Immediate Feedback

Counseling is a professional and dynamic relationship that requires clinicians to integrate and demonstrate their intellectual and interpersonal skills. This expectation may well have originated with Sigmund Freud, who required all who studied with him to submit to personal psychoanalysis as part of their academic and clinical training. Today, counselors and psychologists prepare for their professional responsibilities through a series of academic and field-based experiences at the graduate level of study. This preparation focuses on an integration of the intellectual, personal, and interpersonal capabilities of individuals.

Counselors-in-training (CITs) receive instruction in a number of subject areas, including, but not limited to, counseling and personality theories, treatment approaches, human life-span development, cultural competencies, research, appraisal and assessment, clinical issues, and treatment. At different points in their education, CITs will treat clients under the supervision of university faculty or other professionals in order to demonstrate a level of competency in providing clinical treatment.

These hands-on or real-world experiences are identified by many terms: practica (plural of practicum), internships, clinical rotations, or field-based placements. Practicum, the common term used here, describes the initial clinical training CITs experience and may take place in a variety of settings utilizing a variety of training formats. Counselors-in-training may see clients in a university-based clinic or training center. Clients and counselors are viewed either in real time through one-way mirrors by an instructor and the counselor’s training group or in the previously described setting but with a videotaped rather than live supervision component. Some CITs will treat clients in a community or school setting where sessions may be audio- or videotaped for feedback at a later time. Although the titles, location, and technologies may differ, the common expectations are that

CITs will provide counseling services to clients; receive feedback, instruction, and supervision on those interactions; and integrate that information into their future treatment of client concerns.

Feedback, Instruction, and Supervision

The terms feedback, instruction, and supervision seem closely related and yet are distinct and well-defined processes in counselor training. Feedback is generally described as a brief process of providing specific and behavioral information to CITs about their interactions with clients. Feedback is both content and process oriented. In a live supervised setting, the CITs’ practicum instructor and/or peers give feedback in an oral format immediately after the client session is concluded. Systemic counseling approaches have used reflecting teams, not discussed here, during live observations as a method of delivering immediate feedback to couples and family counselors.

In a field-based or community setting, CITs usually receive immediate feedback only when they engage in cotherapy with a supervisor or other clinician. Many field-based settings are not equipped to have counseling rooms with one-way mirrors and recording technology. Field-based CITs usually video- or audiotape their sessions for delayed feedback, which occurs at the next meeting with the supervisor.

Instruction includes the direct teaching of a skill, intervention, or process. Prior to enrolling in a practicum, most CITs have a course on helping skills. Students are taught more observable counseling behaviors through an experiential-didactic program. Regardless of the training model used, CITs receive immediate evaluation on their role-played sessions with peers and are expected to incorporate the feedback in order to improve their skills. Instruction differs from feedback in that skill instruction is task-oriented and assumes the CITs have some skill deficit. The focus of instruction is to increase the CITs’ knowledge base in order to improve the application of his or her counseling skills.

Most counselor training programs require that counselors-in-training receive weekly individual supervision of their client sessions. Supervision is a training intervention in which CITs meet with their supervisors in order to review and assess the CIT’s overall counseling performance. Supervision is an interpersonally focused interaction, in which the CIT and supervisor discuss the CIT’s conceptualization of the client concerns, treatment approaches, and the impact of the client and the training process on the CIT. Supervisors serve in many roles relative to CITs, including, but not limited to, those of teacher, counselor, consultant, and evaluator. Feedback and instruction are elements of supervision.

Immediate Feedback

There are several models of immediate feedback used in counselor training. Two, live observation and interpersonal process recall (IPR), are examined here. Immediate feedback in counselor training is defined as information and critique provided to CITs by their counseling supervisor or peers immediately following the conclusion of a counseling session. When sessions are video- or audiotaped, feedback is provided as the tape is replayed or immediately following its conclusion.

Immediate feedback models described here differ from directive, in-the-moment interventions that occur while CITs are actively engaged with clients. These supervisory instructional practices such as bug-in-the-ear, an in-session electronic voice transmission to CITs; or bug-in-the-eye, an in-room, computer-assisted feedback to CITs; or supervisory interruptions via the telephone or knocking at the door are meant to instruct and redirect the CIT’s process with the client. Immediate feedback models also differ from fishbowl or reflecting team models in that clients are not involved in giving or hearing the feedback.

Live Observation

In settings where live or real-time observation is conducted, CITs meet with their instructor and or training group immediately after the session for no more than 10 to 15 minutes of feedback. This model is not as widely used as it once was due to the costs of the facilities and faculty time. The model is an outgrowth of the training models of the 1970s and 1980s that were based on humanistic and group process approaches.

Numerous scholars have identified guidelines for giving feedback in this type of setting. They note that the supervisor has much the same responsibilities as a group leader and as such should ensure that the guidelines are followed in order to provide structure and safety to the group members. Live, immediate, postsession feedback sessions closely parallel the process of group counseling in their development through stages, their intensity, and the initial anxiety of members.

The guidelines highlighted in the counseling literature include the following: First, the CIT should be asked to briefly evaluate his or her performance by indicating his or her strengths and weaknesses. The CIT is asked to speak in behaviorally specific terms about what he or she did or did not do. The focus is kept on the CIT’s counseling behaviors, and discussion related to the client or the client’s issues is kept to a minimum or referred to supervision.

Second, peer feedback should precede supervisor feedback. Peers are to identify behaviorally specific strengths and weakness in the CIT’s performance. Peers are to own the feedback they provide the CIT by directly stating: “I observed…,I saw…,I witnessed …” The supervisor provides his or her feedback last in order to summarize the group’s input and address or explore any counseling competencies that are directly related to the CIT’s concrete actions.

Third, in the early stages of the training group’s development, CITs need to hear a balance of positive and corrective feedback. As the group’s cohesion and trust grow, CITs can more readily hear more critical feedback. Fourth, supervisors are encouraged to regulate the flow and quantity of peer feedback. The supervisor should ensure that all peers are heard and that the CIT is not overwhelmed by too much information or processing. Some researchers suggest that the CIT on the “hot seat” be allowed to call a time out or break in the feedback if he or she is feeling overwhelmed.

The strengths of this model include (a) a focus on time sensitive training; (b) CITs are provided opportunities to learn directly and vicariously; (c) CITs exhibit greater skill improvement and increased self-efficacy after observing a peer than after observing an expert; and finally (d) the immediate and intense nature of this process provides students the opportunity to interact at multiple levels of cognitive and emotional functioning. This model of immediate feedback is highly dependent on the quality of the supervisor’s leadership skills. Therefore, the weaknesses of this model include (a) a dependence on the supervisor’s ability to manage the CIT’s normal and expected anxiety, (b) a dependence on the supervisor’s ability to focus the feedback process, and (c) the cost of maintaining the faculty and facilities.

Interpersonal Process Recall

Interpersonal process recall (IPR) is a blend of an instructional method and immediate feedback developed by Norman Kagan in the 1980s. In IPR, CITs are given the opportunity to play videotapes of their counseling sessions in order to examine and bring into awareness feelings and attitudes they may have been experiencing in the session. The supervisor functions as a consultant and inquires as to the CIT’s understandings and experiences during the session. The CIT can stop the tape at any time. The supervisor assumes that CITs have knowledge of their own experiences but may or may not have consciously examined them. Because the CIT expresses these thoughts and feelings in the moment, without criticism from the supervisor, the CIT’s awareness of factors that influence the therapeutic relationship is enhanced.

The strength of the IPR model is that CITs feel a sense of respect and control in directing the feedback session. The IPR experience also encourages CITs to reflect on their personal processes and experiences in a manner that may help them identify and correct old patterns of ineffective behavior. The IPR process can be time consuming and uncomfortable for CITs who are reluctant to experience the discomfort of self-examination and emotion. Finally, the personal nature of the feedback limits its use, for some, in a group setting.

Immediate feedback and the processing that follows are valuable tools to encourage CITs’ growth in the areas of self-assessment, self-awareness, and reflective practice skills. Immediate feedback makes the training process personal and authentic.

References:

  1. Carkhuff, R. R. (2000). The art of helping in the 21st century (8th ed.). Amherst, MA: Human Resources Development Press.
  2. Hillerbrand, E. (1989). Cognitive differences between experts and novices: Implications for group supervision. Journal of Counseling and Development, 67, 293-296.
  3. Ivey, A., & Ivey, M. B. (2002). Intentional interviewing and counseling: Facilitating development in a multicultural society. Belmont, CA: Thompson.
  4. Kagan, N. (1980). Influencing human interaction—Eighteen years with IPR. In A. K. Hess (Ed.), Psychotherapy supervision: Theory, research, and practice (pp. 262-283). New York: Wiley.
  5. Stoltenberg, C. D., McNeill, B. W., & Delworth, U. (1998). IDM supervision: An integrated developmental model for supervising counselors and therapists. San Francisco: Jossey-Bass.

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