Training Directors' Perceptions of Faculty Behaviors ... - APA PsycNET

Training and Education in Professional Psychology 2013, Vol. 7, No. 1, 23–32

© 2013 American Psychological Association 1931-3918/13/$12.00 DOI: 10.1037/a0032068

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Training Directors’ Perceptions of Faculty Behaviors When Dealing With Trainee Competence Problems: A Mixed Method Pilot Study Linda Forrest

Nancy S. Elman

University of Oregon

University of Pittsburgh

Steven K. Huprich

Jennifer C. Veilleux

Eastern Michigan University

University of Arkansas

Sue C. Jacobs

Nadine J. Kaslow

Oklahoma State University

Emory University School of Medicine

Despite the increasing emphasis on competencies in professional psychology graduate training, little is known, other than from anecdotal reports, about faculty behaviors in doctoral training programs when addressing trainees with problems of professional competence (TPPC). This mixed method pilot study explored training directors’ perceptions about faculty behaviors that help or hinder program functions; first in a quantitative survey format yielding descriptive data and then in individual interviews that were analyzed using grounded theory (Charmaz, 2006; Glaser & Strauss, 1967). Results suggest: (a) a wide range of faculty behaviors that both help and hinder effectively dealing with TPPC, and (b) variations in the degree of intentionality and preparedness that training programs use to guide their practices with TPPC. Implications of these preliminary results are discussed and recommendations are offered. Keywords: training, faculty behavior, professional competence, competence problems, impairment

Within the literature on education and training in professional psychology, increasing attention has been paid to trainees with problems of professional competence (TPPC), yet there has been minimal consideration given to how faculty behaviors affect actions and decisions about TPPC. Considerable effort has been made to address definitional and terminology problems with movement toward a competency focus and avoiding complications arising from overlap with the Americans with Disabilities Act (1990) language and intent (Collins, Falender, & Shafranske, 2011; Elman & Forrest, 2007; Schwartz-Mette, 2011). Both ethical

and legal issues surrounding policies and fair practices in addressing TPPC have been addressed (Behnke, 2012; Bodner, 2012; Falender, Collins, & Shafranske, 2009; Gilfoyle, 2008; Johnson et al., 2009; McAdams, Foster, & Ward, 2007), and recommendations for best practices have been put forward (APA Working Group on Trainees with Competency Problems, n.d.; Jacobs et al., 2011; Kaslow et al., 2007). Empirical studies have addressed an array of topics, including recognition of near-universal prevalence rates (Busseri, Tyler, & King, 2005; Huprich & Rudd, 2004; Vacha-Haase, Davenport, &

LINDA FORREST, the Associate Director for Faculty Outreach at the University of Oregon Center on Diversity and Community, earned her PhD from the University of Washington. Her research focuses on professional education and training issues with a special interest in the intersections of competence problems with diversity issues and ethics. NANCY S. ELMAN, PhD, ABPP, is an emeritus faculty member of the University of Pittsburgh. She served on the APA Commission on Accreditation, is currently a member of the Committee on Ethics, and received the 2011 Lifetime Achievement Award from the Council of Counseling Psychology Programs. Her research focuses on psychologists and trainees with professional competence problems. STEVEN K. HUPRICH, PhD is a professor of psychology at Eastern Michigan University. He is currently an associate editor of the Journal of Personality Disorders and is the incoming editor for the Journal of Personality Assessment. Dr. Huprich’s research is on the classification and assessment of personality disorders. JENNIFER C. VEILLEUX, PhD received her PhD in clinical psychology from the University of Illinois, Chicago. She is currently an assistant professor of Clinical Psychology at the University of Arkansas. Her research focuses

on basic emotional dynamics and emotion regulation processes underlying externalizing behaviors, including substance use, binge eating, and selfharm. SUE C. JACOBS, the Ledbetter Lemon Counseling Psychology Diversity Professor at Oklahoma State University, earned her PhD in counseling psychology from the University of Southern Mississippi in 1989. Her interests include ethics, education and training, difficult dialogues in teaching, older adults, diversity, social justice, health, disaster response, mindfulness, and anger. NADINE J. KASLOW, PhD, ABPP is Professor and Vice Chair for Faculty Development in Emory’s Department of Psychiatry and Behavioral Sciences and the 2014 APA President. She obtained her PhD in clinical psychology from the University of Houston. Her research examines competency-based approaches to education and training, family violence, and suicide. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Linda Forrest, 3831 Woodson Ct, Eugene, OR 97405. E-mail: forrestl@ uoregon.edu 23

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Kerewsky, 2004). Recent work on the intersections of diversity with trainee competence problems (Shen-Miller, Forrest, & Burt, 2012; Shen-Miller, Forrest, & Elman, 2009), and students’ perspectives on peers with competence problems (Oliver, Bernstein, Anderson, Blashfield, & Roberts, 2004; Rosenberg, Getzelman, Arcinue, & Oren, 2005; Shen-Miller et al., 2011; Veilleux, January, VanderVeen, Reddy, & Klonoff, 2012), have helped us realize that competence problems have broad impact on others in the training environment. Comprehensive summaries and analyses of conceptual and empirical articles related to TPPC can be found in two reviews (Forrest & Elman, in press; Forrest, Elman, Gizara, & Vacha-Haase, 1999). Initially, the conceptual and empirical literature focused on the individual trainee, yet over time authors have encouraged a contextual and systemic view of how competence problems arise in training programs (Elman, Forrest, Vacha-Haase, & Gizara, 1999; Kaslow et al., 2007). Forrest, Shen-Miller, and Elman (2008) proposed using Bronfenbrenner’s ecological model as a framework for capturing more accurately the intersecting nature of the multiple and layered influences on trainees who manifest competence problems during training. Within an ecological framework, a critical component for understanding the dynamic and complex nature of competence problems is the influence of the faculty, individually and as a group. We identified several articles that described faculty confusion and conflict among faculty as sources of difficulty in addressing TPPC (Elman & Forrest, 2004; Gizara & Forrest, 2004; McAdams et al., 2007; Vacha-Haase et al., 2004; Wester, Christianson, Fouad, & Santiago-Rivera, 2008). One empirical study (ShenMiller et al., 2012) examined the intersection of diversity and TPPC and the findings revealed faculty behaviors that improved or impeded program actions such as the role of existing tensions among faculty, and faculty conflicts about the appropriate approach to diversity (e.g., color-blind vs. culturally attentive strategies). We were unable to locate any studies that addressed more generally faculty behaviors that help or hinder the processes of identifying, assessing, remediating and/or dismissing students’ with competence problems. Consequently, this pilot study was designed to address this gap by gathering and analyzing data based on Directors of Training (DTs) perceptions of faculty behaviors and group interactions that either facilitate or negatively impact the program’s ability to address and manage trainee competence problems.

Method Mixed Methods Approach This study utilized a mixed methods design (Creswell & Plano Clark, 2011; Teddlie & Tashakkori, 2009) that included both quantitative (survey) and qualitative (interviews) methods. With this integrated approach, the limitations of quantitative methods (e.g., interpreting participants’ responses to simple phrases) can be supplemented with the strengths of qualitative methods (e.g., more in depth questions and probes to better understand participants’ survey responses). Because most previous surveys (Busseri et al., 2005; Gaubatz & Vera, 2002, 2006; Huprich & Rudd, 2004; Mearns & Allen, 1991; Procidano, Busch-Rossnagel, Reznikoff, & Geisinger, 1995) have studied solely clinical or counseling pro-

grams (the one exception is Vacha-Haase et al., 2004), we chose to cast a wider net surveying across accredited clinical, counseling, school, and combined professional psychology training programs. In depth qualitative data were obtained via phone interviews with a subsample of survey respondents who stated that they would be willing to be identified and interviewed further about their survey responses. Thus, the use of a mixed quantitative⫺qualitative design allowed us to pursue the same research questions using two different approaches to develop a better understanding of survey responses and a more coherent narrative about faculty behaviors, thereby increasing the trustworthiness of our findings and their potential usefulness to training programs (Morrow, 2005).

Researcher Stance All of the authors are members of the Working Group on Trainees with Competence Problems, which formed in association with the Competencies Conference (Kaslow et al., 2004). Originally, the Working Group was supported by the Council of Chairs of Training Councils and now receives staff support from the APA Education Directorate. Five authors have been members of the Working Group since its inception. Five authors are/were faculty members in accredited doctoral programs in professional psychology, three in counseling psychology, and two in clinical psychology; one author is a DT for internship postdoctoral residency and actively involved in internship training. Since 2002 the authors have collaborated to publish articles and offer professional presentations on trainee competence problems. As a group we have been influenced by both positivist and postpositivist traditions (Charmaz, 2006). Those involved in the qualitative research hold ontological assumptions that include a belief that reality is multiply determined and use an epistemological framework that assumes that meaning is mutually constructed by interactions between interviewee and interviewer (Charmaz, 2006; Morrow, 2005).

Quantitative Methods Recruitment procedures. Participants were DTs recruited through an electronic mailing to the listservs of professional groups involved in the training of doctoral level psychologists in clinical, counseling, and school psychology: Council of Counseling Psychology Training Programs (CCPTP), Council of Directors of School Psychology Programs (CDSPP), Council of University Directors of Clinical Psychology (CUDCP), Consortium of Combined-Integrated Doctoral Programs in Psychology (CCIDPIP), and National Council of Schools of Professional Psychology (NCSPP). At the time the e-mail was distributed to the five listservs, the Commission on Accreditation annual online statistics reported that there were 369 APA accredited programs in clinical (n ⫽ 233), counseling (n ⫽ 69), school (n ⫽ 59), and combined (n ⫽ 8, APA, 2010), so we estimated that the request reached approximately 369 DTs. Participants were asked if they would be willing to complete a brief, 15–20 minute, online survey. In the e-mail, the purpose of the study was described as follows: “To examine how faculty members’ discussions and actions positively and negatively affect the management of TPPC.” The e-mail assured participants that their responses would be anonymous. If interested in participating they clicked the “live” link embedded in the e-mail


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that took them to the online survey where they were once more reminded of these instructions. Toward the end of the survey, respondents were given an option to participate in a follow-up semistructured telephone interview of 1 hour to answer more detailed questions about their unique responses to the survey items. The survey responses were completed anonymously except for those respondents who volunteered to be interviewed. Those individuals agreed to reveal their identity and let their survey responses be the focus of a phone interview, though they were assured that their survey and interview responses would only be used in aggregate form and all identifying information about them, their students, and programs would be removed from the transcripts. The Institutional Review Boards of two study authors approved the study. Survey participants. DTs were selected as the research participants because they are senior level faculty members with considerable experience, and their roles and responsibilities as DTs provide them a more comprehensive view of individual faculty behavior, as well as faculty group dynamics and interactions. Seventy-four DTs responded by opening the survey (20% response rate), reading the informed consent, and perhaps reading some of the survey questions, but only 47 DTs completed the survey (13%). Two follow-up e-mail messages were sent to the listservs with the intention of increasing the response rate. Minimal responses to these follow-up e-mails resulted in a decision to close the survey and begin our analyses. Survey instrument. The authors developed the survey instrument. Questions were developed based on the limited literature on faculty behaviors and conflicts, knowledge gained from authors’ consultations with DTs, and anecdotal stories shared among the authors. The survey began with a reminder about informed consent, and an introduction to the study that included the purpose of the study and a definition of trainee professional competency (i.e., those academic, intellectual, and interpersonal skills that are minimally necessary for safe and effective practice as a psychologist). The body of the survey consisted of five parts: (a) demographic variables about the DTs (e.g., number of years at current institution and as DT, age, sex, faculty rank); (b) description of the training program (APA accredited, program type, degree awarded); (c) general questions about experiences with TPPC (e.g., number of instances of TPPC, number handled by two or more faculty, number of positive and negative outcomes, percentage of faculty with good or excellent skills to address TPPC, faculty behavior that created legal risk, faculty behavior resulting in sanctions); (d) list of faculty behaviors that facilitate the process (strong listening skills, ability to suspend judgment, willingness to engage in difficult conversations, respect for students and faculty colleagues, working knowledge of program policies and APA Ethics Code, willing to make difficult decisions, and ability to see problem from student perspective); and (e) list of faculty behaviors that hinder the process (avoidant strategies, fear of negative consequences, previous faculty conflicts interfering with decisions about TPPC, lack of adequate interpersonal skills to address TPPC). Data analyses. Simple descriptive statistics were conducted on survey items that resulted in reporting frequency, percentages, means, standard deviations, and ranges for the 47 DTs who completed the survey. Twenty-seven DTs opened the survey but an-

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swered no survey questions, making decisions about missing data irrelevant.

Qualitative Methods Interview procedures. Audio-recorded interviews were conducted via telephone by study authors. Interviews lasted about an hour; a professional transcriptionist transcribed the audio recordings. Two authors reviewed the nine transcripts to remove all names and other identifying information. Interview participants. Thirty-four respondents indicated a willingness to be contacted and provided their name and contact information for follow-up interviews. Selection of the individuals to be interviewed was based on an effort to create a representative subsample of the overall survey sample using DTs and program demographics. For example, the survey sample was evenly split between men and women, and associate and full professors. Thus, we selected our interview sample by alternating between these categories. In selecting each additional DT, we continued to try to maximize the overall fit between interview and survey sample. In Table 1, frequency, percentages, means, standard deviations, and range on key DT and program variables are compared between the survey and interview samples. Interview questions. The interview was designed using a semistructured format with open-ended questions derived from participants’ responses to the survey. The respondents’ answers to the survey questions became the core questions (e.g., tell me more Table 1 Descriptive Statistics on Participants and Programs: Comparison Between Survey and Interview Samples Survey sample (N ⫽ 47)

Variables

Age

Director of Training (DT) variables X ⫽ 50.6 (8.5) years Range 38–68 years

Sex Females Males Faculty rank Assistant Associate Full Years at institution Years as DT

APA accredited Yes No Specialty Clinical Counseling School Combined Degree awarded PhD PsyD

n ⫽ 26 (55.3%) n ⫽ 21 (44.7%) n ⫽ 4 (8.5%) n ⫽ 20 (42.6%) n ⫽ 23 (48.9%) X ⫽ 12.3 (9.3) years Range 2–40 years X ⫽ 5.3 (4.6) years Range 1–20 years Academic program variables

Interview sample (N ⫽ 9) X ⫽ 51.6 years Range 41–58 n ⫽ 4 (44%) n ⫽ 5 (56%) n ⫽ 1 (11%) n ⫽ 5 (56%) n ⫽ 3 (33%) X ⫽ 9.3 years Range 2–18 yrs X ⫽ 4.6 years Range 2–17 yrs

n ⫽ 43 (91.5%) n ⫽ 4 (8.5%)

n ⫽ 8 (89%) n ⫽ 1 (11%)

n ⫽ 32 (68.1%) n ⫽ 11 (23.4%) n ⫽ 3 (6.4%%) n ⫽ 1 (2.1%)

n ⫽ 4 (44%) n ⫽ 3 (33%) n ⫽ 1 (11%) n ⫽ 1 (11%)

n ⫽ 34 (72.3%) n ⫽ 13 (27.7%)

n ⫽ 5 (56%) n ⫽ 4 (44%)

Note. Where appropriate, standard deviations or percentages are presented in the parentheses.


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about your answer or can you provide more details about your answer) and starting point for the telephone interviews. The interviewers then engaged participants in further questions and probes based on participants’ initial interview responses to clarify any confusion, deepen the conversation, and create thick description. The interviewers systematically worked their way through the participant’s responses to each survey question. For example, participants were asked to provide more details about their survey response to the question on avoidance strategies. Depending upon the interviewee’s response, the interviewer followed up with further probes in an effort to learn more about how the DT viewed this behavior and how this behavior affected faculty decisions and program actions. Charmaz (2006) recommended that interviewing be discontinued when redundancies become common and no additional categories are likely to emerge. At that point saturation has occurred. Based on ongoing and preliminary reviews of the interviews, we decided that saturation had been reached at the completion of nine interviews. We judged that the interviewees had adequately described the categories of helpful and hindering behaviors because no new categories of helping or hindering behaviors were emerging and DTs’ descriptions had sufficiently enhanced the quantitative data to proceed with coding of the interviews. Official coding of the transcripts occurred after the completion and transcription of the nine interviews. Interview data analyses. This part of the study used the postpositive paradigm of grounded theory methodology, an ideal way to explore behavior when there has been little previous theory or research about contextual factors affecting the behavior (Charmaz, 2006; Glaser & Strauss, 1967). Our work was epistemologically grounded in our shared belief that knowledge and meaning about faculty behaviors related to TPPC would be jointly constructed between the DTs and the researchers by relying on the existing literature and the rigor of our analysis to create credibility, transferability, dependability, and confirmability, all aspects of trustworthiness (Morrow, 2005). As recommended by Lincoln and Guba (1985) and Morrow (2005) we used the following methods to increase the trustworthiness: multiple data sources (survey and interviews), a research team with diverse perspectives, thick description, internal audit trails, and examination of discrepant cases. The analysis utilized a constant comparison methodology (Charmaz, 2006) to create categories and overarching themes, first with line by line open coding, then by axial coding explicating the categories of helping and hindering behaviors, then the overarching themes of programmatic approaches, and finally linking the categories and themes across the interviews once we had conceptualized the broad thematic program level functioning of intentionality. Three authors were involved in the analyses of the transcripts. Two authors independently conducted line by line open coding and development of initial categories and themes. Discussions occurred between these two authors until agreement on the coding of categories and themes was reached. Then these two authors worked to identify the core constructs that “grounded” the categories and themes. Seeking dependability and confirmability of that analysis, the third coder then reviewed the transcripts, checking the categories and themes to determine if she agreed with them and whether any categories or themes had been missed. Several new categories and subthemes were added based on the third coder’s recommendations and upon agreement with the two

original coders; no new themes were added. Finally, we reviewed the transcripts to identify discrepant cases that did not fit within the themes/subthemes and found none.

Results Survey Results Descriptive statistics of the participants and their programs are reported in Table 1. Participants were balanced between women and men, and almost all DTs were affiliated with an APAaccredited doctoral program. Participants represented clinical (68.09%), counseling (23.40%), school (6.38%), and combined (2.13%) doctoral programs and had an average of 12.32 years of experience at their respective institutions. As a group, they averaged over five years serving in the DT role, the median number of years was 4.0, and the modal number of years was 3.0; hence, the responses represented relatively recent events and perceptions of the respondents. Across institutions, an average of approximately seven individual cases of TPPC were reported by DTs who had an average of 5.29 years’ experience in that role. This suggests an average of slightly more than one student identified with TPPC per year of DT experience. DTs also reported an excellent or good outcome for 62% of these cases. DTs’ reported their perceptions about the percentage of faculty they classified as having good to excellent skills in knowing how to manage student competency problems resulting in an average of 75% with a range from 30%–100% of their faculty. For specific skills/attributes of faculty behaviors that were viewed as positive, DTs’ mean percentages varied from the high 70s to the high 80s and included: working knowledge of program policies (75%), willingness to make a difficult decision (76%), ability to suspend judgment (78%), willingness to engage in difficult conversations (80%), ability to see problem from student perspective (80%), strong listening skills (83%), respect for faculty colleagues (85%), working knowledge of APA Ethics Code (87%), and respect for the student involved (88%). The responses associated with helping behaviors reported by DTs resulted in wide variability with the largest standard deviations found for willingness to make a difficult decision (23.75), see the problem from the student’s perspective (21.40), and engage in a difficult conversation (20.67). DTs rated approximately half of the faculty as recognizing different types of conflicts that might potentially influence their decisions about TPPC including interpersonal conflicts (51.90%), conflicts within themselves (52.05%), system conflicts (58.75%), or conflicts of interest (47.18%). DTs also perceived that a sizable number of their faculty have bad or very bad skills for managing TPPC (average of 18%, with a range of 0%–70%). DTs reported that some faculty struggled to address TPPC by demonstrating avoidance (42%), fearing negative consequences (41%), and enacting faculty conflicts with students (21%). One DT reported having a faculty member disciplined for the mismanagement of a student’s competency problem. A table of all of descriptive statistics are available upon request from the authors.

Interview Results Descriptive statistics on individual and program variables for the DTs who were interviewed are presented in Table 1. The nine


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transcripts averaged 22 single-spaced pages and ranged from four to 45 pages in length. Preliminary first level coding yielded more detailed descriptions of faculty behaviors that help and hinder success in addressing TPPC. Second level analyses of DTs’ descriptions of faculty interventions to manage TPPC coalesced into broader system level themes. Although DTs described some individual faculty behaviors, many participants focused more on the functions, interactions, and dynamics of the overall faculty, as well as factors associated with program preparedness and effectiveness at a system level. During second level coding, program-level themes emerged. Due to space limitations, the following sections will focus only on the program level themes. See Table 2 for a summary of overarching themes, subthemes, and categories. Effective program-level strategies. The theme that best captures effective program strategies for dealing with TPPC we have termed intentionality, namely actions characterized by being purposive or deliberate rather than reactive. Five subthemes appeared fairly consistently in doctoral programs that intentionally addressed TPPC: identify problems early, respond at program level, engage in difficult conversations, attend to diversity issues, and engage in ongoing education about TPPC.

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First, programs were committed to addressing problems early. One DT likened the process to being monitored by a dentist: “Okay, we’re going to watch it, and let’s look and see if anybody else has this issue.” DTs described faculty members with concern about a trainee informing others in the system and the trainee, so assistance in the form of a remediation could be provided at the earliest possible opportunity. One DT called it the “nip it in the bud” perspective: . . . every time we have done it [taken early action], the resolution tends to be positive, addressing negative behavior, it’s . . . try to nip it in the bud as early as we can . . .. We have to address it and once we practice it, it becomes a little easier.

Other DTs described specific efforts to document student behaviors and faculty responses in an intentional and programmatic manner. One DT described the development of: . . . a much more focused official type of process, where things are actually put in writing about what . . . could be done, . . . where the student is fully aware of what change is documented and found. It stays in the person’s file.

Table 2 Effective and Ineffective Program Themes, Subthemes, and Categories Subthemes Effective program strategies (Intentionality)

Identify problems early

Categories: Faculty/Program behaviors

• • • • Commit to program- level responses • • • • • • • Demonstrate willingness to have • difficult conversations • • Attend to diversity issues • • Engage in ongoing education about • TPPC • • • Ineffective program strategies Culture of avoidance • (Confusion/uncertainty) • • • • • Hold on to individualistic attitudes • • • • • • Ignore cultural/diversity issues/competence

Identify concerns as early as possible Propose early remediation plans Early and regular monitoring of students Early documentation Make decisions as a group, not individually Regular discussions of student issues at faculty meetings Seek multiple perspectives on TPPC Search for common understandings Broaden view from individual trainee to systems perspective Include supervisors (field, adjunct) in discussions Program policies are clear and process is transparent to all Avoid polarization (among faculty and between faculty and students) Discuss differences openly and respectfully Engage in individual self-monitoring and willingness to acknowledge own role Discuss the complexities of competence assessment within multicultural frame Attend to fears of multicultural insensitivity Provide support for senior faculty Mentor junior faculty Consult when needed Read and discuss literature on TPPC Deny or ignore problems Avoid taking action to address problems Avoid giving student direct feedback about concerns Delay action until a later date Hope student will improve without faculty action Avoid giving feedback to colleagues about problematic behavior Leave decisions to individual faculty members Maintain disorganized policies/do not clarify or improve program policies Attempt to polarize faculty and students Attempt to “win” people over to one side Argue about consequences/remediation plans Consequences on TPPC or program of individual faculty actions are not addressed • Avoid self-reflection and perspective taking about diversity issues • Abstain from discussions of faculty multicultural competence • Avoid difficult discussions about differentiating cultural factors from competence problems

Note. Themes, subthemes, and categories were identified based on analyses of interviews with nine Directors of Training (DTs) about faculty behaviors that help or hinder program decisions about trainees with problems of professional competence (TPPC).


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Early documentation, what one DT described as a “paper trail,” was reported to contribute to addressing concerns raised by others or appeals, and was seen by several DTs as fostering earlier intervention with better opportunities for improvement as well as preventing legal action by a trainee against an unfavorable outcome. Another subtheme described by DTs was responding at the program level by having regular discussions about students at faculty meetings—for several programs, student development concerns are on every faculty agenda. DTs described faculty communication that included attempts to understand different perspectives, a search for common understandings, and openness to consider multiple strategies to address the problem. One DT described: . . . a lot of consultation that I would define as expertise. When you have a group you have more careful judgments and you consider more information before reaching a judgment and you have more confidence in your decisions and you have organizational consistency across cases that is better.

Other elements of intentional program actions included faculty understanding that (a) decisions about a trainee are the responsibility of the faculty as a group, (b) faculty are expected not to act alone, and (c) planful involvement of field-based supervisors and adjunct faculty. One DT described this programmatic approach as: . . . someone who kind of pays attention to signals, consults with other faculty to think through how do we want to approach it, is not impulsive in responding.

Several DTs noted the importance of faculty commitment as a group to program policies and positions that are clear, transparent, and agreed upon by all. Intentional program-level strategies also included an acknowledgment of the need to have difficult conversations among faculty and with trainees as well as a commitment to avoid dividing or polarizing the issues either between the trainee and faculty or among faculty and supervisors. Two quotes from DTs make this point: We’re not going to do those kinds of alliances or have those kinds of conversations because it’s very splitting. Sometimes when you have a student with competence problems, they will use splitting. . . . if a student is using [splitting], the large majority of faculty will see it similarly and splitting gets acknowledged and addressed.

DTs also noted the importance of open and respectful conversations among faculty that included willingness to self-monitor and acknowledge one’s potential involvement in unhealthy or unproductive group dynamics. DTs mentioned that their faculty were able to discuss personality conflicts and differences among faculty (e.g., theoretical orientation, research or clinical focus) as an issue that requires attention because faculty conflicts can rise to the level that negatively affects trainees’ development. DTs observed that understanding the influence of faculty conflicts creates a more complete picture of the origins of problems as well as results in more targeted and nuanced responses by faculty to TPPC.

Programs that exhibited intentionality also appeared to acknowledge diversity as an important factor that needs direct attention. Several DTs mentioned the need to be prepared to deal with international students and how culture and language issues might complicate clarity about competence assessments. Concerns were expressed by DTs about how to avoid both inadvertent racism (not addressing a trainee competence problem for fear of misunderstandings or being perceived as not respectful of cultural differences when working with an ethnic minority or culturally conservative trainee) and accusations of racism or anticonservative bias being used by trainees to avoid acknowledging their competence issues. A fifth intentionality subtheme involved ongoing education and support for senior faculty and mentoring/preparation of junior faculty to be skillful in addressing TPPC. One DT described the modeling and mentoring of junior faculty: . . . more senior faculty have modeled that when they have to engage in difficult decision or discussions and dialogue with students . . . it’s nice that they say “it’s not easy, it’s hard, it’s probably the most difficult thing they ever had to do” . . . [they] normalize . . . the fact that each of them have to do these discussions with students. It is not just concentrated . . . on the director or one faculty, that all have done this at some point.

Another aspect of the ongoing education subtheme included program faculties (and some DTs mentioned trainees, too) who have read and discussed the scholarly literature on TPPC. Several DTs described how over time both faculty and students have become better prepared to address TPPC. One DT noted: We also spent some time actually in faculty meetings looking at the literature on dealing with student impairments and some of that has come back from faculty members going to [training council] meetings.

In some cases, a turnaround in the program culture took the arrival of newer and more recently trained faculty members or better prepared and equipped department chairs to address inappropriate or unethical faculty behavior with students, and faculty resistance to addressing TPPC. At least one program used an outside consultant to assist the program faculty who were struggling to resolve a difficult TPPC situation. These responses suggest that DTs may perceive a culture shift has occurred in faculty behavior related to addressing TPPC, as well as a greater understanding of the impact of systemic and contextual variables on faculty behaviors. Overall, DTs described faculty being better prepared to act early when problems arise, assume more responsibility at the program level, have more capacity to explore conflicts together as a faculty group, and understand how a specific trainee problem might involve them as faculty members or ways that the training program is operating. Ineffective program strategies. Analysis of the interview data revealed that DTs who described their programs as struggling to manage instances of TPPC were characterized by three subthemes of a culture of avoidance, individualistic attitudes, and concerns about multicultural competence. We conceptualize these subthemes as the converse of the systematic, program-focused intentionality and program-level preparedness strategies described above.


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DTs from these programs described faculty avoidance as a major challenge in handling TPPC, including denying that a problem exists; avoiding recognizing early seeds of a problem and delaying the process of investigation; or acknowledging the problem, but avoiding explicit faculty action. For some programs, avoidance of action involved hoping the student would improve on his or her own, possibly with a vague or informal remediation. As one DT stated: “You need therapy, and come back when you’ve changed.” Alternately, avoidance involved stalling actions (e.g., deferring to a more opportune time or relying on others to handle the problem). One DT shared a faculty comment: “Well, it’ll just work itself out when we get to the dissertation. Nobody will [agree to] be on the committee and that will be the end of it.” Avoidance frequently was described as stemming from wellintentioned motives, albeit with negative repercussions: Faculty . . . who are really very, very giving and very, very willing, to work with students no matter where they are and that’s the matter of saying, well, . . . where they are is at a level where they’re not going to make it in the program . . . it’s better for us to be honest and talk with them about that, than to carry them on . . . it’s a painful process.

There were multiple explanations offered for avoidance, including lack of an organized system for handling TPPC that resulted in reactive responses, junior faculty afraid of becoming embroiled in conflict with senior faculty prior to tenure decisions, general apprehension about giving negative feedback to students, fear of damaging the advisor⫺advisee working relationship, and general diffusion of responsibility across faculty members responsible for student monitoring. One DT captured the latter idea: You know, we’d hear from the individual supervisor on the site or at the field placement that the student was really struggling, and then the faculty practicum instructor would give a passing grade nevertheless. And so gosh, it didn’t give a lot of leverage or opportunity to really intervene. When the prac instructor isn’t going to do anything and the advisor isn’t going to do anything, then it really takes an exceptional faculty member to say, well, I’m going to take on something that’s not my direct responsibility, but is a responsibility I think because we are faculty members and this student is representing our program.

In addition to the overarching theme of avoidance as an ineffective program strategy, another subtheme surfaced focused on individualistic attitudes about faculty responsibilities for managing TPPC. One DT described the interaction among faculty members in this manner: I think the culture of a program makes a big difference here, whether you think of the program as a certain set of faculty and their students, like, you know, clusters, . . . so you have faculty member X and her protégées, . . . and if there isn’t the culture of collective, . . . then you have the hard feelings about “How dare you say that about my student,” because it’s a reflection on me as a faculty member.

One corollary of an individualistic perspective was increased likelihood of tension and friction among faculty. Several DTs described situations in which one faculty member was pitted against another; for example, the individual advocating for harsh consequences was seen as being in opposition to the one pushing to allow the student the benefit of the doubt. DTs described these situations, particularly when not processed effectively at the group

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level, as resulting in mixed messages to students as well as damage to faculty relationships. DTs also suggested that individualistic faculty attitudes might inadvertently have contributed to the creation of competence problems for some students. These included faculty with high, harsh standards or who were hypersensitive to criticism or whose behavior appeared to be driven by wanting to be liked. Other DTs reported that some faculty lacked insight into their own interpersonal processes and how they affect students, including those who (a) had strong impression management concerns, (b) were oblivious to how lack of timely responsiveness by faculty hinders student progress, or (c) formed judgments about competence based on limited information. DTs also described instances in which faculty avoided discussing cultural or diversity components of TPPC. Awareness of the role of culture or ethnicity, or lack thereof, was also mentioned by several DTs in relation to individual faculty assessments of TPPC. Some DTs raised concerns about an individual faculty member’s multicultural competence. For example, one DT commented: There’s a particular faculty member who feels like speaking with heavy, accented English is detrimental to the counseling relationship . . . and often gives international students a poor rating . . . So then when I hear the tapes, I don’t see that. I see the international student responding to affect, I see the student tracking well.

Several DTs described cultural insensitivity of faculty members (e.g., faculty who are concerned about trainees or fellow faculty members’ beliefs about race and ethnicity or sexual orientation). Several DTs described uncertainty about how to proceed in addressing conflictual and unresolved diversity issues that surface as part of addressing TPPC. Other DTs described faculty who were unwilling or unable to discuss potential multicultural components of their interactions with each other or with students. In sum, in some programs, TPPC difficulties may be exacerbated by individual faculty behaviors and may not reflect solely on a trainee’s competence limitations. Programs with avoidant, individualistic approaches, and multicultural insensitivity or incompetence allow for significant levels of influence by individual faculty members’ style and personality on decisions about TPPC, which in turn may increase the likelihood of conflict among faculty and/or avoidant behaviors, unclear messages to trainees about program expectations, and inconsistent program decisions and responses to TPPC.

Discussion Several points emerging from this mixed methods pilot study deserve further reflection. The lack of knowledge about faculty behaviors and programmatic efforts when working with TPPC is a critical gap in the psychology training literature. Our mixed methods effort to describe faculty behaviors empirically provides a beginning step toward increased understanding and has expanded our view from a focus on individual faculty behaviors to an emphasis on training programs and their systemic intentionality in addressing TPPC. Comparing and contrasting the quantitative survey and interview results confirmed that programs represented in our sample all have experienced working with TPPC, supporting prior research findings. DTs in our sample also observed faculty behaviors that


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both helped and hindered programs successfully addressing TPPC. Survey and interview results both found that DTs perceived a large percentage of their faculty possess helpful behaviors (e.g., listening skills, ability to suspend judgment, willingness to engage in difficult conversations), yet DTs also perceived a smaller percentage of their faculty displayed behaviors detrimental to the process (e.g., avoidance, acting out faculty conflicts while dealing with TPPC). Although both methodologies resulted in similar results, interviewees elaborated and revealed more complex conceptualizations of faculty behaviors and their effects on program decisions and actions. Although DTs described individual faculty behaviors during the interviews that were similar to survey results, the interview results suggested that patterns of effective or ineffective management of TPPC may more likely be a function of the training program as a system than individual faculty behavior, a finding that was not discoverable from the survey data. DTs’ descriptions of their faculty and programs during the interviews suggested that program cultures varied from highly individualistic, avoidant and somewhat demoralized, to intentional and planful articulation of roles and responsibility of the program and its faculty. Analyses of the interview data suggest that programs with more effective strategies were described by DTs as using conscious decision making and planning, early and regular opportunities to address concerns, clarity and agreement about policies and practices, recognizing and addressing the role of diversity, an intentional commitment to supporting faculty development (especially junior faculty who might feel more vulnerable), and utilization of the available scholarship on TPPC (i.e., publications and presentations at training council meetings). These findings make us wonder if there is a cultural shift emerging in the way doctoral programs address TPPC. This may reflect a transition over time within programs, fostered by a period of increased focus on professional competencies (Kaslow et al., 2004), influenced by the burgeoning specificity and developmental levels of each competency (Fouad et al., 2009; Kaslow et al., 2009), increased emphasis on training outcomes, and the expansion of TPPC scholarly publications and professional presentations during the last decade. We also note that challenges of cultural diversity increasingly are addressed in the TPPC literature (Shen-Miller et al., 2012; ShenMiller et al., 2009) and emerged spontaneously in these interviews. Further attention to this topic is beyond the scope of this article but is an important area for future research.

Study Limitations We assume that the emergence of program level themes may have occurred because all of the participants were DTs. Their roles as DTs may orient them to a more comprehensive view over an extended period of time about the entire TPPC process than individual faculty members; thus, their descriptions may focus more at a program level than if our sample had included non-DT faculty. Another limitation from a positivist perspective is that DTs’ views of their faculty may be idiosyncratic, and/or influenced by unconscious bias, faculty conflict, or department or university contexts, yet from a postpositivist and constructive perspective these are rich aspects of the data. Also, DTs’ own skills in dealing

with competence problems probably influenced their ability to accurately observe and evaluate the skills of their faculty in addressing TPPC. We recognize these are limitations of research that asks participants to report on their perceptions of others’ behaviors, yet we strove to minimize this limitation through interviews that allowed us to probe more deeply DTs’ assessments of faculty behavior. Similarly, the emergence of program level themes may have been influenced by a selection bias. We hypothesize that DTs who volunteered for the survey as well as those who volunteered to be interviewed may have a greater interest than most DTs in this topic and may have already been working toward improving their faculty and programs’ response to TPPC. Based on the rich descriptions and depth of detail revealed in the interviews, the interviewees were personally and professionally invested in understanding and intentionally improving their response to TPPC. Yet the nature of the selection criteria may mean that those selected to be interviewed were not representative of DTs across the totality of clinical, counseling, school, and combined programs. Because the survey questions (i.e., faculty behaviors that help or hinder program decisions) were the basis for the interview questions, thus pointing interviewees in the direction of the types of faculty behaviors identified by the authors, saturation may have been reached prematurely. Some potential limitations associated with trustworthiness are also present. For example, greater credibility (Lincoln & Guba, 1985) could have been obtained by gathering multiple perspectives on faculty behavior from the same program (i.e., triangulation), as well as member checking (e.g., review of categories and themes by research participants themselves). There are additional limitations to this pilot study; perhaps the most important is the low response rate to the survey. A low response rate raises questions about the potentially biased nature of the findings and associated generalizability of the survey results. Response rates for previous TPPC survey studies that used DTs of professional psychology programs as research participants have varied from 18%–52%, yet most of these studies focused on a single specialty (e.g., clinical psychology or counseling psychology) perhaps creating a potential benefit of the researchers being known and trusted by those who responded (52%, Busseri et al., 2005; 20%, Huprich & Rudd, 2004; 18%, Mearns & Allen, 1991; 36%, Procidano et al., 1995). The single study (Vacha-Haase et al., 2004) that surveyed all three major specialties in professional psychology had a response rate of 37%. We hypothesize that the focus on faculty behavior may have been more anxiety provoking than these studies. Also, the proliferation of survey research requests via DT listservs since these studies were conducted (1995– 2005) may have made DTs more selective in their responding. These reasons, combined with a somewhat lengthy survey, may have reduced the response rate.

Research Recommendations Because this was a pilot mixed methods study with small samples for both components, we do not yet have data to be able to generalize to doctoral programs. Studies are needed that provide more robust response rates. Our suggestions for increasing the response rate include using well respected colleagues to request participation and providing incentives for participants. Our findings suggest a need for comprehensive quantitative and qualitative


FACULTY BEHAVIORS

research on intentional program level functioning and its impact on faculty behaviors and program culture when dealing with TPPC that allows for a more fine-grained understanding of faculty and program level behaviors. The bimodal distribution of effective and ineffective behaviors suggests that it would be useful to conduct research on what facilitates programs moving toward more effective strategies. The line of research that follows from the findings of the qualitative interviews suggest a focus on the effects of program-level strategies (effective and ineffective) on program rates of TPPC, types of TPPC, and TPPC remediation efforts and outcomes. Studies are also needed that focus on how faculty are intentionally inducted into the responsibilities of addressing TPPC as well as the impact of TPPC on student cohorts.

Training Implications Emergent themes from this study imply some suggestions that training programs might utilize in attempting to improve their capacity for dealing with TPPC. Planning and intentionality at the program level, rather than avoidance, are first steps. The literature, as well as the findings from this mixed method pilot study, confirms that programs can expect regularly to have occurrences of TPPC. Preliminary recommendations that flow from the interviews with DTs include (a) clear and well-articulated policies that are known to all and understood to be the responsibility of the entire faculty group, (b) early engagement when concerns arise, (c) general faculty openness to reflecting on their own behavior, (d) documentation at every step of the process, (e) attention to ways that ethnic and cultural diversity may impact perceptions of professional competence, and (f) support for senior faculty and mentoring of junior faculty toward competence in addressing TPPC. Most of these recommendations are supported by the extant literature cited in the introduction; the final recommendation, however, is a new one. In sum, research participants’ responses suggest that some programs create a socialization process and professional development opportunities for faculty that increase effectiveness in addressing TPPC. We encourage programs to experiment with and evaluate these practices and behaviors. We also encourage further research on the influence of faculty behaviors and program cultures on the management of TPPC, an understudied yet critical component of the training ecology.

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Received November 28, 2011 Revision received December 17, 2012 Accepted December 27, 2012 䡲