Tuesday, December 11, 2012

Supervision of Counselors Working with Clients in Crisis: A Review for Supervision Practitioners

Allison C. Marsh, The University of North Carolina at Greensboro

What was the purpose of this literature review?
            The purpose of this review was to summarize the existing literature on supervision of client crisis and to offer useful tips to practicing supervisors as they guide counselors through challenging client situations. Crisis intervention is becoming an increasingly common part of many counselors’ practice. Among the numerous responsibilities we assume in meeting the needs of our clients, it is one of the most impactful and anxiety producing. Many counselors report feeling underprepared for intervening in client crisis. Yet crisis is a very real part of many of our clients’ lives. Counselors are frequently told of the importance of consultation and supervision – “Whenever in doubt, consult!” These resources are particularly vital in cases of client crisis when powerful emotions and the need for quick decision-making can feel overwhelming.

Major findings or points:
            Researchers have indicated that counseling clients in crisis can have a significant impact on the personal and professional lives of counselors, and lead to feelings of anxiety, shock, anger, frustration, helplessness, sadness, and responsibility (McAdams & Foster, 2000; Richards, 2000; Smith, Kleijn, & Hutschemaekers, 2007). Patterns of stress, burnout, and impairment in functioning highlight the vital importance of external support, particularly from counselor supervision. In fact, supervisory support has been rated the most useful resource for counselors working through a client crisis (McAdams & Foster, 2002).
            The following are some basic recommendations, based on research findings, for supervising counselors in working with client crisis:
1)    Supervisors should work with counselors from the beginning of the supervisory relationship to assess competence and confidence in working with clients in crisis, and to identify challenge areas.
2)    Supervisors should talk openly with counselors about the potential impact of working with clients in crisis and the range of reactions they may experience, including but not limited to those mentioned above.
3)    Both supervisors and counselors should be knowledgeable about agency policies and procedures regarding client crisis intervention, as well as area resources for referral.
4)    Supervisors should encourage counselors to consult when making decisions that affect a client in crisis and to seek more frequent supervision during these times.
5)    Counselors should also be encouraged to seek support beyond the supervisory relationship, including personal therapy as needed.
            In addition, some models exist that provide a framework for supervisors to use in addressing client crisis with their supervisees. The Preparation, Action, Recovery (PAR) model breaks crisis intervention down into three stages and outlines steps for thorough and ethical practice at each stage, as well as potential threats to effective counselor intervention (McAdams & Keener, 2008). The Cube Model (McGlothlin, Rainey, & Kindsvatter, 2005) incorporates two well-known and established models for supervision into a comprehensive framework for supervising counselors as they work through client crisis at various levels of severity. This model is particularly useful in helping supervisors gauge interventions that are appropriate to a counselor’s developmental level and to the specific needs of the client.

Major caveats:
            The onus of consultation in working with client crisis does not end with the counselor. Remember that it is important for supervisors to consult as well, particularly with other professionals who have experience supervising during client crisis. It is also important to remember that, although these basic guidelines may be helpful, each situation is unique and should be approached with consideration for the individual needs of the client as well as the counselor involved.

What does this research mean for counseling practice, settings, and/or training?
            Although working with clients in crisis can feel overwhelming and confusing for both the counselor and supervisor, these guidelines and models provide some structure for approaching these challenging situations in supervision. By remaining aware of the unique demands of working with client crisis and by maintaining best practices in supervision, counselor supervisors can maximize the effectiveness of their support and interventions and minimize negative outcomes for practitioners.

Supervision of client crisis, client crisis, suicidal ideation

For Further Reading:
*Most recommended for supervisor practitioners
*Hipple, J., & Beamish, P. M. (2007). Supervision of counselor trainees with clients in crisis. Journal of Professional Counseling: Practice, Theory, and Research, 35(2), 1–16.
McAdams, C. R., & Foster, V. A. (2000). Client suicide: Its frequency and impact on counselors. Journal of Mental Health Counseling, 22(2), 107–121.
McAdams, C. R., & Foster, V. A. (2002). An assessment of resources for counselor coping and recovery in the aftermath of client suicide. Journal of Humanistic Counseling, Education and Development, 41, 232–241.
*McAdams, C. R., & Keener, H. J. (2008). Practice & preparation, action, recovery: Preparation and response in client crises. Journal of Counseling and Development, 86, 388–398.
*McGlothlin, J. M., Rainey, S., & Kindsvatter, A. (2005). Suicidal clients and supervisees : A model for considering supervisor roles. Counselor Education and Supervision, 45, 135–146.
Miller, G. D., Iverson, K. M., Kemmelmeier, M., Maclane, C., Pistorello, J., Fruzzetti, A. E., Watkins, M. M., et al. (2011). A preliminary examination of burnout among counselor trainees treating clients with recent suicidal ideation and borderline traits. Counselor Education and Supervision, 50, 344–359.
Richards, B. M. (2000). Impact upon therapy and the therapist when working with suicidal patients : Some transference and countertransference aspects. British Journal of Guidance and Counselling, 28(3), 325–337.
Smith, A. J. M., Kleijn, W. C., & Hutschemaekers, G. J. M. (2007). Therapist reactions in self-experienced difficult situations: An exploration. Counselling and Psychotherapy Research, 7(1), 34–41. doi:10.1080/14733140601140865

No comments:

Post a Comment