Using Cognitive Interventions with Counseling Practicum Students during Group Supervision. (Innovative Methods)
Fitch, Trey J., Marshall, Jennifer L., Counselor Education and Supervision
The authors argue that students in counseling practicum courses experience many self-defeating thoughts and anxieties. These worries can impede their performance as new counselors and can have a negative impact on the supervision process. The authors outline innovative methods used by cognitive therapists to address this anxiety. In addition, a model is presented for counselor educators to use cognitive restructuring techniques as a supervision tool.
First-year practicum students often indicate that they have many fears and worries about their initial counseling experiences (Bernard & Goodyear, 1992). If this anxiety becomes excessive, it can impede the skills development of the practicum student and impair his or her functioning as a counselor. When excessive anxiety lingers past the practicum experience, counselors might become at risk for burnout. The ability to handle the anxiety and stress related to practicum and initial counseling experiences is a crucial skill that is needed by practicum students. Cognitive therapists (Beck & Emery, 1985; Ellis & Grieger, 1986) identified interventions that can be used to alleviate stress and anxiety problems. These techniques can be used effectively with practicum students (Dodge, 1982). The purpose of this article is to outline an innovative strategy for identifying practicum students' common self-defeating thoughts and to provide cognitive intervention strategies for addressing these thoughts.
Anxiety in Supervision
Bernard and Goodyear (1992) identified personalization skills as a major area of development for counselors. Personalization skills relate to the personality and emotional traits of the counselor. Being patient with resistant clients and managing anger if clients are confrontational are examples of personalization skills. The ability to manage and to cope with anxiety is another personalization skill. Counselors need to learn how to keep their own personal issues (e.g., performance anxiety) from interfering with the counseling relationship. This can be achieved by applying the principles of cognitive therapy in the training of counseling practicum students. The supervisor is not acting as the practicum student's therapeutic agent but is instead simply working on ways of managing the cognitive stressors that are related to training.
Bernard and Goodyear (1992) suggested that anxiety is pervasive among both supervisors and supervisees. They reported that there is no apparent need to avoid anxiety altogether, especially because moderate levels of anxiety probably improve counselor performance (p. 176). However, unchecked anxiety can negatively influence the counselor's speech rates, the accuracy of his or her perceptions, and his or her ability to provide appropriate affective feedback. Bernard and Goodyear also noted that anxiety can lead the supervisee to play supervision games that distort and impede supervision. For example, an anxious practicum student might be too critical of his or her performance in the hope that the supervisor will give only positive feedback. If supervisors can find effective ways to combat anxiety early in the process, the need for such games diminishes.
A distinction must be made, however, between irrational self-criticism and realistic self-appraisal. A practicum student may experience anxiety because he or she is actually ineffective with clients. In such cases, the anxiety is warranted and is a warning that supervisees need to change their behavior. Practicum supervisors need to address these worries with a clear remedial plan and increased supervision. Cognitive interventions would not be appropriate in these instances.
Neophyte counselors are rarely able to avoid anxiety during early counseling sessions (Yager & Beck, 1985). The anxiety involved in demonstrating counseling skills stems from rational and irrational beliefs about the counseling process, uncertainty about necessary skills, and anxiety related to the change process. Yager and Beck stated that the effects of practicum anxiety may interfere with counseling effectiveness, ability for recall in sessions, and supervisory relationships. Resistance may be used by new counselors to counteract their fears of criticism and evaluation. It seems that addressing this anxiety is a major step toward successful counselor development (Bradley, 1989).
There are multiple sources of anxiety for the counseling practicum student (Liddle, 1986). First, evaluation anxiety is evident in supervision settings. Evaluation anxiety can also be fostered in the academic climate of high achievement (Ronnestad & Skovholt, 1993). Students who are accustomed to academic success may struggle when a course focuses on performance skills rather than content knowledge. For many, this shift in orientation can be a threatening experience. Second, performance anxiety also threatens a counselor trainee's sense of competence and ability. Students often have an unrealistic sense of the counseling process, and they tend to set high expectations despite their lack of experience (Liddle, 1986). Studies on the impact of anxiety (Skovholt & Ronnestad, 1992a, 1992b) showed that intense anxiety existed among graduate students in counseling. Interviews with senior practitioners revealed that they experienced a high degree of anxiety as student counselors. The respondents who were currently students, however, did not report this anxiety. This discrepancy might have been influenced by the current students' fear of acknowledging insecurity and the students' need to maintain a feeling of competence.
Third, counselors' own personal issues can surface during the practicum experience. For example, a student with a high need for approval might be afraid of appropriately challenging and confronting clients. The student has learned how to compensate for this tendency in his or her personal life but now must address the issue in supervision. Addressing a personal weakness in an already threatening process can be a source of tension for the practicum student. Fourth, the fear of trying new techniques or dealing with client anger frequently scares practicum students. During practicum, students must be open to trying new strategies, with no guarantee of success. This requires a sense of self-confidence. Without this confidence, they are likely to gravitate toward safe harbors and avoid positive learning experiences (Liddle, 1986).
Supervisors need to understand the effects of anxiety during practicum. They also need to be prepared to help supervisees learn to manage and reduce their anxiety levels. When using cognitive strategies or other techniques, practicum supervisors must be careful to avoid dual relationships. In using such approaches to help supervisees reduce anxiety, supervisors are not counseling their students. Rather, they are helping supervisees learn about interpersonal factors that might affect their performance during the counseling process. Supervisors can help avoid dual relationships by teaching and applying these techniques in a group setting.
Many authors have emphasized the influence that cognition has on affect and behavior (Beck, Rush, Shaw, & Emery, 1979; Ellis & Grieger, 1986; Meichenbaum, 1977). Cognitive therapists attempt to identify maladaptive cognition and thought patterns, challenge and dispute these thoughts, and delineate alternatives to the maladaptive cognition. This approach has been widely accepted as the treatment of choice for anxiety disorders and depression (Beck et al., 1979). Therefore, this approach is well suited for addressing the anxiety of practicum students. More recent research also showed that cognitive interventions were highly effective in relieving anxiety (Borkovec & Costello, 1995; Mitchell, 1999). For example, Mitchell studied the effects of medication alone versus medication combined with cognitive-behavioral group therapy in the treatment of panic disorder. Members of the medication plus therapy group had lower posttest anxiety scores than did those who received medication alone (Mitchell, 1999, pp. 188-201). However, this study may not be generalized to a nonclinical population, nor does it support the use of cognitive therapy without medication. Borkovec and Costello compared treatments for generalized anxiety disorder. Ten different rating instruments showed that cognitive-behavioral treatment was effective in treating anxiety.
Cognitive therapists use different methods for achieving the same results. Beck and Emery (1985) stated that people with anxiety problems have a pattern of negativistic thinking. They reported that the manner in which such individuals perceive information is skewed toward defeat, helplessness, and lack of hope. These reoccurring themes are prevalent in the thinking of some practicum students. Ellis and Grieger (1986) emphasized the presence of specific irrational thoughts such as "I must be liked by everyone" or "I must be perfect." These themes are seen in practicum students when they believe that all of their students or clients must love them. They also tend not to allow themselves room for error. Meichenbaum (1985) focused on the tracking skills (i.e., the ability to mentally gauge patterns of thought) needed by people with anxiety problems to help identify their self-defeating thoughts. By tracking these thoughts, practicum students can identify their damaging thoughts and actively replace them with more reasonable, productive ones.
Cognitive Interventions With Practicum Students
Cognitive therapy techniques have been used in counselor supervision (Dodge, 1982). Dodge outlined the following steps for using cognitive strategies in supervision: (a) identifying and accepting counselors' anxiety and related defensive reactions, (b) identifying cognitive patterns regarding approval and performance demands, (c) challenging and disputing these irrational beliefs, (d) constructing more rational and logical thoughts, and (e) taking behavioral risks that support the soundness of the logical arguments. Specific thoughts that elicit a strong emotional reaction are termed "hot thoughts" (Padesky & Greenberger, 1995). Each approach to cognitive interventions includes the need to identify hot thoughts. Counselor educators constantly hear recurring themes of hot thoughts. For example, anxiety about being taped during a counseling session is a common worry for practicum students. If counselor educators can anticipate or identify these anxieties early in the course, then they can remove those barriers to performance quickly and efficiently.
To help identify common self-defeating thoughts during practicum, students in one counselor education program, over a 2-year period, were asked to identify specific anxieties they had in the practicum course and to write specific anxiety-related thoughts. This was done in a 1st-year practicum class. These hot thoughts were collected by the practicum instructor in order to anticipate common anxieties. The hot thoughts were identified and placed in thematic groups (see Table 1). Examples of the thoughts included "I do not have time to complete my hours," and "I am worried how I will sound on tape."
Once the self-defeating, anxiety-producing thoughts were identified, the counselor educator used several techniques during group supervision to reduce the tension. Although the techniques can also be used in individual supervision, doing so is more likely to lead to dual relationship issues. Using Ellis and Grieger's (1986) ABCDE (activating event, belief about the event, consequence of belief, disputing belief, and new effect) model, the practicum students disputed irrational thoughts about their class. They were given examples of self-defeating thoughts and then discussed possible disputes to this belief. One popular dispute was to think of all of the graduates before them who had completed the requirements. Basically, it was an "if they can do it, I can do it" belief. Going through this process not only helped the practicum students improve their coping skills, it also modeled cognitive therapy interventions.
The stress inoculation technique (Meichenbaum, 1985) was also applied in practicum settings. A practicum student experienced disabling anxiety about listening to a taped session in class. The instructor went through the process of conceptualizing the problem (fear of hearing tapes), skill acquisition (calming self-talk), and then application (using techniques before class began). Identifying specific positive self-statements was a crucial element of this approach. The statements had to be easy to remember and powerful enough to counter the hot thought. The counselor educator facilitated this process by having a list of self-statements available. For example, by using the statements listed in Table 1, the counselor educator asked the student to identify the applicable thought. The supervisor used the "thoughts list" to help the student confront these fears.
Beck and Emery's (1985) collaborative empiricism was also applied to reduce the practicum student's anxiety. When practicum students were asked to identify anxiety provoking thoughts and then questioned on the evidence supporting and not supporting the thought, they thought of ways to test their beliefs. For example, one student stated that she was fearful that committing time to practicum would ruin her teaching performance. She was asked if anyone had commented negatively on her performance since she started practicum. The answer was "no." She was asked to give specific examples showing that her teaching had been compromised. She reported that she showed more videos than usual, which the students actually preferred, and that students' test grades were not negatively affected by this approach. She admitted that the pressure came from herself and not from outside sources. The conclusion was that if the students' class grades were not affected and if she had received no complaints, then she could allow herself not to feel guilty about time that was redirected toward practicum.
One effective way to begin these interventions is to review cognitive therapy during group supervision and then to discuss some of the common hot thoughts listed in Table 1. Practicum students work with the instructor to create disputing thoughts to counter the anxiety-provoking thoughts. The students are then asked to identify their own hot thoughts and to develop a list of alternative beliefs. The reduced levels of anxiety improve counseling effectiveness, enhance the supervisory relationship, and create a more positive classroom environment. The summative evaluations of supervision effectiveness revealed several open-ended statements from students who reported that these interventions helped to reduce anxiety and to promote a collaborative supervisory relationship. Researchers, using this technique, might empirically test its efficacy by conducting pretest and posttest assessments of practicum students' levels of anxiety and stress compared with the levels of a control group.
Throughout their studies, counseling graduate students face many possible fears and anxieties that arise from their classroom experiences. The greatest fears and anxieties seem to be related to the counseling practicum experience. This experience is one in which students may feel incompetent, vulnerable, and unskilled as they begin to put their classroom knowledge and experiences into practice. If these fears and anxieties persist, students have a hard time making progress in the area of the counseling relationship and skill building.
We have examined how practicum students' fears and anxieties might be addressed, using cognitive interventions. Such interventions allow students to take irrational thoughts and change them to rational thought patterns. This is accomplished by asking students to state their fears verbally, to think about the effects of the fears and the consequences, to think about intervening beliefs and thoughts, and to restate the fears in a rational manner.
Our experience suggests that cognitive interventions are useful strategies to help practicum students combat fears and anxieties. Further research might examine the use of other behavioral interventions to address these fears. For example, does role-playing a counseling technique in supervision make a student less anxious about applying it in a real counseling session?
In summary, fear and anxiety can impede the preparation of counselors during their practicum experiences. Understanding the underlying thoughts that cause these fears can help students overcome self-defeating thought patterns. Cognitive restructuring techniques have been shown to reduce tension and can be used with counseling practicum students to help relieve performance and supervision anxiety.
TABLE 1 Common Anxiety-Related Thoughts of Practicum Students Major Theme Positive Self-Talk/Cognitive Restructuring Thoughts Will this affect Although it will take time away from my teaching my teaching job now, learning to counsel students can improve teaching. I need to prioritize my semester and plan ahead for my job and practicum. Listening to I assume everyone in class is basically starting audiotaped from the same point, so my tape will not stand sessions in out. class My tapes do not need to be perfect. It takes time to get good at this, so be patient. Counseling skills It is confusing to know what to do; however, if I are inadequate stay focused and follow my training, I will be fine. Students are not as fragile as I think. As long as I am positive and focused, I will be fine. Change takes time and patience; also, they are responsible for their own change, not you. Lack of I will not always know what to do. conceptualization It is OK to ask for help with this case. skills It will take time to learn how to apply the theories. Course demands and I can handle the stress if I break the demands time commitments down into smaller pieces. You eat an elephant one bite at a time. Other students have survived before me so I know it can be done. Personal stressors Learning to be an effective counselor takes time away from family and friends so I will have to manage time carefully this semester. I need to stay focused on my training, although other things in my life are very demanding. Being less effective with my counseling will only make things worse.
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Trey J. Fitch, Department of Counseling, Columbus State University; Jennifer L. Marshall, Department of Counseling, Berea College. Correspondence concerning this article should be addressed to Trey J. Fitch, 2329 Rockdell Lane, Auburn, AL 36830 (e-mail: firstname.lastname@example.org).…