Clinical Supervision: Skill Building and Empowering Supervisees

Counselors-in-Training Developmental Model (CTD)
According to Stolenberg & Delworth, (1987) there are three stages of counselor development: (a) dependency, (b) trial and turbulence, and (c) growth. The CTD model explains the developmental process of counselors-in-training and the subsequent attempts to restore equilibrium. Figure 1 displays the CTD model. Counselors-in-training progress through the stages by evaluating three overriding structures of: autonomy, motivation and self, and awareness. In the cyclical process to restore cognitive consistency; affect, meanings and motivations emanate. Counselors-in-training cycle through self-focus layered with increased levels of anxieties, fears and uncertainties to client emotional and cognitive focus. The cycle occurs as a result of counselors-in-training reliance on others, cognitive heuristics and social comparison to provide structure to information from the counseling experience. Consequently, counselors-in-training with the capacity to organize, elaborate on and evaluate the information to which they are exposed are able to move back and forth from his/her emotional and cognitive responses to the client's emotional and cognitive responses. Ultimately, supervisor roles are encouraged by the behavior of counselors-in-training.

Counselors-in-Training Stage Development
Stage 1 (Dependency). Stages I counselors-in-training are highly motivated. They lack basic counseling skills but have a strong desire to perform effectively. Their focus is on how to perform a skill. The emphasis of skill mastery evokes performance anxiety or apprehension to perform intervention. This apprehension is representative of cognitive self-focus. Autonomy at this stage is absent but dependency is extreme. For example, counselors-in-training begin at a level of over-reliance on assessment instruments and as they develop counselors-in-training grow to critically assimilate and accommodate the use of assessment instruments.

Stage II (Trial and Turbulence). Stage II counselors-in-training vacillate from high to low motivation because of the theory-to-practice chasm. The break in cognitive structure causes performance anxiety which is the impetus for counselors-in-training to function by received knowledge driven by external expertise--the supervisor. As counselors-in-training move into stage II of their supervision experience, the dynamics shift. Supervisors focus on the interpersonal and intrapersonal aspects that direct the counselor-in-training to take on the role of counselor.

Stage III (Growth). Stages III counselors-in-training are highly motivated because of learned skills and acquired knowledge. Counselors-in-training are driven by internal expertise. The supervisor is no longer viewed as all truth and accurate. The supervisor's view becomes a part of counselors-in-training cognitive schema.

The supervisor also assumes one of three essential roles in counseling supervision process (Bernard & Goodyear 1979, 1997). The most prominent is teaching counselors-in-training basic counseling skills. The role of teacher is the most directive. As teacher, the supervisor assumes no responsibility for what counselors-in-training do and what adjustments are needed by counselors to enhance skill development. Second is the counselor, a role that consists of assisting counselors-in-training with personal adjustment and/or developmental problems that require attention. The third role involves supporting and enhancing counselors-in-training skill efficacy through consultation. In this role, supervisors are viewed as a resource.

Assimilation/Accommodation Process within Supervision
Self efficacy and the readiness levels of counselors-in-training are usually determined by their ability to successfully assimilate or accommodate new data into present schemata. Thou there are typical needs operating in each level, there are various exceptions.

Dependency
Counselor skill development appears to be in a hierarchy.  Ronnestad & Skovholt (1993) stated that counselors-in-training and entry level counselors enter counseling sessions dependent on the assistance of their supervisors. The dependency stage of skill competency requires teaching fundamentals of counseling by supervisors that is consistent with the "discrimination model" of Bernard (1979). Supervisors must be cognizant of their didactic role of teaching counseling skills and techniques (Hart, 1994; Worthington, 1987). For example, with counselors-in-training, supervisors explain the rationale for counseling strategies and interventions used in counseling, assist with case conceptualization, evaluate counseling sessions, model intervention techniques and instruct (Hart, 1994; Stolenberg & Delworth, 1987).

Counselors-in-training in the dependency stage may over assimilate information received from clients; fitting most information received into preconceived notions about the client's condition. As mentioned before, conceptualization follows from the stage I counselor-in-training-centered focus. On the other hand, counselors-in-training may over accommodate for any information received from supervisors, abandoning any preconceived assumptions about clients and replace all assumptions about the client with the voice of supervisors.

Trial and Turbulence
As illustrated in Figure 1.1, once counselors-in-training self efficacy level is enhanced (in form of equilibrium within the person), and the desire for autonomy emerges they are then able to trust their basic counseling skills. The desire for autonomy is sometimes garnered by opposition towards the supervisor (Bernard & Goodyear, 1992; Bradly & Gould, 1994; and Ronnestad & Skovholt, 1993). It is typical for counselors-in-training to become combatant with supervisors as the need for autonomy grows.

According to Liddle (1986) counselors-in-training develop resistant behaviors to protect self from perceived inadequacy. During the antagonistic phase of stage II, the supervisor must affirm counselors-in-training competency and respond collegially and therapeutically (Worthington, 1987; Hart, 1994). The challenge for supervisors is to effectively facilitate counselors-in-training to process their emotions and defenses and their resistant to addressing their own issues in supervision. From clarification of emotions and defenses counselors-in-training are able to establish meaning from their behavior that evokes equilibrium which allows the trainee to move toward the next stage.

Stage II counselors-in-training are typically more likely to over accommodate for information received by clients as part of their tendency to overly focus on their client's development. On the other hand, they may maintain overly tight assimilation with their supervisors, often finding it difficult to adjust or restructure their present assimilation to accommodate any new information.

Growth
As counselors-in-training discern their new sense of self, procure control of the counseling sessions, are able to conceptualize, can process a case and personalization, their interactions with the supervisor become collegial and the supervisor becomes more of a consultant, as shown in Figure 1.1 (Ronnestad & Skovholt, 1993). At the Growth Stage supervisors explore issues related to theoretical orientation, use of techniques, and personal style. The new collegial relationship between counselors-in-training and supervisors allows the supervisor to acknowledge, encourage and/or reflect on counselors'-in-training thoughts and concerns (Worthington, 1987; Hart, 1994).

Stage III counselors-in-training are distinguished by their ability to find a balance between assimilation and accommodation, with both clients and supervisors. The assimilation-accommodation concept becomes more fluid and flexible as counselors-in-training acquire confidence and progress towards increasing independence and a more collaborative/consulting relationship with the supervisor. A state of equilibration is reached, characterized by a period of acceptance of responsibility for one's behavior (Stolenberg & Delworth, 1987; Ronnestad & Skovholt, 1993; Hess, 1986; Bear, 1994). This level of development is less a need for skill competency. Thus during stage III is the desire to maximize counseling efficacy. As noted previously, counselors-in-training progress through three stages. Each stage builds on successful assimilation and/or accommodation of the preceding stage. The stages are not mutually exclusive. Many counselor 's-in-training vacillate between stages. However, as counselors-in-training skill efficacy increases the stage shift becomes less cyclical.

Conclusion
The role of a supervisor may fluctuate from teacher to consultant as the rhythm of the environment dictates with counselors-in-training and entry level counselors to facilitate counseling competency as illustrated in Figure 1.2. The Supervision Conceptual Model shows that as counselors-in-training enhance cognition their readiness and efficacy levels increase. The Readiness Assimilation Accommodation Hierarchy Theory is not an all encompassing framework for counseling supervision, but rather a conceptualization pillar that may be useful in predicting readiness and self efficacy of counselors-in-training on a high or low probability basis. This theory prepares supervisors for the challenges of supervision. Consequently, further empirical studies are now needed to examine the reliability and validity of the theory.
- Thompson, Jill; A Readiness Hierarchy Theory of Counselor-in-Training; Journal of Instructional Psychology, Jun2004, Vol. 31, Issue 2.

Personal Reflection Exercise #9
The preceding section contained information about the hierarchy theory of counselor-in-training. Write three case study examples regarding how you might use the content of this section in your practice.

Update
Effect of deliberate practice training of graduate students in general
psychotherapeutic skills compared with theoretical teaching:
protocol for the randomised controlled TRIPS trial

- Østergård, O. K., Nielsen, J., Hjorthøj, C., Nilsson, K. K., & Poulsen, S. B. (2022). Effect of deliberate practice training of graduate students in general psychotherapeutic skills compared with theoretical teaching: protocol for the randomised controlled TRIPS trial. BMJ open, 12(9), e062506. https://doi.org/10.1136/bmjopen-2022-062506

Peer-Reviewed Journal Article References:
Gibson, A. S., Ellis, M. V., & Friedlander, M. L. (2019). Toward a nuanced understanding of nondisclosure in psychotherapy supervision. Journal of Counseling Psychology, 66(1), 114–121.

Johnson, E. A. (2019). Recommendations to enhance psychotherapy supervision in psychology. Canadian Psychology/Psychologie canadienne, 60(4), 290–301.

Latorre, C., Leppma, M., Platt, L. F., Shook, N., & Daniels, J. (2021). The relationship between mindfulness and self-compassion for self-assessed competency and self-efficacy of psychologists-in-training. Training and Education in Professional Psychology.

Newman, D. S., Hazel, C. E., Faler, A., & Pomerantz, L. (2021). Supervision training in APA-accredited school psychology doctoral programs: An analysis of syllabi. Training and Education in Professional Psychology, 15(3), 176–188.

Norcross, J. C., Sayette, M. A., & Martin-Wagar, C. A. (2021). Doctoral training in counseling psychology: Analyses of 20-year trends, differences across the practice-research continuum, and comparisons with clinical psychology. Training and Education in Professional Psychology, 15(3), 167–175.

Online Continuing Education QUESTION 34
According to Stolenberg & Delworth, what are the three stages of counselor development? Record the letter of the correct answer the CE Test.