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Critical Elements of Effective Supervision With the Experienced Counselor

A Dissertation Submitted to the Faculty of Argosy University Schaumburg Campus College of Psychology and Behavioral Sciences In Partial Fulfillment of the Requirement for the Degree of Doctor of Education

by Alice H. Crawford August 2010

ii Critical Elements of Effective Supervision With the Experienced Counselor

2010 Alice H. Crawford All rights reserved

iii Critical Elements of Effective Supervision With the Experienced Counselor

Abstract of Dissertation

Submitted to the Faculty of Argosy University Schaumburg Campus College of Psychology and Behavioral Sciences in Partial Fulfillment of the Requirements for the Degree of Doctor of Education by Alice H. Crawford Argosy University Schaumburg

August 2010

Katherine Miley, PsyD Dale Septeowski, PhD La-Don Jackson, PhD Department: School of Behavioral Science

iv Abstract The current research project explored answers to the question, what are the critical elements to conduct effective supervision with experienced counselors? A three round electronic Delphi study was conducted with a panel of eight clinical supervisors. The study, conducted over a nine week period, gave participants an opportunity to answer four open-ended questions in the first round and address consensus of the group during the second and third round. Results of the study identified four critical elements for conducting effective supervision with experienced counselors: the supervisor; the supervisee/experienced counselor; the supervision process; and the supervision relationship. Conclusions of the study direct further research in the area of diversity and outcome of supervision with experienced counselors.

v Table of Contents TABLE OF TABLE..vii TABLE OF APPENDICES..viii Table of Table..vii........v Table of Appendices..viii.........v Table of Appendices..........................................................................................................vii Appendix A: Electronic Invitation Error: Reference source not found.............................vii Appendix B: Informed Consent Error: Reference source not found................................vii Appendix C: Study Description Error: Reference source not found................................vii Appendix D: Nominee Invitation Error: Reference source not found..............................vii Appendix E: Round One Questionnaire and Demographics Error: Reference source not found..................................................................................................................................vii Appendix F: Application for IRB Review and Certification of Compliance Error: Reference source not found...............................................................................................vii Appendix G: Round One Response Error: Reference source not found..........................vii Appendix H: Additional Comments Round 2 Error: Reference source not found............vii Appendix I: Additional Comments Round 3 ..Error: Reference source not found..................vii Acknowledgements..........................................................................................................viii Chapter One: The Problem.................................................................................................1 Problem Background.......................................................................................................2 Purpose of the Study........................................................................................................6 Research Question...........................................................................................................7 Limitations of the Research.............................................................................................9 Definitions......................................................................................................................10 Importance of the Study.................................................................................................11 Chapter Two: Review Of The Literature..........................................................................12 Administrative Supervision...........................................................................................12 Clinical Supervision.......................................................................................................17 Components of Clinical Supervision.............................................................................22 Good Supervision vs. Bad Supervision.........................................................................50 Chapter Three: Methodology............................................................................................58 Research Design.............................................................................................................58 Data Processing and Analysis........................................................................................69 Chapter Four: Findings.....................................................................................................71 Chapter Five: Summary, Limitations and Future Research..............................................88 The panel of eight clinical supervisors submitted their ideas in an electronic Delphi study exploring what are the critical elements of conducting supervision with an experienced counselor. As the study unfolded, the panel pinpointed four critical elements that were considered necessary for effective supervision with this population. The critical elements focused upon characteristics of the supervisor, characteristics of the supervisee/experienced counselor, characteristics of the supervision process, and

vi the supervision relationship. In Campbells (2000) discussion of conducting effective supervision it was noted that the supervisor should include models of supervision, methods and techniques of clinical supervision, role of the relationship in supervision, methods and techniques to help the supervisee grow, legal and ethical issues in supervision, multicultural issues in supervision, administrative tasks in supervision, and the role of personal development in supervision. The four elements discussed by the Delphi panel coincided with Campbells definitions of effective supervision........88 Characteristics of the Supervisor...................................................................................88 Characteristics of the Supervisee...................................................................................94 Characteristics of the Supervision Process....................................................................98 Characteristics of the Supervision Relationship ........................................................103 Limitations of the Study...............................................................................................107 Future Research...........................................................................................................108 References........................................................................................................................110 Appendices......................................................................................................................121 Appendix A......................................................................................................................122 Electronic Invitation ......................................................................................................122 Appendix B......................................................................................................................126 Informed Consent............................................................................................................126 Appendix C .....................................................................................................................129 Study Description ...........................................................................................................129 Appendix D .....................................................................................................................131 Nominee Invitation..........................................................................................................131 Appendix E .....................................................................................................................135 Round One Questionnaire and Demographics................................................................135 Appendix F .....................................................................................................................138 Application for IRB Review and Certification of Compliance.......................................138 Appendix G .....................................................................................................................151 Round One Response.......................................................................................................151 Appendix H .....................................................................................................................164 Additional Comments Round 2.......................................................................................164 Appendix I ......................................................................................................................166 Additional Comments Round 3.......................................................................................166

vii Table of Appendices Appendix A: Electronic Invitation..................................Error: Reference source not found Appendix B: Informed Consent.....................................Error: Reference source not found Appendix C: Study Description.....................................Error: Reference source not found Appendix D: Nominee Invitation....................................Error: Reference source not found Appendix E: Round One Questionnaire and Demographics.....Error: Reference source not found Appendix F: Application for IRB Review and Certification of Compliance..............Error: Reference source not found Appendix G: Round One Response...............................Error: Reference source not found Appendix H: Additional Comments Round 2.................Error: Reference source not found Appendix I: Additional Comments Round 3 ..Error: Reference source not found

viii Acknowledgements

The author would like to express sincere gratitude to committee members, Dr. Katherine Miley, Dr Dale Septeowski, and Dr. La-Don Jackson, for their invaluable support and guidance in the planning and implementation of this research project. The deepest appreciation is further offered to Dr. Jeffrey Edwards for his guidance in the research methodology of the project and Robert Racine for help with data analysis. The most heartfelt appreciation is offered to my editor, Amy Gralewski, for quick completion of the task. The deepest appreciation is further offered to the Clinical Supervisors of the Linked In groups for their participation in the research study. Without their contributions of time and resources, this study would not have been possible.

ix Dedication

To my husband, Bryant, for your patience during this process and my son, Christopher, for understanding when Mom was in a grumpy mood. To my Mother and Father who are my prayer warriors, my sister who always asked are you getting something done? and family members whose prayers, love, and support have helped turn this dream into a shared reality. It could not have been possible without you.

CHAPTER ONE: THE PROBLEM Supervision is a common occurrence and major part of training and licensure for beginning and novice counselors (Grant & Schorfeld, 2007). As part of a counseling curriculum, the counselor-in-training is expected to complete hours of supervision in order to meet degree requirements as well as continue postgraduate supervision to obtain licensure. Bhat and Davis (2007) stated supervision is the primary vehicle in the counseling profession through which trainees provide services to clients in a monitored environment (p. 80). However, the discussion of supervision and its focus on the beginning or novice counselor discounts a population of counselors who continue to receive supervision, the practicing or experienced counselor. Grant and Schorfeld (2007) found that not only do counselors engage in supervision after licensure, they often engage in supervision for years after licensure. Their study focused on members of the Psychotherapy and Counselling Federation of Australia and found that a large percentage of the respondents continued to engage in supervision, with 79% engaging in individual supervision rather than peer or group supervision (Grant and Schorfeld, 2007). While the literature speaks to effective ways for supervisors to conduct supervision for the counselor in training, it does not speak specifically to how supervisors conduct supervision with experienced counselors and how it may differ from supervision of a counselor-in-training. Ronnestad and Skovolt (2003) discussed the changes experienced by the counselor as he or she gains experience. Goodyear, Wetheimer, Cypers, and Rosemond (2003) acknowledged this finding and pointed out that there should be more in-depth discussion about the impact of supervision on the experienced counselor as the

2 experienced counselor gains experience. The authors contended that supervision with the experienced counselor should be investigated to understand the impact of supervision on this type of counselor. Problem Background Campbell (2000) stated, effective supervisors need a broad range of competencies in a variety of areas (p. 5). The supervisor must assess and monitor the supervisee no matter the level of skill or experience. This baseline helps the supervisor to get to know the supervisee and meet the needs of the supervisee within the supervision realm. According to Campbell, the important supervision skills include knowledge of clinical supervision; understanding of the supervision models, methods and techniques; understanding the importance of the supervisory relationship; understanding of cultural issues and environmental factors; understanding of legal and ethical issues; and familiarity with assessment and evaluation. While Campbells list is not exhaustive, it is extensive; however, Campbell did not state whether the listing could be generalized across all levels of counselor skills and experiences. Campbell also did not specify whether these same factors are addressed in supervision with an experienced counselor or if additional or fewer factors are needed. While the major counseling and psychotherapy organizations in the US (i.e., American Psychological Association and American Counseling Association) do not require ongoing supervision after licensure, many experienced counselors, like the beginning or novice counselors, engage in supervision for personal and professional growth. Not only do the experienced counselors express a desire to participate in supervision, they have been known to seek it out if it is not provided in their work setting.

3 The difference in the experienced counselor and the novice/beginning or counselor-intraining is how they define their personal and professional growth and what is needed in supervision to achieve this growth. Ronnestad and Skovholt (2003) contended that the professional development of the experienced counselor should not only encompass the issues of the novice/beginning counselor, such as anxiety and supportive work environments, but also include the counselors personal life challenges and experiences. Roberts and Borders (1994) agreed that supervision is to focus, among other things, on ones personal traits and issues affecting counseling performance (p. 1). Borders (1991c) further stated, although skill enhancement frequently is the specified goal, the supervision process also encourages greater self-awareness and fosters an integrated professional and personal identity as a counselor (p. 254). According to Stoltenbergs (1981) developmental model, the experienced counselor is a professional who is considered Level 4 or Master Counselor: The counselor has personal security based on awareness of insecurity; is insightful, with full awareness of the limitations of insight; and is able to function adequately, even with some occasional changes in degrees of motivation. (p. 63) The experienced counselor is one who has practiced for a number of years, is independently licensed, and can be found in various work contexts from educational programs and schools to agencies and hospitals. Further, the experienced counselor is aware of and understands the role of being a counselor. Experienced counselors are open to new ideas and experiences, in touch with their inner feelings and their emotions, possess trust, possess self-awareness, and have different personality characteristics, which can help enhance the supervisory relationship Ronnestad and Skovholt (2003).

4 This professional is expected to incorporate theories of counseling, the importance of the therapeutic relationships and processes, setting boundaries, approach to counseling, distinction between their personal and professional life, ethical and legal issues, the impact of diversity and environmental factors on client issues, and positive client outcomes. The experienced counselor, not unlike the novice counselor, also recognizes the importance of ongoing supervision for professional development (Shechtman & Wirzberger, 1999). Though experienced counselors are viewed as selfregulating, self-monitoring, and competent in the field of counseling, Barretta-Herman (1993) argued that the emotional demands placed on counselors to deal with traumatic, pervasive, intractable individuals and social problems warrant continued support. This support can be achieved through clinical supervision. The supposition that the experienced counselor may not need supervision defines supervision only as a teaching tool for those who must learn how to be counselors rather than as an enhancement tool for continued growth and competence. While there are many different approaches to supervision for the counselor-in-training or the novice, it is not known if these same approaches can be just as beneficial for the experienced counselor or if the experienced counselor is looking for other factors to address. Unlike the novice counselor, the experienced counselor has a wider knowledge base on counseling techniques and therefore may need a different or additional focus in supervision. Supervisors may know of the demand for additional focus and address those issues in supervision with an experienced counselor, but to date nothing in the literature describes those issues. The experienced counselor can bring many different perspectives to supervision due to their experiences with counseling clients. The supervisor could learn from the

5 experienced counselor in supervision rather than the traditional theory that the supervisee is to learn from the supervisor. Holloway (1988) questioned the developmental model of supervision, since the emphasis is more on the counselor-in-training than the experienced counselor. She stated that training helps the emerging counselors develop within the supervisory context and the development results in a counseling professional. She asked whether someone who has been a counselor and then furthers their professional training is to be viewed as someone who is now an inadequate counselor during supervision. She emphasized the idea that supervisees bring experiences to the table, which are not to be dismissed but rather embraced to enhance the supervision process. Holloway (1988) commented, ultimately, of course, investigators in the field must engage in confirmatory research in which they test the efficacy of various supervisory approaches with trainees of various levels of experience, learning styles and motivational attributes (p. 139). Barretta-Herman (1993) concurred with Holloway regarding the developmental model and recognition of the experience of the counselor in supervision: It is important that the supervisor is not assumed to hold superior knowledge and skill vis--vis the practitioner, who in this model is experienced, licensed, often a specialist and in some cases a recognized expert. The supervisor of a competent practitioner recognizes and acknowledges the practitioners expertise and views the supervisor role as one of reflection, critique, challenge and support. (p. 60) According to Worthington (2006), experience level adds to personal autonomy and self-assurance. Counselors needs and abilities change as they gain experience, and therefore, supervision should be conducted differently based upon the counselors level of experience. This difference across the experience and skill levels leads to the conclusion that supervisors approaches to supervision should be different for experienced counselors in order to address the differences of the experience levels.

6 Purpose of the Study Literature has stated that the experienced counselor looks for supervision in order to enhance accurate case conceptualization (Gainor & Constantine, 2002), address transference-countertransference issues (Worthen & McNeill, 2001), deflect experiences of burn-out (Niebrugge, 1994), increase self-efficacy (Larson & Daniels, 1998), decrease job dissatisfaction (Kavanagh et al., 2003), adhere to ethical and legal guidelines (Cormier & Bernard, 1982), increase their knowledge of diverse populations (Sue, 1991), and elicit feedback on performance (Pistole & Roberts, 2002) in order to increase positive client outcomes (Worthen & McNeill, 1996). Tromski-Klingshirn and Davis (2007) also stated that supervision promotes development or maintenance of counseling skills. Since the experienced counselor is concerned with these issues in the supervision process, it is possible the supervisor is addressing more than what is documented in the literature. Many authors have discussed the fact that research is badly needed to understand the applied methods of supervising experienced counselors (Goodyear et al., 2003; Herbert & Trusty, 2006; Skovholt & Ronnestad, 1992; Spence, Wilson, Kavanagh, Strong, & Worrall, 2001). Supervisors conduct supervision with this skill level counselor and yet there is a lack of in-depth literature on how supervisors conduct the process and whether or not it is different from supervising a counselor-in-training. Understanding the practices and techniques of supervisors engaged in supervision with the experienced counselor will add to the supervision literature regarding the best practices of effective supervision with this population.

7 Research Question What are the critical elements of effective supervision with experienced counselors? Wheeler and Richards (2007) advocated that a research agenda needs to be formulated that takes into account long-term supervision and experienced practitioners. Since there is sparse literature regarding supervision with an experienced counselor, the literature reviewed will build upon the factors that are currently discussed in supervision. At no time is the list considered all-inclusive, but rather a beginning point of exploration into possible supervision practices currently done with experienced counselors. Utilizing the outline of Campbells (2000) workbook of becoming an effective supervisor, this study explored the important and critical elements of effective supervision with experienced counselors from the supervisors point of view. In addition to Campbells outline of factors for effective supervision, the guidelines of supervision by the Association for Counselor Education and Supervision (ACES) (1993) were also included as a guide to the exploration of supervision with an experienced counselor. ACES establishes guidelines in order to enhance the counseling profession. The Association for Counselor Education and Supervision (ACES) is composed of people engaged in the professional preparation of counselors and people responsible for the ongoing supervision of counselors (ACES, 1993). Since the literature is sparse regarding the important and critical elements involved in the effective supervision of an experienced counselor, a Delphi study was utilized to enlighten the field of supervision with this particular population. A Delphi method of research is practical to use when there is an absence of theoretical body of knowledge to point to a particular decision (Jenkins & Smith, 1994, p. 413).

8 The Delphi method, first developed by the RAND Corporation, is a technique in which a panel of experts is queried about their opinion on a specific topic (Dalkey & Rourke, 1971; Dalkey & Helmer, 1963). Once query and review takes place, a consensus of the panel of the important factors of a topic result. The Delphi method used in this study possessed several advantages such as anonymity for participants, participants who were geographically dispersed which added to discourse, and being a method that utilized both qualitative and quantitative aspects of research and was effective for conducting this pilot study. Since the current study was a pilot study of preliminary research, the Delphi method was an appropriate research vehicle. The researcher looked for the supervisors interpretations of the important and critical elements necessary, in their opinions, to conduct effective supervision with experienced counselors in contrast to conducting supervision with a counselor-intraining. The information was elicited from the Delphi panel through three rounds of questionnaires. The first round consisted of open-ended questions exploring what were considered to be important and critical elements of effective supervision with experienced counselors and novice counselors, the advantages of conducting supervision with experienced counselors, and the disadvantages and the comparison between the experienced counselor and the novice counselor in supervision. The information gathered from the first round was thematically analyzed and then coded as a survey for the second round. The second round consisted of confirmation and ranking of the researchers analysis on emerging themes quoted by the panel members in the first round, along with any additional comments on missed themes. The third round consisted of a review of the rank order of the themes and gave the panelists an opportunity to make any

9 final comments. The results of the study contributed to further understanding of supervision practices. Limitations of the Research The disadvantages of the Delphi technique were possible poor analysis, summarization and presentation of the panels responses by the researcher, the construction of the questions to encourage rich data and discourse, sample size, and rigorous data analysis (DeVilliers, DeVilliers, & Kent, 2005). The solicitation for participants resulted in a diverse sample with participants from the East Coast, Midwest, and West Coast. The participants worked and supervised in various organizations within the counseling field. The results possess a low generalizability across the profession due to the small sample size. However the study added to the current body of work on supervision. The study was a pilot to begin to understand the aspects of supervision with the experienced counselor; however, the study did not address all aspects of effective supervision with the experienced counselor, but rather resulted in an initial point of discussion for further exploration. The focus of the study was from the supervisors perspective and did not encompass the experienced counselors perspective on being supervised. Since the supervisor is considered the gatekeeper of the profession and works to address many issues presented by the counselor in supervision, supervisors can enlighten the supervision literature by discussing their experiences in supervision with the experienced counselor. Rather than suggest the supervisor conduct supervision with the experienced counselor based upon the criteria for the counselor-in-training, it was more beneficial to hear the supervisors experiences of this phenomenon.

10 Definitions The term experienced counselor refers to counselors who are independently licensed and have practiced for a number of years. The term counselor-in-training refers to individuals currently involved in counselor education classes. The term beginning counselor refers to individuals who are involved in practicum phase and the term novice counselors refer to those who are prelicensure. The term clinical supervision is in accordance with the definition given in the Preamble of the ACES Ethical guidelines, which states, Clinical supervision includes the supportive and educative activities of the supervisor designed to improve the application of counseling theory and technique directly to clients (ACES, 1993, p. 1). In addition, clinical supervision includes support and expansion of the counselors skills, abilities, and talents as a counselor. The term supervision is used interchangeably with the term clinical supervision for the purposes of this study. The term administrative supervision is in accordance with the definition given in the Preamble of the ACES Ethical guidelines, which states, Administrative supervision refers to those supervisory activities which increase the efficiency of the delivery of counseling services (ACES, 1993, p. 1). The term organization refers to organizations, schools, counselor training programs, mental health facilities, agencies, and companies that train, educate, or employ the experienced counselors. The term supervisor is used interchangeably with clinical supervisor and refers to the individual who performs clinical supervision.

11 The term administrative supervisor is used to designate those individuals responsible for the delivery of counseling services. The term supervisee designates a counselor in clinical supervision. For the purposes of this study, the supervisee also refers to the experienced counselor. Importance of the Study The literature on supervision has placed emphasis upon the counselor-in-training, beginning, or novice counselor rather than any other stages in a counselors career. While various studies have investigated the reactions, thoughts, and feelings of experienced counselors and supervisors, the studies have not looked specifically at what practices are being used to accomplish effective supervision with experienced counselors nor have the studies investigated whether the accepted practices in the field are uniform or variant. The current study focused upon the initial exploration or pilot study of what supervisors think are critical elements of supervision with this profession and addressing the issues and concerns of this profession. Understanding what is done in supervision with the experienced counselor will better prepare supervisors who deal with this population to be most effective in addressing their needs. Since the current literature on supervision does not particularly separate counselors-in-training from the experienced counselor, but does address much of what is discussed by ACES and Campbell regarding supervision, the framework will give a starting point to review supervision practices in the literature. This will allow an opportunity to formulate questions that can be explored during the data collection phase of research. Therefore, the literature review explored those predominantly listed factors of clinical supervision.

12 CHAPTER TWO: REVIEW OF THE LITERATURE The list of factors within this literature review is by no means all-inclusive or exhaustive, but rather a list of the frequently discussed topics within the existing supervision literature. The factors discussed within this literature review are presented as enhancements for effective supervision. While the literature primarily addresses the counselor-in-training, beginning, or novice counselor more so than the experienced counselor, many of the factors may be applied to the supervision process with experienced counselors. The following literature review will utilize Campbells (2000) workbook on effective supervision as an outline. Additionally, the literature review will discuss the topics of the ACES components of effective supervision. Administrative Supervision Counselors work in private practice, schools, companies, organizations or agencies. For counselors employed in all work settings but private practice it is not uncommon to frequently receive supervision. The focus of supervision is both administrative and clinical. Clinical and administrative supervision are often collapsed into one function and provided by one individual, which could lead to task-oriented administrative supervision becoming more critical than clinical supervision (BarrettaHerman, 1993). Henderson (1994) stated that administrative skills in supervision are helpful for the ongoing development of counselors. Administrative skills include the leadership of the counselor workforce, dealing with organizational issues, and program effectiveness. Administrative supervisors can create a framework for the counselor to have a stable and salient environment in which to practice; in addition, administrative supervisors address

13 the structure of the clinical program, coordination of clinical services, and evaluation mechanisms for the counselor to function as an employee of the school, company, organization, or agency. The supervisor performing administrative supervision may not be viewed as a resource for personal and professional growth but rather the administrative supervisor is the person whom the counselor supervisee considers her or his boss at the counseling site (Tromski-Klingshirn & Davis, 2007, p. 295). TromskiKlingshirn and Davis (2007) further stated that the administrative supervisor is responsible for the managerial tasks such as overseeing case record, implementing policy and procedures for continuity of care, quality assurance and accountability, the hiring, firing and corrective actions of staff, and evaluating the counselor as an employee. The authors warned that the dual role of administrative and clinical supervisor can threaten the supervisory trust since the supervisor possesses increased power from being the evaluator as well as the teacher. As a result of their study, the participants who had difficulty in supervision because of the supervisor holding both roles of administrative and clinical reported negative consequences from discussions in supervision regarding their inadequacies because the submissions are utilized in evaluations, affecting monetary and promotional opportunities. In order to avoid poor evaluations the counselors would refrain from discussing their inadequacies and weaknesses which could result in a greater risk of the counselor providing poor or unethical treatment. According to Herlihy, Gray, and McCollum (2002) many supervisors must also deal with the administrative supervision of counselors within organizations (p. 55) as well as the clinical supervisor role. Since the supervisors are to monitor the counselors actions and behaviors as an employee and give feedback with regard to work performance, there is the concern that

14 supervisees will not disclose everything they are doing with clients during supervision. Any areas of problematic issues with clients may not be disclosed due to the supervisee feeling it could be counted against them when it comes to evaluation. With demands upon the supervisors to contain costs and streamline daily functions, the benefits of clinical supervision may compete with the administrative supervision tasks. When an organization does not have a clear direction of the benefits of clinical supervision, the result may be that there are not enough clinical supervisors trained to handle the clinical supervision workload, resulting in task-oriented supervision rather than growth supervision (Ask & Roche, 2005). Due to the demands on schools, companies, organizations, and agencies to become more cost effective, supervisors may have no choice but to conduct both the administrative and the clinical supervision. These competing focuses can make it difficult for the supervisor to prioritize what aspect of supervision is most important at any given moment. Roberts and Borders (1994) studied existing supervision practices among school counselors. The participants consisted of a random selection of North Carolina School Counselor Association members. While 450 surveys were mailed, 168 usable surveys were returned. A three-part survey was constructed to gather demographic information, existing supervision practices, and preferences of supervision at this point of the participants careers. The participants were asked to categorize the existing supervision practice in one of three areas of supervision: administrative, clinical, and the counseling program for school counselors. The participants answered questions about the type of supervision received and whether this was their preference. The results indicated that the school counselors were receiving more administrative supervision than any of the other

15 two types. However, the counselors preferred the other two types of supervision, which allowed them personal and professional growth. Oberman (2005) concurred with the findings of Roberts and Boders (1994) and concluded that the main barrier experienced by school counselors receiving clinical supervision was that the supervisors did not have the training to perform clinical supervision. The supervisors were usually school administrators who did not understand the significance and importance, nor possess the training in order to perform clinical supervision with the school counselor. Barretta-Herman (1993) stated that the administrative function of the supervisor is just as important as clinical supervision. The supervisor is charged with the responsibility to facilitate the professional development of the practitioner and to create, maintain and evaluate systems of client and agency accountability that enhance service delivery (Barretta-Herman, 1993, p. 61). The administrative supervisor is helpful in organizing the counselors work duties (Herbert & Trusty, 2006), and gives structure to the work. The over-riding aim is to optimize the service provided to clients in line with the goals, expectation and ethical and profession concerns (Spence et al., 2001, p. 136). This is to say that administrative supervisors can be beneficial for the counselor when identifying goals, expectations, processes, and the philosophy of the counseling work within the organization. Administrative supervisors can also be used to provide personal support to increase worker motivation, morale, and commitment. At the same time, they can help to decrease staff burnout, workplace problems, worker stressors, and coworker conflicts. Niebrugge (1994) found the desire to leave the job and the profession is significantly related to satisfaction with supervision and the number of years the

16 counselor is engaged in supervision. Robinson, Murrells, and Smith (2005) examined high attrition rates within a psychiatric hospital, which were attributed to work overload, lack of management support, violence to staff from clients, lack of flexible work, uncertainties about roles of different staff groups (role conflict and role ambiguity), anxieties about adapting to new approaches to care for clients, and lack of opportunities for career progress and continuing professional development. Supervision is expected to aid in retention of the mental health worker. The study reported mandatory policies instituted ongoing supervision of mental health nurses at a lower work grade with a person of higher grade to assist in personal and professional growth. Results of the program evaluation demonstrated a decrease in attrition, more work satisfaction, a continued vigilance to professional interaction with patients, and a decrease in burnout. Supervision can help counselors set realistic goals, address counselor shortcomings, and alleviate work difficulties (Raquepaw & Miller, 1989). Given the significant cost to mental health organizations of staff turnover and absenteeism resulting from burnout and work stress, there is a clear need for research to examine the parameters of supervision that could assist staff to cope with the stressful aspects of their employment (Spence et al., 2001, p. 6). While the administrative supervision gives structure to the counselor clinical supervision solely focuses on ways of improving the counselors clinical skills. Clinical supervision needs to focus on clinical issues, such as clinical case review and processing counselor-client dynamics as it is these clinical activities by which close supervision of a supervisees clinical skill is maintained (Tromski-Klingshirn, 2006, p. 59).

17 Clinical Supervision Barnett (2007), in a discussion of supervision for psychologists, stated clinical supervision is an essential aspect of each psychologists training and as psychologists, we each may participate in it throughout various phases of our careers (p. 268). Just like the psychologist, counselors can participate in clinical supervision throughout their entire careers. In a discussion regarding the continual competence of licensed psychologists, Carroll (1998) discussed new challenges arising for the practitioner and the fact that there is no formal program to monitor whether the practitioner remains competent throughout his or her career. Clients present new challenges and counselors must continue to address those challenges. Kanz (2001) concurred with Carroll, stating that experienced psychologists should have ongoing clinical supervision due to the challenges of client problems and difficulties, and that the wide-range of client issues that psychologists encounter also lends support to the need for supervision (p. 45). Warnke, Duys, Lark, and Renard (1998) indicated that supervision is beneficial for the counselor when met with new and unfamiliar tasks. The counselor could loop back through the initial stages of uncertainty experienced as a novice counselor when faced with an unfamiliar task. Clinical supervision allows for discussion of intervention strategies, case conceptualization, and new counseling approaches. While clinical supervision is believed to be an effective way to obtain professional development, there are many who have not received clinical supervision since licensure. The empirical data is scarce on exactly how many continue with supervision and how many do not continue after licensure. Henderson (1994) asked how a professional continues to remain

18 competent in their role, since clinical supervision plays a major part in addressing the continued competence of the counselor. The counselor will continue to have issues of dealing with new areas and challenges, which may not have been encountered before. Cohen and Laufer (1999) concurred with Henderson regarding the importance of clinical supervision for continued professional competence. Cohen and Laufer (1999), in their research on Israeli social workers and their perception of their continued competence, concluded that if clinical supervision is viewed as satisfactory by the participant it can result in high levels of self-confidence and professional competence. Worthen and Lambert (2007) discussed the importance of understanding client outcomes to adjust the focus of supervision. The authors noted that understanding the outcome of the intervention should change the focus of supervision and thereby promote the most appropriate interventions. Monitoring of the clients progress during therapy and whether or not the interventions work is of great importance. The authors attempted to make sense of the findings that whether the counselor is experienced or new, the outcomes of therapy appear to be the same. Therefore, it is important to understand the outcome of intervention to adjust the focus of supervision. Stoltenberg, McNeill, and Crethar (1994) reviewed the current literature that discussed developmental models of supervision, and suggested experience is a crude indication of development and expertise (p. 421). Just like the psychologist, the counselor could need clinical supervision to deal with more complex clinical situations and case conceptualization. According to Worthington (2006), experience level adds to personal autonomy and self-assurance. Counselors change in needs and abilities as they gain experience, and clinical supervision changes based upon the counselors level of experience. Since there

19 is a difference across the experience level it leads to the conclusion that supervisors approaches to supervision must address the differences in the supervisees experience levels. Supervisors must meet the counselors at their level of experience; otherwise the supervision is not beneficial for either the supervisor or the supervisee. Supervisors cannot use a one-size fits all approach because the needs of supervisees are different depending on experience level. As time goes on, counselors may disengage in utilizing the necessary skills to do effective interventions with their clients. Schaefle, Smaby, Maddux, and Cates (2005) demonstrated that there is a decline in counseling skills and non-transfer of skills of counseling students after beginning to practice. Their study evaluated preparation for the counselor to engage in counseling skills continually during and after training, and demonstrated an increase in retention of skills. Supervisors who continue to engage in clinical discussion may help the counselor to continue to adhere to appropriate clinical skills. Supervisors are gatekeepers to ensure not only the quality of service for the clients, but also to ensure that the supervisees are protected from losing their rigor for the services. Schroffel (1999) explored clinical supervision and job satisfaction. The author offered four arguments for why good supervision is important: life-long skill development; emotional support; the need to maintain practice boundaries (e.g., transference and counter-transference issues); and the exchange of knowledge to minimize a sense of isolation. Supervisors who remain distant are viewed as less effective and out of touch with the counselor, while supervisors who are viewed as accessible and engaging are seen as a resource and mentor. Supportive supervision includes reassurance, encouragement, approval and recognition, expressions of

20 confidence, ventilation, desensitization, and attentive listening (Schroffel, 1999, p. 50). In this study the supervisor was viewed as the bonding agent or linking pin. Effective supervisors must do more than sustain a bureaucratic machine or clinical tutoring, in addition they are communicators who must be competent in team building and mediation skills, encourage autonomy and self-direction, and foster empowerment for the supervisee. Such a supervisor demonstrates a sense of confidence and accomplishment. Clinical and interpersonal skills, along with building trust, possessing open communication, sharing information, and encouraging the counselors involvement, are factors included in Campbells (2000) model of effective supervision. The participants revealed the desire for routine and relevant clinical supervision to help in skill enhancement. All respondents felt clinical supervision should never be eliminated and those satisfied with clinical supervision demonstrated more satisfaction with their jobs. The author suggested that the supervisor should periodically take a pulse as to whether the supervision continues to address relevant issues and remains effective. The study demonstrated that the quality of the clinical supervision helped the counselors feel more empowered. Results further demonstrated an increase in counselor job satisfaction and the fact that supervision needs to be tailored to individual needs. The clinical supervisor needs to possess competence and accessibility. The major point of this finding is that it is not the amount of supervision but the quality of the supervisor that was the most helpful and most valued by respondents (Schroffel, 1999, p. 170). Schroffel (1999) further stated, based on the results of this finding it appears that workers want to be clinically challenged in order to be introduced to new thoughts, ideas, and insights (p. 172). The supervisors clinical quality of supervision is considered by the supervisees as

21 one of the factors that contribute to staff satisfaction and retention within counseling organizations, because supervision is a forum to resolve clinical issues. Clinical supervision can offer an increase in techniques and case conceptualization for the supervisee (Borders, Cashwell, & Rotter, 1995). There is a general consensus that supervision is different from therapy, though personal issues can arise in both settings. There is a suggestion that advanced stages of counseling are the appropriate time to discuss the impact of personal issues on counselor performance. Advanced counselors repeatedly examine any personal issues that affect the counseling relationship. They are concerned about involvement with the client and the process of counseling. Supervisors can discuss those personal issues as they, too, gain experience in the supervision process (Sumerel & Borders, 1996). Borders and Usher (1992), in conducting a quantitative study on post-degree counselors, found the primary goal of post-degree counselors in supervision was to receive professional support and create skill-oriented goals within supervision. The data reported that 32.1% of the 357 usable surveys were not receiving any type of clinical supervision. Nearly 35% of the respondents reported receiving clinical supervision at least once a month. The other approximately 32%, while receiving clinical supervision, received it less often. While it was found that the post-degree counselor had less frequent clinical supervision after achieving the degree than during the acquisition of the degree, the post-degree counselor still preferred to have clinical supervision. In fact, the more experienced counselors in the study were shown to seek out clinical supervision. Earley (2004) discussed the relationship factors in clinical supervision and how those factors impact a counselors usage of supervision based upon Banduras definition

22 of self-efficacy. Earleys study described how clinical supervision and counselor performance may correlate in practicing counselors. Supervision is found to demonstrate supportive instruction, increase counselor confidence, and moderate counselor anxiety, which increases counselor self-efficacy. Self-efficacy is built on interactive mastery of skills, vicarious learning, verbal persuasion, and emotional arousal. One limitation is the difficulty of finding someone who has something to teach the more experienced counselor with regard to conceptualization, personal, and professional growth. Performance feedback mechanisms, specific counselor tasks, and a variety of supervisor orientations contribute to counselor self-efficacy. The counselors in the study viewed clinical supervision as critical no matter the type or frequency. The counselors further stated that clinical supervision is helpful in improving confidence and counselor performance. Components of Clinical Supervision Working alliance. The supervisors style deals with the elements of attractiveness, interpersonal sensitivity, and task orientation. The attractive style is defined as the supervisor being warm, friendly, open, and supportive. Interpersonally sensitive means the supervisor is therapeutic, invested, and perceptive regarding the supervisee. The task-oriented style means the supervisor is one who is focused on the goals of learning and structure. The supervisory style is related to the supervisory relationship and particularly the working alliance (Ladany, Walker, & Melincoff, 2001). A counselor entering supervision is looking for a competent supervisor to assist with the learning process whether the counselor is a novice or experienced. The counselor, in this case the experienced counselor, is looking for a supervisor who offers the opportunity to

23 learn and to progress in different aspects of the counseling profession. The supervisor can be instrumental in helping with this endeavor. Good supervisors seem to have many of the same qualities of good teachers and good counselors. They are genuine, open flexible, respectful of individual differences. (Borders, 1994, p. 45). The supervisory working alliance is based upon mutual agreement of goals, tasks, and emotional bonds, and considered an essential factor of effective supervision. A strong working alliance between the supervisor and supervisee will enable both participants to grow. Bordin (1979) developed the concept of the working alliance, stating that a working alliance between a person seeking change and a change agent can occur in many places besides the locale of psychotherapy (p. 252). The working alliance includes three features: goals, assignment of tasks, and emotional bonds. Goals demonstrate the outcome of achievements, while the tasks are the agreed upon contract of how to reach those goals. The bond, essentially made of trust and attachment, is the foundation that facilitates this process. A strong working alliance has a significant impact on the supervision process and constitutes active involvement of the supervisee and promotes development and acquisition of complex skills (Kavanagh, Spence, Wilson, & Crow, 2002). Coll (1995) explored preferential types of supervision alliance of experienced college counselors. The college counselors wanted to discuss, through self-report, the types of clients and counseling interventions during their supervision sessions. The author noted that the problem with self-report is that the counselor may neglect, whether intentionally or not, to mention very critical information regarding intervention techniques, client characteristics, and counselor involvement. The counselor may feel

24 anxiety exhibiting a sense of vulnerability in dealing with a specific client, because they often believe that they should be able to handle any situation presented by a client and never appear inept in their counseling duties. However, this is an incorrect assumption as there are many different clients who present with various issues that are not necessarily the same as those the counselor may have previously encountered. The results of the study concluded that counselors wanted to receive ongoing supervision with a knowledgeable, experienced counseling professional. Usher and Borders (1993) found post-degree counselors preferred a collegial relationship-oriented supervisor and one with emphasis on conceptual personalization and process skills. Considered the practicing counselor, this counselor seeks out a supervisor who operates out of a peer-like collegial relationship. The authors investigated three different classifications for the counselor: novice, intermediate, and experienced. Utilizing the Supervisory Styles Inventory Revised (SSI-R) and the Supervisor Emphasis Rating Form Revised (SERF-R), the authors explored the preferred styles of supervision for the three categories. The SSI-R, developed by Friedlander and Ward (1984), possesses three sub-scales used to holistically measure supervisory style: attractive, interpersonally sensitive, and task-oriented. The instrument measures the supervisors self-perception and the supervisees perception of the supervisor. The attractive subscale measures the supervisors collegial dimension, meaning the supervisors warmth, support, friendliness, and openness. The interpersonally sensitive subscale measures the supervisors relationship-oriented approach to supervision, meaning the supervisor is committed, therapeutic, and perceptive. The task-oriented subscale reflects a content approach to

25 supervision, meaning the supervisor is goal-oriented, thorough, focused, practical, and structured in supervision. The SERF-R, which was developed by Lanning and Freeman (1994), demonstrates measurements of supervisors emphasis within the supervision process. The four sub-scales of the SERF-R are professional behavior, process skills, personalization, and conceptualization. The professional behavior subscale defines the supervisors behavior within supervision. The process skills subscale is defined as the way in which the supervisor conducts supervision. The personalization subscale addresses the supervisors ability to see the supervisee as a counselor possessing warmth and positive regard. The conceptualization subscale is defined as the appropriate interventions and techniques utilized at the appropriate time in supervision. The participants within the study were drawn from a listing of National Certified Counselors. Two hundred seventy four participants responded to the research request to complete the surveys. The results of the survey demonstrated that counselors with more post-degree supervision have a stronger preference for an emphasis on personalization skills and less on professional behaviors, and the results also demonstrated that all categories of counselors wanted a collegial-relationship-oriented supervisor. Usher and Borders (1993) concluded the highest-level professionals, considered the experienced counselor, preferred a focus on personalization skills and a preference for the collegial-relationshiporiented supervisor. The supervision dyad, not unlike the counseling dyad, is noted to go through weakening and repair of the alliance resulting from the resistance to change or selfdefeating behaviors and mistakes of either participant. This conflict will either result in a

26 strengthening or a deterioration of the bond. Burke, Goodyear, and Guzzard (1998) studied the weakening and repairs of 10 supervisory dyads over time. Utilizing a modified Working Alliance Inventory, the researchers explored the impact of weakening and repair upon the supervisory alliance. The weakening-repair of the supervisory alliance is considered the conflict between the supervisor and the supervisee and how those conflicts are resolved. The conflicts can occur because of supervisee resistance, supervisees self defeating behavior, or the supervisors mistakes. One of the results of the study indicated the more experienced supervisee set the tone of the supervisory sessions focusing upon his or her own needs. Another result of the study demonstrated that more experienced clinicians attended to the repairing of the alliance more often than novice clinicians. Actions taken by the supervisor in the context of a strong working alliance can minimize role difficulties, thus reducing the likelihood of negative consequences within supervision. Working alliance is significantly related to supervisees perception of role conflict and role ambiguity within supervision. Stronger bonds result in working through conflicts, which decreases role conflict for both the supervisor and the supervisee. The concept of the working alliance is just as salient in the supervisor-supervisee working alliance as it is in the therapist-client relationship. Presumably, when supervisors and trainees discuss expectations, set goals, and agree on the tasks of supervision within the context of a positive relationship, trainees are less likely to experience confusion or conflict in supervision (Ladany, Friedlander, & Nelson, 2005, p. 220). As supervisees gain experience they may be reluctant to follow supervisor recommendations. They may feel they are in the counseling relationship and better understand the client than the

27 supervisor. Being treated as a novice can result in role conflict for the supervisee who may identify as a competent clinician but feels that he or she is being treated as if incompetent. Due to the very essence of supervision, the supervisor is supposedly the expert and should know best how to intervene. This type of role conflict could affect confidence in the working alliance for both. Role ambiguity could also result, diminishing self-confidence and resulting in a sense of futility. If the supervisor views supervision in which the expert is teaching the student, this can cause role ambiguity particularly for the experienced counselor, who does not need to be taught how to do counseling. In this case, the experienced counselor may not benefit from supervision if the counselor believes that his or her expertise and experience are being dismissed (KirkBrown & Wallace, 2004; Olk & Friedlander, 1992). Worthen and Isakson (2003) contended that the working alliance is thus being able to understand the elements of effective supervisory relationships, monitoring those relationships and intervening as needed... (p. 4). The authors presented a discussion of the variables that mediate the supervisory relationship: the matching variable; developmental or experience level; role induction processes; settings for practice; previous experience with supervisor; supervisee variables; supervisor issues; dual role concerns; evaluation issues; cultural variable; impression management and previous supervision experience. All have an impact upon supervision. The authors indicated that addressing the variables within supervision will enhance the supervision process. Supervision is often a hierarchical relationship and therefore the role conflict could escalate because of the relationship. Strength based supervision is a nonhierarchical supervisory relationship. One where there exists a give and take, where the

28 supervisor does not assume to have more correct privileged knowledge of both the supervisees and clients goals, intentions or views and where the supervision works intentionally to create a strength based supervision (Edwards & Chen, 1999, p. 10). Milliren, Clemmer, and Wingett (2006) agreed that a non-hierarchical supervisory relationship is of more benefit for the supervisee. In the authors discussion of Adlerianbased supervision, they posited that a democratic relationship is much more beneficial for the supervisee. The Adlerian-based supervision utilizes Respectfully Curious Inquiry. Respectfully Curious Inquiry is comprised of seven components, which focus upon mutual goals: attentive reflective listening on the part of the supervisor; assessing the strengths; resilience and social interest; validating and encouraging useful behavior; sharing humor, clarification, intuition, imagination to develop understanding; problem conceptualization; and identification of socially useful solutions. The outcome of the Adlerian-based supervision is the Therapeutic Empowerment in the supervisory relationship, which produces equality, empathy, encouragement, and education for both the supervisor and the supervisee. Supervisors style. The supervisors style, whether task-oriented, superviseefocused, or clinically based, has an impact upon the comfort level of the supervisee in supervision. Ladany et al. (2001) conducted a study to examine the relationship between supervisory style and the supervisory working alliance, and predicted a strong relationship between the two concepts. Supervisors who are comfortable with selfdisclosure appear to possess characteristics of more warmth, attractiveness, and interpersonal sensitivity, thereby modeling openness. Results indicate that those supervisors who are perceived as attractive have a greater emotional bond and more

29 agreement on tasks and goals with the supervisee than those who are not. Those who perceived themselves as interpersonally sensitive and task-oriented possessed the most agreement on tasks in supervision. The more attractive and interpersonally sensitive supervisors did self-disclose the most in supervision. The more task-oriented supervisors did not self-disclose as often. Both the supervisor and the supervisee who viewed the relationship as warm, friendly, and trusting saw the supervisory relationship as very beneficial. The various styles of supervision are underlined by support and direction. Support shows empathy and building rapport, while direction refers to instructing, teaching, and challenging the supervisee. The adaptive counseling and therapy model proposed by Hart and Nance (2003) stresses these concepts. The model comprises four concepts of style, which include telling, teaching, supporting, and delegating, changes for the supervisee with the development of skills, competency, and experience. The study asked what type of supervision is preferred by supervisees and whether it matches the level of supervision requested and received by the supervisees. The four styles are designated as A, B, C, and D. Style A is the directive/expert teacher; Style B is the supportive/teacher; Style C is the counselor role; and Style D is the consultant. The results were that supervisors prefer to be viewed as Style C and the supervisees preferred Style B, meaning the supervisees were looking for a supervisor who was supportive but was also a teacher. This was the preferred style of supervision across all levels of experience. Experienced counselors appeared to prefer a supportive style of supervision. The age of the counselor may be of importance in looking at the supervisory style. As a counselor ages and experiences life, the influences can have an impact upon the

30 counselor's approach to counseling and supervision. Gorrell (1997) performed a study to understand supervisory styles for seasoned clinicians. Beginning with six hypotheses to guide the study, Gorrell looked at how supervisees level of experience and age would relate to preference of supervisory style; supervisees with up to 10 years experience would have preference for the task-oriented supervisory style; supervisees with more than 11 years experience will prefer the interpersonally sensitive and attractive supervisory style; supervisees between the ages of 23 and 45 prefer task oriented style of supervision; supervisees between the ages of 46 and 60 would prefer interpersonally sensitive supervisors; and supervisees 61 and older prefer attractive supervisory styles. As mentioned in the study, people mature at various levels and their worldviews differ based upon life experiences. The same is true for experience levels, due to clinicians dealing with different populations possessing different mental and emotional disorders, which has an impact upon their clinical expertise. The study resulted in the null set for all hypotheses. The experienced counselors preference of style appeared to be more about the experience level of the supervisor rather than the experienced counselors ages. Feedback. Feedback is an important component of supervision. Blackwell, Strohmer, Belcas, and Burton (2002) stated failure to provide evaluative feedback raises a serious ethical concern because the supervisor fails to provide one of the most essential tasks of supervision and this can compromise both the supervisees growth as a counselor and the clients progress in counseling (p. 242). The feedback given can lead to an enhancement in skills; however, counselor educators and field supervisors often feel uncomfortable about assessing trainee skills and struggle to find an appropriate vehicle for delivering essential constructive feedback regarding performance (Harris, 1994, p.

31 19). Problems with feedback in supervision are often a result of poorly navigating the delicate balance of encouraging trust in the relationship and giving meaningful constructive feedback. Chur-Hansen and McLean (2006) discussed using formative feedback, which can help the supervisee to identify abilities and improve strengths. The reasons given for supervisors not giving summative feedback include lack of time to provide the feedback and possible fear of litigation. These are some of the components of feedback that can cause anxiety for the supervisor. However, Daniels and Larson (2001) found that positive feedback can increase the counselors self-efficacy and minimize anxieties. Negative feedback can result in a lowering of counselor-self-efficacy and an increase in anxiety. The way in which the supervisor gives feedback is apparently important and has an impact upon the supervision relationship. Supervisors are encouraged to examine methods of giving feedback. Problems with the supervisors methods of feedback could cause threats to the supervisory bond (Goodyear & Bernard, 1998). Ladany et al. (2005), in a discussion of negotiating role conflicts within supervision, stated that there is role conflict due to the feedback component of supervision. However, the authors stated that if the feedback component is missing, the supervisee may not trust the supervisor due to wanting the opportunity to learn more or focus on personal issues. Without feedback the supervisee is unclear about the tasks and direction of the process. It is advisable for supervisors to offer constructive feedback when evaluating counselor performance to help counselor growth (Harris, 1994). King and Wheeler (1999) conducted a survey of supervisors who engaged in supervision with private practice counselors. The study investigated whether the

32 supervisors felt any responsibility for the work of their supervisees and what responsibility the supervisor should assume for the counselors work. The qualitative study interviewed 10 individuals who were considered supervision experts due to length of practice. The results of the survey stated that supervisors do have some professional and ethical responsibility for the quality of the counselors work, but do not have legal responsibilities. One of the participants in the study expressed the view that supervisors are aware when counselors engage in unethical behavior but that it is another thing for them to report the improprieties, most often as a result of supervisors viewing the supervisory relationship as one between peers rather than one of a hierarchical nature. Though the study was conducted in the UK, it does posit a question as to whether supervisors in the United States have the same view. The supervision relationship should challenge, stimulate, and encourage the supervisor as well as the supervisee. The dilemma of the supervisor of having to both encourage and give feedback effectively places them in the vicarious position of balancing the dual role of encourager and critic. The dual role of the supervisor as educator and critic could lead to the supervisee not reporting everything during supervision and therefore missing the opportunity to address important issues (Minnes, 1987). The evaluative aspect of supervision can also cause anxiety for the supervisor. The experienced counselor would have no problems revealing areas of competence, but may have problems in revealing areas of weaknesses. With an evaluative component of supervision, the experienced counselor may not trust the supervisor enough to reveal weaknesses therefore leading to problems of truly addressing issues within the counseling

33 relationship as well as personal challenges of the experienced counselor. Supervisors as well as supervisees experience this double bind. The counselor, in an effort to look good and yet manage their anxiety, may find themselves either becoming over accommodating or defensive when feeling vulnerable. The supervisor may find it difficult to address and confront incompetencies of the experienced counselor since the counselor is also seen as a peer (Lizzio, Stokes, & Wilson, 2005). Boyd, McNaughton, and OShea (2008) investigated a way to enhance supervision by having formal feedback developed from counselor self-audit. The authors contended that counselors can become better at delivering services if they are able to share self-audits in consultation supervision. The authors invited counselors and supervisors to be part of a focus group to offer views regarding self-audit and its place in supervision. The focus groups were divided into three groups. One group was comprised of counselors who decided to do the self-audit, another group was comprised of counselors who decided against self-audit, and the third group consisted of consultative supervisors. The qualitative study asked each group to address reactions to conducting self-audit, positive and negative aspects, impact of self-audit on the client, impact of selfaudit on the counseling process, impact of self-audit on the counselor, ethical responsibilities to the client having the feedback to inform the counseling, individual progress, and mandatory vs. voluntary usage of self-audit. The data was transcribed using thematic and SWOT analyses. The groups explored the strengths, weaknesses, opportunities, and threats of utilizing self-audit to improve service. The results of the study indicated that using the self-audit had more positive than negative aspects. There was concern the counselors would be afraid to review the self-audit in supervision

34 because it would demonstrate their weaknesses; however, this was not the case because the supervision was consultative rather than an evaluative relationship. The counselors were able to examine areas that were positive outcomes for the client and therefore help them to focus upon areas for personal growth. Counselors felt the self-audit information had little impact upon the supervisory relationship and they were able to openly and honestly discuss issues with the supervisor. Counselors were resistant to collecting the data initially but after the positive experience of using the information for discussion in supervision they found this to be very beneficial to their practice, so much so they began to use the data to explore other areas such as clients leaving prematurely and the best practices for addressing client issues. In order for the experienced counselor to reveal areas of vulnerability and weaknesses, the supervisor is tasked with promoting a level of trust. Not unlike the therapeutic relationship, the need to build trust is pertinent when revealing information during the supervision process. Unlike the therapeutic relationship, the supervision relationship calls for a deeper level of trust because of the feedback component. Counselors and supervisors are both vulnerable. Supervision requires a level of two way trust unmatched in the counseling relationship (Pearson, 2000, p. 285). Supervisory relationships can last for years; therefore, the trust becomes imperative for the relationship to flourish. This demands special attention to the trust within the supervision relationship. Pearson (2000) stated that the success or failure of the relationship depends upon the trust developed between the supervisor and the supervisee. Anxiety resulting from the act of supervision and the evaluative component should be discussed in the supervision process in order to minimize any reluctance or resistance and build trust.

35 Ladany et al. (2001) concurred, stating a unique feature of the supervisory working alliance is that the relationship is considered to be based on perception of mutual connections between supervisors and trainees. In other words, the supervisor perceives mutual trust exists with the trainee, rather than a unidirectional notion of trust (p. 265). The supervisee will open up to the supervisor if supervision is a safe haven to demonstrate vulnerabilities and inadequacies. Supervisee resistance to supervision can result from a fear of being perceived as inadequate as a counselor. Counselors are human and can therefore make mistakes. The importance of the ethical behavior is being able to own up to the mistakes and having supervision can offer a forum to discuss those mistakes. Cormier (1988) discussed the fact that many first time counselors cover up their mistakes in order to look good to the supervisor. The problem of appearing inept can cause stress and anxiety. If trust is built within the supervision relationship, the counselor will be able to own mistakes, avoid unproductive blaming, and shatter myths about the counseling process. Cormier also discussed the veteran counselor and their problematic beliefs that they know everything about how to do good therapy, they are an effective and powerful therapist, they are the expert on the clients behavior, they know about life and death, they are always self-aware, and they know what is needed to save the world. The impact of life experiences will change worldviews and the counselor is not immune to having these experiences. Having the trust to talk with the supervisor about these mistakes and perform corrective action becomes imperative. Communication. In order to build trust in the supervision relationship, effective communication must take place. The communication sets the tone of the relationship by

36 relating the respect the supervisor has for the supervisee, understanding the supervisees worldview, and accepting their differences. Current descriptions of counseling supervision invariably include a discussion of the supervisor-counselor relationship and the means by which the individuals communicate, manage the process of reciprocal influence, affiliate, make decisions, and accomplish their respective tasks (Dye, 1994, p. 9). The communication is influenced by characteristics such as gender, race, ethnicity, developmental level of supervisor and supervisee, theoretical approach, and the power differential (Dye, 1994). Supervisors are expected to be aware of individual differences, including experience levels, gender, multiculturalism, supervisee attributes, self-efficacy, and supervisee conceptual level. Contextual elements that affect supervision include the clientele being serviced, and the relationship and communication between supervisor and supervisee (Goodyear & Bernard, 1998). The way men and women communicate could impact supervision. Sells, Goodyear, Lichtenberg, and Polinghorne (1997) stated that women demonstrate behaviors to enhance the strength of relationships whereas men demonstrate more of a task orientation in relationships. Using a quantitative index, the researchers measured the amount of communication patterns between supervisors and supervisees of different gender and the perception of effective supervision for the participants. Utilizing 44 dyads they found that in male-male dyads the focus was more task-oriented, but the other three types of dyad, female-male, male-female, and female-female showed no significance of communication and impact upon ratings by the supervisees of effective supervision. The researchers attributed the minimal significance of communication within the female-

37 male, male-female and female-female dyads to trying to do what was expected rather than following their own values and beliefs of counseling thus not demonstrating any conflict. However the study did point out a significant difference of communication due to gender issues. Gender issues are important to examine in the supervision process. Gender issues and communication. Gender is a complex construct that is defined by what society believes is true of males and females and the stereotypes placed upon the sexes (Doughty & Leddick, 2007, p. 18). Gender differences can interfere with the supervision relationship particularly when it comes to communication styles. Women may be viewed as needing more help and this perspective can cause problems of effective supervision and communication (Doughty & Leddick, 2007, p. 18). Lichtenberg and Goodyear (2000) studied structure in the supervision relationship and found that male supervisors were expected to give more structure to the process than female supervisors, as it was reported the male supervisors seem more directive in their discussions. Martin, Goodyear, and Newton (1987) performed a qualitative study examining a supervision dyad between a male supervisor and a female supervisee with seven years experience over a 10-week period. The exploration was to understand the best and worst sessions of supervision from both the supervisors and the supervisees point of view. Both stated the best session for each focused upon personal issues and their ability to be vulnerable with one another. The worst session in the viewpoint of the supervisee occurred when the supervisor placed the supervisee in the position of counselor. The worst session for the supervisor was the one in which the supervisee did all the talking. Scores of the supervisee went up in task orientation, interpersonal sensitivity, and

38 attractiveness during the course of the supervision sessions, adding to the importance of supervision and communication. However, it makes one wonder if the scores for supervision did not increase because of becoming familiar with one another during supervision and therefore understanding the expectations within the supervision sessions. When the supervisee and supervisor were both able to do more talking during the supervision session, they rated the session as the best. Twohey and Volker (1993) stated that women run the risk of not being heard due to communication or relational styles devalued in a male dominant supervision relationship. The authors explored the power differential in supervisory dyads between men and women. It appeared that when men supervise women, a power imbalance results from the hierarchical nature of supervision and the societal norms. A woman supervising a man can result in the same power imbalance, because the woman may be considered less experienced. Research in business literature has demonstrated stereotyping of women in management positions, and women being viewed as not possessing the expertise to lead and manage. Similar notions may exist in supervision. Twohey and Volker (1993) discussed two different camps with regard to women in supervision. One side argues that gender differences have no impact upon supervision and the other side argues that these differences do have an impact upon the supervision process and relationship. However Twohey and Volker did state that there is a stereotyping of males as well as females regarding the supervision communication. The male supervisors may be viewed as not being able to speak in a caring and nurturing voice in order to encourage the supervisee; rather it is thought the male supervisor will only focus on tasks. Women speak from a voice of care while men speak from a voice of

39 justice; however, both voices are necessary in supervision in order to have a balance of support and yet have a voice of instruction. It is important for supervisors to be aware of both voice of justice and the voice of care within themselves and within their supervisees (Twohey & Volker, 1993, p. 196). Gender differences are important to address within supervision, and supervisors can do this by remaining vigilant in understanding the existence of gender bias. Nelson et al. (2006) documented discussions among sixteen members of the Section for the Advancement of Women conference. As a result of the discussion, the members felt that it is up to the supervisor to approach the subject of gender and cross cultural issues within the supervisory relationship. However, the supervisor could run the risk of alienating the counselor if the counselor is not able to deal with a discussion about race, culture, or gender. The group felt that in order to minimize the risk of alienation, the supervisor as well as the counselor should explore philosophies about these issues and perspectives regarding their impact upon the supervisory relationship. Addressing the gender differences can make supervisors and supervisee more aware of gender biases that can affect supervision and ultimately affect client outcome. Challenging our own biases, prejudices and issues is one of the most critical parts of the process (Paisley, 1994, p. 14). Both men and women counselors prefer the supervisor to possess expert power during supervision, but the preference for power base does not appear to be tied to gender, but rather to the trust of the supervisee in the supervisor not to abuse their power (Robyak, Goodyear, Prange, & Donham, 1986). Multicultural issues and communication. Multiculturalism looks at the differences of race, gender, socioeconomic background, ethnicity, sexual orientation, and

40 many other areas that demonstrate differences in supervision and the counseling relationship. The multicultural perspective will become essential as we move into the twenty-first century (Fong, 1994, p. 15). It is recommended that supervisors conduct cultural responsiveness in supervision. Garrett et al. (2001) investigated the development of a paradigm of cultural responsiveness for supervisors. In their discussion of cultural responsiveness, the authors stated the importance for the supervisor to be able to communicate with the supervisee about the cultural differences not only within the therapeutic realm but also in the supervision realm. Being able to have discussions about the cultural differences would result in the supervisee being able to understand the impact of culture upon the communication patterns and thus upon supervision. Nilsson and Duan (2007) concluded in their study regarding role difficulties, counseling self-efficacy, and prejudice for minority supervisees working with White supervisors, that if the supervisee perceives prejudice within the supervision relationship the supervisee will not feel the freedom to speak freely about various issues encountered in the counseling relationship. They concluded, these findings support the ideas that supervisory relationships are not isolated from the social contexts in which we live and that racial and ethnic minority students experiences of perceived prejudice, among other factors, are associated with their experience in supervision (Nilsson & Duan, 2007, p. 226). Guanipa (2002) created an instrument to help in evaluating how multicultural issues are addressed in supervision and promoting the discussion of multicultural issues. The Evaluating Multicultural Issues in Supervision is a scale that scores the inclusion of multicultural issues in marriage and family supervision. The instrument contains a 31 question Likert scale and four qualitative questions that monitor how and if multicultural

41 issues are addressed in supervision. The author utilized a broad term of multicultural by including any differences in background between the supervisor and the supervisee, including culture, gender, ethnicity, education, language, and any other differences that could affect the supervisory relationship. The instrument is not meant to evaluate the supervisors and supervisees competence as much as it is to promote discussion of multicultural issues within the supervision process. The author recommended taking the instrument at the end of each supervision session in order to monitor the discussions of multicultural issues within the supervision process and to help each participant to reflect and think about the multicultural issues that could affect the counseling relationship. The author concluded that one instrument is not enough to address all the nuances of complex multicultural issues, but rather is useful for initiating the processing of these issues by both the supervisor and supervisee. Mori, Inman, and Caskie (2009) examined the influence of acculturation and cultural discussion in supervision and the level of satisfaction in supervision with a population of international students. The authors wanted to see whether the influence of acculturation and the supervisees cultural issues could contribute to supervision being beneficial. The authors contended that communication has an impact in the supervision relationship because international students may be at a disadvantage when articulating their thoughts, since English is their second language. If the supervisee is more acculturated he or she will be more able to speak fluently within the English language and the supervision experience will be more supportive and helpful in their training. One hundred and four supervisees took the electronic survey on-line. As a result, the authors found that the level of acculturation and the discussion of cultural issues in supervision

42 did contribute to a higher level of satisfaction. However, the authors also found satisfaction with supervision was still present for those who had lower levels of acculturation. The authors contributed this to the fact that supervisors who are culturally competent and initiate cultural discussion help the supervisee have a better supervision experience. The authors offered the conclusion that supervisors should initiate and promote discussions of cultural issues in supervision in order to result in better supervision outcomes. Burkard et al. (2006) explored the impact of responsiveness and unresponsiveness in cross-cultural supervision with supervisors of color and supervisors of European American decent. Twenty-six female doctoral students across the United States agreed to participate in the study. The authors examined the impact of supervision satisfaction with regard to the responsiveness and unresponsiveness of the supervisor surrounding cultural issues. The participants were broken up into groups of supervisees with supervisors of color and supervisees with supervisors of European American decent. The authors found that the supervisees who had supervisors who were responsive in discussion of cultural issues found supervision to be more satisfying. While the participants with supervisors of color felt more growth as individuals, supervisees with European American supervisors felt they were given the opportunity to discuss not only the topic of cross cultural issues but the opportunity to discuss any issues in supervision. The reports of participants of unresponsive supervisors listed dissatisfaction with supervision and reported participants becoming emotionally upset. The result was that the responsiveness of supervisors regarding cross cultural issues in supervision added to the trust in the supervisory relationship.

43 The supervisor will benefit from this exchange and enhance his or her own abilities to relate to culturally different supervisees if he or she is willing to explore and understand the communication patterns in diverse groups of supervisees. Supervisors demonstrating a wide range of competencies included in the areas of cultural awareness, knowledge and communication skills are more fully and effectively able to facilitate the competence and continued development of the supervisees (Garrett et al., 2001, p. 147). The supervisor should become more culturally competent and responsive in order to help the supervisee to become more culturally competent and responsive to clients. Discussion of spirituality, beliefs, and values can also help to enhance the supervisory experience (Polanski, 2003). Polanski went on to state, addressing the supervisees professional functioning can also be viewed as including personal reflection and values clarification (p. 131). Discussions of the counselors spirituality and beliefs will help both the counselor and the supervisor to understand the differences in their worldviews. Berkel, Constantine, and Olson (2007) also recommended discussing religion, spirituality, and counseling within supervision. Understanding spiritual and religious issues helps the supervisory relationship and the counseling process. The authors stated, it is, imperative that supervisors first increase their level of awareness about their own values, related to these issues and then help supervisees recognize their values and how these values might be expressed in therapy (Berkel et al., 2007, p. 11). Supervisors dedicated to understanding their own values and spiritual perspectives can help the counselor to examine and appreciate their values and spiritual perspectives and how this impacts both the supervision and counseling relationships.

44 While multicultural issues in supervision include language barriers, prejudice, and bigotry, lack of knowledge of cultural differences and the counselors defensiveness can add to these barriers. Supervisees who perceive prejudice in supervision will have difficulty self-disclosing to their supervisor and will thus miss opportunities for growth (Nilsson & Duan, 2007). Minority supervisors have reported being questioned about their competence and acceptance of their expertise in supervision by both majority and minority supervisees (Stoltenberg et al., 1994). Bhat and Davis (2007) discussed the impact of race, racial identity, and the working alliance. The authors found a strong working alliance between supervisors and supervisees who reported high levels of racial identity and a weak alliance when the supervisor and supervisee had low levels of racial identity. The authors felt if the supervisor had a low level of racial identity they had an elevated sense of the working alliance. The results of their study also demonstrated that race did not have a significant impact upon the working alliance. The supervisee was able to freely discuss diversity issues within supervision. Multicultural competence addresses stereotyping not only in counseling but also in supervision. The supervisor is charged with the importance of exploring multicultural competence with the supervisee and helping the supervisee to enhance cultural competency skills (Priest, 1994). Effective supervisors are aware of the impact they have on their supervisees attitudes and views and use the supervisory relationship and supervision process to promote attention to and respect for the full range of diversity of those they serve (Barnett, 2007, p. 270). Discussion of diversity issues can enhance not only the skills for the experienced counselor but also the supervision process. In

45 addition to considering multiculturalism with clients and working to increase selfawareness in the supervisee, using the supervisory relationship itself to explore diversity is often valuable (Erickson, 2007, p. 273). Erickson (2007) conducted research to address the strength of the Supervisory Working Alliance (SWA) and satisfaction in supervision as it pertains to cultural variables. The results were that supervisees who discussed similarities and differences regarding ethnicity in supervision reported higher SWA with their supervisors and more satisfaction with supervision. There were higher bond levels reported on the SWA subscale. Gender and sexual orientation showed no difference of view between supervisors and supervisees. Supervisees who discussed gender and sexual orientation similarities and differences had higher levels of satisfaction in supervision. Supervisees had no preference of similar supervisors but felt more akin to the supervisor if the cultural issues were discussed; therefore, it was not necessary for the supervisor to have the same cultural background for the supervisee to feel a strong alliance in supervision. Ericksons result demonstrated that sexual orientation appears to be the least discussed concept in supervision, which could be due to there being less training for supervisors on this subject matter. Supervisees did more initiation of cultural discussions, which could be due to more emphasis being placed on diversity issues during counselor training today than it was when many supervisors were in school (Gatmon et al., 2001). Sue (2006) presented three concepts for cultural competency: cultural awareness, cultural knowledge, and cultural skills. The levels of analysis are the individual, the agency/organization, and the community for cultural competency. Cultural competency is both a process and a content area. Parra-Cardona, Holtrop, and Cordova (2005) stated

46 that as time goes on the counselors cultural competency can wane, leaving it up to the counselor to seek out support, possibly in supervision, to sustain and maintain the cultural competencies. The authors also stated that there are problems in supervision in which the counselor may not share their inadequacies which will result in the counselor missing out on an opportunity to examine and re-examine their cultural competencies. While the authors acknowledged that counselors may have good intentions to remain culturally competent, their reluctance to talk about these issues in supervision will stagnate their opportunities for growth. Worthen and McNeill (2001) presented five categories to improve the cultural competency of supervisees: didactic education; discussion of client characteristics in supervision; exploring personal experiences with diversity; ensure a diverse caseload; and providing diverse supervisors/consultants. An additional category labeled as other included developing guidelines for multicultural supervision. The relationship of client, counselor, and supervisor will incorporate diversity issues due to a growing number of minorities being serviced in the mental health field. All counseling and supervision contacts have cultural, racial-ethnic aspects, which shape core assumptions, attitudes and values of the person involved and which may enhance or impede counselor effectiveness (Fong, 1994, p. 15). Multicultural issues should be explored in supervision early on to understand the biases of the supervisor as well as the counselor. Challenging core assumptions of the counselor and encouraging expression will help in promoting growth regarding cultural issues. Ethical issues. Professional ethics is considered to be of the utmost importance in counselor competency (Menne, 1975). The supervisor is confronted with ethical

47 dilemmas such as transference-countertransference issues, power and dependency, dual relationships, gender-role or stereotyping other roles, and the supervisors posing their beliefs and value systems on the counselor (Kurplus & Gibson, 1991). Other ethical and legal issues to address in supervision include informed consent, due process, and confidentiality (Cormier & Bernard, 1982). Dual relationships occur when the supervisor and supervisee do not adhere to the boundaries of their existing relationship and form another relationship. The concept of dual relationships has two components present that make them unethical: exploitation and objectivity. In a study by Neukrug, Healy, and Herlihy (1992) regarding ethical complaints against counselors, one of the complaints was having sexual relationships with clients, which is clearly an ethical violation. This type of exploitation is possible in supervision due to the power differential. Understanding the existence of the power differential between the supervisor and supervisee and conducting open discussions about this imbalance can help deter this behavior. Informed consent is helpful to document what will transpire in supervision and what the expectations are for the supervisee regarding participation in supervision. If the supervisee is aware of what to expect they will more freely engage in the supervision process. The supervisor informs the supervisee of the evaluative criteria and expectations of supervision in the beginning of supervision. Due process is a legal term, which means the rights of the supervisee are to be protected in supervision. Ethically, the supervisor should ensure that the rights of the supervisee are not violated in any way. The supervisee will build trust with the supervisor if it is known the supervisor will hold their rights as individuals in high regard. Confidentiality within

48 supervision is not unlike that in the counseling process. The psychological contract between the supervisee and the supervisor is that the supervision meetings are held in confidence and no information will be shared with outside sources. Again, this will build on the trust factor within supervision. Supervisors need to be prepared to discuss a myriad of ethical and legal concerns, including the supervisors own liability (Bernard, 1994). Clinical supervisors have to deal with increasing ethical issues within and about supervision. If engaged in supervision, the counselor is more apt to adhere to ethical guidelines (Vallance, 2005). Tarvydas (1995) stated that: Additionally, the general climate within political, economic and technological content will place increasing pressures on supervisors for accountability in their practices. Examples of ethical issues for supervisors may include a) increasing need for knowledge and technical advancement in the profession b) increasing complexity and severity of client situations c) tightening of standards for supervision d) increased customer empowerment and self-advocacy with greater numbers of grievances and malpractice litigations e) movement toward the use of managed care and f) increased financial and business competition. (p. 295) Ethical issues also include the problem of supervisors not having formal training in supervision, which goes against the ACA Code of Ethics (American Counseling Association, 2005). Supervisors are responsible for the accountability and liability with regard to the quality of services provided by counselors to clients. Supervisors who are able to explore ethical dilemmas and confront ethical issues are able to help the supervisee learn the importance of conducting ethical practice. If the supervisor does not engage in ethical practice it can only serve to demonstrate to the supervisee that ethical behavior is of no importance. Supervisors who are able to model ethical behavior in the supervision process are able to help the supervisee not only engage in ethical decision

49 making, but understand the importance of ethics within the counseling profession (Cobia & Pipes, 2002). Severinsson and Hummelvell (2001) discussed the importance of ethical behavior in the psychiatric nursing profession regarding work stress and appropriate patient care. The ethical behavior demonstrated by the supervising nursing staff helped the nurses not only to achieve personal growth, but also to make sound decisions regarding patient care. The nurses reported less stress from feeling inadequate in their duties. Psychiatric nurses who attended supervision experienced less work-related stress and decreased shortcomings in performing their duties. This is a result of clinical supervision bringing about more self-awareness of moral issues and values. Due to supervision, it was shown that the nurses did not feel the constraints of rules and ethical dilemmas. The nurses were given the opportunity to reflect on those values and therefore make moral decisions about patient care. Worthen and McNeill (2001) also discussed ethical issues and client welfare as they relate to supervision. The supervisees counseling competency, boundary issues, confidentiality and informed consent; mandated reporting and multiple roles; high-risk situations and follow-up were not as overwhelming for the supervisee if discussed in supervision. The other category included how to teach/model corrective learning, supervisee motivations for career, and bad supervisors. The opportunity to discuss ethical dilemmas helped the supervisee to internalize appropriate ethical behaviors. Cobia and Boes (2000) suggested using professional disclosure statements to outline the supervision services and formal agenda of supervision. Supervisors are instructed to sign an informed consent, which has the stated and agreed upon goals of

50 supervision between the supervisor and the supervisee. Informed consent can also include discussion of the supervisors competence in providing services not only in supervision but also in counseling. Just as the counselor can encounter problems if they engage in counseling techniques in which they are not well versed or trained, so too can the supervisor encounter problems if they engage in supervision and are not well versed and trained. Good Supervision vs. Bad Supervision It is important to have a supervisor who is trusted and who will stretch the knowledge base and personal growth of a counselor. The supervisor should have the ability to challenge the counselor and help the counselor gain insight into his or her own competencies and inadequacies (Kahan, 2006). Each time counselors enter into supervision the outcome could be one of good interaction or poor situations. Worthen and McNeill (1996) conducted a qualitative phenomenological study involving intermediate to advanced supervisees to understand the experience of good supervision from the perspective of the supervisee. The authors stated that the research approach is appropriate because the quantitative approach would miss very vital information that could only be elicited from personal accounts. After conducting interviews with eight different supervisees, they concluded that the supervisory alliance is the most important factor of good supervision. The good supervision experience factors include the relationship empathy, respect for the supervisee, and encouragement to explore and experiment. The authors, further, stated that the outcome of good supervision is an increase in self-confidence, an increase in the ability to see complex issues, conceptualization, and intervention enhancement. Counselors within the study

51 felt re-energized and ready to try new strategies as a result of supervision and claimed continued professional identity growth, which further increased their commitment to supervision. The study however, did not address the impact of diversity issues upon the supervision process. The participants were all of Euro-American decent and therefore could not speak to the perspective from a different cultural background. Further, the background of the supervisors was not discussed. The impact of similar backgrounds also had an impact on the supervisory relationship, which resulted in a perspective of good supervision. Worthen and McNeil (2001) conducted a study in which they surveyed the experts in the field of counselor supervision. They purported the two main focuses of supervision were the relationship and promoting learning, which would result in effective client outcomes and continued counselor competency. Surveys were sent to the experts in the field chosen from a list of authors of supervision articles in various journals. The Supervision Beliefs and Practices Survey was developed specifically to elicit the data to examine effective supervision in the study. The survey addressed supervision effectiveness, outcomes, ethical concerns, evaluation, negative experiences, important literature, multicultural counseling competencies, supervision as art or science, process versus outcome orientation, and the role of theory. The study took an exploratory approach rather than trying to confirm an all-inclusive definition of effective supervision. The data analysis looked comparatively at training experts and literature experts. The training experts were those who engaged in the teaching and training of counseling students in Counselor Education and Supervision, while the literature experts were those who engaged in research of supervision. Training experts appeared to emphasize

52 procedural goals more than the literature experts. They further emphasized neglecting authority role, and negative supervision experiences. Development of a supervisor was noted by two important influences, course work/reading and mentors/colleagues. The experts noted nine concepts warranting further research, supervision outcomes, multicultural and diversity issues, process issues, ethics, measuring and evaluating supervision, developmental issues, matching issues, relationship factors and supervision models. An other category encompassed supervision limitations and options and a way of rating supervision experiences. The literature and training experts, though slightly different in their perspectives on supervision, for the most part believed that supervision should be a science rather than an art. The training experts felt that increased selfawareness was the most important factor affecting supervision outcome. Evaluating effective supervision resulted in objective measures, self-report/evaluation, supervision interviews/feedback, evaluating client outcomes, and evaluating video/audio sessions. However, again, this is from the perspective of counselors in training. Worthen and McNeil (2001) stated: In summary, effective supervision according to the experts consists of a good working alliance, an attitude of serious commitment to supervision science informed practice, clearly articulated tasks and procedures and attention to developmental levels. There also needs to be more attention to the continual training of effective supervisors, developing multicultural counseling competence, clarity in regard to desired outcomes, effective evaluation instruments and methods to evaluate those outcomes and a commitment to informed ethical practice. (p. 21) Magnuson, Wilcoxson, and Norem (2000) sought to identify the problem patterns in supervision that can result in ineffective supervision and to develop a schema of the patterns to help supervisors understand what not to do during supervision. The uniqueness of this study was that the data collected consisted of retrospective

53 observations of experienced counselors and experienced supervisors. Done as a qualitative study, the participants were limited to only counselors who practiced for a minimum of five years. Eleven counselors with professional experience ranging from seven to 23 years participated in research interviews. Participants were selected to reflect diversity with regard to geographic location, work setting, experience, and cultural background. The data collection occurred during semi-structured interviews, which ranged in time from 45 minutes to 75 minutes. The participants were asked questions about exemplary supervision characteristics. The supervisory relationship emerged as the central theme with four dimensions: preparation for supervision; participation in supervision; demonstration; and stimulation. The participants characterized the exemplary supervisory relationship as one in which supervisors communicating respect for supervisees developmental and dynamic needs (Magnuson, Wilcoxon and Noreem, 2000, p. 97). A description of poor supervision included being unbalanced, being developmentally inappropriate, participants being intolerant of differences, modeling poor professional/personal attributes, being untrained, and being professionally apathetic. In addition factors such as supervisors not addressing conflicts, neglect initial assessment of developmental level, unprepared for supervision, inadequate as counselors, rigidity in inadequate supervision. While the study asked questions of experienced clinicians it still addressed supervision issues from a counselor-to-be perspective. The study was a confirmation that trust, diversity, ethics, and communication are important aspects of good supervision. Hess et al. (2008) investigated the reasons for nondisclosure in supervision. The authors conducted a qualitative study in which they queried 14 pre-doctoral interns about

54 the reasons for nondisclosure in supervision. The reasons for the investigation were to explore participants experiences of nondisclosure, reasons for intentional nondisclosure, the content of nondisclosures, factors to facilitate disclosure, the impact of nondisclosure on personal development, and satisfaction with supervision. The researchers administered the Supervisory Styles Inventory (Friedlander & Ward, 1984) and the Supervisory Satisfaction Questionnaire (Ladany, Hill, Corbett, & Nutt, 1996), along with conducting 45 to 60 minute interviews with the participants. Utilizing the CQR method of analysis the researchers divided the participants into two groups, those with good supervisory relationships and those with problematic supervisory relationships. The results were that both groups of participants felt an impact of nondisclosure; however, the impact was different for each group. For the good supervisory relationship group, the participants contributed the anxiety of nondisclosure to their own personal barriers. For the problematic group, the participants stated that the nondisclosure was due to difficulties within the relationship. The problematic group felt that the lack of trust due to the supervisors behavior contributed to their nondisclosure. The impact of the supervisors behavior was such that the participants of the problematic group dismissed their supervision experience all together and sought out other sources for personal growth. Both groups pinpointed the main issue of nondisclosure as having to do with the power differential present in the supervision process. Since supervisors were evaluating them, discussion of any issues in which the intern appeared incompetent was withheld. The interns in both groups noted that the evaluative aspect gave the supervisor a higher power level which made it difficult to either disappoint the supervisor, if the intern was in the good group, or not trust the supervisor to give a good review, if the intern was in the

55 problematic group. The conclusion was that the nondisclosure did have an impact upon the supervisory relationship as well as the counseling relationship because of anxiety, fear, and lack of confidence. Cutting (2004), in a qualitative study, investigated the positive and negative experiences of in-group supervision (i.e., where one supervisor does the facilitation of participants groups) during Clinical Pastoral Education. The participants in the study were designated as either part of a positive experience group or a negative experience group. Both groups discussed the positive and negative experiences of supervision. Oddly enough, both groups cited personal growth and learning whether the supervision experience was reported as negative or positive. More critical incidents during supervision were reported in the negative supervision experience group. The positive experience group described the supervisor and supervision as competent, experienced, knowledgeable, sharp, astute, empathic, compassionate, supportive, present, invested, respectful, validating, and affirming. The negative experience group described supervision and supervisors as not present, did not listen well, arrogant, patronizing, disrespectful, demeaning, critical, judgmental, hostile, abusive and enraged (Cutting, 2004, p. 39). The negative experience group further discussed contributing factors with regard to gender/cultural background issues not being addressed in supervision, which contributed to the negative experience. The positive experience group saw growth as a result of supervision, which fostered a need within them to receive ongoing supervision. Nelson and Friedlander (2001) investigated conflictual relationships within supervision that resulted in detriment to the supervisee. They conducted a qualitative research study using 13 participants, 11 of whom were in doctoral programs. Eleven of

56 the participants reported prior supervision and the average age of the participants ranged from 29 to 52 years. Given the age and prior supervision experience, it is possible that the participants were experienced counselors, though the study did not designate how long they had practiced. The supervisees demonstrated a pattern of role conflict with the supervisor particularly if the supervisee possessed more clinical expertise or was older than the supervisor. This appeared to be of some threat to the supervisor. Some of the reported conflicts included dual relationships where the supervisee was placed in more than one role, and unethical behavior from the supervisor involving sexual matters. The major conflict involved what should take place in supervision. The supervisee looked more for a collegial relationship and if met with authoritarian supervision, saw this as a major source of conflict. The supervisees further reported problems of inflexibility, anger, denial of conflict in the relationship, and loss or lack of trust. The supervisees reported extreme stress during the supervision process and found they would attempt to address the conflict more often than the supervisor; however, some would not talk about the experience due to fear of retaliation, as the power differential was of major concern. The positive outcomes were that the supervisees found a sense of resiliency and they possessed the ability to seek out support in other resources. The supervisees were empowered for being assertive with the supervisor and attempting to address issues, and learned what not to do during supervision should they ever find themselves in a supervisory role. The negative outcomes resulted in some of the supervisees becoming cynical about the counseling profession, experiencing distrust of supervisors, and considering changing their professional plans. The study demonstrated a need for supervisors to think about interactions with experienced counselors. Unlike the novice

57 counselor, the experienced counselor has many expertise and life experiences that can have an impact on the supervision process. Supervisors who conduct supervision with an experienced counselor need to have insight into their relation to others, particularly with regard to power. Ladany and Friedlander (1995) emphasized the working alliance and minimizing role conflict for the supervisee. If the working alliance is strong the role conflict is weakened. Should the power differential promote role conflict, it can result in lower levels of satisfaction with supervision (Keller, 1975). As the literature has pointed out, the working alliance in supervision is crucial to the effectiveness of supervision. The supervisee must feel comfortable enough to trust the supervisor. The communication within the supervisory relationship must enhance the working alliance. Henderson (1994) asked how a professional continues to remain competent in their role. Clinical supervision plays a major part in addressing the continued competence of the counselor. Supervisors must address many different factors in supervision, including ethical issues, diversity issues, multicultural issues, and gender issues. As the literature demonstrates, all of these factors are important, but it is unclear which is the most important in supervising an experienced counselor. The current study attempted to define the critical factors needed to conduct effective supervision with experienced counselors.

58 CHAPTER THREE: METHODOLOGY Research Design It is important to ask supervisors who have either supervised or are supervising experienced counselors their opinions of the critical elements involved in supervision with this population of counselors. In order to gather this information, the researcher utilized a Delphi. The Delphi method is a technique that enables a panel of experts to collectively offer their opinions on a particular subject when there is limited information available (Dalkey & Rourke, 1971; Dalkey & Helmer, 1963). For this particular study the Delphi was conducted electronically. The Delphi method offered an opportunity to explore both qualitatively and quantitatively the critical elements necessary to conduct supervision with experienced counselors. Understanding the experiences of supervisors who conduct such supervision can help to understand the current practices and also to create a pilot study to enhance the process of supervision. The Delphi consisted of three rounds of questions with the panel of supervisors. The first round consisted of four open-ended questions requesting the panels perspective regarding elements of supervision with the experienced counselor. The second round consisted of a presentation of the researchers interpretations of the various elements offered by the panel, in addition a request to the panel to attempt to reach a first consensus of the critical elements. The third round consisted of a confirmation by the panel regarding the critical elements voted on by the panel to result in a final consensus of the critical elements to conduct effective supervision with experienced counselors. The researcher was interested in how the participants experienced the phenomenon of

59 supervision with experienced counselors in order to pinpoint what is critical and important to them in conducting the supervision. According to Caelli (2001), phenomenological inquiry seeks to answer the question is this what the experience is really like? (p. 274). Patton (2002) stated that the phenomenological approach to inquiry is a way of exploring how human beings make sense of their experiences and transform them into consciousness. He further stated, this requires methodologically, carefully and thoroughly capturing and describing how people experience some phenomenon how they perceive it, describe it, feel about it, judge it, and remember it, make sense of it and talk about it with others (Patton, 2002, p. 104). Therefore, the original questions developed for the first round were designed to elicit responses from the supervisors regarding their experiences of conducting supervision with the experienced counselor. Selection of subjects. The participants chosen for a Delphi study is one of the most critical steps of the research because the criteria for choosing participants dictates the rigor of the data collected. The panel of participants must be well chosen because the results of the study are contingent upon their qualifications (Pollard & Pollard, 2008). Therefore, the participants in this study consisted of a purposive sampling of supervisors who met the following selection criteria for inclusion: The supervisor conducts one-to-one supervision. While the other modalities of supervision, such as group and peer are discussed in the field, the current study was only interested in the one-to-one supervision modality. The supervisor engaged in both clinical and administrative supervision.

60 The supervisor has or does conduct supervision with experienced counselors. Again the experienced counselor is post-licensure and is practicing independently. The supervisor received training in supervision whether through a formal program or through continuing education classes that included ethics, diversity issues, administrative supervision, clinical supervision, an understanding of the feedback process, supervision models, working alliance, and supervision style. The supervisor is a licensed clinician who conducts direct client services. This criterion was included in order for the supervisor to possess some understanding of the demands upon the experienced counselor. The supervisor currently conducts or has conducted supervision with at least two different experienced counselors. This criterion was included in order to demonstrate contrast in the individual demands of supervisees. The supervisor also supervised counselors-in-training, who are pre-licensed. This criterion was included because the supervisor was expected to give a contrasting understanding, if any, of the supervision of an experienced counselor. The supervisor is to at least meet the accreditation of the Center for Credentialing and Education of a clinical supervisor with the exception of criteria 6, which was deemed unnecessary for this research. The Center of Credentialing and Education (CCE) was created in response to ongoing requests from other organizations to the National Board for Certified Counselors, Inc. and Affiliates (NBCC) for assistance with credentialing, assessment, and management services (Center for Credentialing and Education, 2009, paragraph 2). CCE is recognized internationally for its standards in credentialing and accreditation, and

61 has an accreditation of the Approved Counselor Supervisors (ACS). Counselors who hold this accreditation meet the following criteria: 1. Licensure, certification, accreditation, or approval: Must be one of A to E: A. National Certified Counselor B. Licensed or Certified Mental Health Provider C. Licensed or Certified Clinical Supervisor D. Mental Health Related Educator E. Mental Health Related Doctoral Candidate 2. Educational Training: Minimum of a masters degree in a mental health field. 3. Specialized Training: Must document either A or B: A. A graduate course in clinical supervision B. A total of 30 contact hours of workshop training in clinical supervision 4. Mental Health Related Experience: Minimum of three years of post-masters degree experience in mental health services, with a minimum of 1,500 hrs direct service with clients. 5. Supervision Experience: Must have provided a minimum of 100 hr. of clinical supervision of mental health services with supervisees OR an endorsement from a mental health professional attesting to the applicant's supervisory activity. The Center for Credentialing and Educations Approved Clinical Supervisors are represented in all states with the exception of Alaska, District of Columbia, Hawaii, and West Virginia. With the exception of West Virginia, the credentialing for the missing representative states does not meet the same rigorous certification criteria.

62 In the state of West Virginia, a supervisor is designated to meet the requirements for accreditation as an Approved Licensed Professional Supervisor (ALPS) by the West Virginia Board of Examiners (2009) in Counseling if the individual meets the following criteria: Supervisors must be permanently licensed as a Counselor for at least two years. Supervisors must have five years counseling experience, licensed or unlicensed, that can be documented. Supervision Experience is demonstrated by two professional endorsements from either a former supervisor or supervisee and the endorser must have worked with the supervisor for at least a year and acknowledged reading the Supervisors Professional Disclosure and Professional Statement. Professional Disclosure consists of counselor license number, place of business, education, and degree date, along with counselor specialties. Professional Statement includes categories such as education, contextual influences, professional credentials, therapy experience, theoretical influences, supervision experience, supervision orientation, supervision philosophy, and any other items deemed important by the Supervisor such as supervision specialty. Coursework or Continuing Education with LESS THAN 10 years documented counseling experience that reflect at least 30 contact hours in clinical supervision training. All trainings must contain the term clinical supervision in the title and all trainings must be completed prior to being approved as a professional Supervisor.

63 Coursework or Continuing Education with MORE THAN 10 years documented counseling experience that reflect at least 15 contact hours in clinical supervision training. All trainings must contain the term clinical supervision in the title and all trainings must be completed prior to being approved as a professional Supervisor (West Virginia Board of Examiners, 2009, paragraph 2). The criterion for the ALPS is similar to the criteria listed for the Center of Credentialing and Educations ACS with only minor differences between the two accreditations. The ACS does not state how long the supervisor should possess licensure as a counselor, and requires two less years of counseling activity than in West Virginia. The ALPS criteria distinguish the amount of coursework or continuing education between supervisors with less than 10 years and supervisors with more than 10 years. In order to find participants who could meet the Center for Credentialing and Education criteria, this researcher posted invitations to participate on four different groups on the LinkedIn website. The LinkedIn website was created in December 2002 and launched in May 2003, to facilitate professional networking and allow members of a group to share ideas, share information, and exchange best practices. The four groups chosen for posting were the American Counseling Association LinkedIn Group, Illinois Mental Health Professionals LinkedIn Group, Psychologist-Psychotherapist-Counselors LinkedIn Group, and the United States Mental Health Professionals LinkedIn Group. In addition, the researcher contacted the clinical supervisors of West Virginia listed on the Board of Examiners of West Virginia website. The missions of the four LinkedIn groups are as follows:

64 American Counseling Association LinkedIn Group is for user experience design professionals to expand our network of people and ideas (1,271 members). Illinois Mental Health Professionals LinkedIn Group is to improve collaboration amongst counselors, licensed clinical professional counselors (LCPC), licensed professional counselors (LPC, LMFT), licensed clinical social workers (LCSW), psychologists (Ph.D. or Psy.D.), in/near Illinois (counselor, counseling, therapist, social worker, psychologist) (291 members). Psychologist, Psychotherapist and Counselors LinkedIn Group is a community of psychologists, psychotherapists, and counselors whose aim is to create a network of professionals, facilitate job opportunities, and knowledge sharing (psychologist, psychology, psychotherapist, psychotherapy, counseling, counselor, coach, coaching, mentor, mentoring, LCSW, LICSW, PhD, Psy.D, Psy.D) (3,914 members). United States Mental Health Professionals LinkedIn Group is designed to improve collaboration amongst marriage & family therapists (MFT), LCSW, psychologists (Ph.D. & Psy.D.), & psychiatrists in the US (therapist, therapy, psychotherapy, psychotherapists, psychotherapist, psychologist, psychology, psychiatrist, psychiatry, social worker, counselor, counseling) (3,716 members). Following the example of Edwards (2003), an electronic invitation was posted on the general discussion board of each group and followed by invitations sent to individual members of the four groups who designated their title as Clinical Supervisor, in the event that the general post was not read by the members. Individual invitations were electronically sent to the West Virginia clinical supervisors. The criteria for inclusion as

65 a panel member was posted as well as sent with the individual invitations. The members were asked to respond to the researcher by private email in order to receive further instructions regarding the study. When the members of the groups responded directly to the researcher and agreed to participate, an electronic informed consent was sent to the member by email. A minimum of six and a maximum of 20 participants were anticipated for the panel of supervisors as this is considered an appropriate number of participants for a Delphi study (Van De Ven & Delbecq, 1974). The researcher was interested in recruiting supervisors in service areas that included behavioral organizations, community agencies, schools, and private practice in order to achieve a cross section of supervisors thus enriching the data collected to give different perspectives of supervision. The researcher also sent a request to the respondents who agreed to participate asking if they knew of colleagues who also met the criteria for inclusion and were interested in participating in the study. A nomination invitation was sent to those colleagues. Considered snowballing in qualitative research terms, this enabled the researcher to find more participants who met the criteria and were considered subject matter experts. Instrumentation. The Delphi was dependent upon the participants who were able to illuminate the experience under investigation (DeVilliers et al., 2005; Edwards, 2003; Hycner, 1985; Jenkins & Smith, 1994; Morrow, 2005; Morse, Barrett, Mayan, Olson, & Spiers, 2002). The method is a mixture of exploratory qualitative and confirmatory quantitative and offered an opportunity for the participants to come to a consensus about the critical elements for conducting effective supervision with the

66 experienced counselor. Very little literature was available regarding the critical elements; therefore this type of study was beneficial. Pollard and Pollard (2008) presented a model for conducting an electronic Delphi study. The electronic Delphi, like the traditional Delphi, lends itself to anonymity from other panelists, iteration, controlled feedback, and statistical aggregation of the group response. The participants were sent individual links to the survey inquiries and were further notified not to forward the link as it was tied to their private email address. The three rounds of questions consisted of with open-ended questions in round one, a four point Likert Scale survey to rate the responses of the panelists along with any additional comments, and a final round reviewed the results and made a request for any further submissions or clarifications by the participants. Assumptions. Due to electronic interactions, it was assumed the participants would be internet savvy and able to manipulate the instrument. When the solicitation for participants was sent, the researcher had to rely upon the respondents regarding their meeting the criteria for inclusion. In addition, it was assumed that the participants would not request that a colleague who was not approved to be involved in the study complete the surveys. The researcher depended upon those who volunteered to truthfully attest to meeting the criteria of inclusion ensuring the integrity of the data collected. The researcher also depended upon participants to complete the entire research study in each round of the Delphi study. The researcher expected each participant to respond from experience rather than what the participants deemed as an appropriate answer to the questions. In other words, the supervisors were to report what they were doing or had done in supervision rather than what they should be doing. It was further assumed that

67 the website utilized worked properly for the participants and no technical problems were encountered. Procedures. The electronic invitation (See Appendix A) was posted to all general discussion boards of the LinkedIn groups along with individual invitations sent to the members of the groups. The individuals were chosen by searching for members with current or previous job titles and descriptions of Clinical Supervisor. The member was allowed to respond to the researcher through the LinkedIn email system. This was helpful for the participants so as to know the researcher was not seeking any personal information which the participant was not confident in sharing. The electronic environment does, unfortunately, allow for unsavory characters to attempt to gain advantage over others. If the participant met the criteria and was comfortable with the solicitation being legitimate, a request was sent for the participant to send a private email address to contact the participant directly. An informed consent (See Appendix B) was then forwarded to the member. The informed consent stated that the study met approval of the Institution Review Board and included direct contact information for the researcher and the dissertation chairperson. The individual invitations were sent one at a time to recipients so as to avoid the possible security controls within the LinkedIn environment and the individual email security environments. The emails invited participants to contact this researcher regarding the criteria of inclusion in the study. Once it was determined that the participant met the criteria for inclusion, an informed consent consisting of the purpose for the research, the risk and benefits of the research, the voluntary nature of research participation, the participants right to stop the research at any time, and the procedures

68 used to protect confidentiality was sent to the volunteer. In addition, the email also included the study description (See Appendix C). Once volunteers for the panel were obtained, the researcher forwarded an email notifying the participants to contact this researcher to nominate a colleague for participation. Once a nomination was received the researcher forwarded an invitation by email to the nominee (See Appendix D) stating that a colleague felt they met the researchers criteria for inclusion in the study and felt the nominee would be interested in participation. The nominee was requested to electronically reply just as the initial participants were requested. The researcher reviewed and printed all informed consents in order to protect the confidentiality of the participants and emails from the participants were then permanently deleted from the researchers electronic environment. During the first round, participants were asked to complete the initial open-ended questions and demographic questionnaire (See Appendix E & F). Participants were requested to complete the task within a three week timeframe. Once the information was collected, the researcher compiled and analyzed the responses by thematic analysis (Braun & Clarke, 2006; Fereday & Muir-Cochrane, 2006). The results from the thematic analysis were then constructed as a survey for the second round. The participants who had not responded, a week before the conclusion of the round, were sent a reminder email of the survey closing date. The researcher included an election statement for the participant to opt out of the study. At the deadline date and time announced, the survey was then closed by the researcher. During the second round, the participants were sent an email announcing the opening of the second round survey. The participants were given three weeks to review

69 and rate the themes based upon a four point Likert scale ranging from 4-Critical element, 3-Important element, 2-Somewhat unimportant element and, 1-Not an important element. The researcher chose an even-numbered Likert scale in order to force the participants to give an opinion on each element. Avoiding a neutral response encouraged the participants to really think about their opinion of the critical elements to conduct effective supervision with experienced counselors. A space was provided if the participants wanted to add additional comments forgotten during the first round. A week before the ending of the second round survey a reminder email was sent to any participant who had not responded, notifying them of the survey closing date. During the third round, the consensus of the important and critical elements of supervision ratings from round two were published for review and a request was made of the participants to indicate their agreement or disagreement with the consensus of the panel. A comment line was provided if a participant wanted to provide input about the results. The researcher followed up with the participant regarding any additional comments by email. Data Processing and Analysis According to Braun and Clarke (2006), thematic analysis is a method for identifying, analyzing and reporting patterns (themes) within data (p. 79). The process of thematic analysis requires the researcher to view and determine the themes one response at a time (Fereday & Muir-Cochrane, 2006). The themes can be identified either inductively or deductively. According to Patton (2002), the inductive process is not driven by the researchers theoretical interest but rather from the data; therefore the researcher conducted inductive thematic analysis. Groenewald (2004) cautioned

70 researchers to bracket their biases while reviewing data so as not to impose their ideas and suppositions upon the data. The themes were identified at a semantic level and coded within a spreadsheet to keep track of the themes. Braun and Clarke (2006) stated, the analytic process involves a progression from description, where the data have simply been organized to show patterns in semantic content, and summarized, to interpretation, where there is an attempt to theorize the significance of the patterns and their broader meanings and implications (p. 84). The researcher performed a review of the data by copying and pasting the participant responses from the Excel spreadsheet. The process of cut and paste into the spreadsheet provided an opportunity to begin analyzing the data. Upon completion of the analysis of the first round data, the researcher reviewed the findings with a colleague who was a post-licensure clinician, had practiced for over 20 years, and was a recipient of supervision for those years. The colleague assisted with the interpretation of the openended answers and then a comparison was conducted with the researchers. The review of the themes with the colleague helped to strengthen reliability, validity, and credibility of the initial data analysis resulting in the compilation of themes. This step also aided in reduction of researcher bias. The website utilized to gather the data possessed a built in program to conduct simple statistics on the ratings and generated the final report. The participants were sent the final findings. The Delphi method allowed the participants to do member checking on the data, with the exception of the initial theme generation, therefore adding further validation of the data.

71 CHAPTER FOUR: FINDINGS The current pilot study explored what supervisors consider are the critical elements in conducting effective supervision with experienced counselors. Utilizing an electronic Delphi method the researcher sought to gather consensus from a panel of experts regarding the question, what are the critical elements of effective supervision with the experienced counselor? An invitation was posted on the discussion board of 4 different counseling groups of the professional networking site Linked In. In addition the researcher sent individual invitations to members of the Linked In groups, which designated their current or former job titles or specialties as Clinical Supervisors for both pre-licensed and post-licensed counselors. The researcher also sent individual electronic invitations to a list of Approved Licensed Professional Supervisors (ALPS) from the state of West Virginia. The email addresses of the ALPS were posted on the Board of Examiners for the state of West Virginia. The individual invitations were sent to the members of the Linked In groups because the general post to the groups discussion boards may not have been seen by everyone in the group and to also avoid the electronic security environments for blast emails. The invitations were posted on the discussion boards of United States Mental Health Professionals, Illinois Mental Health Professionals, American Counseling Association and Psychologist, Psychotherapist and Counselors, the 4 Linked In groups. The researcher sent 303 individual invitations to the LinkedIn group members and the ALPS requesting participation. Thirty five individuals responded with interest to participate in the study, resulting in an 11.55% rate of return. While 35 responded to the request, only 14 met the criteria for inclusion as an expert panel member. Several

72 ALPS from West Virginia expressed interest in participating; however, the individuals who responded were only experienced in conducting supervision with pre-licensed counselors. Some individuals did not meet various aspects of the inclusion criteria. Reasons for exclusion from the panel included conducting supervision with experienced counselors, the length of time of conducting supervision with experienced counselors, supervision training whether through continuing education units or a formal university program, geographically not from the United States, or did not adhere to the deadline for participating in the first round. Interestingly, the researcher was contacted several times by some individuals interested in participating but who had been excluded from participation. The individuals wanted to understand the reasons for exclusion by the researcher. After discussion with the individuals it was understood that the researcher was specifically looking for those individuals who met the criteria in order to sustain reliability and validity of the study. The reliability and validity of the Delphi study is heavily reliant upon the criteria of the panel. A study description, schedule for the study, and an informed consent were forwarded to the 14 individuals who met the criteria and showed interest in participation. All 14 informed consents were returned electronically to the researcher, which were then reviewed and secured. Of the 14 respondents, four did not respond to requests to complete the first round of study. Two of the remaining 10 respondents did not complete all the questions of the first round survey, leaving eight respondents who completed all three rounds of the Delphi. The panel members were geographically located on the East coast, the Midwest, and the West coast of the United States. Demographic information was gathered from

73 the panel members requesting highest educational degree, professional title, and work setting. Panel members were also asked about their counseling and supervision theoretical approaches. All of the participants were Masters Level with either an MA or MS degree. Some of the panelists listed more than one degree. Some of the panel members listed more than one professional title, more than one work setting, more than one counseling theoretical approach, and more than one supervision theoretical approach. Table 1 presents the demographic information gathered on each of the panel members with regard to education, professional title, work setting, counseling theoretical approach, and supervision theoretical approach. For the purposes of this study, the panel members are identified as Panelist 1-8. Fifty percent of the panelists reported supervisor/supervising in their professional title. Sixty-two and a half percent of the panel members worked in private practice, while an additional 25% worked in hospitals and 37.5% worked in social agencies. Twenty five percent of the panel members were Art Therapists, while another 37.5% obtained degrees in psychology or clinical psychology. Fifty percent of the panel members noted cognitive or cognitive behavioral theory as one of their counseling theoretical approaches, while 50% of the panel members noted their supervision theoretical approach as developmental. Three of the panelists had conducted supervision for 3-5 years, three panelists had conducted supervision for 6-10 years, and two panelists had conducted supervision for 16-20 years. Five of the panelists had conducted supervision with experienced counselors for 2-5 years. One panelist had conducted supervision with experienced counselors for 6-10 years, one panelist for 11-15 years, and one panelist for 16-20 years.

74 Table 1 Panel Members by Education Degrees, Professional Title, Work Setting, Counseling Theoretical Approaches, Supervision Theoretical Approaches
Panel Member Education Degrees Professional Title Work Setting Counseling Theory Supervision Theory

Social Work

Supervising Clinician

Hospital

Structural Family

Task-Centered

Psychology

Clinical Supervisor

Private Practice

Object Relations

Integrated

Counseling Education

Counselor

Agency; Private Practice

Cognitive; Humanistic

Competency Based; Developmental*

Art Therapy; Clinical Pastoral; Ph.D. Student

Art Therapist; LICDC; Private Practitioner; Teaching Fellow

Hospital; Private Practice; University

Art Therapy; Dialectical Behavioral; Person-Centered

Alternative Therapies; Competency Based; Developmental

(continued)

75 Table 1 (continued) Panel Members by Education Degrees, Professional Title, Work Setting, Counseling Theoretical Approach, Supervision Theoretical Approach
Panel Member 5 Education Degrees Social Science; 4year Clinical Training Professional Titles Clinical Supervisor Work Settings Agency Counseling Theories Infant Mental Health; Psychoanalytic Supervision Theories Developmental

Clinical Psychology

Clinical Supervisor

Agency

Cognitive Behavioral; Systems; TraumaInformed

Integrated; Systems

Art Therapy

Art Therapist; Supervisor Rehabilitation

Hospital; Private Practice; University

Cognitive Behavioral; Eclectic; Humanistic; PersonCentered; Psychodynamic

Humanistic; PersonCentered; Psychodynamic

Choice; Developmental Cognitive; Psychodynamic; Systems Note. *Researcher labeled categories according to panel members description of theoretical approach.

Psychology; Social Work

Private Practitioner

Private Practice

76 Two of the panel members stated formal training or coursework while the other six panelists obtained training through continuing education units (CEU). One of the panelists listed informal training and self-study in addition to CEUs, and another panelist listed yearly online CEUs. The panel members reported conducting supervision for 3-8 individuals with an average caseload of five individuals. The panel members reported a range of 25% 100% of their caseloads being spent supervising experienced counselors. The panel members further reported that the frequency of conducting supervision was daily, weekly, bi-weekly, and monthly, with the range of 60-120 minutes for a supervision session. The average length of time panel members spent in supervision was 68.75 minutes per session. Each panel member was sent an individual survey link for the first round of the study, which was tied to their email address. The panel members were instructed not to forward the link to colleagues since it was tied to their email address. Panel members were sent a separate nomination invitation for any colleague the panel member felt would be interested in participating in the study. This was sent under separate email. The first round consisted of 4 open-ended questions. The panel members were instructed the survey would be available for 3 weeks and if there was no response from the members a week before the survey closed, the researcher sent out a reminder e-mail, which prompted panel members to complete the survey. Appendix G lists the responses of each panelist during the first round of the study. The researcher applied thematic analysis to the responses by the panel members. Each response was analyzed and themes were recorded in a Word document. The

77 researcher reviewed the response of each panelist and then reviewed the response again after waiting 24 hours for any additional themes not noted in the first review. Each panelists response was then cross tabbed with the responses of the other panelists for any redundant themes. The researcher requested a colleague who is a long time recipient of supervision to review the data and record any themes which emerged from the colleagues perspective. Comparison of the researchers themes and the colleagues theme was then conducted. Any themes which appeared on both lists were documented for inclusion in the second round survey. Discussion took place regarding the discrepancies between the researcher and the colleague. As a result if the researcher and colleague came to an agreement the theme was included in the list if no agreement was reached the theme was then eliminated. In addition the interpretation of the meanings of the themes was also discussed and agreed upon between researcher and colleague. As a result of the thematic analysis, the researcher noted four elements as being critical to supervision of the experienced counselor, which were the characteristics of the supervisor, characteristics of the supervisee/experienced counselor, characteristics of the supervision process, and characteristics of the supervision relationship. During the second round, the researcher listed the characteristics in a four point Likert scale for rating by the panelists. A four point Likert scale was purposely utilized so the panelist had to make a forced choice on the characteristics. The panelists were asked to vote on the characteristics and indicate whether the researcher had the correct interpretation of the characteristic. In addition, the panelists were asked to include any

78 comments or characteristics not listed by the researcher (See Appendix H). Results from the second round voting for each of the critical elements are listed in Tables 2-5. Round three of the Delphi consisted of the panelist voting on the list of characteristics based upon the consensus criteria of Green (1982). The purpose of the final round was to confirm the consensus of the panelists and again to allow any additional comments. The consensus criterion was greater than or equal to 75% of the panelists with a mean score of greater than or equal to 3.25. A definition followed each characteristic and represented this researcher's interpretation of the panel's discussions in the first round. If panelists disagreed with the interpretation they were to include additional comments. The panelists had 3 weeks to complete the survey and submit any additional comments. A reminder e-mail was sent a week before the closing of the survey. The panelists voted to keep the remaining characteristics of the critical elements on the lists and added additional comments. The consensus of the panel regarding the characteristics of the supervisor, in rank order, included: 1 2 3 4 5 6 7 ability to promote trust sets boundaries in the supervision session promotes respect in the supervision session being supportive in the supervision session possessing credibility as a supervisor personally comfortable in the role of supervisor competent in the practice of supervision

79 Table 2 Supervisor Characteristics Panel Rating Themes Not Importan t 1 Somewhat Important Critical Rating Percentage Important Average Agreement

Broad Theoretical Counseling Base Broad Theoretical Supervision Base Set Boundaries Promote Trust Promote Respect Supportive Empathic Continued Training Receptive to Criticism Appropriate Interventions

2.50

62.5

2.25

37.5

0 0 0 0 0 0 0 0

0 0 0 0 2 4 1 3

3 2 4 4 5 3 6 4

5 6 4 4 1 1 1 1

3.63 3.75 3.50 3.50 2.88 2.63 3.00 2.75

100 100 100 100 75 50 87.5 62.5 (continued)

80 Table 2 (continued) Supervisor Characteristics Panel Rating Themes Not Importan t 0 0 0 0 0 0 0 0 1 Somewhat Important Critical Rating Percentage Important Average Agreement

Competent Confident Credible Comfortable in Supervisor role Available Teacher/Educator Patient Role Model Empower

1 1 1 1 3 5 0 1 1

4 6 3 3 3 2 7 5 5

3 1 4 4 2 1 1 2 1

3.25 3.00 3.38 3.38 2.88 2.50 3.13 3.13 2.75

87.5 87.5 87.5 87.5 62.5 37.5 100 87.5 75

81 Table 3 Supervisee Characteristics Panel Rating Themes Not Importan t 0 0 Somewhat Important Critical Rating Percentage Important Average Agreement

Open to Supervision Understand Supervision Expectations Understands Goals of supervision High Standard Client Care Receptive to Corrective Feedback Confident in Counselor Identity Open to Suggestions Integrates Information Quickly SelfReflective

0 2

4 4

4 2

3.50 3.00

100 75

3.13

87.5

3.50

100

3.75

100

2.38

37.5

0 1

0 3

6 4

2 0

3.25 2.38

100 50

3.25

87.5 (continued)

82 Table 3 (continued) Supervisee Characteristics Panel Rating Themes Not Important 0 0 0 0 Somewhat Important 2 3 2 2 Important Critical Rating Average 3 3 2 1 3.13 3.00 3.00 2.88 Percentage Agreement 75 62.5 75 87.5

Self-Directive Self-Motivated Challenge supervisor Continual Counselor Training/Education Empathic Broad Theoretical Base Professional Development Vulnerable with Supervisor

3 2 4 5

0 1 0 0

2 4 4 2

4 3 4 1

2 0 0 5

3.00 2.25 2.5 3.38

75 37.5 50 75

83 Table 4 Supervision Process Characteristics Panel Rating Themes Not Important 0 0 0 0 0 0 0 0 0 0 Somewhat Important 1 5 1 1 2 0 1 2 1 1 Important Critical Rating Average 6 1 3 4 2 5 2 1 1 3 3.63 2.50 3.25 3.38 3.00 3.63 3.13 2.88 3.00 3.25 Percentage Agreement 87.5 37.5 87.5 87.5 75 100 87.5 75 87.5 87.5

Protect the Clients Best Interest Monitoring Case Progression Address Ethical Guidelines Providing Effective Feedback Model Appropriate Counselor Behavior Setting Boundaries Setting Goals Setting Expectations Assessing Counselor Developmental Level Tailoring Supervision to Meet Developmental Level Education of Various Theoretical Methods/Approaches

1 2 4 3 4 3 5 5 6 4

2.25

37.5

(continued)

84 Table 4 (continued) Supervision Process Characteristics Panel Rating Themes Not Important 0 Adherence to Ethical Guidelines TransferenceCountertransference Issues Expand Supervisee's Knowledge base Refining skills of the Supervisee Beneficial for Supervisor/Supervisee Case Conceptualization Addressing Role Conflict Addressing Safety Concerns Explore Counselor Complacency Challenge Supervisee Assumptions Creating Structure for Supervisee 0 0 5 3 3.38 100 Somewhat Important 0 Important 4 Critical Rating Average 4 3.50 Percentage Agreement 100

0 0 0 0 0 0 0 0 0

1 0 2 1 2 1 2 1 3

5 5 5 5 2 2 3 2 3

2 3 1 2 4 5 3 5 2

3.13 3.38 2.88 3.13 3.25 3.50 3.13 3.50 2.88

87.5 100 75 87.5 75 87.5 75 75 62.5

85 Table 5 Supervision Relationship Characteristics Panel Rating Themes Not Importan t 0 0 0 0 0 0 0 0 0 0 0 0 Somewhat Important Critical Rating Percentage Important Average Agreement

Collegial Collaborative Empowering Supportive Trustworthy Encouraging Challenging Growth Respectful Open Reciprocal Inspiring

3 0 0 0 0 0 2 0 0 0 2 2

4 3 6 3 1 6 2 1 3 5 4 6

1 5 2 5 7 2 4 7 5 3 2 0

2.75 3.63 3.25 3.63 3.88 3.25 3.25 3.88 3.63 3.38 3.00 2.75

62.5 100 100 100 100 100 75 100 100 100 75 75

The consensus of the panel regarding the characteristics of the supervisee/experienced counselor, in rank order, included: 1 2 3 4 being receptive to corrective feedback open to supervision committed to high standards of client care willing to be vulnerable in supervision

86 5 6 open to suggestions self-reflective

The consensus of the panel regarding the characteristics of the effective supervision process included: 1 2 3 4 5 6 7 8 9 protecting the clients best interest setting boundaries adhering to ethical guidelines addressing safety concerns for both the supervisee and the client challenging the supervisees assumptions providing effective feedback exploring transference-countertransference issues refining the supervisees skills tailor the supervision process to match the developmental level of the supervisee

10 addressing ethical guidelines 11 addressing role conflict Finally, the consensus of the panel regarding the characteristics of the supervision relationship included: 1 2 3 4 5 6 being trustworthy enabling growth collaborative supportive respectful open

87 7 8 9 empowering encouraging challenging The researcher applied thematic analysis to qualitative information provided by the panel in the first round and developed interpretations for each of the elements.

88 CHAPTER FIVE: SUMMARY, LIMITATIONS AND FUTURE RESEARCH The panel of eight clinical supervisors submitted their ideas in an electronic Delphi study exploring what are the critical elements of conducting supervision with an experienced counselor. As the study unfolded, the panel pinpointed four critical elements that were considered necessary for effective supervision with this population. The critical elements focused upon characteristics of the supervisor, characteristics of the supervisee/experienced counselor, characteristics of the supervision process, and the supervision relationship. In Campbells (2000) discussion of conducting effective supervision it was noted that the supervisor should include models of supervision, methods and techniques of clinical supervision, role of the relationship in supervision, methods and techniques to help the supervisee grow, legal and ethical issues in supervision, multicultural issues in supervision, administrative tasks in supervision, and the role of personal development in supervision. The four elements discussed by the Delphi panel coincided with Campbells definitions of effective supervision. Characteristics of the Supervisor To promote trust was interpreted by this researcher as the supervisors ability to relay reassurance to the supervisee/experienced counselor regarding the supervisor's knowledge, skills, and abilities in supervision. However, one of the panelists gave an addendum to the definition of promoting trust that addressed the interpersonal issues between the supervisor and the supervisee/experienced counselor. The supervisee/experienced counselor needs to know that the supervisor cares about him or her. Understanding the interpersonal aspects of the relationship, Panelist 7 stated that the supervisor should possess a personal comfort and sense of competence, knowledge of a

89 variety of theories and methods, and a personality that means that experienced counselors respect your opinion. Promoting trust sets the tone of supervision if the supervisee/experienced counselor know the supervisor cares about their wellbeing. Just as the supervisor should possess the ability to promote trust, the panel stated that the supervisor should possess the ability to promote respect. The researcher interpreted this characteristic to be the ability to recognize and appreciate the supervisee's/experienced counselors knowledge, skills, and abilities in counseling. This characteristic, like promoting trust, is a part of the supervisors interpersonal skills. The supervisors ability to acknowledge the supervisees/experienced counselors expertise promotes a feeling of mutual respect. As Panelist 3 stated, the supervisor needs to have trust as well as respect in order to have effective supervision. The characteristics of trust and respect were also discussed in the supervision relationship. The panel was in complete agreement that it is important for the supervisor to have appreciation for the supervisee's/experienced counselors viewpoints and vice versa; the relationship is trustworthy because the relationship is authentic, dependable, and ethically conducted. Respect for one another changes the relationship to one of collegial rather than teacherpupil. Panelist 3, in discussing the difference between a novice counselor and an experienced counselor, stated the relationship between novice and supervisor is more teacher/pupil, whereas the supervisor/experience counselor relationship is more collegial. Setting boundaries and remembering their role as supervisor was a characteristic frequently mentioned by more than one panelist for both the novice and experienced counselor supervisees. The researcher interpreted this characteristic as one in which the

90 supervisor understands his/her role as the supervisor and adheres to the role during supervision. Campbell (2000) concurred that the supervisor must, in order to be effective, decide upon a role and adhere to that role in supervision. Panelists 2, 3, and 6 all discussed the characteristic of setting boundaries. The panelists stated the supervisor needs the ability to have strong boundaries, a clear understanding of the boundaries, expectations and roles of the supervisor and counselor, and a clear understanding of what is expected, required, respectively. Panelist 3 further pointed out, not setting boundaries, results in a drawback to supervising experienced counselors. A drawback might be remembering your role as the supervisor. It feels great to have experienced counselors to speak with about cases and if the boundaries aren't clear it could become merely peer supervision. Interestingly enough, one of the panelists, while agreeing the supervisor should possess this characteristic felt it is a more critical element for the supervision process, rather than for the supervisor. The panel unanimously agreed about the importance of setting boundaries within the supervision process. The researcher interpreted this characteristic as a formal structure within the supervision sessions, which follows supervision policy and procedures. Panelist 2 stated, the ability to have strong boundaries and to have the ability to provide input and feedback to the supervisee to assure that the case is progressing, is an important aspect of the supervision process. In addition, Panelist 8 added that setting boundaries is a way to model for the counselor on how to set boundaries in counseling, stating more than the formal supervision structure, [supervision] role models interpersonal limits and respect, to be reflected in the counseling provided by the supervisee.

91 Not unlike the novice counselor, the panel stated that the experienced counselor also needed to feel supported; therefore, the supervisor needs to have the ability to be supportive. The researcher interpreted this characteristic as the supervisors ability to attend to the needs of the supervisee/experienced counselor during supervision. According to Panelist 7, the supervisor needs to be supportive within the supervision environment because supportive environments enable clinicians to do their best work. Panelist 8 added that being supportive also includes the supervisor's ability to encourage the supervisee's/experienced counselors ability to make sound clinical decisions. The panel was in agreement that the supervisor as well as the supervision relationship should be supportive. The researcher interpreted the characteristic of supportive within the supervision relationship as a complimentary alliance between supervisor and supervisee/experienced counselor. However, while there was a general consensus that the supervisor should be supportive, two of the panelists did not agree that it was necessary for the supervision relationship. Seventy five percent of the panel still agreed it is an important and critical characteristic of the supervision relationship. Credibility was the next characteristic noted by the panel; however, only 87.5% of the panel agreed that it was critical. A panelist felt it necessary to add an addendum that the supervisor must be able to leave room for differing opinions and points of view. The researcher interpreted the idea of being credible to mean that the supervisors information is both dependable and reliable and the interpretation appeared to be supported by comments from the panelists. Panelist 4 stated, I believe it is critical for the supervisor to be available and intentional about supervision, while Panelist 7 stated ongoing

92 training and updates on research and effective methodologies are needed to conduct effect supervision. Personal comfort was the next supervisor characteristic that the panel felt was important for effective supervision with the experienced counselor. The researcher interpreted this characteristic to mean that the supervisor is not intimidated by the demands and duties of supervision; 85% of the panel agreed that this was necessary for the supervisor. The panelists made reference to the fact that an experienced counselor may have expertise which is beyond that of the supervisor, therefore causing discomfort for the supervisor. The supervisor should be able to deal with this in supervision and not allow this to influence interactions with the supervisee/experienced counselor. Panelist 2 stated the supervisor should have a clear understanding of role of the supervisor along with a personal comfort and sense of competence. Panelist 7 stated the supervisor should possess a personality that means that experienced counselors respect your opinion. If the supervisor is to appear credible to the experienced counselor, it is expected that the supervisor is personally comfortable in the role of supervisor. Panelist 8 discussed the fact that experienced counselors are much more interactive and challenging to the supervisor and the supervisor must be able to handle his or her own feelings when challenged by this population. The supervisor should have the ability to allow for the experienced counselor to advance beyond the supervisor's expertise. The panelist went on to state that the supervisor will meet professional and personal challenges with the experienced counselor but must set aside their expertise in order to learn from the experienced counselor. Panelist 1 concurred with Panelist 8, stating the supervisor needs to be comfortable with discomfort and be able to handle intense

93 moments and differences in supervision. The experienced counselor already possesses expertise from practicing and the supervisor will be challenged more regarding opinions. The supervisor must be comfortable with his or her abilities in order to meet the challenges. Panelist 8 did point out that there is a level of discomfort for supervisors who are just starting out with this population, stating you have to become a new supervisor at some point, and you would not be fully comfortable at that point. Therefore, one must make allowance for new supervisors. The final characteristic deemed important and critical to supervision with the experienced counselor was that the supervisor must be competent. Competent was interpreted as being adequate, appropriate, and effective in supervision. Panelist 5 stated that supervision presents the opportunity to put your own knowledge into words and see how much you know. The supervisor must have a broad theoretical base regarding supervision approaches in order to accommodate the many different learning styles of the supervisees/experienced counselors. Panelist 2 stipulated that the supervisor must possess the ability to have a theoretical knowledge base that is broad enough to support many different areas of learning. Campbell (2000) concurred, stating effective supervisors need a broad range of competencies in a variety of areas (p. 5). Two of the panelists noted additional comments regarding the characteristics of the supervisor. Panelist 4 felt that the supervisor should have the ability to provide structure in supervision and be accepting of diverse thinking, while Panelist 1 included the importance of the supervisor being able to understand personality differences (i.e., supervisor is extroverted vs. introverted supervisee, etc.). The additional comments

94 made by the panelists were included in the last round to determine whether the other panelists would agree with the inclusion of the characteristics. Characteristics of the Supervisee The panel concluded that the characteristics of the supervisee/experienced counselor are a major contributory factor of effective supervision. Along with some of the characteristics mentioned above, the panel discussed other characteristics that are important or critical to effective supervision. The characteristics listed by the researcher as a result of analyzing the first round of the Delphi resulted in total agreement on all of the characteristics of the supervisee. The panel felt the most important characteristic of the supervisee/experienced counselor is the ability to be receptive to corrective feedback, which was interpreted as the supervisee being amenable to adjusting his or her counseling approach or techniques in order to better serve the client. Panelist 2 stated, some experienced counselors also enter supervision as if they are fully trained and don't need case consultation, though Panelist 5 stated that it is expected in any supervision realm to encounter resistance and obstacles with the supervisee/experienced counselor. However, as Panelist 4 stated, the supervisor must be able to provide both supportive and challenging feedback at welltimed moments in supervision. This will nurture the growth of the supervisee. Campbell (2000) stated, challenging and giving corrective feedback can be a positive experience, helping supervisees to explore what theyre saying or doing, to discover their own resources and personal strengths (p. 95). In order for the supervisee to grow, he or she needs to be open to supervision. Being open to supervision was interpreted as being receptive and appreciative of the

95 benefits of supervision. The supervisee/experienced counselor must see the benefits of supervision, again to enhance personal and professional growth. If the supervisee/experienced counselor struggled with supervision, they can benefit from the information shared within the process. Panelist 6 contributes this to greater tendency

for clinicians to become set in their style and methods, and some experienced counselors struggle with supervision, especially if from a less experienced counselor. While the experienced counselor does possess the expertise to practice independently, they are not as experienced within the first year of practice as they are in the tenth year of practicing. The experiences of counseling continue to change the experienced counselors perspective on counseling as they encounter different types of clients and situations (Ronnestad & Skovholt, 2003). The next characteristic the panel felt was of importance or critical for effective supervision was that the supervisee/experienced counselor be committed to high standards of client care, which was interpreted as the supervisee/experienced counselor engaging in best practices to provide efficient and effective services and interventions to their clients. Panelist 7 agreed there should be a discussion of best practice but indicated that this could come later; rather, the most important idea is for the supervisee/experienced counselor to be invested and value the importance of high standards of client care. Panelist 4 discussed the importance of the supervisees/experienced counselors behavior in supervision, stating I also believe the supervisees openness, ability to initiate and collaborate and values regarding high standards of client care are critical. Panelist 5 concurred by stating the

96 supervisee/experienced counselor should have the ability to hold the best interest of the client as a very important aspect of supervision. In order to commit to high client care standards, the supervisee/experienced counselor must be willing to discuss his or her deficiencies, and to be vulnerable in supervision. This was interpreted as the supervisee/experienced counselor being able to expose deficits and weaknesses even though considered an expert professional. Panelist 5 stated that while it is necessary for the experienced counselor to be vulnerable in supervision, this may be a lot to expect from those new to the process of supervision. The experienced counselor needs to feel comfortable in the supervision process in order to expose vulnerabilities. Panelist 3 stated that supervision has to afford the novice counselor the freedom for the counselor to process counter-transference and fears, which appears to be the same for the experienced counselor. Panelist 7 noted that the experienced counselor, unlike the novice counselor, is often more open to discussing some of the more difficult subjects in supervision. Panelist 7 stated experienced counselors are able to integrate more quickly and are more open to bringing issues to supervision. Therefore, the experienced counselor needs to be open to sharing their insecurities, vulnerabilities or transference issues. The experienced counselor also must be open to suggestions from the supervisor. The researcher interpreted this characteristic as the willingness to learn new and different approaches to the counseling process. Panelists mentioned that while the experienced counselor is open to suggestions, problems can arise if the experienced counselor is set in his or her ways and does not hear the suggestions made by the supervisor. Panelist 1 mentioned the know-it-all attitude that sometimes pervades or they are stuck in a certain

97 modality and have difficult time adapting to new ideas. Panelist 1 further discussed that there are times when the novice counselor outshines the experienced counselor. Panelist 5 discussed this difficulty of dealing with the experienced counselor as the potential drawback is that they think they know things, which they do, but have not yet made it a part of who they are. Panelist 1, however, stated the advantage of supervising the experienced counselor is that they GET IT more quickly without the need for repeating oneself. The experienced counselor, due to independent practice, will likely have engaged in self-reflection regarding interactions with the client, approach to helping the client, and many other aspects of the counseling sessions. The final characteristic that emerged as a theme was the ability to self-reflect, interpreted as the supervisees/experienced counselors willingness to be introspective and studious regarding his or her own behaviors in supervision as well as counseling. Panelist 3 stated that the experienced counselor possesses a clear understanding of the role of the counselor. The panelist went on to say an experienced counselor has had prior supervision and is intuitively more aware of what they might need from their supervisor. Knowing their role as counselor rather than having to develop their counselor identity appears to contribute to the panel agreeing that this is an advantage of supervising this population. Panelist 7 stated that the experienced counselor is quicker at integration and understanding of concepts- a thirst for understanding of self and patient relationships, which is unlike novice counselors who are developing their counselor identities. As an additional comment, Panelist 2 stated that self-reflection is more than just with behaviors; selfreflective should include, by definition, how one is affected on a cognitive, affective and

98 somatic level. Panelist 4 included an additional comment regarding the importance of the experienced counselor following up immediately with safety issues and ethical issues by addressing them in counseling and in supervision. The next element of focus for the panelists was on the characteristics of the supervision process itself. This element generated the most discussion and themes from the panelists. Characteristics of the Supervision Process The characteristics of the supervision process were the most discussed area by the panel. The panelists were in total agreement with regard to all the characteristics and provided the most additional comments in this area. The number one characteristic the panel felt important and critical to supervision of the experienced counselor was protection of the client, which is also a goal with novice counselors. This characteristic was interpreted as ensuring the wellbeing of the client and committing to high standards of client care. Panelist 5 discussed this as a primary focus in supervision and noted that the supervisee should have the ability to hold the best interest of the client. Panelist 2 stated that supervision and the focus within supervision should address areas of clinical developmentgreater with regard to diagnosing and assessing clients. In addition, Panelist 2 further stated an experienced counselor will have an idea of case progression and intervention strategies that are more sophisticated than the trainee. Therefore, supervision needs to focus on protecting the client. Campbell (2000) discussed the fact that the supervisor is the gatekeeper of the profession and protection of the client is a gate keeping function. Two other characteristics of the supervision process are adherence to ethical issues as well as addressing ethical issues in supervision. Adherence to ethical issues was

99 interpreted as the ability to address the appearance of dual relationships, manipulation of the supervisee/experienced counselor by the supervisor, and manipulation of the supervisor by the supervisee/experienced counselor, as well as adherence to appropriate behaviors in supervision. Addressing ethical issues refers to the ethical behaviors of the counselor with the in the counseling session. Panelist 8 stated that adherence to ethical guidelines also encourages the supervisee's use of professional ethics as an integral part of clinical decision-making. The ethical guidelines to practice as a clinician and to educate and guide the supervisee within these parameters was mentioned by Panelist 6 regarding the integral part of addressing ethical guidelines in the counseling realm. The Association for Counselor Education and Supervision (ACES) (March 1993) as well as Campbell (2000) emphasized the importance of ethical behavior in supervision as well as monitoring ethical behavior in the counseling relationship. Addressing safety concerns in supervision is yet another characteristic the panel felt was a goal of the supervision process. This characteristic was interpreted as exploring a clients risk issues and implementing procedures to ensure the clients safety. Panelist 4 stated this is imperative particularly with regard to assessing for risk issues as well as substance abuse issues. Panelist 5 mentioned it is critical to assess for risk issues and act upon those issues. Ensuring the safety of the client is important, but the panel members also addressed safety for the supervisee. Panelist 2 talked about the fact that the experienced counselor could practice in an area which endangers their wellbeing, stating that the need is to address the safety of the supervisee, i.e., some are in communities and schools that have safety concerns for the counselor themselves.

100 The ability to challenge the experienced counselors assumptions drew a lot of comments from the panel. The researcher interpreted this characteristic as being able to address presumptions regarding counseling philosophies. Panelist 1 mentioned that it helps if the experienced counselor and the supervisor share the same model, though it is not critical in order to conduct supervision. However, having the same model could still result in challenging the experienced counselor regarding their interpretation of the model. If the supervisor and the experienced counselor do not have the same philosophy or model of how to deal with the issue, Panelist 8 stated that possible clinical and professional impasses due to difference in philosophy/approach could occur in the supervision process. Additionally, this panelist stated that there is a degree of responsibility for the supervisors decisions and ability/willingness/necessity to override supervisees decisions, particularly with regard to case conceptualization. Panelist 5 gave credit to the experienced counselor for having a great deal of clinical knowledge, but stipulated for the experienced counselor, they know things intellectually, but have not yet made clinical thinking part of who they are. Panelist 7 concurred, stating the experienced counselor may feel that they have mastered certain areas that still need improvement. Challenging the experienced counselor results in providing the experienced counselor with critical and corrective feedback which was discussed as a characteristic the supervisee/experienced counselor should possess for effective supervision. Another goal of the supervision process is a discussion of transference and countertransference issues. This characteristic was interpreted by the researcher to mean monitoring the experienced counselor to ensure they are addressing the clients issues

101 rather than their own personal issues during counseling. Panelist 6 stated as a counselor progresses, discussions move to more of an overview of the case, discussions about dynamic and system issues and countertransference issues. Within the supervision process, the supervisor is called upon to examine the case presentations to bring forth discussions of countertransference issues. Panelist 7 stated that a goal in supervision is to have the ability to look beyond the counselors report of their work with their clients and catch any countertransference that may be impacting their clinical relationships. Panelist 5 also stated that transference and countertransference issues need to be examined not only in the counseling relationship but also in the supervision relationship. Campbell (2000) discussed that transference and countertransference issues can indicate problems with supervisees in supervision as well as the supervisor having to explore this concept with the supervisee in the counseling session with the client. Helping the experienced counselor to discuss these issues will help enhance their skills. Refining the skills of the experienced counselor was the next characteristic discussed by the panel. The researcher interpreted this to mean the ability of the supervision process to enhance the counseling skills of the supervisee. The supervision of the experienced counselor does not have to be directive, provide technical assistance, nurture passion for the work, provide crisis management, review basic counseling techniques, help to develop their own style of counseling, or support the counselors identity like the novice counselor, but rather is utilized as a means to address case conceptualization. Panelist 2 stated an experienced counselor will have an idea of case progression and intervention strategies that are more sophisticated than the trainee. Areas of clinical development will be greater with regard to diagnosing and assessing clients.

102 Panelist 8 stated that refining skills is the ability to provide less technical expertise and instruction and more eliciting the experienced counselors self-determination and self directedness. Unlike the novice, the experienced counselor is refining skills and becoming an expert. Refining the counselors skills is the goal not only with novice counselors, but also experienced counselors. Some of the panelists mentioned that though the counselor is experienced it does not necessarily mean that the counselor is proficient in all areas of counseling. Therefore, the panel felt that supervision still needed to be tailored to meet the needs of the experienced counselor. Tailoring supervision was interpreted as addressing the needs of the supervisee based upon their professional experience level. Panelist 2 noted that the experienced counselor could have limited exposure to certain areas in their traineeship and may actually be at a very beginning stage. Panelist 8 further stated that there is a need in supervision to allow the ability to accurately assess the degree of professional development of the experienced counselor because the supervisor cannot assume the same degree of competency, skill implementation, critical thinking, ability to think on ones feet, intervention creativity, and attention to details. Assessing for the experienced counselors developmental level will help to be receptive to working with the supervisees style. Campbell (2000) stated that it is not only the supervisee who must be assessed for their developmental level, but that the supervisor needs assessment as well. The experienced counselor may have difficulty being treated as a beginning counselor because of needing guidance in an area in which they are not proficient. This could set up role conflict for the experienced counselor. Role conflict was interpreted as

103 the ability to discuss and resolve any confusion which arises with regard to knowledge and experience of both supervisor and supervisee. The experienced counselor is postlicensed and practicing independently, but supervision may cause the counselor to feel inadequate at times. This could cause conflict for the counselor and therefore conflict within the supervision process. Panelist 2 stated some experienced counselors also enter supervision as if they are fully trained and dont need case consultation. Both the supervisor and the experienced counselor have many demands within their roles and the difficulty of fitting supervision into this schedule can contribute to more role conflict. Panelist 4 stated, there can be moments when both the supervisor and the supervisee wonder whether the service is fully needed in the context of a challenging work schedule. However, typically both see the overall value in that it is such a rewarding experience. The experienced counselor is able to talk in the counseling jargon and the discussions can be more in-depth with an experienced counselor. Panelist 3 stated, remembering your role as supervisor. It feels great to have experienced counselors to speak with about cases The experienced counselor is then viewed as a colleague rather than a supervisee. The panel agreed that the experienced counselor and the supervisor can both experience role conflict within supervision. It is important to keep the relationship within the boundaries of supervision. The relationship is considered an important and critical element to perform effective supervision with the experienced counselor. Characteristics of the Supervision Relationship The panel discussed characteristics of the supervision relationship that are considered a critical element of supervision. As discussed previously, the relationship needs to foster trust and the participants need to be authentic, dependable, ethical,

104 supportive, and respectful in the relationship, and the supervisor and the supervisee/experienced counselor need to have an appreciation for the others opinions, thoughts, and ideas. However, the panel discussed other characteristics of the relationship that they deemed important or critical to the supervision relationship. Supervision must enable growth for the experienced counselor. This characteristic was interpreted as allowing the supervisee/experienced counselor the opportunity for advancement and improvement in their counseling skills. The entire panel agreed that growth is an essential component of the supervision relationship. Panelist 5 stated that enabling growth is the ability to teach so the counselor develops professionally; capacity to allow the counselor to develop their own way of working; you can help people get to the next level in their work. So not unlike the novice counselor, the panel felt it is important for the counselor to achieve growth and enhancement through supervision. Collaboration was the next characteristic reviewed by the panel. Eighty seven and half percent agreed this was an important characteristic in the supervision relationship. Twelve and a half percent did not agree this was a critical characteristic to the supervision relationship. The researcher interpreted the characteristic as a concerted effort by the supervisor and the supervisee/experienced counselor to work jointly on issues with equal responsibility. The supervisor and the counselor should have a give and take communication about issues, rather than a unidirectional conversation in which the supervisor holds the only opinion that counts in the supervision relationship. Panelist 5 stated that the relationship is the ability to make supervision more of collaboration and less teaching/oversight/directives when it comes to the interaction with the experienced

105 counselor. In previous statements, this panelist alluded to the characteristic of collaboration in the supervision process and that it was a necessary to have effective supervision. Another characteristic the panel agreed was important to the supervision relationship was that of being open. The supervisor and counselor must be flexible and non-judgmental toward one another in the supervision relationship. Again, only 87.5% of the panel agreed this was a critical characteristic for the supervision relationship. Twelve and half percent did not feel it was a critical part of the supervision relationship. Panelist 8 discussed the openness of the supervision relationship as the ability to remain flexible in setting the supervision agenda and focus. The relationship being open will allow both the supervisor and the counselor to address what is important to them at that moment rather than sticking to a rigid agenda. This will allow the opportunity for growth for the counselor. The final characteristics of the supervision relationship were that it must be empowering, encouraging, and challenging for both the supervisor and the counselor. Empowerment enables the counselor to make decisions about the counseling process. Encouragement enables the supervisor and the counselor to strengthen their bond in the supervision relationship. Being challenging, as discussed in the supervision process, means that the supervisor and the counselor investigate assumptions of the supervisor and the experienced counselor in supervision. Inclusion of the characteristics appeared to allow the counselor to have autonomy in the supervision process. Panelist 5 stated that supervision is the capacity to allow the counselor to develop their own way of working. Panelist 4 discussed the ability to have challenge in the relationship, stating be ready to

106 be challenged, allow for questioning and experimentation. It is important for the supervisor to be able to allow the supervisee to challenge the supervisor and to experiment with new ideas. This in turn will help the counselor to grow and enhance their counseling skills and techniques. As a final opportunity for the panel to include any characteristics that were not mentioned in the previous rounds the researcher asked for input about comments made during the initial and second round. The panel was requested to answer whether the additional characteristics listed by various members should be included as a characteristic for the critical elements of supervision. One of the additional characteristics listed was the importance of the supervisor providing structure in supervision. Seventy five percent of the panel felt this was critical while 25% did not. The panel was asked if the supervision process needed to embrace diverse thinking and the panel was in total agreement. The panel was also in 100% agreement with the characteristic that the supervisor accepts different viewpoints and is tolerant of personality differences. Eighty seven and a half percent of the panel stated it is not necessary for the experienced counselor to implement suggestions made in supervision quickly. Therefore, they felt this characteristic was not critical to effective supervision with the experienced counselor. The panel concluded the critical elements of effective supervision with an experienced counselor are the supervisor, the counselor, the supervision process, and the relationship. Since four of the supervisors preferred the developmental model of supervision and a fifth preferred a developmental type model, it would seem logical that the panel would develop characteristics for the supervisor, supervisee, the supervision process, and the supervision relationship. The developmental model places focus upon these areas of

107 supervision. One of the panelists preferred a psychodynamic approach which coincides with the developmental model regarding the supervisee. The task-centered approach espoused by another panelist added to the focus of the supervision process. Limitations of the Study Due to the small sample of participants for the study, its generalizability across various supervisor populations is limited. While the participants were from different work areas of supervision, the panel only represented a very small portion of the supervising population. If a larger sample were accessed the outcome may have been different. The panel reported from their experiences and if there were more participants more experiences could have contributed to the outcome. The Delphi study outcome is reliant upon a representative panel of experts within the field of study. The researcher was reliant upon the self-report of the participants, and while this researcher did not doubt the credentials of the participants, the study was done electronically and the researcher could not validate the backgrounds of the participants. The researcher is a novice in conducting research studies, particularly the Delphi study, and while many articles and books regarding the Delphi study were read and reviewed by the researcher, there is still novice error to contend with in the study. The researcher is also a novice in thematic analysis and though many resources were also reviewed in this area, the study may have had a different outcome if the researcher were more experienced in the technique. The interpretation of the data was based upon the researchers perspective and background, and therefore biased towards the researchers experiences of supervision and counseling even though the interpretations were also reviewed by a colleague.

108 Future Research The pilot study explored supervisors perspectives of the critical elements of effective supervision with the experienced counselor. However this is their perspective of the process. The process could be viewed very differently from the counselor regarding the critical elements of conducting effective supervision. Therefore, it is important to explore this area with the recipients of the supervision to see if the outcome of the present study is confirmed or refuted. According to Campbells (2000) model of effective supervision, diversity is an important issue to deal with in supervision; however, the panel did not mention this as a critical element of supervision. It is not clear if the panelists were from different cultural dimensions whether the responses would have been different responses. While one of the panelists did mention the phrase diverse thinking, the panelist was not referring specifically to diversity issues within the supervision realm, nor giving attention to diversity in the counseling process for the experienced counselor. It is possible that supervisors assume that the experienced counselor is aware of exploring diversity issues; however, the experienced counselor may not be proficient in addressing diversity issues nor the supervisor. This area needs further exploration. The current instruments to explore supervision are geared more towards the supervision of the novice counselor rather than the experienced counselor. The instruments do not include some of the characteristics addressed by the panel. Some of the panelists mentioned assessment of the experienced counselor in order to determine their familiarity with different theoretical approaches. An assessment tool that can determine the developmental level of the counselor with regard to certain theoretical

109 approaches and theoretical skills may be of help in pinpointing where to begin in the supervision process. Some of the panelists had more than one degree, held more than one professional title, and worked in more than one setting. The question arises as to whether the panelists found it necessary to have more than one degree in order to enhance their supervision expertise. Research into whether more than one degree could help the supervisor to have a broader perspective on supervision is another area which needs further exploration. One of the last areas to explore in future research is the outcome of supervision with experienced counselors. The benefits of supervision for the experienced counselor have not been widely explored. Given the discussion about counselor burn-out and continued education, supervision may be a way to help the experienced counselor to remain vibrant within the profession. Supervision could also be a deterrent to improprieties within the counseling profession. Is supervision a way to help deal with ethical issues, so the counselor does not blur the lines in counseling services or supervision services? Research has stated that the experienced counselor seeks out supervision if not offered. This is an area which needs further exploration along with the reasons that experienced counselors seek out supervision. The goal of the study was to provide a starting point of exploration within this area of supervision since there scant literature regarding this population. The critical elements needed to conduct effective supervision with experienced counselors are an area that warrants further exploration.

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121

APPENDICES

122

APPENDIX A Electronic Invitation

123 Experienced supervisors are being considered for participation as panelist on an electronic three-round Delphi forum to explore the critical elements necessary to conduct effective supervision with experienced counselors. Experienced counselors are considered post-licensure and practicing independently for at least two years. The Delphi forum will enable the expert panelists to name and prioritize critical elements they believe necessary to effectively supervise experienced counselors based upon the groups consensus. In order to be considered for participation on the panel the supervisor must meet the following criteria: The supervisor conducts supervision with experienced counselors. Again the experienced counselor is post-licensure and is practicing independently for at least two years. The supervisor must conduct one-to-one supervision with the experienced counselor. The supervisor engages in both Clinical and Administrative Supervision. The supervisor has received training in supervision whether through a formal program or through continuing education classes specifically in the areas of ethics, diversity issues, administrative supervision, and clinical supervision, an understanding of the feedback process, supervision models, working alliance and supervision style. The supervisor is a licensed clinician who currently conducts direct client services.

124 The supervisor has conducted supervision with at least 2 different experienced counselors. The greater the number of supervision events with experienced counselors will improve chances for the supervisor to be considered a part of the panel. The supervisor has experience with supervising counselors-in-training, who are pre-licensed. Licensure, certification, accreditation or approval: Must be one of A to E:
A. B. C. D. E.

National Certified Counselor Licensed or Certified Mental Health Provider Licensed or Certified Clinical Supervisor Mental Health Related Educator Mental Health Related Doctoral Candidate

Educational Training: Minimum of a masters degree in a mental health field Specialized Training: Must document either A or B
A. B.

A graduate course in clinical supervision A total of 30 contact hours of workshop training in clinical supervision

Mental Health Related Experience: Minimum of 3 years of post-masters degree experience in mental health services, with a minimum of 1,500 hrs direct service with clients.

If you meet the above criteria, have access to a computer, can provide an email address for contact, and would like to be considered for possible participation you are asked to copy and paste the informed consent (listed below) with your name typed in the blank provided in an email to this investigator. After review of the informed

125 consent the researcher will provide a web link to the invited participants. Please contact the investigator by email at acrawfordil@sbcglobal.net. Participants may withdraw from the study at any time. If you have any questions regarding the research or concerns regarding the investigator you may contact me by telephone at 630-670-3168 or the Dissertation Chairperson, Dr. Katherine Miley of Argosy University- Schaumburg 999 Plaza Dr. Schaumburg, IL 60195, at drmiley@drkatiemiley.com. Thank you for your consideration.

126

APPENDIX B Informed Consent

127 Informed Consent I understand I am being asked to participate as a panelist for a research study to investigate supervision practices with experienced counselors and I was selected as a possible participant because I meet the criteria stipulated above for inclusion. The study will be conducted using a Delphi Method with the purpose of this study being to explore supervisors perception of critical elements for conducting supervision with experienced counselors. If I participate, I will be requested to complete a demographic form, in addition to three rounds of query in the Delphi study. The investigator will send me a web link to a secure website in which I will answer open-ended questions in the first round, rating of responses from all participants in the second round, and a final review of the outcome and any additional comments made by the participants in the third round. The risks associated with this study are extremely marginal and if risk is present it is only in the likelihood of my disagreement with the outcome of the study. The benefits of participation are nominal. I understand I will receive no monetary gains for participation in the study, that it is anonymous, and will be accomplished by posting answers to a secure website. The investigator will have an email address to contact me and will only be utilized for followup during the study. The records of this study will be kept private. No identifiers linking me to the study will be included in the published report. Research records will be stored securely by the investigator and in addition the investigator will permanently delete any electronic transmissions from participants in the investigators electronic environment.

128 My decision, whether or not to participate, will not affect my current or future relations with Argosy University. If I decide to participate, I am free to refuse to answer any of the questions that may make me uncomfortable. I can withdraw at any time with out my relations with the university, job, benefits, etc., being affected. I can contact Alice Crawford at acrawfordil@sbcglobal.net and Dr. Katie Miley at drmiley@drkatiemiley.com with any questions about this study. I understand that this research study has been reviewed and certified by the Institutional Review Board, Argosy UniversitySchaumburg. For research-related problems or questions regarding participants' rights, I can contact the Institutional Review Board through the IRB Chair at Argosy University-Schaumburg 999 Plaza Dr. Schaumburg, IL 60195. I have read and understand the explanation provided to me. I have had all my questions answered to my satisfaction, and I voluntarily agree to participate in this study. I have been given a copy of this consent form. By signing this document, I consent to participate in the study.

Signature: __________________________________

Date: __________________

129

APPENDIX C Study Description

130 Study Description The Delphi Method, which was first implemented in the 1960s by the Rand Corporation, will be utilized to obtain supervisors opinions of the critical elements necessary to conduct supervision with experienced counselors. Experienced counselors are considered post-licensure and practicing independently for at least 2 years. The Delphi study will consist of three rounds which will enable the participants to list the critical elements believed to be necessary to supervise experienced counselors and prioritize those elements based upon the groups consensus. The first round questions will request a narrative of your supervision experiences along with demographic questions. The second round will consist of a compilation of the generated responses and a request to review and rate the responses based upon a 4 point Likert Scale. The third round will consist of participants reviewing the outcome of their ratings and an opportunity to add additional comments for any issues which may have been overlooked. The researcher may also contact you by telephone for further clarification of your additional comments. Each round will have a three week period for participants to respond. The researcher will send a reminder email a week before the ending of each round to request responses if participants have not responded by that time. It is hoped the results of the study will generate areas of discussion, study, and future research in the field of Counselor Supervision. Thank you for your participation.

131

APPENDIX D Nominee Invitation

132 I am contacting you because a colleague has nominated you as a possible panelist on an electronic three-round Delphi forum to explore critical elements necessary to conduct effective supervision with experienced counselors. Experienced counselors are considered post-licensure and practicing independently for at least two years. The Delphi forum will enable the expert panelists to name and prioritize critical elements they believe necessary to effectively supervise experienced counselors based upon the groups consensus. In order to be considered for participation on the panel the supervisor must meet the following criteria: The supervisor conducts supervision with experienced counselors. Again the experienced counselor is post-licensure and is practicing independently for at least two years. The supervisor must conduct one-to-one supervision with the experienced counselor. The supervisor engages in both Clinical and Administrative Supervision. The supervisor has received training in supervision whether through a formal program or through continuing education classes specifically in the areas of ethics, diversity issues, administrative supervision, and clinical supervision, an understanding of the feedback process, supervision models, working alliance and supervision style. The supervisor is a licensed clinician who currently conducts direct client services.

133 The supervisor has conducted supervision with at least 2 different experienced counselors. The greater the number of supervision events with experienced counselors will improve chances for the supervisor to be considered a part of the panel. The supervisor has experience with supervising counselors-in-training, who are pre-licensed. Licensure, certification, accreditation or approval: Must be one of A to E:
A. B. C. D. E.

National Certified Counselor Licensed or Certified Mental Health Provider Licensed or Certified Clinical Supervisor Mental Health Related Educator Mental Health Related Doctoral Candidate

Educational Training: Minimum of a masters degree in a mental health field Specialized Training: Must document either A or B
A. B.

A graduate course in clinical supervision A total of 30 contact hours of workshop training in clinical supervision

Mental Health Related Experience: Minimum of 3 years of post-masters degree experience in mental health services, with a minimum of 1,500 hrs direct service with clients.

If you meet the above criteria, have access to a computer, can provide an email address for contact, and would like to be considered for possible participation you are asked to copy and paste the informed consent (listed below) with your name typed in the blank provided in an email to this investigator. After review of the informed

134 consent the researcher will provide a web link will to the invited participants. Please contact the investigator by email at acrawfordil@sbcglobal.net. Participants may withdraw from the study at any time. If you have any questions regarding the research or concerns regarding the investigator you may contact me by telephone at 630-6703168 or the Dissertation Chairperson, Dr. Katherine Miley of Argosy UniversitySchaumburg 999 Plaza Dr. Schaumburg, IL 60195 at drmiley@drkatiemiley.com. Thank you for your consideration.

135

APPENDIX E Round One Questionnaire and Demographics

136 Round One Questionnaire: 1) An experienced counselor is considered a counselor who is post-licensure and has practiced independently for at least two years. Reflecting on your supervision experiences, what do you consider to be the most critical elements necessary to conduct supervision with an experienced counselor? 2) A novice counselor is considered a counselor who is pre-licensure and practicing under supervision. Reflecting on your supervision experiences, what do you consider to be the most critical elements necessary to conduct supervision with a novice counselor? 3) What do you consider to be the major differences in conducting supervision with an experienced counselor as opposed to a novice counselor? 4) What are the major benefits of supervising an experienced counselor? What are the major drawbacks of supervising an experienced counselor?

137 Demographic Information 1) Highest education degree 2) Professional position 3) Work setting (i.e., agency, EAP, Hospital, School, etc.) 4) Supervision theoretical Approach 5) Length of time in the counseling field 6) Length of time conducting supervision 7) Length of time conducting supervision with experienced counselors 8) Number of counselors supervised in a typical caseload 9) Ratio of experienced counselors supervised compared to novice counselors supervised in a typical caseload 10) Type of supervision training received (i.e., formal program or CEUs) 11) Frequency of conducting supervision (i.e., daily, weekly, monthly) 12) Average length of supervision sessions 13) Gender

138

APPENDIX F Application for IRB Review and Certification of Compliance

139 Application for IRB Review and Certification of Compliance: Expedited Application Form Checklist Expedited Review (Level 2) Application, Moderate Risk (Review by the designated IRB member or the IRB Chair). Application Form Checklist To the Principal Investigator of a research project: 1. Please review the documents listed below that pertain to your research project. In the event that
your project does require the use of any of the listed documents, attach a copy of that document to the application submitted for IRB review.

2. Please be advised that research projects involving interaction with human participants must have
an Informed Consent Form(s) attached. If a minor or incapacitated individual of any age is involved, parent/guardian permission must be included. 3. Parental permission does not negate the childs right to chose to not participate. must attach a signed permission letter from a supervisor/administrator who is in a position to grant you permission to conduct the research at that site. The letter must be on institutional letterhead and must have an original signature. 5. If that institution also has a Human Subjects Review Committee--often referred to as the Institutional Review Board (IRB)-- then written permission from the participating institutions IRB must be attached to your IRB application. If you are conducting the research outside of the United States, attach a letter of assurance that where the research is being conducted.

4. If you are conducting a research project in another institution (e.g., a hospital or school), you

6.

Please check: The attached Application for Certification of Compliance contains


Institutional Permission Letter (where research is taking place) Assurance of Adherence to Governmental Regulations concerning Human Subjects (if research project is conducted outside the US) Letter(s) of Informed Consent Parent/guardian Permission Letter (must have provision for written signature) Oral statement of Assurance (used with minors) Data-gathering instruments(s): Observation, Interview, Survey Conflict of Interest Disclosure Statement Also required on your application: CRP or Dissertation Chairperson/Research Supervisors signature Principal Investigators signature (2 places) Packet reviewed by CRP or Dissertation Chairperson/Research Supervisor Initials ______

140

Application for IRB Review and Certification of Compliance Expedited Cover Sheet IRB# ________ Date Logged: _______

Expedited Review (Level 2) Application, Moderate Risk (Review by one or more IRB MembersMay lead to Full IRB Review) Principal Investigator/Researchers Name: Alice H Crawford Student ID Number: 00047452 Type of Research Project (CRP, Dissertation, describe other) Dissertation Title of Research Project: Critical Elements of Supervision with Experienced CounselorsA Delphi Study Principal Investigator/Researchers Address: 832 McCormick Lane West Chicago, IL 60185 Telephone Number: 630-670-3168 Dissertation Committee Chairs Name: Dr. Katherine Miley

College:

BUS HS

PBS OTHER

EDUC Degree Ed. D.

Program of Study: Counseling Psychology Project Proposed Start Date: December 1, 2009 Project Proposed Completion Date: May 1, 2009

Signature of Principal Investigator/Researcher __________________________/_______


Date

Signature of Dissertation Committee Chair: ____________________________________________________/_____________


Date

IRB Certification Signatures: __________________________________________________________/_____________


Date

141 The above named research project is certified for compliance with Argosy Universitys requirements for the protection of human research participants with the following conditions: 1. Research must be conducted according to the research project that was certified by the IRB. 2. Any changes to the research project, such as procedures, consent or assent forms, addition of participants, or study design must be reported to and certified by the IRB. 3. Any adverse events or reactions must be reported to the IRB immediately. 4. The research project is certified for the specific time period noted in this application; any collection of data from human participants after this time period is in violation of IRB policy. 5. When the study is complete, the investigator must complete a Completion of Research form. 6. Any future correspondence should be through the principal investigators research supervisor and include the assigned IRB research project number and the project title.
****************************************************************************** ********************

NOTES: Please complete this cover and the Petition in detail. Every question must be answered. Please type your answers. Attach the appropriate documents and submit the entire application materials under the cover of a completed Application Checklist to the CRP or Dissertation Chairperson. Do not proceed with any research work with participants until IRB Certification is obtained. If any change occurs in the procedure, sample size, research focus, or other element of the project impacts participants, the IRB must be notified in writing with the appropriate form (see ancillary forms). Please allow 30 days for processing.

DO NOT COLLECT DATA PRIOR TO RECEIVING IRB CERTIFICATION

142 Application for IRB Certification of Compliance Expedited Application Expedited Review (Level 2) Application, Moderate Risk (Review by one or more IRB Members May lead to Full Review) Research with minors, prisoners, mentally/emotionally/physically challenged persons, pregnant women, fetuses, in vitro fertilization, and/or individual or group studies where the investigator manipulates the participants/ behavior or the subject is exposed to stressful or invasive experiences do(es) not qualify for Expedited status. Please completely answer the requested information (NA is not acceptable for any question). Begin typing in the gray boxes.

1. Purpose of the Study: The investigator is interested in what Counselors Supervisors deem the critical elements of conducting Counselor Supervision with an Experienced Counselor. An Experienced Counselor is considered post-licensure and practicing independently for at least 2 years. 2. Summary of the Study. Methodology (Be Specific--attach extra page if needed). The project is going to approach the West Virginia Board of Examiners Approved Certified Supervisors. In addition this researcher is requesting to invite members of the following Linked In Groups to participate in the research project: American Counseling Association Illinois Mental Health Professionals Psychologist, Psychotherapist and Counselors United States Mental Health Professionals The researcher currently subscribes to the aforementioned groups purely as a member and does not gain any monetary or professional assets as a part of the groups. The groups are made up of mental health professionals and a description of the groups is as follow: American Counseling Association Linked-In Group This is a group for User Experience Design professionals to expand our network of people and ideas (1,271 members) Illinois Mental Health Professionals Linked-In Group

143 To improve collaboration amongst counselors, licensed clinical professional counselors(LCPC), licensed professional counselors(LPC),(LMFT),licensed clinical social workers(LCSW), psychologists(PhD.&Psy.D., PsyD), in/near Illinois (counselor, counseling, therapist, social worker, psychologist) (291 members) Psychologist, Psychotherapist and Counselors Linked-In Group This community of psychologists, psychotherapists, and counselors aims to create a network of professionals, facilitating job opportunities and knowledge sharing (psychologist, psychology, psychotherapist, psychotherapy, counseling, counselor, coach, coaching, mentor, mentoring, LCSW, LICSW, PhD, Psy.D, PsyD) (3,914 members) United States Mental Health Professionals Linked-In Group To improve collaboration amongst marriage & family therapists (MFT), LCSW, psychologists (PhD &Psy.D., PsyD), & psychiatrists in the US (therapist, therapy, psychotherapy, psychotherapists, psychotherapist, psychologist, psychology, psychiatrist, psychiatry, social worker, counselor, counseling) (3,716 members) I am requesting participation of Counselor Supervisors who meet the following criteria: The supervisor conducts supervision with experienced counselors. Again the experienced counselor is post-licensure and is practicing independently. The supervisor conducts one-to-one supervision. While the other modalities of supervision, such as group and peer are discussed in the field of supervision, the current study is only interested in the one-to-one supervision modality. The supervisor engages in both Clinical and Administrative Supervision. The supervisor has received training in supervision whether through a formal program or through continuing education classes. The supervisor has received training in the areas as they pertain to supervision, which include ethics, diversity issues, administrative supervision, and clinical supervision, an understanding of the feedback process, supervision models, working alliance and supervision style. The supervisor is a licensed clinician who conducts direct client services. This criterion is included in order for the supervisor to possess some understanding of the demands upon the experienced counselor. The supervisor has conducted supervision with at least 2 different experienced counselors. This criterion is included in order to possess some contrast in individual demands of supervisees. The greater the number of supervision events with experienced counselors will improve chances for the supervisor to be considered a part of the panel.

144 The supervisor has experience with supervising counselors-in-training, who are pre-licensed. This criterion is included because the supervisor is expected to give a contrasting understanding, if any, of the supervision of an experienced counselor. The supervisor is to at least meet the accreditation of the Center for Credentialing and Education of a clinical supervisor with the exception of criteria 6, which is deemed unnecessary for this research.

6. Licensure, certification, accreditation or approval: Must be one of A to E: A. National Certified Counselor B. Licensed or Certified Mental Health Provider C. Licensed or Certified Clinical Supervisor D. Mental Health Related Educator E. Mental Health Related Doctoral Candidate 7. Educational Training: Minimum of a masters degree in a mental health field 8. Specialized Training: Must document either A or B A. A graduate course in clinical supervision, Or B. A total of 30 contact hours of workshop training in clinical supervision 9. Mental Health Related Experience: Minimum of 3 years of post-masters degree experience in mental health services, with a minimum of 1,500 hrs direct service with clients. 10. Supervision Experience: Must have provided a minimum of 100 hr. of clinical supervision of mental health services with supervisees OR an endorsement from a mental health professional attesting to the applicant's supervisory activity. 11. Self-Assessment and Professional Disclosure: Submit a Professional Disclosure statement which assesses the understanding of multiple responsibilities of clinical supervision. The invitations will be sent in small groupings of recipients so as to avoid the possible security controls each participant may have on their electronic environment, resulting in the email solicitation being sequestered as spam. Spam is considered unsolicited advertisement sent electronically. Many email filters can be built into email servers, email software, antivirus software or internet service providers to protect the recipient from unwanted emails. The initial email will invite participation in the study along with the informed consent consisting of the purpose for the research, the risk and benefits of the research, the voluntary nature of research participation, the participants right to stop the research at any time and the procedures used to protect confidentiality in addition the email will describe how the study will be conducted and include instructions in the email explaining to send a reply email to the researcher, which includes a cut and paste of the informed consent with their name placed in the agreement, along with an email address to contact the participant during the study. Participants must respond by a deadline date. The invitee will be informed if they are willing to participate the researcher will send a link to the website of the study in a later email. In addition the email will state, the study meets approval of the Institution Review Board, direct contact information for the researcher, and direct contact information for the dissertation chairperson (See Appendix

145 A). If participants do not have an email address listed for initial contact, a printed invitation will be sent to the ALPS and ACS by the researcher using United States Postal Service. The invitation will include all elements mentioned in the electronic invitation. The participants will be notified the study is to be conducted electronically and ask if they have access to a computer and an email address in order to participate. The researcher will include an email address for the researcher so invitees can send this information. Once volunteers for the panel are obtained, the researcher will send the information regarding the procedures for the study, the schedule of the rounds of questions and the link to the study website (See Appendix B). As stated above, should the researcher not receive enough responses from participants solicited, the request will be made of participants to nominate other supervisors who may not be listed with the Center of Credentialing and Education or West Virginia Board of Examiners but meet the criteria of inclusion. The researcher will send nominees a secondary email or hardcopy of the email invite stating they were nominated by a colleague, who felt the supervisor meets the researchers criteria for inclusion and ask their consent for participation along with the same information included in the initial participants invite (See Appendix C). The nominee will be requested to electronically reply as the initial participants. Once the returned emails and envelopes are received from the participants, all informed consents will be printed or reviewed and will be kept by the researcher in order to protect the confidentiality of all participants identity. The emails will then be permanently deleted from the researchers electronic environment. First Round Participants will be asked to complete a demographic information questionnaire along with the initial open-ended questions (See Appendix D). Participants will be requested to complete the task within a three week period. Once the information is collected the researcher will compile and analyze the responses by qualitative means. The results will then be constructed as a survey for the second round. The participants will be given 3 weeks to respond to the initial questionnaire and as the participants respond the researcher will compare against a master list of participants who agreed to be in the study to tally the response rate. After two weeks of the initial round opening, a reminder email will be sent to participants who have not responded. After three weeks an email announcing the website will be closed will be sent by the researcher. The themes which emerge from round one will then be placed in survey form Second Round The participants will be sent an email stating the second round has begun. The participants will be given three weeks, again, to review and rate the themes based upon a 4 point Likert scale ranging from 1-Critically important, 2-Important, 3-Unimportant and 4-Definetly unimportant. The researcher has chosen an even-numbered Likert scale in order to avoid neutral responses. The researcher wants to avoid a neutral response in order to make the participants really think about the elements presented and choose which are critical. A space will also be provided in which the participants may add any additional comments forgotten during the first round. The researcher will compare the respondents to the master list of participants and will send reminder emails to participants who have not responded a week before the ending of the second round. The researcher will close the survey after three weeks.

146 Third Round The results of the ratings will then be published for the participants to review and a request will be made if the participants are in agreement with the outcome. If participants are not in agreement a comment line will be provided for any last minute comments about the results. The researcher will follow up with the participant regarding any additional comments by telephone.

3. Subject/participant Demographics: a. b. Anticipated Sample Size: 20

Special Ethnic Groups (describe): Requesting Diverse Population of Participants Institutionalized Y N Protected Group (describe): No Age group: 18 years and above General State of Health: Participants possess general good health

c. d. e.

e f. Other details to describe sample group. Counselor Supervisors either accredited or approved certification as a Counselor Supervisor

4. 5. 6.

Will deception be used in the study? Y N (please describe) No Will audio or videotapes be used in the study? Y N (please explain) No Confidentiality protection issues (pertains to audio and video as well as written documents.) a. What precautions will be taken to insure the privacy and anonymity of the participants? (i.e. closed doors, private rooms, handling of materials where participants identify could be discovered, etc.). Participants will be able to complete the inquiry on a specifically specified website, which is only accessed by a website link provided by the investigator. The investigator requests email addresses of participants merely for follow-up. Once

147 follow-up is completed the email addresses will be permanently deleted from the investigators electronic environment. b. What specific precautions will be taken to safeguard and protect subjects confidentiality while handling the data (audio/video/paper) both in researchers possession and in reporting the findings? (i.e. coding, removal of identifying data) Participants will respond to an on-line environment. The on-line environment is secured by individual usage to access the electronic surveys. The on-line environment utilized will be Survey Monkey, which is a highly utilized and dependable research tool. Describe procedures where confidentiality may be broken by law (e.g., child abuse, suicidal intent). Participants are addressing professional relationships and not involved in any area in which confidentiality has to be broken by law.

c.

7.

Review by institutions outside of Argosy University/XX Y N (Attach copies of permission letters, IRB certifications, and any other relevant documents). Application to Center for Credentialing and Education requesting permission to access the database of Accredited Counselor Supervisors (see attached) Informed Consent and Assent (Attach copies of all relevant forms). If consent is not necessary (e.g., anonymous interview), describe how you will inform all participants of the elements of consent (see instructions). See attached If written or oral informed consent is required, describe the manner in which consent and/or assent was obtained for each category). (a) Adult Participants (18 years and older written consent required). Participants will copy and paste an electronic copy of the informed consent with participants name typed in blank which stipulates the participant is in agreement with participation in the study. The informed consent is to be sent to the investigator by email or Postal Service to demonstrate agreement. (b) Child Participants (under 18 parent/guardian permission and participant assent required). There are no child participants in the study a. Institutionalized participants (parent/guardian/conservator permission with appropriate participant assent). There are no Institutionalized participants in the study

8.

.9

148 10. Describe any possible physical, psychological, social, legal, economic or other risks to participants (Attach another page if needed). a. Describe the precautions taken to minimize risk to participants. The investigator will ensure there is no risk to participants, as the participants will only be asked their opinions to open-ended questions and rating their responses to the questions.

b.

Describe procedures implemented for correcting harm caused by participating in the study (e.g., follow up calls, referral to appropriate agencies). The investigator will publish contact information for should participants have any questions regarding the study and if any participant feels the study has caused harm the investigator will do follow-up calls to the participant affected to make appropriate referrals to any resources necessary to address the issues.

11.

Potential benefit of the study: a. Assess the potential benefit(s) of the study for the participants: The study is constructed such there are moo individual benefits for participation.

b.

Assess the potential benefits(s) to the professional audience in the study: The results of the study will eliminate areas of Counselor Supervision which have limited exploration and therefore promote healthy discussion of the subject matter.

As the principal investigator, I attest that all of the information on this form is accurate, and that every effort has been made to provide the reviewers with complete information related to the nature and procedures to be followed in the research project. Additional forms will be immediately filed with the IRB to report any change in participant(s), selection process, principal investigator, or faculty dissertation chair, as well as notification of any adverse incidents and final completion date of project. I also attest to treat human participants ethically and in compliance with all applicable state and federal rules and regulations that apply to this study, particularly as they apply to research work conducted in countries other than the United States.

Signature Principal Investigator

Date

149

Signature of Research Supervisor/Committee Chair

Date

Attach any other forms, tests, institutional permission slips, etc., relative to this study. Failure to do so will result in delayed processing of the certification form.

150 Conflict of Interest (Disclosure) Statement

To the Institutional Review Board: I have reviewed the EDMC Code of Business Ethics and Conduct Statement found in SECTION 5.0 of the Argosy University Intuitional Review Board Handbook and wish to disclose the following potential conflict of interest related to my research study: _______________________________________________________________________ _______________________________________________________________________ _____________________________________________________________ or I have reviewed the EDMC Code of Business Ethics and Conduct Statement found in SECTION 5.0 of the Argosy University Intuitional Review Board Handbook and state that I have no potential conflicting interests that might influence or be perceived to influence how I professionally conduct my research study. Signed and Dated (under printed name).

Alice Crawford

Date

151

APPENDIX G Round One Response

152 Round One Response Responses to question one Panelist 1 The supervisee should have had post grad training in a focused area it helps is the supervisor and supervisee share the same model, but not crucial.

Panelist 2

The ability to have a theoretical knowledge base that is broad enough to support many different areas of learning. The ability to have strong boundaries and to have the ability to provide input and feedback to the supervisee to assure that the case is progressing.

Panelist 3

1 A clear understanding of the boundaries, expectations and roles of the supervisor and counselor 2 Mutual trust and respect 3 A willingness to collaborate.

Panelist 4

I believe it is critical for the supervisor to be available and intentional about supervision, to be receptive to working with the supervisee's style, and to be able to provide both supportive and challenging feedback at well-timed moments in supervision.

I also believe the supervisee's openness, ability to initiate and collaborate, and values regarding high standards of client care are critical.

153

Panelist 5

Critical elements are: capacity to put oneself in the place of the counselor ability to assess and act upon risk ability to teach so the counselor develops professionally ability to hold the best interest of the client capacity to allow the counselor to develop their own way of working

Panelist 6

The most critical elements necessary to conduct effective supervision is training in supervision and a clear understanding of what is expected, required and the ethical guidelines to practice as a clinician and to educate and guide the supervisee within these parameters.

Panelist 7

1 The ability to look beyond the counselor's report of their work with their clients and catch any countertransference that may be impacting their clinical relationships 2 A personal comfort and sense of competence, knowledge of a variety of theories and methods, and a personality that means that experienced counselors respect your opinion 3 A supportive environment to enable clinicians to do their best work 4 Ongoing training and updates on research and effective methodologies

154 Panelist 8 1 The ability to accurately assess the degree of professional development of the experienced counselor 2 The ability to engage an experienced counselor in tailoring supervision of his/her self-identified professional goals and areas of interest. 3 The ability to remain flexible in setting the supervision agenda and focus. 4 The ability to allow for the experienced counselor to advance beyond the supervisor's expertise. 5 The ability to treat the experienced counselor as a colleague. 6 The ability to make supervision more of a collaboration, and less teaching/oversight/directives. 7 The ability to provide less technical expertise and instruction, and more eliciting the experienced counselor's self-determination and selfdirectedness.

155 Responses to question 2 Panelist 1 Similar to question above the supervisee should have had post grad training in a focused area it helps is the supervisor and supervisee share the same model, but not crucial. Novice could sit in on others sessions and/or video tape their own sessions for best practice.

Panelist 2

The ability to assess strengths and areas for growth for the trainee to assure that learning is tailored to the trainee's needs Making sure that client's are matched to an area where the trainee will feel confident while still working on growing edges. The ability to provide support and guidance to the trainee during this initiatory phase of their development as a therapist

Panelist 3

1 Clear understanding of the boundaries, expectations and roles of the supervisor and counselor 2 Structure for the counselor 3 Education 4 Freedom for the counselor to process countertransference and fears

Panelist 4

I think it is critical for the supervisor to be aware of when supervisees need concrete direction and when they need time to find their own way. I think it is very important for supervisors to be able to give lots of encouragement and when needed to provide corrective feedback. Early on

156 in supervision, it is even more important to be sure to cover safety and ethical issues, workplace concerns, supervisee professional development, diagnosis, documentation, and to be a stable connection for the supervisee. As the supervisee develops his or her style, it is important for the supervisor to be able to allow the supervisee to challenge the supervisor and to experiment with new ideas. Later in supervision, the efforts become more collaborative and there is greater emphasis on abstract thinking including transference and countertransference concerns.

Panelist 5

teaching basic principles of treatment letting them talk about the case and helping them to think though the meaning of the material supporting their sense of themselves professionally

Panelist 6

An open and trusting relationship with the supervisor, ability to self reflect and observe- with the supervisee, and a clear understanding of boundaries within relationships.

Panelist 7

1 Patience 2 Ability to review basic counseling techniques and assist new counselors in developing their own style and theories of change 3 Knowledge of the levels of counselor development and ability to utilize to assess counselor level and guide to greater levels of competence

157

Panelist 8

1 The ability to accurately assess the novice counselor's development level. 2 The ability to be directive when needed. 3 The ability to teach and instruct, and to provide technical assistance/expertise. 4 The ability to nurture passion for the work. 5 The ability to effectively and appropriately role model. 6 The ability to be patient as the novice counselor learns. 7 The ability to be available outside of formal supervision appointments for questions, brainstorming, checking in, and crisis management.

158 Responses to question 3 Panelist 1 Truthfully I have found there are novices that have the post grad training who outshine the experiences counselors without the post grad training.

Panelist 2

An experienced counselor will have an idea of case progression and intervention strategies that are more sophisticated than the trainee. Areas of clinical development will be greater with regard to diagnosing and assessing clients.

Panelist 3

The relationship between novice and supervisor is more "teacher/pupil", whereas the supervisor/experienced counselor relationship is more collegial. With a novice there is a more tangible focus on practical issues, theoretical issues, legal issues. An experienced counselor has had prior supervision and is intuitively more aware of what they might need from their supervisor. More "hand holding" with a novice

Panelist 4

I answered this in # 2. For the novice counselor, provide direction, structure, and lots of support. For the counselor who has been in supervision for a moderate amount of time, be ready t be challenged, allow for questioning and experimentation.

159 For the experienced counselor, support discussion of abstract concepts, meaning in one's professional development, transference and countertransference.

Panelist 5

for the novice, you are teaching them things they do not already know, or know solidly. for the experienced counselor, they know things intellectually, but have not yet made clinical thinking part of who they are. The knowledge is assumed and referred to, but as something they already know about.

Panelist 6

With a very novice counselor, there is more need to review counseling theory and methodologies, how the counselor is conceptualizing the case, and hearing more detail about sessions and interactions. As a counselor progresses, discussions more to more of an overview of the case, discussions about dynamic and system issues, and countertransference issues.

Panelist 7

Experienced counselors are able to integrate more quickly and are more open to bringing issues to supervision, a novice counselor often has this feeling of needing to prove themselves and aren't as open to sharing their insecurities, vulnerabilities or transference issues.

160 Panelist 8 1 Cannot assume the same degrees of competency, confidence, skill implementation, critical thinking, ability to think on one's feet, intervention creativity, attention to details. 2 The role of a supervisor is significantly different between the two, coaching vs. teaching, collaboration vs. direction, developing therapy skills vs. refining existing skills, emphasis on becoming a therapist vs. becoming an expert. 3 Degree of responsibility for the supervisee's decisions, and ability/willingness/necessity to override the supervisee's decisions

161 Responses to question 4 Panelist 1 Benefits are that they GET IT more quickly without the need for repeating oneself. Drawbacks are the know-it-all attitude that sometimes pervades, or they are stuck in a certain modality and have difficult time adapting to new ideas.

Panelist 2

Benefits are that the experienced counselor will have a working knowledge of what it's like to be with clients, where to potentially start with a client and how to build rapport. Drawbacks may be that the counselor had limited exposure to certain areas in their traineeship and may actually be at a very beginning stage. Some experienced counselors also enter supervision as if they are fully trained and don't need case consultation.

Panelist 3

Supervising experienced counselors allows the supervisor to work on a deeper level with the counselor; to look at nuance, to be freer in the direction they go with their work. A drawback might be remembering your role as the supervisor. It feels great to have experienced counselors to speak with about cases and if the boundaries aren't clear it could become merely peer supervision.

Panelist 4

The major benefits of supervising an experienced counselor are the more mutual collaboration, the exchange of exciting ideas, and the discussion of

162 transference and countertransference. One downfall to supervising an experienced counselor is that there can be moments when both the supervisor and supervisee wonder whether the service is fully needed in the context of a challenging work schedule. However, typically both see the overall value in that it is such a rewarding experience.

Panelist 5

benefits are that you have the opportunity to put your own knowledge into words and see how much you know. you can help people get to the next level in their work potential drawback is that they think they know things, which they do, but have not yet made it a part of who they are.

Panelist 6

Major benefits include being able to discuss cases at a deeper clinical level and a greater trust for the clinicians abilities in handling a variety of situations. Major drawbacks include the possibility of overlooking a major issue due to trusting the clinician more, a greater tendency for clinicians to become "set" in their style and methods, and some experienced counselor's struggle with supervision, especially if from a less experienced counselor.

Panelist 7

Benefits- quicker integration and understanding of concepts- a thirst for understanding of self and patient relationships Drawbacks- may feel that they have mastered certain areas that still need improvement, not as open to feedback

163

Panelist 8

Benefits: more intellectual and professional challenge, more personal challenge to set aside one's expertise, ability to learn more from an experienced counselor, less responsibility and more collaboration. Drawbacks: at times can become more administrative than clinical, possible clinical and professional impasses due to differences in philosophy/approach

164

APPENDIX H Additional Comments Round 2

165 Additional Comments Round 2

Round 2 Additional comments Supervisor Characteristics

Panelist 1

1 Be comfortable with discomfort (be able to handle intense moments and differences in supervision) 2.Understand personality differences (i.e. supervisor is extroverted vs. introverted supervisee)

Panelist 4

ability to provide structure ability to accept diverse thinking

Additional comments Supervisee Characteristics

Panelist 4

follows up immediately with recommendations regarding safety and ethical issues

166

APPENDIX I Additional Comments Round 3

167 Additional Comments Round 3 Additional comments on Supervisor Characteristics Promotes Trust Panelist 5 Your definition seems to be about confidence, but trust is interpersonal, about the supervisor's concern for supervisee and trustworthiness as well.

Credible Panelist 5 Although there should be room for differing opinions or points of view

Comfortable in Supervisor Role Panelist 5 Yes, but the ones above are more important. You have to become a new supervisor at some point, and you would not be fully comfortable at that point.

Competent Panelist 5 Yes, but as above, newer supervisors would differ from seasoned ones.

Supportive Panelist 8 I would add that "Supportive" also includes the supervisor's ability to encourage the supervisee's ability to make sound clinical decisions.

168 Additional comments on Supervisee Characteristics Self-Reflective Panelist 2 More than just with behaviors; self-reflective should include, by definition, how one is affected on a cognitive, affective and somatic level.

Corrective Feedback Panelist 5 But it would be expected that there are obstacles/resistance as well, to be understood in the supervision. Yes, but this may be a lot to expect for newer supervisees. Another quality to develop over time

High Standards Client Care Panelist 7 The Supervisee is invested and values the importance of high standards of client care. Knowledge and use of best practices can be taught.

Additional comments on Supervision Process Protect the client Panelist 5 Although the supervisee really is the primary focus of supervision, and the supervisor develops the supervisee's capacity to put client first.

Setting Boundaries Panelist 4 This also includes boundaries regarding protecting one's time and the level of self-disclosure each person is expected to provide

169 Panelist 8 More that the formal supervision structure role models interpersonal limits and respect, to be reflected in the counseling provided by the supervisee

Panelist 7

I would not focus so much on formal structure in this arena, but more on the roles of supervisor and supervisee demonstrating appropriate boundaries.

Adherence to Ethical Issues Panelist 8 I would add that this encourages the supervisee's use of professional ethics as an integral part of clinical decision-making.

Addressing Safety Concerns Panelist 2 And also with the safety of the supervisee, i.e., some are in communities and schools that have safety concerns for the counselor themselves

Panelist 4

Especially related to suicide, homicide, self-harm behavior, substance

Tailoring Supervision Panelist 5 Also, transference and ct would also arise in the supervision itself, not just the treatment with the patient.

Additional Comments on Supervision Relationship Characteristics Empower

170 Panelist 2 Or to encourage supervisee to think of 'next steps' or interventions in the counseling process