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A study of clinical supervision techniques and training in substance abuse treatment.

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In the absence of formal academic graduate preparation as a required foundation for substance abuse counselors, the role of clinical supervision becomes crucial for the development of the para-professional counselor and the protection of the public. Supervision is a serious practice with many responsibilities. The most important responsibility is protecting the well-being of the client, the counselor, and the profession. Bernard and Goodyear (2004) emphasized the importance of supervision not only to assist the counselor in developing the skills necessary to work effectively with clients, but also for the supervisor to serve as a gatekeeper to protect the public.

During the 1970s, formal substance abuse treatment emerged, following the passage of the Comprehensive Alcohol Abuse and Alcohol Prevention, Treatment Rehabilitation Act, which provided federal funds to communities to build mental health and substance abuse treatment centers and to train individuals to provide clinical services (Banken & McGovern, 1992). This occurred before the establishment of licensure for professional counselors and when other established helping disciplines did not want to become involved in the delivery of addiction treatment services (Primm, 1992). As a result, state legislatures established regulations that permitted individuals to provide clinical services without meeting a prerequisite requirement, which included formal graduate preparation in any of the helping professions (Mustaine, West, & Wyrick, 2003). West, Mustaine, and Wyrick (1999) explored the staffing requirements contained in state policies for substance abuse treatment programs across the United States. The West et al. study showed that staffing requirements for substance abuse counselors, supervisors, and individuals responsible for client assessment still did not require formal academic training at the graduate level; some states, however, did require associate--or bachelor-level degrees for some positions. Mustaine et al. (2003) also compared preparation standards (as presented in state regulations) for substance abuse counselors and supervisors to curricular requirements, found in the accreditation standards of the Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2001). Mustaine et al.'s study found significant discrepancies between the state regulations and CACREP standards and raised concerns regarding the quality of clinical services offered to substance abuse clients who received counseling services from para-professionals.

After the emergence of professional licensure, state legislatures established graduate education as one of the principle requirements for counseling professionals who were seeking licensure (American Counseling Association, Office of Professional Affairs, 2010). The fundamental rationale for this requirement was public protection. However, an examination of state regulations governing the staffing of substance abuse treatment facilities continues to reflect a difference in the preparation standards for substance abuse counselors and the standards established by many of these same legislatures for licensure of professional counselors.

Because states do not necessarily require formal graduate academic training for substance abuse counselors, it is reasonable to assume that the responsibility for counselor development becomes, in part, the responsibility of the clinical supervisor. In this article, we (a) discuss the role of clinical supervision in counseling generally and substance abuse counseling specifically, (b) provide a context for assessing supervision knowledge, and (c) discuss the results of a study that examined supervisor knowledge of substance abuse treatment providers.

Clinical Supervision

One of the integral aspects of professional development of counselors is clinical supervision (Baird, 2011; Getz, 2001). Professional licensing standards for counselors continue to include supervised clinical experiences as a fundamental requirement for credentialing. All states offering a license to professional counselors include not only the requirement for an extended period of supervised clinical experience but also the requirement that individuals providing the supervision are licensed professionals (American Counseling Association, Office of Professional Affairs, 2010). Although it is necessary for all supervisors to be able to provide documentation of their clinical training in the field prior to licensure, uniformity of supervision preparation and training does not exist from state to state.

The need for specialized training for clinical supervisors has become apparent (Granello, Kindsvatter, Granello, Underfer-Babalis, & Moorhead, 2008). Baker, Exum, and Tyler (2002) suggested that longevity as a counselor can no longer serve as a single indicator of adequate supervisor preparation. Baird (2011) indicated that "the supervisory role is at least as complex as the role of the therapist" (p. 77) and that the supervisory position presents a "unique set of demands and vulnerabilities" (p. 77). Clinical supervisors need to focus both on the skill development of supervisees and the knowledge and training necessary to enhance supervisor development (Granello et al., 2008).

Bernard and Goodyear (2004) identified the professional dichotomy that exists between highly proficient professionals (supervisors) and less knowledgeable, lesser skilled supervisees. Specific supervision theories and models emerged in the mid-1970s and continue to evolve today. Bernard (1979, 1981) described the need for supervisor training to increase awareness of supervision options and introduced a 16-hour training module consisting of three segments: baseline data gathering, exposure to models of supervision, and evaluation plus ethical dilemmas. Other supervision models, such as Interpersonal Process Recall (Kagan, 1980), microtraining (Forsyth & Ivey, 1980), and a three-stage model presented by Hess (1986), identified the uniqueness of supervisor-supervisee relationships and emphasized the need for theoretically based models of supervision that, when followed, would result in highly qualified counseling practitioners. These and other supervision models reinforced the position that clinical supervision, as a task-related activity, included a specific knowledge base and set of skills that are different from those of professional counselors.

Other research has moved beyond the development of supervision models to begin exploring methods to enhance supervision techniques (Borders & Brown, 2005). Interpersonal Process Recall uses audio or video feedback of client-counselor interactions followed by the supervisor's inductive questioning to help the counselor identify her or his personal feelings and thoughts that may have interfered with the client-counselor communication patterns (Bradley, 1989). Microcounseling is a supervisory technique that can be used to help beginning counselors enhance their skills of attending behavior, reflection of feeling, and summarization of feeling (Bradley, 1989). Hoffman, Hill, Holmes, and Freitas (2005) addressed the struggles that experienced supervisors can encounter when assessing a trainee's areas for improvement, encouraging self-awareness, and protecting clients. Ladany and Walker (2003) discussed the importance of the supervisory alliance by suggesting that disclosures by the supervisor influence the supervisor--supervisee relationship by communicating trust. Prieto and Scheel (2002) focused on the efforts supervisors could use to enhance the case-conceptualization skills of beginning counselors. McMahon and Slmons (2004) and Kaiser and Kuechler (2008) added to the mounting research that supports the hypothesis that specialized supervisory training enhances supervisory skill development. It is tenable to assume that enhanced supervisory skills result in a higher quality of client care.

Research relevant to clinical supervision shows an evolutionary process. At the beginning of this process was the development of theoretical models that focused on the supervisor-supervisee relationship and counselor skill development. Research today tends to focus on a more sophisticated effort to identify strategies to enhance supervisory development (Granello et al., 2008). How does this body of knowledge regarding the process of clinical supervision affect the actual performance of clinical supervisors in the substance abuse treatment field, a field that has historically supported the use of lesser credentialed para-professions in the delivery of clinical services? To what extent does this body of research influence the professional development of substance abuse counselors?

Clinical Supervision in the Substance Abuse Treatment Field

The substance abuse treatment field has historically promoted the use of para-professionals in the delivery of clinical services. Even as states passed counselor licensure legislation establishing appropriate graduate education as a minimum requirement for professional counselors, para-professionals in the substance abuse treatment field were excluded as a group that was required to obtain licensure in order to practice.

West et al. (1999) explored the staffing requirements contained in state licensure requirements for substance abuse treatment programs. Thirty-four states participated in this study. The staffing requirements for clinical supervisors were contained in this study and revealed that only 32% (n = 11) of the states participating in the study required graduate-level training for clinical supervisors and only three states (9%) required academic preparation specific to clinical supervision (p. 43). West et al.'s study and a subsequent study (Mustaine et al., 2003) revealed a lack of attention to formal graduate education for substance abuse counselors, even those identified as certified addictions counselors.

Para-professionals often do not have a connection to higher education, especially graduate education, where there is a focus on research. How, then, do these individuals compare with professionally trained counselors? Sias, Lambie, and Foster (2006) examined the conceptual and moral development of substance abuse counselors in Virginia. The participants included certified substance abuse counselors, certified addictions counselors, master's-level addictions counselors, and licensed substance abuse providers. One of the central features of this study was the educational level of the participants. Results of that study revealed a significant positive correlation between substance abuse counselors' conceptual complexity and their level of education. When considering the professional development of substance abuse counselors, Sias et al. noted, "counselors in this current study may have lacked the supervision and guided reflection needed to bring about meaningful growth (in cognitive development)" (p. 107). Another finding also suggested that "master's-level education should be a requirement of substance abuse counselors" (p. 108) due to the positive correlation between education and cognitive development and moral reasoning. These findings indicate that advanced education and training for clinical supervisors are necessary to address the individual differences found in supervisees.

Crabb and Linton (2007) studied the belief systems of recovering and nonrecovering substance abuse counselors. This qualitative study included eight counselors, all of whom had a relevant graduate degree and at least 5 years of clinical experience. Data indicated that traditional counselors "did not integrate into their practice research findings and literature that contradicted their beliefs about substance abuse and approaches to treatment" (p. 13). Such a finding raises questions about clinical supervision that would fail to influence a counselor's belief system regarding the importance of empirical research in promoting quality services.

As the literature review suggests, clinical supervision research continues to be focused on two issues. First, there is research that addresses the importance of clinical supervision on the overall development of the counselor (Baird, 2011; Getz, 2001; Granello et al., 2008). Second, there is research that emphasizes the unique knowledge base and skills associated with clinical supervision (Bernard, 1979, 1981; Granello et al., 2008; Kaiser & Kuechler, 2008; McMahon & Simons, 2004). There appears to be a gap in the research that examines the degree to which the special knowledge base and skills associated with clinical supervision and represented in the literature are present in actual clinical supervision activities.

The absence of graduate academic requirements for clinical supervisors in most state licensing regulations for substance abuse treatment facilities (West et al., 1999) raises questions about the professional preparation of clinical supervisors in this field. How do clinical supervisors in the substance abuse field acquire the specialized knowledge base and skills identified in the literature as essential elements for such a position?

Assessment of Supervision Knowledge and Skills

Clinical supervision has an impact on the overall development of counselors. Research suggests that clinical supervision is a complex task that includes a specific knowledge base and unique skills (Granello et al., 2008). In this study, we explored the characteristics of clinical supervisors in the substance abuse treatment field. In particular, we examined the knowledge base and skills level of supervisors based on their education and training.

The Self-Assessment of Supervision-Related Knowledge and Skills survey (Borders & Leddick, 1987) provides a method for gathering data on supervisory skills. The survey was initially developed for clinical supervisors to assess the relevant knowledge and skills that they bring to their role as a supervisor. The self-rating survey measures a supervisor's perceived expertise in the areas of teaching, counseling, consultation, and research. These are elements commonly identified in the literature as fundamental clinical supervisory skills. Items in these four areas are written in a 5-point Likert response format. Respondents indicate the extent to which the activity in the item is characteristic of their own knowledge and skills. There are 10 items related to teaching skills, 18 items related to counseling skills, five items related to consultation skills, and seven items related to research skills.

Teaching skills reflect the emphasis the supervisor places on the supervisee's learning. The questions on the survey ask if the supervisor is able to identify the learning needs of the supervisee, present material in a didactic and experiential way, and give constructive feedback.

Counseling skills reflect the emphasis the supervisor places on the supervisee's ability to work with the client using various interventions. The questions on the survey ask whether the supervisor has knowledge of facilitative and challenging skills, whether the supervisor is able to help facilitate supervisee self-exploration, and whether the supervisor is able to integrate data regarding supervisees into a comprehensive conceptualization.

Consultation skills reflect the emphasis the supervisor places on collegial relationships. The questions on the survey ask if the supervisor is able to (a) provide alternate interventions or conceptualizations, (b) encourage the supervisee to make her or his own choices, and (c) encourage the supervisee to objectively assess a problem situation.

Research skills reflect the emphasis the supervisor places on the integration of basic research and assessment strategies in the evaluation of supervisory duties. Questions on the survey ask if the supervisor is able to state testable hypotheses and to gather data relevant to testing these hypotheses. Other questions ask if the supervisor is able to critically examine and incorporate new research into supervision.

This descriptive and exploratory study was designed to examine the qualifications of clinical supervisors in a mid-Atlantic state and to explore participants' self-perception of their professional expertise. We investigated the following questions, which emerged from the literature.

1. To what extent are licensed professionals represented as clinical supervisors in the substance abuse treatment field in our sample?

2. To what extent is formal academic graduate training in supervision represented as a foundation among clinical supervisors in the substance abuse treatment field in our sample?

3. How does the self-rating of perceived expertise in teaching, counseling, consultation, and research by graduate-level clinical supervisors compare to the self-ratings of para-professionals in our sample?

Method

Our proposal for this study was submitted to and accepted by the Alvernia University Institutional Review Board, which determined that the study presented no potential harm to participants.

This study was limited to licensed substance abuse treatment programs in a mid-Atlantic state. A comprehensive list of programs maintained by the state licensing authority was accessed to identify executive directors and addresses.

An introductory letter and a survey instrument were prepared and sent to 200 agencies. The letter explained the nature of the research project and encouraged the distribution of the survey form to all clinical supervisors in these programs. Satellite treatment programs of larger treatment organizations were not included in this project.

Clinical supervisors who chose to participate in this study were also given the opportunity to participate online. The introductory letter provided a link to the university's website and included a description of the study and an agreement to participate in the study. After the agreement was confirmed, participants were directed to the online demographic data sheet and a survey, which they were asked to complete.

Regardless of the participation method they chose, participants were asked to provide demographic data and to identify the name of their agency, their highest academic degree, the number of years they had served in a clinical supervisory capacity, the source of clinical supervisory training, and the professional licenses and/or certifications held. This information permitted tracking of facilities that did not respond to the initial mailing. Thirty days after the initial letter was sent, representatives from agencies who had not responded to the initial letter were contacted by telephone, and the clinical supervisor(s) was encouraged to participate in the study. Any comments regarding a decision by the clinical supervisor not to participate in the study were recorded.

We obtained permission to use the survey instrument from the survey developer. The items on the survey asked participants to rate their expertise on a 5-point Likert scale (1 = needs development, 5 = expertise) in four general areas related to clinical supervision. Only the end points of the scale were labeled on the instrument. The four areas on the survey included 10 questions related to teaching skills, 17 questions related to counseling skills, five questions related to consultation skills, and seven questions related to research skills. Analysis of the data included an examination of the frequency of the categorical and numerical responses to four of the introductory questions and an examination of the expertise rating responses across different subgroups.

Results

Fifty-seven clinical supervisors from 53 different treatment programs responded to this survey, resulting in a 26.5% response rate. The actual number of clinical supervisors working in the state was unknown, because treatment centers might employ more than one clinical supervisor, and such data were not available.

The survey used in this study was a self-report instrument that elicited participants' perception of their expertise in four clinical supervision knowledge and skill areas (i.e., teaching, counseling, consultation, research). There was no validity or reliability reported for this instrument; however, its use was appropriate as a tool to gather descriptive information for this study. The distribution of the responses to the four self-rating scales (Teaching Skills, Counseling Skills, Consultation Skills, Research Skills) was heavily weighted at the "expertise" end of the 5-point Likert scale, with 79.5% of the total responses being rated either a 4 or a 5. Only 5.29% of the total responses were rated as 1 or 2.

There were 21 male and 36 female participants in this study. The mean age of participants was 46.82 (SD = 11.157), and the average number of years of experience as a clinical supervisor was 9.80 (SD = 7.93). Table 1 presents the distribution of academic preparation for supervisors by gender.

The vast majority of clinical supervisors had earned graduate degrees (men = 81%, women = 72%). Eight male and eight female participants reported that they had completed graduate-level course work in clinical supervision. More female (61%) than male (19%) participants relied on workshops and state training opportunities as the fundamental educational foundation for their clinical supervision tasks. It is noteworthy that 24.6% of the total participants indicated that they relied on on-the-job training or had no training specific to clinical supervision.

Table 1 presents the distribution of participants' professional credentials. The highest credential based on formal academic rigor was recorded for each participant. More women (47.2%) had obtained a state license either as a professional counselor, psychologist, marriage/family therapist, or social worker than did men (33.3%). It should be noted, however, that 33.3% of the participants indicated that they had no current professional credential.

Supervision Skills

Participants were asked to rate their perceived level of expertise in four supervision skill levels on a 5-point Likert scale (1 = need for development, 5 = expert). The skill areas were teaching skills, counseling skills, consulting skills, and research skills.

Participants were divided into two groups: those with graduate degrees (masters, doctoral; n = 43) and those without graduate degrees (associate and bachelor; n = 14). Summed scores of responses for each group of participants for each question in each skill area were used to calculate mean scores. Table 2 presents the mean scores for each set of questions in each of the four skill areas for the two participant groups.

Graduate education did not appear to influence the perception of supervisory expertise among participants. An independent t test showed no significant differences ([alpha] = .05) in self-ratings of perceived level of expertise in all four supervisory skill areas between participants with graduate degrees and those without graduate degrees. The significance levels ranged from .353 to .891 across the skill levels. A job task analysis would be needed to determine the extent to which the perception of expertise reported by participants matched actual job performance.

Impact of Formal Course Work in Supervision

Computation of mean scores for the perceived level of supervision expertise in each of the four skill areas were also calculated for participants who had completed graduate-level course work in clinical supervision (n =16) and for participants who received their supervisory training through less rigorous venues (n = 41). Results are presented in Table 3.

It should be noted that the perception of clinical supervision expertise among participants without formal graduate course work in clinical supervision was very similar to that of participants who had formal graduate-level supervisory training. An independent t test was used to compare the means across the four supervisory skill areas. There was no significant difference ([alpha] = .05) between the two groups for teaching, consultation, or research. Assuming equal variances, there was a significant difference between the two groups when supervisory counseling skills were analyzed (t = 2.077, coefficient of variation = 2.004, df = 55, [alpha] = .05). Again, a job-task analysis would be needed to determine the extent to which these two groups were similar or different in their supervisory performance.

Conclusion

Fifty-seven individuals participated in this survey, representing a 26.5% response rate. Hikmet and Chen (2003) found no real agreement on the acceptable response rate for mail surveys sent to technology sources in the health-care industry. Alreck and Settle (1995) suggested that response rates to mail surveys commonly range between 5% and 10% and that a 30% response rate would be rare. Goyder (1985) suggested that an acceptable range of response rates to mail surveys is 30% to 70%. The lack of consensus on what constitutes an acceptable response rate for mail surveys suggests that the results of this survey should be interpreted with caution.

Most of the participants in this study (75%) had earned graduate degrees, even though graduate education was not a prerequisite for clinical supervisors. The high representation of graduate degrees could be a response to efforts within the state to promote professional standards in the substance abuse treatment field as well as the availability of licensure for professional counselors.

Less than half (42%) of the clinical supervisors who participated in this study were licensed professionals in the state, although most (75%) had earned graduate degrees. For this study, we recorded the highest credential participants had obtained. For example, if a participant was licensed as well as certified, the licensure status was recorded.

The state in which this study was conducted requires a graduate degree of at least 48 credit hours and a total accumulation of 60 credit hours of related graduate course work as part of the criteria for licensure as a professional counselor, social worker, or marriage/family therapist. It is unknown how many of the clinical supervisors in this study who reported having a graduate degree completed degree programs that would qualify them for professional licensure.

Only 28% of the participants indicated that they had completed graduate course work in clinical supervision. Other less rigorous methods of supervisory training included state-sponsored training (21%), workshops (25%), and on-the-job training (19%) as the primary source of training and information about clinical supervision.

Clinical supervision is complex and requires a specific knowledge base and unique skills (Granello et al., 2008). Without the rigor and accountability associated with formal graduate education exposure to clinical supervision theories and skills, the quality of clinical supervision has to be questioned when it is provided by individuals who have not taken advantage of this formal method of training.

Support for this concern about the quality of clinical supervision provided by individuals without formal graduate academic training is reflected in the perception of skill expertise expressed by the study participants. It seems reasonable for clinical supervisors with graduate degrees to rate their supervisory skills higher than do individuals without graduate degrees in the supervisory skill areas (see Table 3). Following this line of reasoning, one would expect clinical supervisors who had completed some graduate-level course work in clinical supervision to rate their expertise higher than would those who had not completed graduate course work in supervision. This result, however, was not reflected in this study. In fact, clinical supervisors without formal graduate course work in clinical supervision rated their level of expertise higher than did clinical supervisors who had completed such course work in three out of four of the supervisory skill areas (see Table 4). In fact, participants who had not completed formal graduate course work in clinical supervision rated their counseling skills significantly higher than did participants who had completed formal course work in clinical supervision. One reason for this finding might be that participants who have completed formal course work in clinical supervision might have a broader understanding of the supervisory responsibilities than the participants who did not complete formal training, resulting in a more critical self-analysis of supervisory skills.

Limitations

There are several limitations associated with this study. First, the data were collected from participants in a specific state and from treatment programs that were licensed by that state. Licensing standards change from state to state and include different staffing criteria for treatment staff. Although formal treatment programs are required to obtain a facility license from the state, private counseling practices that provide substance abuse treatment services as part of a comprehensive counseling agenda may not be required to be licensed by the state. Therefore, individuals providing clinical supervision in private counseling practices where counselors may be providing substance abuse treatment were not included in this study and may represent a limitation.

This research project required the cooperation of executive directors of licensed treatment programs to distribute the survey to clinical supervisors in their respective organizations. We are not sure whether the involvement of executive directors in this process influenced participants' responses. Because of the survey distribution method we used, there was no way for us to determine whether the study participants were a representative sample of clinical supervisors. Although it is assumed that each licensed treatment program has an individual who is identified as a clinical supervisor, it is tenable to assume that some programs will be large enough to have more than one individual holding such a position. It is also tenable to assume that some licensed programs use individuals as administrative supervisors who also have clinical supervision duties.

Clinical Supervision and Licensure

Most of the clinical supervisors (n = 39) in this study had earned graduate degrees, and 24 of the 57 supervisors reported that they were licensed by the state as professional counselors, psychologists, or social workers. Some participants reported degrees relative to specific disciplines that are clearly related to counseling (i.e., counseling, mental health counseling, counseling psychology, psychology, marriage and family therapy, social work), whereas others reported degree concentrations in other areas that might not satisfy the academic preparation requirements for professional licensure (e.g., behavioral health and human services, health services, addictions, social services administration, business administration).

Historically, the substance abuse treatment field has served as an employment haven for para-professional practitioners, that is, individuals who seek to provide counseling services without meeting the academic and experiential licensing requirements supported by mainline professional organizations (counseling, psychology, social work). According to the present study, 42% of the clinical supervisors were professionally licensed. If this study is representative of the general substance abuse treatment field in the state where the study was conducted, the field remains somewhat closed to academically prepared counseling professionals seeking licensure, because there is a mandate that clinical supervision be provided by licensed professionals. Caution must be taken regarding this conclusion, because it is uncertain the extent to which the participants were a representative sample of all clinical supervisors in the state.

Formal Graduate Training in Clinical Supervision

Just over one quarter (n = 16, approximately 28%) of the clinical supervisors who participated in this study indicated that they had completed graduate course work in clinical supervision. Supervisory skill ratings for this group were compared with those for participants who did not report graduate-level course work in clinical supervision. The mean scores of perceived clinical supervision expertise for both groups of participants across the four skill levels were very similar. In three of the four clinical supervisory skill areas (i.e., teaching, consultation, research), the mean scores of the group of participants without formal graduate course work in clinical supervision were higher than those for the group that completed graduate course work in clinical supervision (see Table 3). Additionally, the perceived level of expertise in the counseling skill area for the group without formal course work in clinical supervision was significantly higher than was the perceived level of expertise of the group that had completed formal course work in clinical supervision.

There are several possible interpretations of this outcome. First, this study examined the self-perception of expertise of participants employed as clinical supervisors but did not obtain data to examine the validity of these ratings. It is tenable to assume that participants who completed formal graduate course work in clinical supervision may have had a more thorough understanding of the skills associated with clinical supervision than did participants who received clinical supervision training through less rigorous venues (e.g., trainings, workshops, on-the-job training). Participants with graduate course work may have been more critical in their self-analysis because they had a better understanding of the theory and research associated with clinical supervision.

Second, there was nothing in this study to identify specific job tasks related to the participant's duty as a clinical supervisor. Questions in the survey simply asked participants to rate their ability to perform certain tasks and did not ask if such tasks were performed.

Third, no clear distinction is made between clinical supervision tasks and administrative supervisory tasks in the state regulations for licensing of substance abuse treatment programs. It is conceivable that participants in supervisory positions may serve in both administrative and clinical supervisory roles. Individuals without a clear understanding of the dynamics of clinical supervision might confuse administrative supervisory tasks with clinical supervisory tasks. A separate study focusing on specific clinical supervisory tasks would help to clarify this outcome.

Fourth, it is possible that clinical supervision training provided through workshops, seminars, or on-the-job training might be as effective as formal graduate course work. Again, additional job-task research coupled with assessment of the supervisory experience by those receiving supervision would be needed to validate the reliability of the expertise rankings noted in this study.

Regardless of the interpretation that a job-task analysis would yield, this study showed that the vast majority of the participants in this study (72%) chose less formal and less accountable methods for obtaining their clinical supervisory training skills and perceived that their supervisory skills were equal to or better than participants who had received formal supervisory training. This raises concerns about the quality of clinical supervision available to substance abuse counselors, especially from clinical supervisors who rely on on-the-job-training or those who have had no clinical supervisory skill training.

This study raises concerns about the training of clinical supervisors and reflects concerns that are similar to those raised by Mustaine et al. (2003) and Sias et al. (2006) regarding the training of substance abuse counselors. These studies questioned the quality of training of counselors and clinical supervisors who practice in the substance abuse treatment field and challenged the quality of clinical services provided to clients.

Observations and Recommendations

One third of the clinical supervisors (n = 19) who participated in this study indicated that they were neither professionally licensed nor certified. This raises questions about the quality of clinical supervision provided to counselors, especially with regard to professional development and ethics. Without professional licenses or certifications, clinical supervisors are not necessarily bound to any particular professional code of ethics, nor is the public, including those being supervised, adequately protected from inappropriate or unethical supervisory practices.

As reflected in this study, there was no significant difference noted in the perception of supervisory skill expertise between participants with graduate degrees and those without graduate degrees. With the exception of counseling skills, there was also no significant difference noted in the perception of supervisory skills expertise between participants who completed formal graduate course work in supervision and those who did not. It appears that the participants in this study, as a whole, perceived that their skills as clinical supervisors were very appropriate, as reflected by the high number of total rating responses (79.5%) as either 4 or 5. This pattern also applies to participants who obtained their supervisory training from on-the-job training or cited no formal training at all. This raises some questions about whether a job analysis of the supervisory skills would render the same results as the self-rating instrument used in this study. This also raises concerns regarding whether individuals who rated themselves high on supervisory skills expertise (a rating of either 4 or 5) and who had little or no training in clinical supervision would recognize a need to obtain such training.

Participants in this study also perceived an ability to apply research in their supervisory role as the area in which they had the least expertise. This outcome raises concerns about whether there is sufficient emphasis placed on research skills in graduate counselor education programs, in certification requirements for individuals who choose not to pursue graduate education, or in the application of research skills in substance abuse treatment facility licensing regulations.

Miller, Scarborough, Clark, Leonard, and Keziah (2010) recommmended that education and training should be the basis for a national credentialing system for substance abuse counselors. According to these authors, there is no uniform national curriculum that serves as the foundation for credentialing substance abuse counselors. They also suggested that there is a need for the development and promotion of job descriptions for individuals with educational levels from high school diploma to doctorate and a credentialing process that is education-based. The article focused on minimal education and testing standards for substance abuse counselors but made no specific mention of the need to establish minimal clinical supervision standards.

Research continues to describe the complex nature of clinical supervision, including specific theories and strategies for supervisory skill enhancement. Studies regarding the preparation of substance abuse counselors need to examine the nature and quality of clinical supervision in addition to education and testing of practitioners in this field. Clinical supervisors can have a significant influence on the professional development of a counselor. This study raises many questions regarding the scope and quality of clinical supervision currently available in the substance abuse treatment field. Expanding this research to include a job-task analysis of clinical supervisors seems to be in order.

Received 09/12/10 Revised 03/16/11 Accepted 05/19/11

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Paul L. West and Terri Hamm

Paul L. West, Department of Psychology and Counseling, Alvernia University; Terri Hamm, Department of Art Therapy and Counseling, Ursuline College and Walden University. Correspondence concerning this article should be addressed to Paul L. West, Department of Psychology and Counseling, Alvernia University, Upland Center, 540 Upland Avenue, Reading, PA 19611 (e-mail: paul.west@alvernia.edu).
TABLE 1
Academic Preparation, Supervision Training, and Professional
Credentials of Clinical Supervisors Based on Gender

Variable                             Men (n = 21)   Women (n = 36)

Degree

Associate                                 0               1
Bachelor                                  4               9
Masters                                   15              24
Doctorate                                 2               2

Type of supervision training

Graduate courses                          8               8
Undergraduate courses                     1               0
State training                            1               11
Workshops                                 3               11
On-the-job training                       6               5
None                                      2               1
Credential
State license                             7               17
Nurse                                     1               1

Certification as a substance abuse

counselor                                 4               8
None                                      9               10

TABLE 2
Mean Scores of Perceived Supervision Expertise of Participants With
and  Without Graduate Degrees

               Participants  Participants
                   With         Without
                 Graduate      Graduate
                 Degrees        Degrees    Total
                 (n = 43)      (n = 14)    (N = 57)

Supervisor
Skill Area      M      SD     M      SD     M      SD

Teaching       3.91   0.80   3.87   0.91   3.90   0.83
Counseling     4.21   0.74   4.20   0.61   4.20   0.71
Consultation   4.31   0.63   4.16   0.62   4.27   0.63
Research       3.64   0.94   3.57   0.93   3.62   0.93

TABLE 3
Mean Scores of Perceived Supervision Expertise of Participants
With and  Without Graduate Course Work in Clinical Supervision

               Participants  Participants
                  With          Without
                Graduate        Graduate
               Course Work    Course Work      Total
                 (n = 16)      (n = 41)       (N= 57)

Supervisor
Skill Area      M      SD     M      SD     M      SD

Teaching       3.91   0.76   3.89   0.86   3.90   0.83
Counseling     4.02   0.71   4.28   0.70   4.20   0.71
Consultation   4.24   0.61   4.29   0.64   4.27   0.63
Research       3.41   0.92   3.70   0.93   3.62   0.93
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Author:West, Paul L.; Hamm, Terri
Publication:Journal of Addictions & Offender Counseling
Article Type:Report
Geographic Code:1USA
Date:Oct 1, 2012
Words:6772
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