Tag Archives: counselor supervision

How to land an internship you’re excited about in 48 hours or less

By Wesley Murph January 19, 2022

The accident happened on a sunny Saturday afternoon.

I was driving home from my internship site, where I had seen clients that morning, when I stopped at a red light. As I changed the radio station on my car’s stereo, I heard screeching tires and crunching metal.

Then, as if I were in a Steven Spielberg movie, a maroon-colored car launched over the back of my car. It landed on its side and skidded down the asphalt against oncoming traffic.

As I stared at the unfolding scene, something big plowed into the back of my car, pushing it into the car in front of me. Glass shards and taillight debris rained down inside of my car.

I glanced in the rearview mirror and saw green liquid spewing from the van that was now embedded in my car. I feared that my car would explode and that I would be burned inside. As quickly as I could, I opened the door on my car and stepped on to the slick pavement. I glanced around to make sure I wouldn’t be hit by an oncoming car and heard a woman screaming from behind the maroon car. I immediately dialed 911.

“There’s been a bad accident,” I said to the 911 operator. “I think people are hurt. Please send help quickly.”

Minutes later, several police cars arrived and began directing traffic. A firetruck and an ambulance arrived next. A first responder said the woman driving the maroon car was shaken up but was otherwise OK. Just to be safe, they were taking her to the hospital.

I sat down on the sidewalk, grateful that nobody was seriously hurt. But when I looked at my car, I knew it was totaled. I also knew I would have to find a new internship site because my site was 60 miles from my home and the majority of clients I saw were in-person.

A few days later, I emailed my internship coordinator at the graduate school I attended and told him what had happened. We met on a video call, and he said it might be three months before I was placed at a new site. “If that happens,” he said, “you may not graduate on time.”

My pulse quickened. I had been in graduate school for nearly two years, and I was six months away from graduating. I needed 150 additional direct client hours to walk with my peers, and there was no way I was going to wait three months to find a new internship site.

So, I put on my marketing hat with one goal in mind: to find a new internship site. I never imagined what would happen, but I am grateful to say that I received five internship offers in 48 hours.

I would like to share what I did so that others looking for an internship site can find one they are excited about. Or you might tweak my campaign to connect with potential supervisors and land a new job.

I can’t guarantee the results if you follow this campaign, of course. But I can say it will help you connect with counselors in your area. It will also strengthen your sense of confidence and freedom by giving you more control over your future.

Google search

The first thing you need to do is find clinical supervisors for whom you want to work.

I played around with keyword searches in Google until these searches brought me to a webpage containing nearly a hundred clinical supervisors in my area. The webpage had a picture of each supervisor, a paragraph about the supervisor, and the supervisor’s email address and phone number.

I carefully read each supervisor’s bio until I found 25 whom I wanted to contact. I then researched the various supervisors using Google to find out more about each person. I went to each supervisor’s website, if they had one, and read their “About Me” page. I wanted to make sure that I genuinely connected with each supervisor before reaching out to them in an email.

I recommend that you complete this step too. Research the clinical supervisors in your area until you have a list of folks you want to work for. Really get to know these people. What clinical theories do they practice? Have they published any studies? If so, what are the results of those studies? How did they get into counseling? Have they written any blog posts or been a guest on a podcast? If so, what did you learn from their post or podcast? Do a deep dive into these people so you can honestly say to yourself whether you would want to work with them or not.

Next, I encourage you to create an Excel or Google Sheets file to help you keep track of your campaign. I created a new Google Sheets file using these headings:

  • Full Name
  • Email
  • Phone
  • Specialty
  • When Contacted
  • Response
  • Result

I filled my Google Sheets file with the 25 clinical supervisors I liked and connected with the most. I then sent a sincere and personal email to each of these supervisors.

Cytonn Photography/Unsplash.com

Email marketing

Here is what I wrote in the email:

 

Subject Line: Clinical Supervision?

Hi (First Name of Supervisor),

 

My name is Wes.

I found your contact information online, and I connected with you because ________. I am reaching out with a question about clinical supervision.

I am completing my master’s degree in clinical mental health from Northwestern University. I am supposed to graduate in March 2022.

Last January, I started my clinical hours at an internship site in Salem, Oregon. I live in Portland, and in August I was involved in a car accident that totaled my car. I am unable to drive to Salem to complete my clinical hours and am looking for a new internship site closer to my home.

Do you know of a licensed mental health clinician in Portland who may be interested in letting me finish my clinical hours underneath their supervision?

If not, do you know someone I can contact who may know someone?

I appreciate you for taking time out of your schedule to read my email.

 

Very respectfully,

Wes

 

Notice how the first paragraph has a blank line. This is where you put the information you gathered from your research. The more specific you are, the better connection you are likely to make.

The third paragraph contains my story. It grabs my reader’s attention because it’s heart-wrenching. You may not have a story like mine. But that’s OK. You can tell your contact another powerful reason why you would like to work with them.

The results

I emailed 25 potential supervisors on a Thursday. I received 18 responses and scheduled video interviews with five of them. I interviewed with one supervisor that Thursday night, three on Friday and another one the following Monday. All five of these amazing supervisors graciously offered to take me on as their intern. Working for any of them would have been delightful, but I chose the one that aligned best with my goals.

I relayed this information to the placement team at my graduate school. A day later, the site at which I wanted to intern was approved.

I also responded to each supervisor who got back to me. I told them I was thankful that they took time out of their schedule to try to help me and that I hoped we would bump into each other at a professional conference in the future.

I made sure to sincerely thank the four sites that offered me an internship but which I politely declined. This is respectful and maintains the relationships I established with each of these generous supervisors.

I was amazed at the outpouring of support from the counseling community in my city. The counseling community in your area is likely just as supportive. All it takes is a sincere and genuine email to open a conversation with someone you admire and want to work for. Who knows what will happen? But this process gives you some control over your future instead of simply hoping that fate is on your side.

 

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Before he began a master’s degree program in mental health counseling, Wesley Murph owned two small businesses, including one that was featured on The Dog Whisperer with Cesar Millan. He currently helps couples communicate more effectively so that each person feels valued, heard and appreciated. He also works with men to resolve anger issues and relationship conflicts that are lowering their quality of life. You can find him at BuildingBetterMenPDX.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Making every moment of clinical supervision count

By Tiffany Warner January 18, 2022

When I started providing clinical supervision nine years ago, the standard at my clinic was to use the entire session to discuss cases. Case review is foundational to the supervision process, but later in my career, I learned of alternative methods of supervision. Even when I used different methods, however, there were still too many topics to cover during the one hour of supervision per week. 

Whether one looks at the 2016 Council for Accreditation of Counseling and Related Educational Programs (CACREP) Standards or the 2014 ACA Code of Ethics, it is clear that supervisors are responsible for addressing a multitude of areas with supervisees. Unfortunately, figuring out how to cover every topic seems daunting at best and impossible at worst for many supervisors, especially when coupled with their gatekeeping responsibilities. In reality, there are too many core domains in counseling to cover in every supervision session, and this must be balanced with ensuring that supervisees discuss cases for client welfare. In addition, supervisees are often unsure what to bring up in supervision; without structure, they have difficulty identifying the most salient cases or topics. 

I know from my early experiences that this was a significant challenge. I was often trying to figure out what needed to be addressed first in supervision. I recall one example when I was working with a supervisee on the topic of self-care, but as the supervisee described their self-care practices, I could hear themes related to professional development, lack of confidence, ethical considerations and diversity factors. This moment raised many questions for me: What area do I address? Is it realistic to address them all? Do we have time to do that and discuss the supervisee’s clients to ensure quality of services? 

At this point, most supervisors, myself included, would focus on any high-risk needs, but the options are not always between low-risk and high-risk situations. Consequently, in my early career, I chose to address the areas in which I was most confident or that most interested me. This response is consistent with many of the supervisors I meet as well. 

To confront this challenge and to change my pattern of addressing limited topics, I developed a three-step method to help myself cover more topics with supervisees in the same amount of supervision time. I have found this three-step method has not only helped address a wider range of areas in supervision but also modeled for supervisees what types of issues to introduce. The development of this three-step method started when I was running internship groups in a master’s counseling program. I found it very challenging to cover all the core areas that students were trying to learn while also helping the students make the leap from book knowledge to application. However, I did not want to create so much structure that students no longer had the opportunity to discuss urgent or complex cases. Therefore, the three-step method that I started using includes: 

  1. Identifying a topic list
  2. Collaborating with supervisees on the schedule 
  3. Developing processes to incorporate topics naturally
    into supervision

This three-step method can be incorporated into individual or group supervision formats. At its core, the method is designed to help supervisees deeply apply the knowledge gained during their education. 

Step 1: Identify a topic list

Whether you are someone who loves order (like me) or prefers a more organic flow, identifying a topic list can be useful to help keep pace as a supervisor. It enables you to ensure core areas are addressed and provides an opportunity to assess the supervisee in different competencies. In a sense, this creates personal accountability by developing core areas that need to be addressed and devising a method to track them.   

The topic list I have most often used is a case conceptualization. This assists supervisees with identifying important parts of a case conceptualization, learning ways to articulate the case and working toward a cohesive understanding of the case. Several options are available for outlining a case conceptualization (see also “Case conceptualization: Key to highly effective counseling” by Jon Sperry and Len Sperry in the December 2020 issue of Counseling Today). You can use the case conceptualization format that is most familiar. However, I prefer using the following outline because the order helps students build a deeper understanding of their cases. 

  1. Background and historical information: Salient details such as family structure, relationships, historical trauma, history of mental health or addiction issues, mental health treatment and medical history.
  2. Presenting problem or concern: Client’s description of their problem, what they hope to achieve, risk factors and substance use.
  3. Testing and assessment measures: Identification of any test or assessment measures that are useful for the client, their problem or treatment.
  4. Diagnosis: Past and current diagnosis, differential diagnosis process.
  5. Multicultural considerations: Demographic information, diversity or cultural considerations for the case, important cultural components that impact treatment or mental health.
  6. Systems or developmental theory considerations: Identification of any systems or developmental models or theories that are important for this case.
  7. Counseling theory: The theories or modalities that are being used, research support for the counseling theory.
  8. Treatment plan: Description of the goals, objectives and interventions for the case.
  9. Ethical considerations: Current or potential ethical issues that apply to this case. 

Another option for the topic list is to use the 2016 CACREP Standards, specifically the eight core counseling domains found under Section 2.F.: 1) professional orientation and ethical practice, 2) social and cultural diversity, 3) human growth and development, 4) career development, 5) counseling and helping relationships, 6) group counseling and group work, 7) assessment and testing and 8) research and program evaluation. Although this topic list does not provide the ordered structure of a case conceptualization, it does cover the core areas that developing counselors need to understand and apply to clinical cases. 

One final option would be to use the various competency standards for professional counselors such as the Competencies for Addressing Spiritual and Religious Values in Counseling developed by the Association for Spiritual, Ethical and Religious Values in Counseling or the Minimum Competencies for Multicultural Career Counseling and Development created by the National Career Development Association. Using competency statements can be particularly beneficial if you are supervising within certain settings such as a religious institution or career center. Depending on organization of the competency standards, you would use each standard to help build competencies over the course of supervision. Because most competency standards include a focus in areas of knowledge, awareness, skills and ethics, you can still cover most of the areas outlined in the case conceptualization but with a focus on a particular genre or population. 

My three-step method provides flexibility for you to create a topic list that fits the supervisee, setting and population. I believe the case conceptualization is a better option given its practicality to the counselor’s everyday work. In addition, it provides language and an understanding of the case that is easier to translate into documentation, billing and other business aspects of a counselor’s work. No matter what topics are used, what is important is identifying a list that fits well within your supervision model and setting.

Step 2: Collaborate in setting the schedule

The onus is on the supervisor to ensure that the supervisee is building competency, which might lead to the supervisor determining the schedule of topics. However, there is value in involving the supervisee in this process. In this second step, the supervisor brings the suggested topic list to the supervisee to establish the schedule of topics. This has several purposes. 

First, it provides opportunity to assess the supervisee and their developmental level. You can use formal or informal processes at this step. The goal is to ascertain what the supervisee understands and their current skill level. In this way, you can tailor the list to the need of your supervisee.

Second, this step helps the supervisee take ownership of their development by identifying their own strengths and growth areas, which can assist you in targeting how to incorporate each topic (see step 3 below). For example, a supervisee might show solid understanding of counseling theory but need more assistance with knowing when to use what theory. Another supervisee might demonstrate strong skills with understanding a case but struggle to create a cohesive case conceptualization. At this step, supervisees are also able to identify areas of interest that might be included in the schedule of topics. 

Finally, this step can model the process of collaborating with a client to develop goals. This creates a great parallel process in which the supervisee learns how to work together to create the goals for supervision, which translates well to the counseling room.

After collaboration, the schedule is set up to address one topic per supervision session within a specific time frame, such as over a three-, four- or six-month period. At the end of this time frame, the schedule could be repeated or a new schedule created. 

At the conclusion of this step, you’ll have a set schedule of topics that incorporates the topic list from step 1 along with the supervisee’s feedback. So, you could end up with a four-month rotation of topics in which weeks one through nine focus on going through the case conceptualization and weeks 10 through 16 focus on reviewing the supervisee’s areas of interest. Another option might be a schedule in which each CACREP standard is reviewed in weeks one through eight and then weeks nine through 16 are spent taking each standard deeper to strengthen the supervisee’s development. In this way, the creation of the schedule becomes part of the supervision process. 

Step 3: Incorporating topics into supervision

While the schedule of topics is very structured, the final step offers more flexibility. I prefer to weave the topic into the cases or questions that are already discussed in supervision. In this way, the schedule of topics can be inserted into supervision organically. It uses time more efficiently by capitalizing on what is already brought into supervision. It also enhances a supervisee’s understanding of how these topics directly relate to their current clients. For example, if the topic is “diversity considerations,” you might pose questions during the case discussion or use an existing case to explore the topic deeper. Because this process is more organic, it requires that you quickly formulate the best plan to incorporate the topic. 

To help explain this process better, I’ll offer a case vignette of a supervision meeting. In this example, the topic of the week is the “presenting problem or concern.” The supervisee has brought up a particular case that has been difficult for her because she does not think progress is being made in treatment. The supervisee has been discussing a client who has sought treatment for depression but reports continued depressed mood and lack of motivation. In addition, the client reports a history of addiction but has been clean for six months. The supervisee and client have been seeing each other for five sessions. 

This supervisee has struggled in the past with clients who lack motivation. So, prior to this portion of the supervision session, the supervisor and supervisee focused on the countertransference that the supervisee experiences with clients with low motivation. At this point, the supervisee has had the opportunity to work through the reason for bringing up the case, and the supervisor sees an opportunity to bring in the scheduled topic. 

Supervisor: As I mentioned earlier today, this week’s topic is the presenting concern, and it seems like this client might be a good fit for the topic. As you have mentioned, the client seems to lack motivation. Tell me about what the client’s presenting concern is or how the client would describe their problem.

Supervisee: Well, when we first started, he said he wanted to be less depressed, but we have not really worked on that much. He doesn’t seem to want to talk about anything when he comes in.

Supervisor: So, he identified reduced depression when he started. What other things did he mention?

Supervisee: I can’t think of anything. 

Supervisor: Let’s see if we can’t expand on that a bit. It is common for clients to not have a clear description of what they want when they first start. Based upon your meetings with the client, what do you think the presenting problem or concern is?

Supervisee: I guess that is part of the challenge when I meet with him. I am still not sure. I guess he wants to reduce the depression, but it has been so hard to discuss this with him.

Supervisor: So, we have already established that he lacks motivation, which is common with people who are depressed. I wonder if we can be more specific and think about how you might describe the problem from either a behavioral, cognitive, affective or interpersonal lens? 

Supervisee: Well, he has mentioned several times wanting to see his children again. He stopped seeing them after his last relapse. This might be a behavioral problem that he doesn’t see his children. 

Supervisor: Great. How have you explored this area with him so far?

Supervisee: We haven’t done much. When he brings it up, I ask about what he can do to make that happen, and he just becomes upset. 

Supervisor: Well, it sounds like there might be some deeper challenges there, but let’s finish up with the presenting problem. You have at least one possible goal for the client. I wonder if there are others.

Supervisee: When he talks about wanting to see his children, he has mentioned several times about how he is a failure because of his past substance use. So, I guess there could be something there regarding a cognitive-based problem. 

Supervisor: So, it seems like there are maybe more specific concerns that you could bring into session.

As this vignette makes evident, the supervisor addresses the main concern brought to supervision and uses the same client to also address the day’s topic. This leads to an even richer conversation with the supervisee around some barriers to treatment, such as unclear goals. By using the existing client to discuss the topic, the supervisor is also able to skip repeating the case information, which utilizes supervision time more efficiently, and connect the topic to the clinical issues that the supervisee is wanting to address.

I prefer a more organic incorporation of the topics, but for some supervisors with less experience, this may be too challenging at first. Another option is to have set time during supervision to cover the topics. This could include doing activities such as role-plays, reviewing the major content in the topic area, selecting a client who fits well with that topic or using vignettes to discuss a topic. For example, if that week’s topic is “background and historical information,” the supervisor might role-play how to conduct an intake interview. If the week’s topic is “diagnosis,” the supervisor could include a vignette to help the supervisee work through differential diagnosis. This process can be useful when working with supervisees who are early in their development as counselors. However, it can also seem forced or too basic for more advanced supervisees or require setting aside time that might already be limited. 

Another aspect to consider when choosing the process for incorporating the schedule of topics is the background knowledge that the supervisee possesses. Some supervisees come to supervision with a strong understanding of the different topics, whereas others are early in their development or didn’t receive much prior training on the topic. In these instances, taking time to provide a short training or refresher may be useful. For example, if the topic is “test and appraisals,” you might consider reviewing validity, reliability and the process for determining an appropriate test. 

Finally, you have the option to use some or all of the processes identified here. You could consider providing a short training on the topic, identifying key questions and bringing those questions into the cases discussed during supervision. Ultimately, as a supervisor, you will determine which process fits best with your development as a supervisor, your supervisee and your setting. 

Benefits and problem-solving

An additional benefit of this three-step method is that it assists you in knowing what core areas have been addressed throughout supervision. It is easy to be unaware of the developmental areas that are missed with supervisees, and structuring supervision in this fashion can help mitigate this potential issue.

fizkes/Shutterstock.com

This can then translate well during evaluation times to allow for a more robust formative evaluation process. For example, some evaluations used in state licensure require that a supervisor specifically address the counselor’s diagnostic competency. The supervisor who uses this three-step method can be confident of their assessment of a supervisee’s diagnostic skills. 

The biggest challenge to using the three-step method can be the appearance of rigidity. As any supervisor knows, there are times when high-risk or urgent clinical needs take precedent over any other topic in supervision. Using a topic list does not preclude you from addressing urgent needs; there is space to change course in supervision and not address the topic. 

In fact, the topic list can produce the identification of urgent needs more regularly by training the supervisee on the different areas that should be addressed in supervision. For example, regularly bringing in ethical considerations can move the supervisee from seeing the ethical standards as rules and toward realizing how ethics standards apply to specific cases. This in turn can help supervisees move beyond just addressing confidentiality and abuse reporting to also recognizing potential boundary issues and scope of practice questions. 

The three-step method and group supervision

We have focused mostly on the use of this three-step method in individual supervision. However, there is value to using it in group supervision as well. 

In group supervision, managing time is even more challenging because multiple supervisees are vying for space to address clinical issues. Often, the goal with group supervision is that supervisees will learn as much from each other as from discussing their own caseloads. By establishing a topic list and schedule, you can be sure that more topics are covered for the benefit of multiple supervisees. 

Regarding the earlier vignette, if this conversation took place in a group setting, the other members would have the opportunity to listen and offer feedback on how to address countertransference and the role the presenting problem can play in treatment, even without bringing up their own cases. This could result in these supervisees being more likely to incorporate the presenting problem in other cases. 

Using the three-step method as a supervisee

The role of the supervisor is to teach, model and assist the supervisee in development as a counselor. But even if you are not providing direct supervision — if you are receiving supervision instead — you can still use this three-step method in your own development. 

This could include developing your own schedule based on the case conceptualization provided to you in your training or the competencies that you want to improve. After creating the schedule, you can use that to determine different topics that you want to address in supervision while prioritizing the high-risk issues and supervisor instruction. In this way, you can receive the benefit even if your supervisor uses other models of supervision. 

Supervision is a beautiful process of becoming a seasoned counselor, and as a supervisor, I have had the honor of walking with many supervisees through this process. I take this charge very seriously, which is why I emphasize providing a well-rounded supervision experience. Using this three-step method, I have found success with engaging supervisees on many fronts more efficiently while providing practical application of a counselor’s core functions.

 

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Tiffany Warner is a licensed professional counselor and board-approved supervisor who specializes in working with severe and persistent mental illness. She is currently working as adjunct faculty at Multnomah University and is pursuing her doctorate in counselor education and supervision through the University of the Cumberlands. Contact her at twarner@multnomah.edu.

 

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, visit ct.counseling.org/feedback.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Starting a counseling career in the time of COVID-19

By Lindsey Phillips March 30, 2021

Many counselors can easily distinguish between what their professional career looked like before the coronavirus pandemic started and what it resembles now. But for most new professionals, counseling in a pandemic is all they have known. COVID-19 has shaped almost every encounter they have had with clients and colleagues alike. And the careers that have greeted them upon graduation have looked dramatically different than the ones they prepared for in school.

Hannah McGrath, a recent graduate from the Master of Divinity/Master of Arts in counseling dual degree program at Wake Forest University in North Carolina, always wanted to be a counselor. But as she acknowledges, “This [experience] is not how I thought things would go after I spent four years in graduate school.”

In March 2020, McGrath returned from spring break to discover that she would have to finish her counseling internship virtually. Many of McGrath’s clients, who were university students, had gone home for spring break and did not return to campus because of the pandemic. Some of them were out of state, which meant she was unable to provide counseling to them. Professors and supervisors scrambled to make sure she had the documentation she needed to do telebehavioral health and to help her find clients so that she could complete her internship hours in time.

It’s difficult to anticipate the long-term implications of beginning a counseling career in the time of COVID-19, but McGrath and four other new professionals agreed to shed light on the ways the pandemic has shaped them — and their future outlook on the profession — thus far.

Rethinking a counseling career

Kathryn Beskrowni, a provisionally licensed professional counselor, had concerns about starting her new counseling career even before the pandemic reached the United States. In January 2020, she had just finished her internship at Terrace House, a group practice located in St. Louis. She was apprehensive about leaving a steady job as a learning and development manager at College Bound St. Louis, a nonprofit that empowers students from economically disadvantaged backgrounds to achieve undergraduate degrees, to become a counselor clinician — a career she knew would depend heavily on building a suitable caseload.

Before graduating, Beskrowni, an American Counseling Association member who specializes in relational issues and life transitions, applied to a few jobs in private practices, hospitals and other mental health organizations. After not hearing back from anyone for over a month and a half, her career anxieties only solidified. “I had a two-month period where I didn’t know what I wanted to do,” Beskrowni recalls. “I had to emotionally prepare for this new life I was stepping into.”

She decided to reach out to her former intern supervisor, Christina Thaier, a licensed professional counselor (LPC) and the founder and director of Terrace House. Together, they discussed Beskrowni’s future as a counselor. Through their conversations, Beskrowni realized that one of her biggest hesitations revolved around the limiting feeling of only doing therapy.

Fortunately, Thaier worked with her to create a position that addressed all of Beskrowni’s goals and concerns and would allow for her to grow professionally. So, Beskrowni joined the team at Terrace House both as a therapist and assistant director of community relations (a role in which she helps to oversee and recruit counseling interns).

A few weeks later, COVID-19 made its way to the United States, and all the uncertainty surrounding the pandemic heightened Beskrowni’s career anxieties and concerns about financial stability yet again. Ultimately, she decided to keep her job at College Bound St. Louis, which provided steady pay and hours, while also transitioning into her new role as a professional counselor.

For about six months, she juggled both jobs, switching back and forth between her two work laptops — a privilege she had because of the ability to work from home during the pandemic. “It took me a really long time to feel safe and comfortable enough to fully commit to the unpredictability of a counseling career, so I held on to [the nonprofit job] for longer than I needed,” Beskrowni says. But she’s happy that she finally did become a counselor, and she’s excited about the future direction of her career.

Readjusting career plans

Before the pandemic, Darius Green, a recent graduate of James Madison University’s counselor education doctoral program, planned to find a full-time position in counselor education. He was willing and able to move anywhere. But the pandemic changed things. He wasn’t sure how much the pandemic would affect college enrollment and university faculty hiring, and he was anxious about the job search process and his own financial stability. “I worried if I would be able to find a job in counselor education, and if I did find one, I worried about the risk of that position being eliminated,” he says.

Green, an ACA member whose research interests include wellness, diversity, social justice and counselor education, did apply to some counselor educator positions, and he even scheduled a few interviews. But he ultimately decided not to pursue that career path because he didn’t feel prepared for the several hours of virtual interviews and teacher demonstrations, and given the uncertainty surrounding the pandemic, his willingness to pick up and move just anywhere had dissolved.

“Originally, I felt willing to move just about anywhere to get my foot in the door, but the pandemic shifted my priorities and values,” Green says. “My top priority wasn’t having a job in counselor education [anymore]. My top priority was having a job with benefits and a stable income.”

In part for that reason, he decided to continue working as the assistant coordinator of the James Madison University (JMU) PASS Program, which supports student learning and success in challenging courses at the school. Although he applies some of his counseling skills to this position, the job itself isn’t counseling focused. So, he also works part time as a counselor at the ARROW Project, a community mental health organization in Staunton, Virginia.

Even this part-time position came with new challenges. “I was nervous because I hadn’t been trained to do telebehavioral health,” Green says. “I’m fairly tech savvy, but [with telebehavioral health], there’s just a lot more to think about.”

The pandemic caused Green to readjust his career plans, but it also gave him the opportunity to work from home. This has allowed him to balance his full-time job at JMU and his role as a counselor at ARROW, which otherwise would have involved a 20-minute commute.

Green isn’t sure if a career in higher education is sustainable or obtainable right now, so he wants to keep his options open by working toward his counseling licensure. He also knows his experience as a counselor clinician will strengthen his curriculum vitae if he does decide to pursue jobs in counselor education down the road.

Growing pains

Rachel Wyrick, a master’s student in the counseling program at the University of Missouri-St. Louis (UMSL), was looking for an internship position right when the pandemic hit the United States. Wyrick wasn’t sure if they would be able to find placement with so many agencies focusing on switching their practice to telebehavioral health. After a few weeks of silence, Wyrick finally got the email they had been hoping for: Terrace House offered Wyrick a position as a counseling intern.

Wyrick had felt like they were hitting their counseling stride during their practicum a couple of months before the COVID-19 pandemic. Wyrick had become more comfortable with clients, and Wyrick’s initial nervousness was slowly waning. But when everything went virtual, Wyrick’s anxiety shot back up. In many ways, Wyrick felt like they had to start over by learning how to do therapy using telebehavioral health — something that was not on their radar before the pandemic.

Wyrick specializes in relationship issues, trauma, posttraumatic stress disorder and LGBTQ+ populations. Because Wyrick works with clients experiencing trauma and uses somatic therapies, Wyrick had reservations about how effective telebehavioral health would be. But Wyrick embraced the change and discovered they can still build a strong rapport with clients virtually. In fact, in many ways, Wyrick finds it more intimate. Because they are sitting face to face with clients, Wyrick can easily read the microexpressions on the client’s face via screen.

“And for my style of counseling, it actually really suits me and the populations that I serve,” says Wyrick, who was named UMSL’s clinical mental health master’s student of the year this past December. It can be comforting to clients to be in their own space and to see their counselor as a “real” person in their own space, Wyrick explains. Wyrick notes that when clients ask about Wyrick’s plants or artwork in the background, it often seems to jump-start a stronger connection.

Wyrick still oscillates between weeks of feeling connected to clients and weeks of feeling unsure and inadequate. “Will it always feel this way, or is this a normal part of the process of growing as a professional?” Wyrick wonders. Wyrick hasn’t had much practical experience outside of the pandemic, so it’s hard for the counselor-in-training to know what might be unique to the pandemic and what is simply typical growing pains.    

Difficulty finding a job

After moving to New York, McGrath noticed there were more jobs for social workers than for counselors. That’s when she learned that some states privilege different mental health workers. Social workers have a longer history in New York than do licensed professional counselors and, in turn, more job options. Many of the types of jobs McGrath had assumed would be open to her — such as being a counselor in a hospital — were not.

McGrath applied to every counseling job she could find, but many of the places didn’t respond or told her they were hiring only fully licensed counselors. “I felt like I had no job options,” she says. The fact that New York City had to shut down because of the pandemic didn’t help, she points out. Nothing was business as usual.

Finally, in June, she found a job working with a foster care agency as a mental health counselor-limited permit.

Looking back, McGrath realizes the pandemic heightened her anxiety around her job search. She felt a sense of panic and urgency to find a job. If she could do it all over again, she says, she would slow down and take her time during the process.

During graduate school, a visiting speaker told McGrath, “Your first job doesn’t have to be a perfect job, but it can be the perfect teacher.” She is taking that advice to heart as she continues navigating her counseling career during an uncertain and challenging time.

Building a caseload

After graduating with a master’s in counseling from the University of Mary Hardin-Baylor in spring 2020, Mika Smith-Tjahja, now an LPC associate at Firefly Therapy Austin in Texas, put a lot of pressure on herself to instantly build up her caseload. “I was hard on myself at first,” she recalls. “I had high expectations about getting a certain number of clients each week.” When that didn’t happen, she felt discouraged.

At the beginning of the pandemic, Smith-Tjahja was averaging one to three clients a week for about two months. Her supervisor reminded her that it takes a while to find clientele, so she trusted the process. Smith-Tjahja’s caseload has since doubled, but it is still below the number of clients she would like to average per week. She recently accepted a second counseling job at Connected Heart Therapy in Austin and hopes this will build her client base even more.

Smith-Tjahja, who specializes in anxiety, depression and trauma, wonders how much the pandemic has affected her ability to build a caseload. A few referrals have told her they prefer to wait until in-person therapy resumes, so she knows that it’s a factor.

Smith-Tjahja has started thinking outside the box to find people who need help right now. She joined a Facebook group for mental health professionals in Austin to share and request referrals. She has found the group to be a great resource both for referrals and networking.

She has also suggested to her supervisor the idea of creating a low-fee closed counseling group for individuals who are interested in therapy but can’t afford the higher fees. The group would benefit the community while simultaneously teaching Smith-Tjahja more about the community’s counseling needs and informing others that she is available and eager to help, she explains. Smith-Tjahja is also interested in doing pro bono work in the future, once she feels more settled in her role as a professional counselor.

Finding support amid the isolation

Smith-Tjahja says her biggest challenge throughout the pandemic has been the isolation, especially in terms of not being able to interact in person with colleagues. She imagined trading her graduate school cohort for colleagues in an office or hospital. Instead, she works from home, alone. Because that feeling of community isn’t there anymore, she created her own virtual community — a support group for LPC associates like herself. When she reached out on social media to find others to join her group, she was surprised by the response: More than 50 people joined. They meet once a month, and they recently invited a certified public accountant to present on how to manage taxes for one’s private practice.

She also reached out to her former cohort and formed a peer support group. In their last meeting, they all echoed Smith-Tjahja’s sense of isolation and agreed that they needed this group because they had missed the sense of community it offers.

McGrath acknowledges that it can be challenging to feel connected to other mental health professionals right now. She communicates with her colleagues through emails and phone calls. Sometimes, she says, when she doesn’t get a reply within a couple of days, she wonders if her colleagues are busy, if they are ignoring her or if they think she is a bad therapist.

Wyrick likewise admits that it’s easy to fall into self-doubt, especially when everyone is isolated from each other. The Terrace House internship program tries to address this by pairing new professionals with other new professionals who are a few months or years further along in their careers. Wyrick has benefited during their internship at the Terrace House from having a mentor. Wyrick has had virtual coffee dates with their mentor, which provided a semblance of an in-office interaction.

Supervision is also critical. “It’s hard to know where you stand as a new professional right now,” Wyrick says. “Having a well-seasoned professional reflect back what they see — whether it be strengths or growing edges — is really helpful.”

“Normally we’d have these [professional] experiences with peers and be able to compare … and all develop together,” Wyrick continues. “Without that, our supervisors are our main source of reflection and validation … of how hard this experience has been and the strength that we’ve shown.”

Green encourages counselors to remember that not everyone comes from a privileged background and has the same opportunities and resources. Therefore, it is important for established counselors to reach out and support new professionals, especially as they try to find their footing in the midst of an ongoing pandemic, he says.

Professional connections provide not only career opportunities but also emotional and social support, notes Green, a member of both the Association for Humanistic Counseling and Counselors for Social Justice, which are divisions of ACA. People are less inclined to reach out virtually, so it can be isolating at times, he points out. He had several mentors schedule virtual meetings in the fall, but those meetings have slowly decreased in the succeeding months. Green tries to lead by example, taking the time to message his colleagues as well as other new professionals.

After the pandemic, McGrath looks forward to meeting her colleagues in person and building work relationships that will help her grow professionally. She says she wishes she could just pop into a colleague’s office right now and ask a question or chat about how their week is going. But until that is possible, she advises her fellow new professionals to make efforts to connect with other mental health professionals in whatever way they can.

Establishing work boundaries

Working from home has caused the boundary between work and personal life to become blurred for many new (and seasoned) professionals. As McGrath points out, it’s often difficult for counselors to have set work hours when they are seeing clients six days a week. “The longer the pandemic has gone on, the harder it’s been to keep those boundaries,” she adds.

“Establishing work boundaries is already a struggle for new professionals,” Wyrick says. The pandemic only adds to this problem. Wyrick’s workspace is in the bedroom, which means they can answer emails at all times of the day. It’s also tempting to take on clients outside of scheduled work hours, Wyrick points out. Wyrick often thinks, “What’s one more hour?”

Wyrick has had to create a routine because their partner is a professor who is working from home as well. When Wyrick is working, they shut the door and turn on a white-noise machine. This signals Wyrick’s partner not to interrupt.

Green says the amount of email he receives seems to have increased during the pandemic. It often overwhelms him, he confesses, and he spends a substantial amount of time sorting and prioritizing these messages. Smith-Tjahja also finds herself checking her email constantly because she is trying to build up her clientele right now. She says she hopes to establish a better schedule for checking and responding to emails after she has more clients.

Wyrick says working from home has taught them a lot about their personal work patterns and values. Before the pandemic, Wyrick took pride in always being plugged in, but now they realize that mindset is not in line with their values.

“At the beginning of this [pandemic], we had no idea how long it was going to be, and the optimists of us thought it was going to be a short time. So, that allowed things to be a little chaotic and wild at first,” Wyrick says. “I was thinking very much in emergency ‘go’ mode, but now I’m trying to be very mindful about creating habits that are going to be sustainable over time.”

Finding opportunity in the chaos

Smith-Tjahja experienced several significant events in her life during 2020, but they looked different because of the pandemic. She graduated with a master’s in counseling, but the ceremony was virtual. She got married, but it was not the ceremony she had hoped for. She and her husband bought their first house, but her parents weren’t able to go look at houses with her. Smith-Tjahja feels happiness for these milestones but also a simultaneous sense of grief because these events didn’t follow the traditional route she had expected.

But the pandemic also opened up new career possibilities for her. A year ago, Smith-Tjahja assumed she would probably work in a hospital until she was licensed. Working in a private practice was a distant dream, but that dream became a reality this fall. After getting her provisional counseling license, she reached out to a counselor she had kept in touch with throughout her graduate program to see if the counselor needed any help at her private practice, Firefly Therapy Austin. The counselor offered her a job.

During quarantine, Smith-Tjahja also decided to get trained in eye-movement desensitization and reprocessing (EMDR). She could easily take the classes from her home and didn’t have to spend money on travel, food or a hotel. This training has opened up another career opportunity. She reached out to another counselor who just started Connected Heart Therapy, a private practice offering EMDR to the Austin community. They offered Smith-Tjahja a job as a part-time counselor, which will allow her to continue her EMDR training.

Wyrick describes their initiation into professional counseling as a trial by fire. Although it wasn’t the start to Wyrick’s career that they had hoped for, it has given Wyrick confidence in their ability to rise to the challenge and their capacity for growth. Wyrick hopes the experience of practicing during a pandemic will encourage and allow new and seasoned counseling professionals alike to rethink the ways that they do therapy and how they can best serve their clients.

The uncertainty that the pandemic generated and the sudden shift to telebehavioral health muted some of the traditional milestones for emerging counselors, including graduating and starting a counseling career, Beskrowni points out. She hopes that other new counseling professionals will still take the time to celebrate their accomplishments and find a sense of freedom in their evolving possibilities.

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Voice of Experience: Looking for honesty in the supervisory relationship

By Gregory K. Moffatt October 24, 2019

Sitting in a workshop for supervisors at the American Counseling Association’s annual conference in 2018, I listened to the presenter discuss cases of ethical violations by licensed counselors around the country. All of us in the room were stunned at some of the flagrant violations that had occurred. Among the examples presented were counselors sleeping with their clients, marrying past clients, and seeing clients regularly in social settings. Some of these counselors were disciplined by their state licensing boards, while others voluntarily surrendered their licenses and left the profession.

It’s a good thing that none of them lived in Georgia, the state where I practice, or they could have gone to jail. In Georgia, it is a felony to sleep with your client or to terminate with a client for the explicit purpose of engaging in a sexual relationship.

The 25 or so supervisors in the room were surprised at the risks these counselors had taken. The obvious question was: “How did it get that far?” We were stunned that any professional would throw all of their education and training away so casually, not to mention the damage they might have done to their clients.

Around the same time, I was managing a situation in which one of my supervisees had committed an unintentional ethical violation right before being fully licensed. This counselor, whom I’ll call Pat, had made a mistake and realized the error within a few days. Without hesitating, Pat called me to ask how to correct it.

We worked through the scenario and came up with a plan. Then came the question I had anticipated from Pat: “What does this mean in regard to you signing my paperwork next month for licensing?”

The harsh answer was that I would not be able to sign off on the paperwork at the time. This particular ethical violation served as clear evidence that Pat wasn’t ready yet for a license, or else the lapse wouldn’t have occurred. Such a scenario is exactly why we undergo supervision as counselors. Supervision isn’t a formality.

My decision wasn’t the end of the line for Pat though. Pat accepted the consequences of the breach and the remediation that I required. As a result, just a few months later, I was happy to sign off. Pat is now fully licensed and in a successful private practice, and I haven’t an iota of concern that Pat will make such a blunder again.

Sitting in that ACA workshop, I realized how fortunate I was that Pat had trusted me enough to risk a delayed license by telling me what had happened. I realized that I must have done something right as a supervisor, although it wasn’t deliberate in regard to Pat’s particular issue.

After that incident, I started speaking more overtly with all of my interns and supervisees about what they would do should they commit an ethical violation that might delay them getting their license. I told them I was wondering whether I had created an appropriate environment (as I must have done with Pat) so that they would be willing to tell me about any violations. This opened up a discussion that continued for several weeks.

My story here isn’t meant only for supervisors. If you are currently a graduate student or counselor in supervision, I hope that you have a trusting relationship with your supervisor. If you don’t — if you couldn’t go to her or him and say, “I messed up,” even when knowing that your licensing process may slow down — you need to either adjust that relationship or find another supervisor.

If you are a supervisor, you must make this an overt part of your discussions with supervisees. Since that 2018 ACA Conference, I have had conversations about this issue on a regular basis with all of my new supervisees and interns, and I believe it has strengthened their trust in me. My situation with Pat was one of only a very few serious ethical issues I have had to manage as a supervisor. Even so, we must be prepared for them, and we must prepare our future counselors for them.

Perhaps most importantly, if you are licensed, you must have a confidant or mentor in the field whom you trust enough to confide in when you make mistakes. This person can guide you through sticky ethical situations and must also be willing to tell you when you have messed up. This brings the risk of being reported to a licensing board, but taking that risk is crucial to our professionalism as counselors. The greater risk in an ethical breach is to the client. What it costs us is secondary.

 

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Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The beauty of client and supervisee resistance

By Michelle Backlund and Veronica Johnson August 8, 2018

In the counseling profession, resistance is essentially considered a four-letter word. Actually, many counselors probably feel more comfortable using a four-letter word than they do talking about a client’s or supervisee’s resistance. There are good reasons for this aversion.

Traditionally, resistance shown by clients or during supervision was considered a type of pathology. It was akin to victim blaming. As a profession, we have come to understand that resistance to change or to feedback is often a normal reaction to anxiety, stress, evaluation, trauma or even the learning process. Counselors have substituted many names, including ambivalence and self-protection, in place of resistance to avoid pathologizing normal behavior. As counselors and supervisors, we must choose our words wisely, understanding that every word has unspoken meaning.

History is full of negative references to resistance. Most of these denote the effect of some form of rejection — an idea is discarded, a form of government is found offensive, love has bloomed unrequited in someone’s heart, advice is unwanted, and on and on. However, resistance also has a beautiful aspect: the formation of diamonds as they respond to the pressure of the earth, muscles gaining tone and strength under the resistance of weight, the violinist’s fingers sturdily pressing the strings of her instrument as she then presses her bow to produce the sound.

Taking it a step further, here is an object lesson: I (Michelle Backlund) was visiting with a colleague who previously taught ballroom dance for 30 years, and he recognized how physical resistance could create connection, spontaneity and fun within a dance partnership. I was sharing with this colleague the many negative effects of resistance on relationships.

He asked me, “Did you know that resistance is really a great tool to make relationships strong?”

I said, “How?”

He said, “Put your hand up, with your palm facing me.”

I did, and he placed his hand against mine, then gently pressed. I automatically pressed back. He showed me how the pressure in the form of resistance connected our hands and held us together. The resistance allowed him to move his hand from place to place; it allowed me to feel that movement and follow him. Then he said, “With no resistance, there is no connection — you cannot move together.”

This simple object lesson created a paradigm shift for me as a counselor and as a supervisor. I began wondering how to harness client and supervisee resistance to create stronger, more collaborative, nonpathologizing relationships. This is the beauty of resistance.

Most humans use resistance to assure their physical and emotional safety. The reality is that the world can be truly threatening, and resistance is a means of reducing that threat. Whether we are discussing resistance as it relates to a client who has taken the risk to attend counseling or a supervisee who understands that supervisors serve as gatekeepers to the counseling profession, their anxiety and protection of identity should be regarded as normal reactions to a perceived threat.

An obvious question then arises: How do we recognize resistance that is showing up in our counseling or supervision sessions? You might laugh at this question, feeling that you know all too well how to recognize resistance. Resistance can be difficult to identify, however, especially for new counselors and new supervisors. Responding to the many threatening experiences that humans face from childhood through adulthood, people may unknowingly develop very artful and socially acceptable methods of manifesting their resistance. Of course, some methods are less artful.

Recognizing forms of resistance

Some forms of resistance are easier to detect than others. My interest in this subject came from my experiences as a counselor and as a supervisor. I noticed that sometimes I would come out of a session feeling what I called “yucky,” but I didn’t really know why. Things seemed fine, but for some obscure reason, I did not feel good about the session.

Then I came across some old literature about how resistance manifests in supervision, written by Cheryl Glickauf-Hughes, that changed my world. First, I started saying things like, “I do that to my supervisor,” and “I feel like that.” Then, when I was counseling or supervising others, I suddenly heard what I had not been able to hear previously: resistance. In my new exuberance, however, I quickly picked up on an attitude from other professionals of “We don’t use that word.”

The conclusion I finally reached after an extensive literature review on the different linguistic substitutes for the word resistance is that no word stands alone without using resistance to help define it. To me, this says that turning away from use of the word resistance is not really feasible. However, it is feasible to harness the constructive power of resistance by using it to create relationship. But to use this tool, we need to be able to identify resistance in its various forms.

Game playing

Game playing may be used as a form of resistance either consciously or unconsciously. Either way, it is deployed as an attempt to maintain control. I think of it as a type of shell game in which attention is drawn elsewhere to get the player (i.e., the counselor or supervisor) to lose his or her place. Esteemed social worker Alfred Kadushin wrote about game playing; what follows in this section is a synthesis of some of his ideas combined with some of my own.

One game-playing technique is flattery, which is used to deflect counselors or supervisors either from confrontation or their evaluative agenda. Flatterers are the clients or supervisees who can talk for 20 minutes about the counselor’s or supervisor’s outfit, the office décor or even the “game” the other night, secretly hoping that the counselor will run out of time to address some important aspect of the prior session or the supervisor will run out of time to look at their session recording.

Other types of game playing may include:

  • Redefining the relationship, in which the client or supervisee creates ambiguity.
  • Self-disclosure, in which the client or supervisee talks about himself or herself through telling stories. Clients might do this by skipping from one story to another, giving no time for reflection or comment. Supervisees might use storytelling about self or clients, engaging the supervisor so there is no time for skill correction.
  • Trying to reduce the counselor’s or supervisor’s power, in which clients or supervisees attempt to show that they are more intelligent than the counselor or supervisor.
  • Working to control the situation with the direct use of questions that can steer conversation away from the client’s or supervisee’s areas of anxiety.
  • Focusing on failure and seeking reassurance.
  • Allowing helplessness to feed into dependency by working to implement every single word that the counselor or supervisor shares in session.
  • Practicing self-protection by externalizing blame for their lack of growth on the counselor or supervisor.

It is important to remember that playing games is designed to create safety and protect the self.

One simple way to work with game playing is role induction. Clients and supervisees have constructed coping strategies (resistance) that have served them well. Typically, these strategies have evolved in an organic way and are outside of the client’s or supervisee’s awareness. We can help these individuals understand that counseling or supervision can be stressful and that clients or supervisees may develop certain behaviors as a way of dealing with their anxiety or stress. In normalizing this process, it becomes less threatening.

You could provide your clients or supervisees with a list of behaviors, thoughts and feelings that they might experience during your work together, then invite them to freely point out these behaviors, thoughts and feelings to you as they notice them. This broaching process becomes a step toward creating a collaborative relationship. As they point out their own resistance, you can be appropriately curious about it and then thank them for bringing it to your attention. Often, clients and supervisees will not call attention to their own resistance. However, as they grow more aware of it, they may choose to lay these behaviors down in an effort to use their time more wisely.

Developmental causes of resistance

Another way to look at resistance is through a developmental lens. It has been proposed that manifestations of resistance can have roots in the unsuccessful completion of Erik Erikson’s developmental stages. What would we listen for if we used this framework in our counseling or supervision sessions?

Trust versus mistrust: When clients or supervisees have not fully learned to trust others, the anxiety produced in an ambiguous setting such as counseling or supervision may create enormous tension. In many instances, those who have not successfully navigated this stage have experienced parents, guardians or other authority figures as harsh, critical or unaccepting of them. Often, they expect to be rejected by their counselor or supervisor.

This lack of trust can be recognized by clients’ or supervisees’ maintenance of distance in the relationship; they may seem closed, guarded, defensive and extremely self-sufficient. Identifying these traits is essential to using this information to strengthen the relationship and create collaboration. Glickauf-Hughes suggests that when working with those who are distrustful, taking a person-centered, nondirective approach can help them to feel safe and may provide a corrective experience. Consider letting them know that you can tell they are a bit guarded; ask them whether they have been hurt in the past and whether they are concerned that you might also hurt them.

Autonomy versus shame and doubt: Clients or supervisees who struggle with issues surrounding the need for autonomy can be confusing for counselors and supervisors. Erikson warned that controlling others helps those without a sense of autonomy to feel in control of their own lives.

Often, those who struggle with autonomy cannot quite put a name to what they want, but they can clearly identify what they do not want. They often vacillate between seeking direction and then dismissing the very information they sought. An exchange with someone who struggles with autonomy might sound something like this:

Counselor: “Mary, I hear you saying that this situation is irritating you.”

Mary: “I’m not irritated, I’m frustrated.” 

To protect their personal freedom, these individuals may mince words or say things like “yes, but …” — anything not to accept influence from others.

Glickauf-Hughes and Linda Campbell suggested three ideas for working with those who struggle with autonomy: Socratic questioning, homework, and healing stories or puzzles. These strategies put power directly into the hands of clients or supervisees, allowing them to arrive at the answers they seek without things being laid out for them explicitly. Interestingly, this is helpful even when resistance is not present. Most people enjoy finding their own answers; it increases their self-efficacy and helps them to feel autonomous. This is exactly why it works so well for those with issues of autonomy.

Those who have not successfully navigated the aspect of shame versus doubt are particularly sensitive to any confrontation or feedback, even when it is done with extreme care and sensitivity. Issues of shame originate within relationships and indicate to the individuals being shamed that, somehow, they themselves are unworthy or defective. Unfortunately, shame can be so internalized that it becomes self-activated and no longer attached to an interpersonal event. This may present as clients or supervisees being so hard on themselves that it preempts any possible feedback from others.

This ultra-vulnerable type of person is, in some ways, reminiscent of a sensitive child. This makes sand tray therapy or sand tray supervision an excellent tool for working with clients or supervisees who have internalized shame. For those who believe intrinsically that they are somehow unworthy or defective, the sand tray is a wonderful avenue for them to look at issues and dynamics in a nonthreatening way. The figures become a buffer between these individuals and the counselor or supervisor, protecting the ego from further damage. This is less threatening for supervisees because they can work out the dynamics they are witnessing with their clients. Sand tray therapy or sand tray supervision can also create self-awareness. When incorporated with Carl Rogers’ core conditions, this can cause confidence to grow and doubts to recede among clients and supervisees.

The use of positive reframes can also be used to reduce anxiety and increase receptivity to change. Mark A. Masters suggests that positive reframes should be designed to emphasize the client’s or supervisee’s experience of personal power and self-esteem. The use of positive reframes is most useful when three different components are present.

First, the reframe empowers clients and supervisees by improving their self-reliance and motivation. Second, most behaviors can be asserted in a positive connotation. This can increase clients’ and supervisees’ sense of safety within the counseling or supervisory relationship, thereby promoting reflectivity and growth. Finally, the positive reframe is most useful when it models more effective ways of dealing with the person’s thoughts, feelings and behaviors. When all three of these components are applied together, they can create a powerful alliance that furthers clinical development. Glickauf-Hughes emphasizes that when reframing, the counselor’s or supervisor’s word choice needs to be mild and should evoke curiosity in the client or supervisee.

Identity versus role confusion: What about the client or supervisee whose fundamental issues with others involves the developmental stage of identity versus role confusion? This fragile sense of self can come into play as clients and supervisees strive to find their confidence or shift their already-fragile identity. In this case, learning from the counselor or supervisor would mean merging with him or her, so clients and supervisees in this developmental stage steadfastly hold to their current identity. Signs of this resistance can come through expressions of contempt (such as eye rolling and other demeaning behaviors and statements), often appearing argumentative or expressing directly or indirectly that all other modes of being (for the client) or all other theories (for the supervisee), other than their own, are without value.

Metaphors can provide a means to use what a person already knows and relate it to even more complicated information in a way that transfers the learner’s original understanding to the new situation. The use of metaphors, or the process of transferring information from the known to the unknown, can enhance the learning process and create an atmosphere in which resistance improves emotional connection. For those who feel their identity threatened, the use of metaphors, jokes or Socratic questioning can help them find their own answers. This maintains their identity and prevents them from rejecting the information.

Externalizing issues can also reduce stress in the client or supervisee, again allowing both learning and a better relationship. For example, let’s say your client with a talent for writing music has a goal to develop relationship skills to create a more satisfying social life. Relating the client’s goal to something with which the client is familiar may transfer his or her understanding of one skill to another. In this case, you might first create a theme for the type of song or type of social life the client wants. Let’s imagine it will be a ballad because the client is looking for an intimate relationship. Next, a basic melody is plotted out (what type of person is the client looking for?). Then the lyrics are sketched in (does the client believe this type of person already exists in the client’s current social circle?). Add some harmonies (how can the client enlarge his or her social group?). Once the basic song is set, the addition of instrumentation, percussion and orchestration develops the song into a masterpiece, with all of the different pieces adding to the complexity and beauty of the finished product (how might the client expand the types of activities that he or she enjoys — sports, theater, reading, dancing, outdoor recreation and so on?).

Metaphors, in the form of stories or drawing activities, allow clients and supervisees to depict themes, issues and relationships in their lives or their clients’ lives. At the same time, the use of metaphors leaves the identity or newly emerging identity of the client or supervisee intact.

Motivational interviewing

Motivational interviewing can broaden our view of resistance in a way that can be applied to the supervisory relationship. William R. Miller and Stephen Rollnick, the primary developers of motivational interviewing, explore using resistance to increase connection. Rolling with resistance — which simply means being curious about it — can strengthen relationships and depathologize resistance as normal. Supervisors can easily detect resistance in supervision and can choose to employ some basic motivational interviewing responses to join with the supervisee and open the door to exploration.

Developing the discrepancy: Imagine a supervisee who presents as needing assistance and guidance in working with a difficult client, but when provided with that guidance, responds with, “I don’t think that will work because I already tried ________” or “I don’t think the client will respond well to that because of ________.” 

Developing the discrepancy involves acknowledging what the supervisee wants and then also acknowledging the difficulty the supervisee has in accepting this help or guidance when it is offered. The supervisor’s response might be along these lines: “This sounds like a really challenging client. I hear that you really want help moving forward with the client, and I notice that it’s hard to hear some of the suggestions that I have.”

The specific use of and instead of but in this example is important. And creates the possibility that the supervisee can exist in both worlds — one of wanting help and another of rejecting it. Embracing the ambivalence that a supervisee might feel in supervision can open the possibility for the supervisee to explore what it feels like to be needing connection and resisting it at the same time. And it’s also possible that the supervisee’s client feels the same way — an example of parallel process.

Agreeing with a twist: Being a supervisee is hard work. The courage it takes to present clinical work that is mediocre and the vulnerability required to sit with a supervisor and watch the “magic” unfold can be unnerving. “Agreeing with a twist” refers to reflecting on the risk that a supervisee takes when sharing difficult sessions with a supervisor (especially when the supervisee is not yet in a place to be vulnerable and courageous) and then providing a reframe that opens discussion.

Imagine a supervisee who seems to select sessions or cases to discuss in supervision that aren’t of substance or that don’t allow many opportunities for constructive feedback. This behavior could indicate that the supervisee is protecting his or her already-fragile ego from potentially critical or damaging feedback. Addressing this in supervision is tricky. Agreeing with a twist might sound something like, “It can be so hard to watch sessions that you don’t think are great. I remember what that felt like when I was in training. What are some of your concerns about showing me your not-so-great sessions?”

This example is a three-part equation:

1) Acknowledging and validating the supervisee’s experience.

2) Offering a simple self-disclosure that deepens the reflection.

3) Asking an open-ended question that gets at the heart of what is happening, apart from the actual case the supervisee has brought to discuss.

This method of “caring confrontation” serves to invite the supervisee to share his or her fears of negative evaluation. It also allows the supervisor to assuage those fears and build the kind of relationship in which a supervisee can share “not so great” work without sacrificing a piece of his or her ego.

Using OARS as a basic model for resistance-free supervision: At its core, motivational interviewing is person-centered. Simple strategies for supporting, inviting and engaging supervisees early in the supervisory relationship are often overlooked. OARS is an acronym that can serve as a reminder to supervisors (and counselors) that the basic skills of open-ended questions, affirmation (support, appreciation and understanding), reflective listening and summarizing are absolutely essential and can foster connection, openness and curiosity in both supervisees and supervisors (and clients and counselors).

 

Conclusion

The usefulness of any tool involves its accessibility and effectiveness. The beautiful aspect of resistance as a tool is that it is consistently present in some form. It is always available to strengthen the counseling or supervisory relationship. Try using the tools we have suggested in this article and working to identify strategies that can reframe resistance in positive, collaborative and nonpathologizing ways. Resistance provides opportunities to connect, engage, be curious and, ultimately, foster the kind of counseling and supervisory relationships that create growth and change.

 

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Special thanks to Ray Backlund, coordinator of the New Mexico State University dance program, who holds a doctorate in counselor education and supervision, for sharing his connection between ballroom dance and positive uses of resistance with supervisees.

 

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Michelle Backlund is an assistant professor and clinical director of the master’s program in the Counseling and Educational Psychology Department at New Mexico State University. Identifying positive uses of resistance to enhance all types of relationships is a major part of her research agenda. Contact her at micback@nmsu.edu.

Veronica Johnson is an associate professor and chair of the Department of Counselor Education at the University of Montana. Her research interests are intimate relationship development and maintenance, forgiveness in intimate relationships and clinical supervision. Contact her at veronica.johnson@mso.umt.edu.

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