COUN 6306 Walden University Ethics and Supervision Discussion

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COUN 6306 Walden University Ethics and Supervision Discussion

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Discussion Ethics and Supervision

For this Discussion, reflect on the qualities of effective and ineffective supervisors. Think about a time when you worked with a supervisor. This does not need to be in a counseling position or even a paid position. Consider potential courses of action if you discovered your supervisor was engaged in unethical behavior.

Post  a description of the qualities of the most effective supervisor and the least effective supervisor and explain whether you consider these supervisors to be ethical or unethical. Then, explain how these supervisors affected your performance. Explain the significance of having an ethical supervisor. Finally, explain a potential course of action if you discovered that your supervisor was behaving unethically.

C5 WK11 Layout Disc Oct19 Discussion Ethics and Supervision Counselors who are in a supervisory role must be aware of their ethical obligations. Ethically and legally, supervisors are responsible for the quality of services and actions of supervisees. Ethical supervision includes paying particular attention to the following areas: knowledge and skill development, competence, evaluation and gate-keeping, dual relationships, confidentiality, informed consent and self-care. Many states have specific legal and ethical guidelines for approved clinical supervisors. It is your responsibility to ensure that you are receiving the specific type, quality, and quantity of supervision that is required by your academic program and state of licensure. For this Discussion, reflect on the qualities of effective and ineffective supervisors. Think about a time when you worked with a supervisor. This does not need to be in a counseling position or even a paid position. Consider potential courses of action if you discovered your supervisor was engaged in unethical behavior. Post a description of the qualities of the most effective supervisor and the least effective supervisor and explain whether you consider these supervisors to be ethical or unethical. Then, explain how these supervisors affected your performance. Explain the significance of having an ethical supervisor. Finally, explain a potential course of action if you discovered that your supervisor was behaving unethically. Be sure to use the Learning Resources and the current scholarly (i.e., peer-reviewed) literature to support your response. Ethics and Supervision Introduction Counselors who are in a supervisory role must be aware of their ethical obligations. Ethically and legally, supervisors are responsible for the quality of services and actions of supervisees. Ethical supervision includes paying particular attention to the following areas: knowledge and skill development, competence, evaluation and gate-keeping, dual relationships, confidentiality, informed consent and self-care. Many states have specific legal and ethical guidelines for approved clinical supervisors. It is your responsibility to ensure that you are receiving the specific type, quality, and quantity of supervision that is required by your academic program and state of licensure. This week you examine the qualities of effective and ineffective supervisors; including the significance of ethical supervisory practices and strategies to overcome unethical supervisors. Objectives Students will: • Evaluate the effect of ethical or unethical supervisors • Analyze the significance of ethical supervisors • Analyze strategies to overcome unethical supervisors Learning Resources This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. Required Resources Readings • Remley, T. P., Jr., & Herlihy, B. (2016). Ethical, legal, and professional issues in counseling (5th ed.). Upper Saddle River, NJ: Pearson. o Chapter 15, “Supervision and Consultation” (pp. 358-379) • American Counseling Association (ACA) Code of Ethics. Current Edition. • Eryılmaz, A., & Mutlu, T. (2017). Developing the four-stage supervision model for counselor trainees. Kuram Ve Uygulamada Eğitim Bilimleri, 17(2), 597-629 doi:10.12738/estp.2017.2.22523 • Merriman, J. (2015). Enhancing counselor supervision through compassion fatigue education. Journal Of Counseling & Development, 93(3), 370-378. doi:10.1002/jcad.12035 AMHCA Code of Ethics Revised October 2015 AMHCA Preamble………………………………………………………………………………………1 I. Commitment to Clients……………………………………………………………………………1 A. Counselor-Client Relationship……………………………………………………………..1 1. Primary Responsibility……………………………………………………………………….1 2. Confidentiality…………………………………………………………………………………..2 3. Dual/Multiple Relationships……………………………………………………………..5 4. Exploitive Relationships……………………………………………………………………6 5. Counseling Environments…………………………………………………………………6 B. Counseling Process…………………………………………………………………………..7 1. Counseling Plans……………………………………………………………………………….7 2. Informed Consent…………………………………………………………………………….7 3. Multiple Clients…………………………………………………………………………………8 4. Clients Served by Others…………………………………………………………………..9 5. Termination and Referral………………………………………………………………….9 6. Telehealth, Distance Counseling and the Use of Social Media……….10 7. Clients’ Rights………………………………………………………………………………….13 8. End-of-Life Care for Terminally Ill Clients…………………………………….15 C. Counselor Responsibility and Integrity………………………………………………15 1. Competence…………………………………………………………………………………….15 2. Non-discrimination…………………………………………………………………………17 3. Conflict of Interest…………………………………………………………………………18 D. Assessment and Diagnosis………………………………………………………………..18 1. Selection and Administration………………………………………………………….18 2. Interpretation and Reporting…………………………………………………………..19 3. Competence…………………………………………………………………………………….20 4. Forensic Activity……………………………………………………………………………..21 E. Recordkeeping, Fee Arrangements, and Bartering…………………………..22 1. Recordkeeping………………………………………………………………………………..22 2. Fee Arrangements, Bartering, and Gifts………………………………………….23 F. Other Roles………………………………………………………………………………………..23 1. Consultant………………………………………………………………………………………23 2. Advocate…………………………………………………………………………………………24 II. Commitment to Other Professionals……………………………………………………25 A. Relationship with colleagues………………………………………………………………25 B. Clinical Consultation………………………………………………………………………….26 III. Commitment to Students, Supervisees and Employee Relationships….26 A. Relationships with Students, Interns and Employees………………………..26 B. Commitment for Clinical Supervision……………………………………………….27 1. Confidentiality of Clinical Supervision…………………………………………..28 2. Clinical Supervision Contract…………………………………………………………28 IV. Commitment to the Profession……………………………………………………………31 A. Teaching…………………………………………………………………………………………….32 B. Research and Publications………………………………………………………………….32 C. Service on public or private boards and other rganizations……………….33 V. Commitment to the Public……………………………………………………………………33 A. Public Statements……………………………………………………………………………….33 B. Marketing……………………………………………………………………………………………34 VI. Resolution of Ethical Problems…………………………………………………………..34 AMHCA Preamble The American Mental Health Counselors Association (AMHCA) represents mental health counselors. As the professional counseling organization of mental health counselors, AMHCA subscribes to rigorous standards for education, training and clinical practice. Mental health counselors are committed to increasing knowledge of human behavior and understanding of themselves and others. AMHCA members are highly skilled professionals who provide a full range of counseling services in a variety of settings. Members believe in the dignity and worth of the individual and make every reasonable effort to protect human welfare. To this end, AMHCA establishes and promotes the highest professional standards. Mental health counselors subscribe to and pledge to abide by the principles identified in the Code of Ethics. This code is a document intended as a guide to: assist members to make sound ethical decisions; to define ethical behaviors and best practices for Association members; to support the mission of the Association; and to educate members, students and the public at large regarding the ethical standards of mental health counselors. Mental health counselors are expected to utilize carefully considered ethical decision making processes when faced with ethical dilemmas. I. Commitment to Clients A. Counselor-Client Relationship 1. Primary Responsibility Mental health counselors value objectivity and integrity in their commitment to understanding human behavior, and they maintain the highest standards in providing mental health counseling services. a) The primary responsibility of mental health counselors is to respect client autonomy, dignity and promote client welfare. b) Mental health counselors are clear with clients about the parameters of the counseling relationship. In a professional disclosure statement, they provide information about expectations and responsibilities of both counselor and client in the counseling process, their professional orientation and AMHCA Code of Ethics (Revised 2015) 1 values regarding the counseling process, emergency procedures, supervision (as applicable) and business practices. Information is also provided regarding client rights and contact information for the state counseling licensure authority. 2. Confidentiality Mental health counselors have a primary obligation to safeguard information about individuals obtained in the course of practice, teaching, or research. Personal information is communicated to others only with the person’s consent, preferably written, or in those circumstances, as dictated by state laws. Disclosure of counseling information is restricted to what is necessary, relevant and verifiable. a) Confidentiality is a right granted to all clients of mental health counseling services. From the onset of the counseling relationship, mental health counselors inform clients of these rights including legal limitations and exceptions. b) The information in client records belongs to the client and shall not be shared without permission granted through a formal release of information. In the event that a client requests that information in his or her record be shared, mental health counselors educate clients to the implications of sharing the materials. c) The release of information without consent of the client may only take place under the most extreme circumstances: the protection of life (suicidality or homicidality), child abuse, and/ or abuse of incompetent persons and elder abuse. Above all, mental health counselors are required to comply with state and federal statutes concerning mandated reporting. d) Mental health counselors (or their staff members) do not release information by request unless accompanied by a specific release of information or a valid court order. Mental health counselors make every attempt to release only information necessary to comply with the request or valid court order. AMHCA Code of Ethics (Revised 2015) 2 Mental health counselors are advised to seek legal advice upon receiving a subpoena in order to respond appropriately. e) The anonymity of clients served in public and other agencies is preserved, if at all possible, by withholding names and personal identifying data. If external conditions require reporting such information, the client shall be so informed. f) Information received in confidence by one agency or person shall not be forwarded to another person or agency without the client’s written permission. g) Mental health counselors have the responsibility to ensure the accuracy of, and to indicate the validity of, data shared with other parties. h) Case reports presented in classes, professional meetings, or publications shall be disguised so that no identification is possible. Permission must be obtained from clients prior to disclosing their identity. i) Counseling reports and records are maintained under conditions of security, and provisions are made for their destruction after five (5) years post termination or as specified by state regulations. Mental health counselors ensure that all persons in their employ, and volunteers, supervisees and interns, maintain confidentiality of client information. j) Sessions with clients may be taped or otherwise recorded only with written permission of the client or guardian. Even with a guardian’s written consent, mental health counselors should not record a session against the expressed wishes of a client. Such tapes shall be destroyed after five (5) years post termination or as specified by state regulations. k) The primary client owns the rights to confidentiality; however, in the case where primary clients are minors or are adults AMHCA Code of Ethics (Revised 2015) 3 who have been legally determined to be incompetent, parents and guardians have legal access to client information. Where appropriate, a parent(s) or guardian(s) may be included in the counseling process; however, mental health counselors must take measures to safeguard client confidentiality within legal limits. l) In working with families or groups, the rights to confidentiality of each member should be safeguarded. Mental health counselors must make clear that each member of the group has individual rights to confidentiality and that each member of a family, when seen individually, has individual rights to confidentiality within legal limits. m) When using a computer to store confidential information, mental health counselors take measures to control access to such information. After five (5) years post termination or as specified by state regulations, the information should be deleted from the system. n) Mental health counselors may justify disclosing information to identifiable third parties if clients disclose that they have a communicable or life threatening illness. However, prior to disclosing such information, mental health counselors must confirm the diagnosis with a medical provider. The intent of clients to inform a third party about their illness and to engage in possible behaviors that could be harmful to an identifiable third party must be assessed as part of the process of determining whether a disclosure should be made to identifiable third parties. o) Mental health counselors take necessary precautions to ensure client confidentiality of information transmitted electronically through the use of a computer, e-mail, fax, telephone, voice mail, answering machines, or any other electronic means as described in the telehealth section of this document. p) Mental health counselors protect the confidentiality of AMHCA Code of Ethics (Revised 2015) 4 deceased clients in accordance with legal requirements and agency or organizational policy. q) Mental health counselors may disclose information to thirdparty payers only after clients have authorized such disclosure or as permitted by Federal and/or state statute. 3. Dual/Multiple Relationships Mental health counselors are aware of their influential position with respect to their clients and avoid exploiting the trust and fostering dependency of the client. a) Mental health counselors make every effort to avoid dual/ multiple relationships with clients that could impair professional judgment or increase the risk of harm. Examples of such relationships may include, but are not limited to: familial, social, financial, business, or close personal relationships with the clients. b) When deciding whether to enter a dual/multiple relationship with a client, former client or close relationship to the client, mental health counselors will seek consultation and adhere to a credible decision-making process prior to entering this relationship. c) When a dual/multiple relationship cannot be avoided, mental health counselors take appropriate professional precautions such as informed consent, consultation, supervision and documentation to ensure that judgment is not impaired and no exploitation has occurred. d) Mental health counselors do not accept as clients, individuals with whom they are involved in an administrative, supervisory or other relationship of an evaluative nature. 4. Exploitive Relationships Mental health counselors are aware of the intimacy and responsibilities inherent in the counseling relationship. They AMHCA Code of Ethics (Revised 2015) 5 maintain respect for the client and avoid actions that seek to meet their personal needs at the expense of the client. a) Romantic or sexual relationships with clients are strictly prohibited. Mental health counselors do not counsel persons with whom they have had a previous sexual relationship. b) Mental health counselors are strongly discouraged from engaging in romantic or sexual relationships with former clients. Counselors may not enter into an intimate relationship until five years post termination or longer as specified by state regulations. Documentation of supervision or consultation for exploring the risk of exploitation is strongly encouraged. c) Determining the risk of exploitive relationships includes but is not limited to factors such as duration of counseling, amount of time since counseling, termination circumstances, the client’s personal history and mental status, and the potential adverse impact on the former client. d) Mental health counselors are aware of their own values, attitudes, beliefs and behaviors, as well as how these apply in a society with clients from diverse ethnic, social, cultural, religious, and economic backgrounds. 5. Counseling Environments Mental health counselors will provide an accessible counseling environment to individuals with disabilities. a) Counseling environments should be accessible to all clients, especially being sensitive to individuals with disabilities. b) Counseling environments should allow for private and confidential conversations. B. Counseling Process 1. Counseling Plans Mental health counselors use counseling plans to direct their work with clients. AMHCA Code of Ethics (Revised 2015) 6 a) Mental health counselors and their clients work jointly in devising integrated, individual counseling plans that offer reasonable promise of success and are consistent with the abilities, ethnic, social, cultural, and values backgrounds, and circumstances of the clients. b) Mental health counselors and clients regularly review counseling plans to ensure their continued viability and effectiveness, respecting the clients’ autonomy. 2. Informed Consent Clients have the right to know and understand what is expected, how the information divulged will be used, and the freedom to choose whether, and with whom, they will enter into a counseling relationship. a) Mental health counselors provide information that allows clients to make an informed choice when selecting a provider. Such information includes but is not limited to: counselor credentials, issues of confidentiality, the use of tests and inventories, diagnosis, reports, billing, and therapeutic process. Restrictions that limit clients’ autonomy are fully explained. b) Informed Consent includes the mental health counselor’s professional disclosure statement and client bill of rights. c) When a client is a minor, or is unable to give informed consent, mental health counselors act in the client’s best interest. Parents and legal guardians are informed about the confidential nature of the counseling relationship. Mental health counselors embrace the diversity of the family system and the inherent rights and responsibilities parents/guardians have for the welfare of their children. Mental health counselors therefore strive to establish collaborative relationships with parents/guardians to best serve their minor clients. d) Informed consent is ongoing and needs to be reassessed throughout the counseling relationship. AMHCA Code of Ethics (Revised 2015) 7 e) Mental health counselors inform the client of specific limitations, potential risks, and/or potential benefits relevant to the client’s anticipated use of online counseling services. 3. Multiple Clients When working with multiple clients, mental health counselors respect individual client rights and maintain objectivity. a) When mental health counselors agree to provide counseling services to two or more persons who have a relationship (such as husband and wife, or parents and children), counselors clarify at the outset, the nature of the relationship they will have with each involved person. b) Collateral consent informs family members or significant others involved in counseling, of the parameters and limitations of confidentiality. c) If it becomes apparent that mental health counselors are unable to maintain objectivity resulting in conflicting roles, they must appropriately clarify, adjust, or withdraw from roles. d) Rules of confidentiality extend to all clients who receive services, not just those identified as primary clients. e) When working in groups, mental health counselors screen prospective group counseling/therapy participants. Every effort is made to select members whose needs and goals are compatible with goals of the group, who will not impede the group process, and whose well-being will not be jeopardized by the group experience. f) In the group setting, mental health counselors take reasonable precautions to protect clients from physical, emotional, and psychological harm or trauma. 4. Clients Served by Others Mental health counselors do not enter into counseling relationships with a person being served by another mental health AMHCA Code of Ethics (Revised 2015) 8 professional unless all parties have been informed and agree. a) When clients choose to change professionals but have not terminated services with the former professional, it is important to encourage the individual to first deal with that termination prior to entering into a new therapeutic relationship. b) When clients work with multiple providers, it is important to secure permission to work collaboratively with the other professional involved. 5. Termination and Referral Mental health counselors do not abandon or neglect their clients in counseling. a) Assistance is given in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacation and following termination. b) Mental health counselors terminate a counseling relationship when it is reasonably clear that the client is no longer benefiting, when services are no longer required, when counseling no longer serves the needs and/or interests of the client, or when agency or institution limits do not allow provision of further counseling services. c) Mental health counselors may terminate a counseling relationship when clients do not pay fees charged or when insurance denies treatment. In such cases, appropriate referrals are offered to the clients. d) If mental health counselors determine that services are not beneficial to the client, they avoid entering or terminate immediately the counseling relationship. In such situations, appropriate referrals are made. If clients decline the suggested referral, mental health counselors discontinue the relationship. e) When mental health counselors refer clients to other professionals, they will be collaborative. AMHCA Code of Ethics (Revised 2015) 9 f) Mental health counselors take steps to secure a safety plan if clients are at risk of being harmed or are suicidal. If necessary, they refer to appropriate resources, and contact appropriate support. 6. Telehealth, Distance Counseling and the Use of Social Media Recognizing that technology can be helpful in client’s mental health care management due to availability, expediency, and cost effectiveness, counselors engage in technology assisted, and or distance counseling. a) Counselors only engage in distance counseling when they are licensed in the state of the client. In the case of an emergency, counselors should first attempt to attain permission from the client’s state licensing entity and only proceed when failure to do so could result in harm to the client. b) Counselors only provide distance counseling when they have had training, experience, and supervision to do so. c) Written policies concerning the use of telehealth in a counseling relationship should include informed consent that is clearly set forth, understandable, and addresses the use of phone, online face to face counseling, electronic billing, text, and email contact with a client. This informed consent should clearly discuss the benefits and risks of entering into distance counseling. i) Email: Mental health counselors should advise clients about the risks of exchanging emails. It is recommended to include a disclaimer when sending emails. Refer to the most update to date HIPAA regulations. Email transmissions are part of the client record; copies should be maintained in the client file. ii) Text messages: Text messages are not a secure form of communication therefore texting of personal information should be discouraged. Text messages are considered a part of the client record, and should be kept in the client file. AMHCA Code of Ethics (Revised 2015) 10 iii) Online scheduling: Any online scheduling software should be encrypted and secure. If not, counselors should disclose to clients the fact that the software is not encrypted and therefore is not confidential. iv. Chat Rooms: Counselors should not include chat rooms, because these may imply that a counselor is able to intervene in the event that a crisis is mentioned. d) Counselors follow carefully designed security and safety guidelines when conducting online face-to-face distance counseling. i) Counselors endeavor to protect clients from unwanted interruptions during online face-to-face sessions. ii) Counselors are strongly urged to employ the use of local resources in the community of the distance client should emergency care be needed. Local resources may be law enforcement, health care or EMT services, and someone trusted by the client to be available during distance counseling sessions should it become necessary to have someone close by in the event of an emergency. e) The counselor will evaluate the client to determine that the client is appropriate for distance counseling services. f) Counselors will conduct themselves in a professional manner during distance, online counseling sessions as if the client were in the counselor’s office. g) Counselors will disclose to clients all procedures for documenting and storing of records of distance, online counseling sessions. i) Counselors will safeguard and protect all records of distance counseling sessions as they would for in person sessions in accordance with all state and federal laws and regulations. AMHCA Code of Ethics (Revised 2015) 11 ii) Counselors should have a written policy that prohibits both the therapist and the client from recording a treatment session without the written consent of the other. If a recording of the treatment session has been authorized, the counselor,should either erase or destroy the recording as soon as it has fulfilled its intended purpose (e.g., supervision or conclusion of counseling) in order to maintain confidentiality of the contents. h) Counselors do not engage in virtual relationships with clients as to do so could potentially be a violation of confidentiality. i) If clients follow a professional blog, the counselor will not follow them back. The counselor has a responsibility to make it clear that the blog or website does not create a therapeutic relationship, therefore, professional blogs and websites should be non-interactive in nature ii) Twitter, Facebook, LinkedIn, Google Plus and other social media should be professional profiles that are kept separate from personal profiles. Counselors should not establish connections or engage with clients through social media. In addition, counselors need to have appropriate privacy settings so that clients cannot contact them on these professional social media sites, or access a site in any way. iii) Counselors shall not solicit professional reviews by clients, nor respond to reviews posted, as to do so might violate client confidentiality. iv) Counselors will only seek information about their clients through internet searches for the purpose of determining their own or their clients health and safety. i) Counselors endeavor to provide sensitivity to the cultural make up of all clients, as well as sensitivity to disabilities or physical condition in distance counseling as they would in a physical office. AMHCA Code of Ethics (Revised 2015) 12 7. Clients’ Rights In all mental health services, wherever and however they are delivered, clients have the right to be treated with dignity, consideration and respect at all times. Clients have the right: a) To expect quality service provided by concerned, trained, professional and competent staff. b) To expect complete confidentiality within the limits of both Federal and state law, and to be informed about the legal exceptions to confidentiality; and to expect that no information will be released without the client’s knowledge and written consent. c) To a clear working contract in which business items, such as time of sessions, payment plans/fees, absences, access, emergency procedures, third-party reimbursement procedures, termination and referral procedures, and advanced notice of the use of collection agencies, are discussed. d) To a clear statement of the purposes, goals, techniques, rules limitations, and all other pertinent information that may affect the ongoing mental health counseling relationship. e) To appropriate information regarding the mental health counselor’s education, training, skills, license and practice limitations and to request and receive referrals to other clinicians when appropriate. f) To full, knowledgeable, and responsible participation in the ongoing treatment plan to the maximum extent feasible. g) To obtain information about their case record and to have this information explained clearly and directly. h) To request information and/or consultation regarding the conduct and progress of their therapy. AMHCA Code of Ethics (Revised 2015) 13 i) To refuse any recommended services, techniques or approaches and to be advised of the consequences of this action. j) To a safe environment for counseling free of emotional, physical, or sexual abuse. k) To a client grievance procedure, including requests for consultation and/or mediation; and to file a complaint with the mental health counselor’s supervisor (where relevant), and/or the appropriate credentialing body. l) To a clearly defined ending process, and to discontinue therapy at any time. 8. End-of-Life Care for Terminally Ill Clients a) Mental health counselors ensure that clients receive quality end-of-life care for their physical, emotional, social, and spiritual needs. This includes providing clients with an opportunity to participate in informed decision making regarding their end-of-life care, and a thorough assessment, from a qualified end-of-life care professional, of clients’ ability to make competent decisions on their behalf. b) Mental health counselors are aware of their own personal, moral, and competency issues as it relates to end-of-life decisions. When mental health counselors assess that they are unable to work with clients on the exploration of end-oflife options, they make appropriate referrals to ensure clients receive appropriate help. c) Depending upon the applicable state laws, the circumstances of the situation, and after seeking consultation and supervision from competent professional and legal entities, mental health counselors have the options of breaking or not breaking confidentiality of terminally ill clients who plan on hastening their deaths. AMHCA Code of Ethics (Revised 2015) 14 C. Counselor Responsibility and Integrity 1. Competence The maintenance of high standards of professional competence is a responsibility shared by all mental health counselors in the best interests of the client, the public, and the profession. Mental health counselors: a) Recognize the boundaries of their particular competencies and the limitations of their expertise. b) Provide only those services and use only those techniques for which they are qualified by education, training, or experience. c) Maintain knowledge of relevant scientific and professional information related to the services rendered, and recognizes the need for on-going education. d) Represent accurately their competence, education, training, and experience including licenses and certifications. e) Perform their duties, as teaching professionals, based on careful preparation in order that their instruction is accurate, up-to-date and educational. f) Recognize the importance of continuing education and remain open to new counseling approaches and procedures documented by peer-reviewed scientific and professional literature. g) Recognize the important need to be competent in regard to cultural diversity and are sensitive to the diversity of varying populations as well as to changes in cultural expectations and values over time. h) Recognize that their effectiveness is dependent on their own mental and physical health. Should their involvement in any activity, or any mental, emotional, or physical health problem, compromise sound professional judgment and competency, they seek capable professional assistance to determine whether to limit, suspend, or terminate services to their clients. AMHCA Code of Ethics (Revised 2015) 15 i) Have a responsibility to maintain high standards of professional conduct at all times. j) Take appropriate steps to rectify ethical issues with colleagues by using procedures developed by employers and/or state licensure boards. k) Have a responsibility to empower clients, when appropriate, especially/particularly clients with disabilities. l) Are aware of the intimacy of the counseling relationship, maintain a healthy respect for the integrity of the client, and avoid engaging in activities that seek to meet the mental health counselor’s personal needs at the expense of the client. m) Will actively attempt to understand the diverse cultural backgrounds of the clients with whom they work. This includes learning how the mental health counselor’s own cultural/ ethical/racial/religious identities impact their own values and beliefs about the counseling process. n) Are responsible for continuing education and remaining abreast of current trends and changes in the field including the professional literature on best practices. o) Develop a plan for termination of practice, death or incapacitation by assigning a colleague or records custodian to handle transfer of clients and files. p) Mental health counselors are aware of their language and avoid using language that will be offensive to individuals with disabilities. 2. Non-discrimination a) Mental health counselors do not condone or engage in any discrimination based on ability, age, color, culture, disability, ethnic group, gender, gender identity, race, religion, national AMHCA Code of Ethics (Revised 2015) 16 origin, politic beliefs, sexual orientation, marital status, or socioeconomic status. b) Mental health counselors do not condone or engage in sexual harassment, or violate the provisions of state or federal laws, prohibiting sexual harassment. c) Mental health counselors have a responsibility to educate themselves about their own biases toward those of different races, creeds, identities, orientations, cultures, and physical and mental abilities; and then to seek consultation, supervision and or counseling in order to prevent those biases interfering with the counseling process. 3. Conflict of Interest Mental health counselors are aware of possible conflicts of interests that may arise between the counselor and the client, the employer, consultant and other professionals. Mental health counselors may choose to consult with any other professionally competent person about a client assuring that no conflict of interest exists. When conflicts occur, mental health counselors clarify the nature of the conflict and inform all parties of the nature and direction of their loyalties and responsibilities, and keep all parties informed of their commitments. D. Assessment and Diagnosis 1. Selection and Administration Mental health counselors utilize educational, psychological, diagnostic, career assessment instruments (herein referenced as “tests”), interviews, and other assessment techniques and diagnostic tools in the counseling process for the purpose of determining the client’s particular needs in the context of his/her situation. a) Mental health counselors choose assessment methods that are reliable, valid, and appropriate based on the age, gender, race, ability, and other client characteristics. If tests must be used in the absence of information regarding the aforementioned factors, the limitations of generalizability should be duly noted AMHCA Code of Ethics (Revised 2015) 17 b) In selecting assessment tools, mental health counselors justify the logic of their choices in relation to the client’s needs and the clinical context in which the assessment occurs. c) Mental health counselors avoid using outdated or obsolete tests, and remain current regarding test publication and revision. d) Mental health counselors use assessments only in the context of professional, academic, or training relationships. e) Mental health counselors provide the client with appropriate information regarding the reason for assessment, the approximate length of time required, and to whom the report will be distributed. f) Mental health counselors provide an appropriate assessment environment with regard to temperature, privacy, comfort, and freedom from distractions. 2. Interpretation and Reporting Mental health counselors respect the rights and dignity of the client in assessment, interpretation, and diagnosis of mental disorders and make every effort to assure that the client receives the appropriate treatment. a) Mental health counselors base diagnoses and other assessment summaries on multiple sources of data whenever possible. b) Mental health counselors are careful not to draw conclusions unless empirical evidence is present. c) Mental health counselors consider multicultural factors (including but not limited to gender, race, religion, age, ability, culture, class, ethnicity, sexual orientation) in test interpretation, in diagnosis, and in the formulation of prognosis and treatment recommendations. d) Mental health counselors are responsible for evaluating the AMHCA Code of Ethics (Revised 2015) 18 quality of computer software interpretations of test data. Mental health counselors should obtain information regarding validity of computerized test interpretation before utilizing such an approach. e) Mental health counselors clearly explain computerized test results in their summaries and reports. f) Mental health counselors write reports in a style that is clear, concise and easily understandable for the lay reader. g) To the extent possible, mental health counselors provide test results in a neutral and nonjudgmental manner. h) Mental health counselors are responsible for ensuring the confidentiality and security of assessment reports, test data, and test materials regardless of how the material is maintained or transmitted. i) Mental health counselors train their staff to respect the confidentiality of test reports in the context of typing, filing, or mailing them. j) Mental health counselors (or their staff members) do not release an assessment or evaluation report by request unless accompanied by a specific release of information or a valid court order. A subpoena is insufficient to release a report. In such a case, the counselor must inform his or her client of the situation. If the client refuses release, the mental health counselor coordinates between the client’s attorney and the requesting attorney to protect client confidentiality and the counselor’s legal welfare. 3. Competence Mental health counselors employ only those diagnostic tools and assessment instruments they are trained to use by education, or supervised training and clinical experience. a) Mental health counselors seek appropriate workshops, AMHCA Code of Ethics (Revised 2015) 19 supervision and training to familiarize themselves with assessment techniques and the use of specific assessment instruments. b) Mental health counselor supervisors ensure that their supervisees have adequate training in interpretation before allowing them to evaluate tests independently. 4. Forensic Activity Mental health counselors who are requested or required to perform forensic functions, such as assessments, interviews, consultations, report writing, responding to subpoenas, or offering expert testimony, comply with all provisions of this Ethics Code and act in accordance with applicable state law. a) Mental health counselors who engage in forensic activity must possess appropriate knowledge and competence, including specialized knowledge about special populations, specialized testing and specialized interview techniques. They must be cognizant of the difference between an expert and fact witness b) When conducting interviews, writing reports, or offering testimony mental health counselors objectively offer their findings without bias, personal opinion or investment in the ultimate outcome. One error in their report or testimony could make the difference between acceptance or disqualification. c) The client, in a forensic evaluation will be informed about the limits of confidentiality, the role of the mental health counselor, the purpose of the assessment and potential for unfavorable findings. d) Mental health counselors’ forensic written reports and recommendations are based upon information and techniques appropriate to the evaluation. The forensic mental health evaluator expert pays close attention to only using assessments relative to each case. AMHCA Code of Ethics (Revised 2015) 20 e) Mental health counselors do not provide written conclusions or forensic testimony regarding any individual without reliable information adequate to support any statements or conclusions offered in the forensic setting. The forensic mental health evaluator expert does not diagnose anyone that was not seen during the evaluation process. f) When testifying, mental health counselors clearly present their qualifications and specialized training. They describe fairly the basis for their professional judgment, conclusions, and testimony. Counselors remain cognizant of the social responsibility they bear. The forensic mental health evaluator pays particular attention to avoid being viewed as a “hired gun.” The expert makes every effort to be court appointed to avoid this issue. g) Mental health counselors do not evaluate, for forensic purposes, individuals whom they are currently counseling or have counseled in the past. In addition, mental health counselors do not counsel individuals they are currently evaluating, or have evaluated in the past, for forensic purposes. h) Forensic mental health counselors do not act as an advocate for the legal system, perpetrators, or victims of criminal activity. E. Recordkeeping, Fee Arrangements, and Bartering 1. Recordkeeping Mental health counselors create and maintain accurate and adequate clinical and financial records. a) Mental health counselors create, maintain, store, transfer, and dispose of client records in ways that protect confidentiality and are in accordance with applicable regulations or laws. b) Mental health counselors establish a plan for the transfer, storage, and disposal of client records in the event of withdrawal from practice or death of the counselor, that maintains confidentiality and protects the welfare of the client. AMHCA Code of Ethics (Revised 2015) 21 2. Fee Arrangements, Bartering, and Gifts Mental health counselors are cognizant of cultural norms in relation to fee arrangements, bartering, and gifts. Mental health counselors clearly explain to clients, early in the counseling relationship, all financial arrangements related to counseling. a) In establishing professional counseling fees, mental health counselors take into consideration the financial situation of clients and locality. If the usual fees create undue hardship for the client, the counselor may adjust fees or assist the client to locate comparable, affordable services. b) Mental health counselors usually refrain from accepting goods or services from clients in return for counseling services because such arrangements may create the potential for conflicts, exploitation and distortion of the professional relationship. However, bartering may occur if the client requests it, there is no exploitation, and the cultural implications and other concerns of such practice are discussed with the client and agreed upon in writing. c) Mental health counselors contribute to society by providing pro bono services. d) When accepting gifts, mental health counselors take into consideration the therapeutic relationship, motivation of giving, the counselor’s motivation for receiving or declining, cultural norms, and the value of the gift. F. Other Roles 1. Consultant Mental health counselors acting as consultants have a high degree of self-awareness of their own values, knowledge, skills and needs in entering a helping relationship that involves human and/ or organizational change. a) The focus of the consulting relationship is on the issues to be resolved and not on the personal characteristics of those presenting the consulting issues. AMHCA Code of Ethics (Revised 2015) 22 b) Mental health counselors develop an understanding of the problem presented by the client and secure an agreement with the client, specifying the terms and nature of the consulting relationship. c) Mental health counselors are reasonably certain that they and their clients have the competencies and resources necessary to follow the consultation plan. d) Mental health counselors encourage adaptability and growth toward self-direction. e) Mental health counselors keep all proprietary and client information confidential. f) Mental health counselors avoid conflicts of interest in selecting consultation clients. 2. Advocate Mental health counselors may serve as advocates at the individual, institutional, and/or societal level in an effort to foster sociopolitical change that meets the needs of the client or the community. a) Mental health counselors are aware of and make every effort to avoid pitfalls of advocacy including conflicts of interest, inappropriate relationships and other negative consequences. Mental health counselors remain sensitive to the potential personal and cultural impact on clients of their advocacy efforts. b) Mental health counselors may encourage clients to challenge familial, institutional, and societal obstacles to their growth and development and they may advocate on the clients’ behalf. Mental health counselors remain aware of the potential dangers of becoming overly involved as an advocate. c) Mental health counselors may only speak on their behalf and AMHCA Code of Ethics (Revised 2015) 23 are clear, cautious, and authorized to speak on the behalf of any counseling organization. d) Mental health counselors endeavor to speak factually and discern facts from opinions. II. Commitment to Other Professionals A. Relationship with Colleagues Mental health counselors act with due regard for the needs and feelings of their colleagues in counseling and other professions. Mental health counselors respect the rights and obligations of the institutions or organizations with which they associate. 1. Mental health counselors understand how related professions complement their work and make full use of other professional, technical, and administrative resources that best serve the interests of clients. 2. Mental health counselors treat professional colleagues with the same dignity and respect afforded to clients. Professional discourse should be free of personal attacks. 3. Mental health counselors respect the viability, reputation, and proprietary rights of organizations that they serve. 4. Credit is assigned to those who have contributed to a publication, in proportion to their contribution. 5. Mental health counselors do not accept or offer referral fees from other professionals. 6. When mental health counselors have knowledge of the impairment, incompetence, or unethical conduct of a mental health professional, they are obliged to attempt to rectify the situation. Failing an informal solution, mental health counselors should bring such unethical activities to the attention of the appropriate state licensure board and/or the ethics committee of the professional association. AMHCA Code of Ethics (Revised 2015) 24 B. Clinical Consultation Mental health counselors may offer or seek clinical consultation from another mental health professional. In clinical consulting mental health counselors provide critical and supportive feedback. Clinical consultation does not imply hierarchy or responsibility for client outcome. III. Commitment to Students, Supervisees and Employee Relationships A. Relationship with Students, Interns and Employees Mental health counselors have an ethical concern for the integrity and welfare of supervisees, students, and employees. These relationships typically include an evaluative component and therefore need to be maintained on a professional and confidential basis. 1. Mental health counselors recognize the influential position they have with regard to both current and former supervisees, students and employees, and avoid exploiting their trust and dependency. 2. Mental health counselors do not engage in ongoing counseling relationships with current supervisees, students or employees. 3. All forms of sexual behavior with supervisees, students or employees are unethical. 4. Mental health counselors do not engage in any form of harassment of supervisees, students, employees or colleagues. 5. Mental health counselor supervisors advise their supervisees, students and employees against holding themselves out to be competent to engage in professional services beyond their training, experience, or credentials. 6. In the informed consent statement, students and employees notify the client they are in supervision and AMHCA Code of Ethics (Revised 2015) 25 provide their clients with the name and credentials of their supervisor. 7. Students and employees have the same ethical obligations to clients as those required of mental health counselors. 8. Supervisors provide written informed consent prior to beginning a supervision relationship that documents business address and telephone number; list of degrees, license and credentials/certifications held; areas of competence in clinical mental health counseling; training in supervision and experience providing supervision; model of or approach to supervision, including the role, objectives and goals of supervision, and modalities; evaluation procedures in the supervisory relationship; the limits and scope of confidentiality and privileged communication within the supervisory relationship; procedures for supervisory emergencies and supervisor absences; use of supervision agreements; and procedures for supervisee endorsement for certification and/ or licensure, or employment to those whom are competent, ethical, and qualified. B. Commitment for Clinical Supervision Clinical supervision is an important part of the mental health treatment process. This purpose is two-fold: to assist the supervisee to provide the best treatment possible to counseling clients, through guidance and direction by the supervisor regarding clinical, ethical, and legal issues; and to provide training to the supervisee, which is an integral part of counselor education. Supervision is also a gatekeeping process to ensure safety to the client, the profession and to the supervisee. 1. Confidentiality of Clinical Supervision Clinical supervision is a part of the treatment process, and therefore all of the clinical information shared between a supervisee and supervisor is confidential. Clinical supervisors do not disclose supervisee confidences regarding client information except: AMHCA Code of Ethics (Revised 2015) 26 a) To prevent clear and imminent danger to a person or persons. b) As mandated by law for child or senior abuse reporting. c) Where there is a waiver of confidentiality obtained, in writing, prior to such a release of information. d) Where the release of records or information is permitted by state law. e) In educational or training settings where only other professionals who will share responsibility for the training of the supervisee are present, and formal written client consent has been obtained for such disclosures for training purposes. 2. Clinical Supervision Contract A clinical supervision contract signed by both supervisor and supervisee, should be prepared, which provides for the fees for both individual and group supervision sessions. The contract should also specify the records that will be maintained by both the supervisor and supervisee regarding issues discussed in supervision; the number of hours of supervision that take place, and whether the supervision was individual or group. In addition, the contract should specify the agreement of supervisor and supervisee regarding how often the supervision sessions will be scheduled. The frequency of supervision sessions shall comply with state regulations. In addition, the supervisor and supervisee should agree to the following terms: a) Insurance The supervisee will maintain a professional liability insurance policy during the clinical supervision process, and provide a copy of a certificate of insurance to the supervisor. b) Compliance with the AMHCA Code of Ethics The supervisor should provide a copy of the AMHCA Code of Ethics to the supervisee, or ensure that the supervisee has obtained a copy. The supervisee must agree to comply AMHCA Code of Ethics (Revised 2015) 27 with the AMHCA Code of Ethics in all treatment provided. As needed, the supervisor and supervisee will discuss the principles contained in the AMHCA Code of Ethics. The supervisor needs to be aware of other codes of ethics which may apply to the supervisee. c) State Licensing Board Rules The supervisee needs to obtain a copy of the appropriate State Licensing Board Rules, and agree to comply with them. As needed, the supervisor and supervisee will discuss the provisions of board rules. The supervisor will be aware of all credentials and membership organizations regulating the supervisee. d) Compliance with State Laws The supervisor should inform the supervisee of state laws contained in the Practice Act for counselors, and other legal provisions which apply to treatment, requirements for licensure, billing, and the discipline of counselors. e) Duty of the Clinical Supervisor The contract should specify that the duty of the clinical supervisor will be to direct the treatment process, and to assist the supervisee in complying with all legal and ethical standards for treatment. f) Billing for Treatment Supervisee should agree that all bills submitted for treatment will accurately reflect the amount of time spent in counseling session, and will also identify the professional who provided services to the client. g) Treatment Records and Bills As part of the supervision process, the supervisee will agree to provide treatment records and billing statements to the clinical supervisor upon request. In addition, the supervisee will agree to maintain all treatment records securely, to AMHCA Code of Ethics (Revised 2015) 28 maintain their confidentiality and to comply with state recordkeeping requirements. h) Informed Consent The supervisee will agree to obtain informed consent in writing from the counseling client in compliance with state law. In addition, the supervisee will obtain informed consent in writing from any client whose treatment session is to be videotaped, recorded, or observed through one-way glass. i) Dual Relationships Supervisors will avoid all dual relationships that may interfere with the supervisor’s professional judgment or exploit the supervisee. Any sexual, romantic, or intimate relationship is considered to be a violation. Sexual relationship means sexual conduct, sexual harassment, or sexual bias toward a supervisee by a supervisor. j) Termination of Supervision When a supervisee discontinues supervision, a written notice that the supervision process has terminated should be provided by the supervisor, along with an appropriate referral for supervision. If during supervision a conflict arises which causes impairment to the professional judgment of the supervisor or supervisee, the process should be terminated and a referral made. Both the supervisor and the supervisee have the right to terminate supervision at any time, with reasonable notice being provided regarding the voluntary termination of supervision. k) Consultation for the Supervisor Whenever a clinical supervisor needs to discuss questions regarding the clinical services being provided, ethical issues, or legal matters, the supervisor should obtain a consultation in order to resolve the issue. That consultation must be documented in the supervisor’s clinical supervision notes. AMHCA Code of Ethics (Revised 2015) 29 l) Credentials for Supervisors A supervisor should have the level of clinical experience required by state regulations, which is required for supervision of other professionals. In addition, the supervisor should have training in the clinical supervision process. m) Credentials for Supervisees Supervisors must ensure that supervisees have the requisite credentials under state law to provide counseling to clients. If at any time during the supervision process a supervisor concludes that the supervisee does not have the requisite skills and education to provide counseling safely, and the supervisee is not showing evidence of learning or progressing, the supervisor should inform the supervisee of the deficiencies noted in the supervisor’s evaluation of the supervisee, and terminate the relationship. IV. Commitment to the Profession Mental health counselors promote the mission, goals, values, and knowledge of the profession. They engage in activities that maintain and increase the respect, integrity, and knowledge base of the counseling profession and human welfare. Such activities include but are not limited to teaching, research, serving on professional boards and membership in professional associations. A. Teaching As teaching professionals, mental health counselors perform their duties based on careful preparation to provide instruction that is accurate, current, and educational. B. Research and Publications Mental health counselors, as researchers, conduct investigations and publish findings with respect for dignity and welfare of the participants and integrity of the profession. 1. The ethical researcher seeks advice from other professionals if any plan of research suggests a deviation from any ethical principle of research with human subjects. Such deviation AMHCA Code of Ethics (Revised 2015) 30 protects the dignity and welfare of the client and places on the researcher a special burden to act in the subject’s interest. 2. The ethical researcher is open and honest in the relationship with research participants. 3. The ethical researcher protects participants from physical and mental discomfort, harm, and danger. If the risks of such consequences exist, the investigator is required to inform participants of that fact, secure consent before proceeding, and take all possible measures to minimize the distress. 4. The ethical researcher instructs research participants that they are free to withdraw from participation at any time. 5. The ethical researcher understands that information obtained about research participants during the course of an investigation is confidential. When the possibility exists that others may obtain access to such information, participants are made aware of the possibility and the plan for protecting confidentiality and for storage and disposal of research records. 6. The ethical researcher gives sponsoring agencies, host institutions, and publication channels the same respect and opportunity for informed consent that they accord to individual research participants. 7. The ethical researcher is aware of his or her obligation to future research and ensures that host institutions are given feedback information and proper acknowledgement. C. Service on public or private boards and other organizations When serving as members of governmental or other organizational bodies, mental health counselors represent the mental health counseling profession and are accountable as individuals to the Code of Ethics of the American Mental Health Counselors Association. AMHCA Code of Ethics (Revised 2015) 31 V. Commitment to the Public Mental health counselors recognize they have a moral, legal, and ethical responsibility to the community and to the general public. Mental health counselors are aware of the prevailing community and cultural values, and the impact of professional standards on the community. A. Public Statements Mental health counselors in their professional roles may be expected or required to make public statements providing counseling information or professional opinions, or supply information about the availability of counseling products and services. In making such statements, mental health counselors accurately represent their education, professional qualifications, licenses and credentials, expertise, affiliations, and functions, as well as those of the institutions or organizations with which the statements may be associated. Public statements serve the purpose of providing information to aid the public in making informed judgments and choices. All public statements will be consistent with this Code of Ethics. B. Marketing Mental health counselors market the following: highest counseling-related degree, type and level of certification or license, and type and/or description of services or other relevant information concerning areas of clinical competence. These statements will not be false, inaccurate, misleading, or out of context. Accessibility of marketing materials: mental health counselors will create marketing materials that will be accessible to individuals with disabilities and diverse cultural groups. This includes websites and other promotional materials. VII. Resolution of Ethical Problems Members are encouraged to consult with the AMHCA Ethics Committee regarding processes to resolve ethical dilemmas that may arise in clinical practice. Members are also encouraged to use commonly recognized procedures for ethical decision-making AMHCA Code of Ethics (Revised 2015) 32 to resolve ethical conflicts. Sources for examples of such ethical decision-making procedures are attached to this code. The American Mental Health Counselors Association, its Board of Directors, and its National Committee on Ethics do not investigate or adjudicate ethical complaints. In the event a member has his or her license suspended or revoked by an appropriate state licensure board, the AMHCA Board of Directors may then act in accordance with AMHCA’s National By-Laws to suspend or revoke his or her membership. Any member so suspended may apply for reinstatement upon the reinstatement of his or her licensure. AMHCA Code of Ethics (Revised 2015) 33 American Mental Health Counselors Association 675 North Washington Street, Suite 470 Alexandria, VA 22314 800-326-2642 www.amhca.org KURAM VE UYGULAMADA EĞİTİM BİLİMLERİ EDUCATIONAL SCIENCES: THEORY & PRACTICE Received: November 7, 2013 Revision received: March 28, 2016 Accepted: December 14, 2016 OnlineFirst: February 25, 2017 Copyright © 2017 EDAM www.estp.com.tr DOI 10.12738/estp.2017.2.2253  April 2017  17(2)  597–629 Research Article Developing the Four-Stage Supervision Model for Counselor Trainees Ali Eryılmaz1 Eskişehir Osmangazi University Tansu Mutlu2 Eskişehir Osmangazi University Abstract Counselors should have the counseling skills necessary for making adequate therapeutic progress through counseling sessions. Counselors start learning skills and knowledge for counseling in their undergraduate education. During this critical period, the time, form, and quality of the process of gaining core competencies in counseling differ depending on several factors. Supervised sessions might be regarded among these factors. Supervised sessions should be conducted using a comprehensive, objective-driven, and need based model in order for the sessions to be able to reach their goals. Due to the need for more effective supervised sessions, the current study aims to introduce the four-stage supervision model and report preliminary results related to the model’s effectiveness. This study consists of 17 counselor trainees studying counseling psychology and the guidance department at a public university during the 2012 fall semester. All participants were enrolled in the Counseling Psychology Practicum. The mixed method design was used in the study. A counselor competencies evaluation form, developed by the researchers, was used in the quantitative phase while semi-structured interview forms were used in the qualitative phase. Pretest and posttest scores of counselor trainees’ counselor competencies were provided using the counselor competencies evaluation form. A supervisor and cosupervisor rated the frequency of mistakes that had been made by counselor trainees through counseling sessions to make a frequency chart. The mistakes (ineffectiveness of counseling skills and lack of the required counseling skills) refer to ineffective counseling skills counselor trainees used and counseling skills which they didn’t use although they should have been. Wilcoxon signed-rank test and frequency were used in analyzing the quantitative data, and the descriptive method was used in analyzing the qualitative data. Research findings from the quantitative part of the study indicate that counselor trainees made 280 mistakes at 92.71% over the first five supervision sessions, while making 22 mistakes in the last five supervised sessions at 7.28%. These results show that the supervised session conducted based on the four-stage supervision model reduced the counselor trainees’ mistakes by 85.43%. Moreover, the results indicate a statistically meaningful difference between counselor trainees’ pretest and posttest scores for counselor competencies (z = -3.62; p < .05). According to research findings found in the qualitative part of the study, counselor trainees remarked that the supervised sessions were beneficial for improving their counselor competencies in eight important dimensions. In summary, the four-stage supervision model developed for counselor trainees can be a supervision model that helps counselor trainees enhance their counseling competences. However, the study’s findings should be interpreted in terms of its limitations. Keywords Counseling • Supervision model • Counselor education • Helping skills 1 Correspondence to: Ali Eryılmaz (PhD), Counseling Psychology and Guidance, Faculty of Education, Eskişehir Osmangazi University, Eskişehir Turkey. Email: erali76@hotmail.com 2 Counseling Psychology and Guidance, Faculty of Education, Eskişehir Osmangazi University, Eskişehir Turkey. Email: tansumutlu@gmail.com Citation: Eryılmaz, A., & Mutlu, T. (2017). Developing the four-stage supervision model for counselor trainees. Educational Sciences: Theory & Practice, 17, 597–629. http://dx.doi.org/10.12738/estp.2017.2.2253 EDUCATIONAL SCIENCES: THEORY & PRACTICE Counseling using a collaborative process between counselor and client helps individuals adjust their problems in their life, facilitate lifestyle changes, and improve their quality of life (Carkhuff, 2000; Cormier & Hackney, 2008; Egan, 1975). On this point, mental health counselors should become more qualified in their field. Providing effective supervision during counselor education might be seen as an important cornerstone for the counselor trainees to become more qualified in counseling. (Aladağ, 2013; Cormier & Hackney, 2008). As such, the need for an effective supervision service in a variety of settings is crucial. The counseling process conducted by counselors involved in effective supervised sessions can be seen as a process that enhances life quality and also contributes effectively to human development in all developmental domains. There are many different counseling skills that can help counselors conduct counseling sessions that are effective at improving clients’ quality of life (Aladağ, 2013; Carkhuff, 2000; Cormier & Hackney, 2008; Egan, 1975; Uslu & Arı, 2005). In the literature are many different types of counseling-skills classifications that are an essential part of the therapeutic process. According to Carkhuff (2000), personalizing meaning, the problem, and the goal are the necessary basic helping skills and sufficient for client change. Ivey, Ivey, Zalaquett, and Quirk (2010) have defined counseling micro-skills as basic helping skills that help clients solve the mental health issues in their life. The counseling micro-skills hierarchy provides a demonstration where alternative settings require different counseling skills starting from ethics, cultural competence, and wellness to determining personal style and theory. According to Cormier and Hackney (2008), a counselor should be able to use different counseling skills, ranging from basic and simple to more advanced and complex levels in the counseling profession. Additionally, the full range of skills needed for counseling is defined as basic counseling skills by Nelson-Jones (2003). The reflection of feeling, questioning, paraphrasing, and reframing might be given as an example for basic counseling skills that counselors need in order to conduct effective counseling (Nelson-Jones, 2003). Gerard Egan’s skilled helper model (1975) provides a three-stage model in which each stage consists of specific counseling skills that the counselor uses to assist the client in clarifying or exploring thoughts. The skilled helper model consists of three fundamental stages covering different ranges of counseling skills to be used in counseling sessions. Based on all the classifications (Carkhuff, 2000; Cormier & Hackney, 2008; Egan, 1975; Ivey et al., 2010) mentioned above, one can say that the counseling process and counseling skills needed for use in counseling session differ from each other. Similar to differentiating skills classifications, teaching counseling skills to counselors or counselor trainees in counselor education also differs. Counselor educators help counselor trainees deal with the challenges they face in counseling sessions and help them effectively use their counseling skills in counseling sessions by using a different teaching method aimed at providing counselor trainees with the knowledge and skills to become effective counselors. When examining 598 Eryılmaz, Mutlu / Developing the Four-Stage Supervision Model for Counselor Trainees programs or training (Carkhuff, 2000; Hill, 2004; Hill & Kellems, 2002; Kagan, 1984; Meydan, 2014; Yaka, 2013) aimed at gaining confidence in the counseling profession and developing one’s counseling skills, many programs are seen to be used for this purpose and to have an important place in counselor education. Counselor-education programs last for several years in Turkey like such countries as the US (Council for Accreditation of Counseling and Related Educational Programs, 2009), Germany, Bulgaria (European Board for Certified Counselors, 2013). In Turkey, counselors are able to perform counseling after graduating from the Guidance and Psychological Counseling undergraduate program, which is why the overall quality of a bachelor degree program is expected to be at the highest possible level. The content of counselor education in undergraduate programs in Turkey comes to mind when considering the two important dimensions of counselor education: theory (Gibson & Mitchell, 2008) and practice (Mayfield, Kardash, & Kivlighan, 1999). The course Individual Counseling Practicum is one of the most important experiences in the counseling graduate program and also an opportunity to develop the expertise of counselor trainees for performing individual counseling under close supervision in a professional setting (Eren-Gümüş, 2015). A study done by Aladağ, Yaka, and Koç (2014) aimed at helping counselor trainees develop knowledge of counseling skills and techniques by teaching counselor trainees how to effectively counsel and giving them feedback about their competencies in the course Principles and Techniques of Counseling. These initiatives of counselor educators and researchers enhance counselor trainees’ skills in counseling (Eryılmaz & Mutlu-Süral, 2014a; Uslu & Arı, 2005; Studer, 2005) and also develop their identities as professional counselors (Aladağ et al., 2014; Eryılmaz & Mutlu-Süral, 2014a). Supervised sessions should be part of counselor education in order to help counselor trainees increase their effectiveness while doing individual or group counseling, similar to what counselor educators and researchers aim for in their studies (Bernard & Goodyear, 2009; Hill & Lent, 2006). On this point, weekly individual supervision with a supervisor during the Individual Counseling Practicum class becomes significant. Hill and Lent (2006) stated that a great majority of the research done in counseling emphasizes the importance of supervision. As a result, counselor educators should benefit from both supervision models and counseling-skills training models when providing supervision for counselor trainees. There are three primary models of supervision related to counseling supervision in the literature: psychotherapy-based supervision models, developmental models of supervision, and the social-role supervision model (Erkan-Atik, Arıcı, & Ergene, 2014). For example, in Carroll and Holloway’s (1999) developmental model, the supervision process consists of developmental stages that focus on supervisees’ learning stages at various levels of professional development. In addition to this supervision model, various supervision sessions are performed using a theory-based approach derived from different counseling theories, such as Gestalt (Resnick & Estrup, 2000). Also, 599 EDUCATIONAL SCIENCES: THEORY & PRACTICE there are counseling-skills training models that provide counselor trainees with an opportunity to learn and practice new skills and find better ways to help clients. The micro-counseling program, interpersonal process recall, and skilled helper model might be given as examples of counseling training models that ensure counselor trainees continue to increase their skills. In counseling-related literature, counselors are recommended to choose developmental approaches rather than adopt a specific theory directly in conducting supervisory sessions because developmental approaches are convenient for both supervisors and supervisees. Using developmental models as a framework in supervision is the only way to conduct supervision sessions that take supervisees’ individual differences into consideration (Campbell & Herlihy, 2006). From the information given above, one can conclude that the developmental approach is used as an approach in both supervision as well as micro-skills training. The focus of supervision models based on a developmental approach is on supervisees’ developmental stages in the counseling profession and supervisors’ needs (ErkanAtik et al., 2014; Siviş-Çetinkaya & Karaırmak, 2012). As an example, the integrated developmental supervision model, developed by Stoltenberg (1981), Stoltenberg and Delworth (1987), and Stoltenberg, McNeill, and Delworth (1998), aims to facilitate the development of counselor trainees’ therapeutic competencies with supervised sessions designed by supervisors according to supervisees’ developmental stages. Similar to content from the developmental supervision model, Bernard and Goodyear (2009) also stated that counselors’ vocational development is a continuous process consisting of six phases, and each counselor has special needs at every phase. That’s why supervised sessions should be designed by taking counselors’ personal needs into consideration while setting goals for the supervised session. From the perspective of the micro-skills training program, the skilled helper model developed by Egan (1975) aims to improve practice skills and enhance counselors’ counseling competence. Additionally, that counselor trainees are able to perform counseling after successfully going through each stage of professional development is important. As such, a continuous process of counseling trainee’s growth and development over the developmental stages is also a developmental process. In this context, one can say the aim of this study is to foster the personal growth and development of counselor trainees, who are referred to as advanced students in Rønnestad and Skovhold’s (2003) lifelong development model. From the of counselor trainees’ point of view, they are required to take lessons that will increase their counseling competence before counseling in a professional setting. Although all counselor trainees take same lessons, their readiness levels might differ from one other. In other words, some counselor trainees’ readiness levels are low while others are high. Therefore, information on counselor trainees’ readiness levels needs to be gathered. Secondly, counselor trainees with high readiness levels 600 Eryılmaz, Mutlu / Developing the Four-Stage Supervision Model for Counselor Trainees should be encouraged while counselor trainees with low readiness levels have to master them before advancing to the next level. The way to build professional competence in the counseling profession might be by providing corrective feedback for counselor trainees’ professional skills development, monitoring counselor trainees’ performance, and also informing counselor trainees about therapeutic skills and knowledge based on theoretical framework. Holloway (1995) laid great emphasis on a supervision process consisting of basic counseling-skills training, case conceptualization, professional role, emotional awareness, and self-evaluation in the comprehensive model. In addition to this, as part of their role through their counseling session, Bernard’s discrimination model emphasizes focused supervision, possible supervisory and advisory roles, and supervising with the aim of helping counselor trainees manage the therapeutic process and use their counseling skills (Bernard, 1979, as cited in Siviş-Çetinkaya & Karaırmak, 2012). A stage is needed after being informed in order to improve counselor trainees’ ability to provide value to their clients and strengthen their existing counseling skills. This stage could be called a development stage. Ultimately, counselor trainees and supervisors should be aware of both personal development and professional development through the process. To raise this awareness, the evaluation stage might take place during the supervised process. After doing a critical literature review, no research studies seem to exist that contain all the above-mentioned stages with the aim of improving undergraduate counseling trainees’ counseling skills in Turkey. On this point, developing a supervision model based on the skilled helper model can contribute to the literature. The lack of a supervision model that can be used during counselor education in Turkey has been emphasized, and the counselor education process should be reviewed (Aladağ, 2013). Additionally, research studies related to counseling-skills training are qualitatively and quantitatively inadequate. In this context, while the supervision needs of counselor trainees still exists (Aladağ & Bektaş, 2009; Hamamcı, Murat, & Esen-Çoban, 2004; Özyürek, 2009; Siviş- Çetinkaya & Karaırmak, 2012), the limited number of studies attempting to examine supervision model’s effectiveness or suggesting a new supervision model (Meydan, 2014) draws attention. Moreover, few studies in the literature have demonstrated the micro-skills training model’s effectiveness (Koç, 2013). According to these studies’ research findings in which counselor trainees and guidance and counseling supervisors expressed their perceptions related to counselor education in Turkey, counselor trainees and supervisors expressed the need for developing a supervision model based on Turkish culture. For instance, in Özyürek’s (2009) study, counselor trainees stated that their supervisors’ feedback was constructive, improving, and also encouraging while course content in the guidance and counseling psychology department, as well as supervision sessions, is inadequate. Anjel and Özkan (2009) found similar results. Anjel and Özkan’s (2009) research findings give researchers and counselor educators 601 EDUCATIONAL SCIENCES: THEORY & PRACTICE helpful context clues related to counselor education in Turkey. Another important, attention-drawing point is that almost half of the participants in this study did not have a supervised experience during their undergraduate education. Counselors have earned a bachelor’s degree without participating in professional supervision; because of this, they are attempt to compensate by taking additional training programs where they can have a supervised experience after graduation. The increasing number of counseling and guidance programs in Turkey, as well as evening and daytime availability for these programs, shows the importance of supervision in counselor education. On this point, one can mention the need for integrative supervision models developed in Turkey in order to increase the quality of mental health services and to obtain effective counseling training for counselor trainees. Overall, recent studies (Hamamcı et al., 2004; Özyürek, 2009; Uslu & Arı, 2005) on counselor education show the importance of supervision in counselor education and, in parallel with this, underline the limited body of experimental or theoretical research describing the supervision process. As is discernible from the above information, studies aimed at examining the effectiveness of supervision model developed in the context of Turkish culture and the Turkish education system are needed. A number of good reasons for highlighting Turkish culture and the Turkish education system might exist on this point. Firstly, many educational materials are translated from English to Turkish and thus counselor trainees have a lot of trouble comprehending texts. Therefore, authors’ expressing their recommendations for the new supervision model and testing their effectiveness in Turkey has been found meaningful. To introduce the supervision model to researchers and conduct studies designed by other researchers that aim to examine the effectiveness of the supervision model might be a way to distinguish and fill the gaps in the existing literature. In this study, the supervision model was developed by obtaining a range of different views from lecturers who give a series of lectures on counseling, such as counseling principles, techniques, counseling and guidance. Secondly, one can easily say that counselor trainees’ existing needs and difficulties have shed some light on the context of the supervision model. Therefore, the aim of the current study is to introduce the four-stage supervision model (FSSM) for counselor trainees and provide preliminary results on the efficacy of this model. In order to achieve this study’s main goal, answers to the following questions were sought in the quantitative part of the research: • What mistakes do counselor trainees make in their first five individual supervised counseling sessions developed based on the FSSM for counselor trainees? • What mistakes do counselor trainees make in their last five individual supervised counseling sessions developed based on the FSSM for counselor trainees? 602 Eryılmaz, Mutlu / Developing the Four-Stage Supervision Model for Counselor Trainees • Do counselor trainees make more mistakes in the first five or last five supervised sessions? • Is there a significant difference between the counselor competency pretest and posttest results of counselor trainees who participated in supervised sessions based on the FSSM? In order to reach the study’s main goal, an answer to the following question was sought in the qualitative part of the research: • What are counselor trainees’ opinions about the role of the FSSM in continually improving their counseling competence after they had participated in the supervised sessions developed using the FSSM for counselor trainees? Method Research Design The study’s aim is to introduce the FSSM and provide preliminary results on its efficacy. With this intention, the research process combined qualitative and quantitative methods. Patton (2002) remarked that mixed methods research is an approach that combines quantitative and qualitative research and as such was used by this study. This study implemented the explanatory design because it helps researchers use qualitative data to support what are primarily quantitative data (Patton, 2002). Purposeful sampling was used as a method in the study (Fraenkel & Wallen, 1993). A single-group pretest-posttest design was used in the quantitative component of the study, whose independent variable is the implementation of the FSSM. The research’s dependent variables are counselor trainees’ skill level and the number of mistakes that indicate counselor trainees’ ineffective use of counseling skills or counseling skills that weren’t used but should have been. The three basic categories of mistakes are: a) Lack of mistakes. The number of basic counseling skills that counselor trainees are able to use in the right place at the right time throughout the counseling sessions. b) Ineffective counseling skills. The number of basic counseling skills that counselor trainees ineffectively use throughout the counseling sessions. c) Lacking the necessary counseling skills. The number of basic counseling skills that counselor trainees are unable to use in the right place at the right time throughout the counseling sessions. 603 EDUCATIONAL SCIENCES: THEORY & PRACTICE Seventeen counselor trainees participated in supervised sessions for 12 weeks. A co-supervisor participated in the supervised sessions with the lecturer, who was teaching the Individual Counseling Practicum class. Because each supervisor has different ways of conducting supervised sessions, the single-group pretest-posttest model was applied in this research. Also, because the supervisor’s course load is above average, he was unable to conduct supervised sessions with another group. Counselor trainees’ competency levels were measured before and after supervision. The qualitative part of the study includes the interviews performed with participating counselor trainees during and at the end of the supervised sessions. Participants The male and female counselor trainees who participated in this study were continuing their undergraduate education at a public university during the 2012-2013 academic year. The counselor trainees who would participate in supervised sessions based on the FSSM were determined using random assignment, an experimental technique. Individual Psychological Counseling Practicum is a class conducted in the four branches where counselor trainees are students. Only the names of branches (e.g. A, B, C, D), minus instructors’ names, can be seen in the student information system. Counselor trainees registering for the course do not know which branch belongs to which supervisor. Similarly, the supervisor can only learn who is taking the class when the semester starts. In the selection process, 51 counselor trainees studying at the previously mentioned public university were required to choose one of the four branches. Seventeen counselor trainees received the Individual Counseling Practicum class by assigning the subjects to different groups in a randomized experiment. As a result, 17 counselor trainees were included in the study, one male and 16 females between the ages of 21-22. Data Collection Tools The counselor competencies evaluation form, developed by Eryılmaz and MutluSüral (2014b), was used in the quantitative phase; semi-structured interview forms were used in the qualitative phase. Quantitative data collection tools. The counselor competencies evaluation form was used to gather qualitative data. This form was used to determine the frequency of mistakes counselor trainees made throughout the counseling sessions. In gathering qualitative data, the supervisor and co-supervisor collected relevant data weekly. This form was used to obtain the pretest and posttest scores of counselor trainees’ counseling competency and the frequency of mistakes made throughout counseling sessions. It is based on four main counseling areas: structuring, therapeutic skills, managing the therapeutic process, and therapeutic conditions. Structuring has three sub-dimensions: 604 Eryılmaz, Mutlu / Developing the Four-Stage Supervision Model for Counselor Trainees timing, purpose, and process. Therapeutic skills includes 13 therapeutic skills (i.e., reflection of feeling, personalization, and confrontation), whereas therapeutic conditions consists of five important therapeutic conditions: empathizing, positive regard, genuineness, concreteness, and being present. Managing the client, managing themselves as counselors, and managing the therapeutic relationship are the subdimensions within the scope of managing the therapeutic process. In total, there are 24 features on the form that describe counselors’ professional duties. Counselor trainees’ competences were assessed on the basis of 24 of the counselors’ professional duties being present or absent in their individual counseling practices. The study’s criterion for the presence of a related feature was determined as a counselor trainee receiving a score of 4.17 (100 / 24) for that feature. Based on this criterion, both the supervisor and the co-supervisor gave scores after listening to counselor trainees’ voice recordings and reading their transcripts. A counselor trainee was assumed to have performed a professional duty in their counseling practice when the two supervisors agreed the relevant professional duty is present in a counselor; this awards the trainee with a score of 4.17. However, counselor trainees were determined unable to carry out a professional duty in their counseling practice when both supervisors could not agree as to whether a professional duty is present or not in a counselor. As a result, counselor trainees were unable to score points for a professional duty that is absent in their counseling practice. Counselor trainees’ names were coded on this form as CT-1 through CT-17 when being evaluated. Each counselor trainee’s score was out of 100 points according to their competency level after the supervisor and co-supervisor had used the counselor competencies evaluation form. The lowest obtainable score for the Individual Counseling Practicum class is 0 and the highest is 100. After using the form, the average competence score across all coded sessions was calculated. After the first five individual counseling sessions, the scores that were measured after each were divided by five to obtain an average score. The same process was carried out for the last five counseling sessions. Thus the average scores of both the first five sessions and the last five sessions were calculated. Comparative analyses were based upon the mean scores obtained at the end of the first and last five sessions. To evaluate the level of consistency among experts, two experts with experience in the field of psychological counseling and guidance assessed the competency levels of counselor trainees using the counselor competencies evaluation form. Reliability for each sub-scale was investigated based on the experts’ ratings. Agreement between experts was found to be .92 for structuring, .88 for therapeutic skills, .80 for the therapeutic conditions, and .83 for managing the therapeutic process. Qualitative data collection tools. This study developed a semi-structured interview form in order to obtain counselor trainees’ views on the supervised sessions’ effectiveness. The semi-structured interview form was designed and conducted based on the basic principles of interviewing. When developing the interview forms, two 605 EDUCATIONAL SCIENCES: THEORY & PRACTICE counselor educators and an expert already working in the field of assessment and evaluation were requested for scrutinizing the interview form carefully. One counselor educator had already earned a PhD, while the other counselor educator is pursuing a master’s degree in counseling psychology. The expert in the field of assessment and evaluation is working on a doctoral dissertation. The interview form, which was reviewed in the direction of the given feedback, was utilized for gathering the research’s qualitative data. The supervisor asked the counselor trainees the open-ended questions developed according to the literature when the related stage was completed. The open-ended questions asked in the information-gathering stage are as follows: • What does the seminar, which was developed based on the skilled helper model, you received within the Individual Counseling Practicum remind you of? • How do you reflect the knowledge/skills you gained through the seminar into your counseling practice? • How do you relate the individual counseling sessions to the FSSM that was introduced in terms of the Individual Counseling Practicum class? Supervisors asked counselor trainees, “What do you think about the Individual Counseling Practicum class under supervision?” in the evaluation stage of the FSSM in order to evaluate the supervision process, the supervised sessions, and the supervisor’s role throughout the sessions. Procedure This study is based both on Egan’s (1975) skilled helper model and on the principles and techniques of counseling (Carkhuff, 2000; Cormier & Hackney, 2008; Egan, 1975; Ivey et al., 2010). Egan’s (1975) knowledge and the existing theoretical and empirical knowledge in counseling psychology led us to design this research. Questions about which kind of counseling is used frequently, how therapeutic conditions can be created during the therapeutic process, and what the components of the therapeutic process are at related stage were answered taking the literature into consideration. Also, the authors looked back at each stage according to the answers to these questions. Additionally, the counselor trainees, who were integrating the theory into practice, had enrolled in the Counseling Psychology Theories class through undergraduate education. The knowledge and skills gained in these courses have also created a theoretical framework for counselor trainees. Within this theoretical framework, the supervision sessions provided based on the FSSM lasted for 12 weeks. During the first week of supervised sessions, counselor trainees were informed about the process. In the last week, counselor trainees were asked to share their views on the supervised sessions. During the remaining ten 606 Eryılmaz, Mutlu / Developing the Four-Stage Supervision Model for Counselor Trainees weeks, the supervisor and co-supervisor listened to counselor trainees’ recordings of their latest individual counseling sessions and read their transcripts. Supervised sessions were conducted at the individual counseling room of a public university where the study was being conducted. During the supervised sessions, the study’s primary author was supervisor and the second author was co-supervisor. Similar to the supervisor, the co-supervisor listened to counselor trainees’ recordings of their latest individual counseling sessions and read through each transcript in its entirety in order to determine the competency levels of counselor trainees. All supervisors used the counselor competencies evaluation form to determine the levels of counselor trainees’ competences. In this way, regular feedback was provided to each counselor trainee for a total of 12 supervised sessions. Each counselor trainee conducted individual counseling sessions with only one client face-to-face. In other words, counselor trainees saw only one client on a weekly basis starting from Week 2 to until Week 11. Counselor trainees took the supervisors’ advice on whether their competency level was appropriate for the client after doing an intake on all clients. The supervisors told the counselor trainees when they would be able to begin seeing clients. Moreover, supervisors gave advice to counselor trainees on referring a client they wanted to work with when their competency level was insufficient. There were no criteria related to clients’ gender. However, counselor trainees were requested not to counsel clients close to their own age. Supervised sessions were scheduled for the same time and day each week. All 17 counselor trainees met and received feedback with supervisors for an hour each week starting with the second week of class and ending the last week of class. Only two people were present in the supervised sessions, one being the counselor trainee and the other being…