safeguard participants from believing they were required to join the study, Watkinson and Cicero were not aware of which students agreed to participate until the end of the semester, when grades were submitted. To protect participant identity until after the semester, we took the following steps: 1) the third author, Elizabeth Burton, was the only one who knew the identity of the participants; 2) Burton recruited participants, stored data (erasing identifying information), and communicated with the participants; 3) the data source labeled sandtray reflections included activities that all CITs completed as part of a required seminar experience; 4) a focus group was held after the semester concluded and grades were submitted; and 5) during data collection, Watkinson and Cicero never discussed the study with any of the CITs enrolled in practicum.
Seminar Context The practicum course is the first field experience for CITs enrolled in the school counseling master’s program. As per the CACREP 2016 Standards, the practicum experience is a 100-hour experience in which 40% of those hours are in direct service. In addition to meeting those direct hours by working with several individual clients, practicum students are also required to design and run a small counseling group and deliver several classroom lessons within schools. Further, CACREP-accredited programs must provide practicum students with 1.5 hours on average of group supervision per week throughout the duration of the semester. Thus, our practicum seminars were designed to provide CITs with the required group supervision.
All practicum seminar sessions met in person except for one, which was held synchronously through Zoom, a web conferencing platform. There were three sections of practicum, two taught by Cicero and one taught by Watkinson. Watkinson and Cicero drew upon constructive supervision principles and mindfulness core concepts (e.g., self-compassion, present moment, and nonjudgment) to guide the planning of the practicum seminars. We maintained similar course structures, objectives, and learning outcomes utilizing similar room arrangements, mindfulness exercises, and structured learning experiences. Mindfulness exercises were central to the practicum seminar and were focused on the practicum students’ internal experiences. The 15 weekly practicum seminars were 90 minutes in length, and student-to-faculty ratios were 9:1 for two of the practicum sections and 6:1 for the third. The room arrangement consisted of a circle of chairs for students to use during the opening and closing of the seminar, along with a designated workspace for students to sit at tables to take notes or complete reflective class experiences. Soft meditation music played as students entered the room and was turned off to signal the beginning of class.
Watkinson and Cicero engaged in weekly collaborative planning meetings throughout the 15-week semester to plan their seminar meetings and share insights related to student learning. The instructional design was experiential and incorporated mindfulness exercises during the opening of the seminar to bring attention to the “here and now,” breath, nonjudgment, and self-compassion. Cicero was previously trained in mindfulness and exercises were selected based upon her training; Cicero taught Watkinson how to implement those mindfulness exercises during their weekly meetings. Many of the opening mindfulness exercises can be found through internet searches.
Structure of Seminar Meetings The structure and room arrangement for each practicum seminar were consistent across the three sections. Fourteen of the 15 seminar meetings began with the CITs participating in a 5-minute mindfulness opening that transitioned into structured learning experiences and ended with a sharing circle. Seminar Meeting 11 was entirely dedicated to mindfulness, engaging practicum students in several mindfulness activities for the purpose of drawing their attention to breath and reflection.
Mindfulness Openings The 5-minute mindfulness openings were scripted and consisted of either a guided meditation (e.g., Calm Still Lake, A River Runs Through It), intentional breathing exercises (e.g., Balloon Breath, Meditative Chimes) or chair yoga (e.g., Mountain Pose, Warrior 2). Each mindfulness opening concluded with reflective questions to increase awareness of the present moment (e.g., What was this experience like for you?). The meditation exercises were varied to introduce CITs to different approaches they might want to try outside of seminar for personal use or in their own practice with K–12 students.
Structured Learning Experiences After the mindfulness opening, CITs participated in structured learning experiences that focused on either counselor development, case conceptualization, group counseling leadership, evidence-based planning, or classroom curriculum development and instruction. Guided by constructivist supervision principles, two of the structured learning experiences implemented were metaphorical case drawing (Guiffrida, 2015) and sandtray (Guiffrida, 2015; Saltis et al., 2019).
Metaphorical Case Drawing. Guiffrida’s (2015) metaphorical case drawing was used to assist CITs in the development of their case conceptualization skills. In Guiffrida’s work, a metaphorical case drawing has three steps. First, CITs reflect upon six items that highlight their internal experiences and perspectives specific to an individual counseling session with one of their clients: 1) identification of the client’s primary concern, 2) description of the client and CIT interaction, 3) CIT’s intention for the session, 4) CIT’s description of how they viewed their performance as a counselor during the session, 5) general assessment of how the session went, and 6) statement on what the CIT thought the client gained from the session. Second, CITs use images and/or metaphors to respond to three of the six items above to create a case drawing. Lastly, utilizing their case drawings, CITs share their cases with the supervisor and other supervisees. Through the presentation of their case, the CITs interpreted their work while the supervisor and other supervisees listened and asked questions to facilitate deeper insight by offering alternative perspectives.
Sandtray. Although sandtray is typically used in supervision to help CITs develop their case conceptualization skills (Anekstein et al., 2014; Guiffrida, 2015; Guiffrida et al., 2007), we modified our use of sandtray to focus the CITs on their developmental journey as counselors. Like the metaphorical case drawing, the sandtray facilitates an internal examination where CITs get to interpret their own experience (Guiffrida et al., 2007). The sandtray was used in Seminar Meetings 6 and 13 to document how CITs were encountering practicum at two different times in the semester. The written reflections that followed the sandtray were used as a data source for this study and are therefore described in further detail.
Prior to creating an image in the sandtray, CITs were asked to journal about their experience as a practicum student. The prompt was left open so that CITs would have the freedom to focus on the most salient part of their experience. Next, CITs were partnered to create a sandtray image and each pair were given a large box that contained sand and a small baggie filled with a variety of miniature objects. CITs had 5 minutes to create an image in response to this prompt: Create an image that represents your practicum experience thus far. At the conclusion of the 5 minutes, CITs shared their stories with their partners. After everyone created a sandtray image and shared, CITs wrote a reflection in response to this prompt: Drawing from the sandtray exercise and sharing, describe your experience in practicum thus far. Identify and describe the thoughts and feelings you have as you begin your work with students. These written reflections were submitted to the professor at the conclusion of the seminar meeting.
At Seminar Meeting 13, CITs created and shared their sandtray images. Following the same procedure as identified in Seminar Meeting 6, CITs engaged in the sandtray activity again to create a new image in response to a new prompt: Create an image that described your overall experience in practicum. After creating and sharing of their image with a partner, students reflected and responded in writing to a final prompt: Drawing from the sandtray exercise, describe your experience in practicum. Identify and describe your thoughts and feelings now that practicum has come to an end. What have you learned about yourself? Written reflections were completed during the seminar meeting and submitted to the professor when class ended.
Sharing Circle After the structured learning experience, each seminar concluded with a 5–10 minute sharing circle where students summarized new insights and identified actions to implement at their practicum site. The sharing circle was guided by two questions: What are some key takeaways from today’s seminar? and How might we use what we have learned today within our own practice?
Structure of Mindfulness Seminar Meeting Seminar Meeting 11 was fully dedicated to the practice of mindfulness and did not follow the above seminar format and structure. During this one 90-minute class, CITs identified an intention, created a mindfulness jar, journaled, and walked a labyrinth. Johnson et al. (2020) argued that CITs who receive mindfulness as part of their supervision should start or maintain a mindfulness practice of their own. Yet there is nothing in the research that identifies specific mindfulness exercises as being essential to that practice, only that CITs should be exposed to mindfulness as part of the classroom experience (Johnson et al., 2020). Thus, our intent for this seminar meeting was to engage CITs in mindfulness exercises that would encourage meditation and reflection. For this class we requested a large room to accommodate a small circle arrangement of 10 chairs and three stations: a labyrinth, creating a mindfulness jar, and journaling. During this seminar meeting, the CITs were instructed to visit the three stations at their own pace and to self-select the order in which they participated in those stations. Class opened with a mindfulness exercise that focused on breath and ended with a sharing circle to debrief. An example of a closing question posed by the professors during the sharing circle is: What insights would you like to share about your experience in seminar today?
Labyrinth. CITs were given a brief description of a labyrinth along with written instructions on how to set an intention and walk the labyrinth. We created a floor labyrinth for use during the seminar. CITs set their intention prior to walking the labyrinth. Some examples of intentions were to be open to the process or to demonstrate self-compassion. Once inside the labyrinth, CITs would follow the path and could walk the labyrinth as many times as they desired.
Creating Mindfulness Jars. CITs created a mindfulness jar from an empty 8-ounce bottle, fine glitter, clear hand soap, confetti, and water. Directions on how to create a mindfulness jar were provided at the station. CITs were encouraged to use the mindfulness jar during the 90-minute seminar as a focal point to guide their breath during reflection time.
Journaling. CITs were provided paper, pens, markers, and crayons for journaling at the beginning of the seminar. CITs were provided minimal directions on what they were to journal, outside of selecting a quiet place in the room to write and reflect upon their experience during the session. Journals were private and CITs were not asked to share what they wrote with the professors or other CITs.
Data Sources and Collection We used three data sources to understand CITs’ experience with mindfulness as part of supervision: supervisor observations, sandtray reflections from weeks 6 and 13, and focus group transcripts. Watkinson and Cicero captured supervisor observations in their meeting minutes, which also included specific plans for each seminar session along with assumptions and observations about CIT learning. The written sandtray reflections captured CITs’ overall experience in practicum at two different points in the semester. Using a multi-step process, the sandtray served as a structured learning experience completed and collected during the seminar meetings. Data from sandtray reflections taken at the end of the semester (week 13) were analyzed to examine how CITs reflected on their overall practicum experience at the completion of the semester.
All 25 participating CITs were invited to participate in a focus group. Of the 25, nine (36%) attended and two different focus groups were held to accommodate their schedules. Each focus group was held virtually on Zoom, recorded, and transcribed, and took place at the end of the academic semester after grades were issued. Focus groups lasted 60 minutes, were co-led by Watkinson and Cicero, and served as a type of member checking. Guiding questions/prompts were: Describe your experience in practicum this semester, Describe your feelings throughout the semester, and What was it like for you to engage in mindfulness as part of your development as a counselor?
Trustworthiness Watkinson and Cicero are both counselor educators at a university located within the Mid-Atlantic region of the United States. Watkinson is a Caucasian middle-aged female with 14 years of experience as a school counselor and over 10 years of experience as a counselor educator. Cicero is a Caucasian middle-aged female with 30 years of experience in a large public school district as a teacher, school counselor, and a district-level administrator of school counseling and student service programs, as well as 3 years of experience as a counselor educator. Watkinson and Cicero are licensed professional counselors, board approved certified supervisors, and certified school counselors. Burton was a first-semester school counseling student and served as Watkinson’s graduate assistant. She is a Caucasian female with no prior experience in schools or as a counselor. At the time of data analysis, she had finished her first year of coursework and offered an additional perspective on how the data could be interpreted.
Watkinson and Cicero held certain biases and assumptions about how mindfulness might be experienced by CITs in their practicum sections. We assumed that mindfulness was beneficial to CIT counselor development yet had no preconceived ideas as to the type of benefit it would have on their professional growth outside of our assumption that mindfulness could help CITs work with their anxiety. Additionally, we found that CITs, particularly at the practicum level, were anxious and worried about their performance and believed that supervision was needed to attend to that anxiety. Lastly, we shared a strong desire to better understand our own practice and were therefore open and expected feedback to strengthen that practice.
Trustworthiness was addressed in a variety of ways. In practitioner research, validation is obtained through a form of peer review, where practitioner researchers collaborate to discuss and reflect upon their experiences through peer feedback (Anderson & Herr, 1999; Cochran-Smith & Lytle, 2009). Thus, Watkinson and Cicero met weekly during the 15-week semester to share observations and obtain feedback related to their own practice. Further, during these meetings we engaged in critical dialogue to disrupt previously held assumptions and biases. For example, we challenged each other to share evidence to support the interpretations we made about how students were experiencing the course, asking the question, How do you know? Observations that included peer feedback were recorded in our meeting minutes.
Second, we engaged in prolonged observation of participants as we worked alongside CITs, acting in the role of both inside and outside observers during the 15-week semester. As Creswell (2013) asserted, validation of findings comes from prolonged engagement and persistent observation of participants. Third, we triangulated data, comparing Seminar Meeting 13 sandtray reflection data across the three practicum sections to the focus group transcripts (Merriam, 2009). Fourth, the focus groups served as a type of member checking (Merriam, 2009) to validate and refine our analysis of the final sandtray reflections to the perceptions that were shared by students in the focus groups.
Data Analysis We formed a research team and regularly met to debate and discuss the data during the analysis process. Data from the sandtray reflections taken during Seminar Meeting 13 were organized into a table for analysis so that we could track individual responses and practicum sections. Drawing from Creswell’s (2013) process for analyzing data, we each familiarized ourselves with the data by independently engaging in multiple readings of the final sandtray reflections and focus group transcripts, including memoing to capture initial impressions and key concepts. After familiarizing ourselves with the data, we met as a research team to share initial insights and bracket assumptions. Next, we reviewed each line of the final sandtray reflection data independently to identify initial codes. As a research team, we shared our codes, discussed discrepancies, and reviewed units of data until consensus was reached and a codebook was created. Next, codes from the final sandtray reflections were compared to the focus group transcripts and refined. Lastly, we looked for patterns in the data and organized them into themes.
Findings
To examine our supervision practice, we sought to understand how CITs experienced mindfulness as a supervision approach. Prioritizing mindfulness within our practicum seminar meetings focused our students on the examination and understanding of their internal experiences and meeting uncertainty with nonjudgment and self-compassion. After analyzing the data, three major themes emerged: openness to the process of becoming, reflection and self-care, and attention to the doing.
Openness to the Process of Becoming Although CITs acknowledged the challenges associated with their experience, they also expressed an openness to becoming a counselor who generated personal insight, self-compassion, and wisdom. As one participant stated, “It’s natural to feel uncertain when learning new concepts. However, uncertainty should not consume you and cause your thoughts to become negative. Give yourself permission to grow.” Another wrote, “The biggest growth I’ve seen in myself is self-awareness. Regardless of my weaknesses and shortcomings, I am good enough!! The greatest gift I can give to students is to be myself.”
CITs felt hopeful and purposeful in their development as counselors and expressed excitement about their professional growth. As one participant remarked, “In the beginning everything seemed new and scary, but when I look at the end, I see so much growth. I will continue to grow and expand. I look forward to my career.” Another wrote:
At the beginning of practicum, I felt awkward and unsure of myself. I felt self-conscious. At the end of practicum, I can feel the growth I’ve made. I no longer feel awkward or self-conscious. I know who I am and what kind of counselor I am.
Acknowledging the emotional challenges of their professional journey, CITs highlighted the emotional discomfort they felt at the start of practicum. One student stated: “Anxiety from the beginning—feeling of anxiety and not knowing what to expect.” Another mentioned in her reflection, “I definitely had feelings of inadequacy. I just didn’t think that I was doing what I needed to do.” Some students expressed this discomfort as cyclical:
Understanding everything that was going to be happening and everything that was expected and what it all entails, I definitely started to get more anxious and got comfortable and then getting [anxious] again. So, kind of like back and forth a lot.
Students compared this back and forth feeling to that of a rollercoaster: “I feel like some weeks I’d be on fire, like, yeah, I did really good . . . there would be other days where it’s like my timing is off and I’m uncomfortable in the classrooms . . . it was definitely a rollercoaster feeling.”
Another student agreed, sharing that they “would definitely second the rollercoaster. The beginning was very overwhelming for sure . . . that rollercoaster of like the expectation of learning . . . feeling like you’re doing really bad and then learning what is good.”
There was also a sense of wisdom in how the participants described what they gained from this experience of becoming. One participant mentioned “feeling depressed and anxious. . . . Fast forward 2 months and I had grown so much. I can’t believe in only 60 days my attitude toward practicum changed so dramatically. . . . change and growth take time, but it does happen.” Another CIT stated:
In my first reflection, there seemed to be a lot of low points, but I was hopeful things would get better. In my second reflection, I realized that the things I have done have made an impact and the highs and lows both got me to this point.
CITs expressed recognition of the highs and lows experienced and within that recognition focused on a greater purpose. As one wrote,
I started out being very unaware and doubtful of myself. I was overwhelmed and wasn’t seeing the beauty in the process of learning who I am as a counselor. I began to see the small and big impacts that I had with my students in 15 weeks. I saw the power that comes with being a counselor and am more mindful of the impact I have and will make.
Another reflected:
The biggest growth I’ve seen in myself is self-awareness. Awareness of my strengths and weaknesses so that I can be mindful of how to be the best I can be for all students. So that I can strive to have a positive impact on others.
Another mentioned:
At this point in the journey, I finally met my passion. I always wanted to have an impact not because I taught a great lesson, but because I helped a student and showed I cared. I grew by knowing how to use my tools to make a difference while finding my style of counseling in the process. The growth hasn’t stopped and needs refinement, but I want each day to be better for myself and the students.
Additionally, CITs perceived feedback to be essential to their growth process. One CIT reflected that they “learned to be open to change . . . accepting feedback and letting it help me make positive changes throughout this journey. There is always a need for continued growth and development.” Another remarked:
I’ve realized that in order for me to learn and grow I have to be more open [to feedback]. Being closed off means that I am only working with what I know, which is not helpful to me personally, but also what we tell students not to do. Being open has forced me to become a more active participant in my learning and take more risks . . . it will all be worth it in the end.
Another practicum student focused on gratitude:
Feedback and supervision helped to change my perspective and boost my confidence. Things about myself that I thought had nothing to do with being a counselor were highlighted and the areas for improvement were spoken of and tended to with genuine care. I’m grateful to have had the experience of becoming so reflective. I’m grateful for the lows and the moments where I felt as though I was at a standstill. I’m grateful for falling so hard that my only option was to reach out and ask for help. I’m grateful for the hurdles . . . and I’m grateful for the ever-flowing river. I’m grateful for the art and the science of counseling. I’m grateful for who I’m becoming in the process of becoming. I’m grateful for grace and for the realization of how necessary it is. I’m grateful for family and adopted big sisters in the program. I’m grateful to have had the chance to say “I don’t know” and keep learning.
The theme of openness to the journey was also highlighted in the acknowledgement of not being in control. There was an openness to embracing the unknown and the chaos associated with not having everything figured out, as one CIT concluded:
In the beginning, I was working really hard to try to figure everything out. I saw obstacles everywhere. As I moved on, I started to focus on counseling in a way that didn’t put pressure on me to do all of the right things. I started to grasp the essence of counseling and what makes the profession unique.
Another noted:
One major insight is that it was a chaotic journey. It’s not straightforward, and I don’t always know the path I’ll take, but I am continuously growing and learning about myself as a person and as a school counselor. . . . I am enjoying the unknown. I like what I am doing, and I like moving forward, even if I am unsure at times.
Reflection and Self-Care CITs reported that the seminar was very reflective, which gave them a sense of calm and a new appreciation for self-care. As one student commented, “I did, like everyone else, find [the seminar class] to be calming, enjoyable, and reflective.” Reflection generated by the mindfulness exercises gave CITs an opportunity to get to know themselves:
It was definitely a positive experience for sure. I would agree it was very calming and super reflective. I felt like I understood myself as a counselor and also just like as a person on my own personal journey. Even aside from that I felt like I learned a lot.
Further, CITs expressed the importance of reflection and giving themselves the space to be in the present moment as a means of self-care:
I am so wrapped up in everything that is going on in my life and getting everything done. And school takes a lot of everything I’ve got . . . to be reminded and practice [mindfulness] on a regular basis . . . but doing it each week in class, helped me to do it at home. So that was giving me that practice and repetition and it really made a huge difference.
Another mentioned, “There’s just so many things going on in your life . . . to be reflective and just calm my inner self and learn how to breathe . . . this was a life skill class for me,” and a different student elaborated, “I was so grateful for it because I realized how much self-reflection I have to do . . . that I need to keep doing it and making it a priority.”
Attention to the Doing Although students valued the priority that we placed upon mindfulness to better understand their internal experiences, some wished that we had provided more time for them to share stories about their practicum sites. As one CIT stated, “I would have liked to have had time each week for all of us to share what was going on and to learn from each other’s situations and to support each other in those situations.” Additionally, CITs desired to know more about what was happening at different practicum sites because of the belief that they were missing an experience. As one CIT explained, “I didn’t have a role model so it was nice to hear everyone else’s role models . . . so I could just learn from pieces I wasn’t getting [at my site].” Another CIT agreed: “I think it definitely would have helped to hear more about other people’s sites just because I wasn’t really getting a ton out of my site. Or I did get things, but differently.” Another mentioned, “I wanted to hear other people’s experiences because I felt like everyone was at such different schools and different levels . . . we’re all experiencing different things.”
Discussion
We sought to understand how practicum students experienced mindfulness exercises within supervision to improve our own practice. To help practicum students work with their anxiety, mindfulness exercises were heavily integrated into the course structure to engage all CITs in weekly reflective exercises that directed their attention toward their internal experiences. Practicum students were invited to acknowledge their anxiety and respond to it with nonjudgment and self-compassion. Mindfulness core concepts (e.g., being present, nonjudgment, self-compassion) served as a framework for how practicum students made meaning of their internal experiences. Although our focus was not to determine the impact mindfulness had on our practicum students, to inform our practice we did seek to gain a descriptive understanding of how our students experienced mindfulness as part of their group supervision.
Open to the Process of Becoming Our CITs reported being open to the process of becoming a counselor that included acceptance of where they were in the developmental process. Through acceptance, CITs reported being aware of the uncertainty associated with learning a new skill and leaned into that anxiety with self-compassion and nonjudgment. Further, they were able to acknowledge the ambiguity (e.g., “rollercoaster”) associated with learning something new and the tension that comes with being uncomfortable. Bohecker et al. (2016) found similar results in their qualitative study, acknowledging that CITs who integrated mindfulness practices into their daily lives were better able to handle the ambiguity associated with counselor development. As part of her correlational study, Fulton (2016) found that self-compassion, a core principle of mindfulness, was predictive of a CIT’s tolerance to handle ambiguity. Thus, our findings support and add to the current literature by describing qualitatively how practicum students made meaning of that uncertainty to normalize the tension that was associated with it.
Self-Care Participants saw reflection as a form of self-care, finding meditation to be relaxing, and they acknowledged that meditating each week during seminar allowed them to stay in the present moment. Similarly, Duffy and colleagues (2017) found that CITs in their qualitative study who participated in weekly mindfulness exercises as part of a core class described mindfulness as reflective, providing them with a sense of calm and ability to stay within the present. Banker and Goldenson (2021) noted that CITs within their qualitative study also reported personal benefits to utilizing mindfulness within their practicum seminar, including being able to better transition to the present moment. Thus, the experiences our practicum students had connecting reflection as a form of self-care are similar to the experiences of other CITs who practiced regular meditation.
Attention to the Doing Although CITs saw value in participating in group supervision that integrated mindfulness as a central approach within their practicum seminars, some CITs wanted more focus on learning about the experiences other practicum students had at their school sites. Specifically, CITs desired to know more about school counselor practice by sharing stories of what their peers were doing, as well as the work being done by the practicing school counselor. Participants sought more understanding on school counselor practice either because of a lack of modeling at their own schools or professional curiosity. Similarly, Watkinson et al. (2018) noted that counselor educators reported discrepancies between how school counseling CITs were being prepared versus what they experienced in the field. For example, counselor educators shared that they often taught content (e.g., implementing a comprehensive school counseling program) that their school counseling CITs did not see modeled at their schools. Thus, it would seem logical that CITs at the practicum level would want to have more exposure to activities that school counselors were doing at other sites, especially if what they were observing was not aligned with their training.
Reflecting on Our Own Practice: Lessons Learned Through this practitioner inquiry, we gained some valuable insight into how CITs experienced mindfulness that has informed our practice. First, by analyzing our CITs’ experiences in practicum, we believed that they benefited from the mindfulness exercises as a way to work with their anxiety. Specifically, we were encouraged that practicum students expressed an openness to the process of becoming a counselor, which included self-acceptance. CITs stated they were more open to feedback and less critical of themselves, recognizing they still had much to learn. Second, we learned that although the integration of mindfulness as a central approach to our supervision could be helpful to practicum students, CITs also expressed a desire to have more time dedicated to hearing about the work their peers and other practicing school counselors were doing within schools. This was particularly important if the CIT believed their site was lacking. Hence, as supervisors we needed to create a balance between engaging our CITs in mindfulness practices and the need that our CITs had to share work stories and gain some practical insight into the work of school counselors.
Cochran-Smith and Lytle (2009) highlighted that a benefit to practitioner inquiry was the uncovering of professional dilemmas that naturally occur when you apply a concept to practice. For us, seeking balance challenged us to consider what specific mindfulness exercises were critical to maintain. Watkinson et al. (2018) also found that counselor educators struggled with balancing the amount of content that needs to be covered in a course versus the depth of understanding that is needed for CITs to apply the content learned. Thus, we too needed to decide on depth versus breadth, which boiled down to identifying the frequency with which we had our practicum students participate in mindfulness exercises in each seminar meeting to gain benefit.
Because the recent literature suggested that exposure to weekly mindfulness exercises within core courses and clinical seminars benefited CITs (Campbell & Christopher, 2012; Dong et al., 2017; Fulton, 2016), we decided to keep the opening mindfulness meditative exercises and remove the one seminar session we had dedicated to mindfulness. Further, we increased the time CITs spent in sharing circles to include space for CITs to talk about the work being done by school counselors (or themselves) at practicum sites. Lastly, we looked for opportunities to highlight mindfulness principles in case conceptualization.
To integrate mindfulness principles into case conceptualization, Sturm and colleagues (2012) proposed using metaphors (i.e., Earth, Air, Water, Space and Fire) that represent ancient Buddhist principles when conceptualizing cases. For instance, the Earth metaphor symbolizes grounding, and when applied to case conceptualization enables CITs to consider what grounds them personally and theoretically when treating a client (Sturm et al., 2012). Another example of integrating core mindfulness principles into supervision is through free association (Schauss et al., 2017). Schauss et al. (2017) used free association to help CITs attend to the present by asking questions that focused CITs on the here and now (Schauss et al., 2017). Sample questions include: What are you feeling in this moment? When and in what ways has this feeling surfaced during your counseling experiences at your school site? How does your body respond to this type of feeling and what is the impact on your counseling experiences? By integrating mindfulness principles into skill development (e.g., case conceptualization), our practicum students would be further exposed to core mindfulness principles.
Limitations and Future Research
Our intention of sharing the findings from this study was to offer a practitioner’s perspective on how CITs experienced mindfulness within supervision to contribute to the broader discussions on counselor education pedagogy. Generalization was not the objective, and findings need to be interpreted within the context of practice. Further, this study did not examine the impact that mindfulness had on CIT anxiety, and we are not able to infer such causal relationships. To strengthen our understanding of counselor education pedagogy, future studies could build upon our findings to identify which mindfulness exercises had the greatest impact on helping CITs work with their anxiety. Understanding which mindfulness exercises impact anxiety, counselor educators could be more intentional with the exercises they include, thus making room for other supervision priorities (e.g., CITs hearing about the work of practicing school counselors).
Future research could also investigate how supervisors’ modeling of core mindfulness principles could impact counselor development and the supervisory alliance. Daniel et al. (2015) have called upon researchers to increase understanding of how supervisors’ mindfulness behaviors impact the supervisory relationship. Future research could attend to this deficiency within the literature by looking at the relationship between a supervisor’s mindfulness behaviors and the supervisory relationship through a practitioner lens.
Conclusion
By incorporating a mindfulness approach into supervision, we learned that CITs were open to working with the anxiety associated with becoming a counselor. This openness or self-acceptance gave them the perspective to appreciate the impact this experience had on them and others while also valuing the benefits of reflection through meditation. The intent of this study was not to generalize the experience of these CITs to others; rather, it was to generate conversation and an understanding of how CITs experienced mindfulness to better our practice as supervisors. Although CITs saw benefits of mindfulness within supervision, they also desired more conversations on counselor practice to better their understanding of the role school counselors have in schools. As supervisors, we understand mindfulness should be balanced with the need for CITs to learn about the work of the school counselor through the sharing of experiences at their practicum sites. Beginning each session with a mindfulness exercise and infusing mindfulness core principles into case conceptualization could be a means to achieve such balance.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
References
Anderson, G. L., & Herr, K. (1999). The new paradigm wars: Is there room for rigorous practitioner knowledge in schools and universities? Educational Researcher, 28(5), 12–21. https://www.jstor.org/stable/1176368
Anekstein, A. M., Hoskins, W. J., Astramovich, R. L., Garner, D., & Terry, J. (2014). Sandtray supervision: Integrating models and sandtray therapy. Journal of Creativity in Mental Health, 9(1), 122–134. https://doi.org/10.1080/15401383.2014.876885
Auxier, C. R., Hughes, F. R., & Kline, W. B. (2003). Identity development in counselors-in-training. Counselor Education and Supervision, 43(1), 25–38.
https://doi.org/10.1002/j.1556-6978.2003.tb01827.x
Banker, J. E., & Goldenson, D. (2021). Mindfulness practices in supervision: Training counselors’ experiences. The Family Journal, 29(1), 17–23. https://doi.org/10.1177/1066480720954204
Barrio Minton, C. A., Wachter Morris, C. A., & Yaites, L. D. (2014). Pedagogy in counselor education: A 10-year content analysis of journals. Counselor Education and Supervision, 53(3), 162–177.
https://doi.org/10.1002/j.1556-6978.2014.00055.x
Bohecker, L., Vereen, L. G., Wells, P. C., & Wathen, C. C. (2016). A mindfulness experiential small group to help students tolerate ambiguity. Counselor Education and Supervision, 55(1), 16–30.
https://doi.org/10.1002/ceas.12030
Brackette, C. M. (2014). The scholarship of teaching and learning in clinical mental health counseling. New Directions for Teaching and Learning, 2014(139), 37–48. https://doi.org/10.1002/tl.20103
Campbell, J., & Christopher, J. (2012). Teaching mindfulness to create effective counselors. Journal of Mental Health Counseling, 34(3), 213–226. ttps://doi.org/10.17744/mehc.34.3.j75658520157258l
Carson, S. H., & Langer, E. J. (2006). Mindfulness and self-acceptance. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 24(1), 29–43. https://doi.org/10.1007/s10942-006-0022-5
Christopher, J. C., & Maris, J. A. (2010). Integrating mindfulness as self-care into counselling and psychotherapy training. Counselling and Psychotherapy Research, 10(2), 114–125. https://doi.org/10.1080/14733141003750285
Cochran-Smith, M., & Lytle, S. L. (2009). Inquiry as stance: Practitioner research for the next generation. Teachers College Press.
Creswell, J. W. (2013). Qualitative inquiry & research design: Choosing among five approaches. (3rd ed.). SAGE.
Daniel, L., Borders, L. D., & Willse, J. (2015). The role of supervisors’ and supervisees’ mindfulness in clinical supervision. Counselor Education and Supervision, 54(3), 221–232. https://doi.org/10.1002/ceas.12015
Dong, S., Campbell, A., & Vance, S. (2017). Examining the facilitating role of mindfulness on professional identity development among counselors-in-training: A qualitative approach. The Professional Counselor, 7(4), 305–317. https://doi.org/10.15241/sd.7.4.305
Duffy, J. T., Guiffrida, D. A, Araneda, M. E., Tetenov, S. M. R., & Fitzgibbons, S. C. (2017). A qualitative study of the experiences of counseling students who participate in mindfulness-based activities in a counseling theory and practice course. International Journal for the Advancement of Counselling, 39(1), 28–42. https://doi.org/10.1007/s10447-016-9280-9
Ellis, M. V., Hutman, H., & Chapin, J. (2015). Reducing supervisee anxiety: Effects of a role induction intervention for clinical supervision. Journal of Counseling Psychology, 62(4), 608–620.
https://doi.org/10.1037/cou0000099
Fulton, C. L. (2016). Mindfulness, self-compassion, and counselor characteristics and session variables. Journal of Mental Health Counseling, 38(4), 360–374. https://doi.org/10.17744/mehc.38.4.06
Guiffrida, D. A. (2015). Constructive clinical supervision in counseling and psychotherapy. Routledge.
Guiffrida, D. A., Jordan, R., Saiz, S., & Barnes, K. L. (2007). The use of metaphor in clinical supervision. Journal of Counseling & Development, 85(4), 393–400.
https://doi.org/10.1002/j.1556-6678.2007.tb00607.x
Johnson, D. A., Ivers, N. N., Avera, J. A., & Frazee, M. (2020). Supervision guidelines for fostering state-mindfulness among supervisees. The Clinical Supervisor, 39(1), 128–145.
https://doi.org/10.1080/07325223.2019.1674761
Kabat-Zinn, J. (2016). Mindfulness for beginners: Reclaiming the present moment—and your life. Sounds True, Inc.
Kuo, H.-J., Landon, T. J., Connor, A., & Chen, R. K. (2016). Managing anxiety in clinical supervision. Journal of Rehabilitation, 82(3), 18–27.
McAuliffe, G. (2011). Constructing counselor education. In G. McAuliffe & K. Eriksen (Eds.), Handbook of counselor preparation: Constructivist, developmental, and experiential approaches (pp. 3–12). SAGE.
Mehr, K. E., Ladany, N., & Caskie, G. I. L. (2015). Factors influencing trainee willingness to disclose in supervision. Training and Education in Professional Psychology, 9(1), 44–51.
https://doi.org/10.1037/tep0000028
Merriam, S. B. (2009). Qualitative research: A guide to design and implementation (3rd ed.). Jossey-Bass.
Moss, J. M., Gibson, D. M., & Dollarhide, C. T. (2014). Professional identity development: A grounded theory of transformational tasks of counselors. Journal of Counseling & Development, 92(1), 3–12. https://doi.org/10.1002/j.1556-6676.2014.00124.x
Saltis, M. N., Critchlow, C., & Smith, J. A. (2019). Teaching through sand: Creative applications of sandtray within constructivist pedagogy. Journal of Creativity in Mental Health, 14(3), 381–390.
https://doi.org/10.1080/15401383.2019.1624995
Schauss, E., Steinruck, R. E., & Brown, M. H. (2017). Mindfulness and free association for multicultural competence: A model for clinical group supervision. Journal of Counselor Practice, 8(2), 102–119. https://doi.org/10.22229/xpw610283
Sturm, D. C., Presbury, J., & Echterling, L. G. (2012). The elements: A model of mindful supervision. Journal of Creativity in Mental Health, 7(3), 222–232. https://doi.org/10.1080/15401383.2012.711718
Wagner, H. H., & Hill, N. R. (2015). Becoming counselors through growth and learning: The entry transition process. Counselor Education and Supervision, 54(3), 189–202. https://doi.org/10.1002/ceas.12013
Watkinson, J. S., Goodman-Scott, E. C., Martin, I., & Biles, K. (2018). Counselor educators’ experiences preparing preservice school counselors: A phenomenological study. Counselor Education and Supervision, 57(3), 178–193. https://doi.org/10.1002/ceas.12109
Jennifer Scaturo Watkinson, PhD, LCPC, is a certified school counselor and serves as an associate professor and the School Counseling Program Director at Loyola University Maryland. Gayle Cicero, EdD, LCPC, is a certified school counselor and serves as an assistant clinical professor at Loyola University Maryland. Elizabeth Burton is a certified professional school counselor for Baltimore County Public Schools. Correspondence may be addressed to Jennifer Watkinson, Timonium Graduate Center, 2034 Greenspring Dr., Lutherville-Timonium, MD 21093, jswatkinson@loyola.edu.
Nathaniel J. Wagner, Colleen M. L. Grunhaus, Victor E. Tuazon
According to recent research, counselors may benefit from a variety of supports offered by mental health agencies after a client dies by suicide. Research is sparse concerning how often agency supports and outreach are offered to counselors and what supports counselors find to be the most helpful after a client suicide. In this cross-sectional survey research study, the researchers recruited a sample of counselors (N = 228) who self-identified as having experienced a client suicide. The authors examined relationships between perceived organizational support, supervisory alliance, and the impact of the event on counselors. The authors also examined the use and perceived helpfulness of agency policies regarding counselor-oriented support after client suicide. Results highlight the need for more counselor training around suicide, increased empathy for counselor survivors, and the need for agency policies related to postvention.
According to McAdams and Foster (2000), approximately 23% of counselors are counselor survivors, meaning the counselor has had a client die by suicide. These client suicides impact counselor survivors personally and professionally. Counselors can feel sad at work and lose professional confidence in the aftermath of client suicides (Draper et al., 2014). Some counselor survivors demonstrate a fear of working with clients who present with suicidal ideations and are reluctant to accept subsequent suicidal clients (Hendin et al., 2000). Counselors also may experience various emotions, including anger, betrayal, fear of blame, grief, guilt, self-doubt, shame, and shock (Draper et al., 2014; Hendin et al., 2000). In addition, counselor survivors may become more sensitive to client suicidal ideation and experience heightened stress (e.g., Draper et al., 2014; Fairman et al., 2014; McAdams & Foster, 2000, 2002).
McAdams and Foster (2002) reported that counselor survivors found the support of a supervisor helpful in the recovery process. However, counselors further along in their professional experience, or practicing independently, might not have access to supervisory support. According to Fairman et al. (2014), after a client suicide, counselors benefitted from the following: (a) facilitated debriefing, (b) informal group support, (c) individual counseling, (d) paid leave of absence, and (e) continuing education activities. A dearth of research exists regarding how often employers offer the above supports to counselor survivors of client suicide. Considering the deleterious impact of client suicide on the personal and professional functioning of counselor survivors, researchers have implored mental health organizations to provide supportive actions to the distressed individual (e.g., Michel, 1997).
For this study, we recruited a sample of counselor survivors who identified as having a client who completed suicide during their professional career. We explored the effect of supervisory and organizational support on participants’ perception of the impact of client suicide. Participants also described the responses of their colleagues, supervisors, and agencies, and reported which responses participants viewed to be the most and least helpful for counselor survivors coping with client suicide.
Suicide is the 10th leading cause of death in the United States, and for younger populations (ages 15–24), suicide is the second leading cause of death (McIntosh & Drapeau, 2020). In a study of 5,894 deaths by suicide, Ahmedani et al. (2014) found that nearly one-third (29%) of individuals who completed suicide were enrolled in mental health services in the year prior to their death. In this same study, 45% of those who completed suicide had an appointment with a health professional resulting in a mental health diagnosis within the month prior to their completed suicide. In a national comorbidity survey (N = 5,692), Nock et al. (2010) found that 44.1% of those who attempted suicide were diagnosed with an anxiety disorder and 43% were diagnosed with a mood disorder. In total, Nock et al. estimated that 76% of people who attempt suicide have a mental disorder of some kind. Unsurprisingly, counselors are highly likely to work with clients who complete suicide. Approximately 25% of counselors will experience a client suicide (McAdams & Foster, 2002), and the vast majority of mental health professionals will encounter clients with presentations of suicidality or suicide attempts throughout the course of their career (Kleespies & Dettmer, 2000; McAdams & Foster, 2002; Rogers et al., 2001).
Counselors have some training to assess and respond to suicide risk through required trainings on models and strategies of suicide prevention as well as methods of suicide risk assessment (Council for Accreditation of Counseling and Related Educational Programs [CACREP], 2015). Despite this experience and exposure, counselor survivors often reported feeling overwhelmed and unprepared, substantial emotional distress, and reduced work performance when a client suicide occurs (Ellis & Patel, 2012). Identifying avenues of support for affected counselors is paramount to address the harmful effects to counselor well-being and effectiveness.
The Impact of Client Suicide
The profound emotions counselor survivors experience when a client dies by suicide may be moderated by the length and quality of the therapeutic relationship (Grad & Michel, 2004; Luoma et al., 2002). Researchers found that counselor survivors experienced shock, disbelief, or numbness upon learning of a client suicide (Darden & Rutter, 2011; Sanders et al., 2005). Counselor survivors described strong emotions in the context of losing control; for example, some felt angry toward a mental health system that presumably failed the deceased client along with emotions related to grief and sadness (Christianson & Everall, 2009; Knox et al., 2006). Sadness was associated both with the loss of the client and regret that the client was unable to thrive (Sanders et al., 2005). Other counselor survivors experienced fear of litigation or guilt related to holding some responsibility for the death (Christianson & Everall, 2009; Grad & Michel, 2004). Shame impacted counselor survivors’ self-conception as competent counselors and may have prevented them from admitting their fears to family and intimate partners (Darden & Rutter, 2011; Grad & Michel, 2004).
Behaviorally, counselor survivors often changed their professional practices after experiencing a client suicide. Some counselor survivors refused to see clients they perceived as potentially suicidal (Hendin et al., 2000). Knox et al. (2006) found that counselor survivors’ sensitivity to suicide risk and client suicidal ideation may be heightened after client suicide. Loss of a client can lead to increased feelings of self-doubt. Darden and Rutter (2011) determined that approximately half of counselor survivors who participated in their study experienced increased self-doubt when working with clients who presented with suicidal ideations or intent. Similarly, Sanders et al. (2005) found that counselor survivors felt like professional failures after client suicide. On the other hand, counselor growth may also accompany the loss of a client. For example, some counselor survivors indicated using the pain of the experience to grow in their understanding and approach with suicidal clients (Grad & Michel, 2004; Sanders et al., 2005). This growth included greater self-confidence in clinical instincts because of what they learned from the suicide event (Sanders et al., 2005). Counselor survivors can also grow through external supportive resources such as supervision and support groups.
Supportive Resources
Researchers found that counselor survivors often look to the professionals around them (e.g., colleagues, supervisors, mental health professionals) to provide a response, support, or assistance in processing bereavement (Grad & Michel, 2004; Knox et al., 2006; Sanders et al., 2005). Counselor survivors’ complex emotions and perception of failing as a professional can leave survivors grasping for assistance to make sense of the event. Professional responses to survivors vary and include chart audits (Grad & Michel, 2004), debriefing (Ting et al., 2006), or avoidance (Christianson & Everall, 2009; Darden & Rutter, 2011; Grad & Michel, 2004).
Organizational Support
Counselor survivors can benefit from organizational support and outreach in the wake of client suicide. Often, survivors experience frustration and isolation in unsupportive organizational contexts (Hendin et al., 2000). Counselor survivors indicated that institutional responses such as case reviews were rarely helpful and instead increased counselor survivor self-doubt and distress, particularly when these reviews included blame for the client suicide or false reassurance that the suicide was inevitable (Hendin et al., 2000).
On the other hand, supportive contexts that allow for increased social connection with colleagues and debriefing can be helpful (Ting et al., 2006). Michel (1997) suggested that debriefing sessions for the team may be beneficial for coping with client loss. Fairman et al. (2014) stated that when coping with a patient suicide, hospice clinical staff found team-based support strategies and debriefings supported counselor recovery. Alternatively, Michel reported that counselor survivors may find it difficult to disclose intimate and personal feelings to colleagues, especially in a team setting and without reassurance of confidentiality; these counselors may only disclose emotional problems to a personal therapist. Hendin et al. (2000) suggested that team-based debriefings may inhibit insight when they include platitudes such as “it’s not your fault.” Similarly, counselor survivors felt isolated by client suicide when coworkers offered empty assurances. On the other hand, counselor survivors felt supported and less isolated when coworkers shared their own experiences and demonstrated empathy (Hendin et al., 2000).
Counselor survivors may perceive organizational and collegial support as helpful, but researchers have not described the extent to which professional organizational support ameliorates the impact of the suicide event. Further research is needed to explore this interaction. In addition, further inquiry is needed to clarify what forms of organizational support are frequently offered to survivors of client suicide and which resources are most and least helpful.
Supervisory Support
Supervisors play a critical role in preparing for and responding to client suicidal behavior (Ellis & Patel, 2012). Knox et al. (2006) found that counselors-in-training who survived a client suicide appreciated when supervisors created a safe place to discuss the event, self-disclosed their experiences with client suicide, and provided reassurance that the suicide was not the fault of the counselor-in-training. Conversely, counselor survivors found conversations that were particularly critical of their actions prior to the client suicide, or insensitive to the counselors’ experience of the loss, as prohibitive to coping (Knox et al., 2006). Ellis and Patel (2012) recommended that supervisors actively guide supervisees toward self-care (e.g., support-seeking, personal counseling) and reduced workloads, rather than expecting them to know how to manage their grief and professional concerns simultaneously.
Darden and Rutter (2011) found that counselor survivors without a direct supervisor perceived lack of supervision as a barrier to recovery from the loss. Alternatively, counselor survivors in training programs can feel inhibited in fully processing grief and other emotional reactions with a supervisor who also is responsible for their professional evaluation (Gill, 2012). Counselor survivors without a strong supervisory relationship prior to the client suicide typically have limited access to effective and cathartic supervision experiences and to other professional support networks. Depending on the approach of the supervisor and the relationship between the supervisor and supervisee, supervision can be helpful or harmful. Further empirical research is needed to determine the effect of the supervisory relationship on the impact of the suicide event. In addition, more specific information related to agency and supervisory practices and policies that are helpful for counselor survivor recovery would provide further clarification.
Purpose of the Present Study
The following research questions guided our study: (a) Does the perceived support from a supervisor or an organization impact counselor survivors’ experiences of client suicide?; (b) Which policies are most frequently utilized by agencies when a counselor experiences client suicide?; and (c) What interpersonal and agency responses are perceived to be most and least helpful for counselor survivors?
Method
Participants
Prior to data collection, the researchers were granted Institutional Review Board approval to conduct the research. We utilized Qualtrics as a survey management website to conduct a web-based survey to collect data from practicing counselors. We invited 9,521 counselors to participate; however, eligible participants were only counselors who experienced a client suicide, and many invited participants did not meet this study requirement. Potential participants’ names and email addresses were accessed from the Florida licensing board and publicly available state counseling association directories, including those from Alabama, Connecticut, Georgia, Illinois, Kentucky, Maine, Missouri, New Hampshire, New Jersey, Rhode Island, Texas, and Wyoming. We distributed the survey through an initial email that provided a description of the study and included a link to the web-based survey. Potential participants who did not complete the survey and did not choose to opt out of the survey received a second email. Finally, participants who did not respond after the first two emails received a final email reminder. Emails and survey materials were developed according to the Tailored Design Method (Dillman et al., 2014). No incentive was provided for participation in this study.
Of the 9,521 potential participants contacted, 980 of the addresses provided were invalid. In addition, 172 individuals responded to the invitation and indicated that they had not experienced a client suicide. Out of the resulting 8,369 potential participants, 228 participants completed the survey (2.7% useable response rate). The response rate was low; however, only counselors who had experienced a client suicide were appropriate for the survey and it is likely that approximately 75% of those surveyed did not meet the qualifications for this survey (McAdams & Foster, 2002). Also, Dillman et al. (2014) noted that low response rates may be acceptable for niche populations that are difficult to directly access. We used an a priori power analysis (Balkin & Sheperis, 2011) with a power of .8, an alpha error probability of .05, and a .25 effect size, resulting in a required sample size of 200 for the most robust statistical test we used in our data analysis.
Our participants (N = 228) were predominately Caucasian females. Also, participants had a mean age of 49.1 (SD = 11.6, Mdn = 48) with 15.5 years of experience (SD = 10, Mdn = 14). Table 1 describes additional demographics of our participants, including their race/ethnicity, licensure status, professional orientation, and the agency type that employed them.
Table 1
Participant Demographics
Variable
n
%
Gender
Female
175
76.8
Male
51
22.4
Other
2
0.9
Race/Ethnicity
Caucasian
174
76.3
Black or African American
21
9.2
Hispanic or Latino
19
8.3
Multiracial
9
3.9
Asian
3
1.3
Native Hawaiian or Other Pacific Islander
1
0.4
Other
1
0.4
Professional Orientation
Licensed professional counselors (LMHC, LPC etc.)
159
69.7
School counselors
43
18.9
Marriage and family therapists
7
3.1
Clinical psychologists
8
3.5
Social workers
3
1.3
Other
8
3.5
License Level
Fully licensed
190
83.3
Provisional license
23
10.1
Other
15
6.6
Employment setting
Outpatient
58
25.4
K–12 schools
54
23.7
Inpatient
43
18.9
Private practice
35
15.4
Community mental health
8
3.5
Corrections
8
3.5
College counseling
6
2.6
Intensive in-home
4
1.7
Social services
4
1.7
Government
4
1.8
Shelter and domestic violence
2
0.9
Telephone counseling
1
0.4
Religious-based counseling
1
0.4
Note. N = 228
Measures
For the purpose of this study, three measures were utilized: (a) the Short Supervisory Relationship Questionnaire (S-SRQ; Cliffe et al., 2016), (b) the Survey of Perceived Organizational Support (SPOS; Eisenberger et al., 1986), and (c) the Impact of Event Scale–Revised (IES-R; Weiss & Marmar, 1997). We also used open-response questions to ask about client suicide experiences and perceptions of agency responses. Participants completed a demographics form that queried participants’ personal information (e.g., age, race, ethnicity, and gender) as well as professional experiences (e.g., discipline, years of experience, and agency responses).
S-SRQ
Cliffe et al. (2016) created the S-SRQ scale, which is an 18-item self-report scale to measure an individual’s perception of their supervisory relationship with their supervisor. Respondents identified their level of agreement to each item on a 7-point Likert scale that ranged from strongly disagree to strongly agree. Sample statements on the S-SRQ include “my supervisor was approachable,” “my supervisor encouraged me to reflect on my practice,” and “supervision sessions were focused.” Evidence for reliability was described by Cliffe et al., including internal consistency (α = .96), and test-retest reliability (r = .94). In the present study, the measure had excellent internal consistency as measured by Cronbach’s alpha (α = .95).
SPOS
The SPOS is a one-factor scale created by Eisenberger et al. (1986). The SPOS scale measures whether individuals believe their organizations care about their well-being. The original scale had 32 items; however, we utilized the eight-item short form self-report measure. Respondents rated their agreement to each statement on a 7-point Likert scale (strongly disagree to strongly agree). The SPOS includes statements such as “The organization values my contribution to its well-being” and “Even if I did the best job possible, the organization would fail to notice.” For scoring purposes, we reverse-scored negatively worded items and summed all items to find a final score. With the full scale, Eisenberger et al. found evidence of internal consistency (α = .97). The current sample had high internal consistency (α = .95).
IES-R
Weiss and Marmar (1997) created the IES-R scale to examine stress responses or PTSD symptoms following an event. The IES-R has 22 items and consists of three subscales, Intrusion (eight items), Avoidance (eight items), and Hyperarousal (six items). Participants responded to items asking about the degree of distress they have been experiencing in the previous 7 days. The IES consists of items such as “Other things kept making me think about it” and “I stayed away from reminders of it.” Responses are on a 5-point Likert scale from 0 (not at all) to 4 (extremely). Participants took the scale twice—once as recommended relating to current experiences (IES-Rc) and once as they remembered their experiences during the first 7 days after the client suicide happened (IES-Rp). Weiss and Marmar reported evidence for good internal consistency for Intrusion (α = .89), Avoidance (α = .84), and Hyperarousal (α = .82). The current sample resulted in Cronbach’s alphas of .90, .86, and .87 respectively. The adapted scale had similar Cronbach’s alphas to the original scale, .90, .88, and .88, respectively.
Open-Ended Responses
We used open-ended questions to assess information not captured by the previous instruments and to gain insight into factors participants believed were helpful or unhelpful in the experience. We asked four open-ended questions: (a) “At the time of your first client suicide, what was most helpful in this experience?” (b) “At the time of your first client suicide, what was least helpful in this experience?” (c) “Thinking back on your experience of your first client suicide, what more could your agency have done that you might have found helpful?” and (d) “Thinking back on your first client suicide, what would you have liked the agency to have done less of, or differently?”
Agency Policies
We asked participants to choose from a list of possible agency policies for responding to client suicide that their agency had in place at the time of the suicide. We also asked participants if they perceived these policies to be helpful in their coping with the event. Policy options included extra supervision, mandated counseling, mandated debriefing, mandated time off, additional paperwork, an option to select “other” along with a text box to explain, and an option for “no policy.” Participants were encouraged to select all options that applied.
Data Analysis
A cross-sectional research design was utilized for this study. Upon completion of data collection, numerical data was transferred to SPSS (Version 23) to conduct statistical analyses. To assess responses to the open-ended questions, we followed Brown’s (2009) method to individually code participants’ responses into categorical themes and clusters. We then compared codes and negotiated results to come to a consensus on categories (Creswell & Poth, 2018). We assessed frequencies and descriptive statistics of these themes to determine the most prevalent participant responses. We examined statistical assumptions (e.g., independence of cases, normality, and homoscedasticity; Tabachnick & Fidell, 2007) for each measure, including the Kolmogorov-Smirnov measure for normality. Data were analyzed with frequencies and descriptive statistics, Pearson’s correlations, one-way analysis of variance (ANOVA), and a simple linear regression (SLR), independent samples t-test, and chi-square goodness-of-fit and tests of independence.
Results
Our first research question examined the impact of supervision and organizational supports as moderators of the impact of client suicide on counselor survivors. More specifically, we wanted to determine whether or not the supervisory relationship (S-SRQ; Cliffe et al., 2016) and counselors’ perceptions of organizational support (SPOS; Eisenberger et al., 1986) predicted the impact of client suicide on the counselor survivor at the time of the event (IES-Rp; Weiss & Marmar, 1997) and at the present (IES-Rc; Weiss & Marmar, 1997). The findings of this research question are reported below.
Participants who reported being under supervision when they experienced a client suicide (n = 118) completed the S-SRQ (M = 96.9, SD = 25) as a measure of their supervisory relationship, and the IES-Rp (M = 45.1; SD = 15.9) and IES-Rc (M = 26.6; SD = 8.4). An SLR was calculated to predict the impact of events at the time of the event based on the counselor survivor’s supervisory relationship at the time of the event. A significant regression equation was found (F[1,116] = 6.9, p = .01) with an R2 of .06. Participants’ impact of events at the time of the event decreased .15 for each point increase in supervisory relationships. This indicates that a strong supervisory relationship at the time of a client suicide may help mitigate counselor survivors’ symptoms. An SLR was also calculated to examine the impact of events at the present with their supervisory relationship at the time of the event. However, the findings were not significant (F[1,116] = 57.53, p = .37), suggesting that any differences found between supervisory relationship and the current impact of events may be attributed to chance.
All respondents (N = 228) completed the SPOS (M = 23.9, SD = 3.5), the IES-Rp (M = 43.7, SD = 16.1), and the IES-Rc (M = 26.8, SD = 9.4). Bivariate correlations revealed a lack of significance between SPOS and either impact of events scale (p = .6 for each). We also conducted an ANOVA to examine the effect of perceived level of support based on agency type and found no significant difference in SPOS scores based on agency type (F[7, 220] = 1.084, p = .4). Contrary to expectations, SPOS did not seem to affect the counselor survivors’ experience of client suicide.
Agency Responses
Our second research question inquired about agency policies governing responses to the counselor survivor at the time of a client suicide. Possible agency policies that respondents could choose from included no policy; debriefing of the event; required paperwork; extra supervision; mandated personal counseling; mandated time off; and a final category, “other,” which allowed respondents to fill in an answer that was not listed in the choices. Respondents were provided with the opportunity to choose as many responses as applied; thus, the responses cumulatively totaled over 100%. The most frequently indicated response for agency-initiated policies was no policy (n = 118, 52%). This was followed by mandated debriefing of the event (n = 63, 28%), required paperwork (n = 57, 25%), extra supervision (n = 16, 7%), mandated counseling (n = 8, 4%), and mandated time off (n = 4, 2%). Fourteen respondents (6%) chose “other” to indicate that the agency enforced a policy not listed in the choices. Write-in responses that differed from the listed choices included group debriefing (n = 6), psychological autopsy (n = 2), notification of administrators (n = 2), crisis team intervention (n = 1), and liability review (n = 1).
We conducted a chi-square test of independence to determine if agency type differed according to the presence of an agency policy for counselor support at the time of suicide. Because of insufficient group size of some of the agency types, only participant responses from agency types that had over five participants (outpatient [n = 59], K–12 schools [n = 54], private practice [n = 34], acute psychiatric [n = 26], and residential [n = 16]) were included in the analysis. A significant difference was detected with this test (χ2 = 14.3, p < .01), which indicated that some agency types may be more likely to have a policy in place than others. We then followed up with multiple chi-square goodness-of-fit tests, which revealed that participants who worked in acute psychiatric settings (n = 26, χ2 = 5.6, p < .05) were significantly more likely to have a policy in place than other agency types, and participants who worked in private practice settings (n = 34, χ2 = 5.77, p < . 05) were significantly more likely to have no policy in place than participants who worked in other settings.
Helpfulness of Agency Responses
Regarding our third research question, participants (N = 228) were asked to rate the level of helpfulness of responses to client suicide. Of the participants who reported receiving counseling after client suicide (n = 99, 43%), 54 (55%) participants reported that this agency response was either very helpful or extremely helpful. Additionally, 28 (28%) participants reported counseling as moderately helpful, 13 (13%) reported counseling as a little helpful, and four (4%) participants reported counseling as not helpful at all.
Over one-third (n = 77, 34%) of participants reported that they took time off work after a client suicide. Most of the participants who reported taking time off reported it was very helpful or extremely helpful (n = 41, 53%). This was followed by those who found time off as moderately helpful (n = 15, 20%), a little helpful (n = 12, 16%), and not helpful at all (n = 9, 12%).
Participant responses to our questions inquiring about agency policies and mandated responses differed from responses to perceived helpfulness of agency responses. For example, only eight individuals indicated that their agency mandated personal counseling, whereas 99 individuals indicated that they engaged in personal counseling after the event and rated the perceived helpfulness of the counseling. Similarly, only four participants indicated their agency required they take time off, whereas 77 participants reported that they took time off and rated the helpfulness of this response. These discrepancies are likely due to the wording of “mandated” in the item choices related to agency policy responses, as most participants (n = 118, 52%) indicated that their agencies had no formal policy.
Participants described debriefing discussions related to the counselors’ emotional experience of the event (n = 140, 61%) and the actions of the counselor leading up to the event (n = 136, 59%). Sixty-three (45%) participants described debriefings related to the emotions of the experience as very helpful or extremely helpful. Other participants expressed that emotional debriefing was moderately helpful (n = 31, 22%), a little helpful (n = 36, 26%), or not helpful at all (n = 10, 7%). Debriefings related to the actions of the counselor were reported by 60 (44%) participants to be very helpful or extremely helpful, whereas 34 (25%) participants identified them as moderately helpful, and 42 participants indicated that debriefing of the actions of the counselor was either a little helpful (n = 26, 19%) or not helpful (n = 16, 12%).
Participants (n = 92, 40%) also described their perception of audits of the client’s chart. About half of the respondents (n = 47, 51%) described their audit experience as only a little helpful or not helpful. Fewer (n = 24, 26%) found audits to be very helpful or extremely helpful and 13 (14%) respondents indicated audits as moderately helpful.
Some participants (n = 72, 32%) reported agencies providing additional training for counselors when there was a suicide in the agency. Additional training was reported as very helpful or extremely helpful 63% of the time (n = 45). Twenty-four (33%) participants described additional training as moderately helpful, whereas three (4%) participants indicated receiving additional training as not helpful at all. Only 25% (n = 58) of participants were provided with increased supervision. Twenty-five (43%) of these participants found it very helpful or extremely helpful, 11 (19%) viewed their additional supervision as moderately helpful, and 22 participants (38%) reported increased supervision as only a little helpful or not helpful at all.
Strategies to Improve Agency Responses
We asked participants open-ended questions regarding agency responses that should be improved, changed, or reduced to improve care of future counselor survivors and categorized these into themes. The most frequent response, which occurred in 29% (n = 94) of responses, indicated that increased empathy and acknowledgement of the traumatic nature of the experience would be most helpful. Sample statements from participants included “more focus on the emotional impact on the clinicians,” “reacted to me as a person and as someone who was also grieving instead of just someone who needed to do their job,” “given me some attention and validation for my distress,” “the school I was at never asked about my wellness,” and “I felt like the suicide was viewed as an unfortunate part of being a counselor.” Some participants (n = 51, 18%) described a need for more thorough debriefing and discussion of the event (e.g., “provide a more thorough debriefing,” “been more open to processing the issue”).
Many participants (n = 37, 11%) indicated feeling unprepared to deal with client suicide and recommended further training and resources so that they would be better prepared if they or others were to face a similar situation again. Similarly, participants reported that it would be helpful if their employers had clearer policies and procedures about how to handle client suicide. Participants expressed a desire for agencies to provide policies and procedures (n = 34, 11%) and indicated that these policies should not focus solely on “pointing the finger” or assigning blame (n = 17, 5%) but on the emotional impact of the death on counselor wellness.
Discussion
Client suicide is a painful personal and professional experience for counselors (Ellis & Patel, 2012). Unfortunately, client suicide is not a rare occurrence for counselors (McAdams & Foster, 2000). For the purpose of our study, we examined how organizational and supervisory support might mitigate the impact of the client suicide on counselor well-being. We also examined the supports offered in various work environments and the perceived helpfulness of this outreach in counselor survivor coping.
Supervisory Support
Our first research question was related to the effect of supervisor and organizational support on the impact of client suicide on the counselor survivor. Based on our findings, stronger supervisor relationships seemed to help participants process their experience of client suicide. This may align with Knox et al. (2006), who suggested that negative interactions with supervisors can prohibit the counselor’s coping. Conversely, supportive supervisory interactions, such as those actions that address counselor survivors’ grief and loss experiences (e.g., accepting responses, openly discussing the loss and trauma, creation of a safe environment), could have a lasting impact on the counselor survivors’ recovery (Ellis & Patel, 2012). According to Broadbent (2013), supportive supervision assisted grieving counselors in experiencing greater empathy and connectedness within their future therapeutic relationships. Effective supervision included developing a safe place in which supervisees felt “heard and witnessed” and affirmed (Broadbent, 2013, p. 268).
We did not find supervisory relationships to have a significant impact on participants’ experience at the present. We suspect that one reason for the lack of impact of supervisory relationships on the current impact of events was that the grief and trauma may have changed and lessened over time, as evidenced by a dramatic reduction in mean scores between IES-Rp and IES-Rc (45 and 27 respectively). Similarly, other life events may have influenced the counselor survivors between the suicide of their client and the present which could serve to diminish the impact of the supervisory relationship on how participants perceived client suicide.
Implications for Mental Health Organizations
Surprisingly, we found no effect of organizational support and the impact of the event on counselor survivors. A number of questions from the SPOS were focused on the employee’s contribution, accomplishments, and effort. However, when coping with client suicide participants reported a desire for emotional care and support. Based on our quantitative data, the support participants perceived from agencies did not influence the IES scores, but participants’ qualitative responses revealed they valued agency responses that demonstrated support for the counselor as a person (e.g., additional counseling, empathy, debriefings related to the counselor’s experience).
Participants expressed a desire for agencies to treat them more holistically, and to recognize that they had experienced a trauma. Other researchers also indicated need for empathic support for the clinician following a client suicide. For example, Ellis and Patel (2012) expressed that “clinicians and supervisors should recognize the right (and responsibility) to engage in self-care activities following a client’s suicide” (p. 285). In contrast, our participants reported finding administrative responses focused on agency liability (e.g., chart audit, debriefings related to the actions of the counselor survivor) as unhelpful.
Nearly half of participants indicated that debriefings were helpful. Participant responses to open-ended questions indicated that debriefings were helpful when focused on the emotional experience of the event. In practice, agencies can work to enhance the debriefing procedures they use. The authors encourage agencies to carefully avoid blaming or finger pointing within debriefing procedures, as these responses often have deleterious effects on counselor survivors. Instead, agencies can provide an environment in which the client suicide can be discussed safely and openly, and offer an opportunity for learning and growth.
Despite relatively infrequent agency utilization, counselor survivors who received trainings related to suicide prevention reported these trainings as one of the most helpful responses to client suicide. Many participants reported not feeling prepared for a client suicide and a desire that their agency would have provided additional trainings that could have prepared them for the loss or helped them better respond to the suicidal client. Trainings may include a wide variety of topics such as factors to look for to recognize suicidal ideation, development of a concrete method of responding to expressions of suicidal ideation/intent, discussion of consultation practices, possible steps that a counselor may take when facing client suicidal ideation, when to explore hospitalization, and how to increase the network of people who know about the client’s suicidal ideations. Participants reported that increased trainings would heighten their self-efficacy in working with clients experiencing suicidal ideation, intent, and planning. Additional training may help counselors feel more prepared to work with suicidal clients and thereby reduce client suicide while also increasing the counselor’s feelings of competence (e.g., Ellis & Patel, 2012).
Training should not only include knowledge and skills, but also the development of appropriate attitudes around client suicide (Ellis & Patel, 2012; Michel, 1997). Considering the lack of self-efficacy identified by our participants in response to client suicide, when developing additional trainings, we suggest consideration of Bandura’s theory of self-efficacy which holds that mastery experiences, vicarious experiences, and verbal persuasion can be used to increase confidence (Bandura, 1986). Trainings developed with bolstering self-efficacy in mind can help counselors develop beliefs that they can effectively work with suicidal clients. Best practice indicates that trainings should occur after the counselor survivor has time to recover, whereas supportive resources to assist with grief reactions can be offered immediately following the event (Dransart et al., 2017).
Agencies and supervisors must develop a realistic sense of the extent and limits of a clinician’s responsibilities regarding client suicide (Ellis & Patel, 2012), but they must do so in an empathic manner. Our participants often reported feeling ill-prepared for client suicide, and then blamed, questioned, or challenged about their treatment of the client; this unempathetic response was prohibitive to counselor coping. Agencies and supervisors can instead offer more helpful supportive resources such as emotional debriefing, time off, and personal counseling, and then implement suicide prevention trainings to bolster self-efficacy after the counselor survivor has stabilized. Suicide prevention training is effective in preventing suicide and in reducing self-doubt and questioning when a suicide occurs (Dransart et al., 2017).
Suicide Response Policy
Over 50% of respondents shared that their agency did not have a formal policy of response to the counselor survivor. Although we found no effect of this lack of protocol on participants’ IES scores, participants from this study, along with researchers in other studies, have suggested that agency responses can be valuable supports to counselor survivors (e.g., Hendin et al., 2000; Michel, 1997; Ting et al., 2006). Counselor survivors in our study reported that organized and empathic agency responses were helpful for their recovery. We found that organizations that predominantly treat higher acuity cases (i.e., acute psychiatric) may be more likely to have a policy in place, perhaps because of the frequency of suicide. However, even agencies less likely to experience client suicide would benefit from a pre-planned agency response policy.
Although organizations and supervisors may have informal responses to counselor survivors and clinical teams, researchers (e.g., Michel, 1997; Ting et al., 2006) have argued that a formal policy can have some beneficial effects. Postvention is an organized response that provides “psychological support, crisis intervention and other forms of assistance” to survivors of suicide (Higher Education Mental Health Alliance, 2018, p. 6). Based on our findings, helpful formal postvention policies include debriefing of the counselor survivor’s emotional experience, suggested time off for self-care and personal counseling, and recommended follow-up trainings for handling future suicidality in clients.
Larger mental health treatment teams such as community mental health agencies or university counseling centers may develop a postvention team that creates a hierarchy and communication chain for informing appropriate parties (including the counselor survivor) in a timely and sensitive manner. Michel (1997) suggested this postvention should include tiered plans specific to staff levels (e.g., therapists, supervisors, administration) that take into consideration confidentiality and the professional closeness of the employee to the client. Thus, responses to those who work closely with the client (e.g., counselor survivors) may be different than to those who are more removed from the client (e.g., administration).
Beyond simply having an action plan, based on our findings and our literature review (e.g., Dransart et al., 2017), we believe that agencies should specifically focus on trainings conducted as preventative measures. Some trainings should include information on how to recognize factors that increase suicide risk among clients. Additional needed trainings may address how to respond to high-risk clients and clients who report suicidal ideations or intent.
Limitations and Future Research
Our study was a cross-sectional survey study; as such, we were only able to examine one point in time. We asked participants to reflect on their experiences of client suicide and how it impacted them at the time, as well as how they currently experienced the impact. The passage of time likely influenced participants’ memories of their traumatic experience and might have impacted our results. Because of these limitations, future longitudinal examination of the experience of client suicide may be warranted. Our low response rate, though acceptable based on the niche population (Dillman et al., 2014), and our use of convenience sampling inherently reduces the generalizability of our findings. We cannot claim that the counselors we found through this method are representative of all counselor survivors. As such, future research that can reach a more representative sample of counselors who have experienced a client suicide could be valuable in reproducing our findings.
There also may be some limitations with our scales. The IES-R scale was originally created to account for the impact of events as perceived within the last 7 days (Weiss & Marmar, 1997) and our use of the IES for recalling past experiences has limited supporting evidence. In addition, the SPOS scale may have been focused more on the organizational structure as opposed to the immediate working environment the counselor survivors faced. Although our findings are generally consistent with previous researchers (e.g., Ellis & Patel, 2012; Michel, 1997), they should be considered in light of these limitations.
Summary and Implications for Counseling
Our findings highlight client suicide as a traumatic event for counselor survivors and their subsequent desire for emotional support in the aftermath. Our results inform counselors and mental health agencies of ways they can provide an active and emotionally aware response that recognizes the impact of the event and the myriad of emotions the counselor survivor might be experiencing. Our findings especially indicate the need for counselors to receive supportive supervision (e.g., that supervisors are approachable, respectful, non-judgmental, and collaborative; Cliffe et al., 2016), as this seems to impact counselor survivors’ experience of client suicide. Our findings support the need for counselors to continue to take care of themselves, find support from others, and pursue their own counseling.
For community agencies, administrators, and supervisors, having an action plan detailing how the agency will respond to crises such as client suicide may increase the thoroughness of agency responses to affected individuals including the counselor survivor. The development of a crisis plan increases sensitivity and awareness, and contributes to the development of an institutional culture in which postvention after a client suicide is common practice. Considering the potential benefits of having an action plan, the number of respondents who suggested the agency where they are employed has no protocol or plan in place in the event of a client suicide is concerning. Recommended agency policies may include encouraging the counselor survivor to engage in personal counseling or take time off, or facilitating empathic debriefings and future suicide prevention trainings.
Conflict of Interest and Funding Disclosure The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
References
Ahmedani, B. K., Simon, G. E., Stewart, C., Beck, A., Waitzfelder, B. E., Rossom, R., Lynch, F., Owen-Smith, A., Hunkeler, E. M., Whiteside, U., Operskalski, B. H., Coffey, M. J., & Solberg, L. I. (2014). Health care contacts in the year before suicide death. Journal of General Internal Medicine, 29(6), 870–877. https://doi.org/10.1007/s11606-014-2767-3
Balkin, R. S., & Sheperis, C. J. (2011). Evaluating and reporting statistical power in counseling research. Journal of Counseling & Development, 89(3), 268–272. https://doi.org/10.1002/j.1556-6678.2011.tb00088.x
Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice Hall.
Broadbent, J. R. (2013). ‘The bereaved therapist speaks.’ An interpretative phenomenological analysis of humanistic therapists’ experiences of a significant personal bereavement and its impact upon their therapeutic practice: An exploratory study. Counselling and Psychotherapy Research, 13(4), 263–271. https://doi.org/10.1080/14733145.2013.768285
Brown, J. D. (2009). Open-response items in questionnaires. In J. Heigham & R. A. Croker (Eds.), Qualitative research in applied linguistics: A practical introduction (pp. 200–219). Palgrave MacMillan.
Christianson, C. L., & Everall, R. D. (2009). Breaking the silence: School counsellors’ experiences of client suicide. British Journal of Guidance & Counselling, 37(2), 157–168. https://doi.org/10.1080/03069880902728580
Cliffe, T., Beinart, H., & Cooper, M. (2016). Development and validation of a short version of the Supervisory Relationship Questionnaire. Clinical Psychology & Psychotherapy, 23(1), 77–86. https://doi.org/10.1002/cpp.1935
Council for Accreditation of Counseling and Related Educational Programs. (2015). 2016 CACREP standards. http://www.cacrep.org/wp-content/uploads/2017/08/2016-Standards-with-citations.pdf
Creswell, J. W., & Poth, C. N. (2018). Qualitative inquiry and research design: Choosing among five approaches (4th ed.). SAGE.
Darden, A. J., & Rutter, P. A. (2011). Psychologists’ experiences of grief after client suicide: A qualitative study. Omega: Journal of Death and Dying, 63(4), 317–342. https://doi.org/10.2190/OM.63.4.b
Dillman, D. A., Smyth, J. D., & Christian, L. M. (2014). Internet, phone, mail, and mixed-mode surveys: The tailored design method (4th ed.). Wiley.
Dransart, D. A. C., Treven, M., Grad, O. T., & Adriessen, K. (2017). Impact of client suicide on health and mental health professionals. In K. Andriessen, K. Krysinska, & O. T. Grad (Eds.), Postvention in action: The international handbook of suicide bereavement support (pp. 245–254). Hogrefe.
Draper, B., Kōlves, K., De Leo, D., & Snowdon, J. (2014). The impact of patient suicide and sudden death on health care professionals. General Hospital Psychiatry, 36(6), 721–725. https://doi.org/10.1016/j.genhosppsych.2014.09.011
Eisenberger, R., Huntington, R., Hutchison, S., & Sowa, D. (1986). Perceived organizational support. Journal of Applied Psychology, 71(3), 500–507. https://doi.org/10.1037/0021-9010.71.3.500
Ellis, T. E., & Patel, A. B. (2012). Client suicide: What now? Cognitive and Behavioral Practice, 19(2), 277–287. https://doi.org/10.1016/j.cbpra.2010.12.004
Fairman, N., Thomas, L. P. M., Whitmore, S., Meier, E. A., & Irwin, S. A. (2014). What did I miss? A qualitative assessment of the impact of patient suicide on hospice clinical staff. Journal of Palliative Medicine, 17(7), 832–836. https://doi.org/10.1089/jpm.2013.0391
Gill, I. J. (2012). An identity theory perspective on how trainee clinical psychologists experience the death of a client by suicide. Training and Education in Professional Psychology, 6(3), 151–159. https://doi.org/10.1037/a0029666
Grad, O. T., & Michel, K. (2004). Therapists as client suicide survivors. Women & Therapy, 28(1), 71–81. https://doi.org/10.1300/J015v28n01_06
Hendin, H., Lipschitz, A., Maltsberger, J. T., Haas, A. P., & Wynecoop, S. (2000). Therapists’ reactions to patients’ suicides. The American Journal of Psychiatry, 157(12), 2022–2027. https://doi.org/10.1176/appi.ajp.157.12.2022
Higher Education Mental Health Alliance. (2018). Postvention: A guide for response to suicide on college campuses. http://hemha.org/wp-content/uploads/2018/06/jed-hemha-postvention-guide.pdf
Kleespies, P. M., & Dettmer, E. L. (2000). An evidence-based approach to evaluating and managing suicidal emergencies. Journal of Clinical Psychology, 56(9), 1109–1130.
Knox, S., Burkard, A. W., Jackson, J. A., Schaack, A. M., & Hess, S. A. (2006). Therapists-in-training who experience a client suicide: Implications for supervision. Professional Psychology: Research & Practice, 37(5), 547–557. https://doi.org/10.1037/0735-7028.37.5.547
Luoma, J. B., Martin, C. E., & Pearson, J. L. (2002). Contact with mental health and primary care providers before suicide: A review of the evidence. American Journal of Psychiatry, 159(6), 909–916. https://doi.org/10.1176/appi.ajp.159.6.909
McAdams, C. R., III, & Foster, V. A. (2000). Client suicide: Its frequency and impact on counselors. Journal of Mental Health Counseling, 22(2), 107–121.
McAdams, C. R., III, & Foster, V. A. (2002). An assessment of resources for counselor coping and recovery in the aftermath of client suicide. The Journal of Humanistic Counseling, Education and Development, 41(2), 232–241. https://doi.org/10.1002/j.2164-490X.2002.tb00145.x
McIntosh, J. L., & Drapeau, C. W. (2020). U.S.A. suicide 2018: Official final data. American Association of Suicidology. https://suicidology.org/wp-content/uploads/2020/02/2018datapgsv2_Final.pdf
Michel, K. (1997). After suicide: Who counsels the therapist? Crisis, 18(3), 128–130. https://doi.org/10.1027/0227-5910.18.3.128
Nock, M. K., Hwang, I., Sampson, N. A., & Kessler, R. C. (2010). Mental disorders, comorbidity and suicidal behavior: Results from the National Comorbidity Survey Replication. Molecular Psychiatry, 15(8), 868–876. https://doi.org/10.1038/mp.2009.29
Rogers, J. R., Gueulette, C. M., Abbey-Hines, J., Carney, J. V., & Werth, J. L. (2001). Rational suicide: An empirical investigation of counselor attitudes. Journal of Counseling & Development, 79(3), 365–372. https://doi.org/10.1002/j.1556-6676.2001.tb01982.x
Sanders, S., Jacobson, J., & Ting, L. (2005). Reactions of mental health social workers following a client suicide completion: A qualitative investigation. Omega: Journal of Death and Dying, 51(3), 197–216. https://doi.org/10.2190/D3KH-EBX6-Y70P-TUGN
Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Allyn & Bacon.
Ting, L., Sanders, S., Jacobson, J. M., & Power, J. R. (2006). Dealing with the aftermath: A qualitative analysis of mental health social workers’ reactions after a client suicide. Social Work, 51(4), 329–341. https://doi.org/10.1093/sw/51.4.329
Weiss, D. S., & Marmar, C. R. (1997). The Impact of Event Scale—Revised. In J. P. Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD (pp. 399–411). Guilford.
Nathaniel J. Wagner, PhD, LMHC, is an assistant professor at Indiana State University. Colleen M. L. Grunhaus, PhD, NCC, ACS, LPC, is an assistant professor at the University of the Cumberlands. Victor E. Tuazon, PhD, NCC, LPC, is an assistant professor at New Jersey City University. Correspondence may be addressed to Nathaniel Wagner, 401 N. 7th Street, Terre Haute, IN 47809, nathaniel.wagner@indstate.edu.
Studies from allied professions suggest that intentional nondisclosure in clinical supervision is common; however, the types of intentional nondisclosure and reasons for nondisclosure have yet to be examined in an adequate sample of counselors-in-training (CITs). The current study examined intentional nondisclosure by CITs during their onsite supervision experience. We utilized content analysis to examine examples of intentional nondisclosure. Sixty-six participants provided examples of intentionally withholding information from their supervisors they perceived as significant. The most common types of information withheld were negative reactions to supervisors, general client observations, and clinical mistakes. The most common reasons cited were impression management, perceived unimportance, negative feelings, and supervisor incompetence. We offer implications for both supervisees and supervisors on how they might mitigate intentional nondisclosure; for example, we present strategies to address ineffective or harmful supervision, discuss techniques to openly address intentional nondisclosure, and explore ways to integrate training on best practices in clinical supervision.
Keywords: intentional nondisclosure, counselors-in-training, supervision, content analysis, best practices in clinical supervision
Counselors-in-training (CITs) in programs accredited by the Council for Accreditation of Counseling & Related Educational Programs (CACREP) are required to complete two supervised onsite field experiences (i.e., practicum and internship) in their area of interest (e.g., clinical mental health, school, rehabilitation; CACREP, 2015). The purpose of this onsite field experience is for CITs to learn the roles and responsibilities of being a professional counselor by applying what they learn in their training programs to their work in a counseling setting (CACREP, 2015). Given CITs’ limited clinical experience, onsite supervisors provide weekly supervision to aid CITs in their professional development (Borders et al., 2011; Borders et al., 2014). Although supervision is a unique opportunity, CITs receive problematic mixed messages about the expectations of the supervisory process (Borders, 2009). CITs are encouraged to discuss the topics and concerns that are the most important to their professional growth (Bordin, 1983), but the information shared is then used by their supervisors to evaluate their clinical performance (Bernard & Goodyear, 2014). These evaluations have a definitive impact on CITs’ ability to pass a practicum or internship course or graduate (CACREP, 2015) and subsequently secure employment in the counseling field. Thus, it is not surprising that studies in allied professions (e.g., clinical psychology, counseling psychology, social work) have shown that trainees commonly withhold potentially unflattering information from their supervisors (Hess et al., 2008; Ladany, Hill, Corbett, & Nutt, 1996; Mehr, Ladany, & Caskie, 2010, 2015; Pisani, 2005). While CITs’ concern to maintain a favorable image in the eyes of their supervisor is understandable, withholding information can result in missed learning opportunities for CITs and negatively impact their clients (Hess et al., 2008).
To date, only two studies have examined supervisee intentional nondisclosure in a sample of counselor education students (Cook & Welfare, 2018; Lonn & Juhnke, 2017). However, neither study examined specific examples of the types and reasons of CIT nondisclosure during onsite supervision. Counselors submit to a unique training model, with specific requirements and goals for master’s-level counselors (e.g., CACREP, 2015). CITs enrolled in CACREP-accredited programs can specialize in one of seven tracks: (a) addictions counseling; (b) career counseling; (c) clinical mental health counseling; (d) clinical rehabilitation counseling; (e) college counseling and student affairs; (f) marriage, couple, and family counseling; (g) school counseling; and (h) rehabilitation counseling. As a result, CITs work in diverse settings with a wide variety of responsibilities that are unique to the counseling profession (CACREP, 2015; Lawson, 2016). Without a study focused on CITs’ experiences in onsite supervision, CITs and supervisors must rely on findings from allied professions that may or may not reflect the counseling training model. Thus, in the current study we aimed to examine the types of intentional nondisclosure and the reasons for the nondisclosure during CITs’ supervised onsite field experience.
Supervised Onsite Field Experience in CACREP-Accredited Programs
Given the growing importance of attending a CACREP-accredited program as an educational requirement for professional counselors (Lawson, 2016), we chose to specifically target intentional nondisclosure by CITs enrolled in CACREP-accredited training programs. State licensure boards are encouraging or mandating that those pursuing professional licensure as counselors must have a degree from a CACREP-accredited program (Lawson, 2016). Additionally, as of January 1, 2022, those applying to be National Certified Counselors (NCCs) will need to graduate from a CACREP-accredited program (National Board for Certified Counselors, 2014). Thus, the standards for onsite field experiences outlined in the 2016 CACREP Standards provide clear guidelines for counselor training. Furthermore, the activities during the onsite field experience are designed to mimic those of a professional counselor in the field (CACREP, 2015). Exploring CIT intentional nondisclosure within the CACREP educational structure can help to inform best practices in counselor training.
Intentional Nondisclosure in Clinical Supervision
The supervision process is reliant on CITs to self-identify important information to share with their supervisors (Ladany et al., 1996); however, identifying this important information is not always clear to CITs given the intricacies of the client–counselor relationship (Farber, 2006; Knox, 2015). Farber (2006) suggested that some nondisclosure “is normative and unavoidable in supervision” (p. 181). Yet, there are instances in which CITs purposefully withhold information they know is relevant because of concerns for what could happen if they shared the information with their supervisor (Hess et al., 2008; Yourman & Farber, 1996).
So why would CITs, who are held to the same ethical standards as practicing counselors (American Counseling Association [ACA], 2014), knowingly choose to withhold information that could be harmful to their professional development or their clients’ treatment? During an onsite field experience, CITs learn the day-to-day tasks of being a professional counselor (e.g., establishing rapport, planning treatment, managing paperwork), but they also must meet the demands of their graduate training programs. Most CITs want to perform counselor functions at a high level, if not perfectly (Rønnestad & Skovholt, 2003). Avoiding clinical mistakes is a dubious belief that CITs hold for themselves (Knox, 2015). These high expectations create a reasonable desire to present oneself favorably to their supervisors, even though supervisors know that perfection is impossible (Farber, 2006). Moreover, CITs are told to share information that is most salient to their personal and professional development with their supervisors, but disclosing information that may be potentially unflattering or embarrassing can then be used by supervisors to evaluate performance (Borders, 2009).
Types and Reasons for Intentional Nondisclosure
In a seminal study on intentional nondisclosure, Ladany et al. (1996) investigated the types and reasons for nondisclosure in a sample of clinical and counseling psychology trainees. Participants were asked to identify instances in which they withheld information from their supervisors and then provide a rationale for why they failed to share that information. The authors found that 97.2% of the participants withheld information from their supervisors.
Through categorizing the content of the nondisclosures, Ladany et al. identified 13 types of nondisclosure, providing definitions and examples of each type: (a) negative reactions to supervisor (e.g., unfavorable thoughts or feelings about supervisors or their actions); (b) personal issues (e.g., information about an individual’s personal life that may not be relevant); (c) clinical mistakes (e.g., an error made by a counselor); (d) evaluation concerns (e.g., worry about the supervisor’s evaluation);
(e) general client observations (e.g., reactions about the client or client treatment); (f) negative reactions to client (e.g., unfavorable thoughts or feelings about clients or clients’ actions); (g) countertransference (e.g., seeing oneself as similar to the client); (h) client–counselor attraction issues (e.g., sexual attraction between client and counselor); (i) positive reactions to supervisor (e.g., favorable thoughts or feelings about supervisors or their actions); (j) supervision setting concerns (e.g., concerns about the placement or tasks required at placement); (k) supervisor appearance (e.g., reactions to supervisor’s outward appearance); (l) supervisee–supervisor attraction issues (e.g., sexual attraction between supervisee and supervisor); and (m) positive reactions to client (e.g., favorable thoughts or feelings about clients or their actions).
They also identified 11 reasons for intentional nondisclosure: (a) perceived unimportance (e.g., information not worth discussing with supervisor); (b) too personal (e.g., information about one’s personal life that is private); (c) negative feelings (e.g., embarrassment, shame, anxiety); (d) poor alliance with supervisor (e.g., poor working relationship with supervisor); (e) deference (e.g., inappropriate for a counselor to bring up because of their role as intern or supervisee); (f) impression management (e.g., desire to be perceived favorably by supervisor); (g) supervisor agenda (e.g., supervisor’s views, roles, and beliefs that guide supervisor’s actions or reactions to supervisee); (h) political suicide (e.g., fear that the disclosure will be disruptive in the workplace and lead to the supervisee being unwelcome or unsupported); (i) pointlessness (e.g., addressing the issue would not influence change); (j) supervisor not competent (e.g., supervisor is inaccessible or unfit for supervisory role); and (k) unclear (e.g., researchers unable to read participants’ statements). The most common types of intentional nondisclosure in the study by Ladany et al. (1996) were negative reactions to supervisor, CITs’ personal issues, clinical mistakes, and evaluation concerns, while the most common reasons for the nondisclosures were perceived unimportance, too personal, negative feelings, and a poor alliance with the supervisor.
Subsequent studies, also from allied professions (e.g., social work, clinical psychology), have found similar results in regard to the types and reasons for intentional nondisclosure (Hess et al., 2008; Mehr et al., 2010; Pisani, 2005). Mehr and colleagues (2010) found 84.2% of psychology trainees reported withholding information from their supervisors, and the most common types of nondisclosures were negative perception of supervision, personal life concerns, and negative perception of the supervisor, while the most common reasons for nondisclosure were impression management, deference, and fear of negative consequences. Additionally, Pisani (2005) found the most commonly withheld information for social work trainees included supervisor–supervisee attraction issues, negative reactions to supervisor, and supervision setting concerns. Finally, in a qualitative study, Hess et al. (2008) explored the differences in a single example of intentional nondisclosure based on psychology trainees’ perceptions of the quality of the supervisory relationship—for example, good (i.e., only one instance of a problem in the supervisory relationship) versus problematic supervisory relationships (i.e., ongoing issues in the supervisory relationship). They found that supervisees in both good and problematic supervisory relationships withheld information about client-related issues. However, supervisees in problematic relationships more commonly withheld supervision-related concerns (e.g., negative reactions to supervisor) compared to supervisees in good relationships. The findings described above provide empirical evidence that nondisclosure in allied professions is common.
The Current Study
Although there is evidence that supervisees from allied professions withhold information, there is currently a dearth of literature regarding intentional nondisclosure by CITs in the field of counseling. Cook and Welfare (2018) found that the quality of the supervisory working alliance and supervisee avoidant attachment style predicted supervisee nondisclosure. In a qualitative study, Lonn and Juhnke (2017) examined supervisee nondisclosure in triadic supervision. They found that the supervisee’s perception of their relationships, the presence of a peer, and opportunity to share were important to whether supervisees withheld information. However, these studies failed to examine the types of information being withheld by CITs as well as their reason for withholding information. Considering that professional counselors have a unique training model (CACREP, 2015), professional identity (Lawson, 2016), and code of ethics (ACA, 2014), the purpose of the current study was to examine the types and reasons of intentional nondisclosure by CITs during their supervised onsite internship experience.
Method
We utilized content analysis (Hsieh & Shannon, 2005) to examine the examples of intentional nondisclosures provided by CITs that occurred in supervision with their onsite internship supervisors. Hsieh and Shannon (2005) defined qualitative content analysis as “a research method for the subjective interpretation of the content of text data through the systematic classification process of coding and identifying themes or patterns” (p. 1278). Our analysis was guided by the findings from Ladany et al. (1996), which allowed us to compare the findings from the current study with those from allied professions while also examining how the phenomenon of intentional nondisclosure might present uniquely in the counseling profession (Hsieh & Shannon, 2005). The current study was designed to answer two research questions: (a) What are the types of information that CITs intentionally withhold from their supervisors during their internship’s onsite supervision? and (b) What are the reasons for their nondisclosure?
Research Team
Our research team included three members. The first and third authors served as coders while the second author served as a peer reviewer. The first and second authors are counselor educators at different universities in the Southeast United States, and the third author was a doctoral student at the same institution as the first author. We all have experience as professional counselors, supervisees, supervisors, and researchers; consequently, we have experienced all parts of the nondisclosure cycle. Prior to the analysis process, we discussed how our previous experiences might impact the analysis. Likewise, we intentionally discussed and bracketed potential influences of bias throughout the project. We also employed triangulation (e.g., multiple coders), utilized frequent peer debriefs, and employed a peer reviewer (Creswell, 2013). Our items also were reviewed by four consultants with counseling, supervision, and research experience to minimize bias and maximize clarity.
Recruitment Procedure and Participants
After securing IRB approval, we recruited participants currently enrolled in internship for the current study through the assistance of counselor education faculty at CACREP-accredited institutions. Fifteen counselor educators at 14 institutions offered paper-and-pencil instrument packets to CITs during one of their class periods. As indicated by the key informants, 152 of the 173 CITs present in class on the day the packets were offered agreed to participate in the study. This resulted in an in-class response rate of 87.86%.
Participants were CITs currently enrolled in internship in a CACREP-accredited program and receiving supervision at their internship sites. The age of the participants ranged from 22 to 60 years old (M = 28.13, SD = 7.43, n = 107). Eighty-eight participants identified as female (80%), 17 participants identified as male (15.5%), three participants identified as nonbinary (gender identity not male and not female, 2.7%), and two participants indicated that they did not want to disclose their gender (1.8%). Regarding race, the majority of participants identified as White (non-Hispanic; n = 71, 64.5%), while 23 participants identified as African American (20.9%), four participants identified as Asian/Pacific Islander (3.6%), three participants identified as Hispanic/Latinx (2.7%), three participants identified as multiracial (2.7%), one participant identified as Native American (0.9%), one participant responded “none of the above categories” (0.9%), and four participants responded that they preferred not to disclose (3.6%). Regarding CACREP track, 64 participants were enrolled in a clinical mental health counseling track (58.2%), 32 participants were enrolled in a school counseling track (29.1%), nine were enrolled in a college counseling and students affairs track (8.2%), and five were enrolled in a marriage, couples, and family track (4.5%).
Instrument
The instrument was designed to gather information about participants’ experiences with their current onsite internship supervisors. Two items were the focus of this study: (a) “Describe a time when you decided not to share something you thought was significant with your current onsite internship supervisor” and (b) “What brought you to that decision to not share it with your current onsite internship supervisor?” In addition, the questionnaire included 15 items to collect demographic information about the participants and their current onsite internship supervisors. Of the 152 participants who began participation, 42 participants (27.6%) were removed from the analysis as they did not complete the open-ended questions, resulting in a final sample of 110 participants. We utilized the demographic variables to check for evidence of nonresponse bias using Chi-square tests of independence and independent t-tests. We did not find evidence of response bias when comparing those who answered the open-ended questions and those who did not.
Data Analysis
We analyzed participants’ responses to the open-ended questions utilizing content analysis. We categorized the types of intentional nondisclosure and the reasons for nondisclosure into categories as recommended by Hsieh and Shannon (2005). For our analysis, we utilized the types of nondisclosure and the reasons for nondisclosure originally identified by Ladany et al. (1996). To reiterate, Ladany et al. identified 13 types of intentional nondisclosure and 11 reasons for nondisclosure (1996). Also, as recommended by Hsieh and Shannon (2005), we allowed for new categories to emerge that did not fit within the categories from Ladany et al. The rationale for this approach was two-fold. First, we could best understand the phenomenon of intentional nondisclosure by comparing our findings to that of previous research from allied professions, while also generating new knowledge of how nondisclosure might uniquely manifest in the counseling profession (Lawson, 2016). Second, utilizing previous research provided structure to our coding procedures and informed the researchers’ interpretation of participant responses (Hsieh & Shannon, 2005).
Coding process. The first and third authors coded the responses of 110 participants for (a) whether or not the participant identified an incident of intentional nondisclosure and (b) to categorize the participant responses that indicated intentional nondisclosure by the type and reasons for the nondisclosure. Each response was coded into one category of type of nondisclosure and one category of reason for the nondisclosure. First, the two coders selected 10 participant responses and coded them as a team. Next, the two coders selected an additional 10 participant responses and coded them independently of each other. They then came together to reach a consensus on the categorization of participant responses. The remaining 90 participant responses were coded independently, and the two coders regularly engaged in peer debriefings throughout the process to ensure consistency (Creswell, 2013). After all 110 participant responses were analyzed, the first and third authors met to finalize the categorization of participant responses and to generate names for the new categories that emerged during the analysis (Hsieh & Shannon, 2005). Regarding the categorization of participant responses in terms of the participant-identified incident of intentional nondisclosure, the coders’ agreement was 100%. Regarding the types and reasons for the nondisclosure, the coders initially disagreed on 15 types of intentional nondisclosure and 23 reasons for the nondisclosure. The two coders established consensus through discussion, resulting in an agreement of 100% (Creswell, 2013). Finally, the second author, serving as a peer reviewer, evaluated the entire coding process. She was chosen based on her expertise with supervision delivery (e.g., protocol, practice) and the topic of intentional nondisclosure. She did not recommend any changes to the categorization of participant responses; however, she recommended renaming two of the new categories for the types of nondisclosures that emerged from the data to better reflect the content of participant responses. Eleven types of intentional nondisclosure and 13 reasons emerged from our analysis.
Results
Forty-four (40%) participants reported that they had never withheld something significant from their current onsite internship supervisors, while 66 (60%) reported that they had. Examples of responses coded as never having withheld something significant from their onsite supervisors include “N/A,” “At this time, I have not withheld any information that I felt was significant with my supervisor,” and “I don’t think there has been one.” For the responses that included an example of intentional nondisclosure (n = 66), 11 types of intentional nondisclosure and 13 reasons for withholding information emerged from the data. The types of intentional nondisclosure included eight types of nondisclosure that were from Ladany et al.’s (1996) research on nondisclosure and three new types of intentional nondisclosure that emerged in this data set: (a) CIT professional developmental needs, (b) a peer’s significant issue, and
(c) experiencing sexual harassment. Regarding the reasons for the intentional nondisclosures, 10 reasons mirrored the findings from Ladany et al. and three reasons were unique to the current study: (a) did not want to harm client or confidentiality concerns, (b) consulted with another supervisor, and (c) issue with other professional in supervision setting.
The Types and Reasons for Intentional Nondisclosures
The most common type of intentional nondisclosures identified by the researchers in the current study were negative reactions to supervisor (n = 18, 27.3%), general client observations (n = 16, 24.2%), and clinical mistakes (n = 15, 22.7%). The most common reasons for intentional nondisclosures were impression management (n = 12, 18.2%), perceived unimportant (n = 8, 12.1%), negative feelings, (n = 8, 12.1%), and supervisor not competent (n = 8, 12.1%). Complete results of the coding and category frequencies of the types of nondisclosures are presented in Table 1, and the final coding and category frequencies of the reasons for nondisclosure are presented in Table 2.
Table 1
Types of Intentional Nondisclosure
Type of Intentional Nondisclosure
n (%)
Examples
Negative Reactions to Supervisor
18 (27.3%)
When my supervisor asked if there is anything that is hindering our relationship, I lied and said that there wasn’t anything and the relationship is fine.
I feel that I am not getting feedback about my counseling from my supervisor in the supervision meetings. Instead I am only getting suggestions of how the supervisor would have handled the client.
Made a comment behind my back. My onsite supervisor is new and so I don’t share too much because he’s easily overwhelmed.
General Client
Observations
16 (24.2%)
I gave [clients] more chances to skip/miss an appointment than [my supervisor] would allow so sometimes don’t let her know when people cancel or no show.
When a client disclosed personal family issues; client’s past trauma.
Clinical Mistakes
15 (22.7%)
I put a client in danger by a lack of knowledge and being new in a position.
Too much self-disclosure in a session; getting behind on case notes/paperwork.
Having a chronically suicidal client and . . . not assessing for SI in a session and feeling as if when assessed it was not done so well.
Client–Counselor
Attraction Issues
4 (6.1%)
I felt attracted to an assessment client.
During a session, a client told me that he liked how I looked in my pants. He then told me that he got excited at the sound of my voice.
Countertransference
3 (4.5%)
A client reminded me of my late mother.
Early in internship, I had strong countertransference with a client.
Supervision Setting Concerns
3 (4.5%)
I was concerned if I was going to have to find another site to finish hours.
Frustration with internship duties.
Personal Issues
2 (3.0%)
I did not tell my supervisor that I chose to cut it off with a potential romantic partner.
CIT Developmental Need
2 (3.0%)
When I was first starting out I had a hard time letting my supervisor know when I needed something extra from them whether it be time or information.
Negative Reactions to Client
1 (1.5%)
Anger toward a student.
A Peer’s Significant Issue
1 (1.5%)
A client wrote a letter to my co-intern about his sexual desires and love for her.
Experiencing Sexual Harassment
1 (1.5%)
When I felt sexually harassed by a colleague.
Note. Not all types of intentional nondisclosure from Ladany et al. (1996) were present in this sample, and three new types emerged: (a) CIT developmental need, (b) a peer’s significant issue, and (c) experiencing sexual harassment.
Table 2
Reasons for Intentional Nondisclosure
Reasons
n (%)
Examples
Impression
Management
13 (19.7%)
Concerned about evaluations by those who supervise my supervisors.
Fear of looking bad or being perceived as not being a good counselor.
[Supervisor] might pass judgment because I can’t possibly know what I’m talking about being only an intern.
I worried she will think I’m unprofessional or not trust me with future clients.
Negative Feelings
8 (12.1%)
Poor self-confidence.
Fear of rejection.
Embarrassment, inferiority felt with supervisor.
Supervisor Not
Competent
8 (12.1%)
I see the way she counsels clients and I know she thinks taking time to establish rapport and positive therapeutic relationships is not always necessary.
Everyone in the office says she is burnt-out and I want to be more compassionate.
Perceived
Unimportant
8 (12.1%)
I did not feel it was necessary.
I was running late to class and I didn’t consult with her because she was in a session with a client so I figured I’d tell her the next day.
Deference
6 (9.1%)
I did not feel like it would be taken well, and that I am only an intern and should not correct her.
Didn’t want to hurt/upset her or burn a professional relationship.
Poor Alliance with Supervisor
5 (7.6%)
The power differential.
She berated me in supervision to the point of tears. I feel unsafe with her and our clinical styles contrast.
I knew she would make me feel inferior.
Supervisor Agenda
4 (6.1%)
I thought he would immediately notify people in charge.
Knowing my supervisor would want to tell [client’s] mother.
Political Suicide
4 (6.1%)
I want to get hired where I’m working and I don’t feel . . . safe during supervision.
It’s a small practice and I have to share a wall with this offender every day.
Did Not Want to Harm Client or
Confidentiality
Concerns
4 (6.1%)
I didn’t want to put client in a bad situation.
That student was not positive of her status and was not in any danger. Revealing her secret at that point would have damaged the relationship.
Confidentiality issues.
Too Personal
3 (4.5%)
It was too personal.
I didn’t want to talk about my grief.
Pointlessness
1 (1.5%)
Thought that was between student and personal physician.
Consulted with
Another
Supervisor
1 (1.5%)
Other supervisor suggestions.
Issues with Other Professionals in
Supervision Setting
1 (1.5%)
The teacher expressed frustration. Hopes to prevent future conflict.
Note. Not all categories and reasons from Ladany et al. (1996) were present in this sample, and three new reasons emerged: (a) did not want to harm client or confidentiality concerns, (b) consulted with another supervisor, and (c) issues with other professionals in supervision setting.
Specific Examples of the Types and Reasons for Intentional Nondisclosure
To provide a more complete picture of the phenomenon of intentional nondisclosure (Hsieh & Shannon, 2005), this section is presented to highlight specific examples provided by participants for each type of nondisclosure and the reasons they withheld the information. Our coded reason for the type of intentional nondisclosure is included in parentheses below (e.g., deference, impression management, political suicide).
Negative reactions to supervisor. One participant stated that she did not disclose that her supervisor “was not helpful during a time that I needed her to be” because the participant “did not want to . . . upset her or burn a professional relationship” (deference). Another participant did not tell her supervisor at her school internship that she disapproved of the way the supervisor addressed a student: “I felt she was being too harsh on a student and not considering other factors.” This participant did not want her supervisor to perceive her as “being wrong” (impression management). A participant stated that even though her supervisor sits in on all of her sessions at her internship site, she still withheld that she is not satisfied with the quality of their relationship and did not share how she felt “in the relationship with her.” She added that she did not disclose this information because “I am afraid she’ll be angry and it will damage the relationship we do have” (negative feelings). Finally, for a clinical mental health CIT, even her supervisor directly asking if she had concerns about the supervisory relationship was not enough to encourage her disclosure: “When my supervisor asked if there is anything that is hindering our relationships I lied and said that there wasn’t anything and the relationship is fine.” The CIT stated she lied because “the power differential, being videotaped, and concerns with confidentiality . . . stopped me from being completely honest about my comfort with our relationship” (poor alliance with supervisor).
General client observations. General client observations differed from clinical mistakes because participants did not self-identify that they perceived the specific examples they provided to be mistakes. Rather, participants indicated that the examples they provided were relevant; however, they failed to disclose this significant information to their supervisors. One school counseling CIT stated that she did not share with her supervisor that she was having trouble “breaking the ice with a client” because she “knew my [supervisor] would make me feel inferior” (poor alliance with supervisor). Another school counseling CIT shared that she failed to disclose that one of her clients was “drinking alcohol on campus” because she thought her supervisor would “immediately notify people in charge of discipline rather than talking to the student first” (supervisor agenda). Finally, another school counseling CIT stated that a client told her she was pregnant, but she failed to notify her supervisor because “that student was not positive of her status and was not in any danger. Revealing her secret at that point would have damaged the relationship” (did not want to harm client; confidentiality concerns).
Clinical mistakes. Participants reported a range of clinical mistakes, from minor clerical errors to potentially more problematic mistakes such as failure to assess for client risk. One clinical mental health CIT did not share that she was “behind on my case notes” because she “did not feel it was necessary” and she “caught up quickly” (perceived unimportant). A student affairs CIT stated that he did not let his supervisor know that he “lacked confidence in theories” because he felt “inadequate” and “embarrassed” (negative feelings). A clinical mental health CIT shared that she failed to disclose something in supervision that her supervisor had previously told her not to do: “My supervisor had previously verbalized that she would be upset.” She withheld this information because “I didn’t want to seem . . . incompetent and I respected her and want her to think I’m doing my best” (impression management). Multiple participants provided specific examples of intentional nondisclosures related to failing to adequately assess for client risk or failing to notify their supervisors that a client was engaging in risk-related behavior. A school counseling CIT shared that she did not discuss with her supervisor that “a client (minor on a school campus) was engaging in [non-suicidal self-injury] again” because “we discussed before how she is obligated to pass that info to school principal who tells parents” (supervisor agenda). This participant added that she decided not to share this information with her supervisor because she perceived the self-injury to be non–life threatening and she wanted to “save rapport” with the client (did not want to harm client; confidentiality concerns). Finally, a school counseling CIT stated that she withheld from her supervisor that she “put a client in danger by my lack of knowledge and being new in my position.” This CIT did not discuss this with her supervisor because “my supervisor wasn’t available” (supervisor not competent).
Client–counselor attraction issues. One clinical mental health counseling CIT stated that her client “told me that he liked how I looked in my pants. He then told me that he got excited at the sound of my voice.” She stated that she did not disclose this information to her supervisor because “I told myself that I did not understand how he meant the comment and I thought he would stop the flirting if I ignored him” (perceived unimportant). Two participants indicated that they experienced sexual attraction to a client but failed to share it with their supervisor. One student affairs CIT stated that she felt “embarrassed” (negative feelings), while a clinical mental health counseling CIT shared that he “did not want anyone to find out and I felt like I handled it fine” (impression management).
Countertransference. One marriage, couples, and family CIT stated that she did not disclose to her supervisor that a client “reminded me of [my] late mother” because she “did not want to talk about [my] grief” (too personal). A clinical mental health counseling CIT echoed the previous participant’s thinking process. She stated she did not tell her supervisor she was experiencing “countertransference” with a client because “it was too personal” (too personal). Finally, another marriage, couples, and family CIT stated that early in her internship she had “strong countertransference with a client” as a result of a personal grieving process. She shared that she did not tell her supervisor because she wasn’t sure “how much I trusted her with this information as it was only several weeks into internship” (poor alliance with supervisor).
Supervision setting concerns. A clinical mental health counseling CIT stated that she did not express her “frustration with internship duties” to her supervisor because “he was unavailable” (supervisor not competent). Another clinical mental health counseling CIT was concerned that she “would need to find another site to finish [internship] hours,” but did not tell her supervisor because “I did not choose to add to stress [of my] site supervisor by posing my concern” (deference).
Personal issues. One participant enrolled in a clinical mental health counseling program withheld from the supervisor that “sad and depressed” feelings because of a “fear of rejection” (negative feelings) arose during supervision. A school counseling CIT did not disclose to her supervisor that she had recently ended a relationship “with a potential romantic partner” even though it was causing her to “feel drained and emotional during the day at her internship” because “I felt that it would be silly to and I thought I did a good enough job ignoring the feelings while with students” (too personal).
CIT developmental need. One clinical mental health counseling CIT shared that she had a difficult time “letting my supervisor know when I needed something extra from them whether it be time or information” because she “felt nervous about [her] position as ‘just an intern’” (negative feelings). Another clinical mental health counseling CIT stated that she failed to let her supervisor know that she is “concerned about being in an individual session with a male client” because she is fearful that her supervisor would think she is “unprofessional or not trust me with future clients” (impression management).
Negative reactions to client. Only one participant indicated that she failed to disclose a negative reaction to a client with her supervisor. This student affairs CIT stated that she did not disclose her “anger towards a client” because she “did not think it was important enough to share” (perceived unimportant).
A peer’s significant issue. One clinical mental health counseling CIT noted that there was a failure to disclose to the supervisor that “a client wrote a letter to my co-intern about his sexual desires and love for her.” This CIT stated that the co-intern did not want this information shared and that the participant “did not think it was my place” (deference).
Experiencing sexual harassment. A clinical mental health counseling CIT stated that she was “sexually harassed by a colleague,” but failed to disclose to her supervisor because “it’s a small practice and I have to share space with this offender every day” (political suicide).
Discussion
The current investigation was designed to examine the types of and reasons for intentional nondisclosure by CITs during their onsite supervision. Sixty percent of the participants provided an example of withholding something significant from their onsite internship supervisors, suggesting that, similar to allied professions, intentional nondisclosure by counseling CITs is common (Ladany et al., 1996; Pisani, 2005; Yourman & Farber, 1996). Participants also provided detailed examples of the types of intentional nondisclosures as well as the reasons they withheld the information. These findings provide insight into the experiences of CITs at their internship placement. In this section, we will connect our findings to those from previous research as well as offer implications for counselors, supervisors, and counselor training programs.
The Types of Intentional Nondisclosure and Reasons for Nondisclosure
Overall, the types of intentional nondisclosure and the reasons for these nondisclosures are comparable to the findings of previous studies in allied professions. There were four categories of the types of intentional nondisclosure that emerged in the study by Ladany et al. (1996) that were not present in the current study: (a) positive reactions to supervisor, (b) supervisor appearance, (c) supervisee–supervisor attraction issues, and (d) positive reactions to client. The category of “unclear” in regard to the reasons for nondisclosure also was not found in the current study, as all participant responses in the current study were legible. Participants of differing CACREP tracks all provided examples of intentional nondisclosure to their supervisors in regard to their field placement. These findings suggest that despite the differences in training models (CACREP, 2015) and professional identities (Lawson, 2016), CITs experience many of the same situations that result in intentional nondisclosure as those from allied professions. The most commonly withheld information in the current study was negative reactions to supervisor, which also was true for psychology trainees in the study by Ladany et al. Supervisees appear most hesitant to discuss their concerns about their supervisor or supervision experience (Hess et al., 2008; Mehr et al., 2010; Pisani, 2005). In addition, CITs also commonly withheld general observations about clients and clinical mistakes similar to allied professions (Hess et al., 2008; Ladany et al., 1996; Mehr et al., 2010; Pisani, 2005).
The CITs in the current study provided many reasons for their intentional nondisclosure, but some reasons were more commonly reported than others. Like the findings from Mehr et al. (2010), participants in the current study most commonly withheld information in order to make a favorable impression on their supervisors. Others reported they withheld because of negative feelings such as “shame” or “embarrassment.” Farber (2006) suggested that internalized negative feelings are often a reason for nondisclosure. Consistent with findings from allied professions (Hess et al., 2008; Ladany et al., 1996), CITs also withheld because (a) they believed a supervisor was not competent, (b) they believed information was not quite important enough to disclose, and (c) they wanted to perform perfectly in their new roles.
Novel Findings Regarding Types and Reasons for Intentional Nondisclosure
An important aspect of content analysis is discussing findings that may extend existing knowledge of a given phenomenon (Hsieh & Shannon, 2005). The current study is the first to examine the types of intentional nondisclosure and reasons for nondisclosure in a sample of CITs. As such, there are several novel findings that warrant discussion. For example, two participants indicated that they did not discuss their professional development needs with their onsite supervisor. This is particularly interesting, given a central function of clinical supervision is to facilitate CIT professional development (Bernard & Goodyear, 2014). CITs who internalize their professional developmental needs as a flaw or who desire to hide these needs for fear of their supervisors’ reactions also may desire to perform perfectly (Rønnestad & Skovholt, 2003). Discussing opportunities for growth as a CIT can be difficult (Mehr et al., 2010); thus, supervisors may need to prompt their supervisees to discuss their needs more directly.
Another novel finding is that one participant indicated that she withheld from her supervisor about her peer’s ethical dilemma (the client letter revealing romantic interest). This participant explained that she did not feel it was her place to share her peer’s information, but all counselors and CITs share some responsibility to address ethical concerns. Ladany et al. (1996) found that 53% of those who withheld information from their supervisors told a peer in the field about their concern. Therefore, it seems likely that other CITs may be placed in a similar position as the participant in the current study. Knowing one’s ethical responsibility to disclose unethical behavior, as in the situation germane to this study, could be prudent (ACA, 2014). Finally, one participant indicated that she was being sexually harassed by a colleague. This report of intentional nondisclosure is particularly concerning given the increased attention to Title IX and attempts to mitigate sexual harassment and sexual assault in university and workplace settings (Welfare, Wagstaff, & Haynes, 2017). This participant’s willingness to share her trauma through the data collection process in this study presents an opportunity for counselor educators and supervisors to explore strategies to prevent these experiences for future CITs.
Regarding the reasons for intentional nondisclosure, there also were novel findings because three new reasons emerged in the current study. First, five participants did not disclose information to their supervisor because they did not want to harm their clients or violate a client’s confidentiality. However, the sharing of information with a supervisor would never violate client confidentiality (ACA, 2014). Perhaps the supervisees’ confusion about the parameters of confidentiality or misdirected efforts to protect clients from the actions of a supervisor they perceived as incompetent led to this decision. A second novel reason for intentional nondisclosure was evidenced by one participant who reported consulting with a supervisor who was not her site supervisor. Ladany et al. (1996) found that 15% of psychology trainees consulted with “another supervisor” outside their primary supervisor (p. 16). Ladany et al. did not ask their participants to clarify the role of another supervisor; however, this finding is relevant to the current study and the training of CITs. Throughout a CIT’s internship experience, they have two supervisors: one onsite supervisor and one university supervisor (CACREP, 2015). It is unclear if the supervisor with whom the participant discussed their concern was another supervisor at the site or the university supervisor. However, this could be an inherent challenge for CITs to identify who to share information with, particularly if there are issues in one of the two relationships. Finally, one school counseling CIT indicated that she had an issue with a teacher and addressed this issue with the teacher directly. Counselors work in diverse settings (ACA, 2014; CACREP, 2015) and may often work with persons outside the counseling profession. Counseling programs and supervisors may need to better prepare students to work with other professionals in their specific setting.
Implications for CITs
The findings from the current study provide empirical evidence that, when faced with the decision to share in clinical supervision, CITs sometimes chose to withhold information from their supervisors despite knowing its relevance. CITs of all CACREP tracks will likely be faced with this difficult decision. We hope that these findings, which offer insights into the experience of intentional nondisclosure, help to normalize the challenges that CITs face and identify strategies to prevent nondisclosure.
Some of the participants described harmful supervision experiences in which they were berated by their supervisors, feared fallout if they were to disclose illegal sexual harassment by another site employee, were concerned about a supervisor’s clinical competence, or did not feel safe to share even blatantly inappropriate client behaviors. Harmful supervision such as this has also been described by Ellis et al. (2014) and is a major concern for counseling and related professions. CITs who find themselves in harmful supervision situations can consider seeking support from another professional, a peer, or a professional association ethics consultant who might help rectify these issues.
Even for those CITs who are not enduring harmful supervision, there are costs to nondisclosure such as stalled development, safety concerns, and ethical or legal violations. Ultimately, the decision to withhold information from one’s clinical supervisor rests with the CIT (Murphy & Wright, 2005). Advocating for a safe and productive supervisory experience may result in a change that serves as a catalyst for supervisee growth or prevents client harm. No supervisee needs to be concerned about burdening a supervisor with disclosures about training issues or ethics; it is the supervisor’s responsibility to address supervisee needs, no matter how burdensome. Relatedly, supervisees who are reluctant to discuss their observations of clients or clinical mistakes for fear of being evaluated poorly or perceived as unqualified should consider ways to demonstrate quality work in order to balance the areas for growth. Making mistakes is expected for all CITs, but it is important to use supervision to learn from these mistakes (Pearson, 2001). In fact, reflecting on previous experiences—and learning from those experiences—is key to becoming a skilled and seasoned counselor (Rønnestad & Skovholt, 2003). CITs also might find it helpful to pursue their own personal counseling as another strategy to facilitate personal and professional growth (Oden, Miner-Holden, & Balkin, 2009).
Several CITs shared their hesitancy in disclosing information to their supervisor for fear of violating their clients’ confidentiality or harming the therapeutic alliance. Although client confidentially is critical, disclosing information to one’s supervisor would not violate a client’s confidentiality (ACA, 2014). In fact, some of the concerns expressed seemed to be more about the limits of confidentiality in the setting more broadly (e.g., high school rules), rather than with the supervisor specifically. Counselors are encouraged to not tell a client that the information shared during the counseling process will remain absolutely confidential. Rather, counselors are encouraged to include a passage in their informed consent about the boundaries of client confidentiality and discuss this information with their clients (ACA, 2014). Finally, predicting when ethical or legal issues will occur may be impossible. Counselors should regularly consult with supervisors to discuss treatment options and legal and ethical issues (ACA, 2014).
Implications for Supervisors and Counselor Education Training Programs
Supervisors and counselor educators play a central role in reducing CIT intentional nondisclosures. The findings from the current study suggest there is a wide range of topics that CITs are reluctant to discuss with their supervisors and a wide range of reasons for withholding. The varying nature of intentional nondisclosures highlights the necessity of individualized interventions. Broadly speaking, supervisors are encouraged to facilitate an open and safe environment that invites disclosure (Bordin, 1983). This might also mean supervisors must be willing to purposefully solicit feedback from their supervisees (Murphy & Wright, 2005). Additionally, supervisors must be proactive in utilizing the knowledge gained from studies like this one to normalize the experiences of their supervisees. Perhaps by discussing each of the types of nondisclosure described above with CITs, supervisors can reduce the pressures associated with performing perfectly (Rønnestad & Skovholt, 2003) or diminish the negative emotions (e.g., shame, embarrassment) associated with making mistakes (Farber, 2006; Knox, 2015).
Finally, some of the experiences described by the participants in the current study are deeply troubling, as they shared specific examples of ineffective and harmful supervision. The burden of providing evidence and reporting instances of harmful supervision is often placed on the CIT (Ellis, Taylor, Corp, Hutman, & Kangos, 2017). We outlined some strategies for CITs in case they were to experience harmful supervision; however, the findings from the current study suggest that CITs are withholding this information for any number of reasons. The participants in this study are not unlike those from other allied professions who have similar supervision experiences (for specific examples of harmful supervision, see Ellis, 2017). Thus, supervisors and counselor education programs must work to prevent CITs from experiencing the damaging effects of ineffective or harmful supervision. We encourage counselor education programs to be proactive by reviewing the signs of ineffective and harmful supervision practices with students before they begin their internships and to regularly check in with students about the supervision experience. Counselor education programs may find it beneficial to solicit student feedback about their practicum/internship site at the end of each term—specifically targeting concerns related to ineffective and harmful supervision.
Encouraging students to disclose their experiences with ineffective or harmful supervision while they are in the process of graded program work might not be possible because of the reasons described above; however, preventing similar experiences for future students may be. Finally, CACREP (2015) requires that all site supervisors receive supervision training prior to serving in this capacity. Accidental instances of ineffective or harmful supervision may be prevented by adding training for site supervisors in this content area (Ellis et al., 2017).
Limitations and Future Research
The current study has limitations that create opportunities for future research. First, we utilized the categories originally identified in the study conducted by Ladany et al. (1996). Although we allowed for the creation of new categories, it is possible that selecting a different study to guide our investigation would have yielded different findings (Hsieh & Shannon, 2005). Also, prompting for a single example of significant intentional nondisclosure may have influenced the findings. Future studies should include the opportunity to provide multiple examples, which could result in different findings. Finally, participants were asked to provide examples of intentional nondisclosure with their onsite supervisors during their internship. These participants were receiving supervision from a university supervisor (CACREP, 2015), meaning the information withheld from the onsite supervisor may have been discussed with the university supervisor. It is also plausible that supervisees withheld the information from both the onsite and university supervisors. Site supervisors and university supervisors might have conflicting agendas, presenting a burden on supervisees to decide what to disclose to whom. Future studies should examine how supervisees decide what to disclose when they have multiple supervisors at one time. Finally, participants in the current study reported they were most hesitant to disclose their negative reactions about their supervisors. Future research should explore how supervisors can better monitor their supervisees’ reactions to them.
Conclusion
Although previous research from allied professions provides evidence of how nondisclosure manifests within those professions, the findings from this study provide empirical evidence of how CIT intentional nondisclosure presents during onsite supervision. These findings provide valuable insights into the types of information that CITs withhold as well as the reasons for their nondisclosure during their onsite supervision. Given that the counseling profession has a unique training model (CACREP, 2015) and professional identity (Lawson, 2016), these findings can be used by CITs, onsite supervisors, and counselor educators to generate targeted solutions to address this critical issue.
Conflict of Interest and Funding Disclosure
This research was supported by a grant from the Association for Counselor Education and Supervision.
References
American Counseling Association. (2014). 2014 ACA code of ethics. Alexandria, VA: Author.
Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th ed.). Boston, MA: Pearson.
Borders, L. D. (2009). Subtle messages in clinical supervision. The Clinical Supervisor, 28, 200–209. doi:10.1080/07325220903324694
Borders, L. D., DeKruyf, L., Fernando, D. M., Glosoff, H. L., Hays, D. G., Page, B., & Welfare, L. E. (2011). Best practices in clinical supervision. Retrieved from https://www.acesonline.net/sites/default/files/ACES-Best-Practices-in-clinical-supervision-document-FINAL_0_0.pdf
Borders, L. D., Glosoff, H. L., Welfare, L. E., Hays, D. G., DeKruyf, L., Fernando, D. M., & Page, B. (2014). Best practices in clinical supervision: Evolution of a counseling specialty. The Clinical Supervisor, 33, 26–44.
Bordin, E. S. (1983). A working alliance based model of supervision. The Counseling Psychologist, 11, 35–42. doi:10.1177/0011000083111007
Cook, R. M., & Welfare, L. E. (2018). Examining predictors of counselor-in-training intentional nondisclosure. Counselor Education and Supervision, 57, 211–226.
Creswell, J. W. (2013). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). Thousand Oaks, CA: Sage.
Ellis, M. V. (2017). Narratives of harmful clinical supervision. The Clinical Supervisor, 36, 20–87.
doi:10.1080/07325223.2017.1297752
Ellis, M. V., Berger, L., Hanus, A. E., Ayala, E. E., Swords, B. A., & Siembor, M. (2014). Inadequate and harmful clinical supervision: Testing a revised framework and assessing occurrence. The Counseling Psychologist, 42, 434–472. doi:10.1177/0011000013508656
Ellis, M. V., Taylor, E. J., Corp, D. A., Hutman, H., & Kangos, K. A. (2017). Narratives of harmful clinical supervision: Introduction to the special issue. The Clinical Supervisor, 36, 4–19.
doi:10.1080/07325223.2017.1297753
Farber, B. A. (2006). Self-disclosure in psychotherapy (1st ed.).New York, NY: Guilford Press.
Hess, S. A., Knox, S., Schultz, J. M., Hill, C. E., Sloan, L., Brandt, S., . . . Hoffman, M. A. (2008). Predoctoral interns’ nondisclosure in supervision. Psychotherapy Research, 18, 400–411. doi:10.1080/10503300701697505
Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 1277–1288. doi:10.1177/1049732305276687
Knox, S. (2015). Disclosure—and lack thereof—in individual supervision. The Clinical Supervisor, 34, 151–163. doi:10.1080/07325223.2015.1086462
Ladany, N., Hill, C. E., Corbett, M. M., & Nutt, E. A. (1996). Nature, extent, and importance of what psychotherapy trainees do not disclose to their supervisors. Journal of Counseling Psychology, 43, 10–24. doi:10.1037/0022-0167.43.1.10
Lawson, G. (2016). On being a profession: A historical perspective on counselor licensure and accreditation. Journal of Counselor Leadership and Advocacy, 3, 71–84. doi:10.1080/2326716X.2016.1169955
Lonn, M. R., & Juhnke, G. (2017). Nondisclosure in triadic supervision: A phenomenological study of counseling students. Counselor Education and Supervision, 56, 82–97. doi:10.1002/ceas.12064
Mehr, K. E., Ladany, N., & Caskie, G. I. L. (2010). Trainee nondisclosure in supervision: What are they not telling you? Counselling & Psychotherapy Research, 10, 103–113. doi:10.1080/14733141003712301
Mehr, K. E., Ladany, N., & Caskie, G. I. L. (2015). Factors influencing trainee willingness to disclose in supervision. Training and Education in Professional Psychology, 9, 44–51. doi:10.1037/tep0000028
Murphy, M. J., & Wright, D. W. (2005). Supervisees’ perspectives of power use in supervision. Journal of Marital and Family Therapy, 31, 283–295. doi:10.1111/j.1752-0606.2005.tb01569.x
National Board for Certified Counselors. (2014). NBCC educational requirements to change in 2022. The National Certified Counselor, 30(3), 1–2.
Oden, K. A., Miner-Holden, J., & Balkin, R. S. (2009). Required counseling for mental health professional trainees: Its perceived effect on self-awareness and other potential benefits. Journal of Mental Health, 18, 441–448. doi:10.3109/09638230902968217
Pearson, Q. M. (2001). A case in clinical supervision: A framework for putting theory into practice. Journal of Mental Health Counseling, 23, 174–183. doi:10.1111/ppc.12003
Pisani, A. (2005). Talk to me: Supervisee disclosure in supervision. Smith College Studies in Social Work, 75, 29–47. doi:10.1300/J497v75n01_03
Rønnestad, M. H., & Skovholt, T. M. (2003). The journey of the counselor and therapist: Research findings and perspectives on professional development. Journal of Career Development, 30, 5–44. doi:10.1177/089484530303000102
Welfare, L. E., Wagstaff, J., & Haynes, J. R. (2017). Counselor education and Title IX: Current perceptions and questions. Counselor Education and Supervision, 56(3), 193–207. doi:10.1002/ceas.12072
Yourman, D. B., & Farber, B. A. (1996). Nondisclosure and distortion in psychotherapy supervision. Psychotherapy: Theory, Research, Practice, Training, 33, 567–575. doi:10.1037/0033-3204.33.4.567
Ryan M. Cook is an assistant professor at The University of Alabama. Laura E. Welfare, NCC, is an associate professor at Virginia Tech. Devon E. Romero, NCC, is an assistant professor at The University of Texas at San Antonio. Correspondence can be addressed to Ryan Cook, 310A Graves Hall, The University of Alabama, Tuscaloosa, AL 35487, rmcook@ua.edu.
Streamlined supervision frameworks are needed to enhance and progress the practice and training of supervisors. This author proposes the SuperSkills Model (SSM), grounded in the practice of microskills and supervision common factors, with a focus on the development and foundational learning of supervisors-in-training. The SSM worksheet prompts for competency-based supervisory behaviors from pre-session to post-session, highlighting a culturally aware supervisory relationship; goals and tasks; and feedback and reflection. The versatility of the SSM allows for utility in various settings, accommodates supervisor developmental level, and may be used to evaluate supervisor-in-training development.
Keywords: supervision, supervisors-in-training, SuperSkills Model, microskills, common factors
The profession of counseling has experienced an evolution regarding counseling training methods over the past decades (Capuzzi & Gross, 2009). Compared to literature on training counselors, literature on training supervisors has received less attention and the topic is less understood (Watkins, 2010). Thus, it is not surprising that systems of development for counselors-in-training (CITs) are more advanced than systems for supervisors-in-training (SITs; Watkins, 2010). For example, Ivey, Normington, Miller, Morrill, and Haase (1968) introduced microskills to the field of mental health care, and after four decades, the approach remains a training prototype (Ridley, Kelly, & Mollen, 2011); yet supervisors still lack a standard training model (Watkins, 2012b). Although much overlap exists in counseling and supervision tasks, the process of supervision adds more skill complexity than clinical tasks alone (Pearson, 2000). Further complicating the situation, many clinicians have assumed supervisory positions without training (Knapp & VandeCreek, 1997). Research has found that many supervisors feel incompetent and could be well-served by more supervisory training (Uellendahl & Tenenbaum, 2015).
A movement toward efficient methods of training supervisors should be informed by existing theory. Identifying with a theoretical model is paramount to facilitating growth in CITs (Lampropoulos, 2003). Various models of supervision have been proposed. Bernard and Goodyear (2014) broadly delineated first-wave supervision models into one of three categories: models grounded in psychotherapy theory, developmental models, and process models. Second-wave models are more eclectic, with the ability to combine or cycle between first-wave models as needed. The third-wave models reflect a common-factors approach, gleaning substantiated elements of supervision from the literature to amalgamate into a best-practices method (Bernard & Goodyear, 2014). Despite the combined breadth of models, there remains a lack of knowledge on what constitutes sound supervisory training, signifying the need for consolidation and movement toward supervisory competency models (Milne, Reiser, Cliffe, & Raine, 2011). Established theories of supervision may be enhanced when translated through microskills, which focus on specific behaviors to link theory and practice (Ivey, 1971; Ivey et al., 1968).
Any model that is chosen or created for effective supervisory training should be competency-based, and microskills may be a viable option. The microskills approach has been adapted for the training of supervisors with successful outcomes (James, Milne, & Morse, 2008; Richardson & Bradley, 1984; Russell-Chapin & Ivey, 2004), and there has been a call in the profession to move toward more competency-based forms of supervisor training (Milne et al., 2011). The SuperSkills Model (SSM) proposed in this article combines microskills training with supervision common factors to create a framework with which to enhance the development and training of supervisors. The SSM worksheet provides a consolidated and user-friendly tool to assist with the supervision of SITs (please contact the author for a copy of the worksheet).
A Brief Background of Microskills
The use of microskills as a training instrument was born from the world of education. Succinctly, microtraining uses a systematic format to teach individual helping skills and may utilize recordings of practice, step-by-step training, and self-observation (Ivey et al., 1968). Fortune, Cooper, and Allen (1967) simplified and codified teaching skills into a model they called micro-teaching, aiming to provide students with an introduction to the experience and practice of teaching. The model provided experienced teachers with a vehicle for training novice teachers and gave the research team more control to track training effects.
When Ivey and colleagues (1968) introduced microskills within mental health care, they proposed the training of microcounseling, which focused on the specific behaviors of counseling skills, as useful in counselor education for the quick and effective teaching of counselor trainees. Ivey and colleagues’ adaptation of microskills to the mental health field allowed counselor preparation programs to move from nebulous training techniques to a more systematic approach, providing supervisors with a more delineated method to track trainees’ progress in actual skill behaviors. The structured method of tracking progress assists supervisors in the process of gatekeeping, making it easier to filter out candidates with difficulties or barriers to learning the core counseling skills (Lambie & Ascher, 2016).
The concept of utilizing microskills in the process of training supervisors has been broached by other researchers. Richardson and Bradley (1984) combined microskills and supervision training to create a microsupervision model, which breaks down the supervision skill acquisition process to assessment, modeling, and transfer. These three stages suggest how an SIT’s supervisor identifies skill areas for growth, provides educative and corrective information to the SIT, and allows the SIT opportunities to integrate and display new skills. Russell-Chapin and Ivey (2004) utilized microskill design to develop the Microcounseling Supervision Model (MSM). The Counselling Interview Rater Form (CIRF) is a component of the MSM, which breaks down the counseling session into stages that are then comprised of specific skills to be assessed (Russell-Chapin & Ivey, 2004). The MSM is a useful tool to practice providing constructive feedback, because the CIRF “is mostly used as a method of providing positive, corrective, qualitative and quantitative feedback for supervisees” (Russell-Chapin & Ivey, 2004, p. 167). James, Milne, & Morse (2008) adapted microskills to the dialogue used by supervisors within a cognitive-behavioral supervisory approach. These models can be useful in the development of supervisors; however, there is a need for the creation of a supervision model that rises above current approaches, yet provides enough focus to be specific to clinical supervision (Morgan & Sprenkle, 2007). The proposed SSM acts to fill potential deficiencies by balancing focus between more detailed supervisory actions and a wider breadth of supervisory behaviors.
The Progression of Supervision Models
Clinical supervision is recognized in the mental health professions as the signature pedagogy (Barnett, Erickson Cornish, Goodyear, & Lichtenberg, 2007; Goodyear, Bunch, & Claiborn, 2006). Introducing students to the foundational skills within mental health care has been a practice of supervisors for over 40 years (Ridley et al., 2011). Different professions within mental health care vary in job function and purpose, but the skills, processes, and objectives of supervision remain somewhat uniform across disciplines and cultures (Bernard & Goodyear, 2014). Supervision as an intervention shares characteristics with other interventions—namely teaching, psychotherapy, and consultation—yet is distinct (Milne, 2006). The unique aspects of supervision include the propensity to be provided by and to individuals in the same profession, an evaluative and hierarchical nature, and an extension over time (Bernard & Goodyear, 2014).
The process of supervision is often referred to as isomorphic, meaning that the relationship between client and counselor is often similar in structure to the concurrent relationship between counselor and supervisor (Koltz, Odegard, Feit, Provost, & Smith, 2012). However, this triadic configuration does not take a fourth entity into account: the relationship between the supervisor and the supervisor’s supervisor. This lapse is partially because of the underrepresentation of supervisory training knowledge in the counseling literature (Richardson & Bradley, 1984).
Another parallel between counseling and supervision is the utilization of theory to inform practice. Models of supervision may be classified in a number of ways. Bernard and Goodyear (2014) broadly delineated first-wave supervision models into one of three categories: models grounded in psychotherapy theory, developmental models, and process models. Psychotherapy-based models utilize psychotherapy’s theoretical approaches as a framework for use in supervision. Choice of psychotherapy-based models is often informed by the supervisor’s theoretical approach when in the counselor role. Familiarity with one’s own theory may provide the supervisor a level of comfort and an added sense of competence. Developmental models focus on the developmental needs of the CIT based on the status, pace, or standard of professional development. Focus on individual development allows the supervisor to tailor interventions to the current needs of the supervisee. Also, under the developmental model umbrella, models of social roles take further consideration of CIT contextual needs, based on such factors as cultural or experiential background (Aten, Strain, & Gillespie, 2008). Process models focus on the process within each supervision session, spotlighting the relationship and interactions between supervisor and CIT. Bernard and Goodyear (2014) proposed that these broad categories are best utilized in conjunction with one another.
From the broad first-wave supervision models, Bernard and Goodyear (2014) identified second-wave models of the next generation: combined models and target-issue models. Combined supervision models may blend multiple approaches within one of the above three categories (e.g., two psychotherapy theories) or between the above three categories (e.g., one developmental model and one process model). This approach may allow supervisors to provide what is needed to themselves and their supervisees within the supervisory process. Target-issue models hone in on specific elements or needs within supervision. These may be helpful to supervisors who need a more direct, concentrated approach to address a specific issue that arises in supervision.
Third-wave models have emerged from continued research on specific supervision models, providing an index of evidence from which supervisors and researchers may benefit. A paucity of evidence for efficacy between supervision models has created a movement toward gleaning aspects found to be effective within supervision models (Sprenkle, 1999). Supervisory common factors refer to core components that remain consistent when cutting across models and perspectives (Watkins, Budge, & Callahan, 2015). Integrating different approaches to create common-factors models hinges on the assumption that supervision models are unique; by borrowing strengths from multiple models, new frameworks may be created to fill in weaknesses (Lampropoulos, 2003). For example, Lampropoulos (2003) used the notion of eclecticism by blending common supervisory pathways, stages, and processes to make a case for the incorporation of empirically validated practices both within and outside mental health care. Morgan and Sprenkle (2007) provided a similar process, utilizing broader supervision models and popular supervision conceptualizations to create a model focused on relationship, development, and role continuums in the supervisory position. Aten et al. (2008) described an integrative model that they referred to as transtheoretical.
The Case for Systematizing Supervisor Training
Aside from choosing a model of supervision, there are other elements that affect supervisory development. There are two environments supervisors practice within. Some assume the role in settings that primarily serve the public, acting as a supervisor to clinicians or interns working directly with clients. Others supervise in academic settings, primarily supervising the development of novice counseling students.
A large percentage of mental health professionals will ultimately act in a supervisory role (Norcross, Hedges, & Castle, 2002). This circumstance makes it especially perplexing that counseling professionals receive only minimal supervisory training (Pelling, 2008) and oftentimes no training at all (DeKruyf & Pehrsson, 2011). Supervisors are frequently placed into supervisory positions to learn on the job (Knapp & VandeCreek, 1997). Gonsalvez (2008) referred to this route of becoming a supervisor via the maxim see one, do one, teach one. When training does take place, it may come in the form of didactic (e.g., seminars, workshops, class instruction) or experiential (e.g., supervision of supervision) means (Watkins, 2012a). However, inconsistencies in training requirements for supervisors have been documented as recently as 2014 (Nate & Haddock, 2014). The Center for Credentialing & Education, an affiliate of the National Board for Certified Counselors, established the Approved Clinical Supervisor (ACS) credential, with 15 states having adopted the requirements as of 2016 (Center for Credentialing & Education, 2016). The compulsory conditions of becoming a supervisor still vary greatly.
Becoming a supervisor has developmental hurdles parallel to those of becoming a counselor (Milne, 2006). Processes and activities in both may look identical (Aten, Madson, & Kruse, 2008; Burns & Holloway, 1990). Encountering the shift in perspective from mental health practitioner to mental health supervisor can be troublesome (Watkins, 2013). SITs may experience feelings of anxiety and demoralization, trouble with forming a supervisory identity, and difficulty finding conviction about the meaningfulness of supervision (Watkins, 2013). Not unlike novice counselors, novice supervisors deal with the juggling of new skills and awareness, the discomfort of trying to find one’s own style, and self-doubt (Gazzola, De Stefano, Thériault, & Audet, 2013). These challenges may account for supervision models that aim to utilize SITs’ inherent therapeutic skills (Pearson, 2006).
The role of supervisor adds layers of responsibility that may not be present in the role of counselor alone. Counselors are responsible for advocating on behalf of clients (American Counseling Association [ACA], 2014); however, supervisors advocate for clients and CITs. The dual role of advocacy places the supervisor in the role of gatekeeper of the profession, charged with CIT development and the well-being of clients (Gaete & Ness, 2015). Balancing the duality of advocacy and evaluation may be taxing on new supervisors (Johnson, 2007).
The added responsibility of the supervisory role ushers in ethical issues beyond those incurred by clinicians alone (Rubin, 1997). Practitioners placed unwillingly into the supervisory role with little interest in the practice of supervision may pose a threat to the development of clinicians and future supervisors (Ladany, Mori, & Mehr, 2013). If trained in supervision by someone lacking passion for the practice, the meaningfulness of supervision is unlikely to be transmitted to the SIT (Watkins, 2013). It is more ideal to develop a supervisory identity while surrounded by others in a similar learning process (Watkins, 2013), a dynamic that may not be present for practitioners in the field learning new skills of supervision.
Essential Supervisory Microskills: The SuperSkills Model (SSM)
The purpose of the SSM is to fill the need for a functional training model focused on supervisory behaviors gleaned from the supervision literature and deemed to be common across research. The focus is less on (but may be combined with) conceptualizations of supervisor theory and roles, and more on practical utility of supervisory behavior and process before, during, and after a given supervision session. The goal of the SSM worksheet and each of the foci is to help SITs integrate important aspects of supervision into each session. With this approach and tool, SITs are not left to remember all topics simultaneously; instead, the checklist included in the worksheet assists with staying on task and works toward laying the foundation for more adept integration of key supervisory factors as SITs gain more experience. The SSM worksheet may be utilized in a checklist or written fashion, incorporated into necessary supervision notes for documentation purposes, and completed to varying degrees of formality. Depending on supervisory style, the worksheet may be used during a supervision session or supervision-of-supervision meeting, or outside of these (prior to and/or after session). The SSM worksheet also can be used as a tool for supervisors to track individual progress and accordance with supervisory common factors. Generally speaking, the SSM and its worksheet can be adapted to meet the needs of the individual and environmental context.
Within the SSM, there is an assumption that appropriate preparation has taken place prior to or concurrently with supervision (e.g., supervisory training, development of a supervision contract, continued growth toward approach and identity/style, alignment with a model or structure, vetting of supervisees, ethical and legal considerations). These assumptions suggest that the SSM is not a stand-alone method for teaching and learning supervision, but rather a means to assist the foundational learning of SITs and provide supervisors at any stage in development with continued prompting of current supervisory focal points. As new potential supervisory common factors emerge from the literature, focal points may be altered or added. The first element of the current SSM is a pre-session contemplation that encourages intentionality and consideration of focus in an upcoming supervision session. The second component of the SSM emphasizes tangible supervisory behaviors that work toward creating and fostering a strong supervisory relationship hinging on cultural interest and awareness. The third facet of the SSM highlights supervisory goals and tasks and differentiates between practical and process goal and task foci. Feedback and reflection is the SSM’s fourth dimension, which also gives consideration to SIT response to practical and process events, and includes attention to direct and indirect feedback and positive and constructive feedback. The final item of the SSM is post-session reflection, which allows for assessment of the supervision session. SITs may use this portion of the SSM to evaluate supervisory skill, consider future areas for focus, and document concerns or needs regarding the CIT.
Pre-Session
The first component of the SSM is pre-session reflection. Prior to beginning a supervision session, it may be necessary for an SIT to refer to notes from previous sessions to recall past areas of focus or pressing issues. A CIT may be working on specific counseling skills chosen for review in the upcoming supervision session and SITs need to be mindful of the focus for the session. The focus also includes supervisory skills that the SIT plans to intentionally practice, which should be written in the initial pre-session consideration on the worksheet. However, flexibility is necessary; when CITs experience difficult client presentations, such as suicidal ideation, SITs may need to adjust focus to best serve the development of the CIT and the supervisory environment (Hoffman, Osborn, & West, 2013). As client welfare falls on the shoulders of both the CIT and the supervisor, there may be a need for SITs to inquire for updates in matters that have legal implications (Branson, Cardona, & Thomas, 2015).
Coming into session considering one’s theoretical stance and supervisory style can be beneficial. Even though supervision is highly contextual with many areas to consider, supervision models act as a conceptual map to follow during sessions (Bernard & Goodyear, 2014). The “newness” of the supervisory role and the added layers of awareness may not equate to seamless use of a supervision model; however, using intention in supervision with regard to theory and style may aid continued understanding and improvement as a supervisor. The second pre-session consideration allows SITs to document intentions related to supervisory model, theory, or role.
Culturally Conscious Supervisory Relationships
The SSM’s second component is creating and maintaining a relationship with a focus on cultural factors. The supervisory relationship is a significant mediating factor for successful supervision outcomes (Ellis, 1991). Not only is supervisor focus on culture correlated with positive supervisory relationships (Schroeder, Andrews, & Hindes, 2009; Wong, Wong, & Ishiyama, 2013), but emphasizing culture fulfills the supervisor’s responsibility to facilitate deeper awareness of cultural realities for supervisees (Fukuyama, 1994). Bordin (1983) conceptualized the supervisory relationship as the emotional bond between supervisor and supervisee and one of the triadic components in the supervisory working alliance (SWA). When SITs bring cultural considerations into supervision, stronger SWAs are created (Bhat & Davis, 2007; Crockett & Hays, 2015). Consequently, a lack of comfort in the supervisory relationship may create a less conducive atmosphere for broaching cultural dialogues (White-Davis, Stein, & Karasz, 2016). The SWA positively affects the therapeutic alliance (DePue, Lambie, Liu, & Gonzalez, 2016), CIT satisfaction with supervision (Crockett & Hays, 2015), CIT willingness to disclose information (Gunn & Pistole, 2012; Mehr, Ladany, & Caskie, 2010), and CIT work satisfaction (Sterner, 2009).
The supervisory relationship is a large component of the SWA, and thus correlations of the SWA on other important supervisory factors may have bearing on building cultural relationships. SITs initiating productive conversations surrounding counseling self-efficacy (Ganske, Gnilka, Ashby, & Rice, 2015), CIT anxiety (Gnilka, Rice, Ashby, & Moate, 2016), and sources of stress and coping (Gnilka, Chang, & Dew, 2012; Sterner, 2009) may ultimately strengthen the supervisory relationship. Focus on these factors has been shown to increase the prevalence of CITs bringing up cultural issues in supervision (Nilsson, 2007). Likewise, supervisors who bring cultural considerations into supervision engender higher levels of supervisee self-efficacy in skill and multicultural competence (Constantine, 2001; Crockett & Hays, 2015; Kissil, Davey, & Davey, 2013; Ladany, Brittan-Powell, & Pannu, 1997; Vereen, Hill, & McNeal, 2008).
A culturally conscious supervisory relationship is beneficial to both supervision and counseling environments; thus, documenting relationship-building actions on the worksheet gives appropriate and necessary focus to the actual relationship-building behaviors by the SIT. Providing time in supervision to focus on CIT relationships in both professional/academic and personal settings is important because both domains influence professional development (Rønnestad & Skovholt, 2003) and may ultimately relate to deepening the supervisory relationship (Mutchler & Anderson, 2010). Challenging dominant ideologies in supervision also has positive implications for broaching the concept of power within the supervisory and counseling environments (Hernández & McDowell, 2010). It may be useful for an SIT to inquire about a CIT’s values, beliefs, and on what the counselor places importance, because highlighting culture and relationships in supervision works toward exemplifying the importance of focusing on culture to create therapeutic relationships with clients (Willis-O’Connor, Landine, & Domene, 2016). The SWA is compatible with a multicultural perspective in supervision (Bordin, 1983) and is considered transtheoretical, making the SWA adaptable to different counseling and supervisory theories (Bordin, 1983; Wood, 2005).
Goals and Tasks
The SSM’s third component, goals and tasks, is based on the two other components of Bordin’s (1983) SWA. These are important to include because the SWA may be the most commonly cited factor in supervision literature (Watkins, 2014b). The goals refer to mutually agreed upon and understood objectives between the SIT and supervisee pertaining to the development of the CIT. The tasks refer to the action steps taken to achieve those objectives and the negotiation between SIT and supervisee to frame these steps in appropriate and achievable ways. Goals help to focus and direct supervision sessions while tasks act to pursue and attain the goals (Watkins, 2014b). The SSM worksheet includes space for the SIT to write goals and tasks for the supervision session, and the 11-point Likert scales provide the means to document the degree to which goals/tasks are agreed upon and achieved.
It is natural for novice supervisors to function from the perspective of a clinician, considering that this framework may be most comfortable or available (Watkins, 2014a). However, in doing so, the SIT may miss important components of CIT growth (Ponton & Sauerheber, 2014). Focus for goals and tasks should be directed at the process of counseling the client and the process of becoming (or being) a counselor; the SIT must attend to the space where the counselor’s “professional” meets the “personal” (Ponton & Sauerheber, 2014). For example, if a supervisee is unsure how to proceed with a client’s presenting issue, sole focus on goals and tasks aimed at client conceptualization and practical measures may foster dependence within the CIT to seek answers externally and work against a sense of self-efficacy and independence. Likewise, only attending to goals and tasks centralized to the counselor’s personal process may miss the opportunity to locate practical skills. Balancing goals and tasks with emphasis on the CIT’s process (e.g., potential feelings of inadequacy, confusion, difficulty with ambiguity) and practical abilities (e.g., specific skill use, conceptualization through a specific theoretical lens) may address individual needs and applicable skills to facilitate growth as a counselor. Differences will exist in CIT personality, ability, and developmental progress; therefore, SITs need to determine the appropriate equilibrium between process and practical focus for each supervisee (Reising & Daniels, 1983). The SSM worksheet contains space for the consideration of both practical and process goals and tasks, and the level of agreement and achievement.
Feedback and Reflection
Feedback and reflection comprise the fourth component to the SSM. An integral component to the supervision process, feedback is considered to be a change mechanism consistent across supervisory theory (Goodyear, 2014). Developmental levels of CITs vary (Rønnestad & Skovholt, 2003) and may influence the style of feedback (e.g., direct, indirect). Using the example of CITs who self-criticize their demonstration of skill, it may be useful for SITs to provide direct positive feedback to communicate successful skill demonstration (e.g., “That is a good example of reflecting a feeling.”). However, it is important to be mindful that feedback is a learning mechanism and to gradually remove oneself as support and transfer responsibility to the CIT (van de Pol, Volman, & Beishuizen, 2010). To that end, SITs may consider using indirect feedback to assist CITs to self-identify strengths (e.g., “If you had to identify a skill you did really well, what would it be?”). Instances exist throughout counselor development calling for various levels of direction in supervision (Goodyear, 2014), and SITs will develop a feel for when to provide direct and indirect feedback as they gain experience. To assist with this process, the worksheet includes a conceptual continuum for SITs to document feedback as direct or helping the CIT to self-identify.
Similar to goals and tasks, feedback for CITs should encompass both skill and process components (Liddle, 1986). Focus on learning counseling skills increases a CIT’s professional competency and identity (Aladağ, Yaka, & Koç, 2014). The ability to make skills explicit helps CITs to know what to look for and may assist the CIT and SIT in providing guidance and structure to the feedback process (Russell-Chapin & Sherman, 2000). Likewise, allowing CITs to use self-reflection to explore personal process components and arrive at meaningful conclusions may help facilitate learning, growth, and development (Guiffrida, 2015). For an example of skill versus process focus, consider a CIT learning to reflect feelings. By reviewing a recording of a counseling session, the SIT may witness the client expressing anger; or the SIT may choose to focus on skill, prompting the CIT to try identifying what feeling is being expressed or how to effectively reflect anger to the client. By focusing on process, the SIT may explore the CIT’s relationship with anger (e.g., how others have displayed anger to the CIT or how the CIT expresses anger), as self-reflection could reveal a barrier toward accurately identifying and reflecting anger. The SSM worksheet contains both practical and process feedback and reflection sections for the SIT to consider.
It is an ethical imperative for supervisors to provide ongoing feedback and evaluation to CITs (ACA, 2014). Positive feedback to CITs has been found to increase counseling self-efficacy and lower anxiety, while negative feedback decreases counseling self-efficacy and elicits more anxiety (Daniels & Larson, 2001). Negative feedback may include such elements as vagueness, inconsiderate tone, hidden meaning, delay between an episode and reference to an episode, and subjectivity (Baron, 1988). Alternately, constructive feedback is relevant, shared immediately, factual, helpful, confidential, respectful, tailored, and encouraging (Ovando, 1994). Constructive feedback in supervision has been found to be the highest-ranked demand among CITs (Ladany, Lehrman-Waterman, Molinaro, & Wolgast, 1999), and when combined with microskills training, it has been found to contribute to learning effectiveness (Fyffe & Oei, 1979). CITs who do not receive constructive feedback may experience stagnation in skill progress (Russell-Chapin & Ivey, 2004). Constructive feedback can be challenging for SITs to provide (Motley, Reese, & Campos, 2014), especially because supervisors are trained as counselors and giving evaluative judgment may seem counterintuitive to the therapeutic skill set (Ladany et al., 1999). The struggles associated with constructive feedback may require supervisors to call upon the supervisory relationship, taking inventory of CIT self-efficacy and confidence levels, to inform how and when to provide constructive feedback (Daniels & Larson, 2001). Supervisor impediments to providing quality feedback are recognized by both CITs and SITs (Heckman-Stone, 2004); thus, the addition of positive and constructive feedback sections on the worksheet may prompt SITs to practice providing both forms of feedback to CITs. The explicit cue for feedback also acts as a practical measure to inform SITs’ recording of supervision progress notes following the supervision session.
Post-Session
The SSM’s final component is post-session reflection. Utilizing the post-session for documentation benefits the CIT and the SIT. Maintaining supervision notes is an ethically sound practice and can assist supervisors in documenting practical, ethical, and legal issues (Luepker, 2012). Keeping records of supervision also proves beneficial to the development of SITs’ style and theoretical stance (Bernard, 2014). Timely and accurate documentation may act as a future reminder for areas on which to focus for the CIT or SIT.
The supervision note may have an evaluative component to it. Where applicable, a supervisor may begin to evaluate a CIT based on criteria set by an associated institution (e.g., university, occupational setting) or on agreed-upon standards between the supervisor and CIT (e.g., a measure found in the literature based on specific need). Likewise, the SIT may utilize documentation to evaluate their progress as a supervisor. Each microskill suggestion may act as an area to consider for evaluation or self-evaluation. These areas may include progress on deepening the cultural relationship, assessment of supervisory actions in working toward agreed-upon goals, appraisal of goal achievement, appropriate balance of direct feedback and assisting the CIT to formulate their own answers, appropriate balance of focus on counseling instruction and personal process, examples of interventions consistent with a theoretical model or supervisory role, and exploration of countertransference during the session.
Discussion
The SSM’s flexibility and focus on a behavioral framework may be efficacious in training supervisors from varying cultural identities and helping SITs learn how to supervise counselors of differing backgrounds. CITs gain multicultural knowledge in their development as counselors; this continual learning process is suitable to microskill techniques, as research has shown that newly acquired skills can be employed during continued multicultural awareness (Hall & Richardson, 2014).
The flexibility of the SSM gives SITs freedom in pace and style of development. Just as neophyte counselors are to focus on their own skills and process in early training, gradually increasing their abilities to work effectively with clients, SITs may follow a similar path of needing to focus on supervisory abilities before providing effective supervision (Lampropoulos, 2003).
The freedom to be flexible in supervisory development is corroborated by existing models. Morgan and Sprenkle (2007) suggested a model that conceptualizes supervisor behaviors and roles on continuums, assuming that supervisors will have knowledge of their own styles and strengths to adjust and flex where needed. Goodyear (2014) created a model that provides SITs the ability to choose how to provide feedback, landing anywhere between direct instruction and self-directed learning. The SSM’s composition of common-factor components allows for adaptation to other models with both flexible and focused supervisory interventions. The SSM also utilizes updated research and literature to inform more specified behaviors associated with positive supervisory and therapeutic outcomes.
Conclusions
Supervision continues to become more recognized, accepted, and vital to the mental health professions for the preparation of multiculturally competent counselors (Watkins & Milne, 2014). There remains a dearth of information on how to effectively train supervisors, and a movement toward competency-based models has been suggested (Milne et al., 2011). Just as Ivey and fellow researchers (1968) adapted microskills training to counseling in order to study and bridge theory and practice, consolidating supervisory common factors “could not only provide a template for supervision research, but also for teaching and providing supervision as well” (Morgan & Sprenkle, 2007, p. 2). The SSM and accompanying worksheet are a step toward a simplified conceptualization and user-friendly tool to continue progressing supervision training and practice.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest or funding contributions for the development of this manuscript.
References
Aladağ, M., Yaka, B., & Koç, İ. (2014). Opinions of counselor candidates regarding counseling skills training.
Educational Sciences: Theory and Practice, 14, 879–886. doi:10.12738/estp.2014.3.1958
American Counseling Association. (2014). 2014 ACA code of ethics. Alexandria, VA: Author.
Aten, J. D., Madson, M. B., & Kruse, S. J. (2008). The supervision genogram: A tool for preparing supervisors-
Aten, J. D., Strain, J. D., & Gillespie, R. E. (2008). A transtheoretical model of clinical supervision. Training and Education in Professional Psychology, 2, 1–9. doi:10.1037/1931-3918.2.1.1
Barnett, J. E., Erickson Cornish, J. A., Goodyear, R. K., & Lichtenberg, J. W. (2007). Commentaries on the ethical and effective practice of clinical supervision. Professional Psychology: Research and Practice, 38, 268– 275. doi:10.1037/0735-7028.38.3.268
Baron, R. A. (1988). Negative effects of destructive criticism: Impact on conflict, self-efficacy, and task performance. Journal of Applied Psychology, 73, 199–207. doi:10.1037/0021-9010.73.2.199
Bernard, J. M. (2014). The use of supervision notes as a targeted training strategy. American Journal of Psychotherapy, 68, 195–212.
Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th ed.). Upper Saddle River, NJ: Pearson Education.
Bhat, C. S., & Davis, T. E. (2007). Counseling supervisors’ assessment of race, racial identity, and working alliance in supervisory dyads. Journal of Multicultural Counseling and Development, 35, 80–91.
doi:10.1002/j.2161-1912.2007.tb00051.x
Bordin, E. S. (1983). Supervision in counseling: II. Contemporary models of supervision: A working alliance based model of supervision. The Counseling Psychologist, 11, 35–42. doi:10.1177/0011000083111007
Branson, A., Cardona, B., & Thomas, C. (2015). Supporting couples, marriage, and family therapy trainees in need of performance improvement: Implications for counselor educators and supervisors. The Family
Burns, C. I., & Holloway, E. L. (1990). Therapy in supervision: An unresolved issue. The Clinical Supervisor, 7, 47–60. doi:10.1300/J001v07n04_05
Capuzzi, D., & Gross, D. R. (2009). Introduction to the counseling profession. Upper Saddle River, NJ: Pearson.
Center for Credentialing & Education. (2016). Approved clinical supervisor. Retrieved from http://www.cce-global.org/ACS
Constantine, M. G. (2001). Multiculturally-focused counseling supervision: Its relationship to trainees’ multicultural counseling self-efficacy. The Clinical Supervisor, 20, 87–98. doi:10.1300/J001v20n01_07
Crockett, S., & Hays, D. G. (2015). The influence of supervisor multicultural competence on the supervisory working alliance, supervisee counseling self-efficacy, and supervisee satisfaction with supervision: A mediation model. Counselor Education and Supervision, 54, 258–273. doi:10.1002/ceas.12025
Daniels, J. A., & Larson, L. M. (2001). The impact of performance feedback on counseling self-efficacy and counselor anxiety. Counselor Education and Supervision, 41, 120–130. doi:10.1002/j.1556-6978.2001.tb01276.x
DeKruyf, L., & Pehrsson, D.-E. (2011). School counseling site supervisor training: An exploratory study. Counselor Education and Supervision, 50, 314–327. doi:10.1002/j.1556-6978.2011.tb01918.x
DePue, M. K., Lambie, G. W., Liu, R., & Gonzalez, J. (2016). Investigating supervisory relationships and
therapeutic alliances using structural equation modeling. Counselor Education and Supervision, 55, 263–277. doi:10.1002/ceas.12053
Ellis, M. V. (1991). Critical incidents in clinical supervision and in supervisor supervision: Assessing supervisory issues. Journal of Counseling Psychology, 38, 342–349. doi:10.1037/0022-0167.38.3.342
Fortune, J. C., Cooper, J. M., & Allen, D. W. (1967). The Stanford summer micro-teaching clinic, 1965. Journal of Teacher Education, 18, 389–393.
Fukuyama, M. A. (1994). Critical incidents in multicultural counseling supervision: A phenomenological approach to supervision research. Counselor Education and Supervision, 34, 142–151.
doi:10.1002/j.1556-6978.1994.tb00321.x
Fyffe, A. E., & Oei, T. P. S. (1979). Influence of modelling and feedback provided by the supervisors in a microskills training program for beginning counsellors. Journal of Clinical Psychology, 35, 651–656.
Gaete, J., & Ness, O. (2015). Supervision: From prescribed roles to preferred positionings. The Clinical Supervisor, 34, 57–77. doi:10.1080/07325223.2015.1006068
Ganske, K. H., Gnilka, P. B., Ashby, J. S., & Rice, K. G. (2015). The relationship between counseling trainee
perfectionism and the working alliance with supervisor and client. Journal of Counseling & Development, 93, 14–24. doi:10.1002/j.1556-6676.2015.00177.x
Gazzola, N., De Stefano, J., Thériault, A., & Audet, C. T. (2013). Learning to be supervisors: A qualitative investigation of difficulties experienced by supervisors-in-training. The Clinical Supervisor, 32, 15–39.
doi:10.1080/07325223.2013.778678
Gnilka, P. B., Chang, C. Y., & Dew, B. J. (2012). The relationship between supervisee stress, coping resources, the working alliance, and the supervisory working alliance. Journal of Counseling & Development, 90, 63–70. doi:10.1111/j.1556-6676.2012.00009.x
Gnilka, P. B., Rice, K. G., Ashby, J. S., & Moate, R. M. (2016). Adult attachment, multidimensional
perfectionism, and the alliances among counselor supervisees. Journal of Counseling & Development, 94, 285–296. doi:10.1002/jcad.12085
Gonsalvez, C. J. (2008). Introduction to the special section on clinical supervision. Australian Psychologist, 43, 76–78. doi:10.1080/00050060802068547
Goodyear, R. K. (2014). Supervision as pedagogy: Attending to its essential instructional and learning processes. The Clinical Supervisor, 33, 82–99. doi:10.1080/07325223.2014.918914
Goodyear, R. K., Bunch, K., & Claiborn, C. D. (2006). Current supervision scholarship in psychology: A five year review. The Clinical Supervisor, 24, 137–147. doi:10.1300/J001v24n01_07
Guiffrida, D. (2015). A constructive approach to counseling and psychotherapy supervision. Journal of Constructivist Psychology, 28, 40–52. doi:10.1080/10720537.2014.922911
Gunn, J. E., & Pistole, M. C. (2012). Trainee supervisor attachment: Explaining the alliance and disclosure in supervision. Training and Education in Professional Psychology, 6, 229–237. doi:10.1037/a0030805
Hall, K. G., & Richardson, E. D. (2014). Multicultural microskills: Implementation on an existing design. Journal for International Counselor Education, 6, 75–89.
Heckman-Stone, C. (2004). Trainee preferences for feedback and evaluation in clinical supervision. The Clinical Supervisor, 22, 21–33. doi:10.1300/J001v22n01_03
Hernández, P., & McDowell, T. (2010). Intersectionality, power, and relational safety in context: Key concepts in clinical supervision. Training and Education in Professional Psychology, 4, 29–35.
doi:10.1037/a0017064
Hoffman, R. M., Osborn, C. J., & West, J. D. (2013). Clinical supervision of counselors-in-training working with suicidal clients: A grounded theory investigation. The Clinical Supervisor, 32, 105–127.
doi:10.1080/07325223.2013.780991
Ivey, A. E. (1971). Microcounseling: Innovations in interviewing training. Oxford, England: Thomas.
Ivey, A. E., Normington, C. J., Miller, C. D., Morrill, W. H., & Haase, R. F. (1968). Microcounseling and
attending behavior: An approach to pre-practicum training [monograph]. Journal of Counseling Psychology, 15, 1–12.
James, I. A., Milne, D. L., & Morse, R. (2008). Microskills of clinical supervision: Scaffolding skills. Journal of Cognitive Psychotherapy, 22, 29–36. doi:10.1891/0889.8391.22.1.29
Johnson, W. B. (2007). Transformational supervision: When supervisors mentor. Professional Psychology: Research and Practice, 38, 259–267. doi:10.1037/0735-7028.38.3.259
Kissil, K., Davey, M., & Davey, A. (2013). Foreign-born therapists in the United States: Supervisors’
multicultural competence, supervision satisfaction, and counseling self-efficacy. The Clinical Supervisor, 32, 185–211. doi:10.1080/07325223.2013.846746
Knapp, S., & VandeCreek, L. (1997). Ethical and legal aspects of clinical supervision. In C. E. Watkins, Jr. (Ed.), Handbook of Psychotherapy Supervision (pp. 589–599). New York, NY: Wiley.
Koltz, R. L., Odegard, M. A., Feit, S. S., Provost, K., & Smith, T. (2012). Parallel process and isomorphism:
A model for decision making in the supervisory triad. The Family Journal, 20, 233–238. doi:10.1177/1066480712448788
Ladany, N., Brittan-Powell, C. S., & Pannu, R. K. (1997). The influence of supervisory racial identity interaction and racial matching on the supervisory working alliance and supervisee multicultural competence. Counselor Education and Supervision, 36, 284–304. doi:10.1002/j.1556-6978.1997.tb00396.x
Ladany, N., Lehrman-Waterman, D., Molinaro, M., & Wolgast, B. (1999). Psychotherapy supervisor ethical practices: Adherence to guidelines, the supervisory working alliance, and supervisee satisfaction. The Counseling Psychologist, 27, 443–475. doi:10.1177/0011000099273008
Ladany, N., Mori, Y., & Mehr, K. E. (2013). Effective and ineffective supervision. The Counseling Psychologist, 41, 28–47. doi:10.1177/0011000012442648
Lambie, G. W., & Ascher, D. L. (2016). A qualitative evaluation of the Counseling Competencies Scale with clinical supervisors and their supervisees. The Clinical Supervisor, 35, 98–116.
doi:10.1080/07325223.2015.1132398
Lampropoulos, G. K. (2003). A common factors view of counseling supervision process. The Clinical Supervisor, 21, 77–95. doi:10.1300/J001v21n01_06
Liddle, B. J. (1986). Resistance in supervision: A response to perceived threat. Counselor Education and Supervision, 26, 117–127. doi:10.1002/j.1556-6978.1986.tb00706.x
Luepker, E. T. (2012). Record keeping in psychotherapy and counseling: Protecting confidentiality and the professional relationship (2nd ed.). New York, NY: Routledge.
Mehr, K. E., Ladany, N., & Caskie, G. I. L. (2010). Trainee nondisclosure in supervision: What are they not telling you? Counselling & Psychotherapy Research, 10, 103–113. doi:10.1080/14733141003712301
Milne, D. L. (2006). Developing clinical supervision research through reasoned analogies with therapy. Clinical Psychology & Psychotherapy, 13, 215–222. doi:10.1002/cpp.489
Milne, D. L., Reiser, R. P., Cliffe, T., & Raine, R. (2011). SAGE: Preliminary evaluation of an instrument for
observing competence in CBT supervision. The Cognitive Behaviour Therapist, 4, 123–138. doi:10.1017/S1754470X11000079
Morgan, M. M., & Sprenkle, D. H. (2007). Toward a common-factors approach to supervision. Journal of Marital and Family Therapy, 33, 1–17. doi:10.1111/j.1752-0606.2007.00001.x
Motley, V., Reese, M. K., & Campos, P. (2014). Evaluating corrective feedback self-efficacy changes among counselor educators and site supervisors. Counselor Education and Supervision, 53, 34–46.
doi:10.1002/j.1556-6978.2014.00047.x
Mutchler, M., & Anderson, S. (2010). Therapist personal agency: A model for examining the training context. Journal of Marital and Family Therapy, 36, 511–525. doi:10.1111/j.1752-0606.2010.00198.x
Nate, R. D., & Haddock, L. R. (2014). An exploration of counselor supervisor requirements across the United
States. Ideas and research you can use: Vistas 2014. Retrieved from https://www.counseling.org/knowledge-center/vistas/by-year2/vistas-2014/docs/default-source/vistas/article_31
Nilsson, J. E. (2007). International students in supervision: Course self-efficacy, stress, and cultural discussions in supervision. The Clinical Supervisor, 26, 35–47. doi:10.1300/J001v26n01_04
Norcross, J. C., Hedges, M., & Castle, P. H. (2002). Psychologists conducting psychotherapy in 2001: A study of the Division 29 membership. Psychotherapy: Theory, Research, Practice, Training, 39, 97–102.
doi:10.1037/0033-3204.39.1.97
Ovando, M. N. (1994). Constructive feedback: A key to successful teaching and learning. International Journal of Educational Management, 8, 19–22.
Pearson, Q. M. (2000). Opportunities and challenges in the supervisory relationship: Implications for counselor supervision. Journal of Mental Health Counseling, 22, 283–294.
Pearson, Q. M. (2006). Psychotherapy-driven supervision: Integrating counseling theories into role-based
supervision. Journal of Mental Health Counseling, 28, 241–252. doi:10.17744/mehc.28.3.be1106w7yg3wvt1w
Pelling, N. (2008). The relationship of supervisory experience, counseling experience, and training in
supervision to supervisory identity development. International Journal for the Advancement of Counselling, 30, 235–248. doi:10.1007/s10447-008-9060-2
Ponton, R. F., & Sauerheber, J. D. (2014). Supervisee countertransference: A holistic supervision approach. Counselor Education and Supervision, 53, 254–266. doi:10.1002/j.1556-6978.2014.00061.x
Reising, G. N., & Daniels, M. H. (1983). A study of Hogan’s model of counselor development and supervision. Journal of Counseling Psychology, 30, 235–244. doi:10.1037/0022-0167.30.2.235
Richardson, B. K., & Bradley, L. J. (1984). Microsupervision: A skill development model for training clinical supervisors. The Clinical Supervisor, 2, 43–54. doi:10.1300/J001v02n03_05
Ridley, C. R., Kelly, S. M., & Mollen, D. (2011). Microskills training: Evolution, reexamination, and call for reform. The Counseling Psychologist, 39, 800–824. doi:10.1177/0011000010378438
Rønnestad, M. H., & Skovholt, T. M. (2003). The journey of the counselor and therapist: Research findings
and perspectives on professional development. Journal of Career Development, 30, 5–44. doi:10.1023/A:1025173508081
Rubin, S. S. (1997). Balancing duty to client and therapist in supervision. The Clinical Supervisor, 16, 1–23. doi:10.1300/J001v16n01_01
Russell-Chapin, L. A., & Ivey, A. E. (2004). Microcounselling supervision: An innovative integrated
supervision model. Canadian Journal of Counselling, 38, 165–176.
Russell-Chapin, L. A., & Sherman, N. E. (2000). The Counselling Interview Rating Form: A teaching and evaluation tool for counsellor education. British Journal of Guidance & Counselling, 28, 115–124. doi:10.1080/030698800109655
Schroeder, M., Andrews, J. J. W., & Hindes, Y. L. (2009). Cross-racial supervision: Critical issues in the supervisory relationship. Canadian Journal of Counselling, 43, 295–310.
Sprenkle, D. H. (1999). Toward a general model of family therapy supervision: Comment on Roberts, Winek, and Mulgrew. Contemporary Family Therapy, 21, 309–315. doi:10.1023/A:1021956214595
Sterner, W. R. (2009). Influence of the supervisory working alliance on supervisee work satisfaction and work-
related stress. Journal of Mental Health Counseling, 31, 249–263. doi:10.17744/mehc.31.3.f3544l502401831g
Uellendahl, G. E., & Tenenbaum, M. N. (2015). Supervision training, practices, and interests of California site supervisors. Counselor Education and Supervision, 54, 274–287. doi:10.1002/ceas.12026
van de Pol, J., Volman, M., & Beishuizen, J. (2010). Scaffolding in teacher–student interaction: A decade of research. Educational Psychology Review, 22, 271–296. doi:10.1007/s10648-010-9127-6
Vereen, L. G., Hill, N. R., & McNeal, D. T. (2008). Perceptions of multicultural counseling competency:
Integration of the curricular and the practical. Journal of Mental Health Counseling, 30, 226–236. doi:10.17744/mehc.30.3.g34u122m16q64g44
Watkins, C. E., Jr. (2010). Psychoanalytic developmental psychology and the supervision of psychotherapy supervisor trainees. Psychodynamic Practice, 16, 393–407. doi:10.1080/14753634.2010.510345
Watkins, C. E., Jr. (2012a). Educating psychotherapy supervisors. American Journal of Psychotherapy, 66, 279–309.
Watkins, C. E., Jr. (2012b). Development of the psychotherapy supervisor: Review of and reflections on 30 years of theory and research. American Journal of Psychotherapy, 66, 45–83.
Watkins, C. E., Jr. (2013). Being and becoming a psychotherapy supervisor: The crucial triad of learning difficulties. American Journal of Psychotherapy, 67, 135–151.
Watkins, C. E., Jr. (2014a). Leading and learning in the psychotherapy supervision seminar: Some thoughts on
the beginnings of supervisor development. Journal of Contemporary Psychotherapy, 44, 233–243. doi:10.1007/s10879-014-9268-x
Watkins, C. E., Jr. (2014b). The supervisory alliance as quintessential integrative variable. Journal of Contemporary Psychotherapy, 44, 151–161. doi:10.1007/s10879-013-9252-x
Watkins, C. E., Jr., Budge, S. L., & Callahan, J. L. (2015). Common and specific factors converging in
psychotherapy supervision: A supervisory extrapolation of the Wampold/Budge psychotherapy relationship model. Journal of Psychotherapy Integration, 25, 214–235. doi:10.1037/a0039561
Watkins, C. E., & Milne, D. L. (2014). Clinical supervision at the international crossroads: Current status
and future directions. In C. E. Watkins, & D. L. Milne (Eds.), The Wiley international handbook of clinical supervision (pp. 673–691). Malden, MA: Wiley Blackwell.
White-Davis, T., Stein, E., & Karasz, A. (2016). The elephant in the room: Dialogues about race within cross-
cultural supervisory relationships. The International Journal of Psychiatry in Medicine, 51, 347–356. doi:10.1177/0091217416659271
Willis-O’Connor, S., Landine, J., & Domene, J. F. (2016). International students’ perspectives of helpful and hindering factors in the initial stages of a therapeutic relationship. Canadian Journal of Counselling and Psychotherapy, 50(Suppl. 3), 156–174.
Wong, L. C. J., Wong, P. T. P., & Ishiyama, F. I. (2013). What helps and what hinders in cross-cultural clinical
supervision: A critical incident study. The Counseling Psychologist, 41, 66–85. doi:10.1177/0011000012442652
Wood, C. (2005). Supervisory working alliance: A model providing direction for college counseling supervision.
Journal of College Counseling, 8, 127–137. doi:10.1002/j.2161-1882.2005.tb00079.x
Dusty Destler is a doctoral candidate and Counseling Clinic Supervisor at Idaho State University – Meridian. Correspondence can be addressed to Dusty Destler, 1311 E. Central Drive, Meridian, ID 83642, dmdestler@gmail.com.
