Clinical Supervision of Licensed Chemical Dependency Counselors: A Survey of Knowledge and Practice

Eric A. Schmidt

Southwest Texas State University

David C. Barrett

Private Practice, Dallas TX

 

 

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 designed to ascertain the amount and type of clinical supervision received during training, as well as the occurrence of clinical supervision in post-training years.

 

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 Texas intended to address this question. The purposes of the statewide survey were threefold: 1) to ascertain LCDCs opinions of clinical supervision, 2) establish the prevalence with which grounded theories are implemented during the delivery of clinical supervision, and 3) explore the frequency with which clinical supervision occurs in treatment settings. For purposes of this article, a grounded theory is one that has been scrutinized through research, encompasses pertinent dynamics related to counselor development and self-assessment, and is recognized as viable by a majority of the counseling profession.

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 Texas was taken from the current list of LCDCs developed and maintained by the state commission overseeing licensure requirements. The surveys were mailed to the random sample. Two hundred and thirty one responses (23.1%) were received.

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.

Table 1

Domain 1- Demographics/Age

 

Age

46+

36-45

36 or younger

 

136 (62%)

63 (28%)

20 (10%)

 

Table 2

 

Domain 1- Demographics/Gender

 

Gender

Female

Male

 

116 (61%)

72 (39%)

 

Table 3

 

Domain 1 -Demographics/Education

Education
High School ("some college")
Bachelor's
Graduate degree
 
69 (31%)
45 (20%)
110 (48%)

 

Table 4

 

Domain 1 - Demographics/Licensure

 

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.

Table 6

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.

Table 7

 

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.

 

 

Table 8

 

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 Texas, and throughout the chemical dependency field. Continued access to supervision post licensure would further promote the competence of chemical dependency counselors in the state.

 

References

Bernard, J. M. & Goodyear, R. K. (1998). Fundamentals of clinical supervision (2nd ed.). Needham Heights, MA: Allyn & Bacon.

Bradley, L. J. & Ladany, N. (2001). Counselor supervision: Principles, process, and practice (3rd ed.). New York, NY: Brunner-Routledge.

Boy, A. V. & Pine, G. J. (1983). Counseling: Fundamentals of theoretical renewal. Counseling and Values, 27, 248-255.

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. New York: Lexington.

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.

Texas Administrative Code, Title 40, Part III, Chapter 150, March 1, 2002.

 

Eric A. Schmidt is an Assistant Professor at Southwest Texas State University

David C. Barrett is in private practice in the Dallas metro area

 

 

Address correspondence to:
E.A. Schmidt, Ph.D., SWT-EAPS,
601 University Dr.
,
San Marcos, TX 78666
,
e-mail: es17@swt.edu
(512) 245-3979
fax (512) 245-8872