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Assessing the Needs of Rural Counselor Supervisors in Texas

Witt, Karl J; McNichols, Christine. Journal of Professional Counseling, Practice, Theory, & Research; Austin Vol. 41, Iss. 2, (Summer/Fall 2014): 15-29.

https://capella.alma.exlibrisgroup.com/openurl/01CAPELLA_INST/01CAPELLA_INST:Services? genre=article&atitle=Assessing+the+Needs+of+Rural+Counselor+Supervisors+in+Texas&author=Witt%2C+Karl+J%3BMcNichols%2C+Christine&volume=41&issue=2&spage=15& 07-01&rft.btitle=&rft.jtitle=Journal+of+Professional+Counseling%2C+Practice%2C+Theory%2C+%26+Research&issn=1556-6382&isbn=&sid=ProQ%3Apsychology_

Abstract

This study explored the needs of rural counselor supervisors (LPC-Ss) in Texas. Fifty participants responded to an online survey consisting of Likert-type items and free-response questions. Rural supervisors commented on their connectedness to their communities and profession, resources, multiple roles, boundaries and dual relationships, self-care, and personal factors. Supervisors felt disconnected from their profession and unsupported in supervisory roles but reported low burn-out rates. They reported perceived areas for additional training and suggestions for counselor education programs. Other findings paralleled earlier research regarding rural mental health professionals.

Headnote This study explored the needs of rural counselor supervisors (LPC-Ss) in Texas. Fifty participants responded to an online survey consisting of Likert-type items and free-response questions. Rural supervisors commented on their connectedness to their communities and profession, resources, multiple roles, boundaries and dual relationships, self-care, and personal factors. Supervisors felt disconnected from their profession and unsupported in supervisory roles but reported low burn-out rates. They reported perceived areas for additional training and suggestions for counselor education programs. Other findings paralleled earlier research regarding rural mental health professionals.

Key words: rural, supervision, counseling, mental health, LPC-S, counselor education, counselor training

A journey from one end of Texas to the other carries a traveler over some of the most diverse regions in the United States (US). While Texas hosts several booming metropolises, many Texans reside in rural agricultural communities (US Census Bureau, 2013), and many of those communities suffer from a shortage of qualified mental health professionals (Texas Department of State Health Services [DSHS], 2014). Most of the state's 18,641 Licensed Professional Counselors (LPCs) reside in urban areas (Texas State Board of Examiners of Professional Counselors [TSBEPC], 2014); seventeen percent of Texas counties lack LPCs altogether (DSHS, 2014). Since the TSBEPC requires supervision by an LPC-Supervisor (LPC-S) in a counselor's early career, the presence of LPC-Ss is important to increasing services. Breen and Drew (2012) and Oetinger, Flanagan, and Weaver (2014) both observed that exposure to rural settings can help attract new practitioners, yet only nine percent of LPC-Ss work in rural areas (TSBEPC, 2014). Researchers have explored the needs of counselors working in rural settings, but few have investigated the needs of rural supervisors. This study sought to answer the question, "What are the needs and experiences of rural supervisors practicing in Texas?" Findings from this study will help stakeholders appreciate rural circumstances and explore ways to assist and support rural supervisors in Texas and elsewhere.

Existing literature contains multiple, conflicting definitions of the term "rural," often based on one of more than 15 US government definitions (Coburn et al., 2007). The most common three are from the Census Bureau, the Office of Management and Budget (OMB), and the US Department of Agriculture's Economic Research Service (ERS). ERS specifically designed a method, the rural-urban commuting area (RUCA) codes, to address other systems' shortcomings (ERS, 2014). RUCA codes combine population density, the Census Bureau's geographic tracts, OMB's commuting patterns, the 2010 national census, and the 2006-2010 American Community Survey to differentiate between urban and rural. In the RUCA method, "rural" is defined as any geographic area where the aforementioned factors result in a RUCA code of four through ten (Coburn et ah, 2007).

Rural communities differ from urban ones in attitudes, beliefs, and values (Breen & Drew, 2012; Saba, 1991). Relationships often are more tightly knit, intersect in multiple ways, and are heavily influenced by family name and history (Cohn & Hastings, 2013; Curtin & Hargrove, 2010). There may be a lack of specialized services and concomitant multiple roles; a person who works as a judge may also be a local emergency first responder (Breen & Drew, 2013; Saba, 1991). Rural regions are often characterized by aging populations facing poverty and a lack of employment, medical insurance, and resources (Curtin & Hargrove, 2010). Qualified mental health providers may be lacking, and mental health concerns are often first addressed by law enforcement or primary health care workers (Robinson et ah, 2012). People who need services may not know how to access them, and affiliated stigmas may dissuade exploration. At times, the high visibility of daily activities in small communities further deters help-seeking and reduces therapeutic gains, especially when communities view helpseeking negatively (Curtin & Hargrove, 2010; Riding-Malon & Werth, 2014). Individuals living in rural settings often become their own advocates, first turning to families and faith communities before pursuing formal mental health assistance. For these reasons, rural mental health providers must work with and within these systems to be successful. Urban counselor training programs may take things like support groups, community centers, public transportation, and day-treatment centers for granted, unaware that rural settings may lack these resources (Helbok, ). These differences affect the way mental health practitioners and supervisors carry out their work.

Though little supervisor-specific rural counseling research exists, supervisors are also practitioners. Furthermore, LPC-Ss help supervisees conceptualize counseling, plan treatments, and work with rural clients under the LPC-S's license. It is therefore important to examine the rural counseling literature to better understand the supervisory context. The complexities of multiple relationships often arise in rural counseling literature (Breen & Drew, 2012; Cohn & Hastings, 2013; Helbok, 2003; Malone, 2010; Oetinger, Flanagan, & Weaver, 2014; Paulson, 2013). While rural citizens take abundant dualities for granted, counselors and supervisors may experience professional and personal difficulties (Paulson, 2013), leading some to question training approaches and the rural relevance of the American Counseling Association's ethical code (Gillespie & Redivo, 2012). Furthermore, mental health resource deficiencies and practitioner shortages often force rural counselors and supervisors to work as generalists who address and supervise a wide range of concerns and roles, including those for which they have little or no training (Breen & Drew, 2012; Paulson, 2013). Travel to expand clinical and supervisory competence through conferences and workshops may also be cost-prohibitive (Cohn & Hastings, 2013; Breen & Drew, 2012; Hastings & Cohn, 2013; Helbok, 2003; Malone, 2010; Oetingei; Flanagan, & Weaver, 2014; Paulson, 2013; Saba, 1991). Similarly, Cohn and Hastings (2013) note limited experience and exposure may impact practitioners' multicultural competence and may create unique challenges in supervision (Paulson, 2013).

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A lack of personal privacy is another frequent finding in the literature. Some authors (e.g., Cohn & Hastings, 2013; Rollins, 2010) labeled this high visibility as "being on stage" or "the fishbowl effect." Personal public outings may require more intention and reflection than in an urban setting. Having a drink in a restaurant, joining certain interest groups, or socializing with various people could have negative consequences for counselors, their families, and clients (Paulson, 2013). For some, feelings of isolation develop from constantly being watched by clients and supervisees (Breen & Drew, 2012; Hastings & Cohn, 2013; Helbok, 2003; Oetinger, Flanagan, & Weaver, 2014; Paulson, 2013). Reduced social support can lead to distress and burnout (Hastings & Cohn, 2013). Counselors might also feel restricted as advocates since advocacy on contentious topics might harm a counselor's practice and personal life, lead to mistrust of the counselor and strain community relationships (Bradley, Wreth, Hastings, & Pierce, 2012). Limited financial resources, substandard pay, demanding caseloads, and rural poverty are other oft-cited challenges for both counselor and supervisors (Oetinger, Flanagan, & Weaver, 2014; Hastings & Cohn, 2013; Paulson, 2013). Such factors may provide barriers to those practicing in rural settings or considering rural practice.

Researchers have suggested ways to aid rural professionals. Some stressed collaboration and continuing education through telehealth and online training modules for supervisors (Nelson, Hewell, Roberts, Kersey, & Avey, 2012; Riding-Malon & Werth, 2014). Paulson (2013) recommended peer supervision for supervisors as an avenue to gain support. Participants in the Breen and Drew (2012) study recommended that counselor education programs stress the importance of seeking supervision throughout one's career. Finally, Paulson (2013) recommended a formal rural counseling course that would specifically address issues related to working in a rural setting.

Despite some of the challenges inherent in rural work, many counselors and supervisors highlight the positive aspects of working in this setting. Oetinger, Flanagan, and Weaver (2014) surveyed 51 rural practitioners; 47% reported being very satisfied. They extolled the inherent diversity of their work, opportunities to help the underserved, work and recreation in natural surroundings, and the slower pace of life. Additional benefits added by Cohn and Hastings (2013) included career flexibility, work with generations of the same family, rural connectedness, school loan assistance, and a lower cost of living. Paulson (2013) found that rural supervisors greatly valued providers' relationships, collaboration opportunities, and rural interconnectedness. Curtin and Hargrove (2010) summed up the benefits of rural practice this way: "Many of the potential problems associated with work in smaller, rural communities may be translated as opportunities for creative practice" (p. 549).

Much of the research conducted over the past ten years focuses on the experiences of rural counselors. As counselors, rural supervisors share many of the same experiences. This study seeks to extend the supervisor-specific literature by asking, "What are the needs and experiences of rural supervisors practicing in Texas?"

Method

Participants

The study had 50 participants: 29 females (58%), 20 males (40%), and 1 selfdescribed other (2%). Participants described themselves as White («=44, 88%), Hispanic or Latino/a («=2, 4%), American Indian or Alaska Native («=2, 4%), Black or African American («=1, 2%), and Native Hawaiian or Other Pacific Islander («=1, 2%). Ages ranged as follows: 26 to 35 («=4, 8%), 36 to 45 («=9, 18%), 46 to 55 («=13,26%), 56 to 65 («=16, 32%), and 66 or older («=8, 16%). Moss, Gibson, & Dollarhide (2014) found that seasoned practitioners perceive counseling and practice differently than their newer colleagues. It follows that there may be differences between a seasoned counselor who is a new supervisor and a supervisor with more years of supervisory experience but less experience overall. Participants held their practitioners' licenses from three to 36-plus years and time in rural settings ranged from less than one to over 36 years. Experience as an LPC-S ranged from less than one to over 36 years. The number of years each participant has been fully licensed as an LPC, the amount of time working in rural settings, and the length of time as an LPC-S are reported in Table 1.

The authors also sought a representative geographic sample. The Texas Counseling Association (TCA) divides membership into five regions comprised of southeastern Texas (Region I), southern Texas (Region II), western Texas (Region III), northeastern Texas (Region IV), and central Texas (Region V; see Table 2).

Procedure

The public roster of Texas LPC-Ss («=3,911) was obtained from the TSBEPC website in June 2014. Eliminating unlisted («=133) and out-of-state («=95) addresses left 3,685 LPC-Ss. Using the May 2014 RUCAzip code correlations co-developed by ERS and ORHP, each address was classified as rural or urban. Addresses with codes one through three were considered urban; codes four through ten denoted rural areas. Zip codes with multiple RUCA codes and seven addresses created after the 2010 census were categorized by matching census tracts from the Federal Financial Examination Council Geocoding System and Google Maps with uncorrelated RUCA data. The resulting rural LPC-Ss («=344) were all mailed postcards inviting participation in an anonymous electronic survey with a second invitation four weeks later. Fifty-three individuals agreed to participate; fifty actually completed the study.

Instruments

The authors created a survey derived from existing rural mental health literature, interactions with rural supervisors, and observations of supervisory processes. Qualtrics web- based survey software was used to collect demographic data and responses to 26 standalone Likert-type items (see Table 3) and five free-response questions. The five free- response questions were: (a) What areas of training do counselor education programs need to include or improve, (b) Counselors often wear multiple hats in their professional settings. What roles do you play in your setting, (c) How do you engage in self-care as a rural supervisor (d) What are the benefits of working as a supervisor in a rural setting, and (e) What other issues do you feel rural supervisors face?

Data Analysis

Different analytic approaches were used for the two types of data collected. For standalone Likert-type items, median, mode, and frequency are the only meaningful descriptive statistics (Boone & Boone, 2012). The endorsement frequency for specific responses, the mode, and the median for each item are reported in Table 3. The researchers also independently conducted a conventional content analysis for each of the free-response questions, as described by Hsieh and Shannon (2005). For each question, responses were read repeatedly to discern initial common thoughts and ideas. A color coding system was created to categorize similar data. Each color code was given a descriptive label highlighting the pattern for that text. Researchers then discussed and reconciled patterns and labels. Resulting patterns were reported.

Results

Quantitative Results

Participants responded to Likert-type items about their connectedness to and collaboration with others, professional development, professional roles, dual relationships, technology, resources, and particular aspects of rural culture. Rural supervisors frequently or very frequently worked as generalists and fulfilled multiple roles in their settings. Despite distances, they did not use technology for distance supervision. They considered the financial resources for mental health to be inadequate and frequently or very frequently engaged in professional development activities. LPC-Ss also felt connected to others in their communities but disengaged from other counseling professionals. The Likert-type items and responses are reported in Table 3.

Qualitative Results

Free-response questions solicited suggestions for counselor education programs, roles played, self-care regimens, and benefits and issues of rural supervision. For the first question, participants recommended that counselor education programs improve training in business management; diagnostic skills and substance abuse counseling, especially dual diagnosis and treatment; boundaries and dual relationships; and couple and family work. Business acumen and "middle management techniques" were consistently stressed. Participants noted that supervisees needed better training about boundaries and dual relationships. One respondent wrote, "many of my practicum students come to me from a larger city and have no idea whatsoever how difficult it is in a small town to maintain boundaries", and another added, "[Supervisees need to know] how to navigate

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dual relationships in a small rural community including how to deal with invitations to social events, church, and community activities." Finally, a participant observed, "family counseling is needed to a greater extent in rural settings and most counseling graduates have had only one course in family therapy and/or diversity."

When asked about roles and self-care, LPC-Ss reported working as managers, community crisis intervention contacts, legal consultants to colleagues, teachers or trainers, committee members and project coordinators, and janitors and babysitters beyond their counseling and supervisory commitments. Participants engaged in self-care through healthy eating and exercise, being in nature, traveling, spending time with others, practicing spirituality, engaging in personal and professional development, and using time management techniques. Some respondents reported that time constraints inhibited their self-care. Others "recognize[d] the need to recharge my batteries" and "knowing what gets me reconnected with things that matter." Perceived benefits of rural settings consisted of no competition with other providers, the atmosphere (e.g., being close to natural beauty, no traffic, slower pace), connection to community, the rewards of conducting supervision, and being able to meet the community's needs. Many respondents commented on how fulfilling supervision in a rural area can be. One respondent wrote,

The interns are passionate and eager to serve in their communities. Since there are not many interns, the needs for supervisors is lessened which allow me to invest in the interns more than if I had a full case of interns. I'm able to help train them for the needs of our area and refer to interns and licensees with confidence in their skills, abilities, and desire to help others. The interns become lifelong friends and colleagues since we need to help each other in rural communities. We form our own support systems for counselors.

The open question about what issues rural supervisors face resulted in five patterns: a lack of resources for referrals such as supervisors, doctors, and other helping agencies; a lack of funding and reimbursement; a lack of access to continuing education; difficulty managing dual relationships and boundaries; and a lack of professional support. When talking about the lack of resources in a rural community, one participant described the issue this way: "how to cope with the strain of feeling that you have to take everyone because there are no options for referrals." Another respondent stated, "I often feel obligated to take on an intern because there are so few options available to them." Issues related to boundaries were also repeated with one participant stating,

I often face challenges maintaining boundaries. My children also attend school and befriend my clients (as there is only one school system) which creates a unique issue. If I were to need clinical help for myself, it would be difficult to find someone I do not already have a relationship with professionally.

Finally, a lack of access to continuing education was a common pattern. Many discussed issues relating to having to travel a great distance to receive continuing education. One respondent stated it this way:

It's difficult to access continuing education that is not offered online. We often must travel six hours for live trainings. This requires significant time away from our practice as well as costly travel. We are not able to meet other supervisors and counselors in our rural areas when trainings are halfway across the state of Texas.

Discussion

This study sought to explore and describe the needs of rural supervisors. Results confirmed and enhanced existing literature about rural practice. Paralleling Paulson's (2013) research with counseling supervisors, rural LPC-Ss generally felt connected to their communities but disconnected from other mental health practitioners. This might be due to the distance and time required to connect with professional counterparts, as it is with counselors (Breen & Drew, 2012; Hastings & Cohn, 2013). This lack of connection stems from competition for a limited paying client base (Cohn & Hastings, 2013); findings from this study suggest similar fears from supervisors. Respondents in the current study described low levels of participation in professional counseling organizations and collaboration with university training programs, which might also contribute to disconnected- ness and isolation. As with their non-supervisory colleagues, rising conference and membership costs and a lack of pertinence to rural settings could also be prohibitive factors (Breen & Drew, 2012). Supervisors might be unaware of nearby training programs or universities' roles as resources. Though respondents engaged in professional development activities, qualitative data conveyed fewer faceto-face opportunities for rural supervisors.

Confirming Paulson's (2013) results, participants felt unsupported as counselor supervisors. As they strived to balance multiple roles, many unrelated to their expertise, role confusion and invalidation sometimes resulted. Though facilities were adequate, respondents decried the lack of local qualified professionals and financial resources for mental health. Unique to this study, despite these obstacles, supervisors reported low burnout rates. This may be due to respondents' age and experience combined with active, quality self-care.

Another finding concerned dual relationships and boundaries within rural communities. Participants noted that while they often fulfilled various community roles, only some had to deal with dual relationships or boundary management with clients similar to Paulson's (2013) findings. This study also inquired about dual relationships and boundary management with supervisees. Incidents were fewer with supervisees than with clients, and frequent conversations about these issues may have decreased the likelihood of problematic occurrences. These results might also indicate that seasoned rural counselors adeptly handle this rural norm.

Supervisors also discussed counselor preparation and distance supervision. They felt universities did not adequately prepare students for rural work. They also very rarely used distance technology and preferred faceto-face interactions. Many also highly valued helping supervisees grow and developing lasting collegial relationships with them.

Implications

Several implications can be drawn from this study. One prevalent need is for rural counselor supervisors to feel supported and connected to colleagues. Professional memberships and continuing education may help. Counseling organizations might continue to closely monitor membership costs and services' relevance. While online continuing education is valuable, contact is crucial to reducing isolation. Regional organizations and universities might host local conferences or workshops, especially on issues such as boundary management, finding resources, and self-care. Increased rural training placements for student counselors may provide fresh perspectives, aid with caseloads, and prepare future rural counselors.

Counselor educators should consider a focus on uniquely rural issues. Navigating, rather than avoiding, realistic dual relationships; rurally-oriented multicultural training; and working within systems as an outsider might be beneficial. Practical lessons on locating resources, making referrals, using non-mental health professionals, and managing businesses may also be constructive. Programs might also infuse self-care and rural exposure into the curriculum.

Advocacy efforts might be made on behalf of rural practitioners. Minimal resources make it hard to meet community needs. Based on participant responses, advocating for proper payment and reimbursement for LPCs and LPC-Interns from insurers and Medicaid could have positive wide-ranging effects.

Limitations

The study had some inherent limitations. While each TCA region was represented, there were more participants from Region IV (northeast Texas) than the other four regions combined. Findings may be heavily colored by the experiences of rural counselor supervisors working within that region. There may also be differences between those who responded to the survey and those that did not. The design relied on potential participants to manually enter a survey link web address from a mailed postcard. The extra steps and reliance on practitioners' technological prowess may have decreased the number of participants or differentiated respondents from the larger population. Although results of this study may be generalized to other rural contexts, conditions in Texas may differ significantly from other rural areas. Therefore, caution is warranted when applying these findings.

Future Directions

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This study examined the needs of LPC-Ss working in rural Texas. The findings support prior literature and open the way for new areas of research. Investigating relationships between the age and experience of rural counselor supervisors and their ability to deal with complicated issues pertaining to dual relationships and boundaries might be one avenue. Another research area might explore how rural counselor supervisors develop methods of self-care despite dealing with high levels of professional isolation. Looking more closely at how and why rural counselor supervisors feel isolated, especially when competition for resources and paying clients exists, may also give practitioners valuable information about how to best help those working in rural settings. Finally, this study only explored rural supervisors in Texas. Subsequent studies from other rural areas or with national samples can further enhance the literature.

Conclusion

There is no doubt that the need for mental health services in rural areas is rising (Robinson et ah, 2012; DSHS, 2014). Those who currently work in rural settings have a diverse set of needs; however the solutions may be tangible and feasible as professional organizations, counselor education programs, and LPC-Ss, both in Texas and beyond, work together to meet the needs of rural supervisors and strengthen rural mental health services.

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AuthorAffiliation Karl J. Witt and Christine McNichols

The University of Texas at Tyler

AuthorAffiliation Author Note:

Karl J. Witt, Assistant Professor of Counseling, Department of Psychology and Counseling, The University of Texas at Tyler; Christine McNichols, Assistant Professor of Counseling, Department of Psychology and Counseling, The University of Texas at Tyler. This project was funded by a research grant from the Texas Association of Counselor

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Details

Subject Supervisors; Rural areas; Counseling; Mental health; Medical personnel; Health services; Studies; Census of Population; Multiculturalism & pluralism

Location United States--US Company / organization Name:

NAICS: Bureau of the Census 926110

Title Assessing the Needs of Rural Counselor Supervisors in Texas Author Witt, Karl J; McNichols, Christine Publication title Journal of Professional Counseling, Practice, Theory, & Research; Austin Volume 41 Issue 2 Pages 15-29 Number of pages 15 Publication year 2014 Publication date Summer/Fall 2014 Section RURAL SUPERVISORS Publisher Taylor & Francis Ltd. Place of publication Austin Country of publication United Kingdom, Austin Publication subject Education ISSN 15566382 e-ISSN 21689156 Source type Scholarly Journal Language of publication English Document type Journal Article Document feature References; Tables ProQuest document ID 1658219097 Document URL http://library.capella.edu/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fscholarly-journals%2Fassessing-needs-rural-counselor-

supervisors-texas%2Fdocview%2F1658219097%2Fse-2%3Faccountid%3D27965 Copyright Copyright Texas Counseling Association Summer/Fall 2014 Last updated 2022-02-02 Database ProQuest Central

Education and Supervision (TACES). The authors thank the TACES research grant committee for their support.

Correspondence concerning this article should be addressed to Karl J. Witt. Email: [email protected] Copyright Texas Counseling Association Summer/Fall 2014

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