Using e-mail for clinical supervision in practicum: a qualitative analysis. (Qualitative Analysis of E-mail Supervision).

Recent advances in computer technology have been a major resource for graduate-level rehabilitation counselor training programs (Gilbride & Stensrud, 1999; Gilbride, Breithaupe, & Hoehle, 1996; Kauppi, 1999). The availability of electronic communication creates some unique opportunities for rehabilitation faculty supervisors who are engaged in practicum and internship supervision. However, clinical supervision during practica and internship may also represent one of the greatest challenges in the distance education curriculum for rehabilitation educators (Smart, 1999).

Studies in electronic communication, or e-supervision, using a distance education approach have reported both advantages and disadvantages. Some trainees report that communications using asynchronous or non-face-to-face interactions appear to stimulate more complex levels of thinking that are more reflective and insightful and effectuate richer meaning than traditional face-to-face approaches (Bailey & Cotlar, 1994; Everett & Ahem, 1994; Gilbride, Breithaupt, and Hoehle, 1996). Stebnicki & Glover (2001) reported benefits of E-mail supervision as including: (a) ongoing access to clinical supervisors, (b) more relaxed communication styles, (c) increased time dedicated to processing and clarifying thoughts, (d) greater immediacy of responses, and (e) greater monitoring capacity. In a study using E-mail as a clinical supervisory approach, Janoff and Schoenholz (1999) reported that supervisees found it helpful to be able to process specific clinical issues and respond online after face-to-face supervision meetings. Kiesler and Sproull (1992) conducted group supervision using electronic communication and found that supervisees were able to provide more uninhibited messages with less concern for social norms than in face-to-face supervision.

Challenges noted by other researchers found that clinical supervisors using electronic supervisory approaches require: (a) more standardized procedures and structure during supervision, (b) increased time for planning supervisory sessions, (c) frequent and ongoing training for operating the newer technology, and (d) better communication between the practica and internship site supervisors (Janoff & Schoenboltz-Read, 1999; Kauppi, 1999; Kiesler & Sproull, 1992; Smart, 1999).

The recent focus upon distance education for supervision purposes has been met with skepticism regarding the adequacy of non face-to-face supervision. In a recent article, Goodyear and Bernard (1998) commented: "... counselor educators are now engaging in Internet supervision (a new millennium indeed!) before we even have any evidence that particular models are more salient than others in person-to-person format" (p. 18). While this controversy is likely not easily resolved, examination of the process and outcome of electronic communication in supervision seems timely and relevant.

In an extensive review of the literature spanning several decades, Stebnicki (1998) found no evidence to suggest that one clinical supervision :model or theory is superior to another, noting that there are an insufficient number of empirical studies to substantiate the advantage of using one model over another (Bernard & Goodyear, 1998; Borders & Leddick, 1987; Herbert, Ward, & Hemlick, 1995, Maki & Delworth, 1995). What is apparent in the literature however, is that clinical supervision is a dynamic process that requires the use of a diversity of supervisory styles and approaches that primarily: assesses supervisee learning needs; changes, shapes, or supports supervisee behaviors; and evaluates supervisees performance (Bernard & Goodyear, 1998).

Clinical supervision has been described as including attention to supervisee's growth and development in both the personal and professional arenas (Emerner, 1978; Stebnicki, 1998) but little research has been dedicated to investigating the personal growth that transpires during the practicum and internship experiences; "What is available is devoted to discussions regarding the behavior, the knowledge, or the skills that characterize effective clinical supervision" (Herbert & Richardson, 1995; p. xx). While studies of practice and process of supervision have provided insight into most commonly used and most helpful supervisor behaviors, little attention has been paid to the content of the supervised interactions. Lynch (1995) stated that "for rehabilitation researchers, the call is to try to more effectively understand what happens in supervision.... It is no longer sufficient to assume that growth as a counselor will `just happen' through supervision without a model of what supervision is and can be" (p. 10). Deiboldt (1999) concluded that hypotheses related to counselor growth (both personal and clinical) during supervision have not been substantiated through direct accounts from supervisees. While electronic communication studies have yielded some knowledge regarding advantages and disadvantages of the media, the content of those communications has remained unexamined.

The purpose of this study is to examine the content of E-mail communication in supervision in order to begin to develop an understanding of what occurs for students who are supervised using this media. Qualitative data is presented using supervisee E-mail communications that resulted due to the E-mail supervision process. The E-mail communications are analyzed for specific emerging themes and direction regarding the supervisory process. This study uses the actual written words of the participants as data in order to gain an understanding of the process and content of E-mail supervision.

Method

The analysis of these E-mails was conducted using the constant comparative method, which involves "the constant comparison of identified topics and concepts to determine their distinctive characteristics so they can be placed in appropriate categories" (Gay & Airasian, 2000, p. 243). Specifically, this study relied upon actual E-mails as the source of data and employed the constant comparative (Glaser & Strauss, 1967) qualitative method of analysis of the data from several sources (students) and was examined for emerging patterns and themes. As themes emerged, data was sorted or re-sorted into themes. Each piece of data was then examined for suitability of fit to the theme. Themes were then compared for similarities in meanings, exclusivity, and overlap. This process seeks to identify connections between categories in order to further identify, refine, and merge categories (Bogdan & Biklen, 1992) and allow for future replicability, define internally consistent categories, and assist with understanding (Lincoln & Guba, 1985).

Because this was an exploratory study, the analysis was not approached with specific hypotheses in mind; the researcher had general questions regarding the nature of supervision via E-mail based upon participants' written representations of their practicum experiences (Glaser & Strauss, 1967). The researchers were interested in the focus and direction of the practicum when E-mail was used as the supervisory communication tool. Qualitative research was best suited to this analysis because it provides an inductive analysis method and incorporates the participant's viewpoints. "To really understand a human experience, it must be appreciated from the subjective point of view of the person undergoing it" (Karp, 1996, p. 11).

Informants

Three of five practicum students enrolled in a master's program were chosen for the study for following reasons: (a) each was a master's student in a Rehabilitation Counseling (RC) Program accredited by the Commission on Rehabilitation Counseling (CORE), (b) all shared the same individual supervisor, (c) all attended group meetings. The two students not included in the study were enrolled in a dual program (school counseling and rehabilitation counseling) and had different or additional supervisory requirements. All three participants were involved in face-to-face group supervision with the faculty member on-campus as well as face-to-face individual supervision with a doctoral-level clinical supervisor-in-training. The doctoral supervisor used a consistent supervisory approach for all three of the participants which consisted of weekly individual one hour sessions.

These students are not intended as a representative sample of all rehabilitation practicum students. They were chosen by virtue of their enrollment in the course in order to gain a deeper understanding of their viewpoints through a detailed analysis of their writings. While some of their experiences were specific to placements and individual perspectives, it was believed the analysis might also provide some insight into commonalities which might exist in their development. The following descriptions provide the reader with general background information. All names have been changed to assure confidentiality of informants.

Sarah. Sarah was a 46 year old Caucasian female who was in her second year of the RC Program. Sarah's practicum was conducted at a day-treatment facility that served persons with severe developmental disabilities. Additionally, Sarah had direct-care experience with a relative with a similar condition. She had extensive volunteer experience that primarily involved working with persons with developmental disabilities.

Doug. Doug was a 26 year old Caucasian male who was in his second year of the RC Program. Doug's practicum was conducted at a day-treatment facility which serves persons with traumatic brain injury. Doug maintained full-time employment as a vocational counselor while completing his practicum and had previous experience working in hospital settings.

Allison. Allison was a 23-year-old Caucasian female who was in her second year of the RC Program. Her practicum was conducted at a private-for-profit company that dealt primarily with Workers' Compensation. During this internship, the student did not have face-to-face contact with consumers and had very limited telephone interactions with consumers. She had previous experience working with children who had developmental disabilities.

Supervision Approach

The supervision style was consistent with literature related to effective supervisory approaches which call for varying degrees of anxiety' management, sensitivity to level of counselor's confidence, clarity, flexibility, consistency, challenge and a supportive relationship dependent upon the counselor's level of development (Maki & Delworth, 1995; Stoltenberg & Delworth, 1987).

In a line by line assessment of nine randomly selected supervisor E-mail responses (three for each student), two researchers independently found that all of the responses could be classified into the following categories: (a) praise/reassurance which addressed anxiety management, counselor confidence levels, and supportive relationship (e.g., Of course you know you are doing well with (client) and I am glad you are getting the credit and positive feelings you deserve), (b) challenge/confrontations responses which addressed stimulation and challenge to increase or develop skills (e.g., You seemed to think (supervisor) did a good job with the client, but you really didn't do much of a critique of what you heard), (c) advise/direction addressed issues of clarifying ambivalence and provided structure (e.g., Please be careful when making statements about "occasionally stopping by." If you are not sure how you did, ask him), (d) social comments which further indicated supportive relationship (e.g., Sorry I missed the opening, take care), (e) clarifying questions in order to clarify ambivalence about the student's actions or thinking (e.g., Did you make an attempt to diffuse the situation yourself?), and (f) class business these responses were related to the business of the class, such as when papers or reports were due (e.g., Thank you for working with (another student) in class....). Both raters agreed that approximately 75% of the supervisory responses were in the categories of: praise/reassurance, challenge/confrontation, or advice/direction. The remaining 25% of responses were clarifying questions, social comments, or class business responses.

Data Collection

The data was collected over the course of one 16 week semester. Students were required to E-mail the instructor regarding daily activities during their practicum as well as personal reactions, problems, personal growth issues, or other thoughts. They were instructed to E-mail at least one time per week, but preferably after each site contact. E-mails were responded to by the faculty supervisor and additionally forwarded to the individual supervisor who was a doctoral student in the program. Students met as a group six times over the course of the semester. These meetings were directed by the faculty supervisor and were generally didactic instruction (e.g. ethics, note-taking) and supportive (student interactions) in nature. Students also met individually with a doctoral student supervisor for one hour per week and with their site supervisors (these contacts varied). Students did not personally meet with the faculty supervisor other than for group meetings.

Data Analysis

A total of 98 student E-mails were received from the three students over the course of the semester. Following the conclusion of the semester, student E-mails were repeatedly read by the first author in order to identify possible topics or themes. Two categories of data types emerged and one of these categories was of interest to this study. This category was then examined for themes or topics. The emerging themes were continually compared with other informants, data and then coded and reviewed for consistency among informants. Using a constant comparative method, themes were further merged, clarified, and refined. Finally, in order to address the potential threat to internal validity, the second author examined the data for discrepant themes. "The search for negative and discrepant data provides an important counterbalance to the researcher's tendency to stick with first impressions or hunches" (Gay & Airasian, 2000, p. 243.) This analysis led to further clarification and re-naming of one of the themes.

E-mail data was originally coded by using separate color printouts of E-mails to identify the student (this has been replaced by the student's first initial), an assigned number was given to each piece of data that reflects the order in which it was received, a date was coded based upon when the data piece was sent, and the week of practicum was additionally noted (e.g. the code D-2-2/6.3 would indicate an E-mail from Doug, assigned #2, sent February 6th, the third week of practicum).

Results

E-mail Writings of Student Interns 

Overall it became apparent that students generally used E-mails to report on what they were doing in practicum or what they were thinking about the practicum experiences. The data was therefore initially separated into those two categories, (a) context data that was reporting daily activities (e.g. meetings, consumer interactions) and (b) conceptual data that in some way commented on or appeared to process or make sense of those daily activities. The context data was not analyzed because it was highly specific to the setting. One hundred forty-six pieces of conceptual data was identified from the 93 student E-mails. Pieces of data ranged from a few sentences to several paragraphs and were considered separate pieces if they addressed seemingly different subjects (e.g. feelings of insecurity with own performance and feelings about supervisor performance). Generally one or two pieces from each E-mail was considered conceptual in nature, but some had no conceptual components.

Although the interns differed in the type of facility and population they served, three consistent categories emerged from the qualitative analysis of the E-mail data. Students E-mails focused upon the categories off consumers, facility supervisors, and themselves. The data was therefore categorized by: (a) student writings about consumers, (b) students writings about facility supervisors, and (c) students writings about themselves.

Category I: How Students Write About Consumers

Forty-nine pieces (33.6%) of the conceptual E-mail data related to student thoughts about the consumers. This data was further scrutinized and tentatively categorized into emerging themes. The final analysis consisted of four themes: acquiring knowledge about the consumers' disabilities; seeking approval; understanding the consumer as a person; and connecting to consumers.

Acquiring knowledge about the consumers' disabilities. An initial theme that developed for all of the students was the students' efforts at getting to know about the consumers' disabilities. Dave provides an example of this as he begins to gain understanding of a consumer medical issue, the problems related to the medical device, and coping difficulty.

The first week at (facility) was truly an eye-opening experience. Most of the time was spent getting acquainted with the consumers-those who have suffered (sic) a TBI.... some people have an instrument that is surgically implanted in their brain that drains fluid so that pressure does not build up. Several clients discussed some of the problems they have had with (this) device. I couldn't imagine having to cope with something like this! (D-1-1/29.6)

Likewise, Sarah began her practicum seeking to understand the implications of the disability.

Was physical care all he could ever hope to receive out of life? Was there any way to ascertain if he found particular experiences enjoyable? (S-3-2/3.2)

Seeking approval. Another consistent theme which emerged from the data was that of student approval seeking. This appeared both on a personal level and on a professional level. Students conveyed a need to be liked by the consumer.

Mike seems to have taken a liking to me as he is constantly asking me questions about school and music. (D-2-2/6.3)

After a few more minutes he looks at me again, and decides instead to sit on the floor next to my chair. I find this both amusing and encouraging. He has shown no anger toward me, did not try to move me, and in fact decides to sit next to me, he could have picked many other open floor spaces. (S-4-2/7.3)

On the one hand I know that expecting Tom to suddenly be all excited that I come to relieve him of his routine is highly unlikely, but that he doesn't yet seem to take any interest in my arrival is disappointing. (S-12-2/7.3)

Another member watched this whole scene develop and told me that I did a "nice job." Although I've been complimented many times before on the job, this one felt particularly good! (D-10-2/19.5)

Understanding the consumer as a person. Another theme that emerged was that students made an effort to connect with consumers through finding similarities to themselves. This occurred largely by confronting their own stereotypes and trying to understand consumer difficulties and relate those to the general population or to themselves.

A personal confrontation with stereotyping occurred when one student connected persons with mobility impairment and emotion and came to see the consumer as like "everyone else."

Well, I guess the "honeymoon" is over. What I mean by that is I observed people struggling with "real life" issues that are relevant to their disability ... (D-7-2/9.3). One thing that I learned about myself was that it is a mistake to assume that just because a person is in a wheelchair or has a physical disability doesn't mean they can't fight or become really angry!!! I don't know why, but for some reason the expressing of these feelings surprised me. People with TBI or any other type of physical disability aren't limited to expressing just "appropriate" emotions. They are complex people just like anyone else who experiences the joys and sorrows of life. (D-8-2/9.3)

Connecting to consumers. As students continue to make efforts at understanding consumers as people, they also begin to make personal connections with consumers and express a sense of privilege in working with the consumers.

What I find fascinating about them are the many things that are going on at once. There are so many personalities, power struggles, nonverbal clues, levels of involvement, etc. I feel privileged to be able to learn in an environment where everything just sort of hangs out and nobody holds anything back. (D-21-3/8.7)

Sarah connects with the non-verbal consumer by making associations with normal developmental stages in persons and imagining the consumer's likes and dislikes. She assigns feelings to her consumer and demonstrates her own affections in buying the consumer a gift.

Tom smiled and looked around with obvious excitement. I wondered what he was excited at. I imagined it was all the colors. I took him ... where all the frilly and satiny stuff is.... He mumbled while we were in the shop--I couldn't understand it, but they sounded happy.... In the end I bought a bunch of flowers for me and a carnation for Tom. (S-29-3/26.10)

When I sense any frustration in myself that Tom doesn't suddenly say "Here I am world." I try to remember that he has to discover the world in the same steps he would have as an infant, but know it is as a forty year old man ... I try to take the same joy watching Tom see his world.... (S-53-3/29.10)

Doug connects with consumers by sharing outside interests and with similar coping styles.

My goal of the first session was to make it as inclusive as possible. I began sharing my own involvement with music and then asking people to talk about what music means to them ... the members appeared pretty enthusiastic about this assignment.... Last but not least, my relationship with the members is solid. The rapport I've developed with almost all of them is something special. (D-24-3/16.8)

(Consumer) would not discuss it any further, even when people asked him more.... Instead, he resorted to making a joke as he often does when the subject matter becomes intense. This is a safe place for him to go though. I know many people, including myself that use humor to deflect attention away from painful Issues. (D-42-4/25.14)

Express compassion, commitment, and a sense of privilege. As students begin to feel more connected, they express increased feelings of affection and dedication toward consumers.

The pleasant conversation with Joe's parent's really touched me. Suddenly I became overwhelmed with compassion for him. (D-26-3/23.9)

For Sarah, compassion is expressed in more physical ways.

In the end I bought a bunch of flowers for me and a carnation for Tom. Tom smelled the flower after I demonstrated it. Smiled. And then took the flower ... As we left the shop he threw the flower back inside. I turned around and picked it up and said "Tom, this is your flower" (S-30-3/26.10)

Just as I was leaving ... Tom arrives. I give him a big hug and tell him how much I miss him. He is sat down and tubed up (for feeding), and I sit with him awhile before I leave. (S-45-4/30.15)

Category II: How Students Write About Site Supervisors

The second category that students wrote about was related to supervision and their site supervisors. For the most part they did not write about their individual supervisor or faculty supervisor, possibly due to the feelings that this would be inappropriate. Several themes emerged from the 49 pieces (33.6%) of E-mail data in this category that were consistent among all three of the students: Initial highly-positive view of the supervisor, need for approval and acceptance, becoming very critical, and accepting the supervisor as fallible.

Highly-positive view of supervisor, express deep gratitude, unquestioned authority. Allison began the practicum expressing gratitude and admiration for her supervisor.

I was really happy to receive it from him (supervisor) for several reasons: I am very interested ... I felt that he was really interested in me as a student and as a person, I know that he had been listening to me.... He is REALLY good at it, and for the first time I realized how much time is used trying to get to the bottom of things. (A-115-2/7.3)

I am really grateful for the extra time (supervisor) takes in getting me information that I am interested in.... He's been really helpful and I really appreciate it. (A-72-2/22.5)

(Supervisor) had me telling him exactly what I was upset about, and why. It was amazing. He should teach a mini course in asking clarifying questions. (A-115-2/7.3)

I'm looking forward to next week and the challenges that it will bring. I don't yet have any complaints or problems. If the time should come when I do, I feel secure about going to (supervisors) and discussing it with them. (D-2-2/6.3)

Need for approval and acceptance. Initially students seemed concerned over approval and acceptance. They expressed a need to relate well to staff, feel connected and understand staff. As would be expected, students expressed insecurity and believed others perceived them as not very competent. Sarah expressed a need for approval as did Allison and Doug.

I was aware that the people who worked at the home were there, and I suppose I found that a bit intimidating at first. I wondered whether they approved on my allowing Tom to sit apart from me. (S-67-2/8.3)]

It felt good to hear (supervisor) tell me he thought everything looked good.... Even though I don't get a grade from (supervisor). It is important to me that what I do for him gets done right. A-66-2/8.3

The other alternative may be that I'm just reading into this and trying too hard to be accepted. I guess the main thing is just to go into the practicum with the right attitude--that of being humble to learn from staff and members and give what I can. (D-71-2/19.9)

Shift to becoming critical, less need for approval. As the practicums progressed, all of the students began to express less need for approval and became critical of supervisors.

I don't think they have a vision of these people being included and fear what will happen to them;.... I don't see any of these folks as risk-takers. What if--and the worst happens. They hear me when I say what if and it works--but they just can't process it. (S-80-3/5.7)

The theme that I have noticed here is a lack of communication and involvement. As a program director (she) should know who is doing what and provide me with more guidance and feedback. I don't expect her to hold my hand and tell me how to do every little thing, but some support and encouragement would be nice. The thing is, the members and other staff notice this also-her lack of visibility about the center.... (D-84-3/11.8)

I understand that they are overworked and sometimes can't do a thorough job but there are some serious issues about the quality of the research that some of the handlers do.... It bothers me because I have trouble cleaning up other people's mess), work. And that is what (supervisor) seems to spend a lot of time doing. (A-85-3/18.9)

Continued critical, but with resolve, supervisor/staff seen as fallible. There has been some strain with my supervisor, but I'm realizing that her supervision style with me as well as with other staff is to "micromanage" (Program coordinator) has told me several times that it is "just a power and control thing.".... I find that not dwelling or overanalyzing these things is the way to go. (D-89-3/23.9)

The one really important issue I've dealt with and learned with (supervisor) is becoming aware of my own values and beliefs, and then developing them to include a professional philosophy. (A-136a-4/7.11)

Category III: How Students Write About Themselves

The final category of data related to E-mails which expressed thoughts about the student's own views and thoughts about themselves in the practicum. Forty-eight pieces (32.9%) of E-mail data resulted in the following themes: a sense of positive anticipation, a lack of confidence, boredom due to a perceived lack of responsibility, increased responsibility and confidence, frustration due to lack of ability to make sufficient changes and contributions, larger view with more realistic goals.

Sense of positive anticipation. All of the students expressed initial positive anticipation regarding the practicum. Doug added his desire to learn about client coping as well.

I think that this will be a good experience for me and help me learn about specific concerns that some of the clients have as well as how they cope with life. I'm looking forward to next week and the challenges that it will bring. (D-61-2/6.3)

Lack of confidence in ability. Even with the positive anticipation, students all experienced a lack of confidence in their abilities to perform well and handle difficult situations with confidence.

So apparently I did an okay job on that even though I wasn't sure exactly what was needed.... It was informative and I learned a lot, but I still feel totally inept when I have no idea.... (A-117-2/7.3)

Although leading this group was a challenge, I feel in the future it will be much easier as I get to know the members. (D-122-2/29.6)

I wasn't really sure what I was going to do next. How long do you let a naked man stand in a room with people walking by, in and out? How do you reconcile what might make most sense to have (client) benefit from this experience and what is an acceptable.... (S-51-2/7.3)

Boredom due to lack of sufficient responsibility. Each of the students found that boredom became a problem until they were given additional responsibilities. They complained about routine, low stimulus activities, and the long work-day. As responsibilities increased, students began to express increased satisfaction and self-confidence.

Tom seems rather driven to walk, but after awhile I am quite bored with it and we return to Tom's room. (S-119-2/20.5)

I spent a LOT of time going over case files and reading the latest reports that the vendor has sent. I was bored for the afternoon, when I was tired of going over them and wanted something new to do, but I attribute most of that to becoming acclimatized to being in one place for a whole day. (A-120-2/22.5)

Increased confidence with increased responsibility

There were times I need to step in and restore order or prevent the group from ganging up on one member, but other than this things went well. Some of the members had some very interesting points- like that we can never escape labels no matter what we do. Throughout the group Lori remained quiet and reminded the members that I was facilitating whenever they asked her something. As a result people recognized me as a facilitator. (D-130-3/16.8)

Sense of frustration over inability to make sufficient change/contribution. Unfortunately, increased responsibilities seemed to lead to frustration in students. This appeared to be due to a lack of ability to make organizational changes that were perceived as necessary or desirable.

I don't think I can do much to change the way things work at (facility).... It has confirmed in me that systems change is a slow and laborious process. It has confirmed for me that just caring sincerely for people does not necessarily mean you are willing to do the best for them. (S-127-3/5.7)

In the beginning, reviewing files was interesting because I was learning medical and legal terminology, and learning how to read them. Now, it seems like every case is a back injury, carpal tunnel, or shoulder problem. It is really scary how these folders are supposed to be people. I just flip through them now and tell Dave what I would do--without ever talking to the injured worker. It's horrible, and I hate to think that I'll ever be in a situation like that, with people flipping through some papers that represent me, and making decisions about my life based on someone else's information gathering. Dave really does talk to the worker, but not until he's formed notions about them by looking at the file.... Yuck. I'm ready to move on. (A-143-4/28.14)

Reflective, more realistic goals expressed. Toward the end of the practicum, students began to express an awareness of what had transpired. They were reflective about what had transpired in themselves during practicum. They appeared less frustrated and reported more realistic goals.

The one very important issue I've dealt with and learned with (supervisor) is becoming aware of my own values and beliefs, and then developing them to include a professional philosophy. (A-136a-4/7.12)

I suppose that when you work with this particular population if you are expecting bells and whistles, fire works, and most of all thanks when something gets accomplished - you are working with the wrong population. The accomplishments are very subtle and slow to come by. I think it is important not simply to visit these community places, but to facilitate some normal interaction by modeling. (S-136b-4/19.13)

I've been thinking about where I want to be for my first internship.... Basically, a place where the rehab counselor's goal is to do a little of at least a few different things. I would like that. That's one of the reasons I was really interested in rehab counseling in the first place. (A-136-4/7.12)

I almost forgot to write my last journal. Everything seems to be coming to a close so quickly. Tomorrow is my last day at the (facility). I've enjoyed my time there and feel that I've grown as a result of the experience. (D-60-5/4.16)

Discussion

During the course of the practicum, several themes emerged that were not only consistent thematically among students, but appeared progressive or developmental in nature because they occurred in generally the same time-frame for students. Initially students; entered the practicums with positive regard for their consumers and sought to understand their disabilities, then made attempts to personally connect with consumers, and finally expressed a deep sense of commitment and compassion. Overall thinking about consumers went from positive to more-positive. This was not the case in student thinking about on-site supervisors or about themselves. While all of the informants entered with a positive attitude toward their supervisors, all experienced some disenchantment and became highly critical of the supervisors' knowledge and performance. Only toward the very end of the practicum was a more balanced view of supervisors beginning to emerge. The students' views of themselves began with positive anticipation but feelings of lacking confidence in their abilities. All of the students expressed boredom shortly after the beginning of practicum which subsided when responsibilities were increased. However, increased responsibility also seemed to make way for frustration at their perceived inability to effect sufficient change. Only toward the end of the practicum did students appear to come to some sense of resolve about themselves in the roles of rehabilitation counselors. Thus, for these students, the experience was a mix of very positive to very negative emotions that occurred within relatively the same time frames. Much of the time in practicum was spent dealing with negative or uneasy personal reactions to supervisors and toward themselves. Table 1 illustrates the developmental processing that occurred for these students within each of the categories by time frame. This is not offered as a model, but rather as a way of simultaneously viewing the data.

This simultaneous view is of particular interest because it affords a wholeness of vision of the developmental process. While it makes sense, for example, that supervisees lack personal confidence at a time when they are seeking approval from consumers and supervisors, other time periods seem less synchronized for students, even disharmonious. For example, when students are feeling most connected to consumers, they are simultaneously feeling critical of supervisors and frustrated with themselves. Focus on any one piece of the equation without awareness of the others could create an imbalanced supervision that neglects essential developmental components.

Several limitations to this study must be noted. A limitation of this methodology is in the inability to generalize the findings. Additionally, the results of the study may be influenced by the supervision approach that was employed with these students. It is not known how, or if, faculty supervisor E-mail responses might influence students' developmental progression during practicum. While beyond the scope of this study, future exploration is needed in order to examine how varying supervisor styles may influence the focus of practicum and student development during practicum. Additionally, on-site supervisor relationships are essential to student development and thus have a potentially significant influence upon students' communications; these influences were likewise beyond the intended realm of this exploration.

Although not really a limitation of this study, student language did become a concern. There were times when E-mail communications were surprisingly less than desirable or appropriate for a developing rehabilitation professional. Dave experienced practicum intensely and personally, using language that sometimes expressed sympathy (e.g., "suffering a TBI", "overwhelmed with compassion"). Future interactions with persons with disabilities may temper his emotional reactions, however such reactions should be expected and anticipated by supervisors, particularly for inexperienced practicum students. While language awareness is essential and indeed reflects thinking, there may be a lag between knowing, internalization, and outward expression of the most desirable thinking, terminology, and phraseology. The open-forum of E-mail provides for interactions that can be honest, uncensored expressions of thought, thus giving insight into the progression of students. Individual supervision approaches will invariably emerge and supervisors may choose to react to this type of statement in a variety of ways. Different supervisors might choose: (a) to directly confront or correct inappropriate language, (b) use directive but reassuring responses, or even (c) choose to allow the language to persist for a time while monitoring the developmental process. Certainly these choices would ideally be based upon knowledge of student needs and specific circumstances as well as supervision approach.

Conclusions and Recommendations

Stoltenberg (1981) developed a model that suggests that counseling trainees go through a four-stage process of development which begins with dependency and progresses toward an insightful, autonomous expert who is aware of personal limitations. Maki and Delworth (1995) concluded that personal development during clinical supervision progresses from a self-focus with concerns about correct performance to a self-awareness and other-awareness. Our study supports developmental progression among students in practicum and further gives insight and specificity about the process when using E-mail supervision. While these are very preliminary findings, future explorations might allow supervisors to more carefully prepare students for potential thoughts, feelings, emotions towards consumers, supervisors, and themselves. While everyone does not necessarily go through the same developmental process, this could be a useful method of gauging practicum student growth. Perhaps with such knowledge, feelings of frustration and disenchantment might be anticipated, viewed by students as typical of the process, and more easily explored and resolved.

In order to assess student reactions to the process of E-mail supervision, students were asked to reflect upon the experience of supervision by E-mail in their final course evaluations (this communication not seen until after assignment of grades). Based upon these written evaluations and final E-mail reflections, it was clear that supervisees benefitted from additional supervision. Supervisees reported that the E-mail communication inbetween individual and group sessions provided them with much more support and resources than they could have had with only face-to-face individual supervision. In a final communication from Allison, she specified her reactions to the process.

   I found the E-mail communication very helpful and effective. (It was) a
   good way to review what I was feeling ... mainly my frustration. I didn't
   even realize that I was frustrated until I read what I wrote. The
   efficiency of the replies was good too ... but it was the actual writing of
   the episodes that was beneficial for me. It gave me time to think about
   what I was learning, what I wasn't learning, how I felt about everything. I
   was also able to say a lot of things (mainly about how I was feeling) that
   I don't think I would have said during an oral supervision. Also, writing
   it first helped to "say it" later. It seems that it also gave supervisors a
   chance to look over and think about what we had to say in writing before we
   talked about it orally. I think this is a practice that should be
   continued.....

The idea that continuous self-reflection is essential to counselor personal and professional growth has long been a support notion in the literature (Neufeldt, 1999; Schon, 1983). It seemed clear that students were able to reflect through E-mail communications upon many significant issues. Unlike journaling or even electronic journaling, this use of the medium allows for a two-way system of communication as well as individualized, reflective thought-processing. It offers a way to know students' thought processing and development at a level not before practically feasible. Additionally, it offers continual student monitoring and support. It is therefore our belief that E-mail supervision can serve to enhance counselor training and should be used not only as a way to gather further data regarding counselor growth and development but seriously considered as a matter of course. E-mails can serve as developmental records for students and can provide written references to supervisee and supervisor that may be referenced in order to assist with training and education. While it is probably too soon to suggest that E-mail supervision can replace face-to-face supervision entirely (because of the loss of visual cues such as facial expression and body language and the loss of audio cues such as tone of voice), with the addition of video monitoring equipment, quality distance supervision is well within reach.

Table 1 Themes by Category and Week in Practicum

        CONSUMERS               SUPERVISORS               THEMSELVES

Week    Focus upon knowing      Highly positive           Positive
1-3     about the consumers'    about supervisor          Anticipation
        disability
                                Expressed deep
                                gratitude
                                Unquestioned authority

Week    Seeking performance     Seeking performance       Expressed
3-5     approval                approval                  lack of
                                                          confidence
        Seeking acceptance
        from consumers

Week    Efforts to understand   Seeking acceptance from   Expressions
5-7     the consumer as         the supervisor            of boredom
        a person.

Week    Feeling personally      Highly critical of the    Increased
7-9     connected to the        supervisor                responsibi-
        consumer                                          lity and
                                Less need for
                                supervisor approval       Frustration
                                                          regarding
                                                          inability to
                                                          make changes

Week    Expressed compassion    Remaining critical but
9-11    and commitment to       with some resolve
        the consumer
                                Supervisor is seen as
                                understandably fallible

Week                                                      Realistic
11-16                                                     goals
                                                          expressed

                                                          Reflective,
                                                          larger view
                                                          expressed.

Acknowledgment 

The authors wish to thank Dr. Steven T. Bossert, Dr. Dennis Gilbride, and Dr. Janine Bernard for their contributions to earlier drafts of this manuscript. Additionally, one reviewer's comments contributed in a substantial way to the final version of this manuscript.

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Noreen M. Glover-Graf, Rh.D., Syracuse University, Department of Counseling and Human Services, 260 Huntington Hall, Syracuse New York 13244.