Supervision of Counselor Trainees with Clients in Crisis

Article excerpt

Supervision of counselors working in college counseling centers whose clients are in the midst of an immediate mental health crisis is a complex process. This article reviews this neglected subject and makes specific suggestions for supervisors and their supervisees as they work together to provide quality counseling during a crisis episode.

As the college student culture and the pressures students experience become increasingly complex (Ottens & Black, 2000), the important role that college counseling centers play in the crisis intervention process becomes critical (France, 1996). Crisis intervention is especially important due to the reported increase in the number of student clients who present with severe pathology (Erdur-Baker, et al., 2006; Stone & Archer, 1990). University and college counseling centers also serve as training sites for counselors-intraining (Guinee & Ness, 2000). Consequently providing supervision is an essential senior staff function.

Supervising counselors-in-training who are actively and immediately involved with clients who are in the midst of an in-session crisis or mental health emergency is a situation of critical importance. Crisis clients are often experiencing a multiplicity of problems and at times are overwhelmed by their personal situations. Clients such as these may require assistance that a counselor-in-training is not prepared to provide. It is in these situations that immediate supervision is essential.

The general process of supervision is an often written about topic from the theoretical as well as the implementation perspective. However, the specific issue of providing supervision for the counselor-intraining who is in the midst of providing service to a client fully involved in a mental health emergency is not addressed in the supervision or crisis intervention literature (Peake, Nussbaum, & Tindell, (2002).

One of the difficulties in supervisory crisis management is that clinical supervisors rarely have direct and detailed knowledge of their supervisees' clients (Falvey, 2002). While national standards recommend direct knowledge of clients (e.g. Association of State and Provincial Psychology Boards [ASPPB], 2005, Association for Counselor Education and Supervision [ACES], 1990) research suggests that this seldom occurs in the field (Borders, Cashwell, St Rotter, 1995; McCarthy, Kalakowski, & Kenfield, 1994; Navin, Beamish, & Johanson, 1995). McKenzie, Atkinson, Quinn, and Heath (1986) found that 61% of 550 supervisors based their supervision on only the written notes of the supervisee. Falvey (2002) noted that self-report by supervisees remain the major method of reviewing cases.

During a crisis situation, this lack of knowledge may present a serious liability issue (Falvey, 2002). When a crisis situation occurs, the traditional model of the supervisory hour which occurs at a leisurely pace sometime after a given counselor-client interchange is neither appropriate nor possible (Alonso & Shapiro, 1992). Yet virtually all of the supervision literature is written from the perspective that supervision is delivered after a given counseling session.

Clear guidelines of either how to deal with the client in crisis or how to supervise the crisis session are not described in professional standards of care and training (Bradley, Kottler, &c Lehrman-Waterman, 2001; Engels 8c Dameron, 1990). Also, this dilemma has not been adequately addressed by ethical codes or standards of conduct.

Yet supervision has become a concern of state licensing boards. A summary of disciplinary actions taken by the ASPPB reports that inadequate or improper supervision ranked fifth in frequency of violations (Reeves, 1998). One state licensing board of psychology found that the largest category of complaints filed (23%) dealt with supervision issues, including inadequate overview of supervisee's clinical performance (Montgomery, Cupit, & Wimberly, 1999). …