Effectiveness of Empathic Response Training on Master™s

Effectiveness of Empathic Response Training on

Master�s Level Counseling Students

by

Jacquelyn Crim-McCrary, M.Ed., LPC, NCC

A Dissertation

In

COUNSELOR EDUCATION

Submitted to the Graduate Faculty Of Texas Tech University in

Partial Fulfillment of The Requirements for

The Degree of

DOCTOR OF PHILOSOPHY

Approved

Loretta J. Bradley

Gerald D. Parr

William Y. Lan

Michael K. Altekruse

Fred Hartmeister Dean of the Graduate School

December, 2008

Copyright 2008, Jacquelyn Crim-McCrary

Texas Tech University, Jacquelyn Crim-McCrary, December 2008

ii

ACKNOWLEDGEMENTS

Beyond the primary influence of the individual client, research studies indicate

that it is the empathic relationship that exists between client and therapist that is the most

significant aspect of therapeutic outcome that can be influenced by the therapist.

Similarly, beyond the primary influence of my spiritual relationship with God, it has been

empathic relationships provided to me by my husband and children, professional

colleagues, academic mentors, and friends that have most significantly contributed to the

successful completion of my dissertation.

Thus, I want to express my deepest gratitude to my husband, Giles McCrary, and

my three sons, Russell, Daniel, and Stephen Crim, for their empathic willingness to set

aside their own needs for my attention while I worked long hours reading, synthesizing,

designing, scoring data, and reporting results. Thank you all for your unfaltering faith in

me and for allowing me the time alone to pursue this dream, in spite of the personal costs

to each of you. In addition, my husband deserves accolades for contributing his technical

and creative expertise in numerous ways throughout the duration of this process,

including undertaking the time-consuming process of co-rating all the transcript data,

adding creative elements to a power-point presentation for my defense hearing, and

patiently assisting with the resolution of nightmarish computer formatting issues.

Next, I would also like to express my deep appreciation to my friend and

professional colleague, Christine Odiorne, for her voluntary service in the tedious and

time-consuming process of co-rating all the transcript data used in the study. I would also

like to express my profound appreciation to my professional colleague, Dr. Perry Collins,

Clinical Director of the Counseling program at Wayland Baptist University for allowing


iii

me to conduct this experimental supervision study with his counseling students as

participants. Without the extraordinary altruism and professional expertise of Giles,

Christine, and Perry to assist me in the complex methodological procedures of this

project, the purity of the research design would have been compromised.

At Texas Tech University, I would like to thank each of my doctoral committee

members for their consistent patience, guidance, and academic expertise with this project:

Dr. Loretta Bradley, who served as my Committee Chairperson and whose published

textbooks and expertise on the topic of counselor supervision is well-documented; Dr.

Gerald Parr, whose mentorship to me as a professor and role model in empathic and

group counseling processes will stay with me forever; Dr. William Lan, whose statistical

expertise and knowledge of educational psychology inspired me to design this very well-

controlled study; and Dr. Michael K. Altekruse, now a professor at Northern Kentucky

University, whose established expertise in counselor supervision processes and the

quantitative measurement of counselor responses also helped to inspire the experimental

design of the study. I also want to express my sincere appreciation to Dr. Alice Denham

for her assistance in grammatical and stylistic editing.

In terms of the study�s design, I also owe a personal debt of gratitude to my

former classmate at the University of North Texas, Dr. Leah Brew, now a professor at

California State University, Fullerton, who met with me personally to discuss

possibilities for the study�s design before the research began. Dr. Brew co-authored the

innovative supervision manual and companion video used in this study.

Additionally, I would like to extend my heartfelt thanks to the professional

colleagues, who, although they were not specifically involved in the design or completion


iv

of this study, reached out to me repeatedly with consistent words of encouragement,

especially my dear friend and mentor, Dr. Max Kaplan, and former classmates, Dr.

Patrick Pauley and Dr. Pamela Nelson-Ray.

Last, but not least, I want to thank all my good friends in Lubbock and Fort Worth

who encouraged me to complete this endeavor, including the members of my Women�s

Circle at Covenant Presbyterian Church, the members of the Pierian Sorosis Study Club,

and many of my new Ft. Worth friends, such as Tony and Kim, Jerry and Colleen,

Norman, Bill, Joe, Lorraine, Latrese, and Marla.

Without the nurturance of empathic relationships, true success is rarely achieved.


v

TABLE OF CONTENTS

ACKNOWLEDGEMENTS ......................................................................................... ii

ABSTRACT................................................................................................................xi

LIST OF TABLES.................................................................................................... xiii

LIST OF FIGURES...................................................................................................xiv

LIST OF ABBREVIATIONS .....................................................................................xv

CHAPTER

I. INTRODUCTION��. ...........................................................................................1

Statement of the Problem...........................................................................................5

Significance of the Study ...........................................................................................7

Research Questions..................................................................................................12

Delimitations ...........................................................................................................12

Limitations of the Study...........................................................................................13

Definition of Terms .................................................................................................14

II. LITERATURE REVIEW��. ...............................................................................21

Therapeutic Accountability ......................................................................................21


vi

Common Factors......................................................................................................24 Model or Technique Factors...............................................................................24

Placebo, Hope, and Expectancy..........................................................................25 Client Factors.....................................................................................................26

Relationship Factors...........................................................................................27

Empathy in the Therapeutic Relationship .................................................................33 Research on Empathy.........................................................................................33

Measuring Empathy Quantitatively ....................................................................35 Therapist Influence on Client Perceptions of Empathy .......................................37

Therapist Response Styles as a Function of Experience and Training .................37

Counselor Education and Supervision......................................................................40 Supervision Research Limitations ......................................................................41

Using Technology in Supervision Research........................................................42 Research on Programmed Instruction .................................................................42

Research on Microtraining .................................................................................44 Research on Supervision ....................................................................................45

Supervisory Evaluation ......................................................................................46 The Supervisory Relationship ............................................................................48

Theoretical Approach to Supervision .......................................................................49

A Common Factors/IntegrativeTheory of Supervision........................................51 Kagan�s Interpersonal Process Recall Method of Supervision ............................56

The Effectiveness of Training Components..............................................................57

Modeling ...........................................................................................................57 Research on Positive and Negative Modeling ...............................................59

Characteristics of the Model.........................................................................60

Role Play and Simulation ...................................................................................61

Self-Appraisal and Skill Monitoring...................................................................61


vii

Videotapes and Audiotapes ................................................................................62

Summary of Literature RevIew ................................................................................63

III. METHODOLOGY��...........................................................................................66

Introduction .............................................................................................................66

Participants ..............................................................................................................66

Instruments..............................................................................................................68 Counselor Interaction Analysis...........................................................................68

Interview Record Form ......................................................................................71 End-of-Semester Questionnare...........................................................................71

Manipulation of the Independent Variable of Treatment...........................................72

Procedures ...............................................................................................................73

Random Assignment Procedures........................................................................74 Co-Rating Training Procedures ..........................................................................76

Co-Rating Procedures ........................................................................................77

Research Design and Statistical Analysis .................................................................78

Hypotheses ..............................................................................................................79

IV. RESULTS ...............................................................................................................81

Research Design ......................................................................................................81

Descriptive Demographic Information .....................................................................82 Gender, Age, and Ethnicity ................................................................................83

Data Management ....................................................................................................84

Deriving Cumulative Scores for the CIA............................................................86 Inter-rater Reliability of Scores ..........................................................................87


viii

Internal Reliability of Test Instruments ..............................................................89 Concurrent Validity of Measurements of Counseling Competence .....................89

Results of Hypothesis Testing ..................................................................................90

Null Hypothesis 1 ..............................................................................................91 Null Hypothesis 2 ..............................................................................................91

Null Hypothesis 3 ..............................................................................................92

Additional Participant Comments ............................................................................92

Summary of the Statistical Analyses ........................................................................95

V. DISCUSSION .........................................................................................................96

Summary of the Investigation ..................................................................................96

Discussion of the Findings .......................................................................................98

Comparing Previous Findings on the Use of the CIA ...............................................99 Inadequate Dosage Effect.................................................................................103

Pre-existing Relationships with the Investigator ...............................................105 Statistical Control Variables Required..............................................................105

Differences in Facility Accommodations..........................................................106

Comparisons with Microcounseling Research ........................................................107

Contributions of the Study .....................................................................................113 Overview .........................................................................................................113

Summary ...............................................................................................................118

Limitations of the Study.........................................................................................119

Sample Size .....................................................................................................119 Sample Homogeneity .......................................................................................120

Instrumentation ................................................................................................120


ix

Dosage Effect ..................................................................................................122 Lack of Follow-Up Testing ..............................................................................123

Lack of Videotapes for Rating..........................................................................123 Cross-Contamination of Methods.....................................................................124

Implications and Recommendations for Future

Supervision Research ............................................................................................124 Sample Size .....................................................................................................124

Instrumentation ................................................................................................125 Length and Intensity of Supervision Training...................................................125

Replication of Experimental Supervision Research ..........................................126 Qualitative Supervision Research.....................................................................128

Summary of Recommendations .............................................................................127

REFERENCES......................................................................................................128

APPENDIX

A. Informed Consent Statement .......................................................................141

B. Instruments..................................................................................................143

Counselor Interaction Analysis...................................................................144 Interview Record Form...............................................................................145

C. Instructions to Groups..................................................................................146

D. Written Group Assignments ........................................................................149

E. End of Semester Questionnaire ....................................................................157

F. Traditional Videos .......................................................................................163

G. Transcript Response Rating Form................................................................172


x

H. Definition of Terms for the CIA ..................................................................174

I. Course Syllabi ..............................................................................................178


xi

ABSTRACT

Because mental health professionals are faced with increasing demands for

therapeutic accountability from managed care companies to demonstrate efficiency and

effectiveness in client care, counselor educators are becoming increasingly concerned

about discerning the effectiveness of the supervision methods with which they are

training their students (Brew & Altekruse, 2006; Brown, Dries, & Nace, 1999; Duncan,

Miller, & Sparks, 2004; Sexton, Whiston, Bleuer, & Walz, 1997).

Counselor educators are responsible for providing students with the necessary

academic knowledge and clinical training experiences that will provide them with the

greatest opportunity to develop into effective counselors (Calhoun, 1999). Determining

the effectiveness of counselor training methods is therefore an emerging theme within the

counselor supervision literature.

This experimental research study was designed to investigate the comparative

effectiveness of two adjunct supervision methods (innovative versus traditional) on

participants� empathic response skills. To fulfill the objectives of the study, 26 master�s

level counseling students were randomly assigned to one of two adjunct, 6-week

supervision methods. Results were obtained through a statistical analysis of within-

subject differences between pre- and posttest measures of counseling transcript

responses, using the Counselor Interaction Analysis (CIA), developed by Altekruse

(1967), scored by three trained co-raters who were prevented from knowing the group

identity of the participants. Posttest scores on the CIA were also correlated with scores

derived from an instructor-rated, counselor competence measure, the Interview Record


xii

Form (IRF), developed by Bradley (2007). Thus, these two instruments seemed to be

tapping into a similar counseling competence construct.

Results of the 2 X 2 mixed design of ANOVA, with posttest CIA scores as the

dependent variable, and time and method as two levels of the independent variable,

indicated that all 26 participants increased their use of relationship-facilitative counseling

response skills to a significant degree over the time period of the study. Notably,

participants assigned to the innovative supervision method, which emphasized the

recognition and reduction of relationship-disruptive counseling errors, increased their use

of empathic response skills to a greater extent than those participants assigned to the

more traditional method of training. However, statistically significant behavioral

differences between the two groups could not be ascertained, perhaps due to the limited

sample size and the brevity of the study.

Additional participant comments indicated appreciation for new learning

attributed to the innovative method and for learning attributed to the transcription of

taped counseling interviews. Implications of the results for future supervision research

concluded the final chapter.


xiii

LIST OF TABLES

1. Demographic Information By Group..........................................................................84

2. Descriptive Statistics of the Dependent Variable Grouped by the Independent

Variable.........................................................................................................................91


xiv

LIST OF FIGURES

Deriving Cumulative Scores for the CIA .......................................................................86


xv

LIST OF ABBREVIATIONS

AE Accurate Empathy

BHQS Butler-Haigh Q-Sort

BLRI Barrett-Lennard Relationship Inventory

CIA Counselor Interaction Analysis

CRF-SF Counselor Rating Form-Short Version

CSIA Counselor Self-Interaction Analysis

BLRI Barret-Lennard Relationship Inventory

EOSQ End of Semester Questionnaire

GLM General Linear Model

GRE Graduate Record Exam

HMO Health Management Organization

HRT/HRD Human Resource Training/Human

Resource Development

IPR Interpersonal Process Recall

IRF Interview Record Form

SPSS Statistical Package for Social Sciences

1

CHAPTER I

INTRODUCTION

The weary travelers� hopes of leaving Chicago that night were dashed by a single

public address announcement declaring that all runways were closed indefinitely, due to a

massive snowstorm. Not being able to sleep, Bob began to talk to Ted, a man about his

age. Ted had been sitting by himself and was simply looking out the window at the

grounded airplanes and the falling snow. Bob began the conversation with some small

talk. He explained that he was a business executive who had been working out of town on

a major project over the weekend and was very anxious to get back home to his wife,

whose birthday was the next day. �And, as usual, I�ve waited until the last minute to buy

her something,� Bob lamented. Ted stated that he was planning to visit his elderly mother

in the small hometown where she still lived. �She had a heart attack last month, and I�m

anxious that she�ll be sick with worry when I don�t show up.� At that point, Carrie, a

college-aged woman who had been listening to Bob and Ted decided to join in. �My

parents were trying to fly me back to my college town before the semester begins for the

biggest party tomorrow. Like, I�ve been looking forward to it all month!� she

complained. Allison, who finally found an electrical outlet for her laptop next to the small

group, asked if she could join them. Allison explained that she had been trying to fly back

home to Texas following a professional conference in which she had just earned some

continuing education credits in time for her license renewal. Bob asked Allison what type

of professional license she was renewing. She replied, �It�s a counseling license.�

At that point, the rest of the group became very interested in Allison. Over the

2

next two hours, each of them began tentatively confiding both personal opinions and

personal experiences with the counseling profession. What soon became clear to Allison

as she listened to their stories was that none of her three companions perceived that they

had experienced empathic therapeutic relationships with their counselors. For example,

according to Carrie, her counselor at the Student Counseling Center was really nice, but

she seemed to want to act like her mother and give her a lot of advice. �Like, all she

talked about was when she was in college, like I wasn�t even in the room,� Carrie said.

�If that�s counseling, then I�d rather be partying.� Bob shared that the marriage counselor

he and his wife had visited years ago spent most of the sessions asking them a lot of

questions and would then give them homework assignments to complete every week. He

said he felt like he was back in elementary school. His wife agreed. �We decided that

counseling wasn�t going to work for us, so we quit going and just decided to avoid each

other whenever we were mad.� Ted chimed in, �Yeah, I went to a counselor last year to

help me work up the nerve to leave Mama. He was convinced that Mama had done

something really bad to me when I was a kid and that I was just afraid to talk about it. In

fact, he said he knew exactly how I felt because his mother had done the same thing to

him.� Ted felt completely misunderstood by his counselor and never went back.

Allison listened to these stories and empathized with each of the members of the

group of stranded travelers as they shared their frustrations. �I really appreciate that each

of you shared so freely with me.� She shared her own perceptions about her beloved

profession, and acknowledged the fact that unfortunately, some counselors may simply

not be well-suited for the profession, and others, who may have the potential to become

3

wonderful counselors, are simply not trained well-enough by their university programs.

Bob smiled and said, �Allison, you�re really different than the counselor I had,� as the

rest of the group nodded. �You didn�t judge any of us. You accepted each of us for who

we are. You listened. Maybe my wife and I should give counseling another shot.�

As the travelers� stories illustrated, certain counselor response styles, especially if

overused, can be damaging to the client-counselor relationship (Brew & Altekruse,

2006). Giving too much advice, asking too many questions, acting more like a friend than

a professional helper, and failing to help the client by demonstrating only a superficial

understanding of the client�s true conflict are counseling errors commonly demonstrated

by therapists who are still in the early phases of counselor training or who have not

received adequate professional supervision beyond graduation (Brew & Altekruse, 2006;

Hill & O�Brien, 1999; Nutt Williams, Judge, Hill, & Hoffman, 1997). On the other hand,

counselors who learn about the damaging effects of such common communication errors

can learn to reduce these behaviors and alternately, to build stronger therapeutic

relationships through the use of empathic response styles that research studies have

shown facilitate client exploration of feelings and cognitions (Brew & Altekruse, 2006;

Carkhuff, 2000; Gazda, Balzer, Childers, Nealy, Phelps, & Walters, 2005; Ivey & Ivey,

2003; Rogers, 1980).

Carl Rogers (1957; 1961; 1980) stated that in order to establish a strong therapeutic

relationship with a client, the helper must be able to provide five primary conditions:

trust, warmth, empathy, unconditional positive regard, and genuineness. He believed that

those conditions comprised a necessary and sufficient environment within which people

4

could solve their problems. In discussing general research findings about empathy,

Rogers (1980) reported �the ideal therapist is, first of all, empathic� (p. 146). This

statement was based on a study by Raskin (1974) who asked experienced therapists of

many different theoretical persuasions to describe the qualities of the ideal therapist, and

of the twelve variables they listed, they gave empathy the highest ranking. Empathy is the

most researched relationship condition identified by Rogers (1957). Even now, most

mental health professionals, regardless of theoretical orientation, agree that these

relationship conditions, most notably the quality of empathy, are necessary for

therapeutic success, although some would argue that they are not sufficient to bring about

client change (Sexton, Whiston, Bleuer, & Walz, 1997). Assay & Lambert (1999)

indicated that a correlation exists as high as r = .82 between empathy and therapeutic

outcome.

A high degree of empathy in the therapeutic relationship is associated with progress

in therapy and encourages a high degree of self-exploration in the client (Bergin &

Strupp, 1972). The degree of empathy that exists in the relationship can be detected very

early by client self-reports and such measurements are predictive of later success or lack

of success in therapy (Bachelor & Horvath, 1999; Barrett-Lennard, 1962). The

implication of these findings is that counselors could avoid a great deal of ineffective

therapy experiences if the therapist�s level of empathy could be measured early in the

relationship, or perhaps, even before the counselor begins to see clients.

5

Statement of the Problem

Mental health professionals are currently faced with increasing demands from

managed care companies to demonstrate both effectiveness and efficiency in client care

(Brew & Altekruse, 2006; Brown, Dries, & Nace, 1999; Duncan, Miller, & Sparks,

2004). The terms �evidence-based� and �brief therapy� are pervasive in counseling

literature, professional conference workshops, and in conversations among licensed

counseling practitioners and university supervisors. Outcome data collected by third-

party payers from clients and therapists throughout the U.S. indicate that specific

treatment guidelines and counseling techniques contribute no more than 13% of the

variance in therapeutic change, whereas the other 87% of positive therapeutic outcome

seems to derive from a combination of other significant factors, including client resources

(40%), the therapeutic relationship (30%), and expectancy and allegiance factors (17%),

such as the client�s knowledge of being in counseling and hopeful expectations on the

part of the client and the therapist that the treatment will work (Duncan, et al., 2004).

Wampold�s (2001) meta-analysis of the outcome literature revealed that only 8% of

change is derived from therapeutic model effects and �only 1% of the total variance of

change can be assigned to specific technique� (Duncan, et al., 2004, p.38). In addition to

these disturbing reports, outcome data indicated that the majority of persons seeking

counseling services only see a therapist once (Brew & Altekruse, 2006; Brown, et al.,

1999; Duncan, et al., 2004.) Differences in therapeutic relational style between individual

counseling professionals contribute significantly to this accountability problem (Beutler,

6

Crago, & Arizmendi, 1986; Beutler, Machado, & Neufeldt, 1994; Duncan, et al., 2004).

Outcome research studies further show that a client�s response to treatment in the first

session is highly predictive of eventual treatment outcome, whether positive or negative

(Brew & Altekruse, 2006; Brown, et al., 1999; Duncan, et al., 2004).

Research indicates that the main reason people often do not return for a second

session is because they do not feel they fit with the helper�s style of relating to them

(Brew & Altekruse, 2006; Beutler, et al., 1986; Beutler, et al., 1994; Duncan, et al.,

2004). Therefore, a therapist�s ability to create a strong, therapeutic relationship with a

client in the first few sessions appears to be more strongly related to a positive treatment

outcome than any specific treatment or technique the therapist provides. Unfortunately,

determining what exactly is therapeutic about the relationship is more difficult than

onmight imagine (Sexton, et al., 1997).

Carkhuff (2000) stated that one of the best ways a professional helper can build a

strong relationship with a client is by reflecting the content and feelings the client is

attempting to communicate. Carkhuff (2000) defined empathic responding as non-

directive reactions, reflections, restatements, and summaries of client verbal and non-

verbal communications.

What seems most important is that �clients perceive their counselor to be

empathetic� (Sexton, et al., 1997, p. 75). Sexton et al., (1997) further stipulated that

certain counselor responses seem to contribute to client perceptions of empathy, such as

the use of analogies, infrequently offering general advice, and engaging in less self-

disclosure. Brew & Altekruse (2006) stated that counseling trainees often have difficulty

7

making the transition from their previous roles as advice-giving and supportive friends to

the more professional and objective role of a professional counselor. Furthermore, Nutt

Williams, et al., (1997) reported that some trainees� difficulties with managing anxiety in

making this transition from nonprofessional to professional helper often result in an

increase of communication errors. Given the salience of the above research findings,

counselors must be able to distinguish between responses that are most and least

facilitative. Specifically, these studies suggest that research is needed to focus on

counseling responses that facilitate the counseling outcome.

Significance of the Study

Counselor education programs are charged with the responsibility of providing

students with the necessary academic knowledge and clinical training experiences that

will provide them with the greatest opportunity to develop into effective counselors

(Calhoun, 1999). This charge comes from both national and state licensing standards and

accreditation councils (Bernard & Goodyear, 1992; Bradley, 1989). Because of the

adaptation of these professional training standards, student counselors in accredited

educational programs receive similar training based on developing the skills and attitudes

needed to become effective counselors (Calhoun, 1999). Specifically, the potential

development of a high quality of counselor interviewing skills is believed to be

developed through participation in the pre-practicum, practicum, and internship

experiences, although the duration and generalization of these skills is unknown (Lambert

& Ogles, 1997).

8

A study that investigates the quantitative measurement of facilitative and empathic

responses and compares these measurement scores to the typical competency ratings of

academic supervisors is therefore needed in order to provide novice counselors, academic

supervisors, supervisors-in-training, and field site supervisors with an objective

evaluation criterion to be used in the evaluation of counseling competence. Lambert &

Ogles (1997) stated research studies thus far have been unable to verify more than a

modestly positive relationship between empathy, regard, and genuineness and

psychotherapy outcome. Still, Watkins (1997) stated that psychotherapy training

programs should give primary interest to helping students learn the core relationship

skills (e.g., empathy), because those skills, or �common factors� are still the best

predictors of therapeutic outcome. These constructs are very difficult to study empirically

without a valid and reliable, as well as objective measurement scale that specifies the

types of therapist responses associated with positive or negative counseling outcomes by

clients.

Although counselor education programs focus on training beginning counselors to

use effective helper responses in pre-practicum, practicum, and internship classes, there is

little empirical research incorporated into these classes on the differential effectiveness of

different response styles (Brew & Altekruse, 2006). Textbooks written by leaders in the

field (Carkhuff, 2000; Ivey & Ivey, 2003; Gazda, et al., 2005; Hill & O�Brien, 1999;

Murphy & Dillon, 1998) specifically for counselor-training classes dedicate whole

chapters to descriptions and practice of specific responses they claim are facilitative;

9

however, experimental research studies are not cited in these pages to support these

claims (Brew & Altekruse, 2006).

Fong & Malone (1994) reviewed a year-long sample of manuscripts submitted to

the Counselor Education and Supervision Journal and reported that over 80% of the

submitted studies were simple descriptive studies and almost 50% of those had research

errors that invalidated the results. What is of even greater concern is that fewer than 18%

of these studies used any form of experimental design (Fong & Malone, 1984). Similarly,

Ladany & Muse-Burke (2001) posited, the majority of supervision research studies have

been hampered by poor research designs. Fong & Malone (1984) suggested that the

research design errors indicate a �lack of research knowledge by counselor educators� (p.

3). If the counselor education faculty members who are teaching their students to utilize

empirical research as a basis for professional and competent practice have difficulty

designing valid research studies themselves, it calls into question the quality of the

research studies upon which counselor educators are basing their training methods and

underscores the necessity of increasing the use of experimental design in counselor

education and supervision research (Fong & Malone, 1994). Ladany & Muse-Burke

(2001), on the other hand, suggest, given the complexity of designing sound counseling

or supervision research, �researchers must select those validity threats they are willing to

accept for any given study with the intention of conducting future studies that will

account for the threats left uncontrolled in the present study.� Furthermore, Ladany &

Muse-Burke (2001) cited Bernard & Goodyear (1998) as stating �supervision is vital to

the development of counselors-in-training,� yet �much of the supervision realm has

10

remained unexplored by researchers� (p. 323). They therefore concluded that the various

methods of training and evaluation of student counselors warrant empirical investigation

(Ladany & Muse-Burke, 2001).

Because most clinical outcome research supports the idea that the relationship

between the client and the counselor, as well as the client�s perception of the core

relationship condition known as empathy, is important to therapeutic success (Beutler, et

al., 1986; Beutler, et al., 1994), one might logically assume that not only are there

specific counselor interactive response styles that represent the quality of empathy to the

client, but that these empathic response styles can and should be taught to counselors-in-

training (Brew & Altekruse, 2006). It is therefore important for the counseling profession

to begin researching, through the empirical measurement of specific, reliable and valid

criteria, the objective effectiveness of the specific counseling response styles the

counseling profession claims to be facilitative. One of the best ways to begin conducting

this kind of research is by utilizing outcome research studies about facilitative and non-

facilitative response styles and designing studies that compare alternative teaching

methods to traditional and typical teaching methods. This type of research will allow for

a comparison to be made between the efficacies of different methods of teaching

facilitative responses while counselors are still being trained.

This research study addresses the research gap in the counselor education and

supervision literature regarding which counseling response styles are most facilitative for

the therapeutic relationship. This study also addresses the research gap in the supervision

literature regarding which supervisory methods are the most effective methods to

11

facilitate the training of student counselors in empathic relationship development skills.

Additionally, this research project compares the effectiveness of different training

methods in developing counselor effectiveness in relationship facilitation, rather than

relying merely upon a subjective and general competency measure. Additionally, this

research project assists in the search for a more objective method to use for the evaluation

and supervision of counselors-in-training. Finally, this research project has the potential

to ultimately, albeit indirectly, provide clients with more meaningful and effective

therapy services offered by skilled and competent counselors trained in this method of

counseling.

In summary, if the counseling profession cannot discover through empirical

research studies which counseling response styles are most effective in facilitating the

early development of an empathic relationship with every client, counselor education

programs cannot be certain that the methods with which they are training student

counselors will result in optimal client care. In addition, if counselor educators remain

uncertain about the differential effectiveness of different response styles, their students

potentially risk occupational ineffectiveness after graduation. Lastly, and most

importantly, if counselor education programs fail to establish training methods and

evaluation criteria that are optimally effective in training student counselors to develop

empathic relationships with their clients, clients will not receive the helpful therapy

services they deserve. Through specific research questions, this study is therefore

designed to address the above issues.

12

Research Questions

This study was designed to answer the following questions:

1) Does an adjunct innovative supervision method consisting of a systematic

training manual, a self-assessment instrument, written assignments designed to

measure comprehension of counseling errors, and a companion video that

demonstrates alternating models of less and more empathic, or relationship-

facilitative counseling responses significantly improve student counselors�

abilities to respond in a more empathic, or relationship-facilitative manner to

clients over the course of a semester?

2) Does an adjunct traditional supervision method that includes a critique of three

videotaped counseling interviews modeled by experts in the field of counseling

significantly improve student counselors� abilities to respond in a more empathic,

or relationship-facilitative manner to clients over the course of a semester?

3) Does the use of an innovative supervision method result in a greater degree of

improvement in counselor empathic or relationship-facilitative responding over

the course of a semester than a more traditional supervision method?

4) Do student counselors� posttest response style scores positively correlate with

academic supervisors� competency ratings?

Delimitations

The following delimitations provide the boundaries for this study. The sample

population for this study was student counselors-in-training enrolled in counselor training

13

classes in West Texas. Because the ethnic makeup of the students was predominantly

European � American, the results of this study may not be generalizable to

rural areas, large cities, and populations that are not predominantly European-American

Limitations of the Study

The geographic location of the study may pose a limitation. The student counselors

in this study reside in West Texas. By virtue of geographic region, the culture and norms

related to the learning or the use of empathic response styles with clients may be peculiar

to the region and this population and may not be generalizable to the general population.

Therefore, the results of this study may not be generalizable to the general population.

The fact that some of the clients counseled by the student counselors in this study

were classmates enrolled in the same counselor training classes, rather than clients

unknown to the students, may pose a limitation to the generalization of results of this

study. Therefore, some of the response styles identified through these measurements may

not be generalizable to the response styles these student counselors will use later when

conducting counseling in the field with actual clients.

Another limitation of this study may result from the fact that the student counselors-

in-training may be able to adapt temporarily to supervisory expectations of empathic

responding because of a desire to �appear professional and look good;� hence the results

of this study may not be generalizable to future un-supervised counseling practice.

An additional limitation of this study may result from the fact that some counselor

education students may have had more experience or training in developing an effective

14

empathic response style prior to their admission to the graduate counselor education

program at the university. Because of their prior experiences or training in effective

empathic relationship building, their previous experience and training may be equal to or

exceed the training offered by this study.

Finally, another limitation of this study may result from the necessarily small

sample sizes of the innovative and the traditional groups in this study. Because of the

tradeoffs inherent in reducing confounding variables and maintaining experimental rigor

to the greatest extent possible, a relatively small number of students were available to

comprise the total number of participants in the matched comparison groups. Therefore,

the study�s results may be subject to questions of statistical conclusion validity, such as a

Type II error.

Definition of Terms

Clients: Clients are defined as any of those counseling students, personal friends, or

family members of the counseling students, or as those community clients typically

assigned by site supervisors to student counselors for the purposes of counseling skill

development, whose sample counseling interviews and accompanying tape transcripts

were submitted to the professor to serve as one or more of the student counselor�s

measures of counselor effectiveness in this study. Because some of these clients

participated in taped counseling sessions with student counselors only once or twice

during the semester, counseling interactions used for the measurement of counselor

effectiveness in this study may be limited to the optimal level of counseling interactions

15

and counseling relationship development that could reasonably be expected to occur

during one or two counseling sessions.

Counselor Effectiveness: Counselor effectiveness, for the purposes of this proposed

study, is defined as a quality of counseling competence or therapeutic relationship

facilitation. This quality or level of competence was determined by three trained non-

faculty raters, in addition to the judgments of the supervising professor of the students,

using two independent rating instruments, the Counselor Interaction Analysis (Altekruse,

1967) and the Texas Tech University College of Education/Counselor Education

Internship Feedback form.

Counselor Interaction Analysis (CIA): The counselor interaction analysis (CIA)

instrument is defined as a quantitative measurement instrument designed to measure the

facilitative nature of interactions initiated by the counselor with the client. Reflective and

less directive interactions have been associated with fostering a more supportive and

collaborative relationship (Altekruse, 1967). Trained non-faculty raters, using this

instrument, analyzed the content of ten counselor-initiated interactions drawn from

counseling session transcriptions. At the time of rating these counselor-initiated

interactions, the non-faculty raters were prevented from knowing the group identity of the

individual student counselors whose transcripts were being rated.

Counseling Sessions: Counseling sessions will be defined as those counseling

sessions conducted by the student counselors in a variety of counseling agencies and

schools under professional supervision during the semesters from which the tapes used in

this study were drawn.

16

Directive Responses: Directive responses will be defined for the purposes of this

study as those responses that are evaluative of a client�s reported thoughts, feelings, or

actions, such as �You�re right,� or �You shouldn�t feel �,� or �You�ve got to be kidding

me;� responses that suggest some form of changed behavior to the client, such as �You

need to�,� or �Why don�t you��, or �Have you ever considered�;� responses that

reveal a counselor�s intention to influence a client with an inappropriate level of personal

disclosure and authoritative advice, such as � I know exactly how you feel�,� or The

best thing to do when that happens is�, or �Whenever that happened to me, I just�;�

responses that avoid exploration of the client�s feelings through reassurance or a rapid

change in the topic of conversation; and responses that are focused on superficial aspects

of the client�s disclosures, such as �How did your mother feel about that?�, or �What was

he thinking�?� or �When did the accident occur?�; or any awkward period of silence,

small talk, or story-telling in which the counselor engages, but which appears to have no

therapeutic purpose or goal.

Empathy: Empathy, for the purposes of this study, is defined as an optimal ratio of

facilitative, or nondirective, counseling responses by a student counselor in interactions

with the client.

Innovative Supervision Method: The innovative supervision method is defined for

the purposes of this study as a six-week intervention consisting of assignments to work

through a systematic and experiential supervision workbook that emphasized the

comprehension and recognition of common counseling errors, the use of a self-

assessment instrument, the systematic viewing of a companion video that demonstrated

17

alternating models of less and more empathic or relationship-facilitative counseling

responses based on identical, client-originating statements, and the completion of four

written assignments designed to measure comprehension of information about common

counseling errors contained in the workbook and video.

Internship: Internship classes are defined for the purposes of this study as the

second of three clinical courses required during the final year of master�s level counselor

education. The Internship classes are required to be taken simultaneous with or following

the completion of academic coursework for the Master�s degree.

Internship Requirements: Internship requirements for the purposes of this study are

defined as the experience of a minimum of 100 clock hours (40 hours of face-to-face

direct counseling hours with actual community clients and 60 hours of indirect client

contact hours) over the course of a semester at various field-site counseling agencies or

schools under the regular, weekly individual supervision of a field-site supervisor, in

addition to participation in a combined 45 hours worth of weekly classroom instruction,

group supervision classes with a supervising professor, and additional individual

supervision sessions provided four times per semester by the supervising professor.

Interview Record Form: This form is defined as the one that has been used

repeatedly as a summative measure for the evaluation of student counselor effectiveness

by those members of the faculty who are responsible for the teaching of the practicum

and internship classes at Texas Tech University. This form was used during the study as

both an evaluative tool for all the research participants and counseling students and as a

comparison measure to evaluate differences in the effectiveness of the experimental

18

training intervention (Method One) versus the traditional training method (Method Two)

in facilitating the development of facilitative counseling skills among the counseling

students.

Nondirective Responses: Nondirective responses will be defined for the purposes

of this study as those counselor responses that include reflections, clarifications,

summaries, analogies, and metaphors based on client-presented content. Reflections are

those counselor responses that are attempts to verbally express to the client the

counselor�s understanding of the feelings, content, or the underlying meaning of what has

been expressed by the client. These may be direct quotes or paraphrases of the client�s

verbal responses, as well as reflections based on a deeper understanding of what the

client is trying to communicate. Clarification is characterized by those counselor

responses that attempt to help the counselor understand what the client is attempting to

convey but which has remained ambiguous to the counselor. Examples of such would be

statements such as �It seems that you�re saying�� or �So, if I�m understanding you

correctly��. Summaries are those reflective responses that attempt to summarize for the

client the counselor�s comprehension and understanding of the most salient aspects of the

client�s feelings. Analogies and metaphors are complex, reflective responses which not

only communicate to the client the counselor�s level of empathic understanding, but

which may also enable the client to reframe a previous understanding.

Participants: Participants are defined for the purposes of this research study as

those students who were enrolled in two sections of CNSL 5360 Practicum in Counseling

19

and in two sections of CNSL 5361 Internship in Counseling at Wayland Baptist

University, Plainview, TX during the Fall 2006 and Spring 2007 semesters, respectively.

Practicum: Practicum is defined for the purpose of this research study as the first

of three clinical courses required during the final year of master�s level counselor

education. The Practicum class is required to be taken simultaneous with or following the

completion of 24 hours of academic coursework for the Master�s degree.

Practicum Requirements: Practicum requirements for the purposes of this study are

defined as the experience of a minimum of 75 clock hours (may be either direct or

indirect client contact hours) over the course of a semester at various field-site counseling

agencies or schools under the regular, weekly individual supervision of a field-site

supervisor, in addition to participation in a combined 45 hours worth of weekly

classroom instruction, group supervision classes with a supervising professor, and

additional individual supervision sessions provided four times per semester by the

supervising professor.

Student Counselors: Student counselors are defined as those masters� level students

participating in their practicum experiences during the Fall, 2006 semester and their

internship experiences during the Spring, 2007 semesters at Wayland Baptist University

in Plainview, TX. All students at this level have completed most of their academic work

as well as a pre-practicum course in counseling techniques.

Trained Co-Raters: Trained co-raters are defined as those graduates of a master�s

level counselor education program who agreed to undergo training in the use of the CIA,

to participate in the process of establishing a high level of co-rater reliability prior to

20

rating the student transcripts, and to assist the researcher in the scoring of the counselor�s

session transcripts. One of the trained raters was simultaneously enrolled in the Texas

Tech Doctoral Program in Counselor Education and Supervision and one of the trained

raters was an experienced counselor with training in counselor supervision and more than

five years of counseling experience.

Traditional Supervision Methods: Traditional supervision methods for the purpose

of this study are defined as those methods specified by the professor whose students

served as the participants in this study. These methods included lecture, didactic material,

video modeling and live modeling of counseling skills, critique of expert counseling

videotapes, transcription and review of personal interview tapes, supervisory feedback,

and evaluation.

Voluntary Participation: Students enrolled in two sections of CNSL 5360

Practicum in Counseling during the Fall, 2006 semester who had enrolled sequentially in

two sections of CNSL 5361 Internship in Counseling during the Spring, 2007 semester

were invited to voluntarily participate in the study. Students who did not choose to

participate in the data collection for research purposes still received the benefits of the

training provided to the rest of the students in each section of the Spring 2007 Internship

class who voluntarily participated in the research study. There were no exclusions

assigned for the study. Prior to participation, prospective participants were required to

read and sign an Informed Consent Statement, which outlined the nature and purpose of

the study, what was required from each participant, and participant rights concerning

participation.

21

CHAPTER II

LITERATURE REVIEW

Therapeutic Accountability

From 1996 - 2005, mental health professionals were faced with increasing demands

from cost-conscious managed care companies to demonstrate increasing effectiveness

and efficiency in client care before they would be paid (Brew & Altekruse, 2006; Brown,

Dries, & Nace, 1999; Duncan, Miller, & Sparks, 2004). Eighty percent of mental health

practitioners who were recently surveyed reported feeling that they had lost complete

control over the kinds of care and treatment decisions they believed they should be able

to control (Duncan, et al., 2004). In addition, accounting changes implemented by

managed care agencies have resulted in a huge increase of non-standardized paperwork

requirements for practitioners, without a concomitant reduction in workload or any

increase in reimbursements for client care (Duncan, et al., 2004). �The paperwork and

phone calls these activities require make it difficult to imagine how they could ever save

time, money, or increase the effectiveness of provided services� (Duncan, et al., 2004, p.

2). Despite the probability that these accounting changes have failed to translate into

better client care, it is unlikely that insurance companies will cease their search for the

economically optimal bottom line. �The medical model, emphasizing diagnostic

classification and evidence-based practice, has been transplanted, wholesale, into the

field of human problems� (Duncan, et al., 2004, p. 21). The terms evidence-based

treatment and brief therapy are pervasive in counseling literature, professional

conference workshops, and in conversations among licensed counseling practitioners and

22

university supervisors. Indeed, brief therapy, especially when defined as any therapeutic

program with a duration of less than 25 sessions, has not only become the norm among

most counselors and counseling agencies, it has also proven just as effective as long-term

therapy for most clients (Koss & Butcher, 1986). Thus, the continuing attempt to discover

which specific treatment guidelines are best for clients and the corresponding effort to

streamline and standardize practice by managed care companies seem both

understandable and reasonable. One might ask why these changes in therapeutic

accountability became necessary in the first place. The logic of managed care companies

becomes understandable when one recognizes that, for many years, therapists practiced

without much financial oversight and many reimbursement dollars were seemingly

wasted (Brown, et al., 1999). Unfortunately, though, managed care�s accounting changes

are unlikely to result in improved client care as long as diagnostic labels are required in

order to determine treatment protocols and reimbursements (Duncan, et al., 2004).

Understandably, some clients would rather not attempt to receive mental health services

if it means that in order to have these expenses reimbursed, they might be faced with the

stigma of a diagnosis recorded in their medical records.

This effort on the part of managed care agencies to discover which treatments work

best for which clients has resulted in thousands of comparative research studies

conducted by different professional schools of psychotherapy. In spite of the failure of

multiple researchers to answer the question of which treatment works best in a definitive

manner, those conducting outcome research have repeatedly demonstrated that

psychotherapy is definitely effective for those treated (Lambert & Bergin, 1994).

23

Researchers have reported that the average treated person is better off than 80% of the

untreated sample (Duncan, et al., 2004; Lambert & Bergin, 1994). However, outcome

data collected by third-party payers from clients and therapists throughout the U.S. also

indicate that specific treatment guidelines and counseling techniques account for only

13% of the variance in outcome (Asay & Lambert, 1999; Brown, et al., 1999; Wampold,

2001). Lambert & Bergin (1994) stated that there has been a growing trend among

practitioners to adopt a �broad, comprehensive and pragmatic approach to treatment that

avoids strong allegiances to narrow theories or schools of thought� (p. 143).

Psychotherapy researchers have failed to find any differences in effectiveness

between different treatment approaches over the last half-decade. �The underlying

premise of the comparative studies, that one or more therapies would prove superior to

others, received virtually no support� (Duncan, et al., 2004). If different theoretical

approaches do not differentiate between effective and ineffective therapists, and if

specific theoretical guidelines and techniques contribute such a small percentage of the

variance to effective psychotherapy, some researchers have concluded that there must

instead be some common, pantheoretical therapeutic factors that comprise the more

significant elements of therapy outcome (Asay & Lambert, 1999; Hubble, Duncan, &

Miller, 1999). In order to stem the tide of wasted research attempts designed to discover

which specific treatments work best with which clients, clinical researchers must finally

demonstrate that successful psychotherapy depends less on the specific kind of therapy

provided than on the resources of the client and the quality of the alliance created

between client and therapist (Duncan, et al., 2004).

24

Common Factors

Hubble, et al. (1999) dedicated their book about psychotherapeutic change, to Saul

Rosenzweig in honor of his infamous 1936 analogy based on the equivalence of

competing psychotherapies and the Dodo Bird Verdict. Rosenzweig (1936) wrote that

just as the Dodo Bird in Alice in Wonderland said, �All have won and all must have

prizes,� the evidence shows that all psychotherapies are equally effective. In other words,

Rosenzweig was the first writer to publicly propose that the underlying rationale for the

equivalent effectiveness of different therapeutic approaches was more likely due to their

common elements than to their different theoretical bases (Hubble, et al., 1999). It took

another 25 years of desperate research attempts on the part of competing theoreticians to

foster another meta-analysis that arrived at the same conclusion (Frank, 1961; 1973;

Frank & Frank, 1991). If there are common elements or factors operating among the

different theories, therapies, and therapists, and if these factors are the most important

elements involved in making psychotherapy work for the majority of persons seeking

help, what are these common factors, and how can managed care companies be certain

that the therapists they are reimbursing are adept at providing the best qualities of these

common factors in their professional work?

Model or Technique Factors

Model or technique factors are the aforementioned specific procedures and

underlying philosophies that are unique to particular therapeutic approaches (Duncan, et

al., 2004). Some examples of specific techniques would include the miracle question in

25

solution-focused therapy, the genogram in Bowen family therapy, desensitization in

behavior therapy, and the theoretical models underlying these practices (Duncan, et al.,

2004). Asay & Lambert (1999) suggested that these factors comprise 15% of the variance

of outcome in therapy. However, Wampold (2001) said that when both general and

specific factors are combined, they equal only 13% of the variance in therapeutic impact

and of that 13%, only 8% can be attributed to the model effects (Duncan, et al., 2004).

Placebo, Hope, and Expectancy

This group of common therapeutic factors explains a little bit more of the outcome

variance and contributes 15% of the variance to psychotherapy outcome (Hubble, et al.,

1999). These factors include the fact that some clients believe that simply because they

have begun the process of psychological treatment, they will be healed; the fact that most

clients believe that credentialed therapists are knowledgeable, trained, and experienced in

providing effective treatment; and lastly, the fact that clients hope that their particular

problems can be resolved with the help of a therapist (Hubble al., 1999). These factors

exist within the perceptions of the client, however, and although they can be heightened

by the therapist�s choice of professional office décor, appearance, and framed diplomas,

not to mention the therapist�s attitudes and abilities, placebo, expectancy, and hope are

factors that, by themselves, do not significantly distinguish effective and ineffective

therapy or therapists (Duncan, et al., 2004).

26

Client Factors

Tallman and Bohart (1999) wrote that it is actually the clients themselves who

constitute the most important common factor in therapy. Hubble, et al., (1999) in their

empirical analysis of the common factors found that the client and the extra-therapeutic

elements of the client�s life contribute 40% of the variance to psychotherapy outcomes.

Citing Milton Erikson (1980), Duncan, et al. (2004) reiterated �What is needed is the

development of the therapeutic situation permitting the patient to use his own thinking,

his own understanding, his own emotions in the way that fits in his scheme of � life�

(Erikson, 1980, p. 223). Outcome research has provided additional support for the idea

that the client has the greatest role in the change process (Duncan, et al., 2004).

Moreover, outcome researchers have posited that a client�s response to treatment in the

earliest phase of treatment is highly predictive of eventual outcome, whether it is positive

or negative (Bachelor & Horvath, 1999; Brown, et al., 1999; Duncan, et al., 2004).

Unfortunately, many of the persons seeking counseling services see a therapist only once

(Brew & Altekruse, 2006; Brown, et al., 1999; Duncan, et al., 2004; Garfield, 1994).

Garfield (1994) reported that of 2,551 cases drawn from 17 community clinics, only

40.8% returned after the intake interview. Another report indicated that of almost 3,000

students seen at a university counseling center, 49% failed to come to the first therapy

session (Beutler, et al., 1994). In Garfield�s (1994) meta-analysis, he reported that Duen

& Proctor (1977) compared 32 individuals who terminated after the first interview with a

similar number of clients who continued in therapy. These researchers were interested in

27

the effects of congruence in verbal interactions between the therapist and the client. In

this study, stimulus-response congruence was used to describe whether the therapist�s

verbal response acknowledged the client�s preceding comment, and content congruence

described whether the therapist�s statement was consistent with client expectations. The

results revealed that incongruence and irrelevance of therapist communications were

significantly more frequent in the transcripts of those clients who terminated therapy

prematurely (Garfield, 1994). �Whether a dyad continues past the first few sessions is

related to how well participants establish mutually agreeable definitions of what each is

to do� (Tracey, 1986, p. 787, as cited in Garfield, p. 203, 1994). In summary, research

indicates that the main reason people often do not return for a second session is because

they do not feel they fit well with the helper�s style of relating to them (Beutler, et al.,

1986; Beutler, et al., 1994; Duncan, et al., 2004).

Relationship Factors

Evidence suggests that the quality of the counseling relationship is critical to the

success of therapy (Sexton, et al., 1997). Bachelor & Horvath (1999) argued that second

to what the client brings to therapy, the client�s perception of the therapeutic relationship

is responsible for most of the gains resulting from therapy. Relationship factors account

for 30% of successful outcome (Asay & Lambert, 1999). Martin, Garske, & Davis,

(2000), in their meta-analytic review of the therapeutic alliance with outcome, concur that

the quality of the alliance is more important than the type of treatment, and that the

alliance is consistently, if moderately, related to outcome. Although researchers agree

28

that a strong therapeutic relationship facilitates the helping process, researchers are not as

clear on how to establish good relationships with clients (Orlinsky, Grawe, & Parks,

1994). Orlinsky, et al. (1994) found that when there is a complementary communication

pattern between therapist and client, they seem to be in harmony; when there is not, they

simply talk past each other. �The cycle of communicative contact consists of

complementary phases of expressiveness and empathic understanding in each

participant� (Orlinsky, et al., 1994, p. 326). While encouraging more careful research on

the communicative aspect of the therapeutic bond, Orlinsky, et al. (1994) reported

research findings on 42 process-outcome studies, �which show a clear pattern linking

communicative attunement to positive outcome, especially when process was assessed by

patient ratings or objective indexes and outcome was evaluated by patients and

therapists� (p. 326). Therefore, a therapist�s ability to create a strong empathic

relationship with a client in the first few sessions appears to be more strongly related to

treatment outcome than any specific treatment or technique the therapist provides

(Bachelor & Horvath, 2001; Orlinsky & Howard, 1986; Sexton & Whiston, 1994).

Unfortunately, determining what exactly is therapeutic about the relationship and, by

extension, the therapist, is more difficult than one might imagine (Sexton, et al., 1997).

Hill & O�Brien (2001) postulated that helpers establish good therapeutic relationships by

attending and listening carefully to clients, using the appropriate helping skills at the right

times, treating clients according to their individual needs, being aware of their own

feelings and limitations, being aware of the clients� reactions to their interventions, and

being open to feedback from clients. Carkhuff (2000) noted that one of the best ways a

29

professional helper can build a strong bond with a client is by reflecting the content and

feelings the client is attempting to communicate. Carkhuff (2000) defined empathic

responding as nondirective reactions, reflections, restatements, and summaries of client

verbal and nonverbal communications.

Differences in therapeutic relational style between individual counseling

professionals contribute significantly to the aforementioned accountability problem that

HMOs and psychotherapy researchers are trying to address (Beutler, et al., 1986; Beutler,

et al., 1994; Duncan, et al., 2004). �Beyond specific therapist skills, it seems as if

therapeutic style (directive vs. nondirective responses, complementary vs. anti-

complementary interactions) may be differentially important with certain kinds of clients

at certain stages of counseling� (Sexton, et al., 1997). Counselors-in-training who haven�t

learned which of their counseling responses are most likely to facilitate, rather than

disrupt the development of a positive therapeutic relationship with a client may

unintentionally continue to commit some of the more common errors of counseling

communication, even after they have graduated from counselor training programs.

Common therapeutic relationship factors can also be conceptualized in a different

way by utilizing a developmental explanatory sequence, which presupposes that

supportive relationship-building functions precede changes in client beliefs and attitudes,

which then precede attempts by the therapist to initiate action (Hill & O�Brien, 1999;

Lambert & Bergin, 1994). Brew & Altekruse (2006) stated that engaging in too large a

quantity of fairly directive verbal activity in the first sessions of a counseling relationship,

such as using a lot of small talk, asking multiple questions, offering multiple problem-

30

solving suggestions, and making multiple attempts to reassure the client by volunteering

personal anecdotes will often prevent the therapeutic relationship from developing in a

healthy and client-centered direction. Hill and O�Brien (1999) proposed that in

facilitating the therapeutic relationship, helpers first try to pay full attention to their

clients and communicate their full understanding of the client�s feelings and experiences.

Patterson (1963) explained that in order for a client to make progress in understanding

himself or herself, the client must be encouraged to talk about certain things in certain

ways. Moreover, the counselor must focus on encouraging the client to talk primarily

about himself or herself and his or her relationships with others, rather than responding to

comments the client makes about the weather, current events, or other impersonal

material (Patterson, 1985). Hill & O�Brien (1999) further stated that it is a therapist�s

empathic responsiveness to client statements during initial counseling sessions that

enables the client to begin to feel safe enough to express the pain and confusion that has

brought the client to therapy. In other words, the first few sessions are most important for

creating the trajectory for the potential healing that will occur during the rest of therapy.

Hill, Helms, Tichenor, Spiegel, O�Grady, and Perry (2001) reported that individual

therapist response modes were significantly related to all immediate outcome measures in

their study of client and therapist ratings of different therapist response modes, although

the unique amount of variance contributed by each response mode was small. For

example, both therapists and clients found that the interpretation response was quite

helpful in the middle to latter stages of therapy, and clients stated that therapist self-

disclosure was also very helpful to them later in the relationship, especially when it was

31

infrequently used (Hill, Helms, et al., 2001). Hill, Helms, et al. (2001) reported that

paraphrasing in order to demonstrate listening and understanding and approval was rated

as a moderately helpful response by clients, in agreement with Carkhuff (2000).

However, Hill, Helms, et al., (2001), reported discrepancies between therapists and

clients in ratings of helpfulness when it came to open questions. For example, therapists

thought these responses were moderately helpful and believed they would lead to more

client experiencing, but clients reported that they felt challenged and fearful following

open questions, perhaps because they felt there was no right answer (Hill, Helms, et al.,

2001). Patterson (1985) provided a thorough rationale for avoiding the use of questions in

counseling interviews including the fact that questions may be threatening to the client,

and particularly when they occur early in therapy, they may unwittingly involve the client

in an exploration of dynamics of which the client is unaware. Patterson (1985) also noted

that questions in therapy tend to promote dependency on the part of the client and

discourage the client from engaging in self-exploration. Lastly, Patterson (1985) wrote

that questions tend to promote an externally oriented process, rather than one in which

the therapist is attempting to empathically understand the inner world of the client.

Patterson (1985) also pointed out that questions change the level of the discussion from

an affective to a cognitive dimension. In the Hill, Helms, et al. (2001) study mentioned

above, the response defined as a confrontation was rated moderately low by clients, as

was information-giving, direct guidance and advice, and closed questions, which were

rated least helpful by clients. Hill, Helms, et al. (2001), explained that when clients are at

a low level of experiencing, which according to these authors is about 75% of the time,

32

they remain at a fairly superficial level of discourse, telling stories or describing details of

situations. Both therapists and clients agreed that the most helpful interventions were

those in which the therapist helped the client explore feelings and behaviors through

paraphrase, interpretation, and confrontation. The most important thing to determine

when deciding whether or not and when to use confrontation with a client is to what

extent the therapeutic relationship has been established and maintained (Patterson, 1985).

Unfortunately, many beginning helpers are not comfortable helping clients explore

their feelings, especially when their clients are feeling strong anger, intense sadness, or

hopelessness (Brew & Altekruse, 2006; Hill & O�Brien, 1999). Some beginning helpers

try to cheer up the client or talk the client out of feeling so bad because the helper seems

to feel obligated to try and solve all the client's problems and help the client feel better

(Brew & Altekruse, 2006; Hill & O�Brien, 1999). Sometimes, these helpers cannot allow

clients to stay with painful feelings because they have never learned to allow themselves

to feel negative feelings (Brew & Altekruse, 2006; Hill & O�Brien, 1999). Some

beginning helpers ask too many closed ended questions because they think they need to

gather all the details of a problem before they can help (Brew & Altekruse, 2006). Other

helpers simply talk too much during sessions, either because they are anxious, or because

they just like to talk (Hill & O�Brien, 2001). However, clients cannot talk if helpers are

doing most of the talking (Brew & Altekruse, 2006; Hill & O�Brien, 1999). Some helpers

feel pressured to give advice, rescue clients, or come up with perfect solutions, and some

helpers want to act like a �friend� with their clients rather than acting like professional

helpers (Brew & Altekruse, 2006; Hill & O�Brien, 1999). Brew & Altekruse (2006)

33

stated that a helper can never go wrong by utilizing accurate feeling reflections to

establish a strong relationship with a client. Historically, the relational characteristics of

the therapeutic relationship have been assumed to be understood by all and therefore,

there has been relatively little effort to define through empirical research just what the

relationship is (Bachelor & Horvath, 1999).

Empathy in the Therapeutic Relationship

Mental health professionals tend to associate the name Carl Rogers with the idea of

the therapeutic relationship and its most well-understood quality, empathy. As previously

stated, Carl Rogers (1957) wrote that in order to establish a strong therapeutic bond with

a person, a therapist must provide five primary conditions: trust, warmth, empathy,

unconditional positive regard, and genuineness. In discussing research findings

concerning empathy, Rogers (1980) reported �The ideal therapist is, first of all,

empathic� (p. 146). Even now, most mental health professionals would agree that

Rogers� core relationship conditions, most notably the quality of empathy, are necessary

for therapeutic success, although some would argue that they are not sufficient to bring

about change (Sexton, et al., 1997). Asay and Lambert (1999) indicated that a correlation

exists as high as r = .82 between empathy and therapeutic outcome.

Research on Empathy

Rogers (1980) further defined empathy by reporting various research findings,

including conclusions that therapist empathy is correlated with client self-exploration and

34

process movement (Bergin & Strupp, 1972), that the level of empathy that exists early in

the therapeutic relationship later predicts either success or lack of success in treatment

(Barrett-Lennard, 1962), and that empathic understanding is provided from the beginning

of therapy by the therapist, rather than being solicited from him or her by the client

(Truax & Carkhuff,1967). Before humanistic theorists, such as Rogers, identified

empathy as a necessary and sufficient condition for psychological change, psychoanalytic

theorists also viewed empathy as a key ingredient underlying psychoanalytic cure (Duan

& Hill, 1996). Citing Kohut (1959, p. 462), Duan & Hill (1996) wrote that empathy is the

very basis of all human interaction and is �an essential constituent of all psychological

phenomena.� Some theorists have proposed that empathy is a stable personality trait or

ability that influences both perceptions and behaviors consistently once it has been

developed within a therapist (Rogers, 1957). However, others, including Rogers (1980)

believe that empathy is also a situational cognitive-affective state that changes depending

on the perception of the perceiver and can be influenced through learning (Barrett-

Lennard, 1962; Brew & Altekruse, 2006; Carkhuff, 2000). According to Bohart, Elliott,

Greeenberg, & Watson (2002), �The two therapeutic approaches which have most

emphasized empathy � client-centered therapy and psychoanalytic therapy � have

focused on its cognitive aspects� (p.89). In other words, empathy according to this

definition is actually a form of cognitive perspective taking (Bohart, et al., 2002).

Moreover, according to many psychologists, at least 70% of Carl Rogers�s responses

would have been more accurately defined as reflections of meaning, despite the fact that

his mode of responding was called reflection of feeling (Bohart, et al., 2002). It is

35

important to recognize, however, that the capacity to understand a client�s frame of

reference would also include an understanding of the way he or she feels (Bohart, et al.,

2002). Conceptually, then, the therapeutic relationship or alliance, as well as the empathic

quality it is supposed to embody, is more complex than the therapist-provided qualities

originally described by Rogers and others (Beutler, et al., 1986).

Counselor educators are primarily interested in whether the development of the

empathic relationship can be taught to student counselors and alternatively, in

understanding how empathy can best be communicated by student therapists to clients.

The first question has seemingly been answered in the affirmative by theorists (Rogers,

1980) and by the writers of textbooks (Carkhuff, 2000), but not equivocally demonstrated

by researchers (Beutler, et al., 1986, Beutler, et al., 1994; Lambert & Bergin, 2003).

Measuring Empathy Quantitatively

Rogers (1980) cited increasingly relevant empathy research when he reported that

the degree of empathy present in the relationship can be inferred simply by listening to

therapist responses, without any knowledge of the client�s statements (Quinn, 1953).

According to Rogers (1980), �Clients are better judges of the degree of empathy than are

therapists.� �Perhaps, then, if we wish to become better therapists, we should let our

clients tell us whether we are understanding them accurately� (Rogers, 1980, p. 149).

Barrett-Lennard (1962) designed such a self-report scale for measuring both therapist and

client perceptions of empathy in the relationship individually. Bohart, et al., (2002)

reported �The Barrett-Lennard Relationship Inventory (BLRI), which measures clients�

36

perceptions, is the closest operational definition of Rogers� hypothesis (p. 91).� Rogers

(1980) further wrote that the client�s perception of the therapist�s empathic quality

correlates highly with the perceptions of unbiased judges listening to recordings of the

therapy sessions, yet, �The agreement between clients and therapists, or between judges

and therapists, is low� (p. 149). Both Carkhuff (2000) and Ivey & Ivey (2003) published

scales to use to measure the level of empathy present in a therapist�s responses, but these

scales have not been quantifiably and reliably validated. Elliott, Filipovich, Harrigan,

Gaynor, Reimschuessel, and Zapadka, (1982) attempted to establish trait and behavioral

correlates of empathy as it was described within the Barrett-Lennard Relationship

Inventory (1962). As cited by Silva (2001), Elliott et al., (1982) developed a

multicomponent rating scale based on the definitions of empathy that are included in

Barrett-Lennard�s scale. This component analysis further refined the process described as

�response empathy: The empathic qualities expressed in particular counselor verbal

responses� (Elliott et al., 1982, p. 379). According to Elliott et al., (1982), the capacity to

measure counselor responses as a specific component of empathy provides �useful

clarification� (p. 379) for the purposes of research, in contrast to earlier efforts which

measured empathy globally (p. 379). Elliott et al., (1982), analyzed 28 counseling

sessions after which clients reported that their counselors had understood them in what

they identified as an empathic manner. Elliott et al., (1982) concluded that out of the nine

components of empathy identified, the three most important components of counselor

empathy included the counselor�s ability to enter the client�s frame of reference or

perspective, the counselor�s ability to use fresh language when reflecting the client�s

37

experiences, and the counselor�s willingness to address the client�s core issues. Based on

their extensive experience in counselor training and supervision, Brew & Altekruse

(2006) also recommended the use of a valid and reliable counselor response or interaction

rating form (Altekruse, 1967) that can be used as a self-analysis instrument by

counselors, as well as by counselor educators charged with the training and supervision

of counselors. This instrument, the Counselor Interaction Analysis (CIA), was designed

to measure the same sorts of counselor responses that have been previously delineated as

empathic responses by other researchers (Barrett-Lennard, 1962; Brew & Altekruse,

2006; Carkhuff, 2000; Elliott et al., 1982; Ivey & Ivey, 2003; Rogers, 1980).

Therapist Influences on Client Perceptions of Empathy

What seems most important is that, �Clients perceive their counselor to be

empathetic� (Sexton et al., 1997, p. 75). Sexton et al., (1997) further stipulated that

certain counselor responses seem to contribute to client perceptions of empathy, such as

the use of analogies, infrequently offering general advice, and engaging in less self-

disclosure. Given the salience of the above research findings, counselors must be able to

learn which counselor response styles are most facilitative of a client-perceived

therapeutic relationship characterized by empathy.

Therapist Response Styles as a Function of Experience and Training

Therapist response styles have also been examined as a function of therapist

experience, skill, verbal and nonverbal behavior, and choice of interventions (Beutler et

38

al., 1986; Beutler et al, 1994). Beutler et al., (1994) reported research results that

indicated that therapist responses usually change as a function of training and

furthermore, that client patterns of speech also begin to parallel those speech patterns

used by their therapists. Further, Beutler et al. (1994) reported �High proportions of

client-therapist topic agreement, regardless of who initiated the topic, were associated

with both continuance in therapy and amount of benefit achieved" (p. 252). Beutler et al.

(1986) also reported that therapists who intend to establish early empathic relationships

with their clients may be considered effective only if they tend to avoid high levels of

directiveness (p. 279). Moreover, Beutler et al. (1986) suggested that therapist experience

and skill level may eventually moderate the effect of verbal activity on clients. For

example, Beutler et al. (1986) reported that some studies have shown that the early use of

confrontations may engender a good deal of resistance and the arousal of negative

emotion on the part of clients when practiced by inexperienced therapists, but may have

quite a different effect when practiced by those who are experienced� (Beutler et al.,

1986, p. 288). Brew & Altekruse (2006) also found that confrontive response styles used

by beginning therapists often serve to destroy the development of the fragile therapeutic

relationship. Therapist directiveness as a therapeutic intervention and as a particular type

of therapist response style continues to be debated in the outcome literature (Beutler et

al., 1994). For example, in several post hoc comparisons, researchers found that poor

therapeutic outcomes were characterized by therapist efforts to extract information or

give advice, as well as to direct or control therapeutic transactions, and were associated

with very few treatment changes (Beutler et al., 1986). Other writers have reported on

39

�the importance of therapist non-verbal behaviors, including posture, vocal quality,

ability to encourage exploration of emotion words, and the relative infrequency of

engaging in such speech acts as talking too much, advice-giving, and interruption�

(Bohart et al., 2002, p. 99). On the other hand, a number of other post hoc analyses found

a positive relationship between therapist directiveness and beneficial treatment outcomes,

especially when working with depressed patients (Beutler et al., 1994). These

contradictory findings may stem from differences in the levels of directiveness exercised

by different therapists, as well as a lack of standard or comparable measures of

directiveness on the part of the researchers, or directiveness may vary as a function of its

interaction with other variables (Beutler et al., 1994). Bohart et al. (2002) reported that

Myers (2000) qualitative research study �found that interrupting, failing to maintain eye

contact, and dismissing the client�s position while imposing the therapist�s own position

were perceived as unempathic,� . . . �whereas paying attention to details and being non-

judgmental, attentive, and open to discussing any topic were perceived as empathic"(p.

99). Regardless of the remaining controversies regarding the differential therapeutic

effectiveness of different response styles used by experienced and inexperienced

therapists, during different stages of therapy, with different client populations, it seems

that substantial agreement has been found among researchers that certain response styles

and interventions are most conducive to the development of the early therapeutic

relationship, especially by novice counselors. This is the primary area of therapeutic skill

counselor educators are most responsible for developing in their students during graduate

school training. Accordingly, it is important for counselor educators to learn which

40

methods are best for teaching empathic and relationship-building communication skills to

their students.

Counselor Education and Supervision

Counselor education programs are charged with the responsibility of providing

students with the necessary academic knowledge and clinical training experiences that

will provide them with the greatest opportunity to develop into effective counselors

(Calhoun, 1999). This charge comes from both national and state licensing standards and

accreditation councils (Bernard & Goodyear, 1992; Bradley, 1989). As a result of

adoption of these professional training standards, student counselors enrolled in

accredited counselor education programs receive similar training experiences based on

developing the skills and attitudes needed to become effective counselors (Calhoun,

1999). Specifically, Bradley & Kottler (2001) noted that the potential development of a

high quality of counselor interviewing skills is believed to be developed through

participation in specified pre-practicum, practicum, and internship experiences, although

the duration and generalization of these skills is unknown (Lambert & Ogles, 1997). In

light of the research gaps identified previously in this literature review concerning

teaching students to develop and maintain a therapeutic relationship, Lambert & Ogles

(1997) stated that research studies thus far have been unable to verify more than a

modestly positive relationship between empathy, regard, and genuineness, and

psychotherapy outcome.

41

Supervision Research Limitations

Supervision research is often plagued with small sample sizes and methodological

problems that obscure research results (Baker, Daniels, & Greeley, 1990; Lambert &

Ogles, 1997; Wampold & Holloway, 1997; Watkins, 1997). Still, Watkins (1997) wrote

that psychotherapy training programs should give primary interest to helping students

learn the core relationship skills (e.g., empathy), because those skills, or �common

factors� are still the best predictors of therapeutic outcome. These constructs are difficult

to study empirically without a valid and reliable, as well as objective measurement scale

that specifies the type of therapist responses associated with positive or negative

outcomes by clients themselves. Measuring the ways student counselors communicate

with others requires a method by which these responses can be objectively recorded,

scored, and rated. This kind of activity requires, at the minimum, the cooperation of three

individuals, including the counselor, the counselee, and the objective observer, and the

time and space necessary to allow for the collection of a representative sample of

communication to be recorded, scored, and rated. Ideally, this type of measurement

should use communication that is as similar to a real therapy session as possible.

Therefore, this sort of measurement is most likely to occur during the last few semesters

of a student counselor�s academic program, when the student has been educated in all the

curricular requirements of the counseling profession that precede actual, or unsupervised,

counseling practice, and is finally enrolled in one of the pre-practicum, practicum, or

internship classes.

42

To understand more fully the history of research on the teaching and supervision of

therapists, it is important to note that originally, there was no way for a counseling

supervisor to observe the therapeutic hour objectively. Supervision consisted of

reviewing case notes and talking with supervisees about what they remembered and

chose to tell about what had actually transpired between themselves and their clients

during therapy sessions (Matarazzo & Patterson, 1986).

Using Technology in Supervision Research

Recognizing the need for improvements in therapeutic training and supervision, and

appreciating the fact that an enhanced capacity to monitor the activities of counselors-in-

training would ultimately result in improved client care, Carl Rogers was the first

psychotherapist to use research technology to make audiotape recordings of his sessions

with students in a university counseling center and was also the first to use a one-way

mirror for supervision purposes (Matarazzo & Patterson, 1986; Rogers, 1957). �He was

also the first to define, behaviorally, what to him were the essential, effective ingredients

in the therapist�s attitude and behavior (facilitative conditions) that could be measured

and evaluated to specify graded experiences for the training of therapists� (Matarazzo &

Patterson, 1986, p. 823).

Research on Programmed Instruction

Following the lead of Carl Rogers (1957), Truax, Carkhuff, and Douds, (1964),

Carkhuff (1967), and Carkhuff (1972) developed didactic-experiential "programs that

43

were designed to teach therapists to use the facilitative conditions" (Matarazzo &

Patterson, 1986, p. 823). They developed measurement scales and attempted to

demonstrate the effectiveness of the training empirically. However, researchers who used

their training programs and their measurement scales discovered that therapist ratings on

some of the scales were not correlated with client�s perceptions of being understood and

the AE (accurate empathy) scale did not seem to be measuring empathy alone, but instead

measuring more of a good-bad evaluative dimension (Matarazzo & Patterson, 1986).

Researchers found that the empathy scales seemed to be measuring responses that were

not particularly relevant to the client statements that preceded them (Matarazzo &

Patterson, 1986). Moreover, researchers found that using 2-3 minute taped segments of

therapeutic interactions to measure the existence of a variable as complex as empathy

provides an inadequate measurement sample (Matarazzo & Patterson, 1986). The social

learning and behavior modification ideas originally used by Truax and Carkhuff, and still

promoted by Carkhuff (2000) and Ivey & Ivey (2003), include the teaching of one

counseling behavior at a time, the provision of immediate written feedback, and

hopefully, the gradual refinement of better approximations of behavior until a desired

level of performance is reached. These training procedures have been retained by

accredited counseling programs as a counselor education and supervision method,

although the measurement of empathy as a therapeutic condition has been called into

question by the aforementioned research problems encountered (Matarazzo & Patterson,

1986).

44

Research on Microtraining

This procedure, originally developed by Ivey, Normington, Miller, Morrill, &

Haase (1968), officially established the method of teaching one skill at a time (attending,

reflection of feelings, summarization, self-disclosure) by breaking each skill down into its

behavioral components - for example, Ivey and his colleagues taught that �attending�

included such behaviors as direct eye contact, appropriate body language, verbal

encouragement to the client to continue, and the like. (Matarazzo & Patterson, 1997). A

large number of studies have demonstrated the effectiveness of the microtraining method

and only a sample of these studies will be examined here. Ivey, et al. (1968) developed a

standard microcounseling technique that involved the following steps for the counselor

being trained: (1) conduct a 5-minute videotaped interview with a counselee, (2) read

about the skill, (3) view videotaped modeling of the skill by effective and less effective

models, (4) review their own videotaped interview and identify their own target behavior

change, and (5) re-interview the same interviewee in a second videotaped condition

(Ivey, et al., 1968). Using this teaching technique, Ivey, et al., (1968), found that

counselor skills improved significantly on a pre and posttest basis, as rated by judges.

More importantly, the members of the treatment group were also rated higher on the

client�s rating of the Semantic Differential Form and the Counselor Effectiveness Scale

(Haase & DiMattia, 1970). The microcounseling supervisors were also rated higher by

the students than were the more traditional supervisors (Matarazzo & Patterson, 1986).

The greater effectiveness of the method was later attributed to the specificity and the

advanced training of the teachers, who were either advanced psychiatric residents or

45

faculty members (Matarazzo & Patterson, 1986). Interestingly, even when compared

against the Carkhuff human relations development-training model, microcounseling has

produced superior results (Matarazzo & Patterson, 1986). Although both groups had

higher empathy ratings than the controls at the posttest measurement, the microtraining

group had superior skills to the group in the human relations training group (Daniels,

Rigazio-DiGilio, & Ivey, 1997; Matarazzo & Patterson, 1986). The vast majority of

research studies on microcounseling training have reported a significant treatment effect,

both when the treatment group has been compared to controls, and when the treatment

group has been compared with less-well specified programs (Daniels, et al., 1997;

Matarazzo & Patterson, 1986). Daniels, et al. (1997) also reported that the more

components of the microcounseling program used, the more effective the outcome. Based

on the literature search, research concerning attempts to incorporate learning about

common counseling errors into a microcounseling training format has not occurred.

Research on Supervision

Wampold & Holloway (1997) wrote that the purpose of supervision is to improve

the ability of the counselor-in-training to deliver effective and efficient psychotherapy by

changing the counselor�s characteristics, �including but not limited to, skill level, role

expectations, therapeutic orientation, values, attitudes, beliefs, and, in some cases,

emotional well-being and cultural attitudes� (p. 12). Given the fact that counselors-in-

training enroll in graduate university programs as fully developed, independent, and

experienced adults, the task of training and changing them in some fundamental and

46

complex ways at this stage of life is even more challenging. Of course, all professions

share a concern that their practitioners are competent (Matarazzo & Patterson, 1986).

However, the counseling profession is faced with an unusual problem in defining pre-

training differences among students that may impact their ability to learn while being

enrolled in certain training protocols, such as the supervised practicum or internship

(Matarazzo & Patterson, 1986). For example, the kinds of intellectual and academic

abilities identified by GRE scores and college-level grade point averages have never been

able to predict which counseling students will benefit most from clinical training, nor

which students will need remediation in training, nor which ones may need professional

psychological assistance to help them deal with their own unresolved issues while they

are being trained as counselors (Matarazzo & Patterson, 1986). Furthermore, the

counseling profession has been unable to identify these prerequisite differences through

empirical research studies (Matarazzo & Patterson, 1986). The more pertinent question is

whether and to what extent counselor education programs can best moderate these

prerequisite differences among students before graduation.

Supervisory Evaluation

Counselor supervisors have not only taught and encouraged their students

throughout their clinical training, but they have also monitored their progress toward

professional status by using the process of evaluation, which has been called the main

task, or the nucleus, of supervision (Gould & Bradley, 2001). It is important that

supervisors have at their disposal objective and research-based evaluation measures so

47

that the evaluative task is less influenced by ambiguous, personal decisions. A clearly

written, consistently applied evaluative measure serves to reduce excess anxiety on the

part of the supervisee.

In addition to the supervisory task of clinical oversight and evaluation, there are

other forces simultaneously influencing the development of the counselor-in-training,

such as didactic and experiential coursework, interactions with other students, and

experiences that take place outside the university environment, including interactions

with clients and interactions with field-site supervisors (Gould & Bradley, 2001;

Wampold & Holloway, 1997). The goal of supervision is not just to change the

counselor-in-training. Supervision is also supposed to ensure the competent delivery of

psychotherapy by supervisees, which should ultimately result in positive psychological

changes desired by the client (Wampold & Holloway, 1997). With managed care

companies pressuring mental health professionals to demonstrate effectiveness and

efficiency in client care, it stands to reason that the academic programs responsible for

training these counseling professionals should also be able to demonstrate effectiveness

and efficiency, not to mention empirical justification, in the supervision methods chosen

for this important task.

Along with the efficacy of supervisory training and evaluative methods, however,

the context within which they are used must also be examined. The context of

supervision, like the context of counseling, is not only influenced by the academic

program in which supervision takes place, but also by the supervisory relationship that

exists between student counselors and their supervisors.

48

The Supervisory Relationship

The quality of the supervisory relationship appears to be important to the

development of the student counselor, as proposed by Rogers (1957) and affirmed by

Carkhuff (2000) and Ivey & Ivey (2003). Muse-Burke, Ladany, & Deck (2001) agreed

with other supervision researchers when they posited that the supervisory relationship is a

fundamental and influential component of supervision (Holloway, 1997; Watkins, 1997).

If the relationship between the supervisor and supervisee is not characterized by

facilitative conditions, supervisory evaluation may be ignored or may be perceived as a

personal attack (Gould & Bradley, 2001). Thus, the quality of the supervisory

relationship has the potential to influence, at least indirectly, in either a positive or a

negative direction, the supervisor�s view of the student counselor, as well as the student

therapist�s capacity to treat the client effectively (Worthen & Dougher, 2000). Similar to

research findings about the importance of the therapeutic relationship, a counselor

educator might assume that the quality of the supervisory relationship would be a more

important component of counselor training than the supervisor�s theoretical approach to

supervision. The challenge, then, is to nurture the supervisory relationship while

preventing it, with its potential biases, from unduly influencing trainee evaluations by

allowing them to be based on the quality of the supervisory relationship rather than fully

informed by competence criteria (Worthen & Dougher, 2000). Bernard & Goodyear

(1998) wrote that because the purpose of supervision is to help the trainee learn new

skills, rather than to change enduring personality patterns, the supervisory relationship is

less central, although still an essential element of supervision.

49

Theoretical Approach to Supervision

In an attempt to answer Sexton�s (1998) question �What approaches to supervision

help our students the most?," Bernard & Goodyear (1998) found that the professional

literature does not provide a clear answer to this question, in part because the terms

supervision and training are used interchangeably in descriptions of supervisory

interventions. Bernard & Goodyear (1998) explained that supervision should refer to

those aspects of training that involve practice with clients, whereas training should be

used to describe all the other components of counselor education that occur before

student counselors begin working with clients. However, �The call for structure for

novice trainees and for trainees of lower conceptual level may in fact be a call for

training,� rather than for the more subtle influences of supervision (Bernard & Goodyear,

1998, p. 7). In other words, even when novice trainees are working with clients, they

seem to need a supervisory approach that more closely resembles training, than

supervision, as defined by Bernard & Goodyear. Additionally, these leaders in the field of

counselor supervision found that the more directive supervisor behaviors, such as

interrupting videotapes of sessions frequently while focusing on specific therapist

behaviors served to accelerate the learning of therapy approaches more than the more

reflective, introspective part of trainee development (Bernard & Goodyear, 1998).

Bernard & Goodyear (1998) also suggested that it is difficult to know which theory of

supervision or supervisory approach is best to use with student counselors because there

is an absence of efficacy research and an over-reliance on supervisee satisfaction

measures for outcomes. To determine which supervision approach works better than

50

another would require comparative studies of supervision models and unfortunately,

studies of this type have not been conducted (Bernard & Goodyear, 1998).

Regarding the use of trainee satisfaction measures to determine the efficacy of

supervision, Bernard & Goodyear (1998) stated that asking trainees to rate their

satisfaction with supervision could be compared to the efficacy of asking people leaving

a donut shop whether they liked the donut and whether they would return to the donut

shop later. Bernard & Goodyear (1998) suggested that although the people would

probably answer affirmatively to both questions, their answers would provide no

information regarding the nutritional value of the donuts. Similarly, satisfaction measures

do not inform counselor educators about the nutritional value of supervision (Bernard &

Goodyear, 1998). Bernard & Goodyear (1998) went further to point out that although

training manuals have been used to study the comparative efficacy of different treatment

approaches in psychotherapy research, only one supervision manual has been developed

thus far (Neufeldt, 1994), and its purpose was for training supervisors, rather than to

articulate a training model for research purposes (Bernard & Goodyear, 1998). However,

given the trend to compare the efficacy of different therapeutic approaches by way of the

standardization of practice that therapy manuals provide, one might ask why the

counselor supervision field has not produced manuals for different supervision

approaches for the same purpose (Bernard & Goodyear, 1998). According to Bernard &

Goodyear (1998), the typical supervisor functions in an integrative manner without the

use of a manual. In fact, one might question what the difference is between a supervision

manual and a supervision textbook (Bernard & Goodyear, 1998). However, if for no

51

other reason than the simplicity and ease of use such a format provides, they recommend

the development and use of such manuals to allow for studies of supervision

effectiveness and efficiency (Bernard & Goodyear, 1998). Thus, the theoretical approach

chosen for this research project will be one that emphasizes the comprehension and

recognition of common counseling errors through the use of a manual, as well as

videotaped modeling, videotaped practice, self-assessment, supervisory feedback, and an

integrative theoretical orientation as the study's contextual background.

A Common Factors/Integrative Theory of Supervision

As previously mentioned in this paper, the common-factors approach to counseling

is a model of counseling integration that has received considerable research attention over

the past two decades (Hubble, Duncan, & Miller, 1999). Lampropoulos (2002) has

recently offered a common-factors framework for supervision in which he integrates

different theories of supervision into a common-factors structure. This approach to

counseling supervision emphasizes similarities between the common-factors view of

counseling and the common-factors approach to supervision, such as a similar importance

assigned to the major influences of the resources and attitude of the supervisee and the

quality of the supervisory relationship. The common-factors view of supervision allows a

broader view of supervision in the context of change-inducing interactions, and includes,

as well, the incorporation of theoretical and empirical findings from the related fields of

counseling and education (Lampropoulos, 2002). Like Bernard�s (1997) Discrimination

Model of Supervision, the common-factors supervisory approach also allows for the use

52

of an eclectic array of supervision methods, depending on the needs of the supervisee and

the roles and focus of the supervisor (Lampropoulos, 2002). Still, important differences

between counseling, supervision, and counselor education exist and have become the

focus of attention in the search for the identity of supervision as a distinct process

(Bernard & Goodyear, 1998). For example, supervision is evaluative and counseling is

not (Lampropoulos, 2002).

As previously noted, the formation of a good therapeutic relationship is the most

commonly identified common factor in counseling, as well as the factor most strongly

related with change (Duncan, Miller, & Sparks, 2004). Not only is the relationship often

curative by itself, but it also seems to be the primary element through which therapeutic

change occurs (Bachelor & Horvath, 1999). In the case of supervision, a good

relationship will enable the trainee to grow professionally and make the most out of the

supervisory experience (Lampropoulos, 2002). Gelso & Carter (1994) described three

elements of the therapeutic relationship: the real relationship, the working alliance, and

the distorted transference relationship. The real supervisory relationship includes the

facilitative Rogerian conditions (empathy, warmth, genuineness, and unconditional

positive regard) as well as supervisor and supervisee personal skills and qualities, such as

self-disclosure, trust, and social influence (Lampropoulos, 2002). As previously stated,

basic facilitative supervisory relationship conditions are important, especially for the

novice trainee (Bernard & Goodyear, 1998; Gould & Bradley, 2001). �Being empathic to

the difficulties that trainees face in each stage of their development, is a quality of the

effective supervisor� (Lampropoulos, 2002, p. 80). However, demonstrating

53

unconditional positive regard toward all trainees at all times, is a more difficult issue for

supervisors because supervision includes evaluative aspects (Gould & Bradley, 2001;

Lampropoulos, 2002). Lampropoulos (2002) suggested that the effects of evaluation

could be reduced if the primary evaluation of trainees took place during the initial

selection of students for training and if early evaluation could be of a more subtle

character for novice trainees. For example, Lampropoulos (2002) cited Ronnestad &

Skovholt (1993) in suggesting �At the beginning level, the effective supervisor of novice

trainees may, to some extent, allow the student to select or distort data� (p. 398). The

rationale for a less stringent form of evaluation for novice trainees is based on the idea

that this type of supervision will allow trainees the time and space to find their strengths,

develop their abilities and style, and to attribute their professional development to

themselves, rather than to the preferences of the supervisor, which will eventually

enhance their self-efficacy as counselors (Lampropoulos, 2002). Related to the issue of

evaluation are the supervisor�s directiveness and the issue of matching the supervisory

approach to the trainee�s characteristics, such as developmental level and personality

structure. Ronnestad & Skovholt (1993) asserted that beginning trainees appreciate an

instructional, directive, and skill-building focus. However, it can be argued that the

degree of directiveness and structure should depend on the supervisee�s reactance

potential (Tracey, Ellickson, & Sherry, 1989). For example, psychological reactance can

be described as an unconscious emotional reaction to a perceived loss of behavioral

freedom or control (Tracey, et al., 1989). In the area of counselor supervision, a

perceived loss of freedom or control over one's previous communication style can

54

unfortunately result in the adoption or strengthening of a less effective counseling style,

rather than the counseling style intended by the supervisor. Tracey et al. (1989) suggested

that the supervisor could best deflect reactance potential by increasing the supervisor's

credibility, by modeling more effective counseling responses interactively with the

supervisee, and by exploring supervisee emotions in response to supervisory directives

from time to time in order to ensure that an effective working alliance has been

developed and maintained. The working alliance element of the supervisory relationship

includes the contract, which Lampropoulos (2002) stated should be signed and should be

as detailed and clear as possible from the very beginning. The working alliance also

encompasses the goals of supervision, which include the assessments of strengths and

weaknesses and the specific skills to be mastered (Lampropoulos, 2002). The tasks used

to reach these goals are also important elements of the alliance and include such elements

of supervision as structure, instruction, feedback, self-evaluation, rehearsal, application of

new knowledge and skills, corrective action, and generation of alternatives on behalf of

the supervisee (Lampropoulos, 2002). Self-reports, process notes, audiotape, videotape,

Interpersonal Process Recall, reflecting teams, and various forms of live observation and

group supervision are some of the most common supervisory methods (Bernard &

Goodyear, 1998).

A theoretical rationale and a ritual for supervision refer to the existence of a training

philosophy (theory) and methodology that all supervision models have (Lampropoulous,

2002). �A theoretical rationale is necessary to explain development and change, and

guide both the supervisor and the supervisee� (Lampropoulous, 2002, p. 87). �A practical

55

ritual is useful in applying the supervision theory and specifying what needs to be done in

terms of supervision techniques� (Lampropoulos, 2002, p. 88). A good description of

different theoretical rationales for supervision can be found in comprehensive textbooks

edited by Watkins (1997) or Bradley & Ladany (2001). An equally complete description

of supervision rituals and methods can be found in Bernard & Goodyear (1998). The

position of the present paper is that (a) important similarities between theoretical models

of supervision exist and similar strategies are used by these models to address common

supervisee needs; (b) supervision methods should be used eclectically to accommodate

individual differences of supervisees; and (c) supervision theories can be integrated in a

harmonious whole and used in different points in supervision, wherever their respective

strengths lie (Lampropoulos, 2002).

Counseling-based supervision theories tend to focus on some functions and stages

in supervision to the exclusion of others. For example, psychodynamic and person-

centered supervision models tend to emphasize the supervisory relationship and the

facilitative conditions in the development of the counselor, whereas behavioral,

cognitive, and social learning supervision theories emphasize more of the use of specific

techniques and are more directive, behavior focused, and instructional (Bradley &

Ladany, 2001; Watkins, 1997). Bernard�s (1997) discrimination model of supervision is

integrative, but it neglects specific attention to the supervisory relationship and the goals

of supervision, which could be problematic for beginning supervisors working with

novice trainees (Bradley, Gould, & Parr, 2001). Using a common-factors approach to

integrate different theories of supervision can be accomplished through the initial

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development of a facilitative relationship and the development of a working alliance

(person-centered, humanistic approach); then behavior-focused exploration (self-

monitoring and self-observing) can increase interpersonal awareness (Lampropoulos,

2002). Following this, an assessment of irrational beliefs about therapy and supervision

can enhance understanding (cognitive school) and different kinds of exposure (behavioral

school) and cognitive restructuring (cognitive school) can be used to address problematic

counseling behaviors, while new counseling skills are acquired through instruction,

modeling, and rehearsal (behavioral philosophy) (Lampropoulos, 2002). The common

factors view works well with the stages of supervisee development and is compatible

with the social role models of supervision (Bernard & Goodyear, 1998) that support the

idea that there are different roles that supervisors assume at different points in

supervision with different supervisees for different purposes (Lampropoulos, 2002).

Kagan's Interpersonal Process Recall Method of Supervision

Lastly, Kagan�s Interpersonal Process Recall (IPR) method in supervision (Kagan

& Kagan, 1997) and its adoption for eclectic use in an integrated supervision approach

seems appropriate to include at this point. �Developed in the person-centered tradition

and with a strong experiential component, IPR is a powerful tool to help supervisees

increase their awareness and understanding of all aspects of their behavior in session�

(Lampropoulos, 2002). In the original model, the supervisor was supposed to be a trusted

facilitator who avoided any interpretative, instructional, and directive intervention. Later,

a more active and directive role for the supervisor was recommended for use with those

57

supervisees who were extremely and repeatedly defensive or who showed a limited

ability to learn from self-discovery and self-reflection (Lampropoulos, 2002; Tracey, et

al., 1989). However, it should be noted that the evaluative aspect of IPR should be

avoided as much as possible, and a good supervisory relationship is a prerequisite for its

effective use (Lampropoulos, 2002).

The Effectiveness of Training Components

The variables that have been examined most frequently have been the value,

individually and in combination, of didactic material, modeling, videotaping and self-

confrontations, supervisor and peer feedback, and in vivo and simulated practice,

including mental rehearsal. The majority of the curricular requirements inherent in

counselor education programs are conveyed to students by way of didactic materials, as

has been alluded to previously in this paper, and this method of instruction is self-

explanatory. Didactic instruction is involved in supervision research primarily as a

comparative method when attempting to test the superior effectiveness of an alternative

component of instruction or supervision.

Modeling

Albert Bandura not only demonstrated through his research at Stanford University

(Bandura, 1969) that people can learn new behaviors merely though the observation of

others performing the same behaviors, he also claimed (Bandura, 1986) that the majority

of what people learn comes from observational learning and instruction rather than from

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the results of their own trial and error experimental behavior (Miller, 1993). �Imitation of

the model�s behavior when the model is no longer present is an especially important

learning skill� (Miller, 1993). According to Miller (1993), observational learning is

especially important for the acquisition of new and complex behaviors. According to

Bradley & Gould, (2001), modeling and reinforcement are two of the most powerful

principles in psychological learning theory. In her supervision textbook, Bradley (1989)

cited numerous investigations into the successful use of modeling for teaching focal skills

to counselors and emphasized the combination of modeling and instruction, the use of

such expert models as Carl Rogers, and the use of step-by-step training and reinforcement

in order to increase the likelihood that the counseling behaviors modeled would later be

regularly performed by counseling students. Although Bandura (1986) found that

reinforcement is not necessary for observational learning to occur, it seems likely that

expectations of positive or negative evaluations following the performance of certain

counseling behaviors might impact a student�s motivation to learn and perform behaviors

consistent with a supervisor�s modeled instructions. Social cognitive theorists proposed

several educational implications based on the assumptions implicit in the theory, such as

the implications that modeling new behaviors for students will help them to acquire those

skills; that learning does not always appear immediately, but may instead be reflected in

students� later behaviors; that students should be encouraged to set challenging yet

achievable goals for themselves in order to obtain them; that teaching students strategies

for monitoring their own learning and behavior will help them to regulate their own

behavior; and the implication that the indirect consequences of reinforcement and

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punishment of certain behaviors should be communicated to students so that their

expectations are shaped appropriately (Ormrod, 2003). Daniels, Rigazio-DiGilio, & Ivey,

(1997) added that �modeling appears to be effective both alone and in combination with

other components such as instruction and manuals, the latter adding incremental validity

to the training� (p. 286). Modeling and reinforcement can be utilized in supervision in

several ways. For example, modeling can be employed within a supervisor-supervisee

dyad while the supervisee either discusses or role plays a question about a client, and the

supervisor models an effective counseling response (Bradley & Gould, 2001). There are

also many faculty members and counseling experts who have produced demonstration

videotapes to use for the modeling of counseling skills for students (Brew & Altekruse,

2006; Carkhuff, 2000; Ivey & Ivey, 2003). Brew & Altekruse (2006) wrote that when

their counseling students were able to watch a videotape of a student similar to

themselves making certain counseling errors, and then were able to watch another

videotaped segment of a student modeling improved counseling responses to the same

client stimulus statements, their students were much more likely to recognize the

counseling errors when they were modeled visually in this way and, most importantly, to

improve their own responses during later counseling interviews as a result.

Research on positive and negative modeling. In a comparative study of positive and

negative modeling in counselor training, Newman & Fuqua (1988) discovered that

negative modeling actually produced training outcomes similar to those achieved by

positive models. Modeling has proven itself as an effective teaching method, especially

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when using models that exhibit both high and low skills (Matarazzo & Patterson, 1986).

According to Brew & Altekruse (2006), trainees seem to benefit most when they are able

to observe the contrast between the modeling of errors followed by the modeling of

empathic communication skills. According to Matarazzo & Patterson (1986), video

modeling produced greater effects on empathic communication when the outcome

measure was an ambiguous critical incident interview, rather than a written test. In other

words, video modeling seemed to facilitate performance in an ambiguous circumstance,

which may also influence counseling performance in a real client interview. In a review

of research on supervision, Hansen, Robins, & Grimes (1982) found that modeling was

definitely an effective approach to teaching facilitative conditions.

Characteristics of the model. According to social cognitive learning theorists,

such as Bandura (1986), certain characteristics of the model also increase the likelihood

that the behaviors being modeled for a student are more or less likely to be imitated,

including the perceived competence of the model, the prestige and power of the model,

whether the model is demonstrating gender-appropriate behavior, and whether the

behavior modeled is relevant to the learner�s own situation (Ormrod, 2003). Brew &

Altekruse (2006) designed a counselor-training video as an accompaniment to their

workbook that is composed of a number of actual counseling students modeling four

common counseling errors, followed by modeled supervision sessions, and then followed

by different counseling students demonstrating improved facilitative counseling skills

with the same clients. This tape also illustrates for the learner the models' impressions of

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their interviews while being interviewed by the first author of the training workbook that

accompanies the videotape. In this tape, the author plays the role of a nonjudgmental

inquirer providing an interpersonal process recall supervisory interview, which is also an

expert demonstration of facilitative counseling skills. All the characteristics of effective

modeling are thus provided for the student in this videotape. The videotaped models

demonstrate competence as they demonstrate the improved facilitative counseling skills;

the author demonstrates additional prestige and power in her dual roles of workbook

author and supervisor; the counseling students, both male and female, model gender-

appropriate behavior; and the counseling behavior modeled is relevant to the learner�s

situation. Although this newly published counselor training videotape has not yet been

tested in experimental supervision research, both counselor educators and supervisors

could benefit from a study in which this videotape was compared to other forms of

supervision and training.

Role Play and Simulation

Supervisors or faculty members can role-play a simulated client while encouraging

students to offer counseling responses to prototypical statements. This modeling

technique allows for the simultaneous training of groups of supervisees.

Self-Appraisal and Skill Monitoring

Unlike other forms of evaluation, self-appraisal and skill monitoring are non-

threatening procedures that can and will be used by the supervisee forever if the

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supervisee learns to appreciate the personal value of the process (Bradley & Gould,

2001). Research has demonstrated that �individuals automatically evaluate observed

behaviors and attempt to influence these behaviors in a desired direction� (Bradley &

Gould, 2001, p. 160).

Videotapes and Audiotapes

�Tapes can be used to aid the supervisee in refining specific therapy techniques, in

learning perceptual-conceptual skills, and, by replaying key moments, to analyze

counseling behaviors� (Gould & Bradley, 2001, p. 285). Rogers recommended the use of

video- or audiotapes in supervision because he had observed that his trainees had tended

to be much more directive in their interviews than he had originally supposed (Bernard,

1997). Furthermore, Rogers discovered that mere didactic training in nondirective

counseling had not been effective enough, and that only when the students had been able

to review their interviews on tape had they been able to identify, acknowledge, and

eventually suppress their natural tendencies to give advice and otherwise be directive in

their sessions (Bernard, 1997). Rogers also suggested that electronically recording the

sessions allowed students and their supervisors to observe resistances, conflicts, and other

kinds of emotional blocks that sometimes occur in sessions (Bernard, 1997).

�Videotaping, currently, is the technology most valued by supervisors and trainees

in individual and family counseling and therapy� (Bernard and Goodyear, 1992).

Videotaping sessions has obvious advantages over the use of audiotapes because

videotape provides access to nonverbal cues (Bernard, 1997). Therefore, videotaped

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counseling sessions also provide the supervisor with a more comprehensive context of the

therapist�s skills for the evaluative aspects of supervision. Transcribing videotapes of

counseling sessions is a time-consuming, but enlightening, self-awareness exercise that

enables supervisees to become aware of the moment-to-moment communication habits of

which they are mostly unaware.

Summary of Literature Review

The efforts of managed care companies to discover which treatments work best for

which clients has resulted in thousands of comparative research studies conducted by

different professional schools of psychotherapy (Brown, et al., 1999). "The underlying

premise of the comparative studies, that one or more therapies would prove superior to

others, received virtually no support" (Duncan, et al., 2004). If differential theoretical



variance to effective psychotherapy, researchers have concluded that there must instead

be some common, pantheoretical factors that comprise the more significant elements of

therapy outcome (Asay & Lambert, 1999; Hubble, et al., 1999). Evidence suggests that

the quality of the counseling relationship is critical to the success of therapy (Sexton, et

al., 1997). Martin, et al., (2000) concur that the quality of the therapeutic relationship is

more important than the type of treatment, and that the alliance between client and

therapist is consistently, if moderately, related to outcome. Clinical researchers must

continue to demonstrate empirically that successful psychotherapy depends less on the

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specific kind of therapy provided than on the resources of the client and the quality of the

alliance created between client and therapist (Duncan, et al., 2004).

Counselor educators are primarily interested in whether counseling skills related to

the development of a strong, empathic relationship can be taught to every student

counselor during the training experience, regardless of pre-existing individual differences

between students. Counselors-in-training who haven't learned which of their counseling

responses are most likely to facilitate, rather than disrupt, the development of a positive

therapeutic relationship with a client may unintentionally continue to commit some of the

more common errors of counseling communication, even after they have graduated from

counselor training programs. Fortunately, therapist response styles usually change as a

function of training and experience (Beutler, et al., 1994).

Rogers (1980) reported that the degree of empathy present in the relationship could

be inferred simply by listening to therapist responses, without any knowledge of the

client's statements (Quinn, 1953). Videotaping and transcribing student counseling

interviews are methods of supervision that enable student counselors and their

supervisors to evaluate and further develop the empathic quality of counseling response

styles during training. Supervision researchers are interested in determining which

supervision and training methods are most effective and efficient with the majority of

counselors-in-training. The writers of supervision textbooks have recommended the

continued use of didactic instruction, as well as the use of programmed instruction, such

as microtraining, the development of supervision manuals, live and videotaped modeling

of effective and less effective counseling skills, role play and simulation of hypothetical

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client issues, counselor self-appraisal and self-monitoring, as well as a nonevaluative and

nondirective form of supervision feedback.

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CHAPTER III

METHODOLOGY

The methodology used in this study is described in the following sections:

introduction, participants, instruments, procedures, and research design and analysis. The

hypotheses will be described at the conclusion of this chapter.

Introduction Using two supervision methods (innovative versus traditional), this experimental

study examined differences in learning for participants enrolled in two counselor

education classes for one semester. Effectiveness of the two supervision methods was

determined by comparing posttest scores of the two treatment groups, which were

obtained from participants� videotaped counseling session transcripts at the end of the

semester with their pretest counseling transcript scores, which were obtained in the same

way, prior to the treatment, at the beginning of the semester. Additionally, summative

counselor competency scores, based on ratings by participants� supervising professors

(faculty evaluation), were compared with the posttest counseling transcript scores

obtained by participants assigned to the two treatment groups to further examine the

effectiveness of each supervision method on the participants� competence as counselors.

Participants

Participants in the study were master�s level counselor education students enrolled

in second-year practicum and internship classes during the Fall 2006 and Spring 2007

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semesters on the main campus of a private, Christian university in West Texas. The main

campus has a local student population of 1,000 students and is located in a West Texas

town with a population of approximately 25,000.

To complete a masters' degree in counseling, the participants were required to

complete three clinical courses before graduation. All of the participants were enrolled in

the second of three required clinical courses before graduation. Although the students�

enrollment in the course was required in order for them to become eligible to take state-

mandated licensing exams, their participation in this supervision study was voluntary.

The criteria for participation in this study was enrollment in the Practicum and Internship

classes, a signed, dated, and witnessed Informed Consent Statement (see Appendix A),

completion of pre and posttest transcribed counseling interviews, and completion of

additional written supervision assignments pertinent to the two supervision methods (see

Appendix C). All students who voluntarily participated in the study at the beginning of

the semester met all required criteria to be included in the final sample. Therefore, there

were no exclusions for this study.

The sample consisted of 26 participants, randomly divided into two groups

representing two methods of supervision, innovative versus traditional. Participant

gender, age, and ethnicity demographics will be described under the Participants heading

in Chapter IV. The process of randomization is described under the Procedures heading

found later in this chapter.

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Instruments

The Counselor Interaction Analysis (CIA) was used to rate the transcript responses

of all participants as pretest and posttest measures of counselor empathic or relationship-

facilitative responding (see Appendix B). Interview Record Form (IRF) (see Appendix B)

was administered to all participants as a summative measure of counselor competency.

The participants were also asked to complete written assignments (see Appendix D)

designed for this study that measured their comprehension of the supervision methods

used and a demographic questionnaire (see Appendix E) that included such data as

gender, age, ethnicity, and evaluative responses regarding the learning obtained as a

result of the study.

Counselor Interaction Analysis

The Counselor Interaction Analysis (CIA) (see Appendix B) was used to score the

pretest and posttest transcripts in this study as a measure of counselor effectiveness and

counselor empathic response style. The CIA is a modified version of the Counselor Self-

Interaction Analysis (CSIA), developed by Altekruse (1967).

Content validity for the CIA is �assumed because the scoring categories are

modifications of categories used by Bales (1950), in his extensive research on teacher

interaction analysis, and Amidon (1965), who first adapted the Bales interaction analysis

for counseling� (Brew & Altekruse, 2006, p. xi). According to Brew & Altekruse (2006),

Amidon wanted to determine if the CIA had content validity to measure indirect and

direct responses. Amidon (1965) found that the two instruments (Bales (1950) Teacher

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Interaction Analysis and Amidon�s (1965) adapted version of the counselor interaction

analysis) were highly related, with a percentage agreement of 93% (Brew & Altekruse,

2006). �The CIA was also submitted to a panel of counselor educators who agreed that

the CIA correctly categorized a sample of helper responses� (Brew & Altekruse, 2006, p.

xi).

Altekruse (1967) established inter-rater reliability in two ways (Brew & Altekruse,

2006). Judges analyzed the same tape recording independently before beginning the

rating procedure and achieved 96% agreement. In the same way, additional judges rated

the same tape after 10 ratings for the purpose of verifying maintenance of inter-rater

reliability. At that point, a 92% agreement was reached. Calhoun (1999), in a separate,

correlational dissertation research study found 98% inter-rater agreement in using the

CIA as a rating instrument.

With regard to effectiveness, the CIA was originally designed to assist counseling

students to objectively evaluate the verbal interactions between the counselor and the

client. Its purpose was to assist the counselor in determining who was dominating the

session and how frequently facilitative responses were used in proportion to less

facilitative responses (Calhoun, 1999). According to Altekruse (1967), relationship-

facilitating responses are those responses that are less directive in quality. Less

facilitative responses are those that are identified by Brew & Altekruse (2006), as well as

process researchers (Beutler, Crago, & Arizmendi, 1986) as more directive in quality.

The CIA allows students to examine their own pattern of response styles and thereby

70

fosters movement toward a more facilitative response style (Altekruse & Brown, 1969;

Brew & Altekruse, 2006; Calhoun, 1999).

The CIA was originally designed as a non-threatening, objective instrument by

which student counselors could evaluate their own in-session verbal interactions, rather

than as a measure of counselor effectiveness or competence (Calhoun, 1999). However,

the nature of the response patterns that the CIA identifies have been correlated with those

counseling response styles that foster the development of an empathic therapeutic

relationship (Carkhuff, 2000; Kottler & Brown, 1996).

The usefulness of the CIA as a self-assessment instrument for student counselors

was demonstrated through a controlled experimental design described by Altekruse &

Brown, (1969). The researcher reported that facilitative responding increased 85% for the

experimental group in comparison to 56% for the control group (Altekruse & Brown,

1969).

The CIA is not a direct measure of counselor effectiveness, but rather of the

interactive response style demonstrated by the counselor. Verbal response styles have

been directly correlated to counseling outcome. Those interactions, which are most

facilitative of the relationship, have been identified as those responses identified as more

facilitative of the counseling session. The authors of the CIA defined the following

pertinent terms: reflection, clarification, support, suggestions or information, directive

behavior, counselor initiation, silence without purpose, and small talk. For more

information on the meaning of these terms, please see Appendix H. The CIA generated a

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major dependent variable in the current study for the investigation of the effectiveness of

two contrasting supervision methods.

Interview Record Form

This instrument (see Appendix B) is a 10-item competency measure completed by a

supervising professor who supervises student counselors. The professor rates student

counselors� performance on a ten item, 5-point likert-type scale, with high values

designated as satisfactory performance and low values designated as less satisfactory

performance. The instrument generates a mean of ratings on the rated items as a measure

of counselor competency, ranging from a low mean score of 1 to a high mean score of 5.

In the current study, the measure was correlated with the CIA score as a validity-check

for the major dependent variable. It was expected that the two measures of student

counselor competence, the supervising professors� rating and the posttest transcript

scores generated by the CIA, would be positively correlated in order to provide evidence

of concurrent validity.

End of Semester Questionnaire This instrument (see Appendix E) is a 28-item questionnaire comprised of

demographic data, as well as questions designed to elicit information from students

regarding educational background, counseling experiences, and learning preferences. The

questionnaire also encouraged the participants to offer additional comments about the

72

research study and the supervision experience. Representative examples of comments

obtained from the participants are included in Chapters IV and V.

Manipulation of the Independent Variable of Treatment

The innovative method was based on a training manual that included experiential

exercises and a self-assessment instrument, a companion training video, and four written

assignments designed specifically for this study (see Appendix D). A unique aspect of the

innovative supervision method was its emphasis on increasing student counselors�

recognition and comprehension of non-facilitative counseling response errors commonly

committed by beginning counselors. Counseling students assigned to this supervision

method were also provided with a non-evaluative explanation of the psychological

rationale underlying the commission of such less empathic, less relationship-facilitative,

and common counseling errors as (1) giving too much advice, (2) asking too many

questions, (3) assuming an inappropriate professional stance, and (4) providing a

superficial level of empathy. Students assigned to this supervision method were also

taught alternative ways of responding that were less directive, more empathic, and more

facilitative of the therapeutic relationship through the inclusion of such responses in both

the manual and the companion video. A quantitative self-assessment instrument designed

to help students initiate measurable improvements in counseling response style was

included in the training manual.

The traditional supervision method was based on an assignment (see Appendix C)

to review and critique three traditional counseling videotapes; each containing counseling

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interviews conducted by experts in the field of counseling (see Appendix F). These

videotapes emphasized and demonstrated positive, empathic, and relationship-facilitative

counseling responses only, rather than demonstrating alternating examples of positive

and negative examples of empathic counseling responses. There were 44 traditional-style

videotapes assigned to this group of participants. These tapes were drawn from a faculty-

owned library of traditional, yet recently published instructional counseling videos. These

traditional videotapes were produced as either stand-alone, individual units, or partial

units of a series of counseling interviews. The videotapes assigned for review and critique

to this method of supervision included counseling interviews conducted by individual

therapists of different theoretical persuasions interviewing clients with different

presenting problems.

Procedures

Students enrolled in two sections of the Fall 2006 Practicum in Counseling course

were recruited to participate in the Spring 2007 supervision study by the clinical director

of the counseling program. The general nature and purpose of the research study was

explained to the students. Those students who planned to enroll in the Spring 2007

Internship in Counseling course were invited to read and sign Informed Consent

Statements (see Appendix A).

Following collection and review of the signed Informed Consent Statements, the

clinical director of the counseling program assembled the Fall 2006 counseling

transcripts submitted by participants. The clinical director then made the counseling

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transcripts available to the researcher so that the pretest transcript co-rating process could

begin. The clinical director also forwarded to the researcher a file containing the

Informed Consent Statements.

Random Assignment Procedures

To accomplish random assignment of students to two treatment conditions, student

participants drew a folded piece of paper (labeled inside with the number one or two)

from a hat on a classroom desk that had been filled with 26 folded pieces of numbered

paper. Participants were instructed to wait until the clinical director left the classroom and

based on the number drawn, to retrieve packets of supervision materials from one of two

large cardboard boxes sitting on tables labeled with matching numbers, one or two, near

the doorway as they left the classroom. Participants were also instructed to sign their

names on a piece of paper next to the box as they retrieved their supervision assignments.

The two lists of signatures were collected by an independent third party (clerical staff

person) and mailed to a pre-arranged colleague of the researcher who kept a file with the

two lists of group assignments sealed until the co-raters had completed the scoring of all

the transcripts.

The clinical director included written instructions with each packet of supervision

assignments in each box that were pertinent to each group of participants. The

instructions included with the supervision packets packed in box number one stated that

the students assigned to that method should work through the materials over the next four

weeks, completing one section of the workbook and video, as well as a brief chapter

75

assignment (see Appendix C) based on the content of that chapter of the workbook and

video each week. The instructions also indicated that the workbook and video would be

theirs to keep, but the written assignments were to be turned in to the supervising

professor after the fourth week or before the next videotape transcription was due. The

clinical director also provided written instructions for students assigned to complete the

supervision assignments in the box labeled with the number two that explained to those

students that they would be asked to view and critique three counseling videos selected

from box number two and complete three written assignments (see Appendix D) based on

their evaluation of these tapes during the next four weeks. The written critiques and

assignments completed by both groups of students were to be turned in to the supervising

professor at the end of four weeks or before the next videotape transcript was due. In that

way, the clinical director ensured that the students completed the entire supervision

intervention before videotaping and transcribing another counseling interview.

All participants were also instructed in writing to keep these additional

assignments confidential from each other and to discuss them only in individual

communications with the clinical director or the supervising professor

The clinical director and the professors assigned to teach the two spring internship classes were prevented from knowing the group identity of the students assigned to each

supervision method and to each class section until the end of the semester. Both

supervising professors participating in the study used identical course syllabi for the

practicum and the internship classes (see Appendix I).

All participants, regardless of group membership, attended all class sessions and

participated in all traditional counseling internship course activities. As the semester

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neared its conclusion, the supervising professors used Interview Record Form (Faculty

Evaluation Method, Appendix B) as an assessment instrument for the evaluation of

participant counseling competence. Once completed, the internship feedback forms were

put into a file and delivered to the researcher for the purpose of correlational statistical

analysis with the major dependent variable, the posttest CIA scores. Finally, participants

were asked to complete an End of Semester demographic questionnaire designed for this

study (see Appendix E). These questionnaires and the other written assignments (see

Appendix E) were collected and assembled for delivery to the researcher at the

conclusion of the semester.

Co-Rating Training Procedures

The co-raters were trained to achieve a high level of co-rater agreement with a

three-step process. First, the co-raters individually read the training manual, viewed the

companion video, and practiced rating the sample responses in the manual using the

Counselor Interaction Analysis instrument. Second, each co-rater individually rated a

minimum of five sample counseling transcripts provided by the researcher. Third, the co-

raters met together to examine and discuss a sample of ratings decisions made during the

training process. In this manner, co-raters were trained to achieve a high level of co-rater

agreement on rating decisions prior to beginning the ratings of the participant transcripts.

It was determined by consensus during that meeting that each co-rater would be free

to determine his or her final response rating, regardless of the ratings of the other co-

raters. It was also determined by consensus during that meeting that in cases wherein

77

more than ten responses were submitted by a participant, the first co-rater would select

the best ten responses to be rated and would inform the other co-raters about the

particular set of responses to rate so that the ratings would be consistently applied. Each

consecutive set of responses selected for rating was rated by each of the co-raters.

Co-Rating Procedures

When the pretest transcripts and the Informed Consent Statements were delivered to

the researcher, the researcher created a data file comprised of 26 rows for each participant

name listed on the signed Informed Consent Statement (Appendix A), with additional

columns created for each of the other items of supervisory materials that were to be

turned in for later analysis. Then, the researcher acting as first co-rater for the pretest

transcripts counted and numbered the responses on each transcript and selected the

beginning response to be rated. The first co-rater identified the beginning response with a

pencil mark arrow and the word �begin.� Using an individualized Transcript Response

Rating/Scoring Sheet developed for this study (Appendix G), the first co-rater then began

rating ten selected responses on each of the first five pretest transcripts. After the rating

of each transcript, a cover sheet was attached by paper clip to the front of the transcript

that included the identity of each co-rater followed by a straight line. A checkmark was

placed on the line beside each co-rater�s identity when the rating of that transcript was

completed. The first set of five transcripts was then bundled with a rubber band. A cover

sheet listing the names associated with that set of transcripts was put on top of the bundle

under the rubber band. Then, the bundle was turned over to the second co-rater and the

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second co-rater began rating the first set of five transcripts using a separate Transcript

Response Rating/Scoring Sheet for each one. After rating each pretest transcript, the

second co-rater then added a checkmark after his or her identity on the coversheet that

had been previously paper-clipped to the top of each transcript. Simultaneously, the first

co-rater began rating the second set of five transcripts utilizing the same documentation

procedures. In this way, all the pretest and posttest transcripts were bundled into groups

of five or six transcripts each (four groups of five and one group of six pretest or posttest

transcripts) totaling 52 transcripts altogether) and scored independently by each of the

three co-raters throughout the remainder of the time period during which the data scoring

procedures were completed.

Research Design and Statistical Analysis

In this study there was one independent variable, the supervision training

methodology (innovative versus traditional) and one dependent variable, the scores

received on the participants� posttest counseling transcripts following the training (their

posttest transcript scores). Student counseling competence prior to the treatment was also

measured and used in the analysis to control for prior competence as a confounding

variable, as well as to examine changes in the amounts of counseling competence gained

by student counselors during the treatment period of both groups.

Using the SPSS software program, the following statistical analyses were

performed. First, co-rater reliability was determined by comparing individual ratings of

three independent co-raters on each of the transcript responses submitted for rating by

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each of the participants. Second, transcript mean scores generated by the CIA prior to and

after the treatment were determined for each set of ten responses by summing the number

of indirect responses appearing in each set of ten transcript responses. Third, a mean

score on the ten-item Interview Record Form (IRF) was obtained for each participant.

This supervisory score was correlated with the posttest transcript mean scores to provide

evidence of concurrent validity of the dependent variable of CIA. Finally, the pre- and

posttest transcript scores were submitted to a 2 X 2 ANOVA of a mixed design with a

within-subject independent variable of Time (pretest versus posttest) and a between-

subject independent variable of Method (innovative versus traditional) to investigate the

Time effect, Treatment effect, and the interaction effect between Time and Treatment.

Hypotheses

Based on the analysis conducted with the data collected for the study, the following

null hypotheses were examined. All hypothesis tests were conducted with the

significance level of p<.05:

1. There is no positive correlation between the posttest transcript scores generated

by the CIA and the summative counseling competency scores generated by the

IRF.

2. There is no significant main Time effect between pretest and posttest ratings

scores generated by the CIA among participants of the study.

3. There is no significant main Treatment effect between the innovative and

traditional supervision groups based on scores generated by the CIA.

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4. There is no significant Interaction effect between Time and Treatment on the

transcript scores generated by the CIA.

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CHAPTER IV

RESULTS

The results of the statistical analyses conducted are reported in the following

sections: research design, demographic data, data management, reliability of the test

instruments, results of hypothesis testing, and descriptive information from the End of

Semester Questionnaire. A summary of the statistical analyses concludes the chapter.

Research Design

The experimental study was designed to investigate the effects of supervision

methods on student counselors� counseling competence. To fulfill the objectives of the

study, participants were randomly assigned to one of the two treatment conditions, a

condition with an innovative supervision method and a condition with a traditional

supervision method. Participants� counseling competence prior to and after the treatment

was measured with an assessment instrument, the Counselor Interaction Analysis (CIA,

Altekruse, 1967). To examine the validity of the measure, the Interview Record Form

(IRF, Bradley, 2008) was used as an alternative measure of counseling competence and

correlated with the scores generated by the CIA.

In this study, the independent variable was the supervision method (innovative

versus traditional) in training and supervising master's level counseling students enrolled

in counseling internship classes. The innovative method group received basic training in

counseling skills aided by the use of a systematic training manual and companion training

video. The innovative method emphasized the comprehension and reduction of four types

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of non-therapeutic, non-relationship-facilitating counseling responses. These kinds of

responses are commonly demonstrated by less experienced, or less effective, counselors.

The innovative training materials also provided participants with contrasting examples of

therapeutic relationship-facilitative counseling responses to the same client statements.

Participants in the traditional method group received the same basic training in

facilitative counseling skills utilizing a traditional counseling internship class and a site-

supervised practicum. Participants in the traditional method condition were provided with

a contrasting assignment to select, review, and critique three traditional-style counseling

videotapes produced by expert counselors (see Appendix F). That is, the participants in

the traditional method condition did not receive a systematic training manual and did not

receive any training that demonstrated and illustrated examples of the kinds of counseling

response errors that commonly result in less effective counseling relationships. .

All analyses presented, both descriptive and inferential, were conducted by

computer analysis using SPSS Version .16 or Microsoft Excel Office 2003.

Descriptive Demographic Information

All the participants (N = 26) enrolled in the master's level internship training

sessions completed questionnaires at the end of the semester with which participants�

demographic information was collected. Twenty-one participants (81%) answered every

question included on the 28-item questionnaire. Five participants (19%) partially

completed the questionnaire.

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Gender, Age, and Ethnicity

Three (11.5%) of the participants were male and 23 (88.5%) participants were

female. By group, participants assigned to innovative method one included one male

(7.6%) and 12 females (92.3%), and participants assigned to traditional method two

included two males (15.38%) and 11 females (84.6%). Overall, the participants ranged in

age from 24 to 53 years, with a mean age of 36.19 years (SD = 10.64). By group,

innovative method one participants ranged in age from 25 to 53, with a mean age of 39

years, whereas traditional method two participants ranged in age from 24 to 50, with a

mean age of 33.38 years. Thus, participants assigned to the innovative method one group

were slightly older, on average, than the participants assigned to traditional method two.

Within the total sample of participants, 21 (80.76%) participants identified their

ethnicity as White or Caucasian, four (15%) identified their ethnicity as Hispanic, and

one (3.8%) participant identified as African American. By group, participants assigned to

the innovative method one group included 13 (100%) White or Caucasian members,

whereas participants assigned to traditional method two included eight (61.53%) who

identified themselves as White or Caucasian, four (30.7%) who identified themselves as

Hispanic, and one (7.6%) who claimed an African American identity.

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Table 1. Demographic Information by Group

Innovative Method One

(13)

Traditional Method Two

(13) Gender:

Female 12 11

Male 1 2 Age:

Mean 39 33.38

Range 25-53 24-50 Ethnicity:

White 13 8

Hispanic 4

African American 1

Data Management

Prior to participating in the study, the participants had already transcribed

counseling interviews and turned them in to the clinical director of the counselor

education program in which they were enrolled during the previous semester[wl1]. These

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transcripts served as the pretest transcripts used as a baseline measurement in the study.

All participants also recorded, transcribed, and submitted to the professors an additional

counseling interview following the completion of the contrasting training assignments.

These posttest transcripts served as posttest measures for the study. In addition, the

prepared participants completed additional assignments (see Appendix C), taped

interviews, and transcripts throughout the semester that served as additional assessment

tools for independent evaluation by the supervising professors at the conclusion of the

semester.

As detailed in Chapter III, the pretest transcripts were turned over to the researcher

immediately after the Informed Consent Statements (see Appendix A) had been signed

and collected. Then, the names on transcripts received from the clinical director were

matched to the names of those participants who had consented to participate in the study.

The posttest transcripts were delivered to the researcher at the end of the semester, by a

combination of hand-delivered paper copies and CD ROM copies. Additional data

collected (see Appendix D, E) was delivered to the researcher in the same manner (by

paper copies and by CD ROM) after all the pretest and posttest transcripts had been rated.

Some of the students chose to e-mail the End of Semester questionnaires directly to the

researcher. All data received in relation to the study was organized and documented by

participant ID code and stored in a locked file cabinet in individual file folders.

After the conclusion of the co-rating process, the researcher contacted the colleague who

had secured the two lists of names of participants assigned to each group and scheduled a

time to retrieve the lists so the computer analysis of the data could begin. The transcripts

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and all other data collected or created in connection to this study are currently stored in a

locked file cabinet. Data was managed according to the requirements set forth by the

Institutional Review Board of Texas Tech University.

Deriving Cumulative Scores for the CIA

When used as a supervisory self-assessment instrument, the CIA allows the

counselor and supervisor to distinguish between and label eight different types of

counseling responses and two additional qualities of interaction. When used as a research

instrument, the CIA can also be used to distinguish between those responses that could be

classified as indirect (relationship-facilitative) or direct (non-relationship-facilitative), a

dichotomous variable that lends itself easily to analysis. In this study, the researcher

trained the co-raters to rate each counseling response as either indirect or direct in nature

in accordance with the CIA scoring protocol. Indirect responses were scored with a 1 and

direct responses were scored with a zero.

After the transcript co-rating procedures were completed, the researcher and the co-

raters calculated and documented the obtained ratio of indirect to the total of the selected

subset of ten responses on each transcript. On each transcript rated, the indirect responses

were summed and placed over the total number of indirect and direct responses as shown

below:

XID

I =+

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n this way, total scores for each transcript were calculated as a decimal sum ratio

score (X) based on the total number of indirect responses in relation to the total number

of responses scored. Each co-rater's ratings were summed in the same way and

documented on the scoring coversheet attached to each transcript. In this way, individual

and group mean changes in counseling skills based on the ratio of nondirective or

relationship-facilitative counseling responses to directive or non-facilitative responses

could be detected over the course of a semester. Higher values of the ratio indicated more

frequent usage of the relation-facilitative strategies and lower values of the ratio indicated

less frequent usage of the relation-facilitative strategies in counseling sessions, with

extreme values of 0 (no nondirective strategy used) and 1 (no directive strategy used).

Inter-rater Reliability of Scores

To calculate agreement on a dichotomous variable with more than two raters, the

method recommended (Garson, 2006), is to report a proportionate agreement statistic

based on the total number of times all the co-raters agreed divided by the total number of

decision opportunities available. Because each transcript required three individual ratings

on 10 unique responses, the researcher also calculated individual Pearson correlation

coefficients based on individual item ratings of the three co-raters in order to provide

additional verification of inter-rater reliability for the reader. The results of the two forms

of analysis are described in the following paragraphs.

Inter-rater reliability of the co-rater scores on the CIA was originally determined in

the following manner according to the proportional method of analysis described and

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recommended by Garson (2006). In order to calculate how many total co-rating decisions

were possible, the researcher determined that because there were 26 participants, and

because all the participants completed and turned in two transcripts each, there were 52

transcripts rated altogether. The researcher then determined that all but three of the 52

transcripts included a minimum of 10 responses to rate. Thus, there were 49 transcripts

with 10 rated responses each, totaling 490 ratings decisions, and three transcripts with

five, nine, and eight responses respectively, totaling an additional 22 ratings decisions.

Altogether, therefore, there were 512 ratings decisions made by each of the three co-

raters. According to the data file, there were nine ratings discrepancies out of 512 total

ratings decisions, leaving 503 perfect co-rater agreements, resulting in an overall co-rater

reliability score of 98%.

As indicated earlier, individual correlation analyses were also calculated on

individual co-rater ratings. The data was originally input into an Excel spreadsheet in the

following manner: participant numerical ID codes were input in the first vertical row.

Next, in a horizontal row across the top of the page, co-rater identity was coded by co-

rater initial for each item rated. Thus, there were three individual ratings input for each

item rated for each participant transcript response. In other words, there were 26

horizontal rows displaying all data relevant to each participant and 60 individual vertical

columns devoted to the listing of individual co-rater ratings, with three individual ratings

per response. [wl4] The data analysis showed perfect agreement (r = 1.0) for all items

rated except for those items in which any one co-rater disagreed with the other two.

Correlation coefficients calculated on individual item discrepancies are as follows: pretest

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item 3 (r = .98); pretest item 9 (r = .87); pretest item 10 (r = .87); posttest item 2 (r =.91);

posttest item 3 (r = .91); posttest item 8 (r = .90); and posttest item 9 (r = .90). As is

apparent in the correlations listed above, including those that show less than perfect

agreement, for the most part, the CIA scoring protocol enabled the three co-raters to rate

responses in perfect agreement with each other.

Internal Reliability of the Test Instruments

Using Cronbach's Alpha, the researcher determined that the IRF that was used to

calculate professor evaluations of participant counseling competency had an internal

reliability of alpha =.86. Separate Cronbach's Alpha analyses were also run on the CIA

pretest and posttest scores, resulting in internal reliability scores of alpha = .56 and alpha

= .61. Thus, the dichotomous CIA scores (based on a ratio of indirect to direct and

indirect responses) demonstrated low internal reliability. According to Heppner,

Kivlighan, & Wampold (1999), "To understand reliability, we must understand that the

variances in scores obtained in any context are due to several factors (p. 284)." These

factors will be examined in Chapter V.

Concurrent Validity of Measurements of Counseling Competence

Because the CIA was originally designed for counselors to self-appraise counseling

competence and effectiveness, but was used as a dependent variable in the current study,

the researcher deemed it necessary to provide extra evidence on the validity of the

measurement. The two measurements of counseling competence, the CIA and IRF, were

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correlated. It can be argued that the correlation between the two measures of the same

construct validates the measures. The null hypothesis of the analysis states: There will be

no significant correlation between ratings on the CIA and ratings on Interview Record

Form. The result of the correlation analysis, r = .39; p <. 05, suggests that the CIA

demonstrates significant concurrent validity with the student counselor competency

evaluation instrument traditionally used by counselor education faculty members at Texas

Tech University. In other words, these two instruments seem to be tapping into a similar

counseling skills construct.

Results of Hypothesis Testing

Using a General Linear Model, a 2 X 2 mixed design of ANOVA was computed

on the dependent variable of counseling competence derived from the CIA. Time was a

within-subject independent variable with two values (before and after) treatment, and

method was a between-subject independent variable with two values (innovative and

traditional). An alpha level of p < .05 was used for all statistical tests. The results of the

hypothesis testing are provided in the following sections. Descriptive statistics of the

dependent variable, including means and standard deviations, are grouped by the two

independent variables and presented in Table 2.

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Table 2. Descriptive Statistics (mean/SD) of the Dependent Variable Grouped by Independent Variable

Measurements Innovative Traditional Total

Pretest .18/.15 .16/.18 .17/.16

Posttest .36/.19 .24/.23 .30/.22

Total .27/.17 .20/.17

Null Hypothesis 1

Null Hypothesis 1 states: There will be no significant main time effect between

pretest and posttest ratings on the CIA among participants. Based on the GLM 2 X 2

mixed design for ANOVA for Null Hypothesis 1, the main effect of time was significant,

F (1, 24) � 12.35, p = .002. Compared with the ratings of counseling competence prior to

the treatment (M = .17, SD = .16), participants, regardless of the condition to which they

were assigned, manifested higher counseling competence according to their posttest CIA

transcript ratings (M = .30, SD = .22). Thus, Null Hypothesis 1 was rejected.

Null Hypothesis 2

Null Hypothesis 2 states: There will be no significant main method effect between

participants assigned to the innovative and traditional supervision methods with pretest

and posttest measures of competence combined. Based on the results of the GLM 2 X 2

mixed design for ANOVA for Null Hypothesis 2, although the mean of the CIA scores in

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the traditional method group (M = .20 SD = .17) were lower than those of the innovative

group (M = .27, SD = .17), the difference failed to reach the significance level of p < .05,

F (1, 24) = 1.082, p = .31. Thus, Null Hypothesis 2 could not be rejected.

Null Hypothesis 3

Null Hypothesis 3 states: There will be no significant interaction effect between

time and method effects on the dependent variable of counseling competence. Although

both groups improved their competence as counselors, and the innovative group

improved to a greater degree (from .18 to .36) than the traditional group (from .16 to .24),

the interaction effect was not significant, F (1, 24) = 2.09, p = .16. Therefore, it cannot be

concluded that the two groups developed counseling competence with different rates or

patterns. Thus, Null Hypothesis 3 could not be rejected.

Additional Participant Comments[wl6]

The End of Semester questionnaire revealed some key trends in written responses to

particular questions. For example, 100% of the students assigned to the innovative

supervision method reported that they learned something new during this class that they

had not learned before. Some of them chose to elaborate by including statements such as

the following, "I learned how to listen & reflect with the client," "I learned how to

respond better with a client," I learned how to respond to clients in a manner that was

therapeutic."

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A surprising number of participants assigned to the innovative supervision method

actually stated that by watching the companion video, they learned for the first time ways

in which they should not respond to clients, as exemplified by the following

representative comments, "I liked seeing what not to do or be like," "I learned more about

limiting advice giving and questioning. I hadn't learned much about professional stance

up until this point in my education," "It was good to compare good counseling to poor

counseling using the same client for each scenario," I realized there are many actions I do

during therapy that aren't conducive," "It assisted me in understanding the client's point

of view when faulty techniques are used," "Advice giving can be harmful and I didn't

realize sometimes we give advice without realizing it," "Good information on no advice

giving and not being superficial," and " I liked watching about how bad counseling skills

affected the clients."

Those participants assigned to the traditional supervision method who chose to

make additional statements often stated that they had learned some new things about

counseling skills as well. Representative comments include the following, "I learned a

technique in working with children that I hope to use one day," "I need to work on being

more personal and relaxed. I also need to work on my relationship skills," "I focused on

their non-verbal communication style. Their posture, their tone of voice, etc.," "I learned

about the importance of using different counseling approaches, especially when stuck in a

counseling situation that has flat-lined progress," and "I could see how the techniques

were applied and the difference between approaches."

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Three participants, all members of the group assigned to the traditional supervision

method reported, however, that they did not learn anything new during the class, as

represented by the following statements "The practicum was composed largely of student

videos. There was little or no opportunity to practice skills or discuss techniques," "I have

watched many of the videos over & over again. Many of them are quite old and could not

keep my attention," "Sorry, I felt it was busy work at a time that I was preparing to take

the comps," and "Went over notes and refreshers that we did earlier in the semester."

When asked about the learning attributed to the transcribing process, participants

assigned to both groups responded very positively. Representative statements offered by

the innovative supervision method participants included "As much as I do not like

transcribing, I feel it helps me to see & hear ways to improve my techniques," "When I

listen to what I said to the client, I become more aware of what I am doing and what I

need to work on: empathy & clarifying. I can also ask myself why I asked that or didn't

ask this & can make notes for further sessions with my client," " It made me analyze each

responding statement that I made toward each client," "Examining each sentence is like

looking through a microscope�you can see each little thing clearer."

Representative statements made by participants assigned to the traditional

supervision group included, "I was able to see where I was not expressing myself

correctly. Also, that I ask too many questions in a row without allowing the client to

answer," "I knew when I was thinking about what to say next, or when I was attempting

to use counseling techniques," "It made me look at my comments & direction. It forced

me to rethink some of my responses in hopes [sic] to be more effective in the future," and

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"It made me more aware of all the things I need to change and it helped me see what

worked."

Summary of the Statistical Analyses

For any quantitative study, reliable and valid measurement of a variable or

variables is the foundation required to make any analysis trustworthy. Therefore, the

researcher carefully scrutinized the psychometric characteristics of the measurements of

the dependent variable of the study: student counselor�s counseling competence derived

from the CIA. Inter-rater reliability was examined from various perspectives to ensure the

raters were in agreement on subjective ratings of participants� use of relationship-

facilitative strategies. Concurrent validity evidence was provided by correlating the CIA

with supervising professors� ratings of students in counseling sessions.

After the reliability and validity of the measurement of the dependent variable were

ensured, a 2 X 2 ANOVA was conducted to examine the main effects of time and

method, as well as the interaction effect between time and method. Although differences

of the time and method effects were found in the predicted directions; that is, participants

in both conditions showed improved competence during the counseling practicum course,

and the innovative group improved more than the traditional group, only the main effect

of time reached the significance level required.

In the last chapter (Chapter V), these results will be discussed. In addition,

additional participant comments will be explored. Attention will also be directed to

limitations and suggestions for further research.

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CHAPTER V

DISCUSSION

Summary of the Investigation

This research was designed to address a void in the supervision literature by

investigating the effectiveness of teaching student counselors to develop a more

relationship-facilitative, or nondirective, counseling response style over the course of one

semester. All participants in the study were master's level counseling students enrolled in

a private university in a small, southwestern city. The participants were provided with no

payment and no incentive to participate in the study, other than the intrinsic value of

knowing that they were participating in a research study that might enhance the field of

knowledge regarding the effectiveness of different methods of counselor training. The

participants were randomly assigned to the two methods of supervision.

All participants taped and transcribed two counseling interviews, one before the

training and one after the training. A selection of rated responses from the interview

transcripts served as the pretest and posttest measures of participant counseling styles.

The supervision assignments distributed to the innovative group (the innovative

workbook, companion video, and brief written assignments related to these materials)

and the supervision assignments distributed to the traditional method group (three

traditional-style videos and written critiques) were completed during a four-week break

between semesters. With the exception of brief written assignments, participants assigned

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to the innovative method were allowed to keep the workbook and companion video and

were able to refer back to them for self-supervision purposes for as long as desired.

In view of the lack of recent inferential research studies examining the effectiveness

of current methodologies in the training and supervising counselor interns, this study

sought to investigate the effectiveness of counselor supervision methods over the course

of a semester of training through a statistical analysis of pretest and posttest measures of

counseling transcript responses, using a previously validated, reliable, and objective

counselor interaction response rating instrument that was scored by trained raters who

had been kept blind to the group identity of the participants throughout the study. In

addition, this study was designed to compare the effectiveness of an innovative

supervision method to the effectiveness of a more traditional supervision method. In

addition to the training based on different supervision methods, participants in both

groups also received training with traditional counseling internship materials and

activities (see Appendix I).

Last, this study investigated whether there was a positive correlation between the

two instruments used to measure counselor competence in this study, the Counselor

Interaction Analysis (CIA) developed by Altekruse (1967) and the Interview Record

Form (IRF), developed by Bradley (1989). The CIA was used as a pretest, posttest

measure. The IRF was used as a posttest measure only. This study used an experimental

design. These instruments can be found in Appendix B. An End of Semester

Questionnaire in which participant demographic information and participant feedback

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responses were included can be found in Appendix E. Written group assignments not

used for the purpose of counselor competency evaluation can be found in Appendix D.

The results of the analysis used in this study indicated that a positive correlation

exists between the instrument used to determine the posttest counseling style scores, the

CIA, and the summative instrument used by the supervising professors to determine each

participant's overall counseling competency, the IRF. The analysis thereby demonstrated

that the CIA showed concurrent validity with the IRF.

The results of the 2 x 2 ANOVA of mixed design indicated that there was a

significant main Time effect between the pretest and posttest CIA ratings among the

participants in the study. However, there was no significant main method effect between

the innovative and the traditional methods of supervision. There was also no significant

interaction effect between time and treatment on the transcript scores generated by the

CIA.

Discussion of the Findings

This section provides a discussion of the findings and conclusions, beginning with a

comparison of the similarities and differences found in other studies that used the same

counselor effectiveness instrument, the CIA. The comparison of studies using the CIA is

followed by a review of previous studies using one of the other major supervision

methods used in this study, familiarly known as microskills training, or microtraining.

These comparisons will be followed by a discussion of the contributions of this study,

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then a discussion of the limitations of the study, and the chapter will conclude with

implications and recommendations for further research.

Comparing Previous Findings on the Use of the CIA

Altekruse (1967) wanted to determine whether a non-threatening, behavioral self-

analysis instrument known as the Counselor Interaction Analysis (CIA) could be a

valuable tool in the training of student counselors. Using the CIA to rate student

counselor responses before and after training in the use of the CIA, Altekruse (1967)

indicated that post-training scores on the CIA differentiated significantly (p < .05)

between effective and ineffective counselors as determined by instructor ratings of each

counselor in his or her practicum class. Post-training CIA ratings showed construct

validity with end-of-semester instructor ratings of counselor effectiveness. In the same

way, in the current study, posttest ratings on the CIA showed construct validity with the

summative counselor competency measure (IRF) scored by supervising professors.

Previous research conducted by Calhoun (1999) indicated that CIA ratings

correlated significantly (p<.05) with the Counselor Rating Form - Short Version (CRF -

SV), a measure of counselor expertness and influence with the client. Congruent with this

previous research, this study found that CIA ratings correlated significantly (r = .39

P <. 05) with instructor ratings on the Interview Record Form (IRF), a summative

measure of student counselor competence

Inter-rater reliability for the scoring of the CIA was originally established by

Altekruse (1967) with a mean percentage agreement of 92% among trained co-raters.

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Later, Calhoun (1999) reported 98% inter-rater agreement when using the CIA as a rating

instrument. In the same way, this study demonstrated 98% co-rater reliability among

three trained co-raters using the CIA scoring protocol for the scoring of counseling

transcript responses. In the current study, individual correlation analyses were conducted

on individual co-rater ratings on each item using the Pearson correlation analysis

procedure, and again, the data showed perfect agreement (r = 1) for all but nine of the

512 items rated. Thus, it appears that raters can be trained to reach near perfect

agreement when scoring counseling responses with this dichotomous measure of

counselor effectiveness and competence.

In spite of the significant and convergent findings regarding the construct validity

of the CIA as a measure of counselor effectiveness and competence, and in spite of the

finding that the CIA lends itself to a high reliability of scoring by raters, other researchers

have hypothesized that significant relationships existed between the CIA and other

theory-driven counselor variables of interest, and analyses of these hypotheses were not

significant at the level proposed. Altekruse (1967) hypothesized that increased scores on

the CIA would correlate positively with increased scores on a measure of self-concept

Butler-Haigh Q-Sort (BHQS). Altekruse (1967) attempted to test a construct based on

Rogers (1957) theory, in which he proposed that a counselor�s self-concept would be

correlated with the counselor�s effectiveness as defined by the CIA. That hypothesis was

rejected because of the correlation analysis. Altekruse (1967) also hypothesized that there

would be a significant relationship found between self-concept change scores and

counseling behavior change scores. That hypothesis was also rejected after statistical

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analysis. In a similar fashion, Calhoun (1999) hypothesized that negative correlations

would be discovered between scores on the CIA and scores on certain counselor

attributes, such as years of teaching experience and hours of religious participation.

Calhoun (1999) hypothesized that an increase in years of teaching experience and an

increase in hours of regular religious participation would be correlated with a counselor�s

use of a more directive counseling style. These hypotheses were also rejected for lack of

significance after an extensive hierarchical regression analysis of the data.

The findings from the Altekruse (1967) study that are most relevant to this

discussion include the finding that the experimental group in the 1967 study did change

their behavior in counseling to a significantly greater degree than did the control group.

In the Altekruse (1967) study, it is unclear what specific kinds of training the control

group received, although the training was described as traditional in nature. In the current

study, the participants assigned to the innovative supervision method also changed their

behavior in counseling to a greater degree than the participants assigned to the traditional

group, but the differences in improvement between the two groups were not significant

(at the p < .05 level of significance).

Altekruse (1967) reported that the student counselors in both practicum groups

tended to change behaviorally from using a majority of direct responses in their

counseling interviews to using a majority of indirect responses. In the current study, the

participant student counselors in both internship groups also changed behaviorally from

using very few indirect responses to using a greater number of indirect responses, but

based on the posttest transcript ratings, neither group as a whole could be characterized as

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using a majority of indirect responses within the posttest counseling interviews chosen

for transcription by the students.

Altekruse�s (1967) data analysis also revealed that there was a significant difference

in counseling behavior between the student counselors who were ranked most effective

and least effective by their supervisors. In the current study, the supervising professors

did not perform any kind of ranking evaluation of counselors from most to least effective,

so the additional information that could have been provided by that kind of additional

statistical analysis could not be performed within the current study. Significantly, by way

of the additional supervisory ranking process, Altekruse (1967) reported that the student

counselors who received the highest indirect scores on the CIA posttest measurement

were also judged by their supervisors to be the most effective counselors in the

practicum, while those who received the lowest indirect scores were judged by their

supervisors to be the least effective counselors in the practicum. Correlating CIA ratings

with supervisor rankings of student counselors based on effectiveness provided an

additional validity check for the instrument.

In contrast, although the analysis of variance in the current study did find a

significant within-subject time effect on increased indirect counseling responses for all

participants over the course of training, and although the counselors assigned to the

innovative method group did increase their use of indirect responses to a greater degree

than the counselors assigned to the traditional method, these findings did not indicate that

a treatment effect conclusion could be found at the p<.05 level of significance. These

results seem to indicate that various traditional aspects of the counselor internship course,

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including the adjunct supervision methods, contributed to the findings of statistically

significant improvements in the objective measurement of the use of indirect counseling

responses by all participants, regardless of group membership. There are a number of

plausible explanations for this difference in results.

Inadequate Dosage Effect

The current study may have suffered from an inadequate dosage effect for the

innovative treatment method. First, a comparison can be drawn between the two studies

based on the amount of time allocated for the training of the participants in the use of the

CIA. The major portion of the innovative treatment method in the current study was

delivered in a four-week period between semesters, and the use of the CIA for self-

assessment was simply described in the didactic instructions located in the back of the

workbook. In contrast, in the Altekruse (1967) study, the training procedures were

described as investigator-administered training in the use of the CIA as a self-assessment

instrument, accompanied by repeated reminders by the investigator throughout the rest of

the semester for the participants to use the instrument for self-analysis. This training

procedure was an ongoing process throughout a 15-week semester.

Another difference in the current study that may have diluted the Treatment effect

of the innovative supervision method is that the participants assigned to the traditional

method were also asked to critique three self-selected videotapes produced by experts in

the field of psychotherapy. The expert models in these videotapes may also have

demonstrated and discussed many of the same empathic or facilitative response styles

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that were demonstrated systematically in the innovative video, though they probably did

not demonstrate or discuss the common counseling errors that were emphasized in the

innovative workbook and video. In addition, the traditional classroom instruction in both

classes contained some of the same instruction regarding nondirective counseling

responses, albeit not presented in the same way. In other words, both groups of

participants were taught very similar counseling concepts, by way of similar training

methodologies throughout the semester, so differences between the two groups� CIA

scores may have been obscured by the lack of substantial differences in the two

supervision methods.

Also, unlike the investigator in the Altekruse (1967) study, the researcher in the

present study never met with the participants to watch counseling interview tapes with

them and thereby train them more intensively in the use of the CIA ratings protocol.

Instead, in the current study, it was expected that the students assigned to the innovative

method would be able to assimilate and integrate the CIA self-supervision rating protocol

into their counseling behavior through systematic self-instruction and experiential

exposure to the supervisory workbook and video.

In refraining from personally implementing the treatment, the researcher, who also

rated transcripts in the current study, was able to prevent the Hawthorne effect from

confounding the results. The Hawthorne effect is a potentially confounding treatment

effect that occurs when participants are aware that they are assigned to a special treatment

group. In fact, Altekruse (1967) wrote that the Hawthorne effect may indeed have been a

limiting factor in the conclusions drawn in his study.

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Pre-Existing Relationships with the Investigator

Another difference that may have influenced the lack of significant results in the

current study might be the fact that in the Altekruse (1967) study, the investigator was

simultaneously enrolled as an instructor in the same counseling program. The students

and the investigator described in the Altekruse (1967) study were well known to each

other prior to and throughout the study. Calhoun (1999) was also simultaneously enrolled

as a doctoral student in the same counseling program in which his study was conducted.

These pre-existing relationships may have also positively influenced the students�

capacity for integrating the CIA rating protocol into their counseling behavior.

Lampropoulos (2002) emphasized the quality of the supervisory relationship as an

important feature of effective supervision. The participants in the current study were

deprived of the relationship-based learning potential that would have been inherent in the

process of being trained in the use of the innovative supervision method by someone who

was uniquely familiar with the methodology, such as the researcher.

Statistical Control Variables Required

There were differences in some of the results of these studies because of the

differences in the statistical control variables required for the study and in some cases, the

different research questions involved. An experimental study such as this one necessarily

involves the need to control certain confounding variables that are not as difficult to

control in a study based on quantifying relationships between variables in a posttest-only

design. Although as previously noted, Calhoun (1999) also found significance of results

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when comparing the CIA to the Counselor Rating Form-Short Version, all the students

and raters were previously trained in using the CIA self-analysis methodology. In

contrast, none of the participants in the current study were instructed by the supervising

professors to use the CIA methodology to analyze their interview behaviors.

The other focus of Calhoun�s research study was on exploring the possible

significance of relationships between effectiveness in counseling as determined by scores

on the CIA, and particular therapist demographic variables, operationally defined as years

of teaching experience and hours of religious participation. Thus, there was no

comparison of different supervision methods in the Calhoun (1999) study and there was

no potential expectancy or Hawthorn effect for the researcher to prevent.

Differences in Facility Accommodations

The more traditional class schedule available in a larger, urban school setting, such

as the university settings involved in the Altekruse (1967) and Calhoun (1999) studies,

could have also accommodated extra on-campus supervision time and on-campus room

locations available for additional, geographically convenient, discreet training sessions

with the researcher, such as the training sessions used for this purpose during the

Altekruse (1967) study. There was no opportunity for the students randomly assigned to

the innovative supervision method in the current study to meet discreetly as a group with

the researcher in a separate classroom during the four-week break between semesters, or

during one of those four intensive semester weekends. The lack of opportunity to be

trained more intensively in the CIA scoring protocol through the provision of a

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supervisory relationship with the researcher may have reduced the learning potential for

the participants in this study. The lack of opportunity to meet discreetly with the

researcher, without necessitating the opening of additional classrooms during non-school

hours, and without drawing the attention of professors, supervisors, or other students,

may have compromised the findings of this study. These extra time and space

accommodations were simply not available during this study.

Other than the two studies previously mentioned for purposes of comparison and

contrast of the use of the CIA scoring protocol, there are other counseling research

studies relevant to this discussion of divergent research outcomes. Brew and Altekruse

(2006) wrote that their workbook and video, along with the CIA rating instrument, would

most likely be used as an adjunct supervision method, along with one of the other well-

known counselor training textbooks and methods. Similarly, in this study, the supervision

methods compared for effectiveness in this study were also treated as adjunct supervision

methods. Please refer to Appendix I for a detailed syllabus describing the traditional

internship curriculum in which the participants were simultaneously enrolled, and note

also the syllabus for the traditional counseling practicum in which the participants were

enrolled and trained prior to the study and from which the pretest transcripts used in this

study as baseline measurements of counseling skills were drawn.

Comparisons with Microcounseling Research

Baker, Daniels, and Greeley (1990) conducted a meta-analytic review of counselor

research studies based on three well-known, systematic major training programs for

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counselors, namely Carkhuff�s Human Resource Training/Human Resource Development

(HRT/HRD) idea, Kagan�s Interpersonal Process Recall (IPR) technique, and Ivey�s

microcounseling procedure. Baker et al. (1990) summarized comparisons between

studies based on differences in mean effect sizes, unbiased effect sizes, standard

deviation of effects in each study, numbers of effect sizes, using design codes based on

Campbell and Stanley�s (1963) system (one-group pretest-posttest, static group

comparison, pretest-posttest control group, Solomon Four Group, posttest only control

group, time series, and non-equivalent control group). The chart created by Baker, et al,

(1990) included additional codes to indicate the kind of comparison group used in the

study (attention control group, treatment control group, alternative treatment control

group, component analysis, and combinations two or more), the weeks of follow-up time

(time between post-testing and collection of behavioral maintenance data), hours of

training, skills taught (low level or high level), clients interviewed (analogue, natural, or a

combination of the two), source of the research publication (journal, dissertation, or a

combination), average IRr (average inter-rater reliability coefficient), average IRAg

(average inter-rater agreement coefficient for the study), size of control group, and size of

total sample.

An extensive comparison of each of the studies reviewed in Baker and associates�

meta-analysis is beyond the purview of this study. Therefore, only a representative

sample of studies most comparable to the current study will be explored in this section.

Because the supervising professors involved in the current study chose Ivey�s

microcounseling procedure as the basis of their supervision methods in all the counselor-

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training courses, and because microskills analysis was a component of the traditional

supervision methods used in this study, only research studies using microcounseling will

be discussed in greater detail in this section. After reviewing the meta-analysis by Baker

et al. (1990), the following studies were selected for comparison purposes in this

discussion of divergent findings.

Ivey, Normington, Miller, Morrill, & Haase (1968) conducted the first time-series

research study on the effectiveness of microcounseling. This study tested

microcounseling training on the development of two basic counseling skills, reflection of

feeling and summarization of feeling, using 10 participants with the same paid volunteer

clients over three counseling interviews. There was no microcounseling training provided

to participants prior to the first interview, two hours of microcounseling training prior to

the second interview, and an additional two hours of training prior to the third interview.

The instrument used for this time series comparison study was described as a semantic

differential self-concept scale developed by the authors of the study, who also served as

the supervising professors and investigators. Ivey et al. (1968) reported the following

results for each of the two counseling interviews following microcounseling training that

resulted in improvements in low level skill development, as well as improvements in

counselor self-concept: 2nd interview: mean effect size, .97; unbiased effect size, .90; SD

= .41; 3rd interview: mean effect size, 1.28; unbiased effect size, 1.17; SD = .34. It is

unclear from the report what method of analysis was used by the authors of the study to

quantify the improvements of reflections and summarizations. Ivey et al. (1968) did not

mention the use of audiotape or videotape transcriptions or observations in this study.

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Ivey, et al. (1968) did not mention the use of an objective response skills rating

instrument that may have been used for the analysis of the results. In the current study,

the CIA rating system quantified by the 2 X 2 analysis of variance conducted that a

significant mean time effect was evident in the significantly increased use of reflections,

summarizations, and other higher level nondirective responses by all participants who

were trained in microcounseling over the semester.

Belle (1976) compared microcounseling to traditional training for teaching

attending behaviors to 30 master�s level students. In a pretest-posttest control-group

design, two intact groups were assigned to either microcounseling or a traditional

treatment (Belle, 1976). In the Belle study, both comparison groups received 36 hours of

training and all subjects conducted pre- and post-training videotapes, each time

interviewing different clients (Belle, 1976). The results showed that the microcounseling

group was significantly better than the control group in overall attending and verbal

behaviors, with a mean effect size of 1.52, an unbiased effect size of 1.38, and SD =.84

(Belle, 1976). In the current study, even though both groups received a much briefer

amount of training in microcounseling (approximately three hours), both groups

demonstrated significant improvements in attending and verbal behaviors as measured by

changes between the pretest and posttest CIA ratings.

Arnold (1976) used microcounseling to train play therapists. In Arnold�s study, 16

master�s level students were randomly assigned to either an experimental

microcounseling group or a control (traditional) group. Prior to the treatment, all subjects

had received 12.5 hours of instruction in play therapy based on traditional didactic

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lectures, readings, and discussion (Arnold, 1976). In addition, the experimental subjects

received 90 minutes of microcounseling systematic training in reflection of behavior

statements, reflection of feeling statements, and limit-setting statements (Arnold, 1976).

Each experimental group trainee participated in four play therapy sessions that included a

5-minute taped session with a child client (Arnold, 1976). The control group trainees also

conducted four taped interviews with child clients, but were trained in traditional play

therapy methods between sessions (Arnold, 1976). All subjects had two follow-up

interviews at 2 and 6 weeks, respectively (Arnold, 1976). After the treatment, the

experimental group, when compared to the control group, used significantly more

reflection of behavior and feeling statements, but not limit-setting statements (Arnold,

1976). Arnold (1976) reported a mean effect size of 1.24, an unbiased effect size of 1.07,

and SD = 1.77. The experimental group maintained the skills at follow-up, but the

difference between the groups was not significant, as the control group increased their

skills, too (Arnold, 1976). In the current study, several of the interviews conducted by

participants assigned to both supervision methods were also conducted with child clients.

It was apparent to the researcher that at least one of these participants had been trained in

nondirective play therapy responses, but it is unclear whether the source of the training in

play therapy was related to microcounseling training.

Regardless of the discrete number of reflective and otherwise nondirective

counseling responses demonstrated by each of the individual participants in this study,

both groups of participants in the current study exhibited a significantly greater number

of nondirective responses when compared to the baseline measurement of nondirective

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responses prior to the training. While the increase in the number of indirect, or

nondirective, responses was evident to a greater extent by the participants assigned to the

innovative supervision method, the conclusion that the innovative method was

significantly more effective than the traditional method of supervision cannot be drawn

based on the analysis.

The meta-analytic review of microcounseling conducted by Baker et al. (1990)

reported a lower overall effect size (i.e., .63) than what was found in the comprehensive

integration of microcounseling training across a wider range of populations (i.e., .83),

indicating that graduate level counseling trainees may be more challenging to train with

the microcounseling program than are samples from other populations (e.g.,

undergraduates, paraprofessionals, and secondary school students. Baker et al. (1990)

also reported a medium overall effect size for the microcounseling training model, with

effectiveness being more conclusive for the teaching of lower-order skills than for the

acquisition of higher-order skills.

Significantly, the more recent research review on counseling outcomes on which

the current study was based suggests that there is a need for counselors-in-training to

develop some of the more subtle counseling response skills, including the recognition and

reduction of the kinds of counseling errors that are commonly committed by novice

counselors. It is possible that the counseling skills that are necessary to develop and

maintain an empathic relationship with an adult client may better fit into the category

labeled above as higher-order skills.

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It is unclear whether the microcounseling training provided to the participants in

this study emphasized the learning of higher-order counseling skills. What is clear,

however, is that there was no significant difference in learning based on the differences

between the two adjunct supervision methods for either group of participants in this

study.

Contributions of the Study

Overview

Efforts on the part of managed care companies to discover which treatments work

best for which clients have resulted in thousands of comparative research studies

conducted by different professional schools of psychotherapy. However, psychotherapy

researchers have repeatedly failed to find any significant differences in effectiveness

between different treatment approaches over the last half-decade. If different theoretical



variance to effective psychotherapy, some researchers have concluded that there must

instead be some common, pantheoretical factors that comprise the more significant

elements of therapy outcome (Asay & Lambert, 1999; Hubble, Duncan, & Miller, 1999).

Clinical researchers have thus been called on to demonstrate that successful

psychotherapy depends less on the specific kind of therapy provided than on the

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resources of the client and the quality of the alliance created between client and therapist

(Duncan, Miller, & Sparks, 2004).

Evidence suggests that it is actually the quality of the therapeutic relationship that is

critical to the success of therapy (Sexton, Whiston, Bleuer, & Walz, 1997). Counselor

educators are primarily interested in whether the development of the empathic

relationship can be taught to student counselors and alternatively, in understanding how

empathy can best be communicated by student counselors to clients. The first question

has seemingly been answered in the affirmative by theorists (Rogers, 1980) and by

writers of textbooks (Carkhuff, 2000), but not equivocally demonstrated by researchers

(Beutler, Crago, & Arizmendi, 1986; Beutler, Machado, & Neufeldt, 1994).

Much of the previous empirical research conducted in order to explore differences

in the effectiveness of different methods of counselor education and training was

conducted more than 20 years ago (Carkhuff 1972; Ivey, Normington, Miller, Morrill, &

Haase, 1968; Rogers, 1980). These procedures have been retained by accredited

counseling programs as a counselor education and supervision method, although the

measurement of empathy as a therapeutic condition has been called into question by the

aforementioned research problems encountered (Beutler et al. 1986; Beutler et al. 1994;

Matarazzo & Patterson, 1986). The study reported herein therefore provides a new

impetus to the field of research in this area by conducting a new experimental study in the

field of counselor education and supervision. In addition, this study introduced new

research findings concerning the effectiveness of counselor supervision methods.

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For example, the innovative methodology described in Chapter III introduced a new

training method in the form of a systematic workbook and companion video, as well as

an objective self-supervision instrument. One of the unique aspects of the innovative

training method was the emphasis on training novice counselors to recognize and reduce

some of the more common and subtle counseling errors, such as reducing the number of

questions and suggestions posed by the counselor in a counseling session, and

substituting deeply accurate empathic responses for superficially empathic responses, as

well as reducing counseling responses that are more characteristic of a friend than a

professional counselor. This innovative manualized supervision approach has not been

empirically investigated previously.

In addition, the results of the statistical analysis used in this the study reported

herein discovered a quantitatively significant time effect between pre- and posttest

measures of participant counseling skills based on objectively scored CIA ratings. Thus,

my study provided the field with new empirical validation of the supervision methods

used in this study.

Although the adjunct training methods explored in this study were conducted over a

relatively brief amount of time and the total sample of participants was relatively small,

these methods of training appeared to be an effective learning tool, not only in terms of

the results of the statistical analyses, but also in terms of the responses volunteered by the

participants on the . This questionnaire was designed for all the participants in both

supervision groups to complete at the conclusion of the semester (see Appendix E). All

the items on this questionnaire were worded in such a way that the participants and their

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supervising professors would not be influenced to answer or interpret the questions or the

answers in a biased way. In other words, the questionnaire did not ask the participants to

report on any specific elements of the innovative methodology, such as the workbook or

the CIA. Questions about sources of learning, about learning based on watching videos,

and learning based on the videotape transcription process, were questions that were

relevant to all the participants. Interestingly, the responses volunteered by the participants

did seem to point out some significant differences in the reactions of the two groups of

participants.

For example, a surprising number (84.6%) of the students assigned to the

innovative supervision method stated that by watching the companion video, they learned

for the first time some new ways in which they should and should not respond to clients,

as exemplified by the following representative comments, �I learned more about limiting

advice giving,� �I hadn�t learned much about professional stance up until this point in my

education,� �It was good to compare good counseling to poor counseling using the same

client for each scenario,� �Actually seeing a counseling scenario first-hand is the most

beneficial to me,� �It helped me to see these skills in action, such as the reflection, to see

how it is done in actuality,� �It assisted me in understanding the client�s point of view

when faulty techniques are used,� �Watching always helps me,� �I will focus on what

the client is expressing and monitor my tone of voice.�

In contrast, less than 50% of the participants assigned to the traditional

supervision method volunteered any positive comments about the more traditional style

of videos they were asked to watch and critique. Examples of their comments are listed,

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as follows, �I learned more concepts just by watching others,� �I need to work on being

more personal and relaxed when counseling,� �I also need to work on my relationship

skills,� �They helped,� �I focused on their non-verbal communication styles�their

posture, their tone of voice, body language, etc.,� �I could see how techniques were

applied and the difference between approaches.� There were a few negative comments, as

well, such as the following: �Seen them a lot, seemed to be a waste of time,� and �I have

watched many of them over and over,� �Many of the tapes are quite old and could not

keep my attention.�

Although both supervision groups were exposed to models of empathic counseling

responses by watching counseling videos, the innovative video assigned to the

participants in that group seemed to be of a more informative and discriminating quality

to watch than the videos assigned to the traditional group, and the more innovative one

apparently taught the students some novel approaches to counseling. Perhaps the effects

of this innovative video will eventually become more apparent in the future counseling

styles of the participants assigned to this method.

Other new forms of data gained as a result of this study direct the reader�s attention

to the effectiveness of the assignment to transcribe and analyze a minimum of two

videotaped counseling interviews. Eighty percent of the participants assigned to the

innovative method volunteered positive comments about the learning they attributed to

the transcribing process, whereas less that 40% of the participants assigned to the

traditional method offered positive responses regarding the learning attributed to the

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transcription process. It is unclear what factor contributed to these differences in

responses between the two groups.

More research is needed to discover whether new learning regarding counseling

effectiveness by way of the innovative supervision method that emphasized the

comprehension and recognition of common counseling errors interacts in some way with

an increased appreciation for the kind of learning that takes place because of self-analysis

by way of the transcription of videotapes. More research is needed to explore whether

student preferences in learning methods translate into more effective counseling

responses.

Summary

This study was designed to address a research gap in the supervision literature

regarding the effectiveness over time of counselor training and supervision, as well as an

investigation into comparing which of two supervisory methods was the most effective

and efficient method to facilitative the training of novice student counselors in the

acquisition and maintenance of empathic relationship-response skills. Information gained

by way of an points to the need for further research in this area.

Additionally, this research project was designed to address the need to discover a

more objective instrument to use for the evaluation and supervision of counselors-in-

training. It appears, based on the significance of the findings, that the CIA is an objective

ratings instrument that can be used effectively by unbiased observers to determine the

effectiveness of counselors-in-training. This instrument has the potential to eliminate or

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reduce the problems of supervisory bias previously addressed in the supervision

literature.

Limitations of the Study Several limitations were identified in the process of conducting this study. These

limitations included sample size, sample homogeneity, instrumentation, and study design.

Sample Size

The most significant limitation of this study was the sample size. The total sample

size was 26. The most significant problem associated with the insufficient power from a

small sample is the increased likelihood of a Type II error, or failing to reject a false

hypothesis. In this study, three of the four null hypotheses could not be rejected, though

the three variables analyzed by the 2 X 2 analysis of variance, time, treatment/method,

and interaction effects, did find significance for the time effect of learning to use more

empathic or nondirective responses in counseling interviews over the course of the

semester. The analysis also revealed the existence of trends in the directions posited by

the directional hypotheses regarding the effectiveness of the innovative supervision

method. If a larger number of participants had been available, the results of this study

may have been less ambiguous.

Sample Homogeneity

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An additional limitation associated with the participants was that of homogeneity.

Approximately 90% of the participants were female and more than 80% of the

participants identified their ethnicity as White or Caucasian. As a result, meaningful

information concerning differences in learning methodologies between men and women

or between Whites or Caucasians versus counseling students of different ethnicities could

not be ascertained as a result of this study.

Instrumentation

�Though objective in its use, the CIA is theoretically tied to a less directive

counseling orientation� (Calhoun, 1999, p. 59). The supervision materials traditionally

used in modern counselor training programs are of a more integrated theoretical focus.

This study, in fact, was based on a literature review of outcome research that revealed the

relative insignificance of theoretical differences among effective and empathic therapists.

The CIA is not a direct measure of counselor effectiveness, but rather of the interactive

response style demonstrated by the counselor. The authors of the CIA defined the

following pertinent terms: reflection, clarification, support, suggestions or information,

directive behavior, counselor initiation, silence without purpose, and small talk. For

more information on the meaning of these terms, see Appendix H. The posttest scores

derived from the CIA ratings served as the dependent variable in the current study.

However, the fact that the CIA is quantitative, rather than qualitative, in nature poses

another limitation to the study�s results (Calhoun, 1999). �The rating of the instrument

relies on the observer tallying the number of nondirective and directive responses�

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(Calhoun, 1999, p. 59). Thus, the empathic quality and the effectiveness of a particular

response, within the context of the session, are not detected by the current scoring format

(Calhoun, 1999). The supervision workbook and video emphasized the recognition of

common counseling errors committed by beginning counselors, as well as the recognition

of the qualitative differences between superficially empathic responses and deeply

accurate reflections of meaning. These kinds of qualitative differences would have been

given the same weight by the CIA scoring method (Calhoun, 1999).

In discussing the internal reliability of test instruments, Ladany & Muse-Burke

(2001), who cited a review by Ellis and Ladany (1997), wrote that dichotomized or

multichotomized continuously distributed independent or dependent variables, which

were present in 7% of the studies analyzed, may present certain methodological

shortcomings related to the unreliability or invalidity of measures. Heppner, Kivlighan,

and Wampold (1999) added that instruments containing more items would be more

reliable than instruments with fewer items. Accordingly, a one-item scale would have a

reliability of 0.25, a value typical of a one-item scale.

Heppner, et al. (1999) extrapolated further that measurements of certain

characteristics, such as therapist skill level, generally have larger random response errors.

According to Heppner, et al. (1999, p. 286), �Idiosyncrasies of the client and of the

novice�s relationship with the client will affect the assessed level of skill, creating

unreliability in the assessment of general counseling competence.� Additionally, when

discussing test-retest coefficients, these authors pointed out, �If a measure of counseling

skills is internally consistent with one client, but the correlation of the skill measure with

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two different clients is low, then one can conclude that the skill measure is not adequate

to measure general counseling competence because it is measuring something related to

specific clients (p. 289)� In this study, separate Cronbach�s Alpha analyses were run on

the CIA pretest and posttest ratings, resulting in internal reliability scores of alpha = .56

and alpha = .61, respectively. Additionally, every pretest and posttest interview in this

study was conducted with a different client. Thus, it appears that the low internal

reliability of the CIA seems fairly typical for this kind of research because it is a

dichotomous measure, and because the responses scored on participant pretest transcripts

were necessarily independent from the responses selected for scoring on the posttest

transcripts.

Dosage Effect

Another possible limitation of this study was the dosage effect of the intervention.

Unfortunately, the intervention took place over six weeks, with one week for orientation

to the study, four weeks for reading and working through the workbook exercises,

watching video models, and completing written assignments, and one final week at the

conclusion of the semester for completion of the End of Semester questionnaire. The

videotaping and transcribing of counseling skills extended over the balance of only one

semester. Therefore, the relatively short length of the training and counseling response

measurement may have been an inadequate amount of time to be able to detect a

significant change in learning and behavior.

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Lack of Follow-Up Testing

An additional limitation related to the length of the study was the lack of

opportunity for additional follow-up testing of the participants� responses styles. It is

possible that the learning had not yet translated into actual behavioral change at the time

of the posttest interview. A follow-up videotaped interview transcript scheduled after

another month had passed would have enabled the researcher to determine if a

participant�s change in behavior was delayed, maintained, or extinguished following the

intervention.

Lack of Videotapes for Rating

One possibly limiting factor was related to the somewhat limited amounts of

supervision material available for objective evaluation of empathic responding according

to the CIA rating protocol. Although the participants were required by the supervising

professors to videotape and transcribe at least two of their counseling interviews each

semester and to show these tapes to their supervisors and classmates during the semester

of the course, the researcher and the other trained raters were not privy to these

videotapes. Although Altekruse (1967) wrote that the CIA was an adequate instrument to

use for the rating of written verbal behavior, the opportunity to watch participant

videotapes might have increased the capacity of the raters to make better judgments of

empathic quality by adding nonverbal cues to the amount of written communication

observed and rated. For example, nonverbal expressions of empathic attunement, such as

facial affect, tone of voice, and rate of counselor speech could not be detected or

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observed in an interview transcript. Likewise, nonverbal communications that could

potentially disrupt the development of a counseling relationship, such as a lack of

appropriate affective responses to client expressions of painful emotions, would not have

been apparent in a transcript.

Cross-Contamination of Methods

Last, because all the participants were master�s level students who had been

enrolled in many previous counselor education classes together for over a year,

friendships previously formed may have led students assigned to different methods of

supervision to share information and videos with each other.

Implications and Recommendations for Future Supervision Research

Sample Size One implication for future research that has developed out of this study is the need

for additional experimental research studies that involve a larger participant sample of

counselors-in-training. The small sample size of participants in this study subjected the

results of the analyses to questions of statistical conclusion validity.

Instrumentation

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Because of the low internal reliability typically present in research studies that use

measurements based on dichotomous, continuous, independent or dependent variables,

and because of the methodological difficulties inherent in assessing general counseling

competence based on ratings of individual counseling responses drawn from pretest and

posttest interviews with two clients, future experimental research studies might instead

compare the qualities of different counselor responses made to one client, about one type

of counseling issue, on a pretest and posttest basis.

Length and Intensity of Supervision Training

A second implication for future supervision research that emerged from this

study�s lack of significance of findings is the increased knowledge that might have been

derived from a longer and more intensive form of supervision training. A longer and

more intense study of different supervision research methods could ideally be conducted

by the supervising professor or academic supervisor assigned to work personally with the

student participants throughout the study, so that the participants could benefit from the

learning that stems from the development of a strong supervisory relationship with the

person who is implementing the supervisory intervention. The scoring of the transcript

responses could still be accomplished by trained raters who would be kept blind to the

individual and group identities of the participants assigned to different supervision

methods. As was discovered by the results of this study, this completely unbiased

measurement of counseling skills could serve as a concurrent validity check of the

professor�s subjective evaluations of participant competence.

126

Replication of Experimental Supervision Research

Because of the dearth of current empirical research in this area, additional

experimental research is needed to better identify which methods of counselor

supervision are most effective in training counselors to reduce their use of common

counseling errors and increase their use of relationship-facilitative responses. The results

of this study further illustrate the effectiveness of using an additional objective response

rating measure, such as the Counselor Interaction Analysis (CIA), to evaluate the

competence of counselors. In addition to a replication of the current research study, a

study that incorporates a repeated measurement of counseling response style scores

conducted a few months after the conclusion of the supervision intervention would allow

counselor educators to discover much needed information about the duration or

improvement of counseling behaviors after the conclusion of a semester-long counselor

training course.

Qualitative Supervision Research

A surprising implication for future counselor supervision research that emerged

from this experimental study is the potentially useful information that could be gained

from an anonymous, qualitative feedback device collected from the participants in a

study following any supervision or training intervention. In future supervision studies,

participants could be invited to write about which methods of supervision they believed

127

were most effective in their development of counseling skills. Additional qualitative

feedback could also be collected from supervisors and professors involved in the study.

Summary of Recommendations

Future research studies should be conducted by faculty supervisors in different

classrooms, with comparisons of different methodologies, administered to a larger

number of participants. The participants should be divided into matched groups of

counselors-in-training. The supervision research studies should be conducted for longer

periods of time, with pretest and posttest objective and reliable measurements of

counseling skills conducted before and after phases of training. In addition, follow-up

measurements of counseling skills should be conducted later in order to test for the

duration of training effects. Qualitative evaluations of the effectiveness of different

supervision methodologies experienced in the study should also be collected from the

participants at the conclusion of the study.

128

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APPENDIX A

INFORMED CONSENT STATEMENT

142

Informed Consent I agree to participate in a study of individuals enrolled in the Spring of 2007

CNSL 5361 counselor training classes. This study is designed to investigate the effectiveness of different methods of instruction in counseling response styles.

As a part of this study, I will submit two taped interviews and two corresponding typed transcripts, one at the beginning of the semester and one nearer to the conclusion of the semester. I understand that all research materials will be kept confidential. I also understand that these materials will be destroyed upon completion of this study.

I have been informed that there is no personal risk associated with this research and that I am free to withdraw my consent and discontinue participation in this study at any time.

I understand that my participation in this study is voluntary. I may choose to participate, withdraw my participation, or decline to participate without risk. My choice will in no way impact my grade, standing in my department, or other opportunities afforded by my department.

If I have any questions or problems that arise in connection with my participation in this study, I should contact Jacquelyn Crim-McCrary, researcher, at (806) 794-8162 or her faculty supervisor, Dr. Loretta Bradley, at (806) 742-1997. Furthermore, I understand that if I should feel any emotional discomfort as a result of participating in this research study, I can obtain confidential counseling services through the Wayland Baptist University Student Counseling Center.

By my signature below, I hereby affirm my willingness to participate in this study.

________________________________ _________ Signature of Participant Date ____________________________ ________________________ Signature of Witness Signature of Investigator As a participant in this study, you have the right to have disclosed to you the final

results of this study. If you would like to have a summary of the results forwarded to you, please indicate so by providing an address to which these results may be sent.

Print Name_________________________________________________ Address____________________________________________________ City/State/Zip________________________________________________ This project has been approved by the Texas Tech University Institutional Review Board for the

protection of human subjects.

143

APPENDIX B

INSTRUMENTS

144

145

APPENDIX C

ASSIGNMENTS

INSTRUCTIONS

END of SEMESTER QUESTIONNAIRE

Interview Record Form

146

APPENDIX C

INSTRUCTIONS TO GROUPS

147

Note to Students: You have agreed to participate in a confidential research project examining the effectiveness of different aspects of a counseling internship class. Please

do not discuss any of these materials or assignments with your classmates until the semester is over.

Due Date: These supervision materials are to be completed at your own pace,

during the semester break. If at any time, you have questions about any of the supervision materials, please email Dr. Collins, at [email protected] or call him at 806-291-9184.

Instructions for Completion of the Supervision Materials Located in Box

Number One: First, review the entire workbook, Building the Relationship: Common Errors in

Helping, and take note of the Counselor Interaction Analysis (CIA) self-assessment instrument on page 112, the instructions that follow, and Appendix B, Sample of Better Responses.

Second, read the Preface, the Introduction, the Definitions, and work through the

end of Common Error1: Giving Too Much Advice on page 24 in the workbook, including the instructions in the workbook to watch the companion video. This workbook and video is yours to keep. Therefore, you should feel free to write in your workbook, or on a separate piece of paper, if you prefer. After you have finished working through Common Error 1: Giving Too Much Advice, please complete the first of the additional four written assignments that are attached to these instructions. This chapter assignment should be turned in to your supervising professor during the spring semester, before the next transcript is due.

Third, work through the end of Common Error 2: Asking Too Many Questions on

page 52 in the workbook, and follow the instructions to watch the companion video. Complete the second written assignment, and keep these two additional written assignments together to turn in to your supervising professor during the spring semester, before the next transcript is due.

Fourth, work through the end of Common Error 3: Inappropriate Professional

Stance on page 80 in the workbook, and follow the instructions to watch the companion video. Complete the third written assignment, and keep these three additional written assignments together to turn in to your supervising professor during the spring semester, before the next transcript is due.

Fifth, work through the end of Common Error 4: Superficial Empathy on page 109

in the workbook, and follow the instructions to watch the companion video. Complete the fourth written assignment, and keep these four written assignments together to turn in to your supervising professor during the spring semester, before the next transcript is due.

Please write your name on each of the four assignments before you turn them in.

148

Note to Students: You have agreed to participate in a confidential research project examining the effectiveness of different aspects of a counseling internship class. Please do not discuss any of these materials or assignments with your classmates until the semester is over.

Due Date: These supervision materials are to be completed at your own pace,

during the semester break. If at any time, you have questions about any of the supervision materials, please email Dr. Collins at [email protected] or call him at 806-291-9184.

Instructions for Completion of the Supervision Materials Located in Box

Number Two: Please select any three counseling videos from this box that you feel will improve

your counseling style. Over the next four weeks, please take note of the time required to watch each of the

videos you have selected and schedule your time appropriately. While you are watching each video, please answer the seven counseling questions included on each of the written critique forms attached to these instructions. These videos and the written critiques will be due to turn in to your supervising professor during the spring semester, before the next counseling transcript is due.

Please write your name at the top of each video critique before turning it in.

149

APPENDIX D

WRITTEN GROUP ASSIGNMENTS

150

Section One

Questionnaire Number One

1. List at least three consequences of giving advice, whether good or bad. 2. While the counselor�s intention of fixing the client�s problem is a correct one,

what the client presents is usually a symptom of some deeper concern. What deeper concerns do you believe Rosemarie is really trying to express?

3. List three examples of potentially bad advice and the serious consequences that

might result: 4. Think of a time when you were given advice by someone who did not seem to

understand all the aspects of your problem. List some of the feelings you had at that time in regard to the advice:

5. What did you notice when you tallied up the responses of each counselor?

151

Section One

Questionnaire Number Two

1. What are two reasons a new counselor might use lots of questions in a counseling

interview? 2. List at least three consequences of asking too many questions. 3. What are some problems associated with the question �How does that make you

feel?� 4. List some alternatives to asking questions for getting the client to elaborate about

something: 5. What is one exception to the rule of asking very few questions?

152

Section One

Questionnaire Number Three

1. List three types of problems that can occur when a counselor is maintaining an inappropriate professional stance: 2. List a possible negative consequence of offering positive reinforcement: 3. Explain how the rate of speech and tone of voice of the counselor can influence the way a client responds: 4. Discuss how the counselor�s perceived ethnic similarity with the client became a blind spot in the counseling relationship:

5. List three alternatives to acting in a professionally inappropriate way:

153

Section One

Questionnaire Number Four

1. Describe three types of superficial reflections a beginning counselor might use: 2. Explain two reasons why a beginning counselor might lead the client to focus on

thoughts rather than feelings. 3. Explain why and how impersonal reflections keep the level of empathy at a

superficial level. 4. List and describe seven alternatives to providing superficial empathy: 5. What new information did you learn as a result of using this workbook and video?

154

Section Two

Questionnaire Number Two 1. List some specific examples of the clues you used to determine this counselor�s

theory of choice. 2. If you were the client in this tape, would you have returned to see this counselor

on another occasion? Why or why not? 3. What was the best counseling response you heard the counselor make? Explain

your choice. 4. What underlying emotional feeling or conflict did the client seem to be having

problems with? 5. List three interpersonal problems you assume this client might have and justify

your response. 6. If you were this client�s counselor, what would be your goal for the next session? 7. Using a different counseling style, describe how this counseling session might

have been handled differently.

155

Section Two

Questionnaire Number Two 1. List some specific examples of the clues you used to determine this counselor�s

theory of choice. 2. If you were the client in this tape, would you have returned to see this counselor

on another occasion? Why or why not? 3. What was the best counseling response you heard the counselor make? Explain

your choice. 4. What underlying emotional feeling or conflict did the client seem to be having

problems with? 5. List three interpersonal problems you assume this client might have and justify

your response.

6. If you were this client�s counselor, what would be your goal for the next session? 7. Using a different counseling style, describe how this counseling session might

have been handled differently.

156

Section Two

Questionnaire Number Three 1. List some specific examples of the clues you used to determine this counselor�s counseling theory of choice. 2. If you were the client in this tape, would you have returned to see this counselor on another occasion? Why or why not? 3. What was the best counseling response you heard the counselor make? Explain your choice. 4. What underlying emotional feeling or conflict did the client seen to be having problems with?

5. List three interpersonal problems you assume this client might have and justify your response. 6. If you were this client�s counselor, what would be your goal for the next session? 7. Using a different counseling style, describe how this counseling session might have been handled differently.

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APPENDIX E

END OF SEMESTER QUESTIONNAIRE

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End of Semester Questionnaire

When you�ve finished answering the questions, simply mail the questionnaire to the researcher in the self-addressed, stamped envelope. Your professor will not see your individual responses to this questionnaire. When the question invites you to elaborate or write specific examples, please feel free to write on the back of the page, if necessary. Just reference your answers to the question number.

1. Please indicate with a Circle, Highlighted Color, Bold, or Italics your answers to the following questions:

1.a. I was / was not one of the students who was asked to work through a

workbook.

1.b. I learned / did not learn something during this class that I had not learned before. Please elaborate briefly on what you mean.

1.c. I felt that watching the counseling videos I was given during this class helped

me / did not help me to improve my counseling skills. Please explain your answer and be as specific as possible.

1.d. I felt that the process of transcribing my counseling interview helped me / did not help me to become more aware of my counseling skills. Please elaborate on what you mean.

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1.e. I probably learned more about counseling from my client(s) / my professor / my

supervisor / written material / videotaped models than from any other source this semester.

1.f. I consider myself to be primarily a school / community counselor.

1.g. Most of my clients are children / adolescents / young adults / middle aged /

older adults.

2. Please answer the research questions that follow and feel free to say as much or as little as you choose. You may write on the back or add an extra page if you need more room, or skip questions entirely if they make you feel uncomfortable or seem tedious:

2.a. What was the most surprising thing(s) you learned about yourself as a student counselor this semester?

2.b. Which counseling skill(s) do you most want to work on or improve in the

future?

2.c. The counseling theory and approach I feel most comfortable with using at this time is:

2.d. I believe that one of the most difficult things about counseling is:

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2.e. I am guessing that the theoretical preference of my professor is:

2.f. I am guessing that the theoretical preference of my site supervisor is:

2.g. The maximum number of counseling sessions I had with any one client this

semester was: _________

3. Please fill in the following demographic data:

3.a. Name: ____________________________

3.b. Age: _______

3.c. Gender ______

3.d. Ethnicity: _______________________

3.e. Birthplace: ______________________

3.f. Where I spent most of my formative years: _____________________________

3.g. The church I went to as a child: ______________________________________

3.h. Marital/Relationship Status: ____________________________

3.i. My birth order in my family of origin: ________________

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3.j. Gender and ages of my children, if any: ________________________________

3.k. Number of grandchildren, if any: ___________________

3.l. Current Occupation, if any: _________________________________________

3.m. Previous Occupations lasting more than two years, if any: ________________

___________________________________________________________________

3.n. Previous Educational Major (Bachelor�s degree):________________________

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A Personal Note to the Research Participant from the Researcher:

I just wanted to express my sincere thanks to each of you for being willing to help

me with my dissertation research. I do not know yet whether, or to what extent, the

information obtained from the end of the semester questionnaire will be utilized to help

interpret the results of my study, but I want you to know that I deeply appreciate each and

every one of you for taking the time to answer these questions for the sake of a doctoral

student you don�t know. I hope that each of you benefited from the research and will be

interested in reading my dissertation once it is published. Best wishes and good luck in

your careers as counselors!

Appreciatively Yours,

Jacquelyn Crim-McCrary, M.Ed., LPC, NCC

9609 Vicksburg Avenue Lubbock, TX 79424

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APPENDIX F

TRADITIONAL VIDEOS

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Traditional Videotapes for the Traditional Method of Supervision

Participants assigned to Traditional Method Two each viewed a set of three of the

following videotapes listed below. The majority of these and other psychotherapy

videotapes are currently available through the Allyn & Bacon/Longman website,

www.ablongman.com. The full catalog of psychotherapy videotapes available from Allyn

& Bacon can also be located at www.ablongman.com/catalog/Fast-Search/fast-quick-

search/1,3064,,00.html?strSea. This listing of videotapes was printed based on an online

listing on 11/7/2007. Five of the videotapes listed below can be ordered through the

following website, http://www.emicrotraining.com/product_info.php?products_id=204.

Other traditional videotapes made available to the students had been owned by the

Clinical Director or the university library for many years and can no longer be purchased

as new copies by researchers interested in duplicating the contrasts used in this study by

using much older traditional counseling videotapes in the traditional group. However,

some of these more traditional counseling interviews, such as The Gloria Tapes, are now

available online through YouTube.com.

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Arredondo, P., & Ivey, A. (Session Hosts). (2007). Culturally competent counseling and

therapy � Part I: Innovative approaches to counseling African descent people, 501,

[Video] (Available from Microtraining and Multicultural Development, 141 Walnut

Street, Hanover, MA).


therapy � Part I: Innovative approaches to counseling Asian-American people,

502, [Video] (Available from Microtraining and Multicultural Development, 141

Walnut Street, Hanover, MA).


therapy � Part I: Innovative approaches to counseling Latina/o people, 503,




therapy � Part I: Innovative approaches to counseling Native-American people,

504, [Video] (Available from Microtraining and Multicultural Development, 141

Walnut Street, Hanover, MA).


therapy � Part I: Innovative approaches from a white American perspective, 505,



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Carlson, J, & Keat, D. B. (Producers). (2002). Multimodal therapy with Don Keat: Child

therapy with the experts video, 1/e, [Video] (Available from Allyn & Bacon, 75

Arlington Street, Boston, MA).

Carlson, J., Keat, D. B., & Brooks, R. (Producers). (2002). Adlerian parent consultation

with Jon Carlson: Child therapy with the experts video, 1/e, [Video] (Available

from Allyn & Bacon, 75 Arlington Street, Boston, MA).

Carlson, J., Keat, D. B., & Edgette, J. S. (Producers). (2002). Family/hypnosis therapy

with Janet Sasson Edgette: Child therapy with the experts video, 1/e, [Video]

(Available from Allyn & Bacon, 75 Arlington Street, Boston, MA).

Carlson, J., Keat, D. B., & Koocher, J. (Producers). (2002). Integrative therapy with

Jerry

Koocher: Child therapy with the experts video, 1/e, [Video] (Available from Allyn

& Bacon, 75 Arlington Street, Boston, MA).

Carlson, J., Keat, D. B., & Kottman, T. (Producers). (2002). Adlerian therapy with Terry

Kottman: Child therapy with the experts video, 1/e, [Video] (Available from Allyn


Carlson, J., Keat, D. B., & Oaklander, V. (Producers). (2002). Gestalt therapy with

Violet Oaklander: Child therapy with the experts video, 1/e, [Video] (Available


Carlson, J. Keat, D. B., & Scharff, D. (Producers). (2002). Object relations therapy with

David Scharff: Child therapy with the experts video, 1/e, [Video] (Available from

Allyn & Bacon, 75 Arlington Street, Boston, MA).

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Carlson, J., Keat, D. B., & Utigaard, A. (Producers). (2002). Person-centered therapy

with Ann Utigaard: Child therapy with the experts video, 1/e, [Video] (Available


Carlson, J., & Kjos, D. (Producers). (2000). Adlerian therapy with Dr. Jon Carlson

(Reprint): Psychotherapy with the experts video,1/e, [Video](Available from

Allyn& Bacon, 75 Arlington Street, Boston, MA).

Carlson, J. & Kjos, D. (Producers). (2002). Theories and strategies of family therapy, 1/e,

[Video] (Available from Allyn& Bacon, 75 Arlington Street, Boston, MA).

Carlson, J., Kjos, D., & Arnold, M. (Producers). (2000). Culture-sensitive therapy with

Dr. Jon Carlson and Dr. Mary Arnold: Family therapy with the experts video, 1/e,

[Video] (Available from Allyn & Bacon, 75 Arlington Street, Boston, MA).

Carlson, J., Kjos, D., & Berg, I. K. (Producers). (2000). Solution focused therapy with

Insoo Kim Berg (Reprint): Psychotherapy with the experts video, 1/e, [Video]


Carlson, J., Kjos, D., & Bugental, J. (Producers). (2000). Existential-humanistic therapy

with Dr. James Bugental (Reprint): Psychotherapy with the experts video, 1/e,


Carlson, J., Kjos, D., & Coyne, J. (Producers). (2000). Strategic therapy with Dr. James

Coyne (Reprint): Family therapy with the experts video, 1/e, [Video] (Available


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Carlson, J., Kjos, D., & Hardy, K. (Producers). (2000). Family systems therapy with Dr. Kenneth V. Hardy (Reprint): Psychotherapy with the experts video,1/e,[Video] (Available from Allyn & Bacon, 75 Arlington Street, Boston, MA).

Carlson, J., Kjos, D., & Ivey, A. (Producers). (2000). Integrative therapy with Dr. Allen

Ivey (Reprint): Psychotherapy with the experts video, 1/e, [Video](Available from

Allyn & Bacon, 75 Arlington Street, Boston, MA).

Carlson, J. Kjos, D., & Krumboltz, J. (Producers). (2000). Cognitive-behavioral therapy

with Dr. John Krumboltz (Reprint): Psychotherapy with the experts video, 1/e,


Carlson, J., Kjos, D., & Meichenbaum, D. (Producers). (2000). Cognitive-behavioral

therapy with Donald Meichenbaum (Reprint): Psychotherapy with the experts

video, 1/e, [Video] (Available from Allyn & Bacon, 75 Arlington St., Boston, MA).

Carlson, J., Kjos, D., & Lazarus, A. (Producers). (2000). Multimodal therapy with Dr.

Arnold Lazarus (Reprint): Psychotherapy with the experts video, 1/e,

[Video](Available from Allyn & Bacon, 75 Arlington Street, Boston, MA).

Carlson, J., Kjos, D., & Rogers, N. (Producers). (2000). Person-centered therapy with

Dr. Natalie Rogers (Reprint): Psychotherapy with the experts video, 1/e,

[Video](Available from Allyn & Bacon, 75 Arlington Street, Boston, MA).

Carlson, J., Kjos, D., & Scharff, J. (Producers). (2000). Object relations therapy with Dr.

Jill Savege Scharff (Reprint): Psychotherapy with the experts video, 1/e, [Video]


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Carlson, J., Kjos, D., Scharff, J., & Scharff, D. (Producers). (2000). Object relations

therapy with Drs. Jill and David Scharff (Reprint): Family therapy with the experts

video, 1/e, [Video] (Available from Allyn & Bacon, 75 Arlington Street, Boston,

MA).

Carlson, J. Kjos, D., & Schwartz, R. (Producers). (2000). Internal family systems therapy

with Dr. Richard Schwartz (Reprint): Family therapy with the experts video, 1/e,


Carlson, J., Kjos, D., & Walker, L. (Producers). (2000). Cognitive-behavioral feminist

therapy with Dr. Lenore Walker(Reprint): Psychotherapy with the experts video,

1/e, [Video] (Available from Allyn & Bacon, 75 Arlington Street, Boston, MA).

Carlson, J., Kjos, D., & Wubbolding, R. (Producers). (2000). Reality therapy with Dr.

Robert Wubbolding (Reprint): Psychotherapy with the experts video, 1/e, [Video]


Carlson, J. & Lewis, J. (Producers). (2002). Stress management with Carlson and Lewis:

7 Skills for addiction-free living video, 1/e, [Video} (Available from Allyn &

Bacon, 75 Arlington Street, Boston, MA).

Carlson, J., Lewis, J., & Alberti, R. (Producers). (2002). Assertiveness skills with Alberti:

7 Skills for addiction-free living video, 1/e, [Video] (Available from Allyn &


Carlson, J., Lewis, J., & Collins, J. (Producers). (2002). Social skills with Collins: 7

Skills for addiction-free living video, 1/e, [Video] (Available from Allyn & Bacon,

75 Arlington Street, Boston, MA).

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Carlson, J., Lewis, J., Myers, R. J., & Smith, J. E. (Producers). (2002). Alternatives to

substance abuse with Myers and Smith: 7 Skills for addiction-free living video, 1/e,


Carlson, J., Lewis, J., & Palanca, P. (Producers). (2002). Managing emotions with

Palanca: 7 Skills for addiction-free living video, 1/e, [Video] (Available from Allyn


Carlson, J., Lewis, J., & Real, T. (Producers). (2002). Problem solving with Real: 7 Skills

for addiction-free living video, 1/e, [Video] (Available from Allyn & Bacon, 75

Arlington Street, Boston, MA).

Carlson, J., Love, P, & Covey, J. (Producers). (2005). Family togetherness with John

Covey: Parenting with the Experts Video, 1/e, [Video] (Available from Allyn &


Lewis, J., Carlson, J., & Berg, I. K. (Producers). (2001). Solution-focused therapy for

addictions with Insoo Kim Berg: Brief therapy for addictions video, 1/e, [Video]


Lewis, J., Carlson, J., & Liese, B. S. (Producers). (2001). Cognitive-behavioral therapy

with Dr. Bruse S. Liese: Brief therapy for addictions video, 1/e, [Video] (Available


Lewis, J., Carlson, J., & Marlatt, G. A. (Producers). (2001). Harm reduction therapy for

addictions with Dr. G. Alan Marlatt: Brief therapy for addictions video, 1/e,


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Lewis, J., Carlson, J., & Miller, W. R. (Producers). (2001). Motivational interviewing

with Dr. William R. Miller: Brief therapy for addictions video, 1/e, [Video]


Lewis, J., Carlson, J., & Norcross, J. C. (Producers). (2001). Stages of change for

addictions with Dr. John C. Norcross: Brief therapy for addictions video, 1/e,


Lewis, J., Carlson, J., & Wubbolding, R. E. (Producers). (2001). Reality therapy for

addictions with Dr. Robert E. Wubbolding: Brief therapy for addictions video, 1/e,


Lewis, J., Carlson, J., & Zweben, J. E. (Producers). (2001). Integrating therapy with 12

step programs with Dr. Joan Ellen Zweben: Brief therapy for addictions video, 1/e,


Schwartz, R. & Carlson, J. (Producers). (2002). Couples therapy with Dr. Richard

Schwartz: Family therapy with the experts, 1/e, [Video] (Available from Allyn &


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APPENDIX G

TRANSCRIPT RESPONSE RATING FORM

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Transcript Response Rating/Scoring Sheet Rater Name:___________________ Counselor Name________________ Pre or Post-test_________________ Group ID______________________ 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

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APPENDIX H

DEFINITION OF TERMS FOR THE CIA

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Definitions for the CIA Reflection: Reflection of feeling, content reflection, and selective reflection are

included in this category. This would be the case wherein a counselor tries to express

verbally the feelings of the counselee, or acts as a mirror for the verbal expression

(repeats content of the counselee�s verbalization), or selects a particular thought or

feeling from a group of thoughts or feelings expressed by a counselee. These responses

are done in a non-threatening manner and can often appear as an interpretation when the

counselor is reflecting feelings. Reflections may be simple or complex in nature.

Clarification: Clarification is used to help clear up the counselor�s thinking as to

what the counselee means. In this category, the counselor verbalizes what he or she

thinks the counsel is trying to say. These responses are often in the form of a clarifying

question, but can be expressed in a statement such as �It seems that you�re saying�� or

�So if I�m understanding you correctly�� or �You�re saying this happened to you

before, right?�

Supportive: Praises or encourages counselee action or behavior. Such responses as

�Yes,� �You�re right,� �You have a good idea,� or such responses as �Um hum,� or �Go

on�, when there are measures of agreement as to what is being said and not reflections or

clarifications.

Gives Suggestions or Information: Comments designed to give the counselee

alternative courses of action or to give the counsel help in making a choice. Suggestions

would include giving simple directions, explaining graduation requirements, etc.

Statements which include such phrases as �You might try�,� What if you did��. The

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counselee would have a choice of actions from which to explore counselor-initiated

suggestions or information.

Directing Behavior: Makes statements intended to change counselee behavior,

threatens action to force conformity to rules, bawls someone out, gives counselee course

of action to follow, etc. The counselor may diagnose and prescribe cure. Directing

statements may, but are not limited to statements which include words such as

�should��, �must��, �need to��, :have to��, and �ought to��.

Counselor Initiation: Counselor initiates the conversation or topic by probing,

asking questions designed to demand a response, by remaining silent until the counsel

speaks, etc. Counselor may also interpret meaning without evidence of feeling, etc., to get

counsel to talk about concerns. Other statements included in this category would be

those, which change the flow or the context of the interaction, solicit new information

through the use of questions, and interruptions of the client, which are out of context with

what the client is verbalizing.

Silence: Pauses, short periods of silence, or breaks in the interaction that appears to

not be a technique of the counselor, but rather a result of the counselor not knowing what

to do or say next. Ask this question: �Does this silence seem to have a purpose known by

me or the counselee?�

Small Talk: Talk that appears to have no goal or purpose and the analyzer doesn�t

know what category it belongs in. Habit words or phrases such as �um hum� or �I see,� if

they have no meaning to the interaction should be included in this category. Other verbal

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interactions included in this category would include engaging in discussions of issues

pertaining to mutual interests but which have no clinical

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APPENDIX I

COURSE SYLLABI

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Spring 2007

COURSE SYLLABUS

WAYLAND BAPTIST UNIVERSITY DIVISION OF SOCIAL SCIENCES University Mission: The University has both an academic and a service mission. Its

academic mission is to prepare, in a Christian environment, broadly educated individuals who can move productively into a variety of professions or into further academic pursuits. The Wayland experience is guided by a dedicated, well-qualified, accessible faculty who value teaching and learning and exhibit both reverence and enthusiasm for that truth which has its ultimate source in God. COURSE NUMBER & TITLE: CNSL5361 Internship (Gates Hall)

TIME Fri. 6pm to 10:00pm/Sat. 9am to 4:30pm (March 2,3; Apr 13, 14; Apr 27, 28; May 11, 12)

INSTRUCTOR: Dr. Collins Email: collins0299@ cox.net OFFICE: 304 Gates Hall Home # 806-291-9184 OFFICE HOURS: You can meet with me before or after class by

scheduling an appointment. COURSE DESCRIPTION: Experience in performing the activities that a regularly

employed community counselor/school counselor is expected to perform in a professional counseling setting under the direct supervision of the program faculty and the site supervisor. Weekly site supervision is provided for observed, recorded, and reported experiences from the field setting. Additional faculty supervision is provided during 4 weekends throughout the duration of this semester.

PREREQUISITES: Enrolled in MAC graduate program; completion of CNSL5360

Practicum. TEXTBOOKS: 1) Bad Therapy by Kottler and Carlson; and 2) Their Finest Hour by

Kottler and Carlson. (these are both paperback trade books) Textbooks are an information source and a means of explaining and stimulating interest in

the material. It does not contain all the information students need to know, however. Additional information, notes and handouts, interpretations, and analyses will be given in class. The following additional textbooks are suggested in preparation for the comprehensive exam in order to graduate from this masters program.

Lifespan development by Santrock (2003) 9th edition (for the human growth and

development section) Counseling the culturally diverse: Theory & practice (4th ed) by Sue & Sue (2002)

(for social/cultural section)

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Family therapy: an overview (6th ed) by Goldenberg & Goldenberg (2003) (for social/cultural section)

Theory and practice of counseling and psychotherapy (7th ed) Corey (2004) (for helping relationships section)

Counseling children (6th ed) Thompson, Rudolph, & Henderson (2004) (for helping relationships section)

Theory and practice of group counseling (6th ed) Corey (2004) (for group work section)

Career counseling: applied concepts for life planning (6th ed) Zunker (for career/lifestyle development section)

DSM-IV-TR (APA) (2000) (for appraisal section) Appraisal procedures for counselors and helping professionals (5th ed) Drummond

(2003) (for testing section) Research design in counseling (2nd ed) Heppner, Kivilighan, & Wampold (1998) (for

research and stats section) Issues and ethics in the helping professions (6th ed) Corey, Corey & Callanan (2003)

(for ethics section) These books are often used in developing test items for the comprehensive exam. You can

save money buy purchasing an older edition of these books through half.com or amazon.com on the Internet.

COURSE OBJECTIVES: The major function/role of counseling is to facilitate individual

and interpersonal development throughout the life span. There are many approaches to promoting the individual�s development, no one of which may serve all. Counselors should mature with experience in their ability to critically evaluate counseling approaches to determine the appropriate one�s to use with their clientele. All counselors, regardless of work setting, should be prepared in a common core of knowledge and basic skills. All counselors-in-preparation should engage in critical self-analysis regarding their suitability for becoming a counselor, their competencies, and weaknesses. All counselors should engage in continuous peer and self-evaluation regarding the quality of their counseling services. Through a critical exposure to a broad spectrum of literature and research, the reflective counselor becomes committed to increasing knowledge about human behavior and the conditions that influence it. Through reflection, counselors appreciate the importance of themselves, as persons, in the helping process and will strive to clarify how their personal characteristics influence the outcomes of the helping process. All counselors should understand, develop, and implement an ethical code of conduct and be aware of their state�s licensing board requirements. Therefore, by the conclusion of this course, successful students will be able to:

A. Accept and use supervisory feedback to improve counseling effectiveness. B. Actively and constructively participate in peer group supervision. C. Demonstrate appropriate use of core counseling skills (e.g., attending, empathy,

respect, concreteness, genuineness, and confrontation.) D. Use counseling skills and competencies E. Conduct initial client assessments and make recommendations for counseling

services. F. Demonstrate ability to appropriately prepare clinical documentation. G. Learn to integrate theory with practice. H. Continue to develop a coherent personalized counseling approach that is

adequately based on accepted counseling theory and research. I. Critically evaluate their in-session counseling behaviors.

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J. Accurately assess their own counseling strengths and weaknesses. K. Engage in professional and ethical conduct at all times. L. Demonstrate awareness, knowledge and skills in counseling clients who are

culturally different, including racial, ethnic, gender, sexual orientation and socioeconomic differences.

CLASSROOM ACTIVITIES: Live demonstrations, roleplays, review of students�

videotaped counseling for analysis and feedback, lectures on topics such as documentation, case conceptualization, microskills, crisis management, and treatment planning, and review of appropriate material in preparation for the comprehensive examination.

COURSE EXPECTATIONS Attendance: Contrary to popular belief, absence does not make the heart grow fonder.

Attendance is required. Excessive late arrivals or early departures are not in the student�s best interest. If a student misses more than one full weekend of classes, they will be given an F for the course. If a student misses an entire weekend, they can make no higher than a B for the course. In addition, they may be assigned additional make up work. If a student misses either a Friday evening class or a Saturday class, then they will be given additional makeup work. Material will be discussed in class and included in the exams that are not necessarily in the book. It is the students� responsibility to obtain any material missed by not attending class for any reason, excused or unexcused. Make-up exams must have authorization by the professor. It is the student�s responsibility to inform the professor of the dates that they will be absent. Students are expected to attend and participate actively. Promptness for all class meetings is expected. If circumstances are such that you cannot attend or you will be late, you should contact the professor before the time of the meeting.

TURN ALL CELL PHONES AND PAGERS OFF DURING CLASS. Readings: Assigned readings and/or chapters are to be completed prior to the class

session for which they are assigned. Students should read a chapter at a time prior to coming to class, so that they can participate in class discussions as well as ask and answer questions. Students should take notes in class, and/or use a tape recorder, rather than just underlining passages in the textbook as they read.

Plagiarism Policy: Intellectual integrity and truthfulness are fundamental to scholarship.

Scholars, whether they are performing as students or as teachers, are engaged in a search for truth. Plagiarism is a form of cheating and also a form of theft. Plagiarism occurs when a student fails to give proper credit when information is either quoted or paraphrased. In essence, plagiarism takes place when you take credit for someone else�s work. This happens when you copy someone�s exam or when you fail to explain which parts of a paper reflect your own ideas and which came from someone else. Looking at or copying someone else�s test, answer sheet, and/or paper is counted as cheating. Carelessness is no excuse. As such, it is a breach of scholarly responsibility. It is also unethical, immoral, and in some cases, illegal. Plagiarism may result in an �F� in the course or in your being expelled from the class.

Disciplinary Procedures: Probation, Suspension, and Dismissal

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The Graduate School Catalog specifies the circumstances under which students may be placed on probation, suspended, or dismissed. Additionally, the Counseling Program Faculty may recommend to probate, suspend, or dismiss from the program students who (a) do not meet the program�s academic requirements, (b) do not make satisfactory progress over time toward completion of the Masters in Counseling degree, (c) exhibit behavior unbefitting a scholar, researcher, or counselor, or (d) display such inappropriate behaviors that cause the Counseling faculty to be concerned about whether the student possesses the interpersonal, emotional, and ethical behaviors necessary for entry into the counseling profession. Accordingly, on an as-needed basis, the Counseling faculty in formal meetings will discuss student progress with regard to academic performance as exhibited in classes, on examinations, and in their field site placements and nonacademic performance as exhibited in counseling relationships, personal and professional attitudes, professional behaviors, adherence to good ethical behavior, and overall compatibility with the Counseling Program at Wayland Baptist University and the counseling profession.

Immediate Dismissal Success in the Counseling Program consists of more than grades. Work habits and

attitudes play a major role in the success of any counseling student. Any of the following actions are considered just cause for immediate dismissal from the Counseling Program: Dishonesty (cheating, plagiarism, etc.), Disclosure of client confidential information with unauthorized individuals, Negligence of misconduct, Mistreatment of clients, fellow students, research participants, or faculty, Abusing a client, fellow student, faculty member, or staff member, (including abusive language), Violations of the rules, regulations, and principles in the ACA Ethical Code, Receipt of a Failing grade in Practicum, Internship, or Advanced Internship, Willful submission of false information or alteration of any official records, counseling reports, papers, or examinations, Willful conduct that may cause injury to self or others, Unethical behavior as defined by ethical guidelines and practice (e.g., ACA), and Sexual harassment as defined by Wayland Baptist University.

Disabilities: It is university policy that no otherwise qualified disabled person be excluded

from participation in, be denied the benefits of, or be subject to discrimination under any educational program or activity in the University. Students should inform the instructor of existing disabilities at the first class meeting.

Evaluation of student performance:

Students must complete supervised internship experiences that total a minimum of 100 clock hours (these hours include 40 hours of direct and 60 hours of indirect client contact hours at a minimum). The practicum provides for the development of counseling skills under both faculty and site supervision. The student�s internship includes an evaluation of the student�s performance throughout the course. Failure to complete the necessary hours will result in a failing grade. A student who takes an �incomplete� will not be allowed to enroll

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in the Internship course in the following semester which may delay their graduation by one semester.

All students must provide proof of professional liability insurance coverage before

they will be permitted to see clients. Students are free to obtain this insurance through any insurance company. Professional liability insurance is available through the American Counseling Association and additional resources can be found in the Counseling Program Handbook.

Field Site Responsibilities. Students will participate in field site activities according to the

mode of operation of the setting, whether it be in a community or school setting. During the internship, students are expected to perform, under supervision, the principal professional activities of the setting. The University delegates supervisory and administrative responsibility for field site activities to field site supervisors. University faculty instructors will communicate and collaborate with field site supervisors as necessary and desirable and may even make site visits. If special problems or concerns (clinical, supervisory, interpersonal, etc.) develop, site supervisors are asked to contact the University supervisor in timely fashion, depending on the nature of the problem. It is the responsibility of the University faculty instructor to work with field site supervisors and students to resolve special problems or concerns. If you as a student have a problem or concern regarding your site or your site supervisor, you must notify your professor immediately. At the end of the semester, site supervisors will complete evaluation forms, on which they assess students� skills and abilities. This form will be provided to you in class and you must give it to the site supervisor with ample time for them to return it to you so that you can get it to the professor by the due date.

Field-Site (Off-Campus) Supervision. Students also meet once a week with their field

site supervisor. These meetings are arranged with the field supervisor according to the requirements of the field setting.

Ethical and Professional Conduct. Counselors-in-training are expected to behave in

accordance with the ACA Ethical Standards and other standards of accepted professional conduct, including attire appropriate to professional counseling. Special attention is called to standards of confidentiality. Specific Ethical and Professional Guidelines for School Counselors are also included in the (a) TEA Code of Ethics and (b) American School Counselor Association Ethical Standards.

University Grading Scale: The University has a standard grading scale as follows:

90 - 100 = A (excellent); 80 - 89 = B (good); 70 - 79 = C (average); 60 - 69 = D (acceptable but below average); below 60 = F (unacceptable); W=the student withdrew from the course before the deadline; WP=the student withdrew passing before the deadline; WF=the student withdrew failing before the deadline (note that WF and F count the same in the GPA); and I=incomplete. A grade of �incomplete� is given only if circumstances beyond the student�s control prevented completion of work during the semester enrolled and any attendance requirements have been met. A grade of �incomplete� is changed if the deficiency is made up by midterm of the next regular semester; otherwise, it becomes an �F�.

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Homework Assignments: A) Case File: (20% of final grade). You will be required to videotape an actual counseling

session and assemble an actual case file for a client you are working with. Over the course of this semester, you will sign up for which weekend you will be presenting your case and will only present one case to the classroom for discussion and constructive feedback. Your video is to be at least 35 minutes long. However, we may only have time to review a portion of the video in class. The class will view this videotape (either in VHS or DVD format) with you and will ask questions, offer feedback and provide suggestions. The purpose of this assignment is to help you polish your counseling skills. If your agency or school will not allow for videotaping or if you cannot find a client who will give consent, then you should find someone (such as a friend, or relative, or neighbor, or another classmate) who would be willing to participate. Be sure to get a consent form signed by the client indicating that you are a graduate student who is serving as a counselor intern and that they are aware that a graduate class and the professor will be reviewing this tape and information. Also, please alter, mask, or blacken out any identifying information on all written documentation to protect and maintain the confidentiality of the client. Please ask your professor during class for clarification on how to do this assignment if you are unsure. You will be graded on your counseling skills, your ethics, your ability to discuss and conceptualize your case, and the quality of your written documentation. Your file should include the following:

Signed consent form Case Conceptualization (which is a one-page double-spaced brief summary of the client

and their issues) Transcription of a portion of the counseling session (which is to be 5 double spaced

pages in length and should include your microskills analysis after each dyadic interaction). Treatment Plan (which is a one-page double-spaced statement of what problem(s) you

would address, what treatment strategies you would employ, long term goal(s), and short term objectives.)

Progress Note of this session which should include the type of treatment (i.e. individual or group), the length of the session, mini-mental status exam (i.e. client appeared alert and oriented with no evidence of psychotic features and was not currently suicidal), what the client talked about, what the therapist explored, any homework given, any progress or recommendations or concluding observations, date/time of next appointment, and clinician�s signature, title, and date.)

Self-evaluation (which is a one-page double-spaced reflection on what theoretical approach you took, how you thought you did and what you thought about your body language as well as what you should have done differently)

Your entire presentation of the video and the discussion that follows should take about 40 minutes to complete. You will prepare and complete only one of these cases over the course of the semester. If you do not have a video camera, consult with your fellow classmates, friends, relatives, or neighbors to borrow one for this project.

B) Student Log Review, Accrual of minimum required internship hours, and turning in evaluation forms as scheduled: (50% of final grade) During each weekend that we meet, your professor will ask each student to turn in their log to sign off on their hours accrued. The site supervisor should sign off on the student�s hours on a

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weekly basis. Half of your grade in this class is determined by your ability to turn in the evaluation forms and log books as scheduled as well as complete the required 100 hours of supervised internship hours (including the minimum number of both direct and indirect client contact hours) as well as your ability to turn in your log book for review each Friday that we meet for class. Your site supervisor�s comments will also be considered as well. You cannot take an �incomplete� for this course because this will prevent you from being able to sign up for the advanced internship course. Therefore, in some unforeseen instance that you will not be able to accrue the required minimum hours, please consult with your professor and/or division chair on how best to address your situation.

C) Book Review: (15% each for a total of 30% of final grade). You will read and review

the two books that are required for this course. For each review, reflect upon several of the cases that you read about and talk about what you learned from this experience or what you might have done differently. Also, talk about the therapists� theoretical orientation and how it fits with your own personal counseling style. More details on these 2 book review assignments can be provided in class. Just ask your instructor. Each of these book reviews are to be a minimum of 5 pages each (double spaced) or a total of 10 pages for both of the 2 book reviews.

Course Outline (Tentative Schedule) March 2, 3 Friday Introduction to Internship course expectations (Weekend #1) Students describe where they will be working and what they will

be doing Get list of students� names and drivers licenses Complete sign-up sheet for when each student is to present their case file to the class. Checking all forms for signatures and checking insurance coverage (if you�ve changed sites since your practicum) Handing out and discussing the Field Site Log Worksheet, Consent forms, and Evaluation Form (as needed since you may already be familiar with the forms from the practicum class) Review the �human growth and development� section in preparation for the comprehensive exam

Saturday Review the marriage and family therapy section, the counseling

theories/techniques section, & career and lifestyle development and career counseling assessment section in preparation for the comps exam.

April 13, 14 Friday Student Log Review due (Weekend #2) Discussion of how the site experiences are going

Discussion of any client issues that students may want consultation with

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Review the �professional orientation, ethics, and professional practice� section and the �group work and group counseling� section in preparation for the comps exam

Saturday Tour of Formby Corrections Facility (9:30am to noon) East

of Plainview Review the program evaluation or research methods/stats section, the testing & assessment section, & the social/cultural foundations section in preparation for the comps exam

April 27, 28 Friday Administration of the Comprehensive Examination

(an alternative activity will be planned for (Weekend #3) those who are not taking their comprehensive exam at this time)

Student Log Review due Discussion of any client issues that students may want consultation with

Presentation of Case Files Saturday Presentation of Case Files

Discussion of Case Conceptualization Discussion of Treatment Planning and Progress Notes In class role plays and demonstrations Discussion of ethical dilemmas and multicultural issues with clients Continued Discussion of Microskills and counseling skills/techniques

May 11, 12 Friday Book Reviews �Bad Therapy� and �Their Finest Hour� are due

(Weekend #4) Student Log Review due Evaluation Forms due (both your evaluation of site, supervisor, and self as well as the site supervisor�s evaluation of the student�this must be turned in this weekend) Discussion of any client issues that students may want consultation with

Presentation of Case Files Discussion of the book �Their Finest Hour� and some of the specific cases in this book

Saturday Discussion of some of the cases from the �Bad Therapy� book

Presentation of Case Files In class roleplays and demonstrations

discussion of best and worst counseling experiences during this semester Discussion of the student�s personal counseling theory

Note: Topics may change when necessary based on class need.

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Rules and Policy for the tour of the Formby unit 1) You must provide your full legal name, driver�s license, and state in which you

have a driver�s license. 2) You must be over 18 years of age. 3) You must not take any cell phones or cameras into the facility. 4) You must have a picture ID upon entering facility. 5) You cannot wear shorts or sleeveless shirts. 6) You must not wear all white clothing. 7) You cannot wear logo t-shirts. 8) You cannot enter the facility if you have a family member currently incarcerated

at this facility.

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Winter 2006-2007

COURSE SYLLABUS

WAYLAND BAPTIST UNIVERSITY DIVISION OF SOCIAL SCIENCES University Mission: The University has both an academic and a service mission. Its

academic mission is to prepare, in a Christian environment, broadly educated individuals who can move productively into a variety of professions or into further academic pursuits. The Wayland experience is guided by a dedicated, well-qualified, accessible faculty who value teaching and learning and exhibit both reverence and enthusiasm for that truth which has its ultimate source in God.

COURSE NUMBER & TITLE: CNSL5360 Practicum (Gates Hall) TIME Fri. 6pm to 10:00pm/Sat. 9am to 4:30pm

(Nov 17, 18; Dec 1, 2; Jan 19, 20; Feb 2, 3) INSTRUCTOR: Dr. Collins Email: collins0299@ cox.net OFFICE: 304 Gates Hall Home # 806-291-9184 OFFICE HOURS: You can meet with me before or after class by scheduling an

appointment. . COURSE DESCRIPTION: Experience in performing, on a limited basis and under

supervision, some of the activities that a regularly employed community counselor/school counselor is expected to perform in a professional counseling setting. Weekly site supervision is provided for observed, recorded, and reported experiences from field settings. Additional faculty supervision is provided during 4 weekends throughout the duration of this semester.

PREREQUISITES: Enrolled in MAC graduate program; completion of 24 graduate hours

in counseling; and completion of CNSL5307 Ethics and Legal Issues in Counseling. TEXTBOOKS: Becoming a Professional Counselor (2nd Edition): Preparing for

Certification and Comprehensive Exams. By Sheri A. Wallace and Michael D. Lewis. Sage Publications. (1998)

Textbooks are an information source and a means of explaining and stimulating interest in

the material. It does not contain all the information students need to know, however. Additional information, notes and handouts, interpretations, and analyses will be given in class.

COURSE OBJECTIVES: The major function/role of counseling is to facilitate individual

and interpersonal development throughout the life span. There are many approaches to promoting the individual�s development, no one of which may serve all. Counselors should mature with experience in their ability to critically evaluate counseling approaches to determine the appropriate one�s to use with their clientele. All counselors, regardless of work setting, should be prepared in a common core of knowledge and basic skills. All counselors-in-preparation should engage in critical self-analysis regarding their suitability for becoming a counselor, their competencies, and weaknesses. All counselors should engage in continuous peer

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and self-evaluation regarding the quality of their counseling services. Through a critical exposure to a broad spectrum of literature and research, the reflective counselor becomes committed to increasing knowledge about human behavior and the conditions that influence it. Through reflection, counselors appreciate the importance of themselves, as persons, in the helping process and will strive to clarify how their personal characteristics influence the outcomes of the helping process. All counselors should understand, develop, and implement an ethical code of conduct and be aware of their state�s licensing board requirements. Therefore, by the conclusion of this course, successful students will be able to:

A. Accept and use supervisory feedback to improve counseling effectiveness. B. Actively and constructively participate in peer group supervision. C. Demonstrate appropriate use of core counseling skills (e.g., attending, empathy,

respect, concreteness, genuineness, and confrontation.) D. Use counseling skills and competencies E. Conduct initial client assessments and make recommendations for counseling

services. F. Demonstrate ability to appropriately prepare clinical documentation. G. Begin to integrate theory with practice. H. Continue to develop a coherent personalized counseling approach that is

adequately based on accepted counseling theory and research. I. Critically evaluate their in-session counseling behaviors. J. Accurately assess their own counseling strengths and weaknesses. K. Engage in professional and ethical conduct at all times. L. Demonstrate awareness, knowledge and skills in counseling clients who are

culturally different, including racial, ethnic, gender, sexual orientation and socioeconomic differences.

CLASSROOM ACTIVITIES: Live demonstrations, roleplays, review of students�

videotaped counseling for analysis and feedback, lectures on topics such as documentation, case conceptualization, microskills, crisis management, and treatment planning.

COURSE EXPECTATIONS Attendance: Contrary to popular belief, absence does not make the heart grow fonder.

Attendance is required. Excessive late arrivals or early departures are not in the student�s best interest. If a student misses more than one full weekend of classes, they will be given an F for the course. If a student misses an entire weekend, they can make no higher than a B for the course. In addition, they may be assigned additional make up work. If a student misses either a Friday evening class or a Saturday class, then they will be given additional makeup work. Material will be discussed in class and included in the exams that are not necessarily in the book. It is the students� responsibility to obtain any material missed by not attending class for any reason, excused or unexcused. Make-up exams must have authorization by the professor. It is the student�s responsibility to inform the professor of the dates that they will be absent. Students are expected to attend and participate actively. Promptness for all class meetings is expected. If circumstances are such that you cannot attend or you will be late, you should contact the professor before the time of the meeting.

TURN ALL CELL PHONES AND PAGERS OFF DURING CLASS.

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Readings: Assigned readings and/or chapters are to be completed prior to the class session for which they are assigned. Students should read a chapter at a time prior to coming to class, so that they can participate in class discussions as well as ask and answer questions. Students should take notes in class, and/or use a tape recorder, rather than just underlining passages in the textbook as they read.

Plagiarism Policy: Intellectual integrity and truthfulness are fundamental to scholarship.

Scholars, whether they are performing as students or as teachers, are engaged in a search for truth. Plagiarism is a form of cheating and also a form of theft. Plagiarism occurs when a student fails to give proper credit when information is either quoted or paraphrased. In essence, plagiarism takes place when you take credit for someone else�s work. This happens when you copy someone�s exam or when you fail to explain which parts of a paper reflect your own ideas and which came from someone else. Looking at or copying someone else�s test, answer sheet, and/or paper is counted as cheating. Carelessness is no excuse. As such, it is a breach of scholarly responsibility. It is also unethical, immoral, and in some cases, illegal. Plagiarism may result in an �F� in the course or in your being expelled from the class.

Disciplinary Procedures: Probation, Suspension, and Dismissal The Graduate School Catalog specifies the circumstances under which students may

be placed on probation, suspended, or dismissed. Additionally, the Counseling Program Faculty may recommend to probate, suspend, or dismiss from the program students who (a) do not meet the program�s academic requirements, (b) make satisfactory progress over time toward completion of the Masters in Counseling degree, (c) exhibit behavior unbefitting a scholar, researcher, or counselor, or (d) display such inappropriate behaviors that cause the Counseling faculty to be concerned about whether the student possesses the interpersonal, emotional, and ethical behaviors necessary for entry into the counseling profession. Accordingly, the Counseling faculty in formal meetings will discuss student progress with regard to academic performance as exhibited in classes, on examinations, and in their field site placements and nonacademic performance as exhibited in counseling relationships, personal and professional attitudes, professional behaviors, adherence to good ethical behavior, and overall compatibility with the Counseling Program at Wayland Baptist University and the counseling profession.

Immediate Dismissal Success in the Counseling Program consists of more than grades. Work habits and

attitudes play a major role in the success of any counseling student. Any of the following actions are considered just cause for immediate dismissal from the Counseling Program: Dishonesty (cheating, plagiarism, etc.), Disclosure of client confidential information with unauthorized individuals, Negligence of misconduct, Mistreatment of clients, fellow students, research participants, or faculty, Abusing a client, fellow student, faculty member, or staff member, (including abusive language), Violations of the rules, regulations, and principles in the ACA Ethical Code, Receipt of a Failing grade in Practicum, Internship, or Advanced Internship, Willful submission of false information or alteration of any official records, counseling reports, papers, or examinations, Willful conduct that may cause injury to self or others, Unethical behavior as defined by ethical

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guidelines and practice (e.g., ACA), and Sexual harassment as defined by Wayland Baptist University.

Disabilities: It is university policy that no otherwise qualified disabled person be excluded

from participation in, be denied the benefits of, or be subject to discrimination under any educational program or activity in the University. Students should inform the instructor of existing disabilities at the first class meeting.

Evaluation of student performance:

Students must complete supervised practicum experiences that total a minimum of 75 clock hours (these hours may be either direct or indirect client contact hours). The practicum provides for the development of counseling skills under both faculty and site supervision. The student�s practicum includes an evaluation of the student�s performance throughout the practicum. Failure to complete the necessary hours will result in a failing grade. A student who takes an �incomplete� will not be allowed to enroll in the Internship course in the following semester which may delay their graduation by one semester.

All students must provide proof of professional liability insurance coverage before

they will be permitted to see clients. Students are free to obtain this insurance through any insurance company. Professional liability insurance is available through the American Counseling Association and additional resources can be found in the Counseling Program Handbook.

Field Site Responsibilities. Students will participate in field site activities according to the

mode of operation of the setting, whether it be in a community or school setting. During the practicum (EPCE 5360) students are expected to perform, on a limited basis and under supervision, the principal professional activities of the setting. The University delegates supervisory and administrative responsibility for field site activities to field site supervisors. University faculty instructors will communicate and collaborate with field site supervisors as necessary and desirable and may even make site visits. If special problems or concerns (clinical, supervisory, interpersonal, etc.) develop, site supervisors are asked to contact the University supervisor in timely fashion, depending on the nature of the problem. It is the responsibility of the University faculty instructor to work with field site supervisors and students to resolve special problems or concerns. If you as a student have a problem or concern regarding your site or your site supervisor, you must notify your professor immediately. At the end of the semester, site supervisors will complete evaluation forms, on which they assess students� skills and abilities. This form will be provided to you in class and you must give it to the site supervisor with ample time for them to return it to you so that you can get it to the professor by the due date.

Field-Site (Off-Campus) Supervision. Students also meet once a week with their field

supervisor. These meetings are arranged with the field supervisor according to the requirements of the field setting.

Ethical and Professional Conduct. Counselors-in-training are expected to behave in

accordance with the ACA Ethical Standards and other standards of accepted professional

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conduct, including attire appropriate to professional counseling. Special attention is called to standards of confidentiality. Specific Ethical and Professional Guidelines for School Counselors are also included in the (a) TEA Code of Ethics and (b) American School Counselor Association Ethical Standards.

University Grading Scale: The University has a standard grading scale as follows:

90 - 100 = A (excellent); 80 - 89 = B (good); 70 - 79 = C (average); 60 - 69 = D (acceptable but below average); below 60 = F (unacceptable); W=the student withdrew from the course before the deadline; WP=the student withdrew passing before the deadline; WF=the student withdrew failing before the deadline (note that WF and F count the same in the GPA); and I=incomplete. A grade of �incomplete� is given only if circumstances beyond the student�s control prevented completion of work during the semester enrolled and any attendance requirements have been met. A grade of �incomplete� is changed if the deficiency is made up by midterm of the next regular semester; otherwise, it becomes an �F�.

Homework Assignments: A) Counseling Video Tape Review: (2.5% each or a total of 7.5% of the final grade). You

will be required to review and complete a �counseling video review worksheet� that will prompt you to reflect upon 3 different counseling videos over the course of this semester. More details will be provided in class.

B) Site Documentation Forms: (2.5% of final grade) You will be required to bring

copies of all forms (i.e. intake forms, blank progress note forms, treatment plan forms, client consent forms, depression screening forms, suicide/risk assessments, etc.) that are utilized with your site�s clientele. Make a packet of these forms for each student in your class. When you turn in a packet of forms to your professor on the due date (see due date under course schedule below), you will also hand out packets to the other students in the class. We will then spend some time reviewing these forms to better understand their purpose and function and may ask you questions about how to fill these forms out or what they are used for, etc. Make sure that your site supervisor does not have any objections with you sharing examples of these forms with your fellow students. Contact your professor if this becomes a problem. If several students are working in the same site, these students only have to submit one set of forms but they might decide from among themselves who will make copies of the forms for the class and who will sort them into packets, etc.

C) Case Files: (15% each or 30% of final grade). You will be required to videotape

an actual counseling session and assemble an actual case file for a client you are working with. Over the course of this semester, you will present 2 of these cases. Your video is to be about 20 minutes long. The class will view this videotape (either in VHS or DVD format) with you and will ask questions, offer feedback and provide suggestions. The purpose of this assignment is to help you polish your counseling skills. If your agency or school will not allow for videotaping or if you cannot find a client who will give consent, then you should find someone (such as a friend, or relative, or neighbor, or another classmate) who would be willing to participate. Be sure to get a consent form signed by

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the client indicating that you are a graduate student who is serving as a counselor intern and that they are aware that a graduate class and the professor will be reviewing this tape and information. Also, please alter, mask, or blacken out any identifying information on all written documentation to protect and maintain the confidentiality of the client. Please ask your professor during class for clarification on how to do this assignment. You will be graded on your counseling skills, your ethics, your ability to discuss and conceptualize your case, and the quality of your written documentation. Your file should include the following:

Signed consent form Case Conceptualization (which is a one-page double-spaced brief summary of the client

and their issues) Transcription of a portion of the counseling session (which is to be 3 double spaced pages

in length and should include your microskills analysis after each dyadic interaction) Treatment Plan (which is a one-page double-spaced statement of what problem(s) you

would address, what treatment strategies you would employ, long term goal(s), and short term objectives.)

Progress Note of this session which should include the type of treatment (i.e. individual or group), the length of the session, mini-mental status exam (i.e. client appeared alert and oriented with no evidence of psychotic features and was not currently suicidal), what the client talked about, what the therapist explored, any homework given, any progress or recommendations or concluding observations, date/time of next appointment, and clinician�s signature, title, and date.)

Self-evaluation (which is a one-page double-spaced reflection on what theoretical approach you took, how you thought you did and what you thought about your body language as well as what you should have done differently)

We will spend a majority of the weekend classes reviewing your videotaped counseling sessions and discussing the case as well as your counseling skills. Your entire presentation of the video and the discussion that follows should take about 40 minutes to complete. You will prepare and complete 2 of these cases over the course of the semester. If you do not have a video camera, consult with your fellow classmates, friends, relatives, or neighbors to borrow one for these 2 projects.

D) Student Log Review: During each weekend that we meet, your professor will ask each student to turn in their log to sign off on their hours accrued. The site supervisor should sign off on the student�s hours on a weekly basis.

Exams: (60% total of final grade) Three exams will be administered during the course of

the semester. The exams will consist of objective questions such as multiple choice questions. The tests may consists of items from either the textbook(s) or from material discussed in class as well as from handouts given out in class or other readings that students may be directed to acquire. Bring a #2 pencil with eraser and a green scan-tron (form #882-ES) on the dates of the exams. I don�t drop the lowest test grade so study hard on every exam. The following additional textbooks are suggested in preparation for the exams.

Lifespan development by Santrock (2003) 9th edition (for the human growth and development section)

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Counseling the culturally diverse: Theory & practice (4th ed) by Sue & Sue (2002) (for social/cultural section)

Family therapy: an overview (6th ed) by Goldenberg & Goldenberg (2003) (for social/cultural section)

Theory and practice of counseling and psychotherapy (7th ed) Corey (2004) (for helping relationships section)

Counseling children (6th ed) Thompson, Rudolph, & Henderson (2004) (for helping relationships section)

Theory and practice of group counseling (6th ed) Corey (2004) (for group work section)

Career counseling: applied concepts for life planning (6th ed) Zunker (for career/lifestyle development section)

DSM-IV-TR (APA) (2000) (for appraisal section) Appraisal procedures for counselors and helping professionals (5th ed) Drummond

(2003) (for testing section) Research design in counseling (2nd ed) Heppner, Kivilighan, & Wampold (1998) (for

research and stats section) Issues and ethics in the helping professions (6th ed) Corey, Corey & Callanan (2003)

(for ethics section) These books are often used by the National Counseling Certification Board in developing

test items for the NCE exam. You can save money buy purchasing an older edition of these books through half.com or amazon.com on the internet.

Course Outline (Tentative Schedule)

Nov 17, 18 Friday Introduction to Practicum course expectations Students describe where they will be working and what they will be doing

Checking all forms for signatures and checking insurance coverage Handing out and discussing the Field Site Log Worksheet, Consent forms, and Evaluation Form Discussion of Microskills

Counseling Video & Discussion (if time permits) Saturday Discussion of Case Conceptualization Discussion of Treatment Planning and Progress Notes

In-class roleplays and practice of counseling skills and techniques (in small groups) Discussion of Critical Incidents and Crisis Management (ie. suicidal client)

Counseling Video & Discussion (if time permits)

Dec 1, 2 Friday Exam #1 (Human Growth & Development) Site Documentation Forms Packet is due Counseling Video Review #1 is due Student Log Review due Discussion of how the site experiences are going

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Discussion of the forms and documents used in the various sites Discussion of any client issues that students may want consultation with

Presentation of Case Files Saturday Presentation of Case Files In class roleplays and demonstrations Counseling video and discussion (as time permits) Discussion of the student�s personal counseling theory

Jan 19, 20 Friday Exam #2 (Social and Cultural Foundations/The Helping Relationship) Counseling Video Review #2 is due Student Log Review due Discussion of any client issues that students may want consultation with Presentation of Case Files Saturday Presentation of Case Files In class roleplays and demonstrations Discussion of ethical dilemmas and multicultural issues with clients Counseling video and discussion (as time permits)

Feb 2, 3 Friday Exam #3 (Group dynamics, process, and counseling/Lifestyle and Career Development/Appraisal of the Individual)

Counseling Video Review #3 is due Student Log Review due

Evaluation Forms due (both your evaluation of site, supervisor, and self as well as the site supervisor�s evaluation of the student)

Discussion of any client issues that students may want consultation with

Presentation of Case Files Saturday Presentation of Case Files In class roleplays and demonstrations Discussion of best and worst counseling experiences during this semester

Counseling video and discussion (as time permits) Note: Topics may change when necessary based on class need.

Documents

Effectiveness of Empathic Response Training on Master™s