Stages of Change and Clinical Supervision: Application to Burnout and Turnover
Intention
Prochaska and DiClemente, (1994) depicted that there are five stages through which a person
progresses when engaging in change. The first stage, pre-contemplation is defined by lack of
awareness of the problem and lack of motivation to change. The second stage, contemplation, the
individual is aware of the problems but rarely needs to rectify them (Prochaska & DiClemente,
1994). The third stage, preparation is marked by small changes, this could be cognitive and/or
behavioural (Prochaska & DiClemente, 1994). Prochaska and DiClemente, (1994) generalised
that the action stage involves further cognitive and behavioural changes. The last stage is
maintenance; this involves active preservation of changes made at previous stages to avoid a
relapse (Prochaska & DiClemente, 1994).
Aten et al. (2008) reported that these five stages are both hierarchical and spiral; this means that
an individual may move through each stage more than once. Prochaska and Norcross (2009)
extrapolated that there are 10 empirically supported processes or activities that people utilise to
alter feeling, thinking, and/or behaving within the above stages. These processes are:
“Consciousness-raising, catharsis/dramatic relief, self-re-evaluation, environmental re-
evaluation, self-liberation, social liberation, counter-conditioning, stimulus control, contingency
management, and helping relationships (Prochaska & Norcross, 2009).
Figure 7.1: Prochaska and DiClemente’s Wheel of Change; Prochaska, DiClemente and
Norcross, (1992).
Aten et al. (2008) applied this model of change to the process of clinical supervision. This thesis
integrated this application to dealing with turnover intention and burnout in clinical supervision.
Pre-contemplation Stage
Aten et al. (2008) depicted that in this stage, Supervisees are not focused on change instead it is
those who interact with the supervisee who may notice the supervisee’s potential growth area.
Aten et al. (2008) further stated that the supervisee might readily accept suggestions for change
based on the quality of the supervisory relationship. The supervisor’s task is to establish rapport
with the counsellor and to present realistic alternatives and opportunities for growth.
Contemplation Stage
Aten et al. (2008) reported that in this stage supervisees have a sense that they need change
however, the supervisee is not sure how this change looks like and whether to commit
themselves to that change. Aten et al. (2008) further construed that at this stage the supervisee
engages in deliberation and stagnation as result of increased awareness about professional
expectations. The supervisor’s task is to explore feelings of ambivalence, apprehension, distress
and anxiety. Further, they can explore with the counsellor the pros and cons of change and what
it costs to implement the changes associated with Burnout and turnout intention (Aten et al.
2008).
From the study findings, a number of participant expressions signified being at this stage. For
example when asked to narrate their incidents of feeling burnout Participant 4 reported that:
“When I feel low or stressed out I share with a supervisor or other trusted counsellor. Most of
the time, they are issues related to work,” Participant 2 narrated: “I was working double shifts. I
was disappointed by the work I do. I expected success, and unfortunately it did not work out
well” and Participant 18 narrated that: “Loss of a loved made me feel burnout, The insecurity of
failing to deliver in terms of counselling, and also meeting my goals and objectives in life both
spiritually and professionally.”
Preparation Stage
Aten et al. (2008) emphasized that those in the preparation stage are aware of areas in need of
growth and intend to change. Turnbull (2000) reiterated that the supervisee would make small
behavioural changes after dealing with ambivalence of the contemplation stage. The task of the
supervisee and the supervisor at this stage is collaborating in setting goals and to evaluate
foundation for changes. Aten et al. (2008) forecasted that structured collaboration results in
success at the action stage.
A number of respondents reported instances that would depict preparation for change. For
example when asked about interventions for dealing with burnout and turnover; Participant 2
reported: “Improving communication channels,” Participant 18 stated: “Proper planning,”
Participant 16 expressed: “Training and also personal therapy” and Participant 18 stated:
“Redefine failure and keep trying.”
Action Stage
Aten et al. (2008) contended that supervisees experience anxiety in this stage as a result of
applying and implementing new knowledge, skills, and treatment interventions. They further
espoused that this anxiety is similar to those experienced by clients in counselling. Aten et al.
(2008) generalised that at this stage the supervisee embarks on making commitments to
professional development, and executing concerted behavioural strategies to affect client growth.
In my view, what stands out is that the supervisee is committed to change that fosters growth.
The supervisor’s task is to evaluate the counsellor’s competence in implementing change.
Further, the supervisor is expected to offer support and challenge the supervisee as they grow in
the change process (Aten et al. 2008).
From the study findings, many participants’ expressions signified being at this stage. For
example when asked to describe interventions for dealing with burnout and turnover; Participant
1 reported: “Referral for personal sessions and sensitization through training,” Participant 21
reported: “Taking time off from work” and Participant 19 reported: “Ensuring personal therapy
and supervision.”
Maintenance Stage
In this stage, supervisees strive for and make a conscious effort to sustain change. In addition,
supervisees in this stage will likely experience less developmental setbacks. Aten et al. (2008)
reported that: “Supervisors’ primary goal during the maintenance stage is to help supervisees
maintain positive momentum, unite developmental changes, and promote continued growth”
(p.3). They further stated that the goal is to build off of positive changes that have been made in
order to prevent regression (Aten et al. 2008).
A number of respondents reported instances that would exhibit being in this stage, for example
Participant 19 stated: “Setting boundaries,” Participant 20 stated: “Learning to manage stress”
and Participant 21 reported: “Taking time off from work.”
Review
Here both the counsellor and the supervisor evaluate the supervision session. They audit whether
the goals set out in the session and supervisory relationship have been met. Burns (2004) stated
that evaluation in supervision is aimed at measuring the benefits of supervision and finding out
whether the supervisee accepts the content and process of supervision. Duncan, Miller, and
Sparks (2004) postulated that the impact mental health professionals can have on change is
achieved by influencing the client’s perceptions of the therapeutic alliance. This can be applied
to the supervisory relationship (Duncan et al. 2004).
Termination Stage
Guillot, Kilpatrick, Herbert, and Hollander (2004) contended that termination
occurs when specific areas of change have been achieved and do not require
attention. Aten et al. (2008) reported that the supervisors and supervisees assess
the gains made in supervision, identify areas still in need of growth, and discuss
the supervisory relationship. Aten et al. (2008) stated that termination in this
model (italics mine) denotes a transition during which supervisors and supervisees
assess supervision goals and refocus on more pressing or advanced areas of
professional development. The supervisor’s task is to evaluate areas where
changes have been achieved and areas that need improvement (Aten et al., 2008).
References
Abelson, M. A. (1987). Examination of avoidable and unavoidable turnover.
Journal of Applied Psychology, 72, 382–386. doi:10.1037/0021-
9010.72.3.382
Abraham, R. (1999a). The impact of emotional dissonance on organizational
commitment and intention to turnover. The Journal of Psychology, 133(4),
441-455. doi:10.1080/00223989909599754
Abraham, R. (1999b). The relationship between differential inequity, job
satisfaction, intention to turnover, and self-esteem. The Journal of
Psychology, 133(2), 205-215. doi:10.1080/00223989909599734
Acker, G. M. (2011). Burnout among mental health care providers. Journal of
Social Work, 12(5), 475-490. doi:10.1177/1468017310392418
Adeli, S. M., Sindabi, A. & Njong’e, T. (2014). Rekindling the service
provider passion for work: The Three ‘R’ approach in dealing with
burnout among student affairs personnel in Kenyan universities.
International Journal of Social Sciences and Entrepreneurship, 1 (12),
655-675.
Agoi, L.F. (2015). Effect of work engagement on employee turnover intention in
public Sector, Kenya. International Journal of Economics, Commerce and
Management, 3(12), 426- 440.
Ahola, K., Kivimäki, M., Honkonen, T., Virtanen, M., Koskinen, S. & Lönnqvist,
J. (2008). Occupational burnout and medically certified absence: a
population-based study of
Finnish employees. Journal of Psychosomatic Research, 64,
185–193. doi: 10.1016/j.jpsychores.2007.06.022.
Aksu, M. & Temeloglu, E. (2015). Effects of burnout on employees’ Satisfaction
a Research at 3, 4 and 5 Star Hotels in Canakkale City Centre.
International Journal of Business and Social Science, 6(1), 219-230.
Allen, D.G., & Griffeth, R.W. (1999). Job performance and turnover: a review and
integrative multi-route model. Human Resource Management Review, 9,
525-48. doi:10.1016/S1053-4822(99)00032-7
Allen, J. P., & Meyers, N. J. (1990). The measurement and antecedents of
affective, continuance, and normative commitment to the organization.
Journal of Occupational Psychology, 63, 1 - 18. doi: 10.1111/j.2044-
8325.1990.tb00506.x
Alexander, J.A., Bloom, J.R., & Nichols, B.A. (1994). Nursing turnover and
hospital efficiency: An organizational-level analysis. Industrial Relations,
33, 505-520.
Allport, G. W. (1961). Pattern and growth in personality. New York: Holt, Rinehart &
Winston.
Ajzen, I. (1991). The Theory of planned behaviour. Organizational behaviour and
human decision processes. 50 (2), 179-211.
Armstrong, M. (2014). Armstrong’s Handbook of Human Resource Management
Practice - 13th edition. London and Philadelphia: Kogan page.
Aten, J. D., Strain, J. D., & Gillespie, R. E. (2008). A Transtheoretical model of
clinical supervision. Training and Education in Professional Psychology,
2(1), 1-9. doi:10.1037/1931-3918.2.1.1
Bachir, F. (2011). Attrition “rate of employee turnover” [Blog post]. Retrieved
from http://fadibachir.blogspot.com/2011/06/attrition-rate-of-employee-
turnover.html
Bakker, A.B., & Costa, P. (2014). Chronic job burnout and daily functioning: A
theoretical analysis. Burnout Research, 1, 112-119.
doi:.10.1016/j.burn.2014.04.003
Ballinger, G.A., Cross, R., & Holtom B.C., (2016). The right friends in the right
places: Understanding network structure as a predictor of voluntary
turnover. Journal of Applied Psychology, 101(4): 535-48.
doi:10.1037/apl0000061
Barak, M., Nissly, J. A., & Levin, A. (2001). Antecedents to retention and
turnover among child welfare, social work, and other human service
employees: What can we learn from past research? A review and meta-
analysis. Social Service Review, 75, 625–661.
Baumeister, R. (2005). Rethinking self-esteem; why non-profits should stop
pushing self-esteem and start endorsing self-control. Stanford social
innovation review, 34-41.
Baumeister, R. F., Campbell, J.D., Kruger, J. I., & Vohs, K. D. (2003). Does high
self-esteem cause better performance, interpersonal success, happiness or
healthier lifestyles? Psychological science in public interest, 4(1), 1-44.
doi:10.1111/1529-1006.01431
