Client Outcomes Across Counselor Training Level Within a Multitiered Supervision Model

A symbiotic relationship has long existed between mental health service providers and graduate student trainees seeking real-world counseling experience. Training sites offer graduate students invaluable opportunities to refine counseling skills, gain professional experiences, and receive expert supervision (Bernard & Goodyear, 1998; Boggs & Douce, 2000; Krasner, Howard, & Brown, 1998). In return, these training sites receive free or low-cost labor from the graduate student trainees (Holland, 1998). In the current climate of increasing financial pressures and clinical demands placed on service providers (Constantine & Gloria, 1998), the use of graduate student trainees has become so commonplace that few scholars question the practice. In this article, we evaluate the assumption that counseling services provided by student trainees under close supervision result in client outcomes that are equivalent to services provided by licensed professionals. A recent review of the counseling outcome literature concluded that "there have been surprisingly few research studies in the area of experience, training, and client outcome" (Lambert, 2005, p. 861). Studies designed to evaluate client outcome across counselor training levels have yielded mixed results (Stein & Lambert, 1995). Although several reports suggested that counselor experience is not crucial to client outcome (e.g., Michael, Huelsman, & Crowley, 2005; Propst, Paris, & Rosberger, 1994), other reports favor experienced counselors (e.g., Callahan & Hynan, 2005). Research has shown that experienced counselors conceptualize clients with greater depth and complexity (Eells, Lombart, Kendjelic, Turner, & Lucas, 2005; Mayfield, Kardash, & Kivlighan, 1999); possess more highly developed cognitive, emotional, and relational characteristics (Jennings & Skovholt, 1999); and experience fewer client drop-outs than do novices (Stein & Lambert, 1995). In particular, novice counselors may display heightened anxiety, which can be detrimental to counseling interventions and to the counselor-client relationship (Kelly, Hall, & Miller, 1989). Under some circumstances, counselor experience level (Roth, 2003) and degree of trainee experience (Driscoll et al., 2003) can be significant predictors of client improvement. However, the overall magnitude of the differences between counselors and trainees in terms of client outcomes has not been established in the literature (Lambert, 2005). Counselor training sites are responsible for the quality of mental health services that they provide to their clients. To compensate for the potential limitations in the effectiveness of clinical services provided by trainees, training sites are required to implement several resource-intensive procedures. Most notably, training sites provide trainees with direct clinical supervision, which often includes both individual and group meetings with licensed professional staff. Typically, the training site will also develop and maintain supervision guidelines with accompanying oversight to ensure adequate models and contingencies to address challenges, such as trainee impairment and remediation (Forrest, Elman, Gizara, & VachaHaase, 1999; Gizara & Forrest, 2004). Ideally, training sites will also regularly evaluate client outcomes to document that the supervised counseling services provided by trainees are effective. Occasionally, training sites must pursue additional funding because of the challenge of obtaining third-party reimbursement for unlicensed counselors (Constantine & Gloria, 1998). Finally, training sites must maintain close working relationships with the trainees' university academic programs. All of these activities require extensive administrative efforts. Therefore, an inevitable consequence of involving trainees in clinical service provision is the shifting of experienced professional staff to roles with more emphasis on administrative and supervisory tasks. …