TEACHING THE WORKING ALLIANCE THROUGH SYSTEMATIC EVALUATION OF PROFESSIONAL DISPOSITIONS IN COUNSELOR EDUCATION ASSESSMENT AS GROWTH: By Allison Levine A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of Rehabilitation Counselor Education -- Doctor of Philosophy 2018 ABSTRACT ASSESSMENT AS GROWTH: TEACHING THE WORKING ALLIANCE THROUGH SYSTEMATIC EVALUATION OF PROFESSIONAL DISPOSITIONS IN COUNSELOR EDUCATION By Allison Levine The 2016 CACREP Standards call for the formal assessment of student professional dispositions throughout a counselor education program. This is a complex and often unwelcome task for faculty given the subjective nature of assessing non-academic competencies. Furthermore, considering the ethical and legal implications of this task, an empirically-based instrument would benefit faculty in counselor education programs in a variety of ways including ensuring due process during evaluations. Using a two-phase methodology, the current study began with a Delphi panel to establish items to be included in an instrument. The second phase involved validation of the instrument items using a survey distributed to Certified Rehabilitation Counselors (n = 148). Instrument items were rated on Relevance and Utility to assess their appropriateness for being included in the instrument. The Assessment as Growth Inventory (AGI), was developed, being framed using the working alliance in order to encourage the development of student professional dispositions in line with this evidence-based practice. AGI comprises four sections, with 48 items (Professional Dispositions – 13, Tasks – 10, Goals – 8, and Bonds – 17). Implications for research, counselor education, and clinical practice are discussed at length. Copyright by ALLISON LEVINE 2018 ACKNOWLEDGEMENTS The journey I have taken over the last four years has been the most impactful of my life. I learned not only professional and practical skills, but also learned a lot about myself in the process. The self-discipline, drive, and intellectual skill necessary to reach this milestone seemed out of reach and uncertain four years ago, at the outset of my doctoral work. Learning to take broad, conceptual ideas and being able to design and conduct a study in pursuit of such answers has been one of the most empowering things that I have learned to do in my life. Reaching this point, and achieving these goals did not come without help from many people that I am very lucky to be surrounded by. First and foremost, I most likely never would have even gone through with getting my PhD without the support, encouragement, and direction from Dr. Nerlich. From introducing me to rehab counseling at Hofstra up through applying to MSU and now at the completion of my program, she has been a guiding light, an amazing friend, and a supportive colleague. Attending MSU introduced me to even more support, in Drs. Leahy and Kosciulek. After my initial shock of having the privilege to work with such impactful researchers in the field wore off, I found two people who have always had the time to vet any idea, review any paper, or just to catch up. Finally, this would not have been possible without Dr. Sung, who has become the voice in my head, helping me to cultivate new ideas, challenge myself to be the best, to seek out as many opportunities as possible, and to remain grounded in being a lifelong learner. Never have I met someone who is able to wear so many impressive hats and yet remains so humble, kind, and truly invested in all of the work her students are doing. In addition to my academic colleagues, my partner Greg has been invaluable throughout this dissertation. Thank you for your unwavering support, for bringing me snacks/coffee/whatever I need whenever things were getting tough, and accepting the long working weekends. I will never be able to thank you enough. iv TABLE OF CONTENTS LIST OF TABLES ............................................................................................................ vii LIST OF FIGURES ......................................................................................................... viii CHAPTER ONE ..................................................................................................................1 Introduction ..........................................................................................................................1 Background ..........................................................................................................................1 Struggles for Gatekeepers ....................................................................................................5 Lack of Formalized Procedures & Assessment Tools .............................................8 Statement and Significance of the Problem .........................................................................9 CHAPTER TWO ...............................................................................................................12 Literature Review ..............................................................................................................12 Background ........................................................................................................................12 Defining Gatekeeping ........................................................................................................13 Components of Gatekeeping ..............................................................................................15 Terminology ..........................................................................................................15 Due Process ...........................................................................................................20 Legal Issues ...........................................................................................................21 Ethical Issues .........................................................................................................24 Barriers to Gatekeeping .....................................................................................................26 Difficulties in Operationalizing: Subjectivity ........................................................26 Reactive Gatekeeping ............................................................................................27 Contextual, Professional, and Legal Issues ...........................................................28 Professional Disposition Development and the Working Alliance ...................................30 Working Alliance: An Overview ...........................................................................30 WA and Counselor Education ...............................................................................32 Using Performance Appraisals in Counselor Education....................................................36 Theoretical Framework for PDD .......................................................................................39 Summary ............................................................................................................................42 CHAPTER THREE ...........................................................................................................43 Method ...............................................................................................................................43 Phase 1 ...............................................................................................................................43 Study Design: Phase 1 ...........................................................................................44 Procedures: Phase 1 ...............................................................................................45 Measures: Phase 1 ..................................................................................................51 Data Analysis: Phase 1 ..........................................................................................54 Phase 2 ...............................................................................................................................55 Study Design: Phase 2 ...........................................................................................56 Sampling: Phase 2 ..................................................................................................56 Procedures: Phase 2 ...............................................................................................59 v Measures: Phase 2 ..................................................................................................60 Data Analysis: Phase 2 ..........................................................................................61 Summary ............................................................................................................................62 CHAPTER FOUR .............................................................................................................63 Results ................................................................................................................................63 Phase 1: Round 1 ...................................................................................................63 Phase 1: Round 2 ...................................................................................................67 Phase 1: Round 3 ...................................................................................................74 Phase 2 ...............................................................................................................................81 Qualitative Comments ...........................................................................................88 Summary ............................................................................................................................89 CHAPTER FIVE ...............................................................................................................91 Discussion ..........................................................................................................................91 Summary of Findings ............................................................................................91 Discussion of the Findings .....................................................................................94 Limitations of the Study ......................................................................................101 Implications for Research ....................................................................................102 Implications for Counselor Education .................................................................105 Implications for Clinical Practice ........................................................................106 Conclusion .......................................................................................................................107 APPENDICES .................................................................................................................108 APPENDIX A: INTERNAL REVIEWBOARD (IRB) APPROVAL .................109 APPENDIX B: EMAIL INVITATION TO DELPHI PANEL ...........................110 APPENDIX C: EXPERT PANEL DEMOGRAPHICS SURVEY .....................112 APPENDIX D: DELPHI ROUND 1: EMAIL ....................................................114 APPENDIX E: DELPHI ROUND 1: INSTRUCTIONS .....................................116 APPENDIX F: DELPHI ROUND 2 INSTRUCTIONS ......................................117 APPENDIX G: DELPHI ROUND 3 INSTRUCTIONS .....................................118 APPENDIX H: INFORMED CONSENT/INVITE FOR PILOT STUDY .........119 APPENDIX I: ASSESSMENT AS GROWTH INVENTORY ...........................121 APPENDIX J: CRCC CEU COMPLETION FORM ..........................................125 REFERENCES ................................................................................................................127 vi LIST OF TABLES Table 3.1: Summary Table of the Steps, Phases, and Activities Involved in the Execution of a Delphi Method with Three Rounds (Vázquez-Ramos et al., 2007)............................... Table 3.2: Participant Demographic Characteristics............................................................. 58 46 Table 4.1: Round 2: Professional Dispositions (Descending by mean Relevance).............. 68 Table 4.2: Round 2: Tasks (Descending by mean Relevance).............................................. 70 Table 4.3: Round 2: Goals (Descending by mean Relevance).............................................. 71 Table 4.4: Round 2: Bonds (Descending by mean Relevance)............................................. 73 Table 4.5: Round 3: Professional Dispositions (Descending by mean Relevance).............. 75 Table 4.6: Round 3: Tasks (Descending by mean Relevance).............................................. 77 Table 4.7: Round 3: Goals (Descending by mean Relevance).............................................. 78 Table 4.8: Round 3: Bonds (Descending by mean Relevance)............................................. 79 vii LIST OF FIGURES Figure 3.1: Round 2 Survey.................................................................................................. 53 Figure 3.2: Round 3 Survey.................................................................................................. 54 Figure 4.1: Professional Disposition Relevance Score Frequency Histogram...................... Figure 4.2: Task Relevance Score Frequency Histogram..................................................... 82 81 Figure 4.3: Goal Relevance Score Frequency Histogram..................................................... 83 Figure 4.4: Bond Relevance Score Frequency Histogram.................................................... Figure 4.5: Professional Disposition Utility Score Frequency Histogram............................ Figure 4.6: Task Utility Score Frequency Histogram........................................................... Figure 4.7: Goal Utility Score Frequency Histogram........................................................... 86 85 84 85 Figure 4.8: Bond Utility Score Frequency Histogram.......................................................... 87 viii CHAPTER ONE Introduction Counselor education programs strive to produce graduates who will engage in sound ethical practice, and who will facilitate positive outcomes in their future clients. The working alliance has been demonstrated as an important factor in the ability to facilitate such outcomes, even regardless of a counselor’s chosen theoretical orientation (Wampold, 2011). The accrediting body of counselor education program, the Council for Accreditation of Counseling & Related Programs (CACREP) provides standards that guide counselor education programs in filling the aforementioned goal. This chapter outlines caveats in accreditation standards and current practices in counselor education that have contributed to a lack of resources and tools which allow faculty to evaluate students’ professional dispositions in a systematic, legally defensible manner. Background In counselor education, master’s-level counseling programs have been challenged with meeting the standards of the Council on Rehabilitation Education (CORE) and/or the Council for Accreditation of Counseling & Related Programs (CACREP), while keeping up with ongoing changes in legislation, service delivery systems, and practice settings (Kelly, 2011; Leahy, Muenzen, Saunders, & Strauser, 2009). Beyond that, counselor education has a unique challenge in both preparing students with academic knowledge about counseling, and aiding them in switching gears from acquisition to knowledge translation and action: putting the content that has been learned into practice— building therapeutic relationships in dynamic and diverse practice settings (Connor & Leahy, 2016). Specifically, the working alliance (WA) is an evidence-based practice that facilitates client change through the relationship between the client and counselor. 1 WA has been demonstrated to be more predictive of positive treatment outcomes, regardless of theoretical orientation or length of treatment, which underscores the significance of this practice within counseling (Horvath & Symonds, 1991; Lambert, 1992; Lustig, Strauser, Rice, & Rucker, 2002; Wampold, 2001). A meta-analysis of WA involving over 200 studies found the aggregate correlation between alliance and outcome was approximately 0.27, which supports the earlier work of Wampold (2001), identifying that at least 70% of psychotherapeutic effects are due to common factors such as WA, empathetic listening, and goal setting (Horvath, Del Re, Flückiger, & Symonds, 2011; Wampold, 2015). A particularly difficult task in counselor education is that counselor educators are expected to “…move beyond assessment of specific counseling skills and content knowledge, and to consider how to appropriately monitor and evaluate behaviors and attributes that are clinical and interpersonal in nature” (Kelly, 2011, p. 112), meaning that in addition to supporting students through standards-driven knowledge acquisition, skill building, and knowledge translation, educators must also be assessing students at another level: identifying if they have the professional dispositions required to become a counselor, and especially, if they are capable of developing WA with clients. The overall process of evaluating student suitability for professional practice including counseling skills, content knowledge and professional dispositions, is called gatekeeping (Brear, Dorian, & Luscri, 2008). Gatekeeping is a complex concept, but it is specifically comprised of three components: (1) it involves a gatekeeper (i.e., educators or supervisors) and a student/trainee, (2) the evaluative process involved in gatekeeping should be based on specific criteria within a defined framework, and (3) the main purpose is protection for the field in which it occurs (Brear et al., 2008). The specific criteria referred to by Brear et al. (2008) include both academic 2 competencies (content knowledge and clinical skills), as well as professional dispositions, which are stipulated primarily via CACREP Standards. Accreditation standards are a primary way in which there has been an attempt to systematically assess counselor education students across various educational institutions. While gatekeeping and evaluation are typically unwelcome tasks in counselor education and supervision, they are absolutely necessary functions for ethical and legal practice (Bernard & Goodyear, 2014). Relating to ethical supervision practice: “If supervisors come to a conclusion that a supervisee does not meet criteria for endorsement … this should never come as a surprise to the supervisee in question” (Glosoff & Matrone, 2010, p. 252). This applies in the counselor education realm as well, and speaks to a need for proactive, transparent student evaluation procedures and instruments that allow educators to facilitate such mechanisms. Gatekeeping is complex and multifaceted, which contributes to its lack of favor amongst those who must do the evaluating. One way that programs have addressed gatekeeping gaps is by implementing specific admissions criterion, which typically comprise of academic abilities gleaned from submitted documentation, and interpersonal interactions during the interview prior to admittance (Ziomek-Daigle & Christensen, 2010). The current study and its ultimate product are not intended to be used at the admissions stage; rather it is intended to address the ongoing process of gatekeeping within the context of a counselor education program (i.e., throughout multiple points in the program, following admission). A problem that has arisen in gatekeeping is the evaluation of professional dispositions, the nature of which are elusive and subjective. This impedes counselor educators’ abilities and likelihoods of evaluating professional dispositions in a systematic way (see Kelly, 2011). When factoring in the CACREP Standard requirement to provide data at a minimum of two points 3 throughout a student's program on Key Performance Indicators (KPIs) of professional dispositions, this is especially problematic (2016 CACREP Standards, Section 4.G). CACREP seeks to assist programs by providing the definition of professional dispositions as “the commitments, characteristics, values, beliefs, interpersonal functioning and behaviors that influence the counselor’s professional growth and interactions with clients and colleagues”. This definition, however, is still lacking in measurable or observable components, or “clear, shared and consistent language to represent the different types of problem behaviors” (Forrest, Elman, Gizara, & Vacha-Haase, 1999, p. 629). Many studies have now been conducted in an attempt to remedy this issue via checklists or evaluations (see Kerl, Garcia, McCullough, & Maxwell, 2002; Moorhouse, 2008), although few have been replicated (Brear et al, 2008; Forrest et al., 1999) and none have been endorsed by CACREP. Student evaluation is complex, ongoing, and often unpleasant for faculty (Foster & McAdams, 2009). Faculty are evaluating students even prior to admission, via screening processes and interviews, however specific student issues such as lack of appropriate professional dispositions may not become evident until later in their program, and may not necessarily impede a student’s academic abilities. Certainly during the clinical portion of a program do these problematic behaviors come to light, however professional dispositions speak to more than just clinical skills and academic competence (Kelly, 2011; Lumadue & Duffey, 1999; Ziomek-Daigle & Christensen, 2010). Although it is clearly so crucial to continually identify and evaluate student competence academically, clinically, and in the realm of professional dispositions, it has been reported that only 40% of programs used a systematic, global assessment of student progress throughout a program (Brear & Dorrian, 2010). 4 Struggles for Gatekeepers Brear & Dorrian (2010) identified three general areas where gatekeeping issues may fall: (a) difficulties in delineating and operationalizing the core competencies necessary for professional practice and the development of systematic assessment methods; (b) the degree to which the mechanisms implemented by training programs to facilitate gatekeeping incorporate a proactive approach as distinct from a reactive one; and (c) diverse contextual, professional, and legal issues. (p. 264) Studies that have attempted to address the delineation and operationalization of core competencies (including academic, clinical skills, and behaviors) necessary for professional practice are typically found in clinical supervision literature (i.e., Fouad et al., 2009; Moorhouse, 2008; Thielsen & Leahy, 2001). Bernard and Goodyear (2014) indicate that while these lists may be somewhat helpful, they are essentially useless unless they are embedded in a well established supervisory relationship. Additionally, as outlined above, counselor educators have limited guidance from accrediting bodies as to how to systematically assess such competencies. Furthermore, there is no current evaluation that directly ties student evaluation to WA. Accreditation standards indicate that evaluation should be ongoing, and held at multiple times throughout a student’s time in a program (CACREP, 2016). What has been largely indicated by the literature, however, is that evaluation of professional dispositions has been coupled with clinical skills, and are evaluated simultaneously during the internship or practicum phase of a student’s program (Moorhouse, 2008). This contributes to the reactive nature of gatekeeping processes; students who are in practicum or internship are receiving supervision and thus most issues are addressed at that point, after they have come to light in a work-based setting. Ideally, in order to alleviate the issue of reactivity, and to be proactive in student evaluation, 5 particularly of professional dispositions, it has been suggested that programs adopt a more transparent method for evaluation which begins at admissions and continues throughout a student’s time within a program (Foster & McAdams, 2009). Another issue related to the reactive nature of gatekeeping is that programs also are less likely to focus on a formal or systematic way to track student evaluation until after there has been legal action taken as a result of a dismissal or intervention in a student’s program of study (Foster & McAdams, 2009). Although there is no doubt that all counselor education programs experience problematic students who demonstrate inadequate professional dispositions, or any number of other inadequacies, it appears that the majority use ad hoc evaluations, which are inconsistently done on an as needed basis. These ad hoc and inconsistent procedures (which may also be referred to as ‘non-formalized procedures’) leave programs vulnerable to legal action by disgruntled students (Foster & McAdams, 2009; Frame & Stevens-Smith, 1995; Kelly, 2011; Kerl et al., 2002; McAdams & Foster, 2007). While legal issues may seem like low incidence, and low risk, they still serve as a deterrent to gatekeeping for faculty, and may not actually be very low incidence, especially as our society becomes increasingly litigious (Bernard & Goodyear, 2014; Brear & Dorrian, 2010). The history of lawsuits from disgruntled students dismissed from academic programs on the basis of “non-academic competencies” stems back to Greenhill v. Bailey (1975), which is the first case in which a student’s academic performance was defined by the court as “a student’s demonstrated knowledge, technical and interpersonal skills, attitudes, and professional character” (Knoff & Prout, 1985, p. 792). This is notable given the inclusion of interpersonal skills and professional character, which would align now with our term of professional dispositions, or non-academic competencies. Board of Curators of the University of Missouri v. Horowitz 6 (1978), just three years later, is considered the landmark case in the area of gatekeeping, as the United States Supreme Court ruled in favor of the inclusion of interpersonal factors as an academic factor. The ruling also underscored an issue that is central to the current study: the procedural requirements necessary to implement an academic dismissal are much less rigorous in comparison to dismissals that are due to factors outside of student academic achievements, such as professional dispositions (Frame & Stevens-Smith, 1995). In other words, formalized procedures in the evaluation of professional dispositions, or non-academic competencies, are crucial to effective, legally defensible, gatekeeping practices. Fear of judgement or disagreement among other faculty also plays a role in gatekeeping, which can compound the concerns faculty already have as a result of legal vulnerability. Faculty may feel that implementing a remedial protocol may cause other faculty members to view them as overreacting to a particular situation, which can be especially concerning to new and non- tenured faculty (Foster & McAdams, 2009). Additionally, disagreement among faculty has been identified as the one of the biggest barriers to dismissing a student, second only to fear of litigation (Vacha-Haase, Davenport, & Kerewsky, 2004). A common feeling in many programs is that problems will self-correct over time, or within the supervisory relationship that the student will have with his/her boss once employed (Foster & McAdams, 2009; McAdams, Foster, & Ward, 2007). Contextual issues such as these can also contribute to social loafing among faculty, or the assumption that someone else will eventually intervene in a particular situation (Brear & Dorrian, 2010). It has been suggested that a way to overcome these issues, and many issues related to gatekeeping, is through the development and regular use of formalized procedures (Bhat, 2005; Brear & Dorrian, 2010; Kelly, 2011; Kerl, et al. 2002; Lumadue & Duffey, 1999), and to 7 implement a culture of transparency around student evaluations which extends from pre- admission, through graduation (Foster, Leppma, & Hutchinson, 2014; Foster & McAdams, 2009; Ziomek-Daigle & Christensen, 2010). Lack of Formalized Procedures & Assessment Tools The lack of formalized gatekeeping procedures available is the most notable challenge cited in gatekeeping literature (Foster, Leppma, & Hutchinson, 2014; Foster & McAdams, 2009; Gaubatz & Vera, 2002, 2006; Kelly, 2011). It has also been determined that faculty have, historically, preferred to address students’ professional performance issues in an informal manner, without documenting what actions were taken to resolve such an issue (Foster & McAdams, 2009). Furthermore, many educational programs do not even provide written remediation and termination policies for students regarding non-academic reasons other than plagiarism, cheating, or sexual/racial harassment; only 29% of programs studied by Brear & Dorrian (2010) indicated having such policies in place. Gaubatz and Vera (2002) provide additional insight into this difficulty for counselor educators: ...counselor educators must balance the need to protect clients from impaired practitioners against legal and institutional pressures to cautiously identify deficiencies among their trainees...however this tension is amplified by the unique nature of the training itself, which aims not only to increase the trainee’s skill in conducting therapeutic work but also to modify his/her personhood. (p. 295) Counselor educators are therefore in a difficult position of being expected to train students and assess for academic competencies, but also for “personhood” or “professional disposition” or “deficits” not otherwise accounted for or specified in academic standards or accreditation requirements. Without appropriate documentation, procedures and interventions, 8 the process of intervening with a problematic student becomes not only troublesome at the faculty level, but can leave the faculty, program or university vulnerable to the legal consequences outlined above. A contributing factor here is that faculty have been under the impression that they are already adequately intervening with “deficient trainees”, even though 98% of faculty in counselor education programs identified that there were currently deficient trainees in their programs (Gaubatz & Vera, 2006). This, in combination with resistance to evaluation both formal and informal, leads to inconsistencies in student evaluation, and most likely “gate- slippage”, or the graduation of deficient students who do not receive remediation (Gaubatz & Vera, 2002). Gaubatz & Vera (2002) studied whether formalized gatekeeping procedures impacted the likelihood of gate-slippage and found that using more formalized procedures lead to significantly lower reports of gate-slipping. The researchers also found that less than 20% of counselor training programs actively conducted routine formal reviews of their students, and Bhat (2005) reported that 54% of programs in a survey by the American Psychological Society did not have formally written guidelines for intervention with problematic students. More recently, Brear and Dorrian (2010) found that more than half of counselor educators surveyed reported having passed a student in one of their courses who they considered to be unsuitable to practice in the field of counseling. Statement and Significance of the Problem Counselor educators are expected to prepare future counselors who will work with individuals at extremely vulnerable places in their lives. As such, graduate level programs should be equipped to identify students with academic deficiencies, and non-academic, professional 9 disposition issues alike. Evaluation and remediation of such students is imperative in order to protect the profession, as well as any future clients of those students. Formalized procedures for collecting data and evaluating students’ non-academic performance, or professional dispositions, are necessary in order to assist faculty in systematically, objectively, and fairly evaluating students in counselor education programs. An instrument for the purpose of specifically meeting the need of evaluating student professional dispositions will serve multiple purposes in counselor education. These include: protection against legal backlash, improvement of conversations around student professional development (among faculty and with students), as well as adhering to requirements for accreditation. The current study sought to create such an instrument which can be embedded into counselor education practice, for use with counseling students from admission through graduation, remediation, and/or dismissal. A key way that this instrument differentiates itself from previously established competency lists is its inclusion of criteria necessary for the development of the WA. The Delphi method was used to develop consensus among rehabilitation and counselor educators, and those who have published gatekeeping literature. The experts involved developed and refined items regarding professional dispositions as well as items specifically related to the WA, honing in on the essence of Connor and Leahy (2016): “the challenge in counselor education is to effectively teach the cognitive and affective complexity of WA so that graduates possess entry-level competence in establishing therapeutic relationships” (p. 375). The purpose of this study is to fill two gaps in counselor education via the creation of an instrument for faculty use in student evaluation: (1) meeting the CACREP professional disposition KPI requirements, as well as (2) providing counselor educators with a tool that 10 fosters transparency in evaluation of professional dispositions and students’ ability to develop WA in practice. The resolution of such gaps was driven by the following research questions, to be addressed by a two-phase research study: 1. What items would be appropriate for faculty to use in the evaluation of professional dispositions in master’s level counseling students? 2. How much do those items relate to the concepts of WA (i.e., goals, tasks and bonds)? 3. How useful are those items for counselor educators? 11 CHAPTER TWO Literature Review To address the previously stated research questions, it is first necessary to provide a comprehensive literature review that synthesizes the concepts and constructs involved in the current study. This literature review begins by introducing the concept of gatekeeping in counselor education. This includes an in-depth discussion of the components of gatekeeping, such as terminology and current issues. This sets the stage for a discussion of barriers to gatekeeping, and specifically to the assessment of professional dispositions of counselor education students. Finally, with the inclusion of a discussion of how WA relates to professional dispositions, it is possible to discuss mechanisms of evaluation, including performance appraisals. Using social exchange and goal setting theories, as guided by performance appraisal literature, the theoretical framework for the current study is established. Background Accrediting bodies such as the Council on Rehabilitation Education (CORE) and the Council for Accreditation of Counseling and Related Educational Programs (CACREP) exist for the purpose of guiding educational programs in preparing future professionals who will be able to provide the best services possible in their respective disciplines (CACREP, 2016; CORE, 2016). Following the merger of CORE and CACREP in 2015, it was determined that CACREP would begin to carry out the mission of both organizations as of July 2017, and CORE ceased to exist (CORE- CACREP Merger Agreement, 2015). As such, the current study is primarily concerned with the current CACREP standards regarding gatekeeping in counselor education, and will honor CORE’s history of guiding standards with empirical support. 12 The evaluative roles of counselor educators, and rehabilitation counselor educators, serves a protective function for the particular discipline in which a student is being trained for (Brear, Dorian, & Luscri, 2008). Knowing that graduates will be working directly with vulnerable populations is a specific consideration, and adds a level of urgency to the need for gatekeeping in all types of counselor education. Faculty of counselor education programs are one of the last lines of defense between a potentially deficient counselor and future clients seeking services. In the many roles that faculty occupy, they are required to adhere to accreditation standards, university policies, program policies, the Commission on Rehabilitation Counseling Certification (CRCC) Code of Ethics, as well as the American Counseling Association (ACA) Code of Ethics, making this task complex and multifaceted. Defining Gatekeeping Given the complexity of gatekeeping, and the numerous stakeholders in the process, it is extremely important that all groups are adhering to the same, or at least similar, definitions of what gatekeeping means. Several studies have already discussed the issue of a lack of adherence to one definition of gatekeeping (Brear et al., 2008; Elman & Forrest, 2007; Forrest et al., 1999; Glance, Fanning, Schoepke, Soto, & Williams, 2012). The term gatekeeping, in itself, has a troubled history within many groups, and especially within the disability community, from the times when “gatekeepers” were those who were perceived as keeping persons with disabilities (PWD) away from the services they needed and wanted. This causes the term to carry a negative connotation with it, which underscores the importance of providing clear, well-thought and operational definitions to be used in gatekeeping literature going forward. Therefore, an essential focus of the current study is to alleviate some of the negative associations with gatekeeping, and to assist counselor educators in understanding gatekeeping as a mechanism for remediation and 13 support, rather than for dismissal or punishment. It is also important to recognize that, given a distaste for the term “gatekeeping”, some papers have chosen to forego the term gatekeeping for “evaluation” (i.e., Kerl, Garcia, McCullough, & Maxwell, 2002), which makes synthesis and systematic use of one definition even more challenging. Systematic, as defined in the CACREP Standards, is “a regular, planned, and comprehensive manner”. First and foremost, counselor educators should be familiar with is the definition of gatekeeping as provided by CACREP (2015): “the ethical responsibility of counselor educators and supervisors to monitor and evaluate an individual’s knowledge, skills, and professional dispositions required by competent professional counselors and to remediate or prevent those that are lacking in professional competence from becoming counselors”. The importance of being aware of the CACREP definition cannot be denied, however, there are certain areas in which the definition is lacking for use and application to counselor education practice. Above all, it is most important to remain consistent as a “lack of definition and criteria makes it even more difficult for counselor educators to address the issue of impairment and stay atop of best practices in the field” (Glance, Fanning, Schoepke, Soto, & Williams, 2012, p. 2). Brear et al. (2008) provide the following definition of gatekeeping, which goes beyond the CACREP definition to include accountability on the part of the gatekeepers (i.e., supervisors and counselor educators) to both monitor suitability as well as to identify the evaluative criteria to be used in evaluation: ...the evaluation of student suitability for professional practice. It is a mechanism that aims to ensure the health of the profession by controlling access to it. It involves the identification of evaluative criteria and process, and the accountability of the gatekeeper to apply the criteria and take responsibility for the evaluative decisions (pp. 93-94). 14 The definition provided by CACREP, while ensures alignment with an accrediting body, leaves much ambiguity about some of the more specific requirements of gatekeepers, such as identifying and applying evaluative criteria. Finally, the CACREP definition does not specifically include what many would consider the most important concept of gatekeeping; the implication that gatekeeping serves to protect the profession in which the gatekeeper currently serves and a trainee is attempting to enter. As a whole, gatekeeping involves the evaluation of both the academic knowledge and professional dispositions necessary for students to become counselors. The current study aligns best with the Brear et al. (2008) definition of gatekeeping. It is also important to note here that the current study diverges from this whole concept of gatekeeping, given the focus on identification and remediation of professional dispositions. Components of Gatekeeping Terminology As discussed above, it is necessary to set the stage for systematic evaluation by providing definitions that are operationalized to be used in the current study. In addition to defining the actual concept of gatekeeping, there are several other terms that arise in the literature which may not be widely utilized in counselor education. These are almost as important as the definition of gatekeeping. Operationalizing concepts such as “gate-slipping”, “professional dispositions”, “impairment”, and/or “competence” are invaluable for use in gatekeeping literature and research. Gate-slipping. Gatekeeping is predicated on the protection of a field via intervention with inappropriate students, or trainees, prior to their entrance into that field (by graduating). This can result in remediation of a particular problem, or the dismissal of that individual from the field, or training program, if necessary. In a 2006 study, Gaubatz and Vera (2006) uncovered that 15 98% of faculty surveyed were aware of potentially deficient students in their programs, and in a 2010 study of Australian counseling and counseling psychology programs, 58% of respondents indicated that they had passed a student that they had considered inappropriate for the counseling field (Brear & Dorrian, 2010). Most recently, in 2016, more than 60% of rehabilitation counselor educators and program directors who responded to the survey indicated that they were aware of currently deficient students in their master’s programs (Levine, 2016). Gate-slipping is essentially the opposite of gatekeeping, whereby “...potentially deficient students may advance through their training without remediation” (Gaubatz & Vera, 2002, p. 36). The definition of this term also serves to provide some clarity about a main function of gatekeeping, which is to identify and remediate students whenever possible, not necessarily to barr entry into a field unless absolutely necessary. Emphasis on remediation over dismissal is absolutely necessary to change some of the negative connotations associated with gatekeeping, and therefore to increase faculty comfort with the concept and implementation of necessary procedures. Professional Dispositions. Section 4 of the CACREP Standards stipulates the development of key performance indicators (KPIs) that “represent a mix of important knowledge and skill measures at multiple points throughout the program” (CACREP, 2016, p. 2) in order to evaluate students. CACREP requires programs to develop KPIs per each core content area, as well as for professional dispositions, which are to be assessed using various measures at a minimum of two time points throughout the student's program. The professional dispositions KPIs are expected to be measured using the same criterion as the content KPIs (i.e., systematically, objectively). A key issue that needs to be addressed is the ambiguity of the term “professional disposition”, and what that means. 16 The 2016 CACREP Standards define professional dispositions as “the commitments, characteristics, values, beliefs, interpersonal functioning, and behaviors that influence the counselor’s professional growth and interactions with clients and colleagues” (p. 43). This breaks from some previous legal precedent and literature where interpersonal functioning had been included as part of a student’s academic performance (Frame & Stevens-Smith, 1995). The ruling of Greenhill v. Bailey (1975) defined academic performance as “a student’s demonstrated knowledge, technical and interpersonal skills, attitudes, and professional character” (Knoff & Prout, 1985, p. 792). It can be assumed that CACREP has intentionally separated academic knowledge and skills from professional dispositions, as the standards require two distinct avenues of KPI data (knowledge and skills, and professional dispositions). CACREP’s current definition of professional dispositions is problematic in two particular ways: (1) faculty attempting to measure a student’s commitments, beliefs, and values may struggle significantly with operationalizing such vague and subjective concepts, and (2) researchers may find that such subjective concepts may not be able to be measured systematically. Lumadue and Duffey (1999) emphasize the importance of performance standards using behaviorally specific student assessment categories, and to be clarified in program policies. It is quite difficult, however, to provide a comprehensive and behavioral assessment category of a student’s commitments or values, and furthermore, how to identify ways in which faculty will assess those and how they affect a student’s professional growth or interactions with clients and colleagues. Use of vague, subjective, and non-operationalized language can make students uneasy, and even more so if they are a part of an underrepresented group such as: students of color, students with disabilities, students learning English as a second language, students who identify as lesbian, gay, bisexual, transgender, or questioning (LGBTQ), and other minority 17 groups (Foster & McAdams, 2009). It is imperative to create and provide clarity regarding this term for future use and collection of data on student professional dispositions. The current study seeks to obtain and disseminate clarity around the term professional dispositions and its operationalization. It is hypothesized that a Delphi study will reveal professional dispositions to be made up components such as: integrity, concern for the wellbeing of others, helping disposition, self-awareness, and interpersonal skills (Fouad et al., 2009). Naming Impairment. There has been a considerable amount of discussion around the most appropriate way to discuss a student whose professional dispositions are deemed inadequate or inappropriate for the counseling field. Terminology problems likely contribute to issues with consistently identifying and acting on issues with student competence (Elman & Forrest, 2007). Historically, many different terms have been used to label student issues such as ‘unsuitable’, ‘incompetent’, ‘inadequate’ and others (Elman & Forrest, 2007; Forrest et al., 1999). In the early 1980’s, use of the term ‘impairment’ had begun and was used throughout the field of psychology to describe deficiencies in professional performance (Forrest et al., 1999). The most commonly used definition of impairment at that time was Laliotis and Grayson (1985): “interference in professional functioning due to chemical dependency, mental illness, or personal conflict” (p. 84). The Americans with Disabilities Act (ADA, 2008) uses the term impairment in describing disability, and thus, use of the term impairment creates legal risk if used to describe a student who does not have a disability (Brown-Rice & Furr, 2015; Elman & Forrest, 2007). Elman & Forrest (2007) recommend to retire the term impairment. In addition to the potential for legal issues, ‘impairment’ does not provide insight into the nature of the issues of a particular student; whether they are impaired as a result of lack of knowledge, experience, or in 18 professional dispositions or skills (Elman & Forrest, 2007). The authors suggest use of the term “problems of professional competency”, or PPC, given that the term impairment provides no precision in its use, and PPC indicates clearly a problem with professional competence. However, Brown-Rice and Furr (2015) warn that changing terminology may not be so simple. Impairment is already included in both the ACA Code of Ethics (ACA, 2014) and it can also be found in the Commission on Rehabilitation Counselor Certification Code of Ethics (CRCC, 2016). A continuum of impairment. An additional issue related to this terminology is the vocabulary used by CACREP. While valid arguments have been made for use of the term PPC, CACREP standards specifically use the term professional dispositions (CACREP, 2016). Deviations from the language used in accreditation standards would perpetuate the present issues with vocabulary in student evaluations. Systematic evaluation begins with the consistent use of cohesive, operational definitions (Bhat, 2005). As such, for the purpose of the current study, issues related to student competence, specifically regarding the development of necessary professional dispositions will referred to as ‘inadequate professional disposition development’ (IPDD). Although this is a different term than that what has been proposed previously, it still adheres to the three critical components of new terminology identified by Elman and Forrest (2007): “(a) the inclusion of the concept that there is a problem with performance, (b) a professional standard, and (c) a focus on competence” (p. 505), and aligns with the vocabulary of choice by CACREP. The term “inadequate” lends itself to a spectrum ranging from unacceptable to acceptable and therefore indicates that students are not permanently problematic, rather that their current status as inadequate and may be improved in the future. IPDD is a term that can be used to describe students at a particular level, therefore it would also be possible to identify 19 someone as adequately developing professional dispositions as APDD, and another student who is above adequate development as exceptional professional dispositions development, or EPDD. Maintaining the term “professional dispositions” in the terminology keeps consistency with the CACREP standards, which will contribute to clarity in discussing these concepts. Finally, the entire phrase indicates a focus on a particular competency that is required of students in CACREP accredited programs. Due Process The Fifth and Fourteenth Amendments of the Constitution stipulates that no one shall be “deprived of life, liberty or property without due process of law” by either federal or state governments (U.S. Const. amend. V & XIV). As a fundamental value of rights in America, due process is one of the most important pieces to fair and effective student evaluation procedures, or gatekeeping. Essentially, due process exists to protect an individual’s rights throughout an accusatory proceeding, and to ensure fairness in order to yield accurate and truthful results (Strauss, n.d.). It has long been acknowledged that while evaluating students, it is very important to maintain documentation in order to ensure that due process rights have been observed, in the event of requiring remediation or dismissal (Bernard, 1975). While it is common practice to regularly document and monitor student academic progress, much less information has been found which provides guidance as to how to protect a student’s due process rights in the event of a dismissal due to non-academic characteristics (Knoff & Prout, 1985). Two types of due process exist: substantive or procedural. Substantive due process cases would involve faculty mistreatment of the student that is prejudicial, inconsistent, or erratic in nature (Knoff & Prout, 1985). A case concerning procedural due process would be related to a lack of timely notice of dismissal, or without the student being given an opportunity for a hearing 20 or to formally defend his or herself (Knoff & Prout, 1985). There are legal precedents of both types of due process involved in the dismissal of students from academic training programs, as due process is the most common basis for legal action by disgruntled students (Frame & Stevens- Smith, 1995). Specifically, there is legal precedent that courts will consistently uphold the rights of institutions to dismiss or terminate students based on evaluation by qualified faculty (i.e., Goss v. Lopez, 1975; Greenhill v. Bailey, 1975) so long as due process has been observed (Lumadue & Duffey, 1999). Greenhill v. Bailey (1975) also provides clarity about what exactly would satisfy due process requirements: any notification of a student’s academic shortcomings prior to termination (Lumadue & Duffey, 1999). In recommending a procedure for teacher evaluation, Matula (2011) succinctly states: “Perhaps the most effective way to provide substantive due process measures is to ensure that the components of a sound evaluation system are present and implemented properly” (p. 101). By extension, use of a sound evaluation system would also most likely satisfy procedural due process, assuming that a sound evaluation system would involve transparency between faculty and students (timely notice of any issues), and steps for remediation prior to dismissal (opportunity for self defense). Thus, due process as a central goal for any evaluation of student professional dispositions would not only satisfy requirements related to accreditation, but also to the law and the U.S. Constitution. Legal Issues With vague guidance and high stakes, faculty often are uncertain how to handle this type of situation and may feel alone (Foster & McAdams, 2009). Legal issues regarding gatekeeping can impact multiple stakeholders, and it may seem more troubling to intervene rather than to 21 disrupt status quo (Foster & McAdams, 2009). Some types of legal issues that have been documented include: ● disgruntled students who have been dismissed from a program (i.e., Harris v. Blake and the Board of Trustees of the University of Northern Colorado, 1986); ● clients suing educational institutions for the work of an inappropriate counselor (i.e., a lawsuit directed at Louisiana Tech University because “...a university has an obligation not only to the degree participants, but also to the public, [to ensure] that a person who graduates from its program is competent in the area in which the degree is bestowed” (Custer, 1994, p. 7); ● issues relating to First Amendment rights (i.e., Keeton v. Anderson-Wiley, 2011: a student sued her institution after being required to complete a remediation plan due to repeated statements of a desire to convert, and an inability to work, with a homosexual client in practicum) Each of these cases provide a unique insight into the issues that counselor educators must take into account when considering gatekeeping interventions. Further investigation of court rulings and statements also sheds light on needed components of gatekeeping policies and procedures. For instance, in Harris v. Blake, the student in question was dismissed after evaluation from just one faculty member, and although the judge ruled in favor of the faculty, current literature, and the ruling of that case, underscore the need for multiple faculty perspectives in a gatekeeping scenario (Bhat, 2005; Foster & McAdams, 2009; Gaubatz & Vera, 2002; Kelly, 2011). The case at Louisiana Tech University involved a client suing a clinic where the counselor worked, which then evolved into a case against the institute where the counselor was 22 trained (Custer, 1994; Frame & Stevens-Smith, 1995). This lends itself to the weight of student evaluation; a graduate from a counseling program essentially has been endorsed by that program’s faculty as fit and competent to practice counseling. In the event of graduating a student with questionable motives or abilities, faculty run the risk of legal action by any client who may be harmed by that student. These legal precedents provide extremely valuable insight into the components that are necessary to effectively evaluate and remediate students when necessary in a way that also protects students’ rights. Keeton v. Anderson-Wiley (2011), highlights an issue that is current and pressing in our society. A student (Keeton) was required to complete a remediation program before she was allowed to move onto the program’s clinical practicum. This decision by faculty was a reaction to Keeton’s expression that, based in her religious beliefs, lesbian, gay, bisexual, transgender or questioning (LGBTQ) individuals have identity confusion and that she would intend to convert any such client she encountered. The federal court found that the faculty upheld due process and offered remediation to Keeton, therefore her efforts were denied. While there are certainly more examples of legal cases regarding student evaluations, the three outlined above provide sufficient information to accentuate the importance of systematic evaluation in all student competencies, and lend insight into specific components that should be incorporated in such evaluations. Empirical evidence reveals that programs which have formalized procedures report significantly lower rates of gate-slipping (Gaubatz & Vera, 2002). As such, the development and implementation of an instrument for use in systematic evaluation of professional dispositions development (PDD) satisfies legal and pragmatic needs of university programs. Additional needs that would be met by the use of a systematic evaluation of PDDs would be those of the accreditation bodies and the ACA, and CRCC Codes of Ethics. 23 Ethical Issues Ethically, it is expected that educators are active and proactively monitoring the students in counselor education programs so as to protect any potential future clients from the harm that can come from an inappropriate or inadequate counselor. This particular task, however, can be an ethical dilemma in and of itself. Gatekeeping requirements and ethical codes, although understood as required functions of faculty, are vague and lack specific descriptors to guide faculty through the process of gatekeeping, making the task unwelcome and daunting (Bhat, 2005; Gaubatz & Vera, 2002; Kelly, 2011). Furthermore, evaluation of professional dispositions, which are not as objectively measured as academic competencies, can add an additional level of ethical consideration and discomfort for faculty. Until the most recent iteration of the CRCC Code of Ethics (2016), gatekeeping was not mentioned. Previously, section H.5: Rehabilitation Counselor Supervisor Evaluation, Remediation and Endorsement, included the statement, “…rehabilitation counselor educators do not endorse students whom they believe to be impaired in any way…” (CRCC, 2009, p. 22). This has changed with the newest revision of CRCC Code of Ethics (2016), in Section H.8.: Education Evaluation, Remediation, and Endorsement; specifically, H.8.b: Gatekeeping and Remediation for Students. This new section indicates three key requirements of rehabilitation counselor educators with regard to “…the inability of some students to achieve required competencies, which may be due to academic performance or personal concerns”: (1) assist students in securing remedial assistance, including counseling, when needed; (2) seek professional consultation and document the decision to recommend dismissal or refer students for assistance; and 24 (3) make reasonable efforts to ensure that students have recourse in a timely manner to address decisions requiring them to seek assistance, or to dismiss them and provide students with due process, according to institutional policies and procedures (CRCC, 2016, p. 27). Similarly, Section F.9 of the ACA Code of Ethics (2014), Evaluation and Remediation, applies to counselor educators’ roles as evaluators of students. In addition to three points that align with those found in CRCC Code of Ethics, the ACA Code of Ethics also states that “Counselor educators clearly state to students, prior to and throughout the training program, the levels of competency expected, appraisal methods, and timing of evaluations…” (p. 15). It goes on to indicate that communication of evaluations and their results should be ongoing during a student’s time in an educational program. The use of an instrument that would support the systematic and objective measurement of particular competencies such as professional dispositions would satisfy the codes of ethics and would alleviate some of the daunting nature of evaluations. In addition to the specific guidelines in the codes of ethics, there are six ethical principles that counselors in both disciplines honor and adhere to which are also relevant to student evaluation in counselor education. Specifically, nonmaleficence is of concern in gatekeeping and student evaluation. Nonmaleficence. As defined in the ACA Code of Ethics, nonmaleficence is “avoiding actions that cause harm” (ACA, 2014). Counselor educators acting to intervene with students demonstrating IDDP are adhering to the ethical principle of nonmaleficence in regards to any potential clients that a student may work with in the future. Simultaneously, this principle serves to protect the welfare of the students in counselor education programs. Transparency about 25 student evaluations in counselor education programs is a method that faculty can use to improve student investment in evaluations, which can also serve to alleviate student anxieties about being evaluated and improve any feelings related to experiences with perceived deficient peers (Foster & McAdams, 2009). That would also align with the aforementioned stipulations in the ACA Code of Ethics, with regard to clearly and regularly disclosing information related to student evaluations. There is no question that counselor educators are legally and ethically required to evaluate students in academic and non-academic competencies. However, the mechanisms for how they are to accomplish this, and what those non-academic competencies are remains vague. These are just some of the many barriers to accomplishing gatekeeping that is systematic and consistent. Barriers to Gatekeeping Brear and Dorrian (2010) postulate three key areas where barriers to gatekeeping fall: (1) difficulties in operationalizing core competencies necessary for professional practice, (2) reactive rather than proactive approaches to gatekeeping, and (3) diverse contextual, professional, and legal issues. The current study seeks to address each of these three areas for the benefit of counselor educators, counseling students, and the clients that will be served in the future. Difficulties in Operationalizing: Subjectivity The earlier sections in this chapter provide an overview of some of the challenges caused by the lack of operationalized definitions in gatekeeping. The current study seeks to alleviate this problem by remaining aligned with the terminology provided by CACREP, and by introducing terms such as IPDD. Another issue not previously discussed in relation to operationalizing definitions is that of subjectivity in evaluation. Supervisors of graduate student counselors 26 reported that the most common feedback that is withheld from supervisees is negative feedback, and that the rationale for this is that the feedback is based on the supervisor’s personal concerns, and the anticipation of the supervisee’s negative reaction (Ladany & Melincoff, 1999). Fear of negative reactions to feedback that may be perceived as subjective leads to withholding potentially valuable feedback, and may also lead to a lack of intervention with problematic students (Hoffman, Hill, Holmes, & Freitas, 2005). Furthermore, Hoffman et al. (2005) found that “nonclinical issues, such as personality and professional issues, were even more likely to be viewed as subjective and difficult than were clinical issues” (p. 10). Operationalized definitions of the concepts deemed necessary for professional success are requisite to the successful evaluation of non-academic competencies such as professional dispositions (Lumadue & Duffey, 1999; Ziomek-Daigle & Christensen, 2010). Reactive Gatekeeping Current practices in gatekeeping are such that programs do not act until after there has been a particularly problematic student, situation, or lawsuit (Brear & Dorrian, 2010; Foster & McAdams, 2009; Kerl et al., 2002; McAdams et al., 2007; Ziomek-Daigle & Christensen, 2010). Program faculty need to determine the appropriate criteria and instruments that they will use for student evaluations which satisfies CACREP Standards, students’ rights, and due process (Brear & Dorrian, 2010; Knoff & Prout, 1985). The current lack of available formalized procedures for evaluating professional dispositions in a systematic way hinders this first step, and therefore makes reactivity common among programs (Kelly, 2011). Additionally, in regard to gatekeeping as a whole (not just evaluation of professional dispositions), educators face poorly defined protocols, inconsistent procedures, and an overall lack of policy to guide them (Brear & Dorrian, 2010; Forrest et al., 1999; Gaubatz & Vera, 2002; Olkin & Gaughen, 1991). Gaubatz and Vera 27 (2006) found that “Deficient students exist in counseling training programs, but well-designed gatekeeping procedures appear to improve the effectiveness with which they are identified and prevented from progressing unremediated into the counseling field” (p. 41). It has been found that more students are being dismissed from counseling programs for personal reasons rather than those of an academic nature (Brear et al., 2008). Given this trend, it is imperative that counselor educators have a systematic way to identify, evaluate, and remediate PDD at multiple stages throughout a student’s time in a program. The model of gatekeeping proposed by Ziomek-Daigle and Christensen (2010) includes four phases, and recommends student evaluation at each phase, from pre-admission through remediation outcomes. This is also supported by the work of Gaubatz and Vera (2002) whereby the researchers found that faculty were more likely to follow up with a problematic student when there were formal gatekeeping procedures in place. It is imperative that faculty feel that they are within a program that would support and back them if they were to feel that it was necessary to intervene with a problematic student. Contextual, Professional, and Legal Issues The above portion of this chapter outlines the legal issues that are involved in gatekeeping. Beyond legal concerns, there is a clear rationale as to why evaluation of professional dispositions are considerably more challenging than academic evaluation (i.e. Kelly, 2011). While the creation of instruments and suggestions of policies for remediation are useful, if there is not an environment that supports the regular use of these instruments and policies, they hold no weight (Brear & Dorrian, 2010). Specifically, institutional pressures and social loafing contribute to these contextual issues in programs. 28 Institutional pressures. Enrollment is an ever-present factor in the lives of university faculty. Unfortunately, the perceived pressure to maintain high enrollment can hinder gatekeeping decisions at admissions and throughout a student’s time in the program (Brear & Dorrian, 2010). Counselor educators are already uncomfortable with the evaluative component of their jobs (Bhat, 2005). Real, or perceived, pressures around enrollment lends some insight into why gatekeeping can fall by the wayside in counselor education programs, when combined with a lack of appropriate tools or resources, it is very clear how this problem has evolved (Forrest et al., 1999). Social loafing. Social loafing has been described as “the diminished effort by those submerged in a group” (Elman, Forrest, Vacha-Haase & Gizara, 1999, p. 716). People in groups can feel less accountable, and as thought their actions are not important. As such, in an academic institution, faculty may assume that someone else (i.e., another faculty member or future supervisor) will take the responsibility for a student with IPDD (Elman et al., 1999). This particular problem, and most contextual issues discussed by Elman et al. (1999) would be best addressed at the systemic level: “Trainee impairment or incompetence is not a single, static event or outcome but a state that emerges over an extended period of time while embedded in contextual elements of the system” (p. 718). Immersing formalized evaluations, and a culture of transparency into the system of counselor education at a particular university program would alleviate the issue of social loafing-- faculty would have clear guidelines for addressing students demonstrating IPDD and would be capable of discussing these issues openly with students and faculty alike (Foster & McAdams, 2009; Gaubatz & Vera, 2002). 29 Professional Disposition Development and the Working Alliance As discussed throughout this chapter, evaluating students based on professional dispositions, or non-academic criteria, is more challenging, less desirable, and requires more stringent procedures than the traditional method of evaluating students based on academic merits (Brear & Dorrian, 2010; Forrest & McAdams, 2009; Gaubatz & Vera, 2002; Hoffman et al., 2005; Ziomek-Daigle & Christensen, 2010). Briefly, this paper has mentioned the importance of the WA with regard to client outcomes. Within the context of the aforementioned barriers to gatekeeping, the current study seeks to incorporate WA into evaluation of professional dispositions as a means to anchor the vague concept of professional dispositions to an evidence- based practice, such as WA. WA already has operational definitions, empirical evidence in support of its utility and underlying components, and a tool for assessing the strength of WA in various types of relationships (Bordin, 1979; Efstation, Patton & Kardash, 1990; Horvath & Greenberg, 1989; Horvath & Symonds, 1991; Lustig, Strauser, Rice & Rucker, 2002; Wampold, 2001). These established components will assist in the development of an instrument which evaluates PDD, specifically intending to aid students in the development of dispositions which would enhance their ability to develop WA with clients across cultures, diagnoses and various demographic factors. Working Alliance: An Overview The beginning of the development of WA started as a reaction to the rigidity of behaviorism. Carl Rogers posited that humans were inherently good, and should have the ability to direct their own lives via the person-centered approach (PCA) in counseling (Rogers, 1951). Rogers theorized that growth and therapeutic change were facilitated by counselors, and key counselor qualities were the “central conditions” that elicit positive client change. The goal of 30 PCA is to assist a client in achieving self-actualization, and Rogers (1951) proposed that this is facilitated by counselors who are supportive and collaborative rather than directive and authoritative. The term working alliance was originated by Greenson (1965), after identifying that “The key to understanding the essential pathology as well as the therapeutic stalemate was in the failure of the patient to develop a reliable working relation with the analyst” (p. 77). Greenson (1965) stipulated that WA was essential for psychoanalytic therapy. Bordin (1979) takes the PCA and WA and provides a framework for the application of PCA’s core conditions into a counseling relationship. Furthermore, Bordin (1979) proposed that WA “...is one of the keys, if not the key, to the change process” (p. 252). This has been empirically supported over time, and specifically discuss Wampold (2001): “The alliance appears to be a necessary aspect of therapy, regardless of the nature of the therapy” (p. 137). It is in light of the significance of WA that the current study was developed: clearly, the importance of WA cannot be understated, and therefore it is crucial that counselor educators are both aiding students in learning how to develop WA, but also in identifying professional dispositions, or non-academic qualities that may hinder one’s ability to form WA. Three features of WA. Bordin (1979) specifically identified three features of WA with the intent to allow researchers to test WA. These three features are: agreement on goals, an assignment of task(s), and the development of bonds (Bordin, 1979). Bordin’s theory is based philosophically in the concept that “in any helping relationship the task of participating collaboratively in the counseling process taps directly into aspects of the client’s self-defeating behavior” (Horvath & Greenberg, 1989, p. 224). 31 Goals, or outcomes, of the relationship should be agreed upon at the outset of therapy, primarily having been determined by the client, but in collaboration between both parties (Bordin, 1979). The goals can be considered the target of the intervention (Horvath & Greenberg, 1989). There must be a mutuality in the agreement of the change goals set, which more specifically can be defined as the change in “...thought, feeling, and action, or some combination” which is necessary for the desired change to occur (Bordin, 1983, p. 35). Tasks will vary based on the theoretical orientation of the counselor and involve the in- counseling behaviors that make up the counseling relationship. Furthermore, both parties must accept responsibility for the tasks, and perceive the tasks as pertinent and effectual (Bordin, 1979; Horvath & Greenberg, 1989). Tasks can be described as the activities or exercises that are identified by the therapist, or counselor, as necessary steps for the client to meet the identified, desired change goal(s). Bordin (1983) has gone so far as to emphasize the importance of the tasks that he identified that the strength of the WA is predicated on how well client understand the relationship between a chosen task and their desired outcome or goals. Finally, the development of bonds speaks to personal attachments which are based in mutual trust, acceptance, and confidence (Bordin, 1979). More succinctly, “Bordin’s concepts of bond, goal, and task involve collaboration and hinge on the degree of concordance and joint purpose between the counselor and client” (Horvath & Greenberg, 1989, p. 224). Bonds can be defined as shared feelings of liking, trusting, and caring within the relationship (Bordin, 1983). WA and Counselor Education WA has been demonstrated as crucial to client outcomes in both rehabilitation counseling, psychotherapy, and supervisory relationships (Bordin, 1983; Horvath & Symonds, 1991; Lustig, Strauser, Rice & Rucker, 2002; Martin, Garske & Davis, 2000). As there is much 32 empirical evidence in support of WA, it follows that “If counselor education programs are to make any level of evidence-based practice, then they should be addressing WA before all else” (Connor & Leahy, 2016, p. 375). Tying the evaluation of professional dispositions to a student’s ability to develop WA satisfies both CRCC and ACA Codes of Ethics given its place as an established evidence-based practice. The CRCC Code of Ethics is the statement that rehabilitation counselors have an ethical responsibility to use evidence-based practices (EBP), that are based on accepted research practices (CRCC, 2016). Similarly, the ACA Code of Ethics states that counselors must engage in counseling practices that are based on rigorous research methodologies (ACA, 2014). EBP has been described as “...a clinical decision-making process beginning with formulating clinical questions to ask, determining the best practice, and critically appraising the evidence for validity and applicability to the particular situation” (Chan, et al., 2010, p. 180). Said another way, EBP provides a solution to the timeless question of Paul (1967): “What treatment, by whom, is most effective for this individual with that specific problem, and under which set of circumstances?” (p. 111). WA even goes a step farther, as a common factor, demonstrating that regardless of what theoretical orientation or counseling technique is used, WA accounts for a large amount of outcome variance (Wampold, 2001). It has been discussed, in this paper and others, that the development of instruments for use in gatekeeping have struggled with empirical evidence or replication, and furthermore, that establishment of an operational and systemic method for assessing professional dispositions continues to elude counselor educators (Bhat, 2005; Kelly, 2011; Kerl et al., 2002). Using WA as a means to ground evaluation of student professional dispositions aligns with ethical practice per ACA and CRCC, and meets the accreditation standards of CACREP (2016), which specifically 33 cites the need for counselor educators to address a student’s ability to develop therapeutic relationships using evidence-based strategies. Moving past microskills. Currently, counselor education is based in a microskills approach. The concept of microskills to address inadequacies in counselor training programs were introduced by Truax and Carkhuff (1967). The authors proposed a curriculum that was intended to teach discrete therapeutic skills which would increase students’ autonomy, decrease defensiveness, and increase ability to establish warmth and empathy. Microskills training, and the cornerstone works of Truax and Carkhuff (1967), and Ivey (1971), are “based on the assumption that the instructors can lessen therapeutic complexity for training purposes by focusing on single skills and allowing students to practice and master them individually” (Ridley, Kelly & Mollen, 2011, p. 803). Recently, there has been a call for reform in counselor education-- a need to move from a microskills approach to “a more comprehensive model of counseling competence” (Ridley, et al. 2011, p. 820). Connor and Leahy (2016) outline a logical and pragmatic conceptualization for teaching WA as a means to take this step in moving towards educational practices which encourage the development of “higher order, cognitively complex skills such as attachment formation and case conceptualization” (p. 4). In alignment with this movement, it is not only practical but timely to provide counselor educators with a means to assess counseling students at a similarly higher level, and to encourage the focus on development of such higher order skills. Personality and WA. In some of the empirical evidence available on WA, there has been an indication that there are particular characteristics of both clients and therapists which can affect the alliance (Castonguay, Constantino, & Holtforth, 2006). Therapist characteristics or behaviors that have been found to positively relate to the quality of an alliance are warmth, 34 flexibility, and accurate interpretation (Ackerman & Hilsenroth, 2003). Characteristics and behaviors which negatively affect a quality alliance are rigidity, criticalness, and inappropriate self-disclosure (Ackerman & Hilsenroth, 2001). As stated by Wampold (2001): “It seems intuitive that some characteristics would be more desirable than others…” (p. 170). This uncovers the question of the relationship between WA and personality, and furthermore, can, and should, counselor educators evaluate student personalities as a function of gatekeeping? Chapman, Talbot, Tatman, & Britton (2009) align “enduring dispositions” with “personality characteristics”. Coming back to CACREP vocabulary, and the term “professional dispositions”, it can become troubling and confusing for counselor educators to feel that they are being required to evaluate students based on personality type. Chapman et al. (2009) explore the Five Factor Model in relation to WA and specifically indicate that information about this relationship would be beneficial to educators and supervisors alike. In alignment with the position of evaluation as a catalyst for remediation, the authors indicate that once educators are aware of a student who demonstrates troubling dispositions, or IPDD, they can then focus on that particular skill in order to aid the student in developing better alliances. Chapman et al. (2009) found that three domains from the Five Factor Model appeared to relate to the alliance include Neuroticism, Openness, and Agreeableness. A key implication of this study is the suggestion that educators or supervisors should be aware of personality traits, and levels of such traits, which can help or hinder the ability to develop WA with clients. Specifically, “Such therapy trainees may be at risk for engaging in tactics which inhibit or impede the development of a therapeutic bond and/or shared goals and tasks with their clients” (Chapman et al., 2009, p. 593). Furthermore, the researchers indicate the need for supervision to include increasing self-awareness and self-monitoring, which is a particular consideration for the 35 development of an instrument which evaluates professional dispositions: in implementing a tool for an ongoing evaluation and discussion around these particular qualities, or dispositions, counselor educators can aid students in their own self-awareness and development. Providing theoretical groundwork and background information can serve to aid educators in increasing their comfort with the evaluative roles they must fill. Moreover, providing an accurate theoretical framework for situating professional disposition evaluation in counselor education and student development may also serve to alleviate these negative feelings or avoidance. Using Performance Appraisals in Counselor Education Bhat (2005) puts forth the concept of bridging the disciplines of personnel management and counseling gatekeeping via the adoption of performance appraisals (PAs) into counselor education. Use of PAs would go a step beyond the existing literature on evaluations in counselor education by providing centuries of theories, data, and resources. PAs have also been specifically designed to minimize legal risk and have empirical basis for fostering employee investment (Bhat, 2005; Grote, 2002). The incorporation of PA theory into student evaluation provides a unique lens through which to theorize, and assess, student engagement in various aspects of their education. Early research on PA did not so much determine if PA worked, but rather explored its utility in the context of a company. Latham & Locke (1984) identify some key characteristics of, and arguments for PA, which are largely applicable to the study of professional dispositions in counselor education. Of particular relevance are the points: “Feedback on goal-directed performance motivates higher performance only when it leads to the setting of higher goals”, and “Feedback alone won’t improve performance, but if it’s missing from a performance system, performance can’t improve” (As cited in Grote, 1996, p. 5). Translating to counselor education 36 and student evaluation: students are interested in feedback that allows them to improve and set higher goals in the future, and feedback about professional dispositions is absolutely necessary for the improvement of student professional disposition development. These points are directly applicable to the need for an instrument which evaluates professional dispositions in counselor education programs, but also alludes to the need for a culture of transparency in which discussion of performance is ongoing. It is interesting to note Latham and Locke’s (1979) early awareness of issues with evaluation, stating that one main problem with motivating employees can be that motivation is internal, cannot be directly observed, and that “most managers are not in a position to change an employee’s basic personality structure” (p. 68). This further substantiates the rationale for using PA in counselor education and gatekeeping. Bhat (2005) takes six good management practices espoused by Grote (2002) for the development of sound appraisal systems and provides an adapted version for their use in counseling: 1. Base evaluations on an analysis of the job. Evaluation instruments should focus on standards set forth by professional bodies. Trait-based rating systems that do not directly relate to specific job responsibilities are ill advised (Grote, 1996). The current study seeks to use experts in the fields of rehabilitation counseling and counseling in order to specifically align an instrument with accreditation standards, codes of ethics, and the required roles of counselors (specifically, the development of WA). 2. Define performance dimensions in behavioral terms and use observable, objective evidence. This has been the catalyst for the development of the current study; abstract and ill- defined concepts have been identified as requiring observation. It is imperative to include specific behaviors which indicate such desired attributes. Grote (2002) suggests that 37 understanding how a “master performer” would perform or exemplify a particular skill or characteristic can be used as the baseline for assessing that particular skill or characteristic. A Delphi panel of experts in collaboration will be able to identify what a “master performer” would look like in counseling. 3. Keep things simple. Provide legitimate rationale for the inclusion of a particular assessment category; only include assessments that are critical and relevant. The current study has been designed specifically to address CACREP accreditation requirements, and thus has been determined as being critical, relevant, and mandatory in counselor education. 4. Check yourselves regularly. Monitoring evaluation instruments and procedures regularly to check for discrimination is imperative to ensure equality across all groups of people in training programs. Regular review of student progress in PDD can encourage useful dialogue among faculty, and provides the opportunity to evaluate if there is any discrimination. The current study intends to embed evaluation into counselor education programs, and to propose the importance of a culture of transparency about evaluation in all areas of counselor education. Faculty should feel that they are able to check on another in the event of any suspected discrimination. 5. Train evaluators adequately. Counselor education literature on gatekeeping policies has indicated that counselor education faculty have not often received formal training in gatekeeping policies or procedures (Gaubatz & Vera, 2002). Bhat (2005) suggests that a detailed and comprehensive training should be given to supervisors or educators. This would also serve to increase inter-rater reliability, and would decrease the likelihood of discrimination as discussed in the previous point. Grote (2002) states that not only should the evaluators be trained, but that the trainee should also be well informed of the process and should have the opportunity to 38 discuss results or feedback. This also aligns with the transparent design discussed throughout this paper, and originally suggested by Foster and McAdams (2009). An additional recommendation by Bhat (2005) is that, in addition to adequate training, inexperienced supervisors or educators should have their evaluations reviewed by those experienced in doing so, such that they feel supported and protected during the process. 6. Ensure formal appeal mechanisms are built in. In keeping with the needs of due process outlined earlier in this chapter, all evaluation procedures should have appeal mechanisms available for students to defend themselves. These should be easily available to the students, and reiterated each time an evaluation takes place. Theoretical Framework for PDD An added benefit to considering PA as valuable for counselor educators is the application of the theories that have been used in PA to evaluation of professional dispositions in counselor education. There are many factors which contribute to the effectiveness of PA, most significant of which is “ratee reactions”, or when key stakeholders consider the PA to be useful (Iqbal, Akbar, & Budhwar, 2015). Primary theories discussed in PA literature include expectancy theory, goal setting theory, and social exchange theory (SET). These theories all provide different explanations as to the ratee-reactions to PA. Reduced to simplistic terms, expectancy theory states that the way to raise an employee’s interest in an organization is to reward them in correspondence to their performance (Harder, 1992; Iqbal et al., 2015). This postulates that the better the employee’s performance, the greater the reward. A great drawback to expectancy theory is that if an employee perceives that they are not being rewarded in a way that is congruent with their performance, that employee will underperform as a way to achieve perceived equity with the organization (Harder, 1992). 39 Expectancy theory would not be an effective lens through which to view the evaluation of professional dispositions in counselor education. Students in counselor education programs are typically not in receipt of rewards, especially not those that would commiserate with their performance levels. A rewards system in counselor education could be viewed as discriminatory and unethical. On the other hand, goal setting theory and social exchange theory are both viable options for the theoretical framework of the current study. Goal setting theory was developed along with Latham & Locke’s development of PA (1979). This theory stipulates that: specific, high (hard) goals lead to a higher level of task performance than do easy goals or vague, abstract goals… So long as a person is committed to the goal, has the requisite ability to attain it, and does not have conflicting goals, there is a positive, linear relationship between goal difficulty and task performance (Locke & Latham, 2006, p. 265). The open nature of goal setting theory lends itself to multiple applications, and it certainly is applicable to evaluation of professional dispositions in counselor education. Theoretically, students may set goals to improve PDD within the broader goal of the completion of a master’s degree. A significant factor of goal setting theory, identified by London et al. (2004), is that ‘setting goals’ is better than ‘assigning goals’, especially in the context of PA. Given the nature of an educational program, and the accreditation requirements faculty abide by, it is possible that students can perceive PDD as an assigned goal, rather than a chosen, or ‘set’ goal, and may view such evaluations as a nuisance or hindrance to their overall goals of graduation and employment, which would be their chosen goals. 40 However, incorporating goal setting theory into the context of social exchange theory produces an ideal theoretical framework for the current study. Emerson (1976) remarks that social exchange theory is not a theory at all, rather a frame of reference for looking at various theories whereby “Implied is a two-sided, mutually contingent, and mutually rewarding process involving “transactions” or simply “exchange” (p. 336). This is a reciprocal process which includes obligations that are contingent upon the actions of another person (Blau, 1964). Cropanzano and Mitchell (2005) discuss the foundational ideas of SET’s explanatory power: (a) rules and norms of exchange, (b) resources exchanged, and (c) relationships that emerge. Underlying these foundational ideas is the core concept that both the giver and receiver must feel appropriately compensated in order for some sort of change to occur (Blau, 1964; Cropanzano & Mitchell, 2005). Furthermore, “actors” (invested parties as individuals or a group) are self- interested, and their behavior is a result of a need to secure a particular benefit. SET most adequately fits with counselor education and PDD evaluation, when considering the explanation that “when individuals feel that the organization is keen for their long-term development, they try to reciprocate” (Iqbal et al., 2015, p. 516). According to SET, students who believe that they are being evaluated for the purpose of their long-term, professional development, will be more committed to the program, and to the process of evaluation as a whole. We can then theorize that students who have set a goal to obtain a master’s degree in counseling will not be troubled with smaller, more specific or challenging goals en route to the overall achievement of that larger goal (i.e., completion of a remedial program, or a specific PDD), so long as they believe that those are central to their long- term development and success. Using SET as the groundwork, if faculty and students have developed a reciprocal, working relationship, and faculty have demonstrated transparency about 41 evaluation procedures with an emphasis on improving student outcomes, we can then assume that students believe that the program (or organization) is committed to their long-term development, would be more committed to the evaluation process, to their role in the program as a whole, and these goals would no longer be ‘assigned’ but could now be considered as ‘set’. Summary Goal setting theory based in the framework of social exchange theory allows the conceptual basis for the current study, which seeks to create an instrument to systematically assesses professional dispositions in master’s level counselor education students using transparency and reciprocal relationships with faculty as a means to foster student involvement and investment in the evaluation process. The current study seeks to (a) bridge gaps in current gatekeeping literature, (b) meet the needs of counselor education programs which adhere to CACREP standards, and (c) provide an empirically based instrument for systematically evaluating student professional dispositions which may influence a student’s ability to develop WA. This was completed using two phases: Phase 1 involved the completion of a Delphi study to develop the items needed for an instrument, and Phase 2 involved a validation survey to establish initial psychometric properties. 42 CHAPTER THREE Method Systematic evaluation of students’ professional dispositions in counselor education is a necessary, yet complex task to accomplish for faculty. Currently, there is no available instrument to guide them in doing so. As such, the purpose of this study is to create an instrument for evaluation of professional dispositions using consensus from experts, and to then provide initial psychometric properties of the instrument items. The current study took place over two phases. Phase 1 includes the completion of a Delphi study involving experts in the fields of counselor education and rehabilitation counselor education, as well as those with experience in gatekeeping and clinical supervision research. The Delphi study provided the items necessary for the development of the instrument to be used in evaluating professional dispositions of master’s level counseling students. Phase 2 involved the completion of a validation survey in order to provide initial psychometric properties of the instrument items. The following chapter describes, in detail, the methodological choices made for the completion of the study. An in-depth description of the Delphi method and its utility in this study is provided, including the establishment of an expert panel, and the facilitation of such a panel by the researcher. This is followed by an overview of the validation survey, which involved a sample of rehabilitation counselor educators. The survey allows for the description of certain psychometric properties of the initial instrument items. Phase 1 The specific research question for Phase 1 is: What items would be appropriate for faculty to use in the evaluation of professional dispositions in master’s level counseling students? 43 Study Design: Phase 1 Research Question 1 has been addressed by way of a three-round Delphi study, in order to identify which items belong in an instrument that intends to evaluate professional dispositions of master’s level counseling students. Literature review and collaboration between experts in the fields of counselor education, rehabilitation counselor education, and in the concept of gatekeeping guided the development of items intended to measure student professional dispositions. The Delphi method, originally developed by the RAND Corporation, was created for the purpose of obtaining a reliable, expert consensus on a variety of complex issues in a systematic way (Okolai & Pawlowski, 2004; Vázquez-Ramos, Leahy, & Hernández, 2007). Delphi methodology has been defined as a “systematic solicitation and collation of judgements on a particular topic through a set of carefully defined sequential questionnaires interspersed with summarized information and feedback of opinions derived from earlier responses” (Delbecq, Van de Ven & Gustafson, 1975, p. 10). The goal of using a Delphi method is to aggregate judgement from a number of experts on a particular topic or problem which would serve to improve decision making about that particular topic or problem (Delbecq, Van de Ven & Gustafson, 1975; Dawson & Brucker, 2001). Dawson and Brucker (2001) have also stated that use of the Delphi method “allows for grouping and analyzing the speculations of many experts on a topic to move closer to knowledge on that topic” (p. 126), so long as the researcher remains aware and warned that truth is relative and may change over time. Perhaps the most succinct and relevant description of the Delphi method for the purpose of the current study is that a Delphi method is best used for a situation in which there is some evidence, but not yet knowledge about a particular topic, phenomena or problem (Ziglio, 1996). Professional dispositions are a concept that have various levels of evidence in counselor education literature, 44 but lack consistency and mechanisms for measurement (Fouad et al., 2009; Glance et al., 2012). As a result, currently there is not an instrument available which is theoretically based, psychometrically sound, or associated with outcome data from clients. Procedures: Phase 1 The current study adhered to Table 3.1, adapted from Vázquez-Ramos et al., 2007 (p. 113), which clearly delineates the steps, phases, and activities required in order to complete a successful Delphi study. The remainder of this section will discuss the accomplishment of the activities completed at each step. Heeding warning from Linstone and Turoff (2011), the number of rounds ultimately used were based on when stability was obtained; not only consensus. This happened quickly within this study, and thus only three rounds were used. Finally, the use of the Delphi method, in addition to the aforementioned benefits, adheres to what is defined as “good scale construction” by Clark and Watson (1995), in which an iterative process is undertaken to continually assess, and identify deficiencies in the initial item pool. The collaborative nature of the Delphi process as well as the access to a panel of experts uniquely suit Research Question 1. Prior to any research methods taking place, the researcher applied for approval by the Michigan State University Human Research Protection Program and the Institutional Review Board (IRB) in order to assure all proposed procedures would be ethical and protect the participants involved in the study. The researcher applied for an Exempt IRB review, given that the involvement of human subjects requires only survey procedures, and is therefore exempt from federal regulations under 45 CFR 46.101(b)(2). The request was granted for exemption and IRB approval, which allowed for the recruitment procedures to begin (IRB approval can be found in Appendix A). 45 Table 3.1 Summary Table of the Steps, Phases, and Activities Involved in the Execution of a Delphi Method with Three Rounds (Vázquez-Ramos et al., 2007) Steps Phases Step 1 Selection Activities a. Identification of potential experts b. Invitation to participate c. Recruitment of panelists d. Constitution of the panel of experts Step 2 Exploration a. Distribution of Delphi Round 1 (questionnaire usually involves an (Round 1) open-ended approach to elicit items or themes from panelists) Step 3 Evaluation (Round 2) Step 4 Re- evaluation (Round 3) b. Follow-up of Delphi Questionnaire 1 c. Completion of data collection for Delphi Questionnaire 1 d. Collation and categorization of results (content analysis) e. Construction of Delphi Questionnaire 2 (first generation of potential items a. Distribution of Delphi Round 2 b. Follow-up of Delphi Questionnaire 2 c. Completion of data collection for Delphi Questionnaire 2 d. Collation and categorization of results (Assessment of these items uses a Likert-type scale. Results are provided in terms of central tendency and measures of dispersion of participants’ responses. Those items that fall under the required central tendency and dispersion measures are included in the next round.) e. Construction of Delphi Questionnaire 3 a. Distribution of Delphi Round 3 (Participants are provided with summary statistics for the previous round and are encouraged to reevaluate their answers based on their individual answers and group responses.) b. Follow-up of Delphi Questionnaire 3 c. Completion of data collection for Delphi Questionnaire 3 d. Re-collation and categorization of results (Assessment of these items uses a Likert-type scale. Results are provided in terms of central tendency and measures of dispersion of participants’ responses.) e. Calculation of summary statistics Step 5 Final a. Identification of potential items on which consensus was obtained consensus (Those items that fall under the required central tendency and dispersion measures are included in the prototype item list.) b. Summary of final results c. Development of instrument prototype based on experts’ consensus 46 Participants: Expert Panel Selection (Step 1). The successful Delphi method includes the use of an expert panel, who are tasked with the development and ratings of particular items, concepts or predictions relevant to the topic being explored (Ziglio, 1996). The validity of a Delphi study is directly related to the expert panel; the knowledge of the panelists must be relevant to the topic being explored (Dawson & Brucker, 2010). Randomization does not improve this process, as it would in a traditional research approach, and there is not a statistical formula that lends itself to the correct number of panelists for any given Delphi study (Ziglio, 1996). It has been warned that the size of the panel remain manageable; as communication across too many individuals will be problematic for lack of response time and volume of information to synthesize, although there is very little literature about the ideal size of a panel (Dawson & Brucker, 2010; Ziglio, 1996). The current study intended to use ten experts from the fields of rehabilitation counselor education, counselor education, and in the topics of supervision and/or gatekeeping. The term “expert” is also one that has remained elusive both in the literature about the Delphi method, as well as in rehabilitation and counselor education literature (Moorhouse, 2008). For the purpose of this study, the selection criteria of the “expert” panelists is as follows (experts meet at least one criterion): ● Has been a tenure-track faculty member (or core faculty member) at a CACREP accredited counselor education program; ● Has published on the topics of supervision, gatekeeping or professional dispositions in literature of counselor education or rehabilitation counselor education Using electronic survey software (e.g., Qualtrics), an email invitation was distributed to all potential participants (N = 41), including information about the study, informed consent, 47 contact information for the researcher, and a link to participate in a demographic survey. Following participation in the demographic survey, participants received a link to Round 1. There was attrition of participants throughout the three rounds of Phase 1, which is an inherent limitation of the Delphi methodology (Vázquez-Ramos et al., 2007; Ziglio, 1996). Each round had a different number of participants: Round 1 (n = 8), Round 2 (n = 5), Round 3 (n = 5). Demographics were only collected prior to the first round, in an attempt to decrease the length of time necessary to complete the surveys. Demographics of the sample of the expert panel was primarily female (n = 8), between the ages of 45 and 54 years of age (n = 6), and was entirely White (100%). The majority of participants reported over 10 years of experience as a counselor educator (n = 10), and identified as the program director (n = 9). All participants held a CRC, and about half also identified as a Licensed Professional Counselor (LPC), or its equivalent (n = 6). Two individuals additionally noted licensure as vocational rehabilitation counselors (LVRC), and one individual additionally noted National Counselor Certification (NCC) as well as the Registered Play Therapist Supervisor (NCC, RPT-S) credential. All participants identified as working in a CORE- accredited program (n = 12), and just over half identified CORE and CACREP-accreditation (n = 7). One participant indicated only CACREP accreditation. Recruitment. In order to recruit panelists, following IRB approval, the researcher sent personal communication to identified experts via email (N = 41). Experts were primarily identified via publications about gatekeeping and/or professional dispositions in counselor education and/or rehabilitation counselor education journals (i.e., Counselor Education & Supervision, Rehabilitation, Research, Policy, and Education, Counseling and Psychotherapy Research). The identification of experts was expanded to include conference presentations on the 48 same topics. The recruitment email contained a summary of the study, including IRB approval, and time expectations per month of participation on the panel (see Appendix B). Once agreement was obtained, panelists received an informed consent document including the purpose of the study, as well as any anticipated risks or benefits. A brief demographic survey was included to collect basic information about the panelists (i.e., age, gender, years of teaching, credentials, etc.) The participants were not compensated for their participation. Following completion of the demographic survey, participants were provided with a link to Round 1 of the Delphi. Exploration (Step 2). Round 1 was distributed using electronic survey software (i.e., Qualtrics). Reminder emails were sent at two-week intervals. The survey remained open for four weeks in order to accommodate the length of the responses being requested. At the conclusion of the collection period, all responses were downloaded. A content analysis was completed following the open-ended questions in the initial questionnaire. Following the analysis of responses for themes and concepts, the questionnaire for Round 2 was created, including the first iteration of items for the instrument. Items were reviewed by the faculty mentor on this project, and approximately four items (e.g., Understands the tendency and the problem of racial stereotyping; Knowing how to consult or refer to resources available in ethnocultural communities) were added from the unpublished Multicultural Supervision Competencies Questionnaire (Wong & Wong, 2003) as multicultural competency was under-addressed in the responses to Round 1. Evaluation, Reevaluation & Final Consensus (Steps 3-5). Steps 3 through 5 in a Delphi study involve evaluating panelist responses for measures of central tendencies, reorganizing the items to reflect the most highly rated items, and returning the list to panelists for further refinement. In these steps, there is the potential for a regression to the mean, whereby 49 panelists see how others have rated the items, and they modify his/her own opinion based on seeing that information (Ziglio, 1996). The researcher took this under advisement throughout the monitoring of responses. Evaluation (Step 3). Once the instrument items evolved out of the responses from Round 1, a survey was created and distributed for Round 2. Round 2 was distributed to the expert panelists using electronic survey software. Reminder emails were sent at two-week intervals. Responses from Round 2 were analyzed for measures of central tendency and dispersion, and qualitative responses were reviewed. It was established that any items falling below 3 on both Relevance and Utility would be removed from the item pool. No items fell below the threshold, and thus the survey for Round 3 was created. Items were organized in each section by mean (high to low). A survey was created for each participant who completed Round 2, and included their scores in addition to the group means and standard deviation. Using survey software, each survey was simultaneously distributed with the same instructions, and the follow- ups simultaneously at the same intervals (two weeks). Re-Evaluation (Step 4). Re-evaluation is where panelists were able to see their scores in relation to the scores of other participants, and to re-rate items given this information. Round 2 revealed that there was little dispersion amongst the scores of items, and Round 3 afforded the opportunity to reconsider previous ratings-- certainly a strength of the Delphi methodology. Round 3 was collected, and responses were again analyzed for measures of central tendency and dispersion. The same threshold was considered for items during this round, and again, no items fell below the threshold of 3 in Relevance and Utility. In fact, no item fell below a rating of 3 in either category, which will be discussed at length in Chapter 4. Given the limited dispersion among scores, it was determined that there was no need to pursue another distribution of the 50 survey items, and thus, the initial instrument prototype was created, and named the Assessment as Growth Inventory (AGI). Measures: Phase 1 Phase 1 of this study did not involve the use of established instrumentation. In the process of this Delphi study, instrumentation evolved from an open-ended prompt to a Likert-scale rating relevance and utility of items. Round 1. Round 1 of a Delphi typically includes a broad, open-ended questionnaire designed to ascertain preliminary opinions and thoughts of the expert panel (Vázquez-Ramos et al., 2007; Ziglio, 1996). In the current study, these questions revolved around the three core components of WA: tasks, goals and bonds, (Bordin, 1979), as well as general thoughts about professional dispositions in counselor education. In order to maintain the reliability of responses, all panelists received the same electronic instructions, as identified as necessary in the literature (see Delbecq et al., 1975; Ziglio, 1996). Additionally, panelists received instructions to preserve homogeneity of language, as described by Ziglio (1996), which included specific definitions of the concepts they were asked about: ● CACREP defines Professional Dispositions as: “the commitments, characteristics, values, beliefs, interpersonal functioning, and behaviors that influence the counselor’s professional growth and interactions with clients and colleagues” This concept/definition has been deemed problematic given its ambiguous nature and subjective phrasing. Gatekeeping literature indicates the need for behaviorally specific assessment categories, and clear, operationalized language (Foster & McAdams, 2009; Lumade & Duffey, 1999). Please adhere to the following definition of WA while responding to the below prompts: 51 ● WA is composed of three features: agreement on goals, an assignment of task(s), and the development of bonds (Bordin, 1979). Goals can be considered outcomes or the target of an intervention. Tasks are the steps necessary to achieve the agreed upon goals. Bonds are the personal attachments necessary for the relationship to work, and are based in mutual trust, acceptance, and confidence. Provision of these definitions allows for all participants to respond to the prompts with the same understanding of the definitions and intentions of the study. The prompts provided were: 1. Please identify behavioral and/or identifiable (i.e., measurable, observable) characteristics which embody professional disposition to you. 2. Please identify items for a potential instrument which collect observations around a student’s ability to develop WA with potential clients. Specifically, within each of the three components of WA: tasks, goals, and bonds. Please identify a minimum of 5 items per component. Round 2. Instrumentation for Round 2 used Likert-scales for ratings of relevance and utility of instrument items. Instructions in Round 2 indicated that there were four sections of the survey: Professional Dispositions, Tasks, Goals, and Bonds. Each section included the items which were developed out of Round 1, with two, four-point Likert-scales: Relevance and Utility (Figure 3.1). Participants were asked “Please rate the following items on their relevance & utility in the evaluation of student competency in [particular section] (range from 1 = Not at all useful/relevant to 4 = Extremely useful/relevant)”. This rating scheme is intended to achieve a ranking of the items, allowing for the removal of items below a particular threshold (Vázquez- 52 Ramos et al., 2007). Participants were also provided the opportunity to include qualitative feedback on items via a comments area at the end of each section of items. Figure 3.1: Round 2 Survey Round 3. Instrumentation in Round 3 was almost identical to that of Round 2. There were two main differences in this round: (1) definitions of relevance and utility were provided following feedback from participants in Round 2, (2) items were presented in rank order (highest mean scores to lowest), and included participants’ previous scores alongside the group means and standard deviations from Round 2 (Figure 3.2). The definitions of relevance and utility provided were: ● Utility: the item will be useful for faculty in their evaluation of pre-service counseling students and their ability to develop the working alliance with future clients. 53 ● Relevance: the item is connected to, or appropriate for, the evaluation of pre-service counseling students and their ability to develop the working alliance with future clients. Figure 3.2: Round 3 Survey Data Analysis: Phase 1 In order to answer Research Question 1: “What items would be appropriate for faculty to use in the evaluation of professional dispositions in master’s level counseling students?”, it was necessary to begin the Delphi with a qualitative exploration of the types of items an expert panel would see as relevant and useful to evaluation of professional dispositions in master’s level counseling students, and which relate to WA. As such, Round 1 of the Delphi differed in data analysis given the qualitative nature of the data collected. Round 1 involved the content analysis of responses to the prompts. Content analysis has been described “...as a flexible method for analyzing text data”, which has also been considered problematic when not specifically differentiated from conventional content analysis, due to a lack of concrete definitions or 54 procedural methods often associated with content analysis (Cavanagh, 1997; Hsieh & Shannon, 2005). In light of these issues, the current study used a directed content analysis, which is more structured than a conventional content analysis, using existing theory to determine a coding scheme (Hickey & Kipping, 1996; Hsieh & Shannon, 2005). The items provided through the open-ended questions were organized into four categories: Professional Dispositions, Tasks, Goals, and Bonds. Coding adhered to the Bordin (1979) definitions of tasks, goals, and bonds, and the CACREP (2016) definition of professional dispositions. Items were coded into the section which definition it best matched. Some participants provided which sections they believed matched their items, and these were verified or re-categorized by the researcher. Items and their respective categorization were reviewed by the research mentor before distribution in Round 2. In Rounds 2 and 3, the Statistical Package for the Social Sciences ® Version 24 was used to calculate descriptive statistics, measures of central tendency and dispersion for all items on both relevance to their category as well as utility in the evaluation of pre-service counselor education students. Items were organized into categories by mean utility, then relevance to the category. Items with both relevance and utility means below 3.0 (Moderately Relevant) will be removed from the instrument. Phase 2 The specific research questions for Phase 2 include: How much do those items relate to the concepts of WA (i.e., goals, tasks and bonds)? How useful are those items for counselor educators? 55 Study Design: Phase 2 In order to establish confidence in the instrument that was developed through Phase 1, additional statistical procedures were necessary. Additional validity is especially important for future implementation and research using this instrument. A goal of this assessment measure is that it aligns with the well-established concept of the WA, and aids faculty in monitoring students’ professional dispositions which may impede their ability to develop a WA with future clients. Phase 2 seeks to further identify the psychometric properties of the proposed instrument, including internal consistency/reliability, and content/construct validity. Psychometric properties were established by having counselors and counselor educators rate the items developed through the Delphi process on their relevance to the particular category to which they have been assigned (e.g., Professional Dispositions, Tasks, Goals, or Bonds). Phase 2 affords the opportunity to evaluate measures of internal consistency in each section, using Cronbach’s alpha. Furthermore, Phase 2 seeks to provide information of the perceived utility of the instrument in counselor education, therefore this sample was also asked to rate items on their usefulness in evaluating pre-service counseling students and student ability to develop WA. Sampling: Phase 2 In order to achieve the appropriate validation of the instrument, the first population to be sampled in its development is that of Certified Rehabilitation Counselors (CRCs). The population will be homogeneous in that way, allowing the researcher to focus on the instrument items and its development, rather than an exploration or comparison between groups of counselor educators. Although the instrument created intends to meet a need in CACREP accredited programs, evaluation of professional dispositions of counselors-in-training would 56 benefit counselors or counselor educators of any specialty. Having a sample inclusive of rehabilitation counselor educators and rehabilitation counselors in practice sheds light on considerations of site supervisors, educators of varying experience, and both new and established counselors in the field. To maximize participant response, the researcher received approval from the Commission on Rehabilitation Counseling Certification (CRCC) to provide one (1) continuing education credit (CEU) for completion of the survey (see Appendix J). Along with this approval, CRCC provided a randomly selected sample of CRCCs (N=1,025) from their database, to whom the survey was sent. Of this population, 29 emails bounced, leaving a population of N = 996. An ultimate sample of 148 participants was achieved (14.9% response rate), following the removal of any participants who had completed less than 55% of the survey (only the demographics section; 20.1%, n = 200). The sample was primarily female (n = 113), with one individual responding that they identified as “transman”. The sample was also overwhelmingly white (n = 114). While more diversity would certainly be ideal, the sample is indeed representative of the current makeup of the national population of rehabilitation counselors: in 2015, White females accounted for 43% of all individuals who earned master’s degrees in Rehabilitation Counseling, and by extension, women account for 78.5% of all master’s degrees awarded in Rehabilitation Counseling (National Center for Educational Statistics, 2015). A full representation of the sample characteristics can be found below, in Table 3.2. 57 Table 3.2 Participant Demographic Characteristics Gender Male Female Other Ethnicity White Black/African American Asian Hispanic or LatinX Other Prefer not to respond Years of experience in counselor education 0-4 5-10 10+ Credential CRC LPC or equivalent LLPC Other Counselor Educator Yes No Frequency (%) 34 (22.5%) 113 (74.8%) 1 (0.7%) 114 (75.5%) 18 (11.9%) 3 (2.0%) 6 (4.0%) 4 (2.6%) 3 (2.0%) 20 (13.2%) 11 (7.3%) 17 (11.3%) 147 (97.4%) 29 (19.2%) 2 (1.3%) 40 (26.5%) 48 (32.4%) 100 (67.6%) Most of the respondents who did not identify as counselor educators also indicated that their current position does not involve the clinical supervision of Master’s level rehabilitation counseling students (n = 76). 40 participants identified having an “other” credential. The most common of these included Certified Case Manager (CCM), and Licensed Clinical Addiction Specialist (LCAS). It should be noted that upon further review, a number of participants who 58 responded “other” did indeed hold LPC or LLPC equivalent credentials, such as Licensed Mental Health Counselor (LMHC), Licensed Professional Clinical Counselor (LPCC), or LPC-Intern. Procedures: Phase 2 Following IRB approval (obtained prior to Phase 1), and the completion of Phase 1, the researcher completed the Application for Use of the CRCC Database for a Research Project, and submitted it along with a copy of the proposed survey, to CRCC for approval. Once approved, the researcher was required to complete the CRCC Mailing List Rental Agreement, stating that the project will not use the mailing list in excess of three times, over three months, and that the mailing list will remain confidential, and will be returned upon completion of its use (via email). In addition, the list was leased for the amount $250, to be paid to the CRCC. This approval allowed the researcher not only to obtain contact information of CRCs, but to provide one continuing-education credit to any participants who completed the study. Following attainment of approval from CRCC, an email was sent out to the list that contained (1) a summary of the purpose of the survey, (2) the purpose of the larger study, and (3) IRB information and contact information for the researcher (Appendix B). A link then took participants to both the informed consent and subsequent measure, using an electronic survey platform (e.g., Qualtrics). The introduction to the survey included a reiteration of informed consent, the study purpose, and operational definitions of “relevance” and “utility”. The survey includes a brief collection of demographics related to the participant’s work experience, as well as a description of his/her job title, or educational program (e.g., accreditation status). Following the initial distribution, three follow-up emails were sent at one-week intervals. In order to obtain their CRCC CEU, at the completion of the survey, participants were taken to a separate site (e.g., Google Forms), where they provided their email address, and the CEU instructions were sent by 59 the researcher at the end of each week the survey is open (see Appendix J). Confidentiality of participants was protected by ensuring that personal information was not linked to survey responses, which is provided via the use of the survey software redirecting participants to the Google Form upon survey submission. Measures: Phase 2 The instrument that was generated in Phase 1 of this study via the Delphi method was used to complete this phase. A goal of this study is to create an instrument that aligns with the Working Alliance Inventory (WAI). WAI was created to be based on Bordin’s conceptualization of WA, specifically as “a measure that not only captures outcome variance but has a clearly articulated relation with a specified body of theory, which in turn clearly explicates the relation of the theoretical constructs to the counseling process” (Horvath & Greenberg, 1989, p. 225). The WAI is composed of three, 12-item subscales, and there was an attempt in the current study to create an instrument that is similarly constructed. Due to the results of Phase 1, the Assessment as Growth Inventory, will differ from the WAI in subscales and number of items. There was high agreement in the relevance and utility of the items throughout the Delphi, leaving Phase 2 with an instrument of 4 sections and varying lengths (Professional Dispositions: 13 items; Tasks: 10 items; Goals: 8 items; Bonds: 17 items) for a total of 48 items. In order to assess the relationship of the instrument items to their category (e.g., Professional Dispositions, Tasks, Goals, Bonds), the survey in Phase 2 asks participants to rate item relevance to their category: “Please rate the following items on relevance in the evaluation of student competency in (category)”, on a four-point Likert scale (1 = Not at all relevant; 4 = Extremely relevant). Participants were also asked to rate the utility of the items for evaluation of 60 pre-service counseling students: “Please rate the following items on utility in the evaluation of student competency in (category)”; (1 = Not at all useful; 4 = Extremely useful). Data Analysis: Phase 2 In order to answer the research questions: “How much do those items relate to the concepts of WA (i.e., goals, tasks and bonds)?” and “How useful are those items for counselor educators?”, Phase 2 used the Statistical Package for the Social Sciences ® Version 24, to calculate descriptive statistics, measures of central tendency and variation for all items on both relevance to their category (e.g., goals, tasks, bonds), as well as utility in the evaluation of pre- service counseling students. Items were again organized by mean utility, then relevance to the category, and explored for any with both relevance and utility means below 3.0 (Moderately Relevant) to be removed from the instrument. Furthermore, a measure of internal consistency (i.e., Cronbach’s alpha) are necessary to establish the relation of items within each section of Assessment as Growth Inventory. Cronbach’s alpha lends itself to the credibility of the sections of the instrument, as it is not intended to be unidimensional, and this provides justification for the grouping of items in their respective sections. Following recommendations in the literature (e.g., Bland & Altman, 1997; Goforth, 2015), the goal of this measure will be to identify internal consistency reliability coefficients of 0.65 or higher. Weaker coefficients would indicate that the items in each section are not correlated, and therefore would require reorganization or removal. Finally, a between- groups analysis (i.e., an independent samples t-test) will be conducted to identify any statistically significant differences in the mean scores between educators and non-educators (e.g., participants who selected ‘no’ to the demographic question “Are you a counselor educator?”). 61 In sum, for completion of Phase 1, an expert panel was invited to participate in a three- Summary round Delphi study with the goal of identifying the appropriate items to include in an instrument for measuring the professional dispositions of master’s level counseling students. Items are related to the concept of WA, which is a known evidence-based practice that positively impacts client outcomes. The initial iteration of items were compiled and distributed for validation in Phase 2. Phase 2 included a survey for the purpose of establishing reliability and validity measures for the Assessment as Growth Inventory. The instrument was comprised of 4 sections and varying lengths (Professional Dispositions: 13 items; Tasks: 10 items; Goals: 8 items; Bonds: 17 items) for a total of 48 items. Content validity is being assessed, asking CRCs if the items developed in the Delphi align with the three core constructs of WA: tasks, goals, and bonds (Bordin, 1979). Internal consistency of each section is also to be assessed, using Cronbach’s alpha to identify reliability of each section of the instrument. Completion of Phases 1 and 2 provide sufficient empirical evidence in support of an instrument for faculty use in the systematic evaluation of master’s level counseling student’s professional dispositions. 62 CHAPTER FOUR Results Results of the study will be presented by phase, and the Delphi in Phase 1 will be discussed by round, to ensure clarity. Phase 1: Round 1 Round 1 of the Delphi study involved the accumulation of potential instrument items in the form of qualitative, open-ended prompts. Eleven expert panelists responded, providing a total of 136 potential items for the Assessment as Growth Inventory. Using a directed content analysis, items were sorted into four sections: Professional Dispositions, Tasks, Goals, and Bonds. Items were sorted based on the section that the participants identified in their responses, however, upon analysis, items did not always remain in their originally identified category. Professional Dispositions. A specific prompt asked for participants to identify items related to professional dispositions, using the following definition provided by CACREP (2015): “the commitments, characteristics, values, beliefs, interpersonal functioning, and behaviors that influence the counselor’s professional growth and interactions with clients and colleagues.” Participants were asked specifically to identify behavioral and/or identifiable (i.e., measurable, observable) characteristics which embody professional dispositions of counselors. Sixty (n = 60) total items were provided. Items were coded into broad categories which exemplified the nature of the item, in order to narrow down the volume while honoring the essence of what participants identified as important. Twelve categories emerged for initial coding: 1. Professional skills (administrative and personal) 2. Lifelong learning and commitment to counseling profession 3. Core conditions of counseling 63 4. Conflict resolution 5. Ethics 6. Counseling identity/professional identity 7. Maturity 8. Microskills 9. Multicultural competence 10. Self-awareness 11. Tasks 12. Integrity In adherence to a directed content analysis, the definition of professional dispositions guided this coding process, leading to moving items to other sections (e.g., tasks into Tasks section and core conditions and microskills into Bonds section), as well as consulting literature on professional dispositions and WA when necessary to remedy a concern. An example of this came up several times in the professional dispositions section, such as “Awareness of how self is impacting the counseling relationship”, or “put needs of client before self (especially the need to fix things for the client- client needs to be supported to fix things for themselves and the student counselors own needs to talk and be heard)” while submitted as professional dispositions, these items were more clearly aligned with the Bonds section, which falls under the definition of “liking, trusting, or a feeling of common purpose and understanding between counselor and client” (Bordin, 1994; Horvath & Greenberg, 1989). Ultimately, after categorization, organization, and rewording, 14 items emerged from the responses of participants in the area of Professional Dispositions. Examples of such items include: “Engaging in difficult conversations with clients, coworkers, and/or supervisors in an appropriate manner”, and “A dedication to, 64 and embodiment of, the ethical values (autonomy, justice, veracity, beneficence, nonmaleficence, fidelity”. Tasks. Tasks, according to the WA, are the activities that occur within the counseling relationship (by both client and counselor) in order to bring the client closer to their identified change goal (Bordin, 1979; Lustig et al., 2002). Originally, 25 items were submitted for the Tasks section of the instrument (n = 25). There was much overlap within the items, which allowed the analysis to consist of the identification of items that were similar in nature, in order to create one item that would represent multiple submissions. An example is the item: “Ability to collaborate with clients to design tasks that are congruent with the mutually agreed upon goal”, which encompassed five other submissions: ○ I feel that the counselor’s assignments will help me achieve my desired change, ○ I feel that the way we are working towards my desired change will be effective, ○ Tasks will be mutually agreed upon, ○ Consistently involves the client in the design of tasks to accomplish, and ○ Ability to identify tasks that will lead to goal attainment Ultimately, the original 25 items were represented by 12 items to be included in the instrument. Examples of such items include: “Application of the use of Evidence-Based Practice (EBP),” “Being able to show support when holding clients accountable for task completion, or non-completion,” “Knowing how to consult or refer to resources available in ethnocultural communities,” and “Adjusting with the client as his/her needs and problems evolve during the counseling process.” Goals. Goals are what is viewed as the outcome of the counseling relationship, and in the WA, they are to be mutually agreed upon by both counselor and client (Bordin, 1979). 21 items 65 were submitted under the heading of Goals in Round 1, and were condensed into 9 items for the instrument. There was again a redundancy in the submitted items, most commonly around the concept of mutually agreed upon goals, which yielded the instrument item “Collaborating with clients in the development of mutually agreed upon goals.” Items also reflected collaboration in the implementation of goal plans, including “Developing SMART (Specific, Measurable, Achievable, Relevant/Realistic, Timely) goals that are mutually agreed upon,” and “Mutual cooperation with the client when establishing and implementing the treatment plan or IPE.” Bonds. Of the three components of the WA, bonds had the most submitted items (n = 29), and also was the section where most misidentified items fit into. As such, it was more challenging to narrow this section down, even while adhering to the WA concept of bonds, including “liking, trusting, or a feeling of common purpose and understanding between counselor and client” (Bordin, 1994; Horvath & Greenberg, 1989). Maintaining confidentiality and a non- judgemental disposition were commonly identified as important for this section. This led to items such as “Maintaining a nonjudgmental disposition regarding client values,” “Demonstrating unconditional positive regard for clients,” and “Communicating in a confidential, responsive, and empathic manner to establish rapport in a way that promotes openness and sensitivity to potential cultural differences.” Additionally, items about cultural sensitivity and addressing multicultural considerations came out of this section, including items such as “Actively avoiding cultural biases and discriminatory practices in working with clients of minority backgrounds,” “Addressing multicultural issues when presented in the session that may affect the counseling relationship or the client’s ability to pursue a goal,” “Willingness to advocate for clients of minority backgrounds who experience institutional discrimination.” The multifaceted nature of client-counselor bonds lead to more items in this section; 17 items. 66 Phase 1: Round 2 Participants in Round 2 were asked to rate items in each section on a 4-point likert scale in Relevance and Utility (1 = Not at all useful/relevant; 4 = Extremely useful/relevant). For the purpose of the Delphi study, items were then assessed for mean utility and relevance, and standard deviation. It was predetermined that any items which fell below a mean of 3 in both relevance and utility would be eliminated from the subsequent round. Professional Dispositions. Items in the Professional Dispositions section were consistently highly rated, with relatively small variation (Table 4.1). The mean Relevance of all items in Professional Dispositions for Round 2 was 3.62 (SD = 0.415), which was just slightly higher than the mean Utility of all items in Round 2, which was 3.59 (SD = 0.509). One item, A dedication to, and embodiment of, the ethical values (autonomy, justice, veracity, beneficence, nonmaleficence, fidelity), was rated Extremely Relevant and Useful by all participants in this round (M = 4.00; SD = 0.000). Showing unconditional acceptance of all clients, peers, or coworkers regardless of their demographics (i.e., age, gender, race, ethnicity, sexual identity/orientation, culture) was rated as Extremely Useful by all participants (M = 4.00; SD = 0.000), with a mean Relevance of 3.83 (SD = 0.408). Half of the items had the same ratings for both Relevance and Utility (n = 6), while just under half of the items were rated more highly on Relevance than Utility (n = 5). No item was rated below 3 in either category. 67 Table 4.1 Round 2: Professional Dispositions (Descending by mean Relevance) Item A dedication to, and embodiment of, the ethical values (autonomy, justice, veracity, beneficence, nonmaleficence, fidelity) Showing unconditional acceptance of all clients, peers, or coworkers regardless of their demographics (i.e., age, gender, race, ethnicity, sexual identity/orientation, culture) Understanding the tendency and the problem of racial stereotyping Demonstrates professional and personal maturity such as accepting feedback, following through on commitments, commitment to professional growth The development of a counselor identity (e.g., theoretical orientation, helping disposition, professional advocacy) Sufficient professional administrative skills (i.e., punctuality, organizational skills, preparation, professional written communication/documentation, awareness of policy/procedures) Maintains a respectful countenance in all interactions: perceives and honors diversity, boundaries, and appropriate communication style Sufficient professional interpersonal skills (i.e., developing personal rapport with coworkers, appropriate tone of voice, language use, use of humor, appropriate dress, etc.) Use of problem-solving skills in a timely and professional fashion Relevance Utility Mean SD Mean SD 4.00 0.00 4.00 0.00 3.83 0.408 4.00 0.00 3.83 0.408 3.60 0.548 3.80 0.447 3.60 0.548 3.80 0.447 3.60 0.548 3.67 0.516 3.40 0.894 3.60 0.548 3.60 0.548 3.60 0.548 3.60 0.548 3.60 0.548 3.60 0.548 68 Table 4.1 (cont’d) Engaging in difficult conversations with clients, coworkers, and/or supervisors in an appropriate manner Commitment to a career in the counseling field via indications of a desire to be a lifelong learner (e.g., always seeking new information and resources, participation in professional organizations) Demonstrates professionalism and professional behavior in interactions with peers, supervisors, clients, and as a representative of their educational program Awareness of his/her role as a counselor, including self-awareness, humility, and integrity 3.50 0.548 3.60 0.548 3.50 0.837 3.40 0.894 3.40 0.894 3.40 0.894 3.40 0.894 3.40 0.894 Tasks. Task items were also highly rated, with limited variability (Table 4.2). The overall mean Relevance for items in the Task section for Round 2 was 3.68 (SD = 0.356), with the overall mean Utility for Task items of 3.62 (SD = 0.356); each higher than the overall means for all items in Professional Dispositions. The item with the highest mean Relevance was Ability to collaborate with clients to design tasks that are congruent with the mutually agreed upon goal (M = 4.00; SD = 0.00). This item was rated as Extremely Relevant by all participants, with a mean Relevance of 3.80 (SD = 0.447). Five items were rated with higher mean Relevance than Utility (n = 5), with four items showing higher mean Utility than Relevance (n = 4). No item was rated below 3 on either Relevance or Utility, and the lowest rating overall was the Utility of Being able to apply theory to justify rationale behind assigned tasks (M = 3.20; SD = 0.837). 69 Table 4.2 Round 2: Tasks (Descending by mean Relevance) Item Ability to collaborate with clients to design tasks that are congruent with the mutually agreed upon goal Developing options to address clients’ needs and problem with identified Ability to identify tasks that will lead to goal attainment Adjusting with the client as his/her needs and problems evolve during the counseling process Ability to do needs assessments with client in order to identify needs that a client may have but may not be aware of Ability to communicate the link between the chosen task and the agreed upon goal Knowing how to consult or refer to resources available in ethnocultural communities Being able to show support when holding clients accountable for task completion, or non-completion Application of Evidence-Based Practices (EBP) Ability to design tasks to meet the unique developmental and individual needs of the client Being capable of helping clients make non- successes into successful learning experiences Being able to apply theory to justify rationale behind assigned tasks Relevance Utility Mean SD Mean SD 4.00 0.00 3.80 0.447 3.80 0.447 3.80 0.447 3.80 0.447 3.80 0.447 3.80 0.447 3.60 0.548 3.67 0.516 3.60 0.548 3.67 0.516 3.80 0.447 3.60 0.548 3.80 0.447 3.60 0.548 3.60 0.548 3.60 0.548 3.40 0.548 3.50 0.548 3.60 0.548 3.40 0.894 3.40 0.894 3.40 0.894 3.20 0.837 70 Goals. The mean Relevance rating of all items in the Goals section for Round 2 was 3.71 (SD = 0.329), and the mean Utility rating of all items in the Goals section for Round 2 was 3.68 (SD = 0.372). The highest rated Goal item was Incorporating client voice into the goal setting process, which was rated as Extremely Relevant and Useful by all participants in this round (M = 4.00; SD = 0.00). There were equal amount of items rated more highly on Relevance and Utility (n = 3), with the item Allowing clients to take the lead in identification of potential goals being rated Extremely Useful by all participants (M = 4.00; SD = 0.00), but representing some variation in Relevance (M = 3.80; SD = 0.447). The lowest rating was the Utility of the item Developing SMART (Specific, Measurable, Achievable, Relevant/Results-Based, Time-sensitive) goals that are mutually agreed upon (M = 3.20; SD = 0.837). Table 4.3 Round 2: Goals (Descending by mean Relevance) Item Incorporating the client voice into the goal setting process Demonstrating empathy in understanding the various influences which have impacted the client's goals and experiences (i.e., cultural background, socioeconomic status, etc.) Mutual cooperation with the client when establishing and implementing the treatment plan Allowing clients to take the lead in the identification of potential goals Relevance Utility Mean SD Mean SD 4.00 0.00 4.00 0.00 3.83 0.408 3.80 0.447 3.80 0.447 3.80 0.447 3.80 0.447 4.00 0.00 Collaborating with clients in the development of mutually agreed upon goals 3.80 0.447 3.80 0.447 71 Table 4.3 (cont’d) Applying theory to a situation in order to provide guidance in the goal setting process Developing goals that follow a strengths based approach, and identifies potential in clients (as opposed to focusing solely on dysfunction) Being able to facilitate goal development in areas that may be in conflict with the counselor’s personal values Developing SMART (Specific, Measurable, Achievable, Relevant/Results-Based, Time- sensitive) goals that are mutually agreed upon 3.60 0.894 3.40 0.894 3.50 0.837 3.60 0.894 3.40 0.548 3.60 0.548 3.40 0.894 3.20 0.837 Bonds. Mean overall scores of Relevance and Utility in the Bonds section were higher when compared with the other sections of the instrument (M = 3.79, SD = 0.245; M = 3.74, SD = 0.305, respectively). There were seven items that were rated as Extremely Relevant by all participants in Round 2 (n = 7), and three of those were also rated as Extremely Useful by all participants (M = 4.00; SD = 0.00). The lowest rating was the Utility of the item Willingness to advocate for clients of minority backgrounds who experience institutional discrimination (M = 3.20; SD = 0.447). Twelve items were rated the same on both Utility and Relevance, while five were rated more highly on Relevance than Utility. 72 Table 4.4 Round 2: Bonds (Descending by mean Relevance) Item Adherence to ethical practice for respecting client’s informed consent and other client rights in order to develop trust, boundaries, and transparency in the counseling relationship Communicating in a confidential, responsive, and empathic manner to establish rapport in a way that promotes openness and sensitivity to potential cultural differences Demonstrating unconditional positive regard for clients Using active and reflective listening to ensure effective collaboration, problem-solving, and decision-making Demonstrating ethical behavior in the development of bonds with clients (i.e., appropriate boundaries, etc.) Addressing multicultural issues when presented in the session that may affect the counseling relationship or the client's ability to pursue a goal Actively avoiding cultural biases and discriminatory practices in working with clients of minority backgrounds Maintaining a nonjudgmental disposition regarding client values Establishing trust with the client as evidence by the communication that occurs between the counselor and client Capacity to appropriately communicate acceptance to the client Relevance Utility Mean SD Mean SD 4.00 0.00 4.00 0.00 4.00 0.00 3.80 0.447 4.00 0.00 4.00 0.00 4.00 0.00 4.00 0.00 4.00 0.00 3.80 0.477 4.00 0.00 3.80 0.477 4.00 0.00 3.80 0.477 3.80 0.477 3.80 0.477 3.80 0.477 3.80 0.477 3.80 0.477 3.80 0.477 73 Table 4.4 (cont’d) Ensuring client autonomy 3.80 0.477 3.80 0.477 To demonstrate openness and flexibility when addressing the clients issues and problems 3.60 0.548 3.60 0.548 Being capable of adjusting interactions with clients to meet his/her individual needs and communication style Identification of client’s needs and problems in congruence with his/her priorities Managing the power differential between counselor and client Sustaining the effort to help a client whether or not he/she makes progress Willingness to advocate for clients of minority backgrounds who experience institutional discrimination 3.60 0.548 3.60 0.548 3.60 0.548 3.60 0.548 3.60 0.548 3.80 0.477 3.40 0.548 3.40 0.894 3.40 0.894 3.20 0.447 Phase 1: Round 3 Participants in Round 3 were again asked to rate items in each section on a 4-point likert scale in Relevance and Utility (1 = Not at all useful/relevant; 4 = Extremely useful/relevant), after having the opportunity to review their previous scores, as well as the group means and standard deviations. Responses were then assessed for mean utility and relevance, and standard deviations. It was predetermined that any items which fell below a mean of 3 in both relevance and utility would be eliminated from the subsequent round. Professional Dispositions. The overall mean scores of Relevance and Utility for Professional Dispositions in Round 3 were 3.63 (SD = 0.383), and 3.52 (SD = 0.482), respectively. Relevance and Utility ratings did not change much from Round 2 to Round 3, but the Utility ratings that changed, most often decreased by a tenth or twentieth of a point. On the 74 other hand, most of the Relevance ratings that changed from round to round increased by a tenth or twentieth of a point (Table 4.5). The lowest rated item in both Relevance and Utility was Awareness of his/her role as a counselor, including self-awareness, humility, and integrity (Relevance: M = 3.40, SD = 0.894; Utility: M = 3.40, SD = 0.894). Overall, the changes from Round 2 to Round 3 were not substantial, and no items fell below the threshold of 3 in both Relevance and Utility in this round. Table 4.5 Round 3: Professional Dispositions (Descending by mean Relevance) Item A dedication to, and embodiment of, the ethical values (autonomy, justice, veracity, beneficence, nonmaleficence, fidelity) Showing unconditional acceptance of all clients, peers, or coworkers regardless of their demographics (i.e., age, gender, race, ethnicity, sexual identity/orientation, culture) Relevance Utility Round 2 Round 3 Round 2 Round 3 Mean (SD) Mean SD Mean (SD) Mean (SD) 4.00 4.00 4.00 3.60 (0.000) (0.000) (0.000) (0.894) 3.83 4.00 4.00 3.80 (0.408) (0.000) (0.000) (0.447) Understanding the tendency and the problem of racial stereotyping 3.83 3.80 3.60 3.60 (0.408) (0.447) (0.548) (0.548) The development of a counselor identity (e.g., theoretical orientation, helping disposition, professional advocacy) Demonstrates professional and personal maturity such as accepting feedback, following through on commitments, commitment to professional growth Sufficient professional interpersonal skills (i.e., developing personal rapport with coworkers, appropriate tone of voice, language use, use of humor, appropriate dress, etc.) 3.80 3.80 3.60 3.60 (0.447) (0.447) (0.548) (0.548) 3.80 3.80 3.60 3.50 (0.447) (0.447) (0.548) (0.577) 3.60 3.60 3.60 3.60 (0.548) (0.548) (0.548) (0.548) 75 Table 4.5 (cont’d) Maintains a respectful countenance in all interactions: perceives and honors diversity, boundaries, and appropriate communication style Engaging in difficult conversations with clients, coworkers, and/or supervisors in an appropriate manner Commitment to a career in the counseling field via indications of a desire to be a lifelong learner (e.g., always seeking new information and resources, participation in professional organizations) Demonstrates professionalism and professional behavior in interactions with peers, supervisors, clients, and as a representative of their educational program Sufficient professional administrative skills (i.e., punctuality, organizational skills, preparation, professional written communication/documentation, awareness of policy/procedures) 3.60 3.60 3.60 3.60 (0.548) (0.548) (0.548) (0.548) 3.50 3.60 3.60 3.40 (0.548) (0.894) (0.548) (0.548) 3.50 3.60 3.40 3.20 (0.837) (0.548) (0.894) (0.837) 3.40 3.60 3.40 3.60 (0.894) (0.548) (0.894) (0.548) 3.67 3.40 3.40 3.40 (0.516) (0.548) (0.894) (0.548) Use of problem-solving skills in a timely and professional fashion 3.60 3.40 3.60 3.40 (0.548) (0.548) (0.548) (0.548) Awareness of his/her role as a counselor, including self-awareness, humility, and integrity 3.40 3.40 3.40 3.40 (0.894) (0.894) (0.894) (0.894) Tasks. The overall means for Relevance and Utility of items in the Tasks section for Round 3 were 3.57 (SD = 0.345) and 3.47 (SD = 0.321), respectively. These scores are slightly lower than the overall means in Round 2 (M = 3.68, SD = 0.356; M = 3.62, SD = 0.356). There were several items that decreased on both Relevance and Utility (Table 4.6). The lowest rated item in this round was the Utility rating of Being able to apply theory to justify rationale behind assigned tasks (M = 3.00, SD = 1.000). 76 Table 4.6 Round 3: Tasks (Descending by mean Relevance) Item Relevance Utility Round 2 Round 3 Round 2 Round 3 Mean (SD) Mean (SD) Mean (SD) Mean (SD) Ability to collaborate with clients to design tasks that are congruent with the mutually agreed upon goal 4.00 4.00 3.80 3.80 (0.000) (0.000) (0.447) (0.447) Ability to identify tasks that will lead to goal attainment 3.80 3.80 3.80 3.80 (0.447) (0.447) (0.447) (0.447) Developing options to address clients’ needs and problem with identified 3.80 3.80 3.80 3.80 (0.447) (0.447) (0.447) (0.447) Adjusting with the client as his/her needs and problems evolve during the counseling process 3.80 3.80 3.60 3.40 (0.447) (0.447) (0.548) (0.548) Ability to communicate the link between the chosen task and the agreed upon goal 3.67 3.60 3.80 3.60 (0.516) (0.548) (0.447) (0.548) Being able to show support when holding clients accountable for task completion, or non-completion 3.60 3.60 3.60 3.60 (0.548) (0.548) (0.548) (0.548) Application of Evidence-Based Practices (EBP) 3.60 3.60 3.40 3.40 (0.548) (0.548) (0.548) (0.548) Knowing how to consult or refer to resources available in ethnocultural communities 3.60 3.40 3.80 3.40 (0.548) (0.548) (0.447) (0.548) Ability to design tasks to meet the unique developmental and individual needs of the client 3.50 3.40 3.60 3.40 (0.548) (0.548) (0.548) (0.548) Being able to apply theory to justify rationale behind assigned tasks 3.40 3.40 3.20 3.00 (0.894) (0.548) (0.837) (1.000) Ability to do needs assessments with client in order to identify needs that a client may have but may not be aware of 3.67 3.20 3.60 3.20 (0.516) (0.447) (0.548) (0.447) Being capable of helping clients make non- successes into successful learning experiences 3.40 3.20 3.40 3.20 (0.894) (0.837) (0.894) (0.837) 77 Goals. The overall mean Relevance and Utility ratings for Goals in Round 3 were 3.73 (SD = 0.181) and 3.64 (SD = 0.130), respectively. This represents an increase in Relevance (up from 3.64), but a very slight decrease in Utility from Round 2 (by 1/100th) (Table 4.7). No items fell below the threshold of 3 in both Relevance and Utility. Table 4.7 Round 3: Goals (Descending by mean Relevance) Item Relevance Utility Round 2 Round 3 Round 2 Round 3 Mean (SD) Mean (SD) Mean (SD) Mean (SD) Incorporating the client voice into the goal setting process 4.00 4.00 4.00 4.00 (0.000) (0.000) (0.000) (0.000) Demonstrating empathy in understanding the various influences which have impacted the client's goals and experiences (i.e., cultural background, socioeconomic status, etc.) 3.83 4.00 3.80 4.00 (0.408) (0.000) (0.447) (0.000) Collaborating with clients in the development of mutually agreed upon goals 3.80 4.00 3.80 3.80 (0.447) (0.000) (0.447) (0.447) Allowing clients to take the lead in the identification of potential goals 3.80 3.80 4.00 3.80 (0.447) (0.447) (0.000) (0.447) Mutual cooperation with the client when establishing and implementing the treatment plan Developing goals that follow a strengths based approach, and identifies potential in clients (as opposed to focusing solely on dysfunction) Being able to facilitate goal development in areas that may be in conflict with the counselor’s personal values 3.80 3.80 3.80 3.80 (0.447) (0.447) (0.447) (0.447) 3.50 3.80 3.60 3.60 (0.837) (0.447) (0.894) (0.548) 3.40 3.60 3.60 3.60 (0.548) (0.548) (0.548) (0.548) Applying theory to a situation in order to provide guidance in the goal setting process 3.60 3.40 3.40 3.20 (0.894) (0.894) (0.894) (0.837) 78 Bonds. The overall mean scores for the Bonds section in Round 3 were 3.79 (SD = 0.206) (Relevance) and 3.74 (SD = 0.153) (Utility). This did not change from Round 2 to Round 3. There was an increase in the unanimous ratings of Extremely Relevant and Useful; in Round 3, eight items were rated both Extremely Relevant and Useful by all participants (M = 4.00, SD = 0.000). Several item ratings changed from Round 2 to Round 3 (Table 4.8). There was a decrease in both Relevance and Utility on the item Identification of client’s needs and problems in congruence with his/her priorities, making it the lowest rated item during this round (Relevance: M = 3.40, SD = 0.548; Utility: M = 3.40, SD = 0.548). No items fell below the threshold of 3 on both Relevance and Utility. Table 4.8 Round 3: Bonds (Descending by mean Relevance) Item Relevance Utility Round 2 Round 3 Round 2 Round 3 Mean (SD) Mean (SD) Mean (SD) Mean (SD) Using active and reflective listening to ensure effective collaboration, problem-solving, and decision-making 4.00 4.00 4.00 4.00 (0.000) (0.000) (0.000) (0.000) Demonstrating unconditional positive regard for clients 4.00 4.00 4.00 4.00 (0.000) (0.000) (0.000) (0.000) Adherence to ethical practice for respecting client’s informed consent and other client rights in order to develop trust, boundaries, and transparency in the counseling relationship Actively avoiding cultural biases and discriminatory practices in working with clients of minority backgrounds 4.00 4.00 4.00 4.00 (0.000) (0.000) (0.000) (0.000) 4.00 4.00 3.80 4.00 (0.000) (0.000) (0.477) (0.000) 79 Table 4.8 (cont’d) Addressing multicultural issues when presented in the session that may affect the counseling relationship or the client's ability to pursue a goal Demonstrating ethical behavior in the development of bonds with clients (i.e., appropriate boundaries, etc.) Ensuring client autonomy 4.00 4.00 3.80 4.00 (0.000) (0.477) (0.000) 4.00 4.00 3.80 4.00 (0.000) (0.000) (0.477) (0.000) 3.80 4.00 3.80 4.00 (0.477) (0.000) (0.477) (0.000) Maintaining a nonjudgmental disposition regarding client values 3.80 4.00 3.80 4.00 (0.477) (0.000) (0.477) (0.000) Establishing trust with the client as evidence by the communication that occurs between the counselor and client Communicating in a confidential, responsive, and empathic manner to establish rapport in a way that promotes openness and sensitivity to potential cultural differences 3.80 3.80 3.80 3.80 (0.477) (0.447) (0.477) (0.447) 4.00 3.60 3.80 3.60 (0.000) (0.548) (0.477) (0.548) Capacity to appropriately communicate acceptance to the client 3.80 3.60 3.80 3.60 (0.477) (0.548) (0.477) (0.548) Managing the power differential between counselor and client 3.60 3.60 3.80 3.60 (0.548) (0.548) (0.477) (0.548) Being capable of adjusting interactions with clients to meet his/her individual needs and communication style 3.60 3.60 3.60 3.40 (0.548) (0.548) (0.548) (0.548) To demonstrate openness and flexibility when addressing the clients issues and problems 3.60 3.60 3.60 3.60 (0.548) (0.548) (0.548) (0.548) Willingness to advocate for clients of minority backgrounds who experience institutional discrimination 3.40 3.60 3.20 3.40 (0.894) (0.548) (0.447) (0.548) Sustaining the effort to help a client whether or not he/she makes progress 3.40 3.60 3.40 3.20 (0.548) (0.548) (0.894) (0.447) Identification of client’s needs and problems in congruence with his/her priorities 3.60 3.40 3.60 3.40 (0.548) (0.548) (0.548) (0.548) 80 Results from Phase 2 intend to provide insight into the questions: (1) How much do those Phase 2 items relate to the concepts of WA (i.e., goals, tasks and bonds)? (2) How useful are those items for counselor educators? Relevance. Participants rated items on their relevance using a 4-point Likert scale (1 = Not at all relevant; 4 = Extremely relevant). Each subscale was scored and then assessed for internal consistency using Cronbach’s alpha. Professional dispositions. The maximum possible score for this section was 52 (13 items, maximum score of 4 per item). The mean score was 47.84 (SD = 4.48), the median was 49.00, the mode was 52.00, and the range 25.00 (N = 148). 26.4% of participants rated all items Extremely Relevant (n = 39). The scores for Professional Disposition Relevance are represented in Figure 4.1. Cronbach’s alpha (ɑ = 0.877) for Professional Disposition Relevance represents strong internal consistency among items in this subscale; removal of any item from this section would decrease the alpha level. Figure 4. 1: Professional Disposition Relevance Score Frequency Histogram 81 Between Groups. The Bonds Utility sub-scale scores were not statistically different when explored comparing educators to non-educators, t(146) =- 0.634, p = 0.527. Tasks. The maximum possible score for the Task section was 40 (10 items, maximum score of 4 per item). The mean score was 36.35 (SD = 3.35), the median was 37.00, the mode was 40.00, and the range was 13.00 (N = 147). 20.4% of participants rated all items Extremely Figure 4. 2: Task Relevance Score Frequency Histogram Relevant (n = 30). The scores for Task Relevance are represented in Figure 4.2. Cronbach’s alpha for the Task Relevance subscale was 0.809, which provides evidence of a strong internal consistency. The removal of any item would not increase the alpha coefficient. Between Groups. The Task Relevance sub-scale scores were not statistically different when explored comparing educators to non-educators, t(145) = 0.646, p = 0.519. 82 Figure 4. 3: Goal Relevance Score Frequency Histogram Goals. The maximum possible score in the Goals section was 32 (8 items, maximum score of 4 per item). The mean score was 29.21 (SD = 2.49), the median was 30, the mode was 31.00, and the range was 12.00 (N = 147). The most common score in this section was 31, with 21.1% of participants (n = 31). Scores for Goal Relevance are represented in Figure 4.3. Cronbach’s alpha for the Goal Relevance subscale represented satisfactory internal consistency (ɑ = 0.718). Removal of the item Applying theory to a situation in order to provide guidance in the goal setting process would lead to an increase in Cronbach’s alpha to 0.754. Between Groups. The Goals Relevance sub-scale scores were not statistically different when explored comparing educators to non-educators, t(145) = -0.925, p = 0.357. Bonds. The maximum possible score in the Bonds section was 68 (17 items, maximum score of 4 per item). The mean score was 63.46 (SD = 5.51), the median was 65.00, the mode was 68.00, and the range was 34 (N = 147). 29.3% of participants scored all items Extremely 83 Relevant (n = 43). Scores are represented in Figure 4.4. Cronbach’s alpha for Bond Relevance was very strong, at 0.908. The removal of any items would decrease the alpha level. Between Groups. The Bonds Relevance sub-scale scores were not statistically different when explored comparing educators to non-educators, t(145) = 0.121, p = 0.904. Figure 4. 4: Bond Relevance Score Frequency Histogram Utility. Participants rated items on their utility using a 4-point Likert scale (1 = Not at all useful; 4 = Extremely useful). Each subscale was scored and then assessed for internal consistency using Cronbach’s alpha. Professional Dispositions. The maximum possible score for Professional Disposition Utility was 52. Mean score was 47.42 (SD = 4.37), the median was 48.00, the mode was 52.00, and the range was 21.00 (N = 148). Cronbach’s alpha of the Professional Disposition Utility subscale indicates a strong internal consistency (ɑ = 0.850). The removal of any item would only decrease the alpha level. 84 Figure 4. 5: Professional Disposition Utility Score Frequency Histogram Between Groups. The Professional Dispositions Utility sub-scale scores were not statistically different when explored comparing educators to non-educators, t(146) = 0.236, p = 0.814. Figure 4. 6: Task Utility Score Frequency Histogram 85 Tasks. The maximum possible score in this section was 40. The mean score was 36.11 (SD = 3.72), the median score was 37.00, the mode was 40.00, and the range was 16 (N = 147). Scores are represented in Figure 4.6. 21.8% of the respondents indicated that all items were Extremely Useful (n = 32). Cronbach’s alpha revealed a strong internal consistency in the Task Utility section, ɑ = 0.836. This analysis also revealed that the alpha level may increase to 0.841 if the item Being able to apply theory to justify rationale behind assigned tasks is removed from the scale. Between Groups. The Task Utility sub-scale scores were not statistically different when explored comparing educators to non-educators, t(145) = 1.411, p = 0.161. Figure 4. 7: Goal Utility Score Frequency Histogram Goals. The maximum possible score in this section was 32. The mean score was 28.74 (SD = 2.89), with a median of 29, a mode of 32.00, and a range of 12 (Figure 4.7). Cronbach’s alpha of the Goal Utility subscale was 0.769. Removal of the item Applying theory to a situation in order to provide guidance in the goal setting process would increase the alpha level to 0.803. 86 Between Groups. The Goals Utility sub-scale scores were not statistically different when explored comparing educators to non-educators, t(145) = 0.529, p = 0.598. Bonds. The maximum possible score in this section was 68. The mean score was 62.93 (SD = 5.87), the median score was 65.00, the mode was 68, and the range was 34.00. Cronbach’s alpha of the Bond Utility subscale was 0.912. The removal of any item would not increase the alpha level. Between Groups. The Bonds Utility sub-scale scores were not statistically different when explored comparing educators to non-educators, t(145) = 0.749, p = 0.429. Figure 4. 8: Bond Utility Score Frequency Histogram 87 Qualitative Comments Participants were provided the opportunity to comment on instrument items at the end of each section and were asked to specifically indicate which item number they were referencing. The comment section was intended to capture concerns about particular items, comments on wording of items, and/or explanations for particular ratings. While the results were collected by section, they will be discussed here as aggregate data. There were 36 usable comments submitted from the 148 total participants. This is after the removal of 10 comments that were not usable, including comments of “none,” “NA,” or those that only submitted an item number with no other information. Many comments (n = 17) included general statements about the importance of the items or of the participant’s experience with that particular concept. Examples of these include: ● Rapport is a critical piece of counseling. All of these items are absolutely necessary; trust and lack of judgment cannot be underestimated in the counseling relationship. ● #2 [Showing unconditional acceptance of all clients, peers, or coworkers regardless of their demographics (i.e., age, gender, race, ethnicity, sexual identity/orientation, culture)] is very important that all counseling professionals should show unconditional acceptance to all people regardless of age, gender, race, ethnicity, and sexual orientation. ● Every quality listed above is extremely important. Without them, counselors, regardless of field, can cause potentially significant harm to a client, client's significant others, the agency's credibility, the credibility/relationship of the referral source, and the social image of counseling. 88 ● Collaboration in developing client goals is essential. Clients are more willing to participate in activities that lead to goal attainment when it is something they have agreed upon. An additional theme of the qualitative results include comments about the items which pertain to theory in practice (n = 6). These comments coincide with ratings of these items previously discussed in this chapter. Examples of these comments include: ● Theoretical orientation/counselor identity is fluid for most counselors and students I encounter - this is an ongoing development and self-discovery process. While theories and their application can be useful (high utility), I do not believe this to be crucial to a successful career in a rehabilitation field. ● #6 [Applying theory to a situation in order to provide guidance in the goal setting process], applying a theory, falls in line with the first comment; while theory can be useful in framing, use of a specific theory or theories is not necessarily requisite in service provision. ● Goal obtainment [sic] is extremely important, as all the theory in the world is worth nothing if you can obtain your goals. One comment was applicable to a specific item, in the Goals section: 8. And being able to refer out if this is not practical or violates personal values. The remaining comments could not be themed due to participants providing information that is excessive, unrelated to the research questions, or does not provide a means to change an item. Summary In general, scores across all items were rated very highly on both Relevance and Utility, throughout Phases 1 and 2. Most often, changes in average ratings of Relevance increased from 89 Round 2 to Round 3 (in Professional Dispositions and Goals), while average ratings of Utility decreased in the same categories from Round 2 to 3. In the Tasks category the ratings decreased in both Relevance and Utility from Round 2 to 3 and remained consistent in the Bonds category. Increases or decreases did not exceed a tenth or twentieth of a point, however, therefore overall, the items remained consistent and never were rated below the threshold of 3 on either Relevance or Utility. Similarly, in Phase 2, items were rated highly, and the subscale scores represented high ratings even throughout the larger sample. Furthermore, the modes, or most frequently occurring score in Professional Dispositions, Tasks, and Bonds were the maximum possible scores for that particular subsection (i.e., participants rated all items Extremely Relevant and Extremely Useful). Consistently, across both Phase 1 and 2, items regarding theory in practice were rated the lowest, and were indicated as increasing the Cronbach’s alpha if removed. These ratings will be discussed further in Chapter 5. 90 CHAPTER FIVE Discussion Phase 1 of the current study established the items necessary to begin an inquiry into what is appropriate for the evaluation of professional dispositions in pre-service counselor education students. The initial iteration of items were then tested in Phase 2 by a large sample of CRCs, both in education and practice. In general, items were rated very highly in Relevance and Utility, and those ratings remained consistent over time. The current study intended to answer three research questions: 1. What items would be appropriate for faculty to use in the evaluation of professional dispositions in master’s level counseling students? 2. How much do those items relate to the concepts of WA (i.e., goals, tasks and bonds)? 3. How useful are those items for counselor educators? The following chapter includes a discussion of the findings of the current study, including an overview of all findings, comparison with similar instruments, future directions for AGI, and implications for research, education, and clinical practice. Summary of Findings Phase 1. Results of Phase 1 of this study provided 48 items for the instrument (by section: Professional Dispositions: 13; Tasks: 10, Goals: 8, and Bonds: 17) named the Assessment as Growth Inventory (AGI), which provided the answer to Research Question 1. These items were developed using a Delphi methodology, and an expert panel. In addition to developing the items for the instrument, an iterative process allowed for there to be feedback on the item beyond the numeric ratings. At the end of both Rounds 2 and 3 of the Delphi, all items 91 remained highly rated, with minimal changes from round to round. There was a slight increase in relevance but a decrease in utility ratings from Round 2 to Round 3, which may be due to considerations of how the items would be used in practice. Many items could be considered relevant (hypothetically), but to really consider how they would be useful to a counselor educator may be more complicated or hard to assess, such as Applying theory to a situation in order to provide guidance in the goal setting process, or Identification of client’s needs and problems in congruence with their priorities. At any given point of the study, no item was rated below the cutoff threshold of 3 (on a 4-point Likert Scale) on both Relevance and Utility in assessment of pre-service counseling students. Given the consistently high ratings, three rounds were considered sufficient to move onto Phase 2, in order to collect further information about the instrument items and to be able to assess psychometric properties. The highest rated items in each section included items about ethical behavior, client- centered, non-judgmental practice, and/or empathetic qualities. Lower rated items were more variable, but also included specific qualities such as: goal-setting skills, maintenance of support through client failure, and role and professional identity as a counselor. While there were ‘highest’ and ‘lowest’ rated items, on average, all were rated nearest to Extremely Relevant and/or Useful. Phase 2. Phase 2 provided input from CRCs both in education and practice and revealed a similar agreement regarding Relevance and Utility of the items developed in Phase 1. The cutoff point was determined to be a rating of 3 on both Relevance and Utility. As with Phase 1, Phase 2 did not reveal any item to have a mean rating of below 3 on Relevance and Utility, as well as Relevance or Utility, therefore all 48 items developed through Phase 1 are to be retained for future use of the AGI. 92 While Phase 1 included several instrument items being rated Extremely Relevant and/or Useful by all participants, there was more variability in Phase 2. Ratings of Relevance were consistently higher than ratings of Utility per item in Phase 2, however these differences were approximately a tenth to a hundredth of a point, making the differences quite minimal. Items were rated on their relevance to the particular category in which they were distributed, lending validity to the organization of the instrument. In terms of how useful each item would be in the evaluation of students in master’s-level counseling programs, all items were rated highly useful, although ratings of utility were typically not higher than the ratings of relevance per item. Phase 2 included sub-scores of each section, in addition to examining each item individually, as was done in Phase 1. Upon an inquiry into the internal consistency of each subscale (Professional Dispositions, Tasks, Goals, Bonds) in regard to Relevance and Utility, Cronbach’s alpha provided evidence that each subscale demonstrated strong reliability, with each sections’ α ranging from 0.718 to 0.912 (Bland & Altman, 1997). The current format of gatekeeping in counselor education programs, especially in the realm of non-academic competencies, tends to be reactive and conducted in an ad-hoc format (Bhat, 2005; Brear & Dorrian, 2010). Additionally, gatekeeping and student evaluation has been historically unfavorable amongst faculty, and poorly explained to students throughout their time in a program (J. Foster et al., 2014; V. Foster & McAdams, 2009). In light of such a situation, the theoretical and philosophical design underlying the AGI is such that the process of evaluating students’ professional dispositions is systematic, transparent, and designed to ensure a collaboration between student, faculty, and supervisors. Furthermore, by aligning the evaluation with the WA, the AGI provides the opportunity for parallel process, and a better understanding of a significant evidence-based practice. 93 Discussion of the Findings Items within each section of the instrument covered a variety of areas within counselor education in which educators are expected to evaluate students but are “non-academic” in nature. Items also echo the CRCC Code of Ethics (2017) and the values and principles espoused including “ensuring the integrity of all professional relationships,” and “enhancing the quality of professional knowledge and its application to increase professional and personal effectiveness” (p. 2). Many of the items representing specific sentiments of the CRCC and ACA Codes of Ethics, such as maintenance of ethical practice, or appropriate boundaries with clients, were consistently some of the highest rated items in the study. Additionally, items referring to client- centeredness, non-judgmental practice and multicultural competence were consistently highly rated, which would also align with both Codes of Ethics, as well as the values espoused by CRCC (e.g., A dedication to, and embodiment of, the ethical values (autonomy, justice, veracity, beneficence, nonmaleficence, fidelity), Adjusting with the client as his/her needs and problems evolve during the counseling process, Collaborating with clients in the development of mutually agreed upon goals, and Demonstrating ethical behavior in the development of bonds with clients (i.e., appropriate boundaries, etc.)). Item alignment with the Code of Ethics remained consistent from Phase 1, suggesting that these items are not only valuable to educators/experts, but also to counselors working in clinical practice settings. It is possible to consider, however, that these items were rated in this way as a result of response and/or sample bias. While the survey was anonymous, it is still possible that participants believe that pre-service counseling students should be being assessed on certain dispositions, rather than considering the practical use of such items. In the current study, the majority of participants indicated that they do not currently engage in the supervision of preservice counseling students. Additionally, it seems that the 94 supervision of pre-service counseling students is perceived as happening less frequently when compared with other job functions of rehabilitation counselors (Leahy, Chan, Sung, & Kim, 2013). As such, the sample of respondents may simply have responded highly to the items that they consider idealistic, rather than a consideration of what items would be useful for such an instrument as the AGI. On the other hand, the lowest rated items through both Phase 1 and Phase 2 were consistently items pertaining to the use of theory in practice (e.g., Applying theory to a situation in order to provide guidance in the goal setting process, and Being able to apply theory to justify rationale behind assigned tasks). Furthermore, upon review of the Cronbach’s alpha test of internal consistency reliability, the removal of the item Applying theory to a situation in order to provide guidance in the goal setting process would increase the alpha level in both Relevance and Utility in the Goals section, and removal of the item Being able to apply theory to justify rationale behind assigned tasks would increase the alpha in Utility in the Tasks section. Again, when compared to the Leahy et al. (2013) study reporting the current perceived job functions and knowledge domains of rehabilitation counselors, the application of theory to rehabilitation falls below the average in perceived importance and perceived frequency of use. In light of this comparison, it is possible that, in general, CRCs feel removed from their educational preparation, and theory is not something they consult regularly in their day-to-day practice. These items may have been rated lower because participants feel less familiar with, or dedicated to, practical application of theory—they also may not feel that they would be able to assess a student on such competencies. As the current study is the initial instrument development process, these items will not be removed. These items will continually be tested in future studies of the instrument, including through factor analysis, to determine their appropriateness, or the necessity of their 95 removal. Future inquiries may also be necessary to explore perceptions of theory in practice in rehabilitation counseling. Items that, while rated as important, but fell to the middle of their category included components that participants may feel are difficult to assess, including maturity, engaging in difficult conversations, communication skills, use of evidence-based practices, facilitating goal development, and managing power differentials. It is not surprising that there would be participants who would rate items such as these slightly lower than average; the literature has demonstrated a general uneasiness in assessing such competencies, and even the uncertainty of being able to assess such competencies in the context of an academic program (Kerl, et al., 2002; Gaubatz & Vera, 2002; McAdams, Foster, V., & Ward, 2007). An additional consideration to be made regarding the items is that they may not all be applicable, all the time. For instance, items pertaining to working directly with a client, or knowledge of particular concepts, may not be applicable within the first semester of a student’s educational program. It is possible that faculty may choose to use particular items at an earlier stage, and other items at a later stage; this may be explored in future research. It should also be noted that the intention of the AGI was not to be used during the application process or admissions procedure. It would be unreasonable to expect faculty to be able to evaluate many of the components of the instrument during that process, and would be unfair to potential students. The AGI and other instruments. Tate, Bloom, Tassara, and Caperton (2014) conducted a review of 41 instruments that have been published for the use of measuring constructs related to counselor competence and/or counseling skills. Most of the instruments reviewed focused specifically on one competence domain (e.g., multicultural counseling), which underscores the issues highlighted by Ridley et al., 2011: there is a focus on specific microskills which can 96 hinder counselor development. Additionally, in the instruments reviewed by Tate et al. (2014), there was a significant emphasis on instruments using self-report, and those assessing self- efficacy. Tate and colleagues (2014) note that there were fewer instruments based on expert-based evaluations, and that “Use of a psychometric measure of counselor competence would specifically benefit the quality of student evaluations by clinical supervisors who are supervising students’ practica and internships” (Tate et al., 2014, p. 302). The AGI, in its underlying theoretical framework, development, and intended use, is not necessarily intended to identify counseling competencies. In aligning with the CACREP definition of professional dispositions, AGI seeks to provide a mechanism for educators and supervisors to evaluate students beyond their counseling skills, in order to more comprehensively develop well-rounded future professionals as well as effective counselors. This bridges the shortcomings identified by Tate et al. (2014), and those left by instruments such as those described by Kerl et al. (2002), Moorehouse (2008), as well as the Counseling Competencies Scale developed by the University of Central Florida’s Counselor Education Faculty (unpublished instrument). The combination of counselors in practice and counselor educators is significant way that the AGI differentiates itself from previously published instruments. Feedback from CRCs in practice and their enthusiasm for such an instrument indicates that a need may be met via the publication and utilization of the AGI. The consistently high ratings of Relevance and Utility on all proposed items for the AGI in both Phases 1 and 2 potentially indicates the need for such a type of evaluation in counselor education, or more specifically, rehabilitation counselor education. This is certainly underscored by the qualitative comments provided at the end of each section, including “Every quality above is extremely important,” and “All of these items are 97 absolutely necessary; trust and lack of judgment cannot be underestimated in the counseling relationship.” Providing the opportunity to evaluate students on a continuum from Inadequate Professional Disposition Development (IPDD) to Exceptional Professional Disposition Development (EPDD) also includes a language and a framework for faculty, students, and supervisors to work within in order to best understand one another. While the current study had access to rehabilitation counselors and rehabilitation counselor educators, the concepts, items, and direction of the AGI meet needs expressed within counselor education. Aligning with the CACREP Standards, and not using language specific to any one counseling specialty were intentional elements built into the current study in order to encourage applicability across counseling specialties. The working alliance, or therapeutic alliance, has been discussed favorably and related to client change in many counseling specialties such as career counseling (Whiston, Rossier, & Hernandez Barón, 2015), substance abuse (Meier, Donmall, McElduff, Barrowclough, & Heller, 2006), school-based counseling (Zirkelback & Reese, 2010), and in mental health counseling (Baldwin, Wampold, & Imel, 2007; Wampold, 2001). As such, the AGI would be useful for all counselor educators attempting to aid preservice counselors in developing the WA with future clients. Professional dispositions and the working alliance. Currently, the instrument is broken into four distinct sections: Professional Dispositions, Tasks, Goals, and Bonds. For the purpose of being a cohesive, unified measure, it may be pragmatic to consider a better integration of the concepts of the WA into professional dispositions. Looking at the CACREP definition of professional dispositions which is inclusive of both interpersonal functioning and behavior, items within the Tasks, Goals, and Bonds sections should also be considered professional dispositions. This inclusion of both behavior and interpersonal functioning allows for many items in the 98 additional sections to be considered professional dispositions, as well as functions of the WA. Through ongoing studies of professional dispositions, it may become more clear as to how these items either are or are not professional dispositions. The current study considers all items to have the potential to be representative of the CACREP professional dispositions definition, and are organized for clarity with regard to the WA. Using the WA framework in the development of the AGI, and its eventual use will work on a number of levels. First, in developing an instrument specifically using an evidence-based practice at its center, evidence-based practice can be advanced upon, and infused into counselor education in a different way. By consistently presenting students with components and examples of the WA (via the instrument items), counselor educators are teaching the WA in a more dynamic way, and are underscoring its importance. Instrument items should be accessible by all students stemming from admittance into a program, allowing them to see the items and ask questions when necessary. Furthermore, by learning about and practicing the WA prior to reaching practicum and internship, students can have specific items that they are working to develop, or that are particularly challenging. This way of identifying specific items within components of the WA will help faculty in working with students to embody or enact a particular item. Towards student collaboration. Discussed in earlier chapters, this study seeks to provide faculty with an instrument that fosters student collaboration in the assessment process. This also allows the students to learn about the WA while engaging in professional development with their advisors, mentors, and supervisors. Research has certainly demonstrated that student involvement in gatekeeping is warranted, and desired by students (V. Foster & McAdams, 2009; 99 J. Foster et al., 2014). Furthermore, it has been made clear that faculty and students are not having the same experiences in terms of gatekeeping (Gaubatz & Vera, 2006). The AGI and its underlying theoretical underpinning of goal setting theory (GST) within the framework of social exchange theory (SET) intends to alleviate such issues within assessment in counselor education. To reiterate, SET has been described as a frame of reference through which other theories can be viewed (Emerson, 1976). Specifically, so long as there is a reciprocal process that involves potential for mutual reward and mutual contingencies, SET is applicable (Blau, 1964). In terms of the AGI, this might mean that students would feel evaluation is being conducted in a manner that encourages their professional development, which in turn would deepen their investment in a particular educational program and the process of evaluation. GST stipulates that high, hard goals lead to a higher level of performance when those goals are realistic, not conflicting, and an individual has the necessary ability to attain the goal (Locke & Latham, 2006). The AGI might provide realistic, tangible goals for all students in counselor education programs. If such goals (e.g., professional disposition development) are provided to students in a transparent way, within a program and a supervisory relationship that the student feels is committed to their development (per SET), then students would be more likely to consider AGI and its purpose as a ‘set’ goal, rather than an ‘assigned’ goal. While achieving “high scores” on the AGI may indicate that a student would be a suitable counselor, it is necessary to deter faculty from using evaluative results this way. The AGI intends to provide faculty with a means to collaborate with students in the development of particular dispositions which will not only help them to be adequate counselors (alongside their coursework, practicum, and internships), but also to help to develop them as professionals and future colleagues. 100 While the development of an instrument does not inherently fulfill these theories, the ways in which it is distributed and instructed for intended use can encourage use in such a way that clearly delineates its correct use. The philosophical beliefs of the current study are an implication that will be discussed later in this chapter regarding inter-rater reliability. It is a goal of this study to ensure that students are involved in these evaluations, and that they serve to foster professional disposition development as well as counseling skills. Limitations of the Study Limitations of the Delphi method include shortcomings in selection of the “expert panel”, the time it takes to complete a proper Delphi, and regression to the mean when panelists are able to see the responses of their peers (Vázquez-Ramos et al., 2007). Attempts to overcome such potential limitations were embedded in the study design outlined in previous chapters, and include: comprehensive criterion for selecting experts from various areas that relate to gatekeeping and counselor education, the use of technology which should have aided in the timeliness of responses, and sensitivity on the part of the researcher in order to effectively facilitate responses and maintain panel participation. A limitation inherent in the use of the Delphi methodology is attrition of the panel over time; due to the completion of the Delphi during the summer, this did occur in the current study. While there is no universally accepted size for a Delphi panel, the current study’s panel size was smaller than desired. In addition to the small size of the expert panel, the study design did not allow for demographics to be collected during each round of the Delphi, potentially causing a loss of useful insights. Future studies using this methodology will need to consider implications of timing and commitment of panelists (e.g., consider incentives). 101 The study design was intentional and intended to ameliorate as many potential limitations as possible, but there are limitations including the use of a panel and sample comprised of rehabilitation counselors, and rehabilitation counselor educators. Rehabilitation counselor educators were more easily accessed for two reasons: (1) the researcher’s position as a student of rehabilitation counselor education and ability to contact and/or meet panelists at rehabilitation counselor education conferences, and (2) the ability to purchase a large, random sample from CRCC. The sample does allow for in-depth testing in one population of counselors, but may not be generalizable to other counseling specialties. It is currently unclear, and unexplored, how different specialties of counseling view professional dispositions and/or student assessment. Additionally, targeting supervisors of pre-service students may also improve the quality of responses. Future studies will be needed to better understand these perceptions across various counseling programs/specialties. Future studies will also need to address the perception of the instrument and items in multicultural populations; the sample of the current study was overwhelmingly White and female, which limits generalizability. Additionally, given the intended use and philosophy of the instrument, it will not lend itself to traditional psychometric tests. The AGI will also require retest reliability and more rigorous research methodologies in order to confidently discuss the psychometrics. Implications for Research There are certain changes to be made to the AGI prior to additional studies using the instrument, including the removal of gendered pronouns in all instrument items. The AGI is a brand-new instrument that will require significant further exploration, refinement, and pilot testing. The current study provides justification for the establishment and use of the initial 102 iteration of items and their organization. Further testing will be needed in a variety of areas, including: 1. Testing instrument validity and reliability (e.g., construct validity, inter-rater reliability, and test-retest reliability) 2. Pilot testing and outcome studies with educators, students, and clients 3. Validation of items within additional counseling specialties (e.g., clinical mental health counseling, school counseling, etc.) Instrument validation. Future studies will be imperative to the efficacy and implementation of the AGI in counselor education. Validation of the content of the instrument within additional counseling specialties as well as within a more diverse sample will be necessary. Additional testing of the items may also allow for there to be a reduction of items in the instrument. Currently, 48 is higher than the intended goal and fewer items would make the process less cumbersome for faculty. Additional testing may also provide more clarity regarding items that were revealed to be near the cutoff threshold in the current study (e.g., those about theory), allowing those to be removed if necessary. Finally, with regard to the instrument’s content, future studies may provide insight into “essential dispositions”, or items that represent dispositional qualities determined to be absolutely necessary for a graduating counselor to embody. The current study utilized Cronbach’s alpha in order to assess the internal consistency of the items presented in the AGI, however the researcher recognizes that Cronbach’s alpha can be a flawed method for assessment of new instruments (Sijtsma, 2009). The current study’s goals were to assess the items necessary for assessment in professional disposition development, and to identify how well those items were believed to fit within the constructs of the WA. As such, 103 Cronbach’s alpha was the most appropriate statistical analysis for the study. Internal consistency is useful in the establishment of instrument items, but in future studies, the AGI will be used for assessment of students in counselor education programs, not in asking participants to rate instrument items. Going forward, the validation of the scale construction will be necessary to determine the underlying factors of the instrument, as well as the internal consistency when the instrument is applied in its intended fashion. Exploratory factor analysis will be conducted during such a study to see if the current underlying factors of the AGI do in fact align with the currently proposed factors of the instrument (professional dispositions, tasks, goals, and bonds). At that time, internal consistency will also be a useful measure for establishing reliability of the instrument. Inter-rater reliability is also significant future direction as it currently is a component that is not emphasized in many other published instruments (Tate et al., 2014), and it is the only way to ensure that evaluation is systematic both within and across counselor education programs. The focus of the AGI is to foster the growth of counselor education students through assessment. Therefore, outcome studies and cross-validation with alternate measures of competency will be useful in the validation of the AGI. Using established measures of the WA (e.g., WAI), these studies may be able to provide insight into criterion-related validity. Understanding the link between use of the AGI and a preservice student’s ability to develop the WA in practice would be immensely beneficial and insightful for faculty and clinical supervisors alike. Additionally, McCrae, Kurtz, Yamagata, & Terracciano (2011) provide evidence that retest reliability may be a more suitable long-term analysis than measures of internal consistency, which will also be taken into consideration for future study development. 104 Implications for Counselor Education The AGI fills a gap in counselor education literature by differentiating itself from other instruments via its theoretical underpinnings, item development, and intended use in practice. The AGI does not seek to provide thresholds of appropriateness, or minimum levels of competency that students should seek to reach. Rather, student are to be rated on a continuum of professional disposition development (PDD), from inadequate to exceptional. Faculty will be asked to rate students in the following manner: “The student in question demonstrates an understanding of, and/or capacity for…” a) Inadequate demonstration of capacity; needs significant support b) Occasional/Adequate demonstration of capacity; needs some support c) Consistent/Exceptional demonstration of capacity; needs minimal support The AGI is intended to be accessible by all students at the outset of their educational program, and to be reviewed regularly by the student and their faculty advisor. Certain items pertain to a student’s ability to work with clients, therefore those items may be excluded from formal assessment while a student is in the pre-practica/internship stages of their program. However, such items should be reviewed and discussed between faculty and students, so that the expectation has been established, and the student has an opportunity to ask questions. Over time, a student should be able to achieve consistent or exceptional demonstration of the capacity described in the instrument items. Using the AGI on an electronic platform will also afford the opportunity for faculty to provide comments and examples for students to improve upon or as representative of an exceptional demonstration. Additionally, given the CACREP requirements for faculty to provide systematic data on student professional dispositions, an electronic platform significantly simplifies this process for programs, and could be expanded for use in program 105 evaluation measures. Within the context of our technology and app-driven society, moving the assessment to an online platform will streamline processes for faculty in the future, and will limit the amount of paperwork necessary to collect. Using the AGI in the above described transparent and collaborative manner may positively impact student experience in counselor education programs (e.g., J. Foster et al.,, 2014; V. Foster & McAdams, 2009). Furthermore, use of the AGI will very likely simplify processes for faculty during their CACREP accreditation process. The AGI provides the potential for faculty to provide due process, parallel process, and to systematically document a facet of counselor education that is currently quite elusive and challenging. Ultimately, implementation of this instrument may improve student and faculty experiences and relationships, and quality of services provided to clients. The current study is the first step of many into the use of the AGI for counselor education programs. The AGI has been developed in order to meet a need of faculty, students, and accreditation bodies, and used intentional methodological choices to ensure its composition of items that are considered relevant and useful by both rehabilitation counselor educators and CRCs in practice. In order to ensure efficacy, and to provide faculty with adequate support, the AGI will obtain an online presence to include the instrument, its instructions, and resources for managing professional disposition development in counselor education programs. Implications for Clinical Practice Through the implementation of an instrument such as AGI, faculty and site supervisors may be able to not only effectively work together using the same measure for assessment, but would also be able to directly work with pre-service counseling students on the development of WA. This has been stated as a needed direction for counselor education: “...the challenge in 106 counselor education is to effectively teach the cognitive and affective complexity of WA so that graduates possess entry-level competence in establishing therapeutic relationships” (Connor & Leahy, 2016, p.375), and also aligns with the importance of embedding evidence-based practice into counselor education. Focusing on the development of the WA in counselor education students both through assessment and the use of parallel process in the supervisory relationship between faculty and students may also contribute to an improvement in the WA a student would be able to develop with their clients. As such, it is certainly feasible to consider the implication of improved client experiences and outcomes following the use of an instrument such as the AGI. Conclusion Results of the current study not only establish an instrument that fills a gap in counselor education, but it also provides insights into what rehabilitation counselor educators and practitioners consider to be relevant and useful in the evaluation of professional dispositions in pre-service counseling students. The AGI differentiates itself from other instruments that have been published in its development, theoretical framework, and philosophical underpinnings. The consistently high ratings on the proposed items for the instrument indicate that faculty and counselors in the field believe that professional dispositions need to be assessed in pre-service counseling students. The study results also revealed that specific components of counselor education such as ethics and client-centeredness are almost universally considered extremely relevant and useful, whereas applying theory to practice is less-so. There are many implications for the AGI, and the current study has allowed for an in-depth, and empirically-based starting point for this much needed, forward-looking instrument. 107 APPENDICES 108 APPENDIX A INTERNAL REVIEW BOARD (IRB) APPROVAL 109 March 9, 2017To:Ying Yuk Sung620 Farm Lane, Room 460Erickson HallRe:IRB# x17-334e Category: Exempt 2Approval Date:March 9, 2017Title:Assessment as Growth: Teaching the working alliance through systematic evaluation ofprofessional dispositions in counselor educationThe Institutional Review Board has completed their review of your project. I am pleased to adviseyou that your project has been deemed as exempt in accordance with federal regulations.The IRB has found that your research project meets the criteria for exempt status and the criteria forthe protection of human subjects in exempt research. Under our exempt policy the PrincipalInvestigator assumes the responsibilities for the protection of human subjects in this project asoutlined in the assurance letter and exempt educational material. The IRB office has received yoursigned assurance for exempt research. A copy of this signed agreement is appended for yourinformation and records.Renewals: Exempt protocols do not need to be renewed. If the project is completed, please submit anApplication for Permanent Closure.Revisions: Exempt protocols do not require revisions. However, if changes are made to a protocolthat may no longer meet the exempt criteria, a new initial application will be required.Problems: If issues should arise during the conduct of the research, such as unanticipated problems,adverse events, or any problem that may increase the risk to the human subjects and change thecategory of review, notify the IRB office promptly. Any complaints from participants regarding therisk and benefits of the project must be reported to the IRB.Follow-up: If your exempt project is not completed and closed after three years, the IRB office willcontact you regarding the status of the project and to verify that no changes have occurred that mayaffect exempt status.Please use the IRB number listed above on any forms submitted which relate to this project, or on anycorrespondence with the IRB office.If we can be of further assistance, please contact us at 517-355-2180 or via email at IRB@msu.edu.Thank you for your cooperation.c: Allison LevineInitial IRBApplicationDetermination*Exempt*Office of Regulatory AffairsHuman ResearchProtection ProgramsBiomedical & HealthInstitutional Review Board(BIRB)Community ResearchInstitutional Review Board(CRIRB)Social ScienceBehavioral/EducationInstitutional Review Board(SIRB)Olds Hall408 West Circle Drive, #207East Lansing, MI 48824 (517) 355-2180Fax: (517) 432-4503Email: irb@msu.eduwww.hrpp.msu.eduMSU is an affirmative-action,equal-opportunity employer. APPENDIX B EMAIL INVITATION TO DELPHI PANEL Dear Dr. (last name), I am Allison Levine, a doctoral candidate at Michigan State University in the Rehabilitation Counselor Education program. I am emailing you regarding my dissertation study titled “Removing Uncertainty: Systematically Evaluating Professional Dispositions in Counselor Education”. As part of this study, we are soliciting the opinions of counseling educators who meet any of the following criteria: ● Has experience as a program director in a CACREP accredited counselor education program; ● Are a tenure-track faculty member (or core faculty member) at a CACREP accredited ● counselor education program; or Has published on the topics of supervision, gatekeeping, or professional dispositions in literature of counselor education or rehabilitation counselor education; More specifically, we are looking to identify and draw consensus on the development of items for an instrument which would evaluate student professional dispositions as they relate to master’s level counseling students and development of the working alliance. If you agree to take part in this study, you will be asked to participate in an anonymous, 4 round Delphi study. There are no anticipated risks or discomforts by participating on this study and participants may withdraw at any time without consequence. Panelists who participate in all 4 rounds will receive a $30 gift card. The research project has been approved by The Michigan State University Institutional Review Board. Only authorized persons from Michigan State University involved in this research study have the legal rights to review the research records and will protect the confidentiality of those records to the extent by law or court order. If the results of the research are published or presented, all expert identities will remain anonymous. Your participation in this study is greatly appreciated. We understand your time limitations as an educator and seek to conduct this study in a thorough and efficient manner. It is anticipated that the total amount of time to complete all 3 rounds of the Delphi will not exceed 5 hours (Round 1 - 1.5 hours; Round 2 - 1.5 hours; Round 3 - 1 hour; Round 4 - 1 hour). However, when considering the time associated with recruiting participants, analyzing the data, and allowing participants time to complete each round, the entire Delphi process may take up to 4 months. If you have any questions, please contact: Allison Levine, MS.Ed, CRC Doctoral Candidate, Rehabilitation Counselor Education Michigan State University levine31@msu.edu 110 OR Connie Sung, Ph.D., CRC, LLPC Assistant Professor, Rehabilitation Counselor Education Michigan State University csung@msu.edu If you have questions or concerns about your role and rights as a research participant, would like to obtain information or offer input, or would like to register a complaint about this study, you may contact, anonymously if you wish, the Michigan State University’s Human Research Protection Program at 517-355-2180, Fax 517-432-4503, or e-mail irb@msu.edu or regular mail at Olds Hall, 408 West Circle Dr Rm 207, East Lansing, MI 48824. You indicate your voluntary agreement to participate by completing and returning the demographics survey below. Further instructions will be sent upon the completion of the demographics survey. Please follow the link below to begin the survey. https://msucoe.az1.qualtrics.com/SE/?SID=SV_bx5vcBpWUwEZwTr 111 APPENDIX C EXPERT PANEL DEMOGRAPHICS SURVEY 1 Gender ❍ Male ❍ Female ❍ Other, please specify: ____________________ ❍ Prefer not to respond 2 Age ❍ 25 to 34 years old ❍ 35 to 44 years old ❍ 45 to 54 years old ❍ 55 to 64 years old ❍ 65 to 74 years old ❍ 75 years old or above ❍ Prefer not to respond 3 Ethnicity (check all that apply) ❍ White ❍ Black or African American ❍ American Indian or Alaska Native ❍ Asian ❍ Native Hawaiian or Pacific Islander ❍ Hispanic or Latino ❍ Other, please specify: ____________________ ❍ Prefer not to respond 4 How many years have you been a counselor educator? ______ 5 What type of program do you currently work in? (i.e., Rehabilitation Counseling, Clinical Rehabilitation Counseling, Mental Health Counseling, etc.) _____________________ 6 Are you the program director? ❍ Yes ❍ No If yes, how many years have you been the program director? ____ 112 7 What credentials do you currently hold? (Check all that apply) ❑ CRC ❑ LPC ❑ LMHC ❑ LCPC ❑ LLPC ❑ Other, please specify: ____________________ 8 What accreditations does your program currently hold? (Check all that apply) ❑ CACREP ❑ CORE ❑ Other, please specify: ____________________ 9 Please indicate your preferred email address. This will be used only for the purpose of sending the instructions for the remainder of the Delphi process, and will not be stored with your responses to this survey or any additional data collected. 113 APPENDIX D DELPHI ROUND 1: EMAIL Dear Counselor Educators, This is a final follow up inviting you to join the expert panel for the Delphi study: Assessment as Growth: Teaching the Working Alliance through Systematic Evaluation of Professional Dispositions in Counselor Education. I know that you all are very busy, and I greatly appreciate your consideration of taking part in this study. I believe that your expertise is invaluable to the successful completion of this study, and have designed it to protect your time as best as possible. The goal of this research is to identify and draw consensus on the development of items for an instrument which would evaluate student professional dispositions as they relate to master’s level counseling, and rehabilitation counseling, students and their development of the working alliance. I do not anticipate that 4 rounds of the Delphi will take more than 5 hours total over the span of 4 months, at most. I have also revised the wording of the expert panel criteria, for clarity. As part of this study, we are soliciting the opinions of counselor educators who meet any of the following criteria: ● Has published on the topics of supervision, gatekeeping, or professional dispositions in literature of counselor education or rehabilitation counselor education; ● Has experience as a program director in a CORE or CACREP accredited counselor education program; or ● Has been, or currently is a tenure-track faculty member at a rehabilitation, or counselor education program The research project has been approved by The Michigan State University Institutional Review Board (IRB Number: x17-334e; i053564). Only authorized persons from Michigan State University involved in this research study have the legal rights to review the research records and will protect the confidentiality of those records to the extent by law or court order. If the results of the research are published or presented, all expert identities will remain anonymous. Please follow this link to participate in Round 1 of the Delphi: ${l://SurveyLink?d=Take the Survey} Or copy and paste the URL below into your internet browser: ${l://SurveyURL} If you have questions or concerns about your role and rights as a research participant, would like to obtain information or offer input, or would like to register a complaint about this study, you may contact, anonymously if you wish, the Michigan State University’s Human Research Protection Program at 517-355-2180, Fax 517-432-4503, or e-mail irb@msu.edu or regular mail at Olds Hall, 408 West Circle Dr Rm 207, East Lansing, MI 48824. You indicate your voluntary agreement to participate by completing and returning the survey above. I understand that you are all extremely busy, and that your time is valuable. I hope that 114 you are able to help in this research study, and appreciate your consideration of providing your time and expertise in doing so. With thanks, Allison Levine, MS. Ed., CRC Doctoral Candidate Graduate Teaching Assistantship Coordinator CEP 470 Instructor Research Assistant- Peckham Project Rehabilitation Counselor Education Office of Rehabilitation & Disability Studies Michigan State University Levine31@msu.edu 115 APPENDIX E DELPHI ROUND 1 INSTRUCTIONS ● Thank you and welcome to the Delphi Study for my dissertation, Assessment as Growth: Teaching the Working Alliance through Systematic Evaluation of Professional Dispositions in Counselor Education. This is Round 1 of the Delphi. ● CACREP Standards (Section 4) require program faculty to assess students Key Performance Indicators (KPIs) in content areas as well as on Professional Dispositions (click here for more information). CACREP defines Professional Dispositions as: “the commitments, characteristics, values, beliefs, interpersonal functioning, and behaviors that influence the counselor’s professional growth and interactions with clients and colleagues” This concept/definition has been deemed problematic given its ambiguous nature and subjective phrasing. Gatekeeping literature indicates the need for behaviorally specific assessment categories, and clear, operationalized language (Foster & McAdams, 2009; Lumade & Duffey, 1999). ● The goal of the current study is to develop an instrument which allows counselor educators: ○ (1) to evaluate master’s level counseling students as required by the KPI standards (i.e, systematically, at minimum of 2 points throughout program), ○ (2) in a way that is less subjective, more legally defensible, and, ○ (3) which aligns with evaluating a student’s ability to develop the working alliance (WA). There is no current mechanism which allows faculty to accomplish all three of these. ● Please adhere to the following definition of WA while responding to the below prompts: ○ WA is composed of three features: agreement on goals, an assignment of task(s), and the development of bonds (Bordin, 1979). Goals can be considered outcomes or the target of an intervention. Tasks are the steps necessary to achieve the agreed upon goals. Bonds are the personal attachments necessary for the relationship to work, and are based in mutual trust, acceptance, and confidence. (1) Please identify behavioral and/or identifiable (i.e., measurable, observable) characteristics which embody professional dispositions for counselors to you. (2) Please identify items for a potential instrument which collect observations around a student’s ability to develop WA with potential clients. Specifically, please identify a minimum of 5 items per component: tasks, goals, and bonds. 116 APPENDIX F DELPHI ROUND 2 INSTRUCTIONS This is Round 2 of the Delphi for Assessment as Growth. This round involves the rating of the utility and relevance of items that were submitted in Round 1. You have the opportunity to add comments and feedback at the end of each section. There are 4 sections: Professional Dispositions, Tasks, Goals, and Bonds, there are 15-20 items in each section; this is because of many wonderful submissions in Round 1-- the goal is to get down to less than 10 per section. You do have the option to save this survey and return to it at a later time. You will have 2 weeks to complete this round. The items that are on the final instrument are to be rated by faculty as follows (measuring frequency and consistency of behaviors): “The student in question demonstrates an understanding of, and/or capacity for:” 1 = never/no demonstration of capacity; needs significant support; 3 = occasional demonstration of capacity, needs some support; 5 = consistent demonstration of capacity, requires minimal support It is necessary to provide your email address at the end of this survey, as in Round 3, you will receive the rating you gave an item in relation to the group means and standard deviations. Your identity will remain anonymous to all other expert panelists and will stored in a password protected account on a password protected computer to protect confidentiality. Thank you for your time, expertise, and dedication to this research project. **If you are using a mobile device to complete this survey, please note that it will be easier to navigate if you turn your device to LANDSCAPE mode. 117 APPENDIX G DELPHI ROUND 3 INSTRUCTIONS This is Round 3 of the Delphi for Assessment as Growth. This round involves the final rating of the utility and relevance of items. Below the items are the group means and standard deviations from previous rounds. Items have been sorted by relevance, in descending order. You have the opportunity to add comments and feedback at the end of each section. There are 4 sections: Professional Dispositions, Tasks, Goals, and Bonds, and there are 15-20 items in each section. You do have the option to save this survey and return to it at a later time. You will have 2 weeks to complete this round. Please use the following definitions of utility & relevance: Utility: the item will be useful for faculty in their evaluation of preservice counseling students and their ability to develop the working alliance with future clients. Relevance: the item is connected to, or appropriate for, the evaluation of preservice counseling students and their ability to develop the working alliance with future clients. The items that are on the final instrument are to be rated by faculty as follows (measuring frequency and consistency of behaviors): “The student in question demonstrates an understanding of, and/or capacity for:” 1 = never/no demonstration of capacity; needs significant support; 3 = occasional demonstration of capacity, needs some support; 5 = consistent demonstration of capacity, requires minimal support Thank you for your time, expertise, and dedication to this research project. **If you are using a mobile device to complete this survey, please note that it will be easier to navigate if you turn your device to LANDSCAPE mode. 118 APPENDIX H INFORMED CONSENT/INVITE FOR PILOT STUDY Dear Rehabilitation Counselors, This is an invitation to participate in the validation of the Assessment as Growth Inventory, an instrument developed during the completion of a dissertation titled: Assessment as Growth: Teaching the Working Alliance through Systematic Evaluation of Professional Dispositions in Counselor Education. I believe that your expertise is invaluable to the successful completion of this study, and have designed it to protect your time as best as possible. The goal of this research is to identify and validate items for an instrument which would evaluate professional dispositions as they relate to master’s level counseling and rehabilitation counseling students, and their development of the working alliance. I do not anticipate that this survey will take more than 20 minutes to complete, and at the completion, you are eligible to receive one (1) CRCC CEU. Please follow this link to participate in the Assessment as Growth Inventory: Follow this link to the Survey: ${l://SurveyLink?d=Take the Survey} Or copy and paste the URL below into your internet browser: ${l://SurveyURL} This research project has been approved by The Michigan State University Institutional Review Board (IRB Number: x17-334e; i053564). Only authorized persons from Michigan State University involved in this research study have the legal rights to review the research records and will protect the confidentiality of those records to the extent by law or court order. If the results of the research are published or presented, all expert identities will remain anonymous. If you have questions or concerns about your role and rights as a research participant, would like to obtain information or offer input, or would like to register a complaint about this study, you may contact, anonymously if you wish, the Michigan State University’s Human Research Protection Program at 517-355-2180, Fax 517-432-4503, or e-mail irb@msu.edu or regular mail at Olds Hall, 408 West Circle Dr Rm 207, East Lansing, MI 48824. You indicate your voluntary agreement to participate by completing and returning the survey above. I understand that you are all extremely busy, and that your time is valuable. I hope that you are able to help in this research study, and appreciate your consideration of providing your time and expertise in doing so. With thanks, Allison Levine, MS. Ed., CRC Doctoral Candidate 119 Rehabilitation Counselor Education Office of Rehabilitation & Disability Studies Michigan State University Levine31@msu.edu 120 APPENDIX I ASSESSMENT AS GROWTH INVENTORY Professional Dispositions (1) A dedication to, and embodiment of, the ethical values (autonomy, justice, veracity, beneficence, nonmaleficence, fidelity) (2) Showing unconditional acceptance of all clients, peers, or coworkers regardless of their demographics (i.e., age, gender, race, ethnicity, sexual identity/orientation, culture) (3) Understanding the tendency and the problem of racial stereotyping (4) The development of a counselor identity (e.g., theoretical orientation, helping disposition, professional advocacy) (5) Demonstrates professional and personal maturity such as accepting feedback, following through on commitments, commitment to professional growth (6) Sufficient professional administrative skills (i.e., punctuality, organizational skills, preparation, professional written communication/documentation, awareness of policy/procedures) (7) Sufficient professional interpersonal skills (i.e., developing professional rapport with coworkers, appropriate tone of voice, language use, use of humor, appropriate dress, etc.) (8) Use of problem-solving skills in a timely and professional fashion (9) Maintains respectful countenance in all interactions: perceives and honors diversity, boundaries, and appropriate communication style (10) Engaging in difficult conversations with clients, coworkers, and/or supervisors in an appropriate manner (11) Commitment to a career in the counseling field via indications of a desire to be a lifelong learner (e.g., always seeking new information and resources, participation in professional organizations) (12) Awareness of his/her role as a counselor, including self-awareness, humility, and integrity (13) Demonstrates professionalism and professional behavior in interactions with peers, supervisors, clients, and as a representative of their educational program 121 Tasks (1) Ability to collaborate with clients to design tasks that are congruent with the mutually agreed upon goal (2) Ability to identify tasks that will lead to goal attainment (3) Developing options to address clients' needs and problems with identified priorities (4) Adjusting with the client as his/her needs and problems evolve during the counseling process (5) Ability to communicate the link between the chosen task and the agreed upon goal (6) Knowing how to consult or refer to resources available in ethnocultural communities (7) Being able to show support when holding clients accountable for task completion, or non- completion (8) Application of Evidence-Based Practices (EBP) (9) Ability to design tasks to meet the unique developmental and individual needs of the client (10) Being able to apply theory to justify rationale behind assigned tasks (11) Ability to collaborate with clients to design tasks that are congruent with the mutually agreed upon goal 122 Goals (1) Incorporating the client voice into the goal setting process (2) Demonstrating empathy in understanding the various influences which have impacted the client's goals and experiences (i.e., cultural background, socioeconomic status, etc.) (3) Allowing clients to take the lead in the identification of potential goals (4) Collaborating with clients in the development of mutually agreed upon goals (5) Mutual cooperation with the client when establishing and implementing the treatment plan (6) Applying theory to a situation in order to provide guidance in the goal setting process (7) Developing goals that follow a strengths based approach, and identifies potential in clients (as opposed to focusing solely on dysfunction) (8) Being able to facilitate goal development in areas that may be in conflict with the counselor's personal values 123 Bonds (1) Using active and reflective listening to ensure effective collaboration, problem-solving, and decision-making (2) Demonstrating unconditional positive regard for clients (3) Adherence to ethical practice for respecting client’s informed consent and other client rights in order to develop trust, boundaries, and transparency in the counseling relationship (4) Actively avoiding cultural biases and discriminatory practices in working with clients of minority backgrounds (5) Addressing multicultural issues when presented in the session that may affect the counseling relationship or the client's ability to pursue a goal (6) Demonstrating ethical behavior in the development of bonds with clients (i.e., appropriate boundaries, etc.) (7) Communicating in a confidential, responsive, and empathic manner to establish rapport in a way that promotes openness and sensitivity to potential cultural differences (8) Ensuring client autonomy (9) Capacity to appropriately communicate acceptance to the client (10) Establishing trust with the client as evidenced by the communication that occurs between the counselor and client (11) Maintaining a nonjudgmental disposition regarding client values (12) Managing the power differential between counselor and client (13) Identification of client’s needs and problems in congruence with his/her priorities (14) Being capable of adjusting interactions with clients to meet his/her individual needs and communication style (15) To demonstrate openness and flexibility when addressing the client's issues and problems (16) Willingness to advocate for clients of minority backgrounds who experience institutional discrimination (17) Sustaining the effort to help a client whether or not he/she makes progress 124 APPENDIX J CRCC CEU COMPLETION FORM 125 College of Education Department of Counseling, Educational Psychology, and Special Education 620 Farm Lane, Rm. 447 East Lansing, MI 48824-1034 517-353-6417 Fax: 517-353-6393 CRC/CCRC VERIFICATION OF COMPLETION (Please Print or Type All Information) SPONSOR INFORMATION (To be completed by program/activity sponsor) Michigan State University 00247563 Sponsoring Organization Sponsor Code 620 Farm Ln Allison Levine Street address, Contact Person East Lansing, MI, 48824-1600 516-356-7957 City/State/Zip Code Phone Number for Contact Person PROGRAM/ACTIVITY INFORMATION (To be completed by program/activity sponsor.) Assessment as Growth: Teaching the Working Alliance Through Systematic Evaluation of Professional Dispositions in Counselor Education Program/Activity Title 2017-10-05 - 2018-10-04 Program/Activity Valid Through Date TRN2115233 1.0 Approval Number Clock Hours Attended/Completed Signature of Individual in Charge of Verifying Completion Date of Signature 126 REFERENCES 127 REFERENCES Ackerman, S. J., & Hilsenroth, M. J. (2001). A review of therapist characteristics and techniques negatively impacting the therapeutic alliance. Psychotherapy, 38, 171-184. Ackerman, S. J., & Hilsenroth, M. J. (2003). A review of therapist characteristics and techniques positively impacting the therapeutic alliance. Clinical Psychology Review, 23, 1-33. American Counseling Association. (2014). 2014 ACA Code of Ethics. Alexandria, VA: Author. Baldwin, S. A., Wampold, B.E., & Imel, Z.E. (2007). 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