Clinical Supervision of Licensed Chemical Dependency Counselors:
A Survey of Knowledge and Practice
Eric A. Schmidt
David C. Barrett
Private
Practice,
Abstract
The training and educational requirements
for licensure as a chemical dependency counselor have continued to increase
over the past three decades. For example, some states have outlined specific
standards that must be successfully met in order to achieve and maintain
a professional license as a chemical dependency counselor (LCDC). Among these
are standards specifically addressing clinical supervision. The state of
Texas requires LCDC counselors-in-training to remain in supervision for thousands
of hours in order to refine the skills needed to effectively treat clients
experiencing substance use, abuse and dependency. Little is known, however,
as to the type, quality and consistency with which clinical supervision is
being provided both during and after training. This article discusses the results of a statewide survey
of 231 chemical dependency counselors. The survey was
Clinical Supervision of Licensed Chemical
Dependency Counselors: A Survey of Knowledge and Practice
The primary purpose
of clinical supervision is to facilitate the transition from the classroom
to the counseling room. Valle (1984) asserts that
a high standard of supervision in chemical dependency counseling contributes
to quality care for the client. Indeed,
clinical supervision has become accepted as an integral part of the counseling
experience. Professional literature
on the importance of clinical supervision for the competent development of
mental health professionals in general, and chemical dependency counselors
in particular, is abundant (Bradley & Ladany, 2001; Culbreth, 1999; Bernard
& Goodyear, 1998; Taleff & Swisher, 1997; Powell & Brodsky, 1993).
Clinical supervision provides a bridge from the
acquisition of knowledge about addiction and human behavior to the implementation
of the skills necessary to promote behavior change and sobriety by effectively
engaging a client in counseling.
The extent of training in clinical supervision received by those who supervise chemical dependency counselors is limited, however (Culbreth, 1999; Taleff & Swisher, 1997). Culbreth (1999) noted that unique characteristics within the chemical dependency field, such as counselor recovery status and education level, might necessitate separate investigation and training of clinical supervision experience and preferences. In spite of such exceptional circumstances for clinical supervisors in the substance abuse field, research suggests that the extent of the training they receive is limited (Culbreth, 1999; Taleff & Swisher, 1997).
Powell (1989) recommended, "More sophisticated mechanisms
must be established for providing clinical supervision to alcoholism and
drug abuse counselors." (p. 146). He found that differences exist between
supervisors’ and supervisees’ knowledge and skill areas primarily in regards
to clinical skills, ..."such as individual and group counseling"
(pg. 145). To effectively address this difference, Powell recommended more
extensive education for supervisors in how to provide clinical supervision.
Likewise, Taleff and Swisher (1997) outlined an advanced level of training
and education for the chemical dependency counselor, listing supervision
as one of seven skills in which chemical dependency counselors should be
trained. Within the skill of clinical supervision, they include emphases
on theory, ethics, grants and public speaking (p. 14), calling for a greater
need for higher education in the realm of chemical dependency training.
Recently, the chemical dependency profession has responded to concerns regarding training and education of clinical supervisors by continuing to increase the educational requirements for certification as a clinical supervisor. For example, some states have outlined specific standards that must be successfully met in order to achieve and maintain a professional license as a chemical dependency counselor (LCDC) (Texas Administrative Code, Ch. 150, 2002). Among these are standards specifically addressing clinical supervision. For example, Chapter 150 of the Texas Administrative Code requires LCDCs-in-training to remain in supervision for thousands of hours in order to refine the skills needed to effectively treat clients experiencing substance use, abuse and dependency. Furthermore, in some states, yearly certification and/or continuing education for those individuals providing clinical supervision in the field may also be required.
Though requirements
for education have increased for many counseling professionals, the following
question remains: Do continuing education
requirements result in an increase in the occurrence and quality of clinical
supervision among and between chemical dependency counselors?
This article will list the results of a survey conducted in the state
of
Method
The 28-item, self-report
survey consisted mainly of a four point Likert scale and included three forced-choice
items (e.g., "Do you have a clinical supervisor now?"). A random
sample of 1000 licensed chemical dependency counselors (LCDCs) in
The survey was comprised of four domains. The first domain gathered demographic data (i.e., age, license/certification held, gender, etc.). The second domain explored the respondent's opinions of clinical supervision. The third focused on the respondent’s experience with clinical supervision (including whether grounded theories of supervision were taught and implemented). Lastly, the fourth domain garnered information regarding the respondent’s current involvement in clinical supervision.
Results
After compiling the responses of all completed surveys, a frequency distribution was obtained on each item. Results regarding the first domain (demographics) can be seen in Tables 1-5. Scanning the demographic data, it is readily apparent that the majority of counseling professionals who completed the survey is comprised of women at or over the age of 46 who have earned graduate degrees. Of all respondents, 97% report having some college experience.
The number of respondents in recovery was similar to the number who reported a nonrecovery status (48% vs. 52%, respectively). The researchers would note that this ratio is similar to Culbreth’s (1999) survey of alcohol and drug abuse counselors.
Age |
46+ |
36-45 |
36 or younger |
|
|
136 (62%) |
63 (28%) |
20 (10%) |
Gender |
Female |
Male |
|
|
116 (61%) |
72 (39%) |
Table
3
|
Education
|
High School ("some college")
|
Bachelor's
|
Graduate degree
|
|
69 (31%)
|
45 (20%)
|
110 (48%)
|
Table
4
Years licensed
|
Less than one |
1-5 |
6-10 |
10+ |
|
|
11 (5%) |
48 (22%) |
95 (42%) |
70 (31%) |
Table
5
Domain 1 - Recovery Status
|
Are you or were you ever in recovery? |
Yes |
No |
|
|
110 (48%) |
119 (52%) |
The second domain (see items in Table 6) explored the respondent’s opinions of clinical supervision. Eight statements were given with which the respondent could disagree, disagree somewhat, agree somewhat, or agree. Seventy four percent of respondents agreed that clinical supervision makes LCDCs more effective. Similarly, 72% agreed that clinical supervision is necessary to the survival of the field.
When asked whether or not they agreed with statements about influences
of counselor’s effectiveness, 81% of respondents disagreed at least somewhat
that a counselor’s personal history is the most important part in proving
effectiveness. Forty one percent agreed somewhat that the counselor’s level
of education is the most important factor, and 73% agreed at least somewhat
with the statement that the quality of supervision is the most important
factor.
Domain 2: Opinions
|
|
Disagree |
Disagree Somewhat |
Agree Somewhat |
Agree |
|
Clinical supervision makes chemical dependency counselors (LCDCs) more effective. |
8 (3.5%) |
7 (3.0%) |
45 (19.6%) |
170 (73.9%) |
|
Clinical supervision is necessary for the survival of the field. |
10 (4.3%) |
12 (5.2%) |
43 (18.6%) |
166 (71.9%) |
|
Clinical supervision is beneficial for CIs. |
4 (1.7%) |
4 (1.7%) |
20 (8.7%) |
203 (87.9%) |
|
Clinical supervision is beneficial for LCDCs. |
5 (2.2%) |
14 (6.1%) |
51 (22.3%) |
159 (69.4%) |
|
A Counselor’s personal history of recovery is the most important part in proving effectiveness. |
129 (56.1%) |
58 (25.2%) |
34 (14.8%) |
9 (3.9%) |
|
The counselor’s level of education is the most important part in determining effectiveness. |
50 (21.7%) |
52 (22.6%) |
95 (41.3%) |
33 (14.4%) |
|
The quality of clinical supervision received is the most important factor in determining effectiveness. |
24 (10.4%) |
36 (15.7%) |
118 (51.3%) |
51 (22.2%) |
|
The counselor’s amount of experience is the most important factor in determining effectiveness. |
18 (8.0%) |
42 (18.6%) |
119 (52.6%) |
47 (20.8%) |
The majority of those surveyed had some personal experience with clinical supervision during their training or education (see table 7). Exploring this experience further, the question was posed as to whether or not they were trained in a particular model. The results show that 80% were not. Of those who were, 13% were able to specify which model. Additionally, 37% received supervision from their boss compared to only 14% who were supervised by a clinical supervisor. While the majority of respondents received clinical supervision as they entered the field, very few were trained in a particular model or by a clinical supervisor.
Domain3: Personal experience/ hours
|
|
None |
1-5 |
6-10 |
11-20 |
20+ |
|
How many clock hours did you spend learning about clinical supervision in your training/education? |
57 (25.3%) |
40 (17.8%) |
35 (15.6%) |
21 (9.3%) |
72 (32%) |
|
During your internship/ training, how many hours of clinical supervision did you receive per month? |
35 (16.7%) |
45 (21.4%) |
45 (21.4%) |
84 (40%) |
1 (0.5%) |
The fourth domain examined professionals’ current involvement with clinical supervision (see Table 8). Over two thirds of respondents reported having no clinical supervisor (67%). Similarly, a majority of respondents received no hours of supervision on a monthly basis (58%). About half of the respondents provided at least some supervision on a weekly basis (52%), with 56% having participated voluntarily, and 44% being required. 97% did not specify which model from which their supervisor provided supervision.
Domain 4: Current Involvement
|
|
None |
1-3 |
4-6 |
6+ |
|
How many hours do you currently spend receiving clinical supervision each month? |
119 (58.1%) |
56 (27.3%) |
22 (10.7%) |
8 (3.9%) |
|
How many hours do you currently spend providing clinical supervision each week? |
100 (47.6%) |
45 (21.4%) |
27 (12.9%) |
38 (18.1%) |
Discussion
From the results of this survey, it seems that LCDCs’ attitudes toward clinical supervision were positive overall. Respondents felt that supervision contributes to the field, is beneficial to interns and practitioners, and played a major role in a chemical dependency counselor’s effectiveness. Respondents rated the importance of supervision equal to a counselor’s experience and more important than a counselor’s education.
It is apparent that while the majority of respondents received clinical supervision as they entered the field, very few clinical supervisors implemented a particular model. Indeed, 80% of respondents were not trained in a particular model at all. Of those who were, only 13% were able to specify which model. Additionally, 37% received supervision from a boss compared to only 14% who were supervised by a clinical supervisor. The power dynamics relevant to this type of dual relationship may call into question the validity of the clinical supervision received.
During training, the vast majority (80%) of respondents reported receiving between one and 20 hours of supervision per month. This suggests that supervision, in some form, is occurring for most chemical dependency counselors-in-training. However, though most respondents share a belief in the importance of clinical supervision for the development of a counselor, very few receive any supervision post licensure. Fifty eight percent (58%) reported currently receiving no supervision, while another twenty seven percent (27%) receive one to three hours per month.
What are the implications for these practices in the field? Valle (1984) has asserted "... a high standard of supervision in alcoholic counseling contributes to quality care for the alcohol afflicted individual." (p. 101). The researchers would assert that such a high standard of supervision would include supervision grounded in a unified theory provided by a trained, qualified clinical supervisor. The power dynamics present in a boss/employee relationship could be prohibitive in promoting the supervisee’s therapeutic competence. Based upon this premise, this survey would suggest that a high standard for clinical supervision in the chemical dependency counseling field is not being consistently met.
Boy and Pine (1983) espoused the importance of choosing and adhering to a single theory. Implementing a single theory of supervision helps one find relatedness and unity among diverse observations and behaviors. Theory unifies seemingly unrelated skills that, in totality, greatly contribute to a counselor’s development, lending to a more comprehensive supervision approach. Furthermore, theory draws attention to relationships previously overlooked. If clinical supervisors are not operating from a consistent theoretical framework, it may be difficult for the supervisor to promote the professional development of the supervisee.
The continuation
of clinical supervision after licensure requirements have been met could
also be emphasized. The goal of clinical supervision is to promote the counselor’s
development of therapeutic competence. Despite the results of this survey,
professional development should not stop once licensure is achieved. Perhaps
more rigorous training and education requirements would help promote the
occurrence of clinical supervision among and between chemical dependency
counselors. In order to provide the best possible treatment for clients facing
issues of substance abuse and addiction, chemical dependency counselors must
hold themselves to high standards. Perhaps continuing to increase the training
and education standards would enhance the provision of clinical supervision
by licensed chemical dependency counselors in the state of
References
Bernard, J. M.
& Goodyear, R. K. (1998). Fundamentals
of clinical supervision (2nd ed.).
Bradley, L. J.
& Ladany, N. (2001). Counselor
supervision: Principles, process,
and practice
Boy, A. V. & Pine, G. J. (1983).
Counseling: Fundamentals of theoretical renewal.
Counseling
Culbreth, J. R. (1999). Clinical supervision of substance abuse counselors: Current and preferred practices. Journal of Addictions and Offender Counseling, 20, 15-25.
Kuver, J. M. & Silver, D.S. (1986). Dynamics of supervision in the treatment of alcoholism. Alcoholism Treatment Quarterly, 3, 125-143.
Powell, D. J. (1989). Clinical supervision - A ten-year perspective. The Clinical Supervisor, 7,139-147.
Powell, D. J. & Brodsky, A.
(1993). Clinical supervision in
drug and alcohol abuse counseling.
Taleff, M. J. & Swisher, J. D. (1997). The seven core functions of a master’s degree level alcohol and other drug counselor. Journal of Alcohol and Drug Education, 42, 1-17.
Eric A. Schmidt is an Assistant Professor at
David
C. Barrett is in private practice in the
Address correspondence to:
E.A. Schmidt, Ph.D., SWT-EAPS,
601 University Dr.
e-mail: es17@swt.edu
(512) 245-3979
fax (512) 245-8872