Client Outcomes Across Counselor Training Level Within a Multitiered Supervision Model.
The authors examined client outcome data to evaluate treatment effectiveness across counselor training level. They used a multitiered supervision model consisting of professional staff, interns, and practicum students. Clients (N=264) demonstrated significant improvement with no significant outcome differences between professional staff and supervised trainees. Limitations and future directions are discussed.
Preview of the article:
A symbiotic relationship has long existed between mental health service providers and graduate student trainees seeking real-world counseling experience. Training sites offer graduate students invaluable opportunities to refine counseling skills, gain professional experiences, and receive expert supervision (Bernard & Goodyear, 1998; Boggs & Douce, 2000; Krasner, Howard, & Brown, 1998). In return, these training sites re-ceive free or low-cost labor from the graduate student trainees (Holland, 1998). In the current climate of increasing financial pressures and clinical demands placed on service providers (Constantine & Gloria, 1998), the use of graduate student trainees has become so commonplace that few scholars ques-tion the practice. In this article, we evaluate the assumption that counseling services provided by student trainees under close supervision result in client outcomes that are equivalent to services provided by licensed professionals.
A recent review of the counseling outcome literature concluded that “there have been surprisingly few research studies in the area of experience, training, and client out-come” (Lambert, 2005, p. 861). Studies designed to evaluate client outcome across counselor training levels have yielded mixed results (Stein & Lambert, 1995). Although several reports suggested that counselor experience is not crucial to client outcome (e.g., Michael, Huelsman, & Crowley, 2005; Propst, Paris, & Rosberger, 1994), other reports favor experienced counselors (e.g., Callahan & Hynan, 2005). Re-search has shown that experienced counselors conceptualize clients with greater depth and complexity (Eells, Lombart, Kendjelic, Turner, & Lucas, 2005; Mayfield, Kardash, & Kivlighan, 1999); possess more highly developed cogni-tive, emotional, and relational characteristics (Jennings & Skovholt, 1999); and experience fewer client drop-outs than do novices (Stein & Lambert, 1995). In particular, novice counselors may display heightened anxiety, which can be detri-mental to counseling interventions and to the counselor–client relationship (Kelly, Hall, & Miller, 1989). Under some circumstances, counselor experience level (Roth, 2003) and degree of trainee experience (Driscoll et al., 2003) can be significant predictors of client improvement. However, the overall magnitude of the differences between counselors and trainees in terms of client outcomes has not been established in the literature (Lambert, 2005).