detailed notes- individual counseling_printed

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Introduction The professionalization of counseling in the past two decades in Britain and Europe has seen increasing attention being devoted to the provision of training and supervision. In North America this process occurred largely during the 1950s. The requirement of professional accountability, and the existence and growing influence of professional associations, have forced colleges, agencies and training institutes to formalize arrangements for training and supervising counselors. In Britain, for example, the first university-based counselor training courses began operation only in 1966. In 1986 the British Association for Counseling produced its first criteria and procedures for approving counseling courses, and in 1992 the British Psychological Society published similar guidelines for courses in counseling psychology. Despite this growth in numbers of courses, relatively little research has been carried out that would assist counseling trainers and tutors in their work. Counselor training remains, curiously, an underdeveloped area for research and scholarship. Even the knowledge that tutors and trainers have gained through personal and professional experience is seldom written up for publication. Supervision An important element in counselor development, not only during training but also throughout the working life of the counselor, is the use of effective and appropriate supervision. It is a requirement of most professional associations that counselors accredited by them should receive regular supervision from a qualified person. In this context, it is necessary to emphasize that supervision has a different meaning from that in other work settings. Supervision in counseling is not primarily a management role in which the supervisee is given directions and allocated tasks, but is aimed at assisting the counselor to work as effectively as possible with the client (Carroll 1988). The supervision role in counseling is similar to that of the tutor or consultant. Hawkins and Shohet (1989) have identified three main functions of supervision in counseling. The first is educational, with the aim of giving the counselor a regular opportunity to receive feedback, develop new understandings and receive information. The second aspect is the supportive role of supervision, through which the counselor can share dilemmas, be validated in his or her work performance and deal with any personal distress or counter-transference evoked by clients. Finally, there is a management dimension to supervision, in ensuring quality of work and helping the counselor to plan work and utilize resources. There are a number of different formats for providing supervision (Hawkins and Shohet 1989). Probably the most common arrangement is to make a contract for individual sessions over a period of time with the same person. A variant on this approach is to use separate consultants to explore specific issues: for example, going to an expert in family work to discuss a client with family problems, and using a mental health counselor for consultation on a client who is depressed (Kaslow 1986). Another possibility is group supervision, where a small group of supervisees meet with a supervisor. The case discussion group is a type of group supervision that gives particular attention to understanding the personality or family dynamics of the client. Peer supervision groups involve a group of counselors meeting to engage in supervision of each other, without there being a designated

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Page 1: Detailed Notes- Individual Counseling_printed

Introduction

The professionalization of counseling in the past two decades in Britain and Europe has seenincreasing attention being devoted to the provision of training and supervision. In North Americathis process occurred largely during the 1950s. The requirement of professional accountability,and the existence and growing influence of professional associations, have forced colleges,agencies and training institutes to formalize arrangements for training and supervisingcounselors. In Britain, for example, the first university-based counselor training courses beganoperation only in 1966. In 1986 the British Association for Counseling produced its first criteriaand procedures for approving counseling courses, and in 1992 the British Psychological Societypublished similar guidelines for courses in counseling psychology. Despite this growth innumbers of courses, relatively little research has been carried out that would assist counselingtrainers and tutors in their work. Counselor training remains, curiously, an underdeveloped areafor research and scholarship. Even the knowledge that tutors and trainers have gained throughpersonal and professional experience is seldom written up for publication.

Supervision

An important element in counselor development, not only during training but also throughout theworking life of the counselor, is the use of effective and appropriate supervision. It is arequirement of most professional associations that counselors accredited by them should receiveregular supervision from a qualified person. In this context, it is necessary to emphasize thatsupervision has a different meaning from that in other work settings. Supervision in counseling isnot primarily a management role in which the supervisee is given directions and allocated tasks,but is aimed at assisting the counselor to work as effectively as possible with the client (Carroll1988). The supervision role in counseling is similar to that of the tutor or consultant. Hawkinsand Shohet (1989) have identified three main functions of supervision in counseling. The first iseducational, with the aim of giving the counselor a regular opportunity to receive feedback,develop new understandings and receive information. The second aspect is the supportive role ofsupervision, through which the counselor can share dilemmas, be validated in his or her workperformance and deal with any personal distress or counter-transference evoked by clients.Finally, there is a management dimension to supervision, in ensuring quality of work and helpingthe counselor to plan work and utilize resources. There are a number of different formats forproviding supervision (Hawkins and Shohet 1989). Probably the most common arrangement is tomake a contract for individual sessions over a period of time with the same person. A variant onthis approach is to use separate consultants to explore specific issues: for example, going to anexpert in family work to discuss a client with family problems, and using a mental healthcounselor for consultation on a client who is depressed (Kaslow 1986). Another possibility isgroup supervision, where a small group of supervisees meet with a supervisor. The casediscussion group is a type of group supervision that gives particular attention to understandingthe personality or family dynamics of the client. Peer supervision groups involve a group ofcounselors meeting to engage in supervision of each other, without there being a designated

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leader or consultant. Finally, supervision networks (Houston 1990) consist of a set of colleagueswho are available for mutual or peer supervision, on either a one-to-one or a small group basis.Each of these modes of supervision has its advantages and disadvantages. Regular individualsupervision facilitates the development of a good working relationship between supervisor andsupervised. On the other hand, specific consultants will have a greater depth of experience inparticular areas. Group and peer group supervision enable the counselor to learn from the casesand issues presented by colleagues. In these supervision settings, however, there may beproblems in maintaining confidentiality and in dealing with the dynamics of the group. Thechoice of mode of supervision depends on a wide range of factors, including personal preference,cost, availability, agency policy and organization, and counseling philosophy. The supervisionprocess is highly dependent on the quality of information that supervisees bring to thesupervision setting. Most often, the supervisee will report what he or she has been doing withclients, using notes taken after counseling sessions to augment his or her recollection. Drydenand Thorne (1991) argue that, if the focus of the supervision is to be on the skills employed bythe counselor, the supervisor needs ‘actual data’ from sessions. These data can be obtained fromdetailed process notes written immediately after a session, and video or audio-tapes of sessions.In some situations supervisors may even be able to make live observations of the superviseeworking with a client. One of the principal dilemmas in supervision is deciding on what it wouldbe helpful to discuss. Potentially, the supervisee might need to explore his or her understandingof the client, the feelings he or she holds in reaction to the client, the appropriateness of differentinterventions or techniques and many other topics. Hawkins and Shohet (1989, 2000) haveconstructed a model of the supervision process that usefully clarifies some of these issues.

They suggest that at any time in supervision there are six levels operating:

1 Reflection on the content of the counseling session. The focus here is on the client, what isbeing said, how different parts of the life of the client fit together and what the client wants fromcounseling.

2 Exploration of the techniques and strategies used by the counselor. This level is concerned withthe therapeutic intentions of the counselor, and the approach he or she is taking to helping theclient.

3 Exploration of the therapeutic relationship. The aim at this level is to examine the ways inwhich the client and counselor interact, and whether they have established a functioning workingalliance.

4 The feelings of the counselor towards the client. In this area of supervision the intention is toidentify and understand the counter-transference reactions of the counselor, or the personalissues that have been re-stimulated through contact with the client.

5 What is happening here and now between supervisor and supervisee. The relationship inthe supervision session may exhibit similar features to the relationship between the counselor

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and his or her client. Paying attention to this ‘parallel process’ (McNeill and Worthen 1989) cangive valuable insights.

6 The counter-transference of the supervisor. The feelings of the supervisor in response to thesupervisee may also provide a guide to some of the ways of seeing the cases that are not yetconsciously articulated by supervisor or supervisee, as well as contributing to an understandingof the quality of the supervisor– supervisee relationship. Hawkins and Shohet (1989, 2000) arguethat good supervision will involve movement between all these levels. Supervisors tend to have apersonal style of supervision in which they stick mainly to a particular set of levels, and themodel can be used as a framework for both supervisors and supervisees to reflect on their worktogether and if necessary to negotiate change. The Hawkins and Shohet model has been widelyused in training, but has not yet generated research. An approach that can be used to complementthe Hawkins and Shohet framework is the ‘cyclical model’ developed by Page and Wosket(2001). The cyclical model pays particular attention to the creation of a ‘reflective space’ inwhich the supervisee can explore dilemmas arising from his or her work, and to the crucial taskof applying supervision insights in practice.

Page and Wosket (2001) suggest that the work of supervision can be divided into five stages:

Stage 1: Establishing a contract. The counselor and supervisor negotiate such matters asground rules, boundaries, accountability, mutual expectations and the nature of their relationship.

Stage 2: Agreeing a focus. An issue is identified for exploration, and the counselor’s objectivesand priorities in relation to the issue are specified.

Stage 3: Making a space. Entering into a process of reflection, exploration, understanding andinsight around the focal issue.

Stage 4: The ‘bridge’ – making the link between supervision and practice. Consolidation, goalsetting and action planning in order to decide how what is to be learned can be taken back intothe counseling arena.

Stage 5: Review and evaluation. Supervisor and counselor assess the usefulness of the workthey have done, and enter a phase of recontracting.

Page and Wosket (2001) emphasize that this series of stages is cyclical, with each completion ofthe cycle leading to a strengthening of the counselor– supervisor relationship, and concludingwith the negotiation of a new contract. An appreciation of the different levels at which learningin supervision may occur, as specified by Hawkins and Shohet (1989, 2000), can inform theawareness of counselor and supervisor at all stages of this cycle. The Hawkins and Shohet (1989,2000) and Page and Wosket (2001) models primarily focus on what happens within a singlesupervision setting. There are also processes in supervision that occur over a much longer time-span, which concern the ways in which the stage of development of the counselor can have an

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impact on the counseling process. Counselors of different degrees of experience and maturityhave different supervision needs, and numerous models have been devised to portray thisdevelopmental track (see Hess 1980 or Stoltenberg and Delworth 1987 for a review of theseideas).

One such model is the six-stage model of development of professional identity constructed byFriedman and Kaslow (1986). The stages, which may take several years to pass through, aredescribed as:

1 Excitement and anticipatory anxiety. This phase describes the period before the counselorhas seen his or her first client. The task of the supervisor is to provide security and guidance.

2 Dependency and identification. The second stage commences as soon as the counselor beginswork with clients. The lack of confidence, skill and knowledge in the counselor results in a highdegree of dependency on the supervisor, who is perceived as having all the answers. The traineecounselor at this stage will use the supervisor as a model. However, anxiety about being seen asincompetent may lead the supervisee to conceal information from the supervisor. The personalityand dynamics of the client, rather than the therapeutic relationship or counter-transference, is themost common focus of supervision at this stage, reflecting the lack of confidence and awarenessof the counselor in exploring his or her own contribution to the therapeutic process.

3 Activity and continued dependency. This phase of development is triggered by therealization of the counselor that he or she is actually making a difference to clients. Thisrecognition enables the counselor to be more active with clients, and to try out differentstrategies and techniques. The counselor is beginning to be more open to his or her own feelingresponse to clients, and may discuss counseling issues with colleagues and family members as ameans of ‘spilling affect’ (Friedman and Kaslow 1986: 38). In this burst of enthusiasm fortherapy, the counselor may experiment by applying therapeutic skills and concepts to friends andfamily members. The primary task of the supervisor at this stage is to be able to accept the needsfor dependency as well as active autonomy, and to allow the counselor to explore differentoptions.

4 Exuberance and taking charge. Friedman and Kaslow (1986: 40) write that ‘the fourth phaseof development is ushered in by the trainee’s realization that he or she really is a therapist.’Having acquired considerable experience in working with clients, having read widely in the fieldand probably having embarked on personal therapy, the counselor is actively makingconnections between theory and practice, and beginning to identify with one theoreticalperspective rather than trying out diverse ideas and systems. In supervision, there is a willingnessto explore counter-transference issues and to discuss theoretical models. The counselor no longerneeds as much support and warmth in supervision, and is ready for a higher degree of challenge.In becoming less dependent on the supervisor, the counselor comes to view the latter more as aconsultant than as a teacher.

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5 Identity and independence. This is described as the stage of ‘professional adolescence’. Inbeginning to envisage life without the protection and guidance of the supervisor, the counselorbecomes more willing and able to express differences of opinion. Counselors at this stage ofdevelopment are often attracted to peer supervision with others at a similar stage. The superviseehas by this time internalized a frame of reference for evaluating client work, and is in a positionto accept or reject the advice or suggestions of the supervisor. The counselor may be aware ofareas in which his or her expertise exceeds that of the supervisor. It is necessary for thesupervisor at this stage to remain available to the counselor, and to accept a lack of control.

6 Calm and collegiality. By this stage the counselor has acquired a firm sense of professionalidentity and belief in his or her competence. The counselor is able to take a balanced view of thestrengths and weaknesses of different approaches to therapy, and is able to use peers andsupervisors as consultants, ‘from a spirit of genuine respect among colleagues’ (Friedman andKaslow 1986: 45). At this stage counselors begin to take an interest in taking on the supervisorrole. The process involved in the formation of a professional identity has the consequence thatthe focus of supervision can be qualitatively different at succeeding stages. It is helpful for bothsupervisors and supervisees to be aware that this kind of developmental sequence can take place,and to adjust their behaviour and expectations accordingly.

Throughout this account of the supervision process, it can be observed that the quality of therelationship between supervisor and supervisee is of paramount importance (Shohet and Wilmot1991). Charny (1986: 20) has written that ‘the greatest possibilities of growth in supervision . . .[lie] in tapping candidly just what is going on in the heart, mind and body of a therapist inrelation to a given case.’ He adds that, for him, the most valuable question in supervision is:‘what about this case really worries me?’ To undertake this kind of open exploration of self inrelation to the client requires the same degree of emotional safety and the same ‘core conditions’that are offered to clients. As in counseling, the freedom to choose an appropriate helper isvaluable, as is the freedom to terminate. The sensitivity to relationship issues that is found inmuch effective supervision can also lead to the danger of straying over the boundary thatseparates supervision from actual therapy. The role of supervision in counselor training andongoing development is, therefore, closely linked to issues of how and when to structurecounselor personal therapy or work on self. There is also an increasing appreciation that,although counseling supervision consists primarily of a secure, confidential relationship betweena supervisor and an individual counselor (or group of counselors), the organizational contextwithin which supervision takes place can have a profound influence on the quality and nature ofwhat takes place. For example, a supervisor may have responsibility to report to the counselingagency management on the competence or effectiveness of the counselor, or to ensure that thecounselor complies with agency regulations around risk assessment or the number of counselingsessions that can be offered. Further discussion of the issues associated with the interplaybetween supervisor, counselor and the organization which employs (and manages) them both canbe found in Hawkins and Shohet (2000) and Copeland (2000). The requirement to engage in

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regular supervision has become one of the cornerstones of the commitment to the provision ofquality therapy services in Britain. In other countries, supervision may be mandatory duringtraining, with regular ‘consultation’ required following completion of training. Although theprecise regulatory arrangements may differ in countries and within different professional groups,there can be no denying the immense commitment of time and energy that is currently devoted tosupervision within the therapy professions. Recently, however, an increasing number ofquestions have been asked about the value of mandatory supervision. Critics have argued thatsupervision has the potential to be counterproductive in some circumstances (see Box 20.1).

Training and supervision in counseling: some conclusions

The development of theory and research into the practice of counseling and psychotherapy hasnot been matched by equivalent critical attention to the problems of training and supervision.Few studies have been carried out on the evaluation of the effects of training programmes. Majorquestions remain unanswered concerning methods of addressing ethical and multiculturalperspectives in training. The implications for training of the movement towards integrationistand eclectic approaches are only beginning to be addressed. The relevance for counselingpractice of research training or the adoption of a ‘scientist practitioner’ model has not been fullyinvestigated. There are few courses for training trainers and supervisors. The specific trainingand supervision needs of non-professional or volunteer counselors have not been assessed. Thereis, therefore, room for a great deal of additional theory and research in this area. On the otherhand, it is possible to assert with some confidence that the core elements of counselor trainingand education are known, or are believed to be known. Competent counselors are able to makeuse of accurate self-awareness, knowledge of theoretical models and a range of counseling skills.