Tag Archives: Licensure

Understanding how counselors are regulated

By Brian Carnahan and Christin Jungers November 10, 2015

The mission of occupational licensing boards is public protection. In essence, that means a licensing board exists to ensure that unqualified persons do not practice in a profession. Licensing boards do this by applying a set of standards to determine minimum qualifications. Supporting licensees and applicants is important, but protecting the public is the first order of business.

A board should not be working against the profession it regulates; however, it is also not working to promote it. Understanding this helps to explain some of the decisions a professional licensing board makes. Although the board wants to support licensees as much as possible, it has to balance its public protection role with an obligation not to interfere with the appropriate practice of the licensed professions.

Boards are created by an act of law. The state passes enabling legislation that gives the board the authority to act. Laws can be influenced by the board and stakeholders, including licensees. Depositphotos_10710853_l-2015Nonetheless, once laws are enacted, they can be very inflexible and difficult to change. Those changes that do occur must be carefully considered to avoid negative consequences.

Licensing boards develop rules and regulations that are the means by which the law is put into effect. These rules lay out the details of what the law authorizes. In Ohio, the Joint Committee on Agency Rule Review, a committee of the state’s House and Senate, approve such rules after a period of public comment and review. This body ensures that licensing rules conform to the law and that the board is properly fulfilling its duties.

Generally speaking, rules are more flexible, and therefore can be changed as circumstances require. For example, a board may implement a rule regarding social media in response to concerns over its use. The rule is developed based upon laws regarding professional boundaries that do not specifically mention social media but that provide a conceptual framework for regulating how professionals manage boundaries with clients. In setting rules, a board is attempting to address issues and questions that arise for its licensees or to act responsively to current developments within the profession, with the goal of balancing the needs of the public and licensees.

Policy is another area in which requirements can be established. Policy rounds out the details on the rules and often addresses processing issues. For example, a board may have a policy regarding how it can be notified of a name change or how documents may be submitted — for instance, via email or postal mail. A board establishes policy, although it may be implementing policy from another authority, such as a gubernatorial administration. Policy is very flexible and subject to relatively rapid change. However, policy cannot be established that would be considered contrary to the law or rules.

Boards usually complete their work through a variety of committees. In the case of Ohio, there are three professional standards committees, one for each profession (counseling, social work, and marriage and family therapy), in addition to other standing and ad hoc committees. The committees review applications using the law and rules as a basis for their decisions, respond to practice questions, review investigations and provide specific, professional expertise that assists board staff in enforcing the laws and rules.

Boards and commissions usually have an investigation and enforcement obligation and, therefore, often have a unit working in these areas. Laws and rules concerning ethical standards of practice must be enforced for licensees and, depending on the state and its laws, for those who are not licensees but who claim to be a licensed professional. The perceived threat of investigation or sanction of one’s license following an investigation is often of great concern to licensees. Moreover, the investigative process may frustrate licensees if they feel a complaint is unfounded.

Although some discretion exists regarding how a board can act at the conclusion of an investigation, the board’s public protection role must ensure that persons who are a threat to the public are not allowed to practice without consequences. Consequences can be minor. For instance, a licensee might receive a written warning that something in his or her professional behavior was suggestive of unethical practice (e.g., a pattern of failing to keep case notes up to date or taking notes home when those notes should be kept private and confidential).

In some extreme cases of ethical violations, a board also has the right to suspend or revoke a professional’s license. It is important for licensees to know, however, that complaints are treated carefully and respectfully and that investigators and board members bring an open mind to an investigation. Just because a licensee is named in a complaint does not mean that he or she is necessarily seen as having violated professional ethical standards. Board members regularly engage in lively dialogue about ethics issues within the profession. These discussions, which are sensitive to the board’s rules and regulations but also represent a diversity of perspectives, inform decisions that involve licensees.

Licensing boards also have a compliance function. This is the activity that occurs after a licensee is disciplined. Compliance staff ensure that licensees properly follow consent agreements or other disciplinary tools — for example, random drug testing or additional training and supervision. The compliance process is in place to protect the public, while also helping licensees to regain their right to practice. The compliance function also assists in setting expectations as compliance practices are discussed among licensees.

Boards are affected by the administrative and political environment. Most regulatory boards, at least in the U.S., are public or quasi-public bodies. For this reason, boards cannot ignore the interests and issues of leading elected officials, which naturally form part of the decision-making environment. These officials’ key policy preferences can result in boards supporting certain rules or policies. For example, if an administration places great value on assisting veterans, the board might create a processing preference for veterans to ensure they are quickly licensed and ready to find employment.

It may surprise people to know that customer service is an important aspect of regulating. By answering questions and working with applicants and licensees, the board gains a critical impression regarding what is occurring in the field. Questions regarding ethics can point to a need to change regulations. Additionally, by providing quality customer service through calls and correspondence, boards ensure that licensees and applicants have the information they need to make the best possible choices regarding their practice.

A key role for boards involves providing education and information. This may be accomplished by providing ethics trainings, consumer pamphlets and publications, and updates on relevant laws that may affect practitioners. Although not formal opinions or pronouncements, trainings and similar activities can help enforce the laws and rules by addressing questions and delivering critical messages. Additionally, board staff can gain an understanding of the issues licensees are confronting, which in turn helps the board to make adjustments to laws, rules and in developing policies.

Partnerships can also be an important tool in properly regulating. Many boards form good relationships with public and private organizations that help ensure an effective regulatory process and keep board members abreast of issues that licensees face in their day-to-day work environments. A counselor advocacy group in Ohio, for instance, presented data to the board that showed professional counselors are underrepresented in clinical director positions at community mental health agencies. One compelling reason the advocacy group presented for this underrepresentation was that licensed counselors did not have requisite training in administrative supervision and could not, under Ohio’s rules and regulations, receive continuing education credit for attending such trainings. This presentation prompted discussion in the Counselor Professional Standards Committee about counselor professional identity, roles and responsibilities. Eventually, this led to adjustments in the rules and regulations governing CEU credits to allow for administrative supervision as an acceptable topic of training for licensed counselors.

The board also may rely on professional associations for information and feedback, while simultaneously encouraging these organizations to be actively involved with how members practice, in part by using their networks to share rules and policy changes. Distinguishing the roles of boards and professional associations can be tricky at times. Board members must be clear that their primary duty is not advocacy for the profession; that role often falls to the association. However, when boards are in regular communication with associations, their members are more likely to be informed of the contemporary issues facing the profession and are more capable of considering how contemporary professional issues affect licensees or should affect changes to rules and regulations.

On a day-to-day basis, the average licensee with sound ethics and a professional approach to practice should not be overly concerned about the existence of a licensing board. Nonetheless, understanding how the counseling profession and other mental health professions are regulated can help when attempting to address issues or understand why a new rule or requirement is in place.

 

Licensees may wish to consider the following as they engage their licensing boards:

  • Know the law and rules. Recognize that the board is responsible for following the law and rules. The law and rules cannot simply be waived. Occasionally, there are loopholes, but not often.
  • Learn who is on the board and how it operates. Attend meetings or public hearings. Know the limits of the board’s authority.
  • Recognize that laws, rules, policies and procedures exist for a reason. Requirements and restrictions typically exist in response to situations that have been identified over time. Regulators use their expertise and experience in creating rules and policies.
  • Share your opinion when asked through surveys and other requests. Comment on issues. The board and its staff can operate best when they are as up to date as possible with respect to what is occurring in your world as a professional counselor.
  • Remember that the public interest and protection of the public come first. But also recognize that board members and staff are often seeking ways to say “yes” to professionals’ questions and requests. Although we care about our duty to protect the public, we want to be responsive to those whom we serve.

 

****

 

Brian Carnahan is executive director of the state of Ohio’s Counselor, Social Worker, and Marriage and Family Therapist Board. Contact him at brian.carnahan@cswb.ohio.gov.

 

Christin Jungers is professor of mental health counseling at the Franciscan University of Steubenville and a member of the Ohio Counselor, Social Worker, and Marriage and Family Therapist Board. Contact her at cjungers@franciscan.edu.

 

Wanted: Inclusive licensure process for clinicians with difficult life situations

By Kevin Wreghitt September 11, 2015

Licensure is a “rite of passage” for most mental health professionals. When new professionals graduate with either a master’s or doctorate in counseling, they usually have great expectations of taking the world by storm. There is one pesky reality standing in the way, however.

I am of course referring to going through the multiyear licensure process, which involves taking a board exam and practicing under supervision for several thousand hours. In my case, this process Disabled parkinghas been more burdensome than I ever imagined because I am in a difficult life situation.

My birth was difficult, and I sustained significant brain injury because of a lack of oxygen. As a result, I have quadriplegic cerebral palsy and am confined to a wheelchair. I have random motion and a speech impediment. The use of my hands is poor to nonexistent, and because of this I can do few things for myself, relying on others for all my daily needs.

Nothing has come easily for me, but I have experienced many successes and surprises in my life. This is due to the hard work and perseverance of many people who have worked tirelessly with me and to my own determination to prevail despite the odds. I also demonstrated a few abilities from a young age. For example, I had an interest in helping others who were going through difficulties by listening to them and being present with them. My thought in early adolescence was that I should go into a field where I could help people with disabilities. Through the years, beginning in high school, I had a number of mentors in the counseling field, including some who were disabled themselves, who encouraged me to join the profession.

I always did well in school, attaining high marks and honors in high school and beyond. When I graduated from high school, I went on to college and then graduate school. Because of my disability, it took me about twice the time as other students to complete my undergraduate and graduate degrees. By the time I finally was done, I was in my mid-30s. My major in graduate school was mental health counseling. Upon finishing, I had planned to go through the state licensure process. This is when some of the toughest obstacles in my life began.

 

Hitting a brick wall

There were multiple considerations I had to think about to make my “dream” a reality. For the sake of simplicity, I will boil it down to two general factors. The first was my disability and how I would be successful in gaining employment with my type of challenges. The second factor was going through a licensure process. Both of these factors interact.

I worked with two rehabilitation counselors and other community career counselors plus my own therapist. I went on some interviews, but many of my inquiries simply went unanswered. After six months to a year of being rejected, I became frustrated. I continued looking for another year, at which point I had to quit because I found the whole process soul destroying. From talking to people, I gathered I could not third-party bill because I did not have a license, and this was a major obstacle to obtaining employment in the field.

I was tired at that point of looking around for other placements. So, in 2009, I found a volunteer job as a mental health clinician counseling people with intellectual disabilities. I had to hire my own supervisor because there were no counseling professionals on staff, but I began trying to accrue hours for licensure. I wanted to clear the “examination hump,” so I took that in 2011 and passed.

All this time, I was seeing very few clients because the population served by the day habilitation facility was considered too severe to be counseled. At the same time, I knew I had a total of 3,360 hours to fulfill for state licensure in Massachusetts. With so few clients available, I had difficulty gaining enough hours, even on a six-year part-time basis. During the past six years, I have looked periodically for other volunteer opportunities, but for whatever reason, other places never materialized.

 

The psychological toll

As with any disappointment or heartache in life, this experience has been a daily rollercoaster. It has really caught up with me in the past couple years, and this year has been the hardest so far. I guess that is because I am nearing 50 and it looks doubtful that I will achieve the type of career I dreamed of so long ago. I feel like I am still back in my 20s and no further along in my career aspirations. I still feel like a student or an intern who is just learning when I should be capable of practicing on my own with expertise, specializations and much experience.

I keep wondering how I got into this mess. What didn’t I see or plan for? Where was the point where I went wrong, and should I have known it? Was I ever meant to be a counselor, or was it all just a pipe dream gone terribly wrong? Was all that effort, all these years, all for nothing? Who am I anyway? These are the questions that haunt me daily.

I do not want people to feel pity for me. That is not the purpose of this article. Most of us in the counseling profession know that we respond with empathy not pity. To correct or manage a problem, we first have to understand it and how it impacts people. This is a core principle in our profession, and I hope by briefly explaining how deeply disappointed I am about this whole situation, perhaps counselors can begin to understand this problem — not only for me but for others who find themselves in similar situations, dealing with a disability or other difficult circumstances, who try to obtain a start in the counseling profession.

 

What the literature says

Despite claims that counseling is a scientific field, the profession (and related others that practice psychotherapy) has failed to validate what it takes to be an effective counselor. All the states seem to have differences in the total number of supervised hours needed to qualify for a counseling license, although it seems to be 3,000 on average. I once posed the following question on the ACA Connect forum: “Where did the number 3,000 or more hours and all the subtotals come from and why?” Nobody could or would answer this question.

Paul Lowinger published a study in the Journal of the National Medical Association in 1979 saying that nonprofessionals could diagnose 70 percent of psychiatric outpatients and that an even larger proportion (80 percent) of 36 patients evaluated could be treated by nonprofessionals. In 1967 in the American Journal of Public Health, Truax reported therapeutic mastery with five novice counselors who took a 100-hour training course.

In a 2005 study that appeared in the Journal of Consulting and Clinical Psychology, Wampold and Brown found factors such as the therapist’s age, gender, education and experience had little effect on client outcome. Nyman, Nafziger and Smith, writing in the Journal of Counseling & Development in spring 2010, pointed out the possibility that supervised paraprofessionals might be as beneficial as licensed and advanced clinicians. In the March 2014 issue of Counseling Today, R. Tyler Wilkinson commented about the inequities of the licensure process (“The Affordable Care Act and counselor licensure”). It is as if the profession and the states have said to candidates who struggle, “You’re good but not good enough” when some of those candidates could be effective therapists.

It appears to me from this brief analysis that the high bar of total clinical hours is arbitrary and not based on real objective proof. In fact, some research would suggest that one could make due with fewer post-degree clinical hours and still perform just as well as those with the thousands of hours now required. In my view, the licensure laws around the country seem created mostly out of subjective cognitive constructionist criteria rather than being based on objective standardized measures designed to benefit society.

 

Achieving licensure inclusion

The American Counseling Association (along with its divisions and branches), outside organizations such as the National Board for Certified Counselors and the states need to work toward inclusion for licensure. If a person wants a license, he or she should be given every chance to achieve that status. Here are a few ideas:

  • Counselor education programs could have two-year residency periods so that universities would be responsible for placements and assist with supervision after graduation, similar to what medical schools do.
  • All students should be educated about the licensure process as part of their course work or by attending extra seminars. They should also be made aware of alternative career paths within the mental health field in case counselor licensure is not a practical pathway for them.
  • Students with disabilities should be encouraged early on to seek counseling about licensure from faculty.
  • State boards should be consulted early about unique circumstances that may require special accommodations.
  • Achieving licensure should not be the only way to be paid in the mental health field. There should be another certification that is recognized by insurance plans, the government and the profession when an individual obtains a degree and is working toward licensure.
  • The licensure process might be able to be streamlined if a new national standard were adopted, with all states and professional organizations agreeing on a uniform number of hours and other requirements needed for licensure.
  • Some states may need to modify rigid licensure laws to allow licensure boards more flexibility in dealing with special circumstances while still complying with competency standards.
  • A robust and active disability interest network needs to be established within ACA to, in part, advocate for counselors with disabilities.
  • Employers in counseling centers need to be educated about the unique opportunities inherent in employing a counselor with a disability, no matter the severity of the limitation. People striving through adverse situations may make some of the best therapists.

The road toward licensure inclusion will be long, but we have to take on this challenge. The counseling profession preaches cultural diversity, but when a person with a different set of life circumstances comes along, I find there is little consideration given to that person. The profession may drive away capable people by promoting high standards without providing a way for those professionals to succeed.

I understand that the counseling profession has to protect the public, but we can do this while providing extra support in becoming credentialed. For the profession to achieve the ideals ACA has set forth, we need to be more inclusive — not exclusive — in licensure and employment practices.

 

Conclusion

This article asks what the soul of the counseling profession really is. Are we content to exclude potential licensed professionals because they have difficult life situations, or do we welcome them into the practice of counseling? Disability, financial concerns and difficult family situations, among other circumstances, may be keeping some people from achieving licensure.

I do not know if I will ever become licensed, but I hope this article might change the way licensure is handled and give new professionals in difficult life situations a chance at this wonderful achievement. There has to be a way!

 

****

Kevin Wreghitt is a mental health clinician counseling people with disabilities in day habilitation and college settings in Massachusetts. Contact him at kevinwreghitt@verizon.net.

 

State licensing boards asked to adopt uniform scope of practice, licensure title

By Bethany Bray July 20, 2015

This summer, state licensing boards across the United States are being asked to accept both a uniform scope of practice and a common licensure title for professional counselors as part of an effort to improve license portability for counselors.

Letters, cowritten and signed by the leadership of the American Counseling Association (ACA) and the American Association of State Counseling Boards (AASCB), were finalized and sent last month.

The two organizations are requesting that state licensing boards adopt a uniform professional title – licensed professional counselor (LPC) — and scope of practice, a five-paragraph job description that defines the work of professional counselors.

portabilityMore than 35 different license titles are currently in use by professional counselors across the country. Scopes of practice for professional counselors also vary state to state.

This summer’s letter is the culmination of the Building Blocks to Portability Project, which was part of 20/20: A Vision for the Future of Counseling, a yearslong strategic planning initiative that ACA and AASCB co-sponsored.

For more background on the profession’s license portability issues, read Counseling Today’s April feature, “Addressing counseling’s portability crisis.”

See a sample of the letter being sent to each state licensure board here.

See ACA’s announcement about the letter, including the full scope of practice for counselors, here.

 

 

****

 

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook: facebook.com/CounselingToday

Addressing counseling’s portability crisis

By Bethany Bray March 26, 2015

Summer 2019 update: The American Counseling Association has created a state-by-state guide with updated information on licensure requirements across the country. Go to counseling.org/knowledge-center/licensure-requirements for information on licensure in your state or U.S. territory.

****

 

It’s a frustrating scenario that happens all too often. A counselor moves to a new state and finds that although she has been practicing and licensed for years (or sometimes even decades), she doesn’t meet the requirements to become licensed in her new place of residence.

That’s because counselor licensure titles and requirements across the United States still vary from state to state. Even the most veteran counselor might need to secure additional supervision hours or meet other requirements to become licensed after moving across state lines.

However, this may not be the case for too many more years. The American Counseling Association and the American Association of State Counseling Boards (AASCB) are working on two separate initiatives aimed at solidifying professional counselor identity and turning licensure portability into a Branding-Box-airplanereality. State licensing boards will be receiving two letters in the coming months, each requesting changes that might make it easier for counselor licenses to transfer from state to state in the future.

“I see this [license portability] as the most important discussion point in the regulatory process for our profession,” says Bill Green, a past president of AASCB and chair of the Professional Counselor Examiners Committee, which regulates the practice of professional counseling and rehabilitation counseling in New Jersey. “My goal is to see portability in my lifetime. I’m 66, and I’m optimistic.”

The first of the two letters will ask state licensing boards across the United States to adopt a uniform professional title — licensed professional counselor (LPC) — and a uniform scope of practice, a five-paragraph job description that defines the work of professional counselors (see sidebar, below). This letter is the culmination of the Building Blocks to Portability Project that was part of 20/20: A Vision for the Future of Counseling, a yearslong strategic planning initiative that was co-sponsored by ACA and AASCB.

The second letter will introduce the AASCB Five-Year Portability Proposal. This idea, developed and endorsed at AASCB’s annual conference this past January, would encourage state licensing boards to grant licenses to counselors who move into their state with at least five years of professional experience and a license in good standing in their previous state.

The first letter will be a joint message from AASCB and ACA, co-signed by the presidents of both associations. The second letter will be from AASCB alone, says Susan Hammonds-White, AASCB president. The two letters will be sent to licensing boards in 52 jurisdictions, which includes all 50 states plus Puerto Rico and the District of Columbia. Both initiatives aim to make counselor licensure more portable and uniform across the country.

License requirements for counselors were set up state by state over a period of decades — beginning with Virginia in 1976 and ending with California in 2009 — as the profession matured and pushed to establish itself. But in the process, significant disparities arose between counselor licenses across the United States, from the number of supervision hours required to obtain a license to the license titles themselves.

More than 35 different license titles are currently in use by professional counselors across the country, points out David Kaplan, ACA’s chief professional officer. Kaplan, a past president of ACA who has worked as a counselor and counselor educator, says the profession is currently in the midst of a “portability crisis.”

In an age when people are more transient, the state-to-state license disparities routinely pose a hardship for counselors, says Hammonds-White, an ACA member and LPC in private practice in Nashville, Tennessee. She believes the counseling profession has reached a stage of development and maturity that will now allow it to address those disparities.

“We’ve been a profession long enough now to have enough longevity and enough people who have been in the field for a while to be able to look at ourselves in a more unified way,” she says.

In the counseling process, it is key for the counselor and the client to understand and trust each other. The same holds true for the factions within the counseling profession, Hammonds-White says. “Maybe we’re doing that [trusting] at a more national level. Maybe what we’re saying is, ‘I see you. I see you as legitimate. I accept what you have chosen to do in your state … [and] I’m OK with you becoming a counselor in my state.’ I see it as another step in the process of connecting across the country,” she says.

According to Kaplan and Hammonds-White, ACA and AASCB receive more calls and questions from counselors about licensure portability than any other issue. Kaplan says ACA headquarters receives at least 10 calls per week from members who are facing challenges related to licensure portability, including those who are moving because of a new job, a life change such as a marriage or divorce, or a spouse who is in the military.

“It’s the single biggest issue we get calls about,” Kaplan says.

A move toward uniformity

The joint letter from ACA and AASCB is expected to be sent this spring, according to Kaplan. A draft was being written as this article went to print.

Co-signed by Hammonds-White and ACA President Robert L. Smith, the letter will formally request that state licensing boards take necessary action to adopt licensed professional counselor as the professional title in their state, along with the five-paragraph scope of practice for counselors.

In certain states, making such changes will take time and may pose a challenge. “We’re asking states to do something that is hard for states to do, which is to open their statutes,” Hammonds-White says. “Depending on the political climate to a degree, opening the statute, you have to be a little watchful about doing that. [However], we hope that some states will be able to do this relatively easily.”

The procedure will vary from state to state, Kaplan explains. Some licensing boards have the ability to change regulations on their own, while others must first petition their state legislature. He is hopeful that some states will adopt the counselor license title and scope of practice within the next year, with a majority of state boards following suit within five years.

“It’s kind of like a wave,” Hammonds-White says. “If we get enough states to get a critical mass going, other states will look at what’s being done and [decide] to get on board. It’s kind of like the domino effect.”

Having a uniform license title and scope of practice rather than the hodgepodge of different titles and job descriptions that currently exist for counselors across the United States should help remove at least two of the obstacles to license portability for counselors, Kaplan says.

This past fall, there was widespread endorsement of both a single licensure title (LPC) and a scope of practice for professional counseling among the 31 major counseling organizations that participated in the 20/20 Building Blocks to Portability Project. Of the 29 organizations that ultimately voted, only the American Mental Health Counselors Association voted not to endorse the common licensure title, while the National Rehabilitation Counseling Association voted not to endorse the scope of practice.

[Editor’s note: The American Rehabilitation Counseling Association (ARCA) voted against accepting the scope of practice last fall. However, the organization changed position and voted to endorse the scope of practice at the 2015 ACA Conference and Expo in March.]

“Being able to say that the profession of counseling accepts this [licensure title and scope of practice] really gives it gravitas. … This shows we’re working on [portability] and making progress,” Kaplan says. “It won’t be immediate, but it’s progress.”

The five-year proposal

The counseling profession’s leaders are taking a multipronged approach to addressing licensure portability, Kaplan says. The scope of practice and licensure title constitute one prong, while AASCB’s five-year proposal represents another prong.

“We need multiple fronts on this,” he says. “There’s no one magic answer that will solve everything as it gets complicated.”

The AASCB five-year proposal will recommend allowing licensing boards to grant licenses to counselors who move into the state with five or more years of experience and a license in good standing from their previous state. Some states might also choose to require a jurisprudence exam, Hammonds-White says.

“This is AASCB’s response to the concerns that we hear, as board members, all the time regarding portability,” she says. “We hear from counselors who move with years, even decades, of experience, and in most circumstances they have to meet the requirements of their new state, which may mean more supervision hours. … We see the effects on people’s lives. We’re very committed to working on portability.”

AASCB will draft a letter asking states to adopt the five-year proposal in the coming months, after the joint letter regarding the uniform scope of practice and preferred licensure title has been sent, Hammonds-White says.

As is the case with the request concerning the scope of practice and licensure title, adoption of AASCB’s five-year proposal would require some states to modify their statues. In New Jersey, for instance, it could take a full year to make such a significant change, says Green, a longtime ACA member and retired professor of rehabilitation counseling at the University of Medicine and Dentistry of New Jersey, which has since merged with Rutgers University. “Counselors need to recognize that any changes we’re proposing require regulatory and statutory process, and that takes time,” he says. “If we can get this conversation, this dialogue, started now, we can make for a quicker passage of any kind of regulatory or statutory changes that need to be made.”

Here, too, Hammonds-White hopes to see a domino effect, with licensing boards adopting the idea as they see other states doing so.

The idea that eventually grew into the five-year proposal was first mentioned and discussed at AASCB’s annual conference in the winter of 2014, according to Hammonds-White. Members were receptive to the idea and returned to AASCB’s 2015 conference in January having spent the year giving it serious thought. “We discussed it more [in January] and really decided it was the way to go,” Hammonds-White says. “It became a proposal, something we feel will work. … As the conference closed, we introduced this proposal for [AASCB] state representatives to take back to their state counseling boards to take a look at.”

Hammonds-White, Kaplan and Green moderated a closing session on license portability at AASCB’s January conference, which was held in Savannah, Georgia. Green calls the proposal “a more creative way of looking ahead.”

“We want to make sure all voices are heard, but at the same time keep AASCB as an independent voice for the regulatory process for our profession,” he says. “We want to make sure we’re doing what’s in the best interest for [the licensing boards’] role, which is to protect the public.”

Keeping the momentum going

Once the two letters are sent, ACA and AASCB will follow up with state licensing boards to provide support and offer any assistance they may need to ensure the five-year proposal, scope of practice and licensure title are adopted, Kaplan says.

The best way for counselors to keep the momentum going is to contact their respective state counseling associations and licensing boards. It will be helpful if counselors let these entities know that the issue of portability is important and that counselors support the ACA and AASCB initiatives, agree Green and Hammonds-White.

“This is the time to step up to the plate,” Green says. “I hope counselors recognize that they have the right to address [portability] concerns with their state licensing boards. [Getting involved] will help move things along.”

Green, Kaplan and Hammonds-White get the sense that the counseling profession will be receptive to the portability proposals from AASCB and ACA — much more so than might have been the case even five years ago. Trust and cooperation between states has increased dramatically during that time, they agree. Hammonds-White points out that two states, Louisiana and Iowa, already accept out-of-state licenses from counselors with five or more years of experience, much as the AASCB five-year proposal hopes to achieve.

“We’ve seen so many significant changes in our profession in recent history,” Green says. “A couple of years ago, people would have said this [portability] could never happen. We’ve been able to have a very mature conversation with all the players. … I’m proud of the fact that ACA and AASCB are willing to take these creative steps as a way to address portability. There are challenges, but I’m confident and hopeful this could be a way to address national portability.”

New Jersey’s Professional Counselor Examiners Committee met in February. Green, its president and chair, says he explained the upcoming portability initiatives to members as well as the two letters that will be arriving in the coming months. “We’re ready to begin the process in New Jersey,” he says. “We’re starting to get our ducks in order.”

New Jersey already uses LPC as the professional title for counselors. However, if the board decides to adopt the scope of practice and five-year proposal, it will require a statutory change, Green says.

At the same time, New Jersey is ahead of the game when it comes to portability because the state licensing board has the ability to waive some of the statutory requirements for counselors who have three or more years of experience in another state, Green explains. This is considered on a case-by-case basis, he adds.

Looking ahead

Portability is a complicated issue, and these initiatives won’t be a total solution for the challenges counselors face in this area, Kaplan says. However, they do offer a step in the right direction and represent movement on a topic that may need to be untangled for years to come.

For example, AASCB discussed two portability ideas at its January conference that are still in the development phase. The first would involve licensure reciprocity between states that share a border, such as Tennessee and Kentucky. If the idea were to come to fruition, state licensing boards could set up an agreement to accept counselor licenses from a neighboring state, and vice versa, Hammonds-White says. This would make circumstances much easier for counselors who live near the border of two or more states.

The second idea is for regional agreements. In this scenario, multiple states within a region — for example, New England or the Southwest — would agree to accept licenses from practitioners who move state to state within the region. These types of interstate compacts “involve a whole lot of legalities,” Hammonds-White acknowledges. “We’re just starting to look at the idea.”

In addition to the five-year proposal, these ideas, though still in the development and discussion phase, show that AASCB is committed to working on portability, Hammonds-White says.

“State licensing boards have done an admirable job of complying to legislative statutes by establishing regulations to protect the public,” Green says. “That is the primary goal of all licensing boards, to protect the public. … We have certainly done that, and I’m very proud of our states. But I also recognize that it’s a very transient profession. Counselors are constantly moving from state to state. We see that in the emails and phone calls that ACA and AASCB receive. We take this as a very responsible challenge for us.”

 

****

UPDATE:

Counseling licensure board representatives from Tennessee, Kentucky, Virginia and West Virginia met at the ACA 2015 Conference in Orlando to discuss an interstate compact for counselor licensure. On Friday, March 20, Kentucky and Tennessee signed the agreement and the other two states are moving forward to implement the compact. This is the first advancement of an interstate compact for reciprocity of counselor licensure within a region.

[Editor’s note: This news came to fruition after the above article went to print.]

 

****

Background information on the 20/20 initiative, as well as contact information for state counseling associations and licensing boards, can be found on the ACA website at counseling.org. Once finalized, a copy of the joint letter from ACA and AASCB will be posted to the CT Online website at ct.counseling.org.

 

****

Scope of practice for professional counseling as endorsed by 20/20 organizations

The independent practice of counseling encompasses the provision of professional counseling services to individuals, groups, families, couples and organizations through the application of accepted and established mental health counseling principles, methods, procedures and ethics.

Counseling promotes mental health wellness, which includes the achievement of social, career and emotional development across the life span, as well as preventing and treating mental disorders and providing crisis intervention.

Counseling includes, but is not limited to, psychotherapy, diagnosis, evaluation; administration of assessments, tests and appraisals; referral; and the establishment of counseling plans for the treatment of individuals, couples, groups and families with emotional, mental, addiction and physical disorders.

Counseling encompasses consultation and program evaluation, program administration within and to schools and organizations, and training and supervision of interns, trainees and prelicensed professional counselors through accepted and established principles, methods, procedures and ethics of counselor supervision.

The practice of counseling does not include functions or practices that are not within the professional’s training or education.

 

****

 

Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org.

Letters to the editor: ct@counseling.org

A steadying hand

By Laurie Meyers November 1, 2014

Receiving supervision is an experience common to all counselors. Some view it as little more than an experience to be endured — another box to be ticked off the list in pursuit of a counseling degree or counselor licensure. Perhaps that’s because securing the proper supervision can be a frustrating, time-consuming and expensive proposition, especially at the beginning of a counseling career when Bird landing on an outstretched handthe paychecks are low and the burden of student loan debt is heavy.

Many other counselors, however, possess a different perspective, believing that all the “gains” achieved through supervision are worth the potential “pains” that accompany the process. Professionals who study and provide counselor supervision contend that the supervisory experience is critical to a counselor’s development. Many of these professionals also think that supervision is something counselors should seek throughout their careers — not just at the beginning of a career — from senior colleagues and peers.

Counseling Today recently spoke with several counselors about what makes a supervisory relationship work, as well as some of the challenges inherent in supervision.

A reflection of the counselor-client relationship

In a recent small study, American Counseling Association members M. Kristina DePue and Glenn Lambie found that effective supervision is more about the relationship itself than the particular methods or strategies used during supervision (studies have found, of course, that the same holds true with the counseling process). Lambie and DePue examined satisfaction ratings by supervisees and supervisors and found that high satisfaction ratings correlated with greater competency levels during the practicum process.

As with the counselor-client relationship, the supervisor-supervisee relationship should include trust and acceptance, says DePue, an assistant professor of counselor education at the University of Florida. As a constructivist, she believes the supervision process is (or should be) a holding environment — one of support, challenge and continuity.

“I know that might sound odd to many people,” DePue says, “but when we think about it, counseling serves the purpose of providing a safe space for growth and change. In reality, supervision does the same thing. Therefore, we should expect to see very similar patterns in these relationships.”

In fact, DePue thinks that in order to provide understanding and effective supervision, those who supervise must keep the therapeutic relationship in mind.

“Students aren’t that dissimilar [from] our clients,” she points out. “They are attracted to this profession for various reasons, but oftentimes they come to training with a history of wounds that need healing. Supervisors should know what to expect from trainees at a particular developmental stage. For example, if we are working with practicum students, skill acquisition and self-awareness may be drastically less than [it is in] a person in their first year of licensure. It is important to consistently think about the individual student and what they need at this point in the trajectory of their career. Always be mindful that students are developing skills and developing personally. We can help or harm their development, and I think having realistic expectations is a huge part of not being too critical or harsh on students.”

Lambie, a professor of counselor education and chair of the Department of Child, Family and Community Sciences at the University of Central Florida, agrees about the importance of maintaining an environment in which supervisees are able to be themselves and feel comfortable trying different things.

Referring to his supervision of students, Lambie says, “We don’t want it to be just sink or swim. When you’re new you need feedback, and we want to provide you with that feedback.”

Lambie’s advice to other supervisors is to remain mindful throughout the process. “Be purposeful in trying to develop a strong supervisory bond. Don’t just take it for granted,” he urges. “It’s important for a supervisor to model what he or she wants to support in his or her supervisees. If I want you to be more empathetic but I’m yelling at you, I don’t think that’s going to be a good experience.”

Critical support

During their professional journeys, many counselors experience critical incidents — specific moments or cases that cause them to question the path they’re on. Oftentimes, these critical incidents can be positive, serving as turning points that deepen a counselor’s sense of professional identity, says Ruthann Smith Anderson, an ACA member and past president of the Ohio Mental Health Counselors Association. However, when a supervisee experiences a critical incident, the encounter can be overwhelming. Supervisors need to recognize when supervisees have had a critical incident so they can help guide the supervisee through it.

“There are moments when counselors-in-training come up against something they don’t expect in terms of who they are in counseling and what counseling is. It can cause them to question themselves, their qualifications and capabilities,” says Anderson, a licensed professional clinical counselor supervisor (LPCC-S) and an assistant professor of counseling and human development at Walsh University in North Canton, Ohio.

Critical incidents among supervisees often involve questioning professional identity, difficulty with the complexity of real-life cases and even struggling with the supervision process itself, Anderson says. In some cases, supervisees are dealing with a sense of disappointment because they are not as professionally competent as they assumed, she adds.

“One of the things that supervisors have to do is provide a safe environment,” Anderson says. “Supervisees frequently feel insecure and full of self-doubt, and they need to feel that they can come to the supervisor and express that. You [the supervisor] have to find a way to give feedback that is clear, concrete and immediate, and you want it to be sandwiched with feedback about what the supervisee has done well. Supervisors need to remember how vulnerable supervisees are and to help normalize it — tell them that these reactions are common. In talking with students, they have consistently said that if they don’t feel safe [in the supervisory relationship], they won’t bring up their doubts.”

Providing consistent feedback requires close supervision. In Anderson’s program, all supervisee sessions are taped so that the supervisor can later review the session with the supervisee. Supervisors also watch some sessions live from another office.

Going over the session tapes with supervisees helps Anderson track their professional development and provide guidance in areas in which they need more help. For example, perhaps the supervisee didn’t stop to note that what the client was saying didn’t match his or her affect — maybe the person was smiling or laughing while talking about something sad. Anderson can jump to that spot in the session tape and ask what the supervisee was thinking at that moment and what the supervisee might say now. If the supervisee still doesn’t recognize the problem, Anderson will explain it and ask why the supervisee thinks he or she missed it. The supervisee can then bring the issue up with the client in the next session and also will have learned to watch for similar reactions with other clients.

Working with and teaching supervisees, not just telling them what they did wrong, is part of successful and supportive supervision, Anderson says. “When [providing] supervision, hopefully you are doing supervision on several levels — developing skills, deepening the ability to hypothesize or conceptualize, and exploring who the supervisee is as an individual and how that influences [his or her] work,” she explains.

When supervising closely on all three of those levels, Anderson says, supervisors are likely to catch a supervisee’s critical incidents and any other issues that need to be addressed.

Protecting against client suicide

Among the most difficult circumstances any counselor will face is a client’s death by suicide. Now imagine confronting that reality in the supervision process. Although it is not a common occurrence, it can and does happen, says Daniel Weigel, a licensed professional counselor (LPC) and ACA member. To protect supervisees, clients and themselves, supervisors must observe caseloads closely, teach supervisees how to assess for clients who may be suicidal and build a strong supervisory relationship that encourages novice counselors to ask for help anytime they are working with a client who is potentially suicidal.

Such clients aren’t likely to come in to counseling and announce that they’re feeling suicidal. Instead, counselors must be on the alert for subtle signs, including behavioral or verbal clues that novice counselors and counseling students might overlook, says Weigel, a counseling professor and the practicum and internship coordinator for the counseling programs at Southeastern Oklahoma State University. As an example, he mentions clients who avoid using a future orientation in conversation, such as discussing plans for the weekend or talking about what they’ll do after graduation, or who speak almost exclusively in the past tense.

Because not all clients will have been diagnosed previously, supervisors also need to teach their supervisees to recognize signs of disorders such as depressive disorders, bipolar disorders, substance abuse and schizophrenia that commonly accompany suicide attempts, Weigel says. Other signs supervisees should be taught to probe for are a previous history of suicide attempts (which Weigel identifies as perhaps the best predictor of future attempts); isolation from social supports such as family members, a partner, friends or a religious community; abuse of alcohol or drugs; and addictive behaviors such as gambling, among many other potential signs.

“Counselors-in-training require education in recognizing these clues and trusting their instincts to ask the necessary questions if such situations arise with a client,” Weigel says. Supervisors can help supervisees by observing or shadowing actual suicide assessments (if clients give their permission). As supervisees become more experienced, they can also learn by co-participating with supervisors or taking the lead (under live supervision) in conducting suicide assessments and interventions.

Providing close and collaborative supervision is likely the only way for a supervisor to accurately determine whether the supervisee’s client is at risk for suicide, Weigel says. “To rely solely on information presented by a supervisee verbally or in written form, as opposed to the raw data presented in recorded sessions, live supervision or co-counseling supervision strategies, is unlikely to reveal the subtle clues of client suicide risk,” he says.

Weigel acknowledges that much of the supervision being provided in the field is not live, in part because many supervisors don’t have the time necessary to see their own clients and observe live counseling sessions conducted by their supervisees. In addition, many supervision sites don’t have the capability to tape sessions for later review. So Weigel stresses the importance of developing a strong supervisory relationship, particularly if supervision must be based solely on verbal or written reports from the supervisee. Otherwise, supervisees may be tempted to hold back and present only that information they think will “please” the supervisor. According to Weigel, this is very common behavior.

Weigel advises supervisors to screen clients carefully before pairing them up with a counseling student or novice counselor to determine if they are an appropriate match. He also directly discusses the possibility of client suicide with his supervisees.

“Allowing supervisees who are not carefully oriented and trained in suicide assessment to see clients is a very dangerous position in which to place everyone. The first step in handling a potential crisis between a supervisee and his or her client is to educate [the supervisee] on the process before clients are ever seen,” says Weigel. He explains that preparation involves carefully reviewing the signs of suicide risk with supervisees, while also encouraging them to tune in to their own feelings and trust their instincts.

“Many novice counselors feel like impostors or feel unprepared to see clients,” he says. “Part of the role of the supervisor is to help supervisees feel empowered to trust the skills they have learned and the instincts they carry. This is especially true regarding skills related to crisis intervention.”

At Southeastern Oklahoma State, if a supervisee at the practicum or internship level suspects a client may be suicidal, he or she must bring the supervisor in immediately. Supervisors should establish a procedure for this circumstance ahead of time because suicidal clients should never be left alone, even for a moment, Weigel emphasizes. Once the supervisor is called in, he or she will typically take over the suicide assessment and ideally give the counselor-in-training the opportunity to observe the assessment and intervention in real time, he says.

Preparing supervisees for the possibility of client suicide is an incredibly difficult part of supervision, Weigel says. “[It] can, quite frankly, become overwhelming at times. Any client with whom we work is at risk of death by suicide, just as any supervisee’s clients might be at risk of the same. For me, the scariest part of clinical supervision is the fact that one of my supervisee’s clients might die by suicide, and I may never have had a chance to meet with that client.”

Multicultural competence

The United States has long been a nation of many cultures, and its population continues to grow more diverse. Yet most counseling programs offer only one course specifically devoted to multiculturalism, notes ACA member Kevin Feisthamel, director of counseling, health and disability services at Hiram College in Ohio. He doesn’t believe that’s enough.

“We need to become aware of our biases and become competent,” asserts Feisthamel, an LPCC-S and national certified counselor. “As supervisors, we need to be up to date on the latest [multicultural] research. [But] we get complacent or get so busy that we don’t have time. We forget that we have an ethical mandate [to teach multicultural skills].”

Being multiculturally competent as a counselor doesn’t automatically make you multiculturally competent as a supervisor, says Paula Britton, an ACA member and professional clinical counselor supervisor who runs a multicultural workshop for supervisors in Ohio. “In many states, you don’t need any additional multicultural training to become a supervisor,” she notes. When supervisors aren’t multiculturally competent, they are really doing their supervisees a disservice, contends Britton, who believes that supervision is the best place to learn multicultural competence.

Multicultural awareness in supervision doesn’t just concern clients; it may also be an issue within the supervisory relationship itself, says Britton, a professor of clinical mental health counseling at John Carroll University. “People who come from oppressed cultures often have trouble with trusting people in power, and supervisors are people in power,” she points out.

If a supervisor doesn’t take the time to understand a supervisee’s personal cultural background, the supervisor may make assumptions that further impede trust being established in the supervisory relationship, Britton says. And if a supervisee doesn’t trust the supervisor, he or she will be less likely to ask questions or bring up concerns, which can have a negative effect on the counselor’s professional development and, ultimately, the quality of care provided to clients.

Britton offers the example of a white supervisor with a supervisee who is African American. The supervisor might make the assumption that the supervisee comes from a low-income background. “Then the supervisee feels misunderstood but doesn’t want to say anything because [he or she is] being evaluated,” Britton says.

The best way for supervisors to start building a relationship of trust is to genuinely get to know their supervisees by asking about their culture. “I see a lot of supervisors who are worried that they will offend someone, so they just don’t say anything [about cultural differences],” Britton says. “We know from literature that that is the worst thing you can do. The more questions you ask, the better. The supervisor can [also] say [something like], ‘I’m aware that I’m white and you are Latino. I want to be sensitive, but if I say something insensitive, let me know.’”

Counselors need to educate themselves, but that doesn’t mean they have to be experts on every culture, either with their supervisees or with their clients, Britton says. Rather, she explains, they simply need to speak up and acknowledge when there are holes in their cultural understanding.

“Say to your supervisee, ‘I don’t know a lot about this culture. Let’s explore it more,’” she urges. By doing that, a supervisor shows the supervisee that learning is a career-long process and that even veteran counselors don’t have all the answers, she says.

Feisthamel sits down with his interns whenever they will be working with a client from another culture and asks them how knowledgeable or comfortable they feel about that particular culture. “They [the supervisee] might say, ‘Well, I’m not too familiar with the culture in India,’ and I’ll say, ‘OK, what are your questions? Let’s look at the research and find out what’s working for Indian people.’”

Feisthamel also encourages his supervisees to ask questions. “I think sometimes students don’t ask questions because they’re afraid to be wrong,” he says. The supervisor needs to make sure that the supervisee feels comfortable enough to ask questions — even if they seem stupid, asserts Feisthamel.

Britton agrees. “The best thing you can do as a supervisor with any supervisee is make them feel safe instead of making them feel like they have to pretend.”

Helping counselors-in-training and the community

Counseling students at Indiana State University receive assistance with internship placement, but the program staff there also wanted students to get more experience under live supervision. So the staff lobbied to reopen a community mental health clinic, associated with the university since the 1970s, that had recently fallen by the wayside.

“We have an underserved community,” says Catherine Tucker, director of the clinical mental health counseling program at Indiana State. “We also have a highly service-oriented program.”

The clinic is staffed by three of the department’s counselor educators, as well as outside clinicians and the students themselves. Students begin work there during their practicum and stay on during the summer between practicum and internship. Although they are placed outside the clinic for internship, they still put in hours at the clinic.

But the clinic isn’t just convenient for the community and students; it’s essential to the supervisory process, says Tucker, a member of ACA. Instead of reviewing tapes from supervised sessions off campus, as the program used to do, all supervision at the clinic is live. Each consultation room has a camera with a live feed that is monitored by staff and other students in a main control room. The camera also records all sessions so that students can review them later. In addition to being observed from the control room, students come out halfway through their counseling sessions for a brief consultation on what is going well, what isn’t and what they might try next.

“It is so much better [than before] because they [the supervisees] can go back in and, if they missed something, they can ask questions,” Tucker says. “Or if they need to change techniques, they can do it then. If they are just bringing in a tape or discussing it [afterward], it’s too late. They can make a change the next week, but the opportunity for immediate change [and learning] is gone. I think all the skills develop more rapidly when you have the chance to go back and correct in real time.”

How do supervisees react to being watched by multiple observers? “They’re very self-conscious at the beginning,” Tucker acknowledges. “It’s strange [for them] to think that they’re being taped and watched.”

But the faculty reassures supervisees that the purpose of the observation is not to catalog all their faults. “We see this as a developmental process,” Tucker explains. “Other students also observe. If you don’t have another client, you are expected to watch another session. At first [the supervisees’ reaction is] kind of deer in the headlights. We talk a lot about that in practicum and let them know that it’s normal to be strung out and anxious the first few times.”

“Starting out, we want to make sure basic skills are solid and that they can do an interview,” Tucker continues. “As time goes on, we want to make sure they are solid on diagnosis and that they can pull in their [chosen] technique. We also want them to know that they are in a developmental role. Growth happens over the length of a career, not just in one process. We don’t expect perfection, but we always expect to see progress.”

The supervisees and the program also benefit from the participation of counselors from outside the university. These counselors not only provide an outside perspective but also help students gain an understanding of the nuts and bolts of private practice, such as billing practices and issues (the clinic charges a nominal fee and doesn’t bill), and all the documentation that practitioners need to keep. “They [the outside practitioners] also have access to outside referral services that we don’t have,” Tucker adds.

The clinic serves individual adults, children, families and couples. The faculty uses this variety to push supervisees out of their comfort zones.

“If they say that children make them nervous, we’ll stick them with a 4-year-old,” says Tucker, noting that several of her supervisees initially voiced feeling uncomfortable counseling children, only to later decide that they wanted to become play therapists.

But the main point of the clinic is to give the students experience counseling a wide variety of clients. “They need to become generalists, because in the beginning [of a counseling career], you need to be able to handle whatever comes through the door,” she says.

Tucker believes live supervision is the key to getting counselors-in-training ready for internship and beyond. Therefore, she urges other counselor educators to find a way to incorporate at least a few live supervision sessions into practicum or internships.

“The growth we see is absolutely exponential when compared with the other model [of just reviewing session tapes],” she says. “The thing that really strikes me is that when internships start, they [the counseling students] say they feel really comfortable walking into a meeting and saying, ‘This is my treatment plan, and this is how I’m going to implement it.’ … Seeing the growth firsthand has been really exciting.”

Peer-to-peer supervision

How do you find supervision when you’re in an area with very few providers? And if you’re one of those providers, how do you learn to supervise novice counselors? These are among the challenges that Lauren Paulson, an LPC and ACA member, has faced while working as a clinician and supervisor in a rural area outside of Pittsburgh.

“Many rural environments are lacking a lot of services, and counselors have to work as generalists,” she notes, adding that practitioners in these small, sometimes remote communities often have to fill most or all of the community’s counseling needs. Not only are these practitioners juggling roles and a wide range of counseling issues; they are often doing so without the assistance of colleagues.

“I had this feeling of isolation, and then I became a supervisor and felt even more isolated,” says Paulson, who is also an assistant professor of psychology at Allegheny College in Meadville, Pennsylvania. “I really wasn’t trained to supervise, and rural communities have unique and specific needs.”

For instance, she says, boundary issues are very common. In a small rural community, it’s harder for counselors to draw the line between personal and professional interactions.

“People have multiple roles in the community, and sometimes they may conflict with your role as counselor,” Paulson explains. “You might be sitting on a school committee, and a client’s parent might be working with you.”

Counselors are also more likely to run into clients outside of the office, Paulson notes. “I work out at the local YMCA, and I often see one of my clients in the locker room,” she says.

So on the one hand, Paulson felt like she had little privacy in her role as a counselor. On the other hand, she felt very isolated professionally. “I wanted to connect with others, but it was hard to find [fellow helping professionals] to connect with,” she says.

Those experiences sparked Paulson’s interest in peer-to-peer supervision, which she currently researches. In her research, she has found that other counselors who practice in rural areas mention having the same kinds of challenges — and a desire for community.

Bill Casile acknowledges the difficulty of finding supervision in the comparative isolation of a rural environment, but he says living in an urban environment doesn’t guarantee that counselors-in-training and prelicensed counselors will secure quality supervision either.

“When I talk to graduates, it’s scary the minimal supervision they’re getting,” says Casile, an ACA member and associate professor in the counseling, psychology and special education program at Duquesne University in Pittsburgh. Too often, he says, supervisees working toward their licensure are learning mainly about administrative tasks such as completing paperwork. While these novice counselors are logging hours and getting clinical experience, no one is attending to their skill development, he says.

Casile was initially drawn to the study of supervision because he was dissatisfied with how counselor education programs were performing supervision during the practicum process. He thought the evaluation process was getting in the way of the functional educational purpose of supervision. In other words, supervisors were too busy grading and critiquing to truly teach their students real-life counseling skills.

Casile has long been interested in group supervision and currently teaches a supervision class inTeacher and student which he tries to create a collaborative environment. His work with group supervision and collaboration led him to believe that peer-to-peer supervision might be a useful supplement to counselors’ other supervision experiences.

Casile and Paulson have now teamed up to research peer-to-peer supervision. Their first study involved bringing counselors together just to talk face to face. “It wasn’t hierarchical, just an exchange of information,” Paulson says. The participants thought the experience was helpful, but most had to drive a considerable distance to meet their peers.

So, Paulson and Casile decided to test online peer-to-peer supervision. They recruited area mental health professionals and established an online group through Google Hangouts, a platform that enables online group interaction through audio, video and a chatlike comments box. After the initial meeting to set everything up, the group met twice a month at first and then scaled back to once a month. The group was diverse and included family counselors, school counselors, private practitioners and even a psychologist.

“Initially, Bill and I led the group, but we wanted the group to take over,” Paulson says. “They decided the structure would be that each meeting, one person would present a case [while maintaining client confidentiality], and then we would all discuss it.” The group also reserved time at the end of each session to discuss any concerns its members might have.

Group members also wanted to learn more about supervision itself, Casile says, so they used different models, including “reflecting teams,” which is a structured way of providing feedback to the person presenting the case. One person assumes the role of supervisor, and the rest of the group listens to the dialogue between the “supervisor” and “supervisee.” Once their dialogue stops, the rest of the group members talk about what they heard, with the supervisor and supervisee now remaining silent. The group repeats this pattern until it has finished discussing all aspects of the case. Casile says this form of supervision helps to keep the presenting counselor from getting defensive when receiving feedback.

The group also engaged in another type of supervision in which each participant played a role in the presented case, such as counselor, client, client family member and so on. This allowed group members to explore the case from multiple viewpoints, Casile notes.

Participants found value in the peer-to-peer supervision group because it allowed for diverse perspectives. And unlike with one-on-one supervision, the group members didn’t feel pressured to demonstrate competence, Paulson and Casile say. Instead, the environment made it safe for members to ask “silly” questions they may have been embarrassed or scared to ask an individual supervisor.

Paulson and Casile emphasize that peer-to-peer supervision is not a replacement for the regular one-on-one supervision that counselors should be accessing throughout their careers. They emphasize that even veteran counselors need the benefit of an outside perspective. At the same time, they realize that many counselors aren’t securing individual supervision for one reason or another, and they believe that some kind of supervision is essential throughout a counselor’s career. Participants in peer-to-peer groups may even end up finding individual supervision opportunities through the peer contacts they make, as happened with some of the members of Paulson and Casile’s group.

To find a group of peers, Paulson and Casile advise counselors to join local professional networks, participate on Listservs or explore an ACA Interest Network (see counseling.org/aca-community/aca-groups/interest-networks).

Counselors searching for peer-to-peer supervision might also want to avoid putting too many restrictions on their definition of a peer. “Peers need not all be LPCs,” Paulson advises. “Others like school counselors or anyone in the helping professions can provide interesting perspectives. With peers, I don’t think you need to limit yourself.”

****

To contact the individuals interviewed for this article, email:

****

Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@counseling.org

****

Related reading: See “Unethical supervision practices and student vulnerability,” the story of one counselor’s experience with unethical supervision practices during her practicum and internship: wp.me/p2BxKN-3Jb

****