Doctoral student perceptions of learning to be reflective practitioners.

Abstract

Reflectivity is integral to therapist development across the life span and differentiates therapists who continue to grow and develop throughout their career from therapists who stagnate (Skovholt and Ronnestad, 1995; Neufeldt et al., 1997). Grounded in ethnographic research methodology, the study sought to describe the role reflectivity plays in the developmental processes of doctoral students, and the ways in which a training context that used a Reflecting Team Format (Andersen, 1987) and Solution-Focused Supervision (Selekman and Todd, 1995; Wetchler, 1990) facilitated or hindered the learning and use of reflectivity. Barriers and facilitators were identified as including the context in which supervision occurs, the peers with whom a student interacts, and personal factors a student brings to the supervisory experience.

Therapist Development and Reflectivity

The development of competent, ethical therapists and the clinical supervision that best facilitates optimum development are complex processes. Researchers have attempted to understand the many components of these processes with regard to individual, environmental and relational factors that contribute to the personal and professional development of therapists and counselors.

A research-based conceptualization of therapist and counselor development formulated by Skovholt and Ronnestad (1995) shares the basic assumptions of the developmental perspective, such as the idea that therapists-in-training progress through sequential stages toward increased competency and autonomy, and that the supervisory relationship changes over time, as do the needs of the trainees. The core assumption of this conceptual model is that therapists either stagnate or develop depending upon the use of a central mediating process they term continuous professional reflection, as well as other individual factors and structuring factors in the supervision or working environment (Skovholt & Ronnestad, 1995). Personal and professional interactions play a key role in therapist development, as does time to oneself to reflect, an open and supportive environment, and a reflective stance. This third, and most important, component of continuous reflection, is the reflective stance. A reflective stance is defined as:

   the individual is consciously giving time and energy to processing, alone
   and with others, impactful experiences. An active, exploratory, searching,
   and open attitude is of extreme importance. Asking for and receiving
   feedback is crucial. (Skovholt & Ronnestad, 1995, p. 107)

Neufeldt, Karno, and Nelson (1996) have also highlighted the prepotent role that reflectivity plays in therapist development. These authors asserted that reflectivity improves supervisees' work and professional judgment. They argue that an important supervisory responsibility is to "facilitate the process of reflectivity" (Neufeldt et al., 1996, p. 3). In fact, Holloway argues that a critical role of the educator is to "teach supervisees in a systematic way to reflect ... and that the learning of reflective processes (i.e., to think in that way of critical inquiry) is half the activity of supervision" (Neufeldt et al., 1996, p. 7).

Purpose of the Study

Given the importance of reflectivity to therapist development, the primary research goal was to understand and describe student perceptions of the ways in which this particular training context facilitated and/or hindered the learning and use of reflectivity.

Supervision and Training Context

Our training facility provided a unique opportunity to explore doctoral students' perceptions of a learning context designed to teach and encourage the use of reflectivity. The clinic is equipped with one-way mirrors that allows for live supervision of students' work, and the practicum instructor is an experienced supervisor with expertise in the reflecting team format (Andersen, 1987) and the solution-focused models of therapy (Walter & Peller, 1992) and supervision (Wetchler, 1990; Thomas, 1994). These approaches to training and supervision are particularly compatible in their assumptions, goals, and philosophies with therapists' learning and use of reflectivity. In addition to these contextual factors, the diversity within the group of students provided a much needed and welcome opportunity to conduct research that was sensitive to and interested in exploring and describing those individual differences.

A learning context was created that was grounded in Skovholt & Ronnestad's (1995) model whereby students were encouraged to be reflective about their own growth and development, and at the same time, the very structuring factors found to be facilitative of reflectivity were provided. The approach to training and supervision was inspired and informed by the work of Cantwell and Holmes (1994, 1995) which provided a roadmap to create a learning context that seeks to encourage a reflective stance. The central goals of training with reflecting teams are to "provide tools for on-going self-reflection" and to encourage the trainees to attend to their own process of learning (Cantwell & Holmes, 1994, p.22). A personal journal of learning (Cantwell & Holmes, 1994) was used for students to reflect on their growth and growing edges. A central assumption of the reflecting team format and a solution-focused approach to supervision is that the inquisitive, curious stance of mutual exploration between supervisor and trainee in a positive relational context will facilitate in the trainee the skill and long-term motivation for self-reflection.

With these supervisory approaches, our intention was to provide the very structuring factors that Skovholt and Ronnestad (1995) found to be critical to the development of trainees' ability to engage in the process of self-reflection. First, the creation of a supportive--yet challenging--supervision environment is emphasized within these approaches to training. The reflecting team approach and the solution-focused model emphasize the acceptance of differences and are intended to build collaborative relationships (Lowe & Guy, 1996). The tentative quality of both approaches (i.e., ideas are presented as options rather than directives) helps to create a supportive learning context (Anderson & Swim, 1995). Second, attention was paid to balance the assimilation of information with the accommodation of experience and knowledge. A priority was placed on creating an environment that allowed time to process the inevitably intense emotional experiences that are inherent in therapeutic work and therapist development. Third, the developmental contract discussed by Skovholt and Ronnestad (1995) was operationalized in the solution-focused model as the supervisor and supervisee created a development contract together and worked together to help the trainee reach the training goals (Thomas, 1994). In addition to setting clear individual learning goals for the semester, the pre-session of each reflecting team allowed the supervisor to collaborate with the student to establish a goal or to clarify how the team may be helpful to him/her, the client or the working alliance.

Doctoral Student Perceptions

The primary research goal was to understand and describe student perceptions of the ways in which this training context facilitated and/or hindered the learning and use of reflectivity. Based on data from the interviews, group process, journal entries, and the researchers' observations, some aspects of the environment were perceived as facilitators while others were perceived as barriers to reflective practice. Facilitators and barriers were identified as including: (1) the supervision context, (2) peers, and (3) personal or individual factors.

Contextual Facilitators

In general, students found the supervision context to be highly facilitative of reflective practice. The context was frequently described as safe, nonjudgmental and as a comfortable setting. Students felt accepted and challenged within the environment, in which they could take risks and learn to develop their own style of being a therapist.

The opportunity, both in and out of class, to spend time thinking about one's work, one's growth and development as a therapist, and one's growing edges was a novel and positive experience for all of the students. Students found that the space and time that was created allowed them to slow down and process, and be able to present different ideas. The personal journal of learning (Cantwell & Holmes, 1994) provided an effective place for students to reflect on the multiple layers of their experience. At the beginning of the semester students were reticent--and some even unwilling--to keep a journal, yet, in the end were genuinely surprised at how helpful it was in keeping them focused on their own growth, and personally meaningful. It was more than just an outlet for students' reflections, it also became the vehicle by which students learned to be self-reflective, to struggle to identify and express one's thoughts and feelings regarding their own development as therapist.

The third aspect of the context that emerged as being facilitative was the physical shift inherent in the reflecting team format as participants were situated behind the one-way mirror while a peer met with a client. Live observation of one's peers and learning to identify and utilize one's reactions to a therapy experience was identified as a key component of learning to be reflective. Experiential rather than didactic learning was key. Students also reported that the physical shift helped them to learn to think on more than one level at a time, heightened their level of attention and increased their involvement in the course.

Facilitators Related to Peers

Watching one's peers work was helpful to all the students for a variety of reasons. For some students, observation was a way to learn new skills or techniques, and for others provided a chance to compare one's own style of working to another's. On an emotional level, watching others work was both calming and anxiety-provoking depending upon the student's perspective of his/her own work and the perception of the peer he/she was observing. Watching less experienced peers work had a bolstering effect on some students' confidence level and sense of self-efficacy. It gave some students the sense that he/she was not alone in the struggle to become a good therapist, and it helped students focus on their own strengths and resources in contrast to the person they were watching.

The diversity within the group of students with regard to age, race/ethnicity, level of experience as therapists, and theoretical orientation was also identified as an important facilitator of reflectivity. Diverse backgrounds allowed for multiple viewpoints and perspectives to be shared and discussed and often spurred further reflection in students' journals.

Individual/personal Facilitating Factors

The attitudinal stances of the students were important factors in whether students were reflective. It was easy for students who were confident, self-efficacious, open to learning, and non-defensive about their work to be reflective. For students who were motivated by the challenges of the course rather than overwhelmed and defensive, being reflective seemed to come naturally. Students' perception of the importance of reflectivity also seemed to be an important factor in whether or not students were reflective. Those students who placed value on reflection and found it meaningful to their own growth and development, not surprisingly, engaged in the process on a more regular basis and were able to incorporate it into their learning.

Personal difficulties, at times, played a role in encouraging reflective practice. Life events such as the breakup of a significant relationship, a low grade on an exam, adjusting to a new city, becoming a parent, or struggling with parenting issues, tended to focus energy on an internal process of self-reflection. In addition, for some students, personal difficulties with anxiety, depression, and struggling with one's professional choice or not feeling competent stimulated a desire to be increasingly aware of one's own approach to clients with a deeper understanding and empathy for the difficulties presented.

Contextual Barriers

There were some constraints within the training context that hindered some students from being reflective. Some of these are consistent with the cognitive demands inherent in a Ph.D. program in general, which places significant demands on students in terms of time and workload. Students found the workload to be too great and left too little time to be reflective about one's own growth. For less experienced students, the facilitator's "hands-off style" was a factor that made it difficult for them to maintain a reflective stance with their peers. Their own perceived lack of skill and expertise with a particular model of therapy left them feeling defensive and they tended to be quieter in the group while more experienced students dominated the conversations. Consistent with the therapist development literature, these students with limited experience perhaps needed more structure and more support, and less challenge.

Barriers Related to Peers

There were a number of behaviors and/or personality characteristics of peers that disrupted students' willingness to engage in a reflective process and encouraged them instead to remain closed off from the group, even when pressed to participate. As students were perceived as arrogant, dominated the group, disregarded others, used inaccessible language, or lacked authenticity, some students discontinued their own participation in the process.

Specific comments made by one's peers were also identified as a barrier to being reflective, particularly for less experienced students. Specifically, comments that were inconsistent with one's worldview such as being sexist or homophobic, were largely ignored or blocked out by students, rather than being addressed and discussed. This was true even when the facilitator or more experienced student challenged the comment. Also, peer comments that were prescriptive or directive served as a barrier to many students since they elicited a closed stance rather than an open stance to feedback.

Individual/Personal Factors as Barriers

The personal and individual factors that impeded reflectivity were the most potent barriers to reflective practice. Low self-efficacy and a diminished confidence level were significant barriers to the less experienced students. Likewise, inflated levels of self-efficacy and/or confidence levels in students with moderate experience were equally problematic. Performance anxiety or fear due to the evaluative environment and concern regarding others' perception of one's work posed another significant barrier. The students who struggled with this, also had a difficult time not taking feedback personally, tended to be defensive and had difficulty modulating their own negative affect in the service of the client.

For some students, personal difficulties, and learning to be reflective about those difficulties, helped them be more empathic of their clients and knowledgeable about some aspects of personal struggle. However, for other students, personal difficulties served as a distraction from the challenging work of learning to be a good therapist. Energy was invested in protecting oneself and meeting one's own needs to feel helpful, competent, or even important, rather than using one's own life experience in the service of helping the client.

Conclusion

Within the context of training and supervision, structural and individual factors have been identified which have the potential to positively affect therapists to be reflective. The contextual factors included aspects within the learning environment that were imposed by the supervisor, the structure of the course, and/or the reflecting team format. Examples of these included creating time and space to reflect both in and out of class, the physical shift used with reflecting teams that that encouraged a perceptual shift, and the supervisor's style which helped to create a nonjudgmental and comfortable learning environment. The peer factors included aspects within the learning environment such as watching other students' work, the opportunity to discuss multiple viewpoints, and connecting with others in the learning environment. The personal or individual factors related to the internal experience of the student, such as one's confidence level, one's level of openness vs. defensiveness to feedback, and personal difficulties experienced by the student. Continued work in this area can help practitioners and educators diminish the barriers to reflective practice and set the stage for life long growth and development for therapists in training.

References

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Kathleen B. Corcoran, Mosaics Integrated Health, OH Sharon D. Kruse, University of Akron, OH John J. Zarski, University of Akron, OH

Corcoran. Ph.D., is a recent graduate of the Collaborative Program in Counseling Psychology at the University of Akron. She is a psychology fellow in private practice at Mosaics Integrated Health. Kruse, Ph.D., is an Associate Professor and Department Chair of Educational Foundations and Leadership. Zarski, Ph.D., ABPP, is a Professor in the Marriage/Family Therapy Training Program.