Structure and Focus of the ‘Burnout-Turnover’ Integrated model
This section presents a model of clinical supervision of counsellors that is integrated and which
can be carried out in managerial, administrative and consultative supervision. The model is
insight oriented and reflective; it can be carried out with groups or individuals.
The rationale of this integrative model is to provide a structure on how to deal with high turnover
and high burnout levels in the context of a supervisor-supervisee relationship. The central point
of this model is on helping counsellors, supervisors and institutions that they work at deal with
burnout and turnover intention. Barak, Nissly and Levin (2001) contended that employee
turnover affects employees, employers and their clients. Smith (2005) further agreed that
relationships have to be modified or terminated, and that at times clients have to start therapy
afresh.
Conversely Hom et al. (2012) stated that employee turnover is inevitable. With this in mind, the
key question for this model is to balance between the motivations of counsellor turnover and
dealing with counsellor burnout on one hand, and dealing with institutional expectations on the
other hand.
In addition, from the study findings, the theme of oversight and gate keeping practices was
extrapolated. Herein the participants revealed three major practices namely: (1) attending
personal therapy, (2) going for clinical supervision and (3) involvement in continuous
professional development programs. However review of literature showed that supervision has a
role in dealing with burnout and supervision. The model presented contributes to this discourse
by providing a ‘guide’ for the supervisor and manager on how to intervene. Further results
reveal a number of institutional procedures, policies and practices in dealing with burnout and
turnover intentions. This model contributes towards these policies and practices.
A number of authors have looked at the qualities of a good model of clinical supervision
(Bernard & Goodyear 2004; Powell & Brodsky 2004). Centre for Substance Abuse Treatment,
(2009) cited the following as characteristics of a good model: “Rooted in the individual,
beginning with the supervisor’s self, style, and approach to leadership, precise, clear, and
consistent, comprehensive, using current scientific and evidence based practices, operational and
practical, providing specific concepts and practices in clear, useful, and measurable terms” (p. 9).
Centre for Substance Abuse Treatment, (2009) further mentioned that a good model is:
“Outcome-oriented to improve counsellor competence; make work manageable; create a sense of
mastery and growth for the counsellor; and address the needs of the organisation, the supervisor,
the supervisee, and the client” (p. 9). However Stoltenberg and McNeill (2012) cautioned by
stating that there is insufficient evidence on which models are most effective.
© University of South Africa 2016
The Care Quality Commission of the United Kingdom (2013) enumerated a number of benefits
of clinical supervision. These benefits include:
managing personal and professional demands, as related to what was narrated by
participants in tables 6.8, 6.9 and 6.10
exploring personal and emotional reactions to work as related to what was expressed by
participants in tables 6.8 and 6.9
enabling staff members to reflect and challenge their own practices as related to what was
reported in table 6.10
Ensuring clients receive services from staff who manage their personal and emotional
issues and ensuring good HR practices as expressed in Table 6.11.
Hence the ‘Burnout Turnover’ integrated model presented in this thesis exhibits these
characteristics.
Supervision Format and Modes of Presentation
From the study findings, many participants talked about attending both individual and group
supervision. In this model, the supervisor can employ various formats e.g., individual, triadic,
peer/colleague review and group supervision. In addition, the supervisor chooses or creates a
structure and process that encourages supervisee involvement and constructive feedback. If
group supervision format is employed the recommended group size is four to six persons. Kinga
et al. (2012) reported that counsellors received great benefits from attending fortnight individual
and or group supervision sessions. They inferred that this is sufficient supervisory time. Group
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© University of South Africa 2016
supervision gives counsellors a sense of commonality with others in the same situation (Bernard
& Goodyear, 2004).
Many respondents reported writing personal journals and diary notes to reflect and deal with
burnout and Turnover intention. Corey, Corey and Callanan (2011) described self-report as one
the most widely used supervision methods. Feist (1999) stated that process notes enhance self-
reports by providing insight into the content and interactional processes of the sessions.
Accordingly, the counsellor can present session logs, or journal entries to help describe the
impact of burnout, turnover intention or self-esteem on their clinical work. In addition, the
supervision for burnout and turnover intention can be done on a needs basis.
Table 7.1 presents the steps of the integrated supervision model, the counsellor’s tasks and
supervisor’s tasks involved. The steps are derived from counseling and supervision literature and
integrated with Participant responses from chapter six. They have been adapted and modified
from Brammer and Shostrom Model (Brammer & Shostrom 1977) and the Transtheoretical
model (Prochaska, DiClemente & Norcross 1992).
Table:
‘Burnout-Turnover’ Integrated model
Counsellor tasks Supervisor tasks
Contracting/structuring Express their expectations of
the supervision session
Set the objectives of the
supervision session
Exploration/narrative Narrative about discrepancy
on burnout, or turnover
intention or self-esteem
Explores current
scenarios and
discrepancies expressed
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by the counsellor.
Psychometric
assessment
Results sharing and
exploration interview
Self-administers and Self-
reports using the burnout
inventory and the turnover
intention scale
Explains the objective
of the assessment
Scores and interprets the
scales
Open to feedback,
participates in the interview
Gives feedback and
explores the different
factors expressed in the
questions of the scales.
Structured
interventions using the
trans-theoretical model
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
Relapse
Explores their own change
process in relations to the
stages of change
Explores the
counsellor’s stages in
the change process and
offers feedback.
Review Summarises the content of
the session, overview of
Provides an overview
and summary of the
feelings and insights gained issues discussed
Terminate/appointment Sets goals for the next
period
Updates their supervision
log and journal
Facilitates goal setting
Contracting/structuring
Structuring refers to an interactional process between counsellors and clients in which they arrive
at similar perceptions of the role of the counsellor, an understanding of what occurs in the
counselling process and an agreement on which outcome goals will be achieved (Brammer, et al.
1989). Further, Structuring is a term that describes the behaviours by which counsellors’ let the
clients knows their respective roles at various stages of the counselling process (Nelson - Jones
1998).
In this case, structuring is identification of the different expectations of the counsellor and the
supervisor. It involves the definition of roles and an agreement of the outcomes of the
supervision process.
From the study findings, a number of participants expressed instances that reflected the need for
structuring. For instance when asked for reasons for desire to change jobs; Participant 23 stated:
“Monotony.”Participant 6 stated: “Discord with management”, Participant 7 stated:
“Dissatisfaction in the current jobs” and Participant 12 expressed: “Both sides sharing
objectives and expectations from the beginning.”
Structuring Purposes
From Nelson - Jones (1998), the following can be outlined and adapted as the purpose of
structuring in supervision:
Helps the counsellor to know the role of the supervisor in the supervision process
Enables the counsellor to understand what occurs in supervision
Helps to establish the goals to be achieved in the supervision
It reduces the counsellor’s ambiguity and anxiety about supervision
Ensures smooth termination during the last stage of supervision
Reduces anxiety about dissolution of the supervisory relationship
Conveys action expectations and information about what may happen after supervision
terminates
Exploration Stage
A number of definitions of the word exploration have been offered. Merriam-Webster's
Learner's Dictionary defines ‘explore’ as: “to look for; to search in order to discover; to try
and find out something; to go far and deep in order to find what is hidden”. Culley and Bond
(2011) stated that exploration means helping clients to articulate their concerns. This is what the
client is expected to do. To look deep within himself to search for his hidden motives, thoughts,
feelings - that he has pushed away from his awareness into his consciousness.
Accordingly when applied to supervision, exploration is essentially an enabling and a
clarification procedure through which the counsellor discovers what is important for them,
examine their own behaviour and find meaning in their feelings. It also involves helping them in
the process of sharing their experiences, hopes and feelings in relation to burnout and turnover
intention (Culley and Bond 2011).
The supervisor in this case has the responsibility for facilitating exploration with the counsellor
and needs both to appraise and to monitor the process. Culley and Bond (2011) proposed the
following questions that have been modified to assess the exploration stage in Supervision.
How specific is this counsellor being? (p. 75).
How focused is the counsellor being? (p. 76).
How prepared is this counsellor to talk about him herself? (Culley and Bond 2011,
p.77).
In summary, exploration for the counsellors means helping them to talk about themselves and
their concerns in a specific and focused way. In addition, it is aimed at making them to
acknowledge their strengths and weaknesses, their achievements and values, and interests. It also
means taking stock of relationship resources and deficits, community back and economic and
cultural factors that influence their burnout and turnover intention (Culley and Bond 2011).
Many respondents reported instances that would have been appropriately and extensively
discussed in the exploration stage. Some of these statements made in regard to Turnover are as
follows: Participant 11 expressed: “I didn’t feel motivated and felt lost within the counselling
department,” Participant 17 stated: “Lack of challenges,” and Participant 19 stated: “Lack of
team work.” Other statements that can be discussed in exploration include: Participant 23 stated:
“Engage in negative self talk, unresolved conflicts about the past.”
Hence based on the above the following can be stated as the aims of the exploration stage:
“To establish a working relationship
To clarify and define problems
To make an assessment
To negotiate a contract” (Culley and Bond 2011, p. 62).
These aims provide a framework for focusing supervision work and for assessing
both process and progress. They are stage specific - that is they are outcomes more
appropriate to the beginning stage of supervision than to any other (Culley and
Bond 2011).
