clinical supervision of consultation
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This article was downloaded by: [University of Southern Queensland]On: 09 October 2014, At: 17:52Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
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Clinical Supervision of ConsultationKaturah Cramer PhD a & Sylvia Rosenfield PhD ba Howard County Public Schoolsb The University of MarylandPublished online: 08 Sep 2008.
To cite this article: Katurah Cramer PhD & Sylvia Rosenfield PhD (2004) Clinical Supervision ofConsultation, The Clinical Supervisor, 22:1, 111-124, DOI: 10.1300/J001v22n01_08
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Clinical Supervision of Consultation
Katurah CramerSylvia Rosenfield
ABSTRACT. Recently, interest in consultation training has begun togrow in the literature after a long period of neglect. Although a case hasbeen made in the literature for improving the clinical supervision of con-sultation skills, the process of supervising the development of consulta-tion skills continues to receive little attention. In this article, strategies forclinical supervision of consultation skills will be described along a devel-opmental framework, with examples drawn from school-based consulta-tion. The importance of audio or videotaping early skill development inconsultation will be stressed. The use of distance learning technology toassist practitioners in building their skills, given the lack of preservicetraining and supervision for many, will also be addressed. [Article copiesavailable for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH.E-mail address: <[email protected]> Website: <http://www.HaworthPress.com> © 2003 by The Haworth Press, Inc. All rights reserved.]
KEYWORDS. Supervision of consultation, clinical supervision, con-sultation skills
Recently, interest in consultation training has begun to grow in theliterature after a long period of neglect (Alpert & Taufique, 2002;Hellkamp, Zins, Ferguson, & Hodge, 1998). Although a case has beenmade in the literature for improving the clinical supervision of consulta-tion skills (e.g., Stoltenberg, 1993), the process of supervising the de-
Katurah Cramer, PhD, is affiliated with Howard County Public Schools.Sylvia Rosenfield, PhD, is affiliated with the University of Maryland.
The Clinical Supervisor, Vol. 22(1) 2003http://www.haworthpress.com/web/CS
2003 by The Haworth Press, Inc. All rights reserved.Digital Object Identifier: 10.1300/J001v22n01_08 111
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velopment of consultation skills continues to receive little attention.Consequently, many professionals are not receiving the intense trainingin consultation they need at the graduate school level in order to feelcompetent in the associated skills (e.g., Costenbader, Petrix, & Swartz,1992; Guest, 2000).
It is problematic to ask individuals to take on professional practicesin which they do not believe themselves to be competent. For example,a survey, collected from two classes of school consultation students af-ter their first semester of consultation training, illustrates this point. Stu-dents were asked to list questions they were left with after their firstsemester of consultation (Cramer, Rosenfield, Mewborn, Anton, &Schulmeyer, 2001). Students’ questions addressed a range of issues, in-cluding content concerns and process concerns, as can be seen in Table 1.Clearly students are left with a plethora of questions and insecurities af-ter one semester of consultation training, and most would not feel com-fortable utilizing their skills independently in the field.
Yet, in a survey of school psychology programs, Anton and Rosenfield(in press) found that less than 10% of the non-doctoral programs and 25%of the doctoral programs surveyed offered two consultation courses. Asurvey of training practices, which included clinical, counseling, indus-trial/organization, and school psychology faculty, indicated that clinicaland counseling programs were even less likely to provide training inconsultation (Hellkamp et al., 1998). Thus, it is especially timely to fo-cus on supervision skills that would enhance consultation skill devel-opment.
The purpose of this article is to describe strategies for clinical super-vision of consultation skills along a developmental framework. Thesestrategies will be presented primarily in the context of preservice con-sultation training. Supervision to address the needs of practitioners atdifferent levels of expertise will be addressed as well, including howdistance learning technology has been used to assist practitioners inbuilding their skills, given the lack of preservice training and supervi-sion for many. Examples will be drawn from school-based consultationservices, but the strategies can be utilized in other contexts as well.
A DEVELOPMENTAL MODELFOR CONSULTATION SKILL DEVELOPMENT
Alexander (1997) described a developmental model of domain learn-ing that can be aligned with the development of consultation skills
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Clinical Supervision in the Schools 113
TABLE 1. Concerns of Consultation Students After One Semester of Training
Process Concerns
Relationship withConsultee
1) How do you address a consultee who has a pattern of not fol-lowing through on what was agreed on during a previous consul-tation session?2) How do you promote collaboration in the relationship but yetmake clear that there are expectations for the consultee?3) What additional skills in multicultural consultation are needed;at the beginning of a case, how do you balance relationship/per-sonal needs and staying task focused when there are multicul-tural issues; how do these factors impact on the IC relationship?
Belief Systems 1) How do you address a conflict in goals, standards, expecta-tions, beliefs about the nature of the problem; how/when do youconfront on these issues, without harming the relationship; howdo you confront a teacher’s medical model beliefs by encourag-ing another way of conceptualizing children’s difficulties?2) How do you explain the IC framework to teachers, makingclear the differences in the process from more traditional ap-proaches to classroom problems; what do you do if consultationitself is not fully accepted in the school or by the teacher withwhom you are consulting?
Managing the Process 1) How do you manage the flow of the process so that both the con-sultant and the consultee perceive progress is being made; particu-larly, how do you judge whether or not problem identification istaking too long, whether good use is being made of sessions?2) How do you prioritize when there are multiple problems?3) How do you transfer the process from one student to thewhole class or group within the class?
Communication Skills 1) How do you develop a skillful use of language, including ques-tioning skills, helping teachers to develop new perspectives onproblems, and using clarification well?
Confidence 1) When do you become more self-confident rather than tenta-tive?
Content Concerns
Academic Assessment 1) Need to develop skills in Classroom Based Assessment Tech-niques, such as CBA, in reading and other subjects, includingwhat materials to use.2) What do you do with the results of an academic assessment?3) How do the results of an academic assessment get translatedinto instructional strategies, especially if the gap between the stu-dent and the classroom materials is large?4) How do you assess several students or a whole class that isnot learning?5) Need to develop skill in academic interventions, particularlyones that are new to the teacher, but flexible and realistic.
AcademicInterventions
1) Need to learn more about interventions useful for differentkinds of problems.2) What do you do if an intervention is working?
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(Rosenfield, 2002). Alexander’s model consists of three stages: novice,competence, and expertise. Characteristics of students in each of thesethree stages will be described, along with implications for supervisingstudents in these stages.
Novice
In the first stage, Alexander (1997) stated that novices have littleknowledge of the domain and the knowledge that they do possess isfragmented. Alexander saw novice students as motivated by situationalinterest that “directs their thoughts and actions” (p. 226). Novices arealso highly reliant on external supports to provide them with the re-sources they need to acquire knowledge and to sort out what informa-tion is important and relevant to the domain (Alexander, 1997).
Alexander stressed three implications for teaching novice stu-dents that are applicable to the supervision of consultation stu-dents: (a) “stress important content both in their teaching and intheir assessments” (p. 227); (b) allow students to investigate topicsbeyond their surface level, so that they may develop areas of indi-vidual interest; and (c) encourage students to become actively engagedin the learning process and to focus on their own self-regulation.
Consultation students are typically in the novice stage throughoutan introductory course or set of practicum experiences in consulta-tion. Novice students should be provided with highly structured su-pervision, as they are not yet able to prioritize various issues fromtheir consultation sessions that need to be addressed. Supervisorsneed to share responsibility with the students in identifying impor-tant points that need to be addressed in supervision. Although thestudents may be asked to identify these points independently prior tothe supervision session, the supervisor may add additional topics tobe discussed. In addition, as students will have only a fragmentedknowledge base, it is important for supervisors to provide direct in-formation about the consultation process, techniques for assessment,and intervention methods. However, supervisors should also guidestudents to outside resources, either experts in the school building,books or articles, so that they may begin answering some questionsindependently.
For example, in one case the teacher stated that the child was receiv-ing extra help in reading by the school’s reading specialist. The student
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consultant then made the assumption that the child’s reading problemwas being addressed. In supervision, the supervisor pointed out the im-portance of using the communication skill of clarification to learn moreabout reading needs of the child, the type of instruction the child was re-ceiving, and its relevance to the classroom instructional program. Thestudent consultant and the supervisor discussed what specific questionsthe student might ask the teacher in order to get a more complete pictureof that student’s reading skills and instructional program. The sessionprovided the student the opportunity to learn more about consultationprocess (in this case, communication skill of clarification), assessmentin reading, and intervention in reading.
Competence
In Alexander’s (1997) second stage, competence, students are moreknowledgeable and can better identify information that is important andrelevant to the domain. Strategies related to the domain also becomemore automatic, so that students “have more mental energy to direct tothe extension of their domain learning” (p. 229). Alexander stated thatstudents in this stage become more internally motivated and better ableto choose appropriate strategies, although some more novel problemsstill require strategic effort on the part of the learner.
There are several implications for teaching students in the compe-tence stage, according to Alexander (1997). Towards the end of thenovice and the beginning of the competence stage, students need tolearn to apply the content knowledge they have gathered to varioussituations. First, as students move into competence, supervisorsshould provide students with less direction and increase opportuni-ties for student self-determination. Second, students should be chal-lenged with the presentation of more novel and complex problems towhich their domain knowledge can be applied. Finally, perfor-mance-based tasks may be beneficial in helping students to generatealternative solutions.
In accordance with Alexander’s (1997) suggestions, supervisorsshould provide less structure at this stage. Students should take on theresponsibility for identifying issues in their consultation sessions thatrequire supervision. In addition, as students become more automaticwith their domain knowledge, more complex and less content-driven is-sues may be addressed in supervision.
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Expertise
Alexander’s (1997) third stage of development, expertise, is gener-ally beyond the scope of graduate student experience. Alexander statedthat experts go beyond simply solving problems and acquiring knowl-edge to actually formulating problems themselves; therefore, theirwell-integrated knowledge base can be used to actually shape aspects ofthe domain itself. Experts need “a role in reshaping the very landscapeof the domain . . . by perceiving aspects of the domain in novel or in-sightful ways, or by creating or redefining the very base of knowledgeor core principals that mark the domain as unique” (p. 237). However,although experts possess impressive knowledge and skill, Alexandercontended that opportunity to confer with other professionals and toconduct independent study will further their development as profes-sionals. Consequently, expert consultants may benefit from peer super-vision or the opportunity to conduct research.
SUPERVISION METHODS
As mentioned previously, the primary purpose of consultation super-vision is to move students from the novice to the competence stage(Rosenfield, 2002). Several methods may be used to realize this goal.Bernard and Goodyear (1998) described a set of clinical supervisionmethods that may be applied to the supervision of consultation, includ-ing self-report, process notes, audiotaping, and videotaping. The advan-tages and disadvantages of these methods as applied to consultationsupervision will be outlined, along with how to optimize their efficacyat each stage of development.
Advantages of Audio and Videotaping
Audio and videotaping are powerful supervision methods to utilizewith consultation students, especially at the novice stage, providing su-pervisors with an accurate recording of what transpired in the session.This recording allows the supervision session to focus on aspects of theprocess of consultation that may not be recognized by novice consultees.For example, one student was assigned to a school in which the culturewas to focus on the etiology of problems and to seek out interventionsthat took place outside of the classroom. The student’s supervisor wasable to help the student observe changes in the teacher that were taking
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place throughout the consultation process. The teacher slowly changedthe language she used to describe the problem to more objective termsand took on more responsibility for interventions in the classroom. Al-though the student did not feel that she was making progress with theteacher, the subtle nuances that could be detected on tape in the supervi-sion sessions made the progress clear.
In addition, the dynamic of the consultation session may be capturedthrough the use of taping. For example, through an understanding ofthis dynamic the supervisor may identify parallel processes between theconsultation and supervisory relationship. Parallel processes in coun-seling supervision have been described as “the common phenomenon ofthe dynamics in supervision replicating those that occurred or are occur-ring in the supervisee’s therapy” (Bernard & Goodyear, 1998, p. 63). Inconsultation supervision, supervisees may reflect their interactions withthe consultee in the context of supervision. For example, school consul-tants in supervision often blame the teacher for not being more receptiveto their consultation experience, at the same time that the teacher isblaming the student for the difficulties in the classroom. According toBernard and Goodyear, acknowledgement of these processes may in-crease the supervisees’ understanding of the consultee and help him orher learn appropriate responses to use in interactions with the consultee.
Taping consultation sessions also allows supervisors to address stu-dents’ misconceptions about various content or process issues that maynot have otherwise been identified. For example, a supervisor, in hear-ing a tape, found that the supervisee was pushing the teacher to explorepossible academic concerns while the teacher very much wanted to fo-cus on the student’s behavior. The student, taking a course in instruc-tional consultation, mistakenly believed that her responsibility was toaddress instructional concerns first in every case. The supervisor thenshared with the student that behavior could be addressed first if theteacher has prioritized that concern, and helped the student to under-stand how to integrate the academic issues into the process.
Another advantage to taping is that it provides an opportunity to workon communication skills. As novices often do not know what points inthe consultation session are especially important, they may need assis-tance in identifying which statements require clarification. The use oflanguage has a strong impact on the consulant-consultee relationship,and listening to tapes can provide an opportunity for refining the consul-tants’ communication skills. For example, many new consultants takeon an expert role in the process; talking about collecting data for “us”rather than for the consultants facilitates the formation of a collabora-
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tive relationship with the consultee and a shared ownership of the prob-lem.
Finally, the taping process makes student consultants more consciousof their performance during the consultation session. Several consulta-tion students have shared that audiotaping caused them to prepare morefully for the session. Students also commented that the actual taping ofthe session heightened their level of arousal during the session itself andmade them work harder.
Disadvantages of Audio and Videotaping
Taping can be initially anxiety provoking for new consultants. Stu-dents may initially try to avoid playing their tapes by unintentionallyforgetting to bring the tapes, forgetting to press record, or by simplysaying that they would prefer not to play them. However, superviseestend to become more comfortable with the process over time, and thebenefits outweigh the concerns.
Videotaping is usually more difficult to arrange in the field setting,and there is some concern that it can provide students with too much in-formation to process at one time (Bernard & Goodyear, 1998). On theother hand, videotaping of skill development can be useful. For exam-ple, Jones (1999) has developed a simulation for the problem identifica-tion phase of instructional consultation. Students in the second author’sconsultation course are videotaped as they consult with an individualrole-playing a teacher who has referred a child. The students analyzetheir tape and receive feedback before they begin their first case in theschool setting.
Despite the many advantages of tape use, these methods are not usedwith regularity in the training of consultation students. In a survey dis-tributed to instructors and supervisors of consultation students, Antonand Rosenfield (in press) found that most instructors provide individualor small group supervision. However, few instructors require studentsto audio or videotape their consultation sessions on a weekly or bi-weekly basis, and even fewer (less than nine percent) reported that theyactually use the tapes in supervision.
It should be noted that when audio or videotaping is used, it is neces-sary to obtain consent for taping from the consultee. The consulteeshould be informed that the consultant and the supervisor will be listen-ing to the tape. If the tape is shared in a group supervision session, theconsultee should give permission for this to occur, and any clients’
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identities should be protected. Only rarely have teachers refused to al-low their sessions to be taped and reviewed by supervisors.
Use of Other Methods
Other supervision methods useful in consultation supervision areself-report, process notes, and role-plays. The self-report method,which is most frequently used in counseling (Bernard & Goodyear,1998), requires the supervisee to verbally report what transpired dur-ing a session, while process notes require the supervisee systemati-cally to document the case in writing. Although they are “generallyviewed as far less appropriate for novice supervisees” (Bernard &Goodyear, 1998, p. 92), these methods may provide needed challengefor more experienced consultants, as they rely on the ability of the stu-dent to extract relevant information and to accurately interpret whattranspired during a supervision session. As is clear from Alexander’s(1997) developmental model, beginning consultation students are notable to provide such information in supervision, especially in the nov-ice stage.
However, process notes, especially in combination with more obser-vational methods such as audio taping for new consultants, have impor-tant value in order to develop consultants’ ability to self-regulate. Theyfacilitate both reflection on what transpired and on planning for the nextsession, especially if the supervisor influences the type of informationrequired. In instructional consultation, for example, each session’s pro-cess notes are structured according to a specific format (see Figure 1 fora log template). Students can also be asked to transcribe some portion oftheir tapes as part of their process notes, to more clearly focus on someaspect of the consultation session.
Finally, during a supervision session, role-playing can be helpfulin preparing for situations that are expected to be difficult for theconsultant-in-training. Role-plays are useful tools to provide stu-dents with practice bringing up certain topics with their consultee orpresenting their own ideas clearly. For example, a student wanted toask the teacher to take on the responsibility of collecting data to doc-ument the effectiveness of the intervention decided upon. Throughrole-plays the student determined what wording would be most ap-propriate and how to address various potential responses from theteacher.
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Developing a Structured Supervision Plan
A combination of the methods described above can facilitate thegrowth of the novice consultants when they are integrated into a system-atic plan. Each novice consultant can be provided with a set of instruc-tions to plan for supervision that maximize the benefit of thesupervision session itself. Students should tape each session (with, ofcourse, the consent of the consultee), listen to the tape, and provide a setof process notes to the supervisor prior to the session. The tape shouldthen be listened to in full by the supervisor before the supervision ses-sion. This allows both the supervisor and student to come into the super-vision session with an understanding of what transpired in theconsultation session and what issues may need to be addressed.
In order to further facilitate the identification of central issues, it isuseful to ask the student to identify a portion of the tape to play and dis-cuss during the supervision session. This helps the student to beginlearning how to separate out important information and ensures that thetape is actually used during the supervision session. The student shouldunderstand that a portion of the consultation tape will be played duringeach supervision session. During the session, some time will be utilizedto address content issues, especially for novice consultants. Increas-ingly, the focus of supervision will be to develop the student’s skillsthrough discussion of the tape and role-playing alternative solutions orfuture interactions.
Communication Skills
One example of how the structured planning process allows super-vision to focus on skill development involves building communica-tion skills. As students move further into the competence stage, therefinement of communication skills may prove to be an appropriatetopic for supervision. Audiotapes and transcribing may be especiallyuseful in order to ensure that students are communicating clearly.Tapes and transcriptions may be reviewed during the supervision ses-sion in order to compare what the student actually said to what theythought they said. Numerous students have commented on their sur-prise, after transcribing a section of tape, that they had been thinkingsomething very different from what they said. Another fruitful com-parison can be between what the consultee actually said and what thestudent perceived was said. Again, students have commented on the
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mismatch that they have found after careful review of their audiotapesand transcriptions.
Taping and transcribing is also useful when students misperceive thetone they set during a consultation session. In one such case, a studentfelt that she was being too aggressive in presenting her perspective tothe consultee. However, after reviewing the tape with her supervisor,she realized that she was not presenting her perspective strongly, as shecould hardly even be heard on the tape as she attempted to share herthinking with the consultee.
Finally, role-plays are invaluable for practicing specific communica-tion skills that students feel a need to work on. Two communicationskills that frequently require such practice are clarification and summa-rization. Mastery of these skills can ensure that misunderstandings suchas those mentioned previously are minimized.
SUPERVISION OF SCHOOL-BASED PRACTITIONERS
Gravois et al. (2002) stressed the need for practitioners to develop ef-fective consultation skills. Yet, most graduate programs do not providestudents with the range and depth of learning opportunities needed toprogress beyond the novice stage (Hellcamp et al., 1998; Rosenfield, inpress). Consequently, practitioners are lacking the competence in con-
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FIGURE 1. Consultation Log Template
Consultant: Interview Date:Consultee: Referral Date:Client or Issue:________________________________________________________________________Consultation Stage (e.g., Problem Identification)
Describe components of stage completed during the session, with reference to goalsand strategies that were initially planned.________________________________________________________________________Consultant-Teacher Working Relationship________________________________________________________________________Communication Skills
What communication skills were used well or need further attention?________________________________________________________________________Proposed Plan for Next Session
Detailed discussion of goals and strategies for the next session.________________________________________________________________________Request(s) for Feedback During Supervision
This section should include a detailed discussion of the issues you would like tohave discussed during supervision.
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sultation skill to utilize it in the field. It is therefore necessary to developavenues by which practicing professionals can engage in learning activ-ities to further develop their consultation skills. One way to accomplishthis is through distance learning.
Distance Learning to Develop Competence
Gravois et al. (2002) described how distance learning can be used indeveloping the instructional consultation skills of practitioners. Afterparticipants engaged in 20-25 hours of didactic training activities inworkshop format, on-line coaching was provided as participants ap-plied their skills to a consultation case with a teacher in their school. Au-diotapes of each consultation session were sent to a trained coach, whothen provided the participant with feedback via e-mail. Gravois et al.concluded that on-line coaching can be an efficient method for provid-ing coaching to practitioners in locations not convenient to traditionalcampus training programs.
Research evaluating the level of competence acquired during thisprocess is currently in progress. Early program evaluation results (Vail,2002) indicated that consultants coached in instructional consultationby distance learning methods demonstrated growth in skills, especiallyin the problem solving process, which they attributed to the coachingexperience. Less skill growth in communication and curriculum-basedassessment skills was also reported, indicating where additional empha-sis in the coaching process needed to be placed. Further study of theskill development attained through coaching is in process.
Developing Expertise
There is little in the literature concerning how practitioners can moveto the expert stage in consultation, or even what behaviors constitute ex-pertise in consultation. In fact, Crego (1985), while noting the increasein training in doctoral programs, reflected also on the lack of trainingthat is “systemic or extended over developmental stages of trainee com-petence” (p. 474). Post-doctoral intensive supervision in consultationhas not been available; nor have the benefits of peer supervision or peerstudy groups for practitioners been explored with respect to consulta-tion training. While the focus here has been largely in moving from nov-ice to competent, much future work remains to be done on definingexpertise in consultation and providing support for developing expertconsultants.
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RESEARCH ON CONSULTATION SUPERVISION
Along with the need for improved consultation training and supervi-sion, there is a corresponding need for research in the area of consulta-tion supervision. Gorenstein, McKenna, Cramer, and Rosenfield (2002)described the paucity of research on supervision within the school psy-chology literature. Rosenfield (2002) pointed out that investigation isneeded to explore how consultation students move from novice to com-petent to expert. For example, given the expense and time of using tapesof consultation sessions, research is needed to explore the impact of au-dio or videotaping on supervisees’ performance during the consultationsession and on their learning outcomes.
CONCLUSION
A framework for the development of consultation skills has been de-scribed here, along with suggestions for optimizing student growth at eachstage. Students in the novice stage have a fragmented knowledge base andrequire structured supervision sessions in order to gain the skills and confi-dence to move to the competence stage. Having obtained competence, stu-dents become more automatic in their use of strategies and can hold more ofthe responsibility for identifying their own supervision needs.
Several methods of supervision were outlined and strategies to ad-dress the needs of students at various stages of development were dis-cussed. The advantages of audiotape use in the context of a structuredsupervision plan were stressed. In addition, the utility of various super-vision methods throughout the supervision process was illustratedthrough examples gathered from case studies in school settings. Waysto enhance practitioner competence and the development of expertise inconsultation continue to need attention. With additional focus on con-sultation supervision, the contribution of consultation to human ser-vices will be substantially enhanced.
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