A Review of the Literature on Promoting Cultural Competence and Social Justice Agency Among Students and Counselor Trainees: Piecing the Evidence Together to Advance Pedagogy and Research

Sep 5, 2014 | Article, Volume 2 - Issue 1

Amie A. Manis

There is a call for research on how to effectively foster cultural competence and a social justice advocacy orientation among counselor trainees. A multidisciplinary review of the literature reveals a body of anecdotal and empirical evidence in support of the use of pedagogical strategies grounded in critical theory to this end. Critical pedagogy regarding the development of a social justice origination is emphasized. Privilege, oppression, and experiential classroom activities are presented.

Keywords: critical theory, pedagogy, cultural competence, social justice, advocacy

The promotion of multicultural competence is an established professional training standard in industry and higher education (Musil, 1996). As a fourth force phenomenon within the counseling profession, multicultural education is intimately tied to advancing social justice (Arredondo & Perez, 2003) for trainees in the context of their studies (Ratts & Wood, 2011), and through populating our profession with culturally competent counselors. Its value in training has been empirically validated, yet much is left to discover about how to most effectively deliver multicultural education and ensure that counselors are able to engage in ethical and competent counseling and advocacy with diverse populations (Coleman, 2006; Manese, Wu, & Nepomuceno, 2001; Seto, Young, Becker, & Kiselica, 2006; Smith, Constantine, Dunn, Dinehart, & Montoya, 2006).

More recently advocacy competence has been recognized as a distinct professional standard for counselors with the American Counseling Association’s (ACA) endorsement of the Advocacy Competencies (Lewis, Arnold, House, & Toporek, 2002), the recognition of Counselors for Social Justice (CSJ) as a division of ACA, the 2005 ACA Code of Ethics, and the 2009 Council for Accreditation of Counseling and Related Educational Programs (CACREP) standards. As such, there is a growing body of literature with respect to the promotion of advocacy competence among counselor trainees grounded largely in critical theories (Bemak, Chi-Ying Chung, Talleyrand, Jones, & Daquin, 2011; Brubaker, Puig, Reese, & Young, 2010; Constantine, Hage, Kindaichi, & Bryant, 2007; Goodman, Liang, Helms, Latta, Sparks, & Weintraub, 2004; Green, McCollum, & Hays, 2008; Hof, Dinsmore, Barber, Suhr, & Scofield, 2009; Lewis, Arnold, House, & Toporek, 2002; Ratts & Wood, 2011; Steele, 2008; Toporek & Reza, 2001). Naturally, counseling research on the relationship between multicultural counseling competence and advocacy competence (Manis, 2008) and effective training methods for promoting advocacy competence (Hays, Dean, & Chang, 2007; Lewis, Davis, Lenski, Mukhopadhyay, & Taylor Cartwright, 2010; Murray, Pope, & Rowell, 2010; Odegard & Vereen, 2010) is early in its development.

Thus, while echoing the synergistic relationship between multicultural counseling competencies and social justice advocacy, Odegard and Vereen (2010) recently concluded “how counselor educators teach these constructs to students is a mystery” (p. 145). Their conclusion resonated with earlier expressions of this conundrum within and beyond the mental health professions. Palmer (2004) spoke to this challenge, indicating that the question of how to teach the constructs had been pondered and studied across disciplines.

In fact, a multidisciplinary review of the literature on multicultural education, social justice advocacy and critical pedagogy revealed not only a paucity of research on effective training practices in counselor education and supervision (Odegard & Vereen, 2010; Toporek, Lewis, & Crethar, 2009), but also a lack of attention and investment in training for social justice advocacy within counselor education programs (Hays et al., 2007; Nilsson & Schmidt, 2005; Ratts, 2006; Ratts & Wood, 2011). It further provided a pragmatic rationale for infusing attention to culture and social justice throughout program curricula (Brubaker, Puig, Reese, & Young, 2010; Dinsmore & England, 1996; Goodman et al., 2004: Green et al., 2008; Hays et al., 2007; Hill, 2003; Paylo, 2007; Ratts & Wood, 2011; Stadler, Suh, Cobia, Middleton, & Carney, 2006; Sue, Bingham, Porché-Burke, & Vasquez, 1999; Watts, 2004), and empirical evidence that suggested theoretically grounded pedagogies could be twice as effective as ungrounded approaches in delivering multicultural education (Smith et al., 2006). The literature also offered anecdotal and empirical evidence that critical pedagogical strategies are effective in raising the social consciousness of students and fostering social justice advocacy.

An analysis of the existing evidence, along with more recent findings specific to the field of counselor education and supervision offered a compelling case for further exploration of critical pedagogical strategies in training counselors and research on its efficacy. A brief overview of critical theory and pedagogy is presented, followed by a summary of key research findings. This is followed by a discussion of implications for counselor education and supervision practice, as well as future research.

Critical Pedagogy

Critical pedagogy is rooted in the work of Paolo Freire, who developed this approach with the explicit goal of empowering Brazilian peasants to advocate on their own behalf for social justice. Freire (1974) theorized that becoming aware of one’s sociopolitical reality and position through reflection and dialogue, or attaining critical consciousness, would serve as a catalyst for social justice advocacy.

The application of critical pedagogy in multicultural education has been described as “a deep examination, through dialogue with others, of the legitimacy of the social order in terms of access to socioeconomic resources and opportunities” (Sleeter, Torres, & Laughlin, 2004, p. 82), or in other words, social justice (Chang, Crethar, & Ratts, 2010; Fouad, Gerstein, &Toporek, 2006). Decoding is the term designated by Freire (1974) for this process whereby sociopolitical realities become transparent and a sense of empowerment as change agents is possible.

Freire (1974) used the term praxis to refer to social justice advocacy. He was deliberate in specifying that praxis is a manifestation, rather an outcome of critical consciousness. Thus, he emphasized the undeniably catalytic nature of developing critical consciousness, and the inherent charge which accompanies it regardless of one’s social positions of privilege or oppression. Freire also was explicit in observing the inherently value-laden nature of praxis, or social justice advocacy. He explained: “praxis (which can never be limited to mere activity of the consciousness) is never neutral; in the same way, education can never be neutral. Those who talk of neutrality are precisely those who are afraid of losing their right to use neutrality to their own advantage” (p. 132).

Sue, Bingham, Porché-Burke and Vasquez (1999) echoed Freire and elucidated the relationship between multiculturalism and social justice relative to mental health training and practice. They made it plain that multiculturalism, “…is not value neutral [and actually] … stands against beliefs and behaviors that oppress other groups and deny them equal access and opportunity” (p. 1064). Recognizing this valence is critical not only to advancing the practice standards of our profession (Ratts & Wood, 2011), but also to how we understand and frame our role as counselor educators and supervisors. “Our task as teachers is to clarify the complexity of the many overlapping economies of power and to work with our students to build the critical skills necessary to examine their own location in such a system and to find strategies of resistance to it” (Chan & Treacy, 1996, p. 214).

Enns and Forrest (2005) underscored the connection between the emergence of critical pedagogy from human rights movements and its regular use in multicultural education. They described the scope of multicultural education grounded in these theories as extending beyond the classroom and entailing: (a) a critical examination of the construction of knowledge, (b) an exploration of the relationships among diverse people, and (c) the recognition that cultural identities are dynamic and complex. The intuitive fit of critical pedagogy for raising the social consciousness of counselor trainees, as well as its regular employment in multicultural education lends the theory for investigation as an effective theoretical grounding for training culturally and advocacy competent counselors.

Cultivating Critical Consciousness: A Developmental Process

Critical pedagogical approaches reflect an appreciation of the socializing role of seasoned professionals and educators (Cornelius, 1998; Prilleltensky, 1989), the non-traditional and relational nature of the instructor–student relationship, and the developmental nature of the process of consciousness raising and becoming advocates (Ford & Dillard, 1996; Kathleen May, personal communications, 2006; Sleeter et al., 2004). Indeed, Ford and Dillard (1996) described multiculturalism in these terms: “… it is more than just a learning process, it is a socialization process that involves qualitative degrees of self-development” (p. 5). Sleeter et al. (2004) emphasized the importance of scaffolding students in this process of reflection on their own and others’ identities relative to social positions and experiences of privilege and oppression. The theoretical (Bemak et al., 2011; Green et al., 2008; Hof et al., 2009; Rasheed Ali, Ming Liu, Mahmood, & Arguello, 2008; Sleeter et al., 2004) and research literature (Hays et al., 2007; Murray et al., 2010; Nilsson & Schmidt, 2005; Paylo, 2007) has been consistent in the valuing of experiential learning as a means of cultivating social consciousness among students, and affording opportunities to practice and engage in advocacy.

Developing a Social Justice Orientation

Broido (2000) explored how college students from privileged positions actively engaged in advocacy for social justice understood their own development as advocates. Her findings initially suggested students’ willingness and ability to act as social justice allies developed through having increased information on social justice issues. She reported: “participants gained an overwhelming share of their knowledge of social justice issues from their experiences in the classroom” (p. 9).

The second critical factor in students’ willingness and ability to act as social justice allies was engagement in a dialectical meaning-making process. Broido (2000) concluded that it was “through reflection, discussion, and perspective taking, [that] the participants developed clarity regarding­­—and confidence in—their own position on social justice issues” (p. 10). The third finding pointed to the impact of self-confidence on the participants’ willingness to reflect on the role of privilege in their success.

These findings pointed to the potential importance of introducing material on social justice in counseling instruction. They also demonstrated the value of specific critical pedagogical practices, namely reflection, dialogue and decoding in the participants’ development of critical consciousness and change agency. Finally, they underscored self-confidence as a student quality that supported a critical examination of their own privileged positions.

Exploring Dynamics of Privilege and Oppression

Exploring dynamics of privilege and oppression is at the heart of critical pedagogy. A critical examination of one’s own social positions, as well as those of others, is considered integral to developing critical consciousness and social change agency. The findings of Chizhik and Chizhik (2002) highlighted the need for faculty to attend to student meaning with respect to dynamics of privilege and oppression.

Chizhik and Chizhik (2002) investigated middle class college students’ conceptions of privilege and oppression. They emphasized the importance for instructors of understanding students’ meaning-making with respect to those dynamics as a means of preparing to effectively guide them. They stated: “Knowing students’ preconceived notions about these terms should help instructors ‘scaffold students’ learning to a more multicultural and social justice orientation (if one does not already exist)” (p. 794).

Chizhik and Chizhik (2002) observed that both privileged and oppressed students as defined in terms of racial identity failed to understand these phenomena in systemic terms. They found that, “White students were more likely to blame oppression on internal factors [and believed that] the oppressed are and should be responsible for helping themselves” (p. 805). They also found that students of color were more likely to attribute privilege to factors external to the individual, but not to systemic factors. Furthermore, they found that students of color viewed “social change as a collective act rather than an individual act” (p. 805).

Chizhik and Chizhik (2002) identified the “lack of connection between privilege and oppression…[as] perhaps, the greatest challenge in multicultural discourse” (p. 806). They further suggested: “Understanding the compensatory relationship between privilege and oppression may be an important first step leading to an obligatory call for action through understanding one’s responsibility to act for social justice” (p. 806). Their findings underscored the need for exploration and collective meaning-making of the dynamics of privilege and oppression with students. They also suggested the relevance of this process for all students (Hays, 2008; Lark & Paul, 1998; Rooney, Flores, & Mercier, 1998). And finally, the findings have implications for helping students to resolve resistance to multicultural education and social justice advocacy.

Scaffolding the Development of Critical Consciousness

The challenging and potentially painful nature of decoding raises the importance of scaffolding students as they engage in reflection and dialogue. Broido’s (2000) findings pointed to the significance of confidence to the willingness and success of students of privileged social positions in decoding their experiences. The findings presented by Chizhik and Chizhik (2002) suggested the importance of attending to students’ preconceived ideas about privilege and oppression, and pointed to possible sources of resistance to engaging in open and active exploration of dynamics of privilege and oppression.

Clearly decoding requires unusual vulnerability within the classroom for both students and instructors (Garcia & Van Soest, 1997; Lark & Paul, 1998; Locke & Kiselica, 1999). Chan and Treacy (1996) captured the heart of the challenge more fully. They observed:
Any serious examination of a system of domination that usually cloaks its relationships of power makes many people uncomfortable; these are topics that are often skirted around. Moreover, this approach asks participants in the inquiry (students and teachers alike) to acknowledge [their] lack of knowledge, to examine what [they] do not know about [their] histories, [their] political and legal systems, [their] education, and the contexts in which [they] seek to understand [their] experiences. As we teach and learn about these power relationships, the world looks different and we take a different place in it; we are at least temporarily decentered from our usual normative self (p. 214).

Garcia and Van Soest (1997) conducted an exploratory study of master’s-level social work students engaged in a required course on diversity, particularly how their understanding of privilege and oppression changed over the course. Course objectives centered on familiarizing students with dynamics of social power, oppression, privilege and empowerment. A key pedagogical strategy was paying “considerable attention…to helping students assimilate information that challenged their world views, self-image, and professional self-concepts” (p. 122).

Their findings indicated that the majority of students’ in the course experienced increased social consciousness at the end of the course (Garcia & Van Soest, 1997). Changes reported by the White/non-Jewish students included increased awareness of privilege, increased understanding of the dynamics of oppression, increased hope and the identification of an action plan. Changes reported by the multiethnic students in the class also fell into the three areas of change reported by the White/non-Jewish students. Their changes were reported in terms of increased understanding “of their own oppression” (p. 125). One African-American student reflected: “This course has opened my eyes… It is easy for me to see how different rules can be racist, whereas in the past, I believed they were fair…I have become increasingly aware of how I am treated” (pp.125–126). In addition, among the reports of the students of color were increases in self-confidence, reflection and awareness of the oppression of other groups, as well as positive plans for change. These findings further supported the value and importance of scaffolding students in decoding dynamics of privilege and oppression for all students, and in this case for students in the mental health field.

The relevance of attending to dynamics of privilege and oppression in counselor education and supervision is further underscored by research within the field on social justice advocacy. Hays et al. (2007) conducted a qualitative study of counselors’ perceptions regarding how privilege and oppression were addressed in their training, and how these phenomena impacted counseling relationships. Their findings pointed to inadequate training in multicultural and advocacy competence, and a lack of attention to social justice advocacy specifically around the phenomena of privilege and oppression.

Experiential Activities: Moving Beyond the Classroom

Based on their findings Hays et al. (2007) proposed strategies to address the training deficits identified by counselors in practice. These resonated with critical pedagogy, and included: (a) addressing social justice advocacy in instruction, (b) attending to counselor self-efficacy as related to cultural and advocacy competence, (c) exploring the systemic nature of oppression in the context of case conceptualization, and (d) building from strategies used to enhance cultural competence such as guest speakers and experiential activities.

Nilsson and Schmidt (2005), among others (Ratts, 2006), also observed a deficiency in counselor training. They pointed out that while social justice advocacy has been emphasized in the literature, “this value appears not to have filtered through graduate training programs to its trainees” (p. 277). They further reported “little evidence that educators encourage students to act individually or in groups to produce social change” (p. 277).

Their findings pointed to a desire to advocate and political interest as two factors that may lead to advocacy and indicated a need for further research on differences in this regard between students of oppressed or privileged social statuses (Nilsson & Schmidt, 2005, p. 275). Nilsson and Schmidt (2005) arrived at conclusions with respect to counselor training that were similar to those of Hays et al. (2007). Specifically they noted: “counselors’ concern for others needs to be guided beyond the individual level and extended to societal and political levels” (p. 276). They also proposed incorporation of pedagogical strategies resonating with critical theory. These included engaging students in dialogue around political and social issues, exposing students to culturally diverse peers and individuals, providing opportunities for campus or community outreach, and teaching advocacy skills.

Paylo’s (2007) study of the characteristics of counselors who advocate also led to similar conclusions and recommendations. Paylo found that counselors who consider advocacy important are more likely to act as advocates. He stressed: “… it is imperative for counselor educators to infuse the importance of advocacy throughout the curriculum. They may not be able to directly affect counselors-in-training’s actual advocacy behaviors but by instilling the importance of advocacy, they may increase advocacy behaviors indirectly” (p. 134). He went on to suggest hands-on, relationally-oriented strategies such as bringing in guest speakers, infusing advocacy concepts within field and coursework, and service projects.

The literature provided both anecdotal and empirical support for service learning across disciplines as a strategy for promoting critical consciousness and social justice agency among students. McAllister and Irvine (2000) offered empirical support that “providing opportunities for students to interact with individuals from other ethnic backgrounds in authentic cultural settings” (p. 20) enhances the multicultural learning process. Beilke (2005) proposed community service as an effective intervention in facilitating the development of critical consciousness in pre-service teachers. She asserted that the “first task of developing a critical multicultural perspective is to see oneself more objectively by ‘unpacking’ power, privilege, and racial identity” (p. 3).

Research within counselor education also supported the practice of service learning as effective (Arthur & Achenbach, 2002), particularly immersion experiences or those involving direct contact with diverse individuals and communities (Burnett, Hamel, & Long, 2004; Coleman, 2006; Díaz-Lázaro & Cohen, 2001; Dickson & Jepsen, 2007).

Piecing the Evidence Together: Implications for Counselor Training and Research

Theory and research across the humanities addressing multicultural education, advocacy and social justice supported the developmental and process oriented nature of developing critical consciousness. It also provided compelling evidence to guide the use and further investigation of critical pedagogical strategies within the field of counselor education and supervision as a means of training counselors who are culturally competent and prepared to act as advocates for social justice. Key themes among the findings were the value of: (a) introducing social justice material in coursework, (b) incorporating examination, dialogue and reflection with respect to dynamics of privilege and oppression in society, (c) scaffolding all students in their meaning-making of the dynamics of privilege and oppression in their own experiences regardless of their identities and relative social positions, and (d) providing opportunities for experiential activities beyond the individual client level and classroom.

Teaching

Consonant with the developmental nature of counselor training and the research findings discussed relative to critical pedagogy, the more recent literature in the fields of counseling and psychology promoted critical theoretical approaches (Brubaker et al., 2010), models (Green et al., 2008) and training strategies (Bemak et al., 2011; Hof et al., 2009; Rasheed Ali et al., 2008). These recommendations pointed to the value of pedagogies that: (a) incorporate a tone of equality, de-ideologize dominant paradigms and incorporate experiential training (Brubaker et al., 2010); (b) recognize the link between social justice advocacy and professional advocacy (Hof et al., 2009); and (c) address the domains of awareness, knowledge and skill in infusing social justice advocacy throughout curricula (Green et al., 2008). Green et al. (2008) proposed an advocacy counseling paradigm that builds from awareness of injustice, to knowledge to empowerment of self and others, up to skills to perform and teach to others. Their model is consistent with the guidance offered by Rasheed Ali, Ming Liu, Mahmood, and Arguello (2008), who advised: “Before the actual practical training of social justice begins, it is equally important for students to understand the meaning and implications of social justice as a theory as well as implementing theory to practice” (p. 3).

In their reflections on infusing social justice advocacy, Bemak et al. (2011) provided a number of suggestions. These included beginning with the faculty and engaging in collective meaning-making about social justice and how it applies across courses and content. They went on to address the relevance of personal experiences of students with respect to their worldview and their identities as counselors, and emphasized the need to explore the challenges of social justice work with students. They recommended utilizing real life situations and news in role plays and further suggested service learning as an important component of hands-on training.

Experiential learning, particularly in terms of service learning was a consistent recommendation in the most current literature. Murray et al. (2010) pointed out that experiential learning is already an essential component of counselor training through fieldwork. In addition to affording students the opportunity to apply gains in awareness, knowledge and skills, they asserted that service learning also encourages civic commitment. Rasheed Ali et al. (2008) described a homeless shelter practicum as an apt example of a practicum experience that reaches an underserved population and that could include attention to public policy initiatives. Ali emphasized the need for sensitivity and care in assessing community needs, placing students, and evaluating the impact of service learning projects when developing fieldwork opportunities for counselor trainees where they will have an opportunity to confront social injustices and engage in advocacy at the client, community and public policy levels.

Supervision

Falender and Shafranske (2004) offered a clear description of diversity competent supervision as a process that not only promotes social justice, but also is in essence a social justice intervention. They asserted that diversity-competent supervision:
includes incorporation of self-awareness by both supervisor and supervisee and is an interactive process of the client or family, supervisee-therapist, and supervisor, using all of their diversity factors. It entails awareness, knowledge, and appreciation of the interaction among the client’s, supervisee-therapist’s, and supervisor’s assumptions, values, biases, expectations, and worldviews; integration and practice of appropriate, relevant, and sensitive assessment and intervention strategies and skills; and consideration of the larger milieu of history, society, and sociopolitical variables (p. 125).

Their conceptualization of the infusion of diversity and social justice within the supervisory relationship and the supervision process is in alignment with the critical pedagogical recommendations of Brubaker et al. (2010) for the infusion of advocacy in counselor training, as well as the recommendations of Glosoff and Durham (2010) for incorporating social justice advocacy in supervision. In short, their recommendations centered on calling supervisee attention to the continuum along which advocacy may occur, encouraging supervisee examination of their own place on the continuum, and scaffolding supervisee development of critical consciousness through reflective questioning, supervisor self-disclosure, and the incorporation of self-assessment and explicit examination of the counseling process in terms of dynamics of privilege and oppression.

Research

Since research on social justice advocacy in counselor education and supervision is so young, the possibilities for investigation appear limitless. First, establishing a clear understanding of the state of social justice advocacy training in counselor education and supervision programs is needed. Surveying current practices would not only shed light on how the field has embraced the charge to train counselors who are competent advocates, but also would provide perspective on the range of practices currently in use. This would include investigation of (a) strategies for promoting advocacy competence currently employed in counselor education and supervision programs overall, (b) theoretical approaches to counselor training for social justice advocacy, (c) exploring the efficacy of standalone courses on cultural competence and/or advocacy as compared to infusion of training throughout a curriculum, and (d) the state and practice of social justice within counselor education and supervision programs.

Further qualitative inquiry into the training experiences of counselor trainees and counselors would lend an important perspective to the knowledge base. Immediate foci may include desires for training, reflections on the process of developing critical consciousness and committing to social justice advocacy, critical incidents in training, and social justice needs within counselor education. Similarly, qualitative investigation of the experiences of counselor educators and supervisors who are charged with implementing training initiatives would bring additional perspective to the challenges and opportunities inherent in this endeavor. In addition, qualitative investigations of the clients and communities with whom service-learning initiatives are planned or conducted could be useful in assessing not only needs but also the impact of such projects and advocacy initiatives (Murray et al., 2010; Rasheed Ali et al., 2008).

Examination of the relationship between multicultural counseling competence and advocacy competence also is indicated as an area in need of exploration. Understanding this relationship could lead to economies in programming and more effective facilitation of student development, as suggested by current practices and understanding of the synergistic relationship between the two competencies (Hays et al., 2007; Manis 2008). In addition, further investigation into how best to assess competence in both areas of practice would be useful (Smith et al., 2006).

Finally, experimental research that assesses the efficacy of critically grounded pedagogical strategies in short- and long-term approaches would be helpful in assessing its ongoing utility in counselor education and supervision curricula, and in considering the question of efficacy of stand alone versus infusion approaches (Manis, 2008). This could be limited to specific strategies such as examination of dynamics of privilege and oppression, or expanded to testing full models or approaches as presented in the literature. And while there is promising evidence of the efficacy of critically grounded approaches for counselor education and supervision, this does not rule out the potential utility of investigating the efficacy of approaches grounded in other theories (Smith et al., 2006).

Conclusion

A review of the literature pointed to an appreciation of critical theories in grounding training for competent social justice advocacy. These approaches call upon counselor educators to attend to social justice across the curriculum and remain alert to their role in socializing counselor trainees as advocates. They also emphasize the importance of attending to the individual meaning-making of counselor trainees with respect to culture and dynamics of privilege and oppression. Lastly, they underscore the developmental nature of developing critical consciousness and the need to incorporate strategies that both instruct counselor trainees, and allow them to apply concepts in the field.

Adopting a critical pedagogical approach demands a high degree of investment from faculty and trainees. Counselor education and supervision practices are inherently reflective and experiential, and thus consonant with critical pedagogies. Critical approaches offer tremendous potential for enhancing the process and content of existing counselor education and supervision curricula so as to better meet the training needs of diverse students and ultimately the clients and communities they will serve.

The time to delve more deeply into transformational practices in our field is now (Ratts & Wood, 2011). It has been five years since Smith et al. (2006) heralded the end of the debate on multicultural education, validated its value in training and called for research to examine the efficacy of theoretically grounded pedagogical interventions in multicultural education. A review of the literature points to the efficacy of critical theory in social justice pedagogy. This offers a sound basis for incorporating critical pedagogical strategies now, while collective efforts to fully investigate the effectiveness of critical pedagogy are undertaken to advance the most efficacious training within the field of counselor education and supervision.

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Amie A. Manis, NCC, is a Core Faculty member in Counselor Education and Supervision at Capella University. The author acknowledges the contributions of colleagues at the University of Virginia, including Dr. Kathleen May, Dr. Sandra Lopez-Baez and Dr. Matthew J. Paylo in the development of this paper. Correspondence can be addressed to Amie A. Manis, 255 Forge Road, Lexington, VA 24450, amie.manis@capella.edu.

Relationship Between Graduate Students’ Statistics Self-Efficacy, Statistics Anxiety, Attitude Toward Statistics, and Social Support

Sep 5, 2014 | Article, Volume 1 - Issue 2

Michelle Perepiczka, Nichelle Chandler, Michael Becerra

Statistics plays an integral role in graduate programs. However, numerous intra- and interpersonal factors may lead to successful completion of needed coursework in this area. The authors examined the extent of the relationship between self-efficacy to learn statistics and statistics anxiety, attitude towards statistics, and social support of 166 graduate students enrolled in master’s and doctoral programs within colleges of education. Results indicated that statistics anxiety and attitude towards statistics were statistically significant predictors of self-efficacy to learn statistics, yet social support was not a statistically significant predictor of self-efficacy. Insight into how this population responds to statistics courses and implications for educators as well as students are presented.

Keywords: graduate students, statistics, anxiety, self-efficacy, attitudes, social support

More graduate programs in various social science fields are requiring students to complete research methods including statistics courses or a blended combination thereof (Davis, 2003; Schau, Stevens, Dauphinee, & Del Vecchio, 1995). These course requirements pose a dilemma for educators and students because many students perceive statistics as difficult and unpleasant (Berk & Nanda, 1998). Some students can struggle in statistics courses as a related complication of this perception as well as other intrapersonal factors related to the course.

To investigate graduate students’ experiences in statistics courses, researchers studied different avenues to understand what occurs with students so steps can be taken to improve learning as well as satisfaction in college statistics courses. For instance, researchers suggested non-cognitive factors such as motivation for further learning (Gal & Ginsburg, 1994; Finney & Schraw, 2003), statistics self-efficacy (Onwuegbuzie & Wilson, 2003), and attitude toward statistics (Araki & Schultz, 1995; Elmore, Lewis, & Bay, 1993; Waters, Martelli, Zakrajsek & Popovich, 1988; Wise, 1985) should be assessed and addressed with students. Finney and Schraw theorized that the difficulty students experience with statistics is not necessarily due to lack of intelligence or poor aptitude, but may be a result of the above mentioned factors. Bonilla (1997), Cohen and McKay (1984), and Solberg and Villarreal (1997) hypothesized that social support may act as a buffer against the development of these psychological manifestations.

The purpose of this study was to examine the various factors that have been introduced in previous research in one comprehensive study. The goal was to determine how graduate student self-efficacy to learn statistics is predicted by statistics anxiety, attitude toward statistics, and social support (Gall, Gall, & Borg, 2007). The overarching intent was to document graduate student self-efficacy to learn statistics and identify how certain variables influence statistics self-efficacy (Pan & Tang, 2005).

Self-Efficacy to Learn Statistics

In order to understand the implications of this research, an explanation of the key variables found in the literature review must first be discussed. Self-efficacy to learn statistics is the dependent variable in this study. Bandura (1977) originally defined general self-efficacy as one’s judgments of his or her capabilities to organize and carry out courses of action required to attain specific types of performances. Bandura asserted that self-efficacy beliefs are manifested from four primary sources, which include the following: (a) personal accomplishments, (b) vicarious learning experiences, (c) verbal persuasion, and (d) emotional arousal. These primary sources lay the foundation for building the concept of self-efficacy to learn statistics. Finney and Schraw (2003) defined self-efficacy to learn statistics and developed an assessment to measure this phenomenon. Self-efficacy to learn statistics is an individual’s confidence in his or her ability to successfully learn statistical skills necessary in a statistics course.

A large amount of information is available on self-efficacy related to academic performance (Lent, Brown, & Larkin, 1984, 1986; Pajares, 1996; Pajares & Miller, 1995; Zimmerman, 2000; Zimmerman, Bandura, & Martin-Pons, 1992). However, little is known specifically about self-efficacy to learn statistics. Finney and Schraw (2003) investigated whether self-efficacy to learn statistics is related to performance in a statistics course and whether self-efficacy to learn statistics increased during a 12-week introductory statistics course. One hundred and three undergraduate students from a large Midwestern university participated in the survey. Finney and Schraw reported a positive relationship between statistics self-efficacy and academic performance as well as an increase in self-efficacy to learn statistics over the duration of the course. Onwuegbuzie (2000) also reported students with the lowest levels of perceived competence had the highest levels of statistics anxiety. Additionally, Pajares and Miller (1995) documented an inverse relationship between self-efficacy and math anxiety.

Statistics Anxiety

Statistics anxiety is one of the three independent variables in this study. Researchers have documented a large amount of information on statistics anxiety over the years. For instance, there are multiple definitions of statistics anxiety available in the literature. Onwuegbuzie, DaRos, and Ryan (1997) defined statistics anxiety as “a state-anxiety reaction to any situation in which a student is confronted with statistics in any form and at any time” (p. 28). Cruise, Cash, and Bolton (1985) defined statistics anxiety as “the feelings of anxiety encountered when taking a statistics course or doing statistical analyses: that is, gathering, processing, and interpret[ing]” (p. 92). The latter is the definition utilized for this study.

We know that instructors of research and statistics courses often encounter students with high levels of statistics anxiety upon their arrival to class (Perney & Ravid, 1991). According to Onwuegbuzie, Slate, Paterson, Watson, and Schwartz (2000), 75% to 80% of graduate students in the social sciences appeared to experience high levels of statistics anxiety. Statistics anxiety was found to be higher among female and minority graduate students in comparison to their male and Caucasian counterparts (Onwuegbuzie, 1999; Zeidner, 1991).

Researchers identified three categories of variables—situational, dispositional, and environmental—that are related to statistics anxiety (Onwuegbuzie & Wilson, 2003). Situational antecedents are factors that surround the student, including previous statistics experiences (Sutarso, 1992). Researchers found a negative connection between the number of completed mathematics courses and statistics anxiety (Auzmendi, 1991; Robert & Saxe, 1982; Zeidner, 1991). Forte (1995) found minimal previous math experience, late introduction to quantitative analysis, anti-quantitative bias, lack of appropriation for the significance of analytical models, and lack of mental imagery were factors contributing to statistics anxiety among social work students.

Dispositional antecedents are intrapersonal factors students bring to the classroom (Onwuegbuzie & Daly, 1999), which includes issues such as perfectionism and perception of abilities at developmental stages in life (Pan & Tang, 2004). Walsh and Ugumba-Agwunobi (2002) found evaluation concern, fear of failure, and perfectionism provoked statistics anxiety. Environmental antecedents are interpersonal factors related to the classroom experience (Onwuegbuzie & Daly, 1999), which can include the student’s experiences with the professor. Tomazie and Katz (1988) reported previous experiences in statistics courses have influenced learning in a current course. Moreover, the environmental antecedent has the least research available in the literature.

Attitude Toward Statistics

Attitude toward statistics is the second independent variable in this study. Attitude towards statistics is defined in this study as a combination of a students’ attitude toward the use of statistics in their field of study and the students’ attitudes towards the statistics course (Cashin & Elmore, 1997; Wise, 1985). Researchers explored this area; however, there are many gaps left to fulfill. Gal and Gingsburg (1994) reported students often enter statistics courses with negative views or later develop negative feelings regarding the subject matter of statistics. Researchers found no statistically significant differences among females’ and males’ attitudes towards statistics (Araki & Schultz, 1995; Cashin & Elmore, 2005; Harvey, Plake, & Wise, 1985). However, conflictingly, Waters et al. (1988) and Roberts and Saxe (1982) found male students had more positive attitudes towards statistics than female students.

According to Perney and Ravid (1991), statistics courses are viewed by most college students as a road block to obtaining their degree. Students often delay taking their statistic courses until the end of their program. Researchers found students’ negative attitudes toward statistics is an influencing factor in low student performance in statistics courses (Araki & Schultz, 1995; Elmore et al., 1993; Harvey et al., 1985; Schulz & Koshino, 1998; Robert & Saxe, 1982; Waters et al., 1988; Wise, 1985).

Perceived Social Support

Perceived social support is the final independent variable in this study. Perceived social support for this study is defined as the level of support an individual self identifies as received from friends, family, and significant others (Zimet, Dahlem, Zimet, & Farley, 1988). This variable is influential in this study in terms of the potential buffering effect it may have on the other independent variables, statistics anxiety and attitude towards statistics.

According to Bonilla (1997), social support acts as a buffer to dysfunctional thoughts or attitudes. In 1985, Cohen and Wills investigated the process through which social support has a beneficial effect on well-being. The buffering model maintains that support is related to well-being primarily for persons under stress. Cohen and Wills identified four support resources, which include the following: (a) esteem support such as the person is valued and accepted, (b) informational support, (c) social companionship such as engaging in leisurely activities with others, and (d) instrumental support such as an individual providing a person with financial aid, material resources, or need-based services.

Solberg and Villarreal (1997) conducted a study to explore the interactions between social support and physical as well as psychological distress of Latino college students. The authors reported social support moderated the distress. Specifically, the Latino students who believed social support was available had lower psychological distress than students who believed that social support was less accessible.

Research Questions

Six research questions were included in this study. The first four focus on descriptive information from our sample and include the following: (a) what is the graduate student self-efficacy level, (b) what is the graduate student statistics anxiety level, (c) what is the graduate student attitude toward statistics, and (d) what is the graduate student level of perceived social support? The predominate research question driving this study is, what is the extent of the relationship, if any, between graduate students’ self-efficacy to learn statistics and statistics anxiety, attitude towards statistics, and social support? A supplemental research question was, what is the influence of social support on statistics anxiety and attitude towards statistics?

Method

Participants
Participants were recruited by the researcher emailing faculty members of doctoral and master’s programs within colleges of education at 250 universities within the United States. The faculty members were asked to forward information about the opportunity to participate in the study to their students. One hundred sixty-six graduate students within colleges of education representing 27 states fully completed the online survey within the 8-week data collection timeframe. An a priori power analysis was conducted considering involvement of three predictors in the multiple regression equation and estimating a moderate effect size based on similar studies. It was determined that 119 participants are needed to achieve adequate power in the study (Faul, 2006); thus, an appropriate sample size was achieved to obtain adequate power in the analysis (Gall et al., 2007).

The sample was predominately female (N = 136, 81.9%) compared to males (N = 30, 18.1%). Participants’ age ranged from 21 to 71 with 34.4 as the mean age. The cultural makeup of the sample consisted of 4 Native American (2.4%), 4 Asian/Pacific Islander (2.4%), 24 African American (14.5%), 124 Caucasian (74.7%), and 10 Latino participants (6%).

The academic level of the participants was close to evenly split with 92 master’s students (55.4%) and 74 doctoral students (44.5%). The majority of the sample (N = 144, 86.7%) were enrolled in counseling or related educational programs such as mental health counseling, school counseling, rehabilitation counseling, student affairs, and counselor education and supervision. Twenty-two (13.3%) participants were enrolled in education graduate programs such as educational leadership, curriculum and instruction, and educational technology. One hundred thirty-six participants (81.9%) were enrolled in programs that were accredited by at least one accreditation body appropriate to their program.

Participants had different backgrounds in terms of taking statistics courses. The mean number of completed graduate statistics classes at the time of participating in the study was 1.63 classes for the sample. The range of courses was 0 to 6, and the mode was 0 classes with 45 participants (27.1%) not having completed a single graduate level statistics course. Of the 121 who completed a statistics course previously, the mean final grade was 89.34% with the lowest grade earned reported as 70%.

Instruments
A demographic questionnaire was used to collect information related to participants’ personal characteristics as well as previous experiences with graduate statistics classes. The Self-Efficacy to Learn Statistics (SELS) scale was used to measure the dependent variable (Finney & Schraw, 2003). The SELS measures confidence in one’s ability to learn necessary statistics while in a statistics course in order to successfully complete 14 specific tasks using a 1 (no confidence at all) to a 6 (complete confidence) response scale. Only a total score is obtained from the instrument. Internal consistency reliability was reported as .975 Cronbach’s alpha. Validity evidence of SELS to other variables was reported. The SELS was positively correlated with the Math Self-Efficacy scale and negatively correlated to the general and statistics Test Anxiety Inventory subscale providing evidence of concurrent validity. The norm group for the instrument was a total of 154 college students enrolled in an introductory statistical methods course.

The Statistics Anxiety Rating Scale (STAR) was used to measure the independent variable statistics anxiety (Baloglu, 2002; Cruise &Wilkins, 1980). The assessment is a 51-item Likert scale ranging from 1 (no anxiety) to 5 (very much anxiety) and measures anxiety in two parts. The first part includes 23 statements related to statistics anxiety and the second part has 28 items related to dealing with statistics. A total score as well as six subscores including the following are generated with this instrument: Worth of Statistics, Interpretation Anxiety, Test and Class Anxiety, Computation Self-Concept, Fear of Asking for Help, and Fear of Statistics Teacher. Reliability for each of the subscales ranged between .68 to .94 with a median of .88 (Worth of Statistics .94, Interpretation Anxiety .87, Test and Class Anxiety .69, Computational Self-Concept .88, Fear of Asking for Help .89, and Fear of Statistics Teachers .80). Validity evidence of STARS to other variables was reported. The STARS had a strong correlation (r = .76) to the Math Anxiety Scale (Roberts & Bilderback, 1980). The instrument was normed with 1,150 university students enrolled in statistics courses.

The independent variable, attitude toward statistics, was measured by the Attitude Toward Statistics (ATS) scale (Schultz & Koshino, 1998). This is a 29 item, 5-point Likert scale ranging from strongly disagree to strongly agree. A total score and two subscale scores, Attitudes Toward the Field and Attitudes Toward the Course, are obtained from the instrument. Both subscales were reported as reliable with Cronbach’s alpha at .92 for Attitudes Toward the Field and .91 for Attitudes Toward the Course (Wise, 1985). The ATS was reported to have strong concurrent validity with the Statistics Attitude Survey. The norm group consisted of 162 university students enrolled in an introductory educational statistics course.

The third independent variable, social support, was measured by the Multidimensional Scale of Perceived Social Support (MSPSS) (Zimet, Powell, Farley, Werkman, & Berkoff, 1990). The instrument has 12 items and utilized a 7-point Likert scale ranging from very strongly disagree to very strongly agree. A total score and three subscale scores (support from significant others, support from family, and support from friends) were obtained. The instrument was reported as reliable with Cronbach’s alpha coefficients reported as .85 to .91 for the three subscales. Test-retest values ranges from .72 to .85. Zimet et al. reported significant correlations between the MSPSS subscales and the Depression and Anxiety subscales of the Hopkins Symptom Checklist as evidence of construct validity for their instrument. The norm group consisted for 275 university students at Duke University.
Data Analysis
A simultaneous multiple regression was analyzed to determine the extent of the relationship between graduate students’ self-efficacy to learn statistics and statistics anxiety, attitude towards statistics, and social support. Alpha level was set at .05 for the analysis and semipartial correlation coefficients were assessed for practical significance. The multiple regression was repeated, removing social support from the analysis to explore any moderating effects of social support on the model.

Results
Descriptive statistics of the sample data are displayed in Table 1 and sample scores for the assessments with a comparison to the maximum and minimum scores for the instruments are included in Table 2. Self-efficacy to learn statistics scores were normally distributed (SW(173) = .986, p = .076) and the box plot for the criterion variable confirmed normality as well. Standardized residuals also were normally distributed (SW(173) = .988, p = .159) and the box plot for the standardized residuals and scatterplots confirmed normality of the error variance or homoscedasticity. Scatterplots were analyzed for linearity, and it was determined no curvilinear relationships between the criterion variable and predictor variables were evident. Statistics anxiety and attitude towards statistics were highly correlated (-0.83), indicating multicollinearity.

There was a statistically significant relationship between self-efficacy to learn statistics and statistics anxiety, attitude towards statistics, and social support: F(3, 162) = 60.489, p < .001. A moderate effect size was noted with 52.8% of the variance accounted for in the model, R2 = .528. Statistics anxiety and attitude towards statistics were statistically significant predictors of self-efficacy to learn statistics and accounted for 3% and 7% of the variance, respectively. Social support was not a statistically significant predictor of self-efficacy to learn statistics and accounted for .1% of the variance. When social support was removed from the analysis, there was no change in statistical or practical significance.

Discussion

This study sought to explore the relationships of graduate students’ self-efficacy to learn statistics, statistical anxiety, attitudes towards statistics, and social support. The scores from the various instruments identifying each of the aforementioned variables produced both negative and positive correlations among each other. A statistically significant relationship was found among self-efficacy and statistical anxiety, attitudes towards statistics and social support indicating the importance of the graduate students’ belief in their competence of facing the challenges of learning statistics. However, there was no change in the relationship when social support was removed from the analysis; thus, it was not a contributing variable. Statistics self-efficacy scores from participants indicated moderate responses which mirrored the prior studies involving undergraduate students (Pajares, 1996; Zimmerman, 2000). As this was the first study that investigated graduate students, these results create a path for future research.

There was a negative correlation between self-efficacy to learn statistics and statistical anxiety of the graduate students. The negative correlation is consistent with Onwuegbuzie’s (2000) findings. Participants reported the lowest responses in the Fear of Asking for Help and Worth of Statistics subscales, signaling graduate students reluctance for asking for assistance from the professor and peers as well as a low belief in the applicability and purpose of statistics. Overall, these results and the negative correlation between self-efficacy and anxiety seem to depict a kind of self-fulfilling prophecy that graduate students assume when faced with taking statistics which is similar to Perney and Ravid’s (1991) report.

A positive correlation was found between self-efficacy to learn statistics and attitudes towards statistics. This results indicated that the better the attitude of the graduate students towards statistics, the higher self-efficacy beliefs to learn the subject. Results indicated a more moderate response to attitudes not found in other studies where students were coming in with a negative attitude or were developing negative attitudes towards the end of the course (Gal & Gingsburg, 1994). It may be considered that graduate students in this study were neutral in their attitudes towards learning statistics without extreme reactions.

Participants reported a high level of social support, which indicates that most of the graduate students believed they had adequate support. The sample perceived social support as an influential factor in their lives, which is similar to most college student population reports (Solberg & Villarreal, 1997). However, social support was not a statistically significant predictor of self-efficacy to learn statistics. Also, when this variable was removed from the multiple regression analysis, there was no statistical or practical change in the regression. The insignificant result implies that social support was present for students, but it did not interact as a buffer between variables and possibly decrease anxiety or increase positive attitudes as indicated by Bonilla (1997), Cohen and McKay (1984), and Solberg and Villarreal (1997). Thus, social support may possibly help one cope but not necessarily remove the problem, change attitudes, or change thinking.

Multicollinearity between statistics anxiety and attitude toward statistics suggests an interrelationship between the two variables (Gall et al., 2007). Both variables may be measuring the relatively same characteristic; thus, neither variable may have brought something completely new to the analysis. It is interesting to note that statistics anxiety and attitude toward statistics as measured by the instruments in this particular study may be focusing on the same phenomenon.

Significance

There were multiple benefits of this study. First, this study contributed to counselor education and student support services by increasing our knowledge of self-efficacy to learn statistics as experienced by graduate students. It also is significant because it documented students’ experiences, which may act as a spring board for (a) future research, (b) implementing support interventions to increase statistics self-efficacy or success in statistics courses, and (c) helping students prepare for intrapersonal challenges that might impact their success in statistics. Each of these improvements are beneficial because they may increase graduate student self-efficacy and success in statistics courses as well as increase the incorporation of statistics into professional work after graduation.

Recommendations for Counselor Educators

Decreasing anxiety among graduate students is vital to developing high levels of self-efficacy towards statistics. Implementing numerous opportunities for students to engage in research throughout their graduate studies allows for opportunities to be exposed to statistics, thus increasing students’ confidence when faced with taking a statistics course. Also, inserting research and statistics into the curriculum of every graduate course exposes graduate students to the terminology and the function statistics play in their development as professionals. Possible ways to decrease statistical anxiety are through language and experience. Allowing graduate students to learn what is being said in a statistics course through weekly vocabulary tests can be one example of decreasing their anxiety. Also, getting the students involved with their own research throughout their course of study will help in promoting statistics mastery.

Improving attitudes towards statistics can help graduate students reframe their negative views towards the course. Helping graduate students to choose a positive view, explore origins or core of negative attitudes, and to appreciate the usefulness of statistics in their profession are good starting points for developing salient attitudes towards the subject. Counselor educators in a position to help graduate students confront negative attitudes, model positive attitudes and enthusiasm for statistics, and place a high value on statistics through verbal support and high expectations of research and statistics for students in graduate programs. The professor teaching statistics can play a key role in positively impacting their students’ attitude toward the subject. Injecting humor, displaying empathy, providing a safe space for students to talk about their challenges, and celebrating their small successes can be tools in combating negative attitudes. Anecdotal stories of statistics professors engaging in statistical rap songs have been reported to successfully alleviate attitudes towards the subject as well as provide a positive environment to engage in learning.

Limitations of the Study

There were limitations to this study. For instance, graduate students in counseling and education related programs were recruited for the study; thus, due to the general nature of the population, there were a disproportionate number of females and Caucasian students in the sample. As a result, a diverse sample was not obtained. However, a representative sample was acquired. Also, there were four scales for participants to answer in the study, therefore putting a time constraint burden on students to finish the instruments. Finally, these instruments were self-reporting, which can promote bias in how the graduate students answered (Gall et al., 2007).

Suggestions for Future Research

Future research should expand investigations into statistics self-efficacy predictor variables that include number of statistics courses taken, previous statistics experience, and broad demographics of graduate students to include more participants representing the various races and ethnicities, marital status, and life experiences. Longitudinal studies to monitor how statistics self-efficacy changes for graduate students over time would provide a snapshot of the development of attitudes throughout their graduate study tenure. Experimental designs to assess classroom and counseling based intervention effectiveness in reducing anxiety and improving attitudes should be conducted to improve the reliability of students learning statistics and influence the participation of conducting their own research for the betterment of the counseling profession. Finally, qualitative studies need to be conducted to better capture students’ experiences in statistics classes.

Conclusion

Researching predictors of graduate students’ statistical self-efficacy beliefs is important to identifying possible barriers to professional growth and development. Exploring how statistical self-efficacy beliefs relate to predicting future academic expectations, performance, effort, persistence, and course selection (Pajares, 1996; Zimmerman, 2000) also is important to explore as a means of promoting professional development (Lent et al., 1984, 1986).

Graduate students who believed they were incapable of achieving success in a statistics course demonstrated higher levels of anxiety (Onwuegbuzie, 2000). This anxiety was pervasive among the 75% to 80% of graduate students in the social sciences profession in previous research studies (Onwuegbuzie et al., 2000), as well as to the 53% of the graduate students in this study. Additionally, graduate students hold off from taking a statistics course due to their negative attitudes towards the subject matter (Gal & Gingsburg, 1994). Teaching graduate students how to reduce their anxiety and improve their attitude will likely enhance their value of statistics and further encourage their professional development in the counseling profession.

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Michelle Perepiczka, NCC, and Nichelle Chandler, NCC, are professors at Walden University. Michael Becerra, NCC, is an Assistant Professor at the University of Alabama. Correspondence can be addressed to Michelle Perepiczka, Walden University, School of Social Work and Human Services, 100 Washington Avenue South, Suite 900, Minneapolis, MN, 55401,
mperepiczka@gmail.com.

Silent Suffering: Children with Selective Mutism

Sep 5, 2014 | Article, Volume 1 - Issue 1

Lisa Camposano

Despite increasing awareness, the childhood disorder of selective mutism is under-researched and commonly misdiagnosed. The purpose of this article is to highlight current issues related to this disorder as well as describe various treatment approaches including behavioral, cognitive-behavioral, psychodynamic, family, and pharmacological interventions. Suggestions for counselors working with children with selective mutism and implications for future research are offered.

Keywords: selective mutism, childhood disorder, children, etiology, treatment approaches

Although early references occurred 125 years ago, very little has been written about selective mutism (Steinhausen, Wachter, Laimbock, & Metzke, 2006). This disorder remained relatively obscure until 2006 when Newsday published an article entitled “Behind a Wall of Silence” that described an eight year-old girl’s struggle with speaking at school. Selective mutism appeared in the news again the following year when it was revealed that Seung-Hui Cho, the shooter in the Virginia Tech massacre, was diagnosed with selective mutism as an adolescent (Kearney & Vecchio, 2007). Despite media coverage and growing public awareness, little research is being dedicated to examining this unique condition.

The lack of quality research and general awareness of selective mutism are serious barriers to helping children who suffer from this disorder. Too often, these children are misdiagnosed or labeled as “just shy.” Schwartz, Freedy, and Sheridan (2006) surveyed 27 parents having a total of 33 children with selective mutism. Their survey revealed that primary care physicians either misdiagnosed or never referred about 70% of these children. The authors explained: “Selective mutism has largely gone unnoticed by most physicians who are not familiar with the key signs and symptoms. Pediatricians commonly assume that the patient with selective mutism is simply exhibiting excessive shyness and reassure the parents that it is something the child will outgrow” (pp. 43–44). Within the same group of survey participants, an accurate diagnosis did not occur until an average of nearly a year after the parents expressed concerns to a medical doctor (Schwartz et al., 2006). Within school settings, labels such as autistic, language delayed, defiant, or learning disabled saddle such children with inappropriate or ineffective interventions. In many circumstances, parents simply wait for the child to “outgrow” this disorder, not realizing that the absence of proper treatment can lead to lifelong psychological problems (Shipon-Blum, 2007).

The purpose of this article is to increase awareness about selective mutism as well as provide an overview of current issues associated with this disorder. Major themes related to etiology and current trends in treatment will be addressed. The importance of early intervention and participation of family members and school personnel in the treatment process will be stressed. This article will conclude with suggestions for future research, the counseling profession, and counselor training.

Definition of Selective Mutism and Prevalence

Selective mutism is described as “persistent failure to speak in specific social situations (e.g., school, with playmates) where speaking is expected, despite speaking in other situations” (American Psychiatric Association, 2000, p. 125). Children with selective mutism often engage, interact, and communicate verbally within comfortable surroundings, such as at home or with trusted peers. These children are capable of speaking and understand their native language. However, when placed in structured social settings such as school, they are mute and socially withdrawn (American Psychiatric Association, 2000).

Social skills among children affected by selective mutism vary greatly (Amir, 2005). These children are usually unable to verbally communicate when approached by an adult, yet social interaction among peers can vary. Some children interact easily with peers in and outside of the home. Other children interact with peers, but do not verbally communicate with them. A third group remains completely withdrawn in social settings (Amir, 2005). Aside from verbal communication, many children with selective mutism are inhibited in other ways as well (McHolm, Cunningham, & Vanier, 2005). Avoidance of eye contact, lack of smiling, tantrums, blushing, and fidgeting are common symptoms associated with selective mutism (Dummit et al., 1997; Kristensen, 2001; Shipon-Blum, 2007).

Recent studies suggest that selective mutism may occur in .7 to 2% of early elementary students, although many researchers agree that these prevalence rates may be underrepresented due to the lack of knowledge of the disorder (Cunningham, McHolm, & Boyle, 2006; Lescano, 2008; Schwartz et al., 2006; Sharkey, McNicholas, Barry, Begley, & Ahern, 2007). Most investigators report that selective mutism seems to occur more frequently among girls (Cohan, Chavira, & Stein, 2006; Dummit et al, 1997; Lescano, 2008; Mendlowitz & Monga, 2007; Sharkey et al., 2007; Steinhausen & Juzi, 1996). Symptoms of selective mutism are usually present by the age of three, but this disorder is frequently not identified until the child enters school where there is an increased expectation to speak within social settings (Cunningham, McHolm, & Boyle, 2006; Sharkey & McNicholas, 2008). Entrance into the school environment appears to be a salient and definitive landmark for children with selective mutism.

Etiology

There is little consensus regarding the etiology of selective mutism. Psychoanalysts have cited unresolved internal conflicts as the cause of selective mutism (Cohen et al., 2006). Family systems theorists argue that children with selective mutism are part of faulty family relationships (Anstendig, 1998). Kratochwill (1981) states that behavioral therapists “have perceived mute behavior as a function of antecedent and consequent environmental events that vary across situation, people, and time” (p. 137). Early theorists argued that trauma or major life events, such as abuse or the death of a loved one, trigger the onset of selective mutism (Dow, Sonies, Scheib, Moss, & Leonard, 1995). However, according to more recent studies, children who have experienced trauma are not more likely to develop selective mutism, and early childhood trauma is rarely associated with the development of the disorder (Gray et al., 2002; Steinhausen & Juzi, 1996). In fact, Dummit et al. (1997) found no evidence of trauma among their case study participants. Therefore, isolating a single cause or traumatic event does not appear to be helpful in identifying selective mutism, thereby confusing diagnostic attempts.

Current conceptualizations of selective mutism link the disorder to anxiety, namely social phobia (Cunningham et al., 2006; McHolm et al., 2005; Sharkey & McNicholas, 2008). This particular phobia prohibits children from interacting and communicating within social settings, such as school and birthday parties. McHolm et al. (2005) explain that just as a young child can develop a fear of spiders or heights, for example, children with selective mutism have developed a fear of talking that is further crippled by anxiety.

Research has shown that anxiety disorders generally run in families. With regard to selective mutism, parents of children who have selective mutism are likely to exhibit signs of moderate to severe anxiety (Kristensen & Torgersen, 2001; Schwartz, Freedy & Sheridan, 2006; Shipon-Blum, 2007). Kristensen and Torgerson (2001) regarded selective mutism as a “family phenomenon” after they examined personality traits of parents of children with selective mutism (p. 652). According to their study, parents of selectively mute children were significantly more likely to have a history of shyness or social anxiety as compared to a control group. In a survey conducted by Schwartz et al. (2006), 33% of the participants reported a family member with social anxiety disorder and 12.1% had a family member with selective mutism. Despite the information obtained from the aforementioned case studies, it remains unclear how genetic and environmental factors affect the development of selective mutism among young children.

There also is mixed evidence concerning the association between developmental delays and selective mutism. In a study of 100 children with selective mutism (Steinhausen & Juzi, 1996), 38% of participants had a history of language delays or disorders. In contrast, other studies report no evidence of developmental delays among the participants (Black & Uhde, 1995). Definitive research in this area is lacking, and the link between developmental factors and selective mutism remains unclear.

Although the exact cause of selective mutism is unknown, researchers generally agree that selective mutism does not fall under the realm of speech/language disorders, communication disorders, defiant behavior, or shyness. In a recent article written by Kearney and Vecchio (2007), the researchers point out that “this disorder is not due to a communication disorder such as stuttering and it is not due to a lack of knowledge or comfort with language” because affected children speak well in certain situations (p. 917). A case study conducted by Schwartz et al. (2006) revealed that a very small percentage of children with this disorder have speech and/or language difficulties. Selective mutism is distinctly dissimilar from shyness due to the severity of anxiety and duration of symptoms. Shyness is not paralyzing like selective mutism and the vast majority of children who suffer from selective mutism do not fully overcome their anxiety without formal intervention (Stanley, n.d.). Finally, selective mutism has been described by some as oppositional; however this assumption implies that mutism is a conscious choice. This viewpoint is clearly disputed by recent research on this disorder (e.g., Cunningham et al., 2006; McHolm et al., 2005; Sharkey & McNicholas, 2008). Anxiety appears to be the most likely culprit at the core of this disorder. There is evidence that family history of anxiety often plays a role in the disorder while speech and language problems, along with willful opposition, do not seem to contribute to the development of selective mutism.

Approaches to Treatment

Because the etiology of selective mutism is unclear, there is much disagreement among researchers regarding effective treatment approaches. Additionally, scarce quality research has been dedicated to examining the effectiveness of individual treatment approaches and interventions. As Sharkey et al. (2007) notes: “Despite the very handicapping nature of this disorder and its negative impact on both short- and long-term functioning in children and adolescents, the evidence for effective treatments is sparse and predominantly in the form of single case reports or small series using a variety of techniques” (p. 539).

Although a systematic approach has not yet been developed, there are some common goals among varying treatment programs. An initial goal of treatment is to lower the child’s anxiety and develop healthy coping mechanisms for dealing with anxiety (Shipon-Blum, 2007). Interventions aimed at achieving this goal include relaxation skills, meditation, and breathing techniques. Increasing self-esteem and confidence in social settings is another integral objective of most treatment programs. The last and most evident goal is to increase verbal communication in social settings. As the final stage in the treatment process, increasing verbal communication may take years as well as long-term therapeutic intervention depending on factors such as the duration of the mutism and severity of symptoms.

Psychodynamic Approach

Early treatment approaches for selective mutism were mainly derived from psychodynamic theories. Interventions and techniques from this realm of therapy seemed to be the best fit as selective mutism was historically viewed as a result of unresolved inner conflicts or traumatic events during early childhood years (Kratochwill, 1981). Psychodynamic theorists describe mutism as a defense mechanism which the child utilizes rather than expressing feelings directly towards a parent, most commonly the mother (Cline & Baldwin, 1994). Through this approach, the primary goal of the counselor is not to directly address the mutism, but rather understand its origin (Cohen et al., 2006). This is accomplished by carefully examining the child’s early psychosexual stages of development as well as the mother-child relationship, then eventually addressing the fears directly with the child (Cline & Baldwin, 1994).

There exists a major pitfall in this type of therapeutic approach. Symptoms of this disorder are deeply rooted in anxiety; therefore, pressure to verbalize thoughts and feelings can overwhelm the child. While expression can be accomplished through nonverbal means such as art therapy, substantial conversation and uninhibited free association are extremely difficult to achieve. It is more likely that the child will become tense and freeze up when placed in the structured setting of the counselor’s office and asked to communicate. Shipon-Blum (2007) explains that psychological approaches are effective only when “all pressure for verbalization is removed and emphasis is [placed] on helping the child relax and open up” (p. 6). When pressure to verbalize is reduced, anxiety decreases and therapeutic interventions can subsequently occur.

In 1963, Browne, Wilson, and Laybourne (as cited in Garcia, Freeman, Francis, Miller, & Leonard, 2004) examined the effectiveness of psychodynamic therapy for selective mutism and concluded that the treatment was costly and commonly yielded a poor outcome. Freeman, Garcia, Miller, Dow, and Leonard (2004) added that there are no major case studies or research to provide evidence that these approaches are successful. While psychotherapy is rarely utilized as a primary mode of treatment for selective mutism today, psychodynamic projective interventions such as play, music, and art therapy are commonly utilized by counselors in conjunction with other treatment approaches. Research has shown that these projective, less verbal interventions have been effective to some degree (Shreeve, 1991; Tatem & DelCampo, 1995).

Play therapy can offer a safe environment in which the counseling relationship is established without placing pressure on the child to speak (Hultquist, 1995). While describing the benefits of using psychotherapy with anxious children, Terr (2008) claims that effective therapy for anxiety disorders such as selective mutism “won’t truly begin until [the spirit of play] is established” (p. 101). Additionally, music therapy can assist children with selective mutism to express their thoughts or feelings via nonverbal means as well as reduce anxiety through musical expression. Amir (2005), the director of a music therapy program at an Israeli university, describes her two-year experience of working with a selectively mute child. She concluded that the therapy sessions encouraged “feelings of safety” and served as “a container and foundation where heavy feelings and emotions [could] be explored” (p. 75). Furthermore, Amir claims that a trained music therapist can interpret music created by the child in order to establish a bridge to the child’s “inner world” (p. 76). Similar to music therapy, art therapy provides a mute child with a nonverbal way to articulate feelings and fears. Cline and Baldwin (1994) noted that art therapy provides a “springboard for verbal communication” (p. 80). While these interventions are not generally used as primary modes of treatment, play, music, and art therapy can improve self-esteem and provide the counselor with an opportunity to build rapport and create a safe, inviting environment for the child.

Behavioral Approach

Researchers from the behavioral perspective view selective mutism as a learned behavior developed as a coping mechanism for anxiety. Therefore, the purpose of treatment is to decrease anxiety and increase verbal communication in settings such as school (Cohan et al., 2006). This approach incorporates practice and reinforcement for speaking in subtle and non-threatening ways. Emphasis is placed on observable behavior rather than early childhood development (McHolm et al., 2005).

Behaviorists rely on various techniques, such as shaping, self-modeling, and contingency management, to increase verbal communication and lower anxiety. Shaping, sometimes referred to as a ritual sound approach, is the procedure in which the counselor reinforces mouth movements and sounds that resemble speech (Mendlowitz & Monga, 2007; Shipon-Blum, 2010). This strategy involves breaking down the target goal of verbal communication into smaller steps in order to minimize anxiety. The exact sequence will vary according to the child, but some steps may include mouthing words, making sounds, whispering, repeating a word the counselor has said, and eventually increasing volume of speech (Cline & Baldwin, 1994; Lescano, 2008).

Another commonly-used strategy to elicit speech is a two-part process known as self-modeling. Using an audio or video recorder, the child speaks and answers questions within a comfortable environment. The tape is then edited to portray the child speaking in settings such as school. The child listens to the tapes repeatedly, often in the company of family members or friends, in order to become accustomed to hearing him/herself speak in these settings (Blum, Kell, & Starr, 1998). A variation of this strategy may include family members who are recorded while asking questions such as those the child might hear in school (Cline & Baldwin, 1994). The child then practices giving oral answers. Case reports (e.g., Kehle & Owen, 1990; Pigott & Gonzales, 1987) have noted successful treatment outcomes after utilizing this strategy with selectively mute clients. This technique is frequently used in many behavioral and eclectic treatment approaches, but Blum, Kell, and Starr (1998) note that taping can increase anxiety and may not be suitable for all clients.

Contingency management refers to the use of positive reinforcement as encouragement for the child to practice verbalizations. As early as the 1930’s, Skinner (1938, 1971, as cited in Neukrug, 2007, p. 101) showed that specific behaviors would be repeated if positive reinforcement were given as soon as the behavior occurred. Contingency management is often used in conjunction with systematic desensitization in which the counselor sets goals of increasing difficulty with corresponding rewards for each leveled task that is completed (Lescano, 2008). This hierarchy of tasks is created with a consideration of locations, activities, and people that affect the child’s comfort level (McHolm et al., 2005). Similar to systematic desensitization, stimulus fading is commonly used to gradually increase the number of people in the room or classroom as the child practices verbalizations. Positive reinforcement often accompanies treatments involving stimulus fading.

While psychodynamic approaches were formally the treatment of choice by many counselors and researchers, behavioral interventions are currently included in most treatment programs for selective mutism. This type of treatment provides a step-by-step approach that can be easily modified to fit the changing needs of the child. Behavioral techniques, such as shaping and self-modeling, are rarely used in isolation so it is difficult to assess the effectiveness of any single strategy. As a complete entity, behavioral treatment has been carefully researched and numerous studies have shown efficacious outcomes of this type of treatment (e.g., Gray et al., 2002; Kehle & Owen, 1990; Lescano, 2008).

Cognitive-Behavioral Approach

While the success of behavioral interventions is rarely disputed, the behavioral approach to therapy does not place emphasis on an individual’s anxious thoughts. Some researchers consider this a major flaw and stress the importance of restructuring thought processes. The cognitive-behavioral approach to treatment, or CBT, is a practical, action-based treatment program that incorporates many of the aforementioned behavioral techniques such as systematic desensitization and stimulus fading. However, CBT is different from behavioral approaches because it has an additional dimension that stresses anxiety management education (Chansky, 2004). Chansky (2004) explains that during CBT, both children and parents develop “a specific set of skills to address the thoughts, physiological responses, and behaviors associated with anxiety” (p. 47). Treatment also requires children to use problem-solving and employ self-talk (McHolm et al., 2005). The ultimate goal of CBT is to help children modify their behavior by assisting them in redirecting their anxious fears and worries in healthy ways (Shipon-Blum, 2007).

Cognitive-behavioral treatment includes several components in addition to behavioral techniques. An important aspect of CBT is assessment. Many early sessions are solely dedicated to identifying factors that contribute to the child’s anxiety (Chansky, 2004). The information obtained in these interviews guides treatment and provides a foundation when planning therapeutic activities. Shipon-Blum (2002), for example, has developed a continuum for ongoing assessment that ranges from non-communicative to initiating verbal communication, with many stages of nonverbal and verbal communication in between. This continuum is used to assess a child’s level of anxiety within different settings as well as to set and modify goals for treatment. Since levels of anxiety are likely to elevate during behavioral interventions, particularly systematic desensitization and stimulus fading, children are taught relaxation skills in order to manage anxiety before applying such techniques (Cohan et al., 2006). These skills may include breathing techniques, muscle relaxation, or story telling (Sharkey & McNicholas, 2008).

Once research linked selective mutism to anxiety, evidence-based CBT interventions that were previously used to treat other anxiety disorders in children and adolescents were commonly incorporated in the treatment of selective mutism (Mendlowitz & Monga, 2007). One of these interventions, cognitive restructuring, has been utilized to call attention to and minimize negative or anxiety-producing automatic thoughts (Chansky, 2004). In its conventional form, this type of intervention requires the client to share and express feelings to the counselor. This clearly presents an obstacle when working with children who are selectively mute and are not comfortable talking in certain situations, such as a counselor’s office (McHolm et al., 2005). If a child can be expressive using nonverbal means, or if a child is comfortable enough to speak to the counselor, cognitive restructuring can assist a child in learning to cope by thinking realistically. It is important to mention that a child’s cognitive development dictates how well this intervention may work. Therefore, this intervention may be most effective with older children having average to above-average intelligence and the ability to think flexibly and in abstract ways. Despite these limitations, cognitive restructuring is an important element in the treatment process for some children.

Cognitive-behavioral treatment has gained attention from researchers of this disorder. Recent case studies and reviews (e.g., Cohan et al., 2006; Mendlowitz & Monga, 2007; Schwartz et al., 2006; Woodcock, Milic, & Johnson, 2007) have demonstrated the success of CBT in treating children suffering from selective mutism. Additionally, the safe nature of this type of treatment along with its high success rates, make it popular. Perhaps its most significant drawback is the amount of time and patience required of the counselor. Mendlowitz and Monga (2007) estimated that children suffering from selective mutism require five to six times more CBT intervention sessions than children suffering from generalized anxiety or separation anxiety.

Pharmacological Approach

Sometimes a child’s symptoms are so debilitating that fully engaging in a counseling treatment program seems challenging. In such cases, researchers may initially utilize pharmacological interventions to assist the child in overcoming anxiety associated with the disorder so that other treatments can subsequently occur. This type of intervention may include selective serotonin reuptake inhibitors (SSRIs) or monoamine oxidase inhibitors (MAOIs) (Kearney & Vecchio, 2007). While pharmacotherapy is not generally recommended as the primary treatment, the use of medication can often facilitate CBT or other interventions (Kumpulainen, 2002). Once anxiety levels have been reduced via medication, verbal communication may become less challenging for the child.

The effectiveness of pharmacological interventions is perhaps one of the most widely debated issues related to this disorder. Shipon-Blum (2007) deems a combination of behavioral techniques and medication the best approach to treating selective mutism, while Black and Uhde (1995) noted that the differences between pharmacologically treated and non-treated groups were mostly insignificant. Kumpulainen (2002) reported that pharmacological interventions could be helpful when treating selectively mute children, but also warns that medication should be used in conjunction with other therapy modalities only when they are not independently successful. It is important to note that the short- and long-term effects of pharmacotherapy remain unclear. While Kumpulainen (2002) reported that participants seldom reported any harmful effects of the medication, Kearney and Vecchio (2007) admit that there are no large-scale studies of pharmacotherapy for selective mutism.

Family Counseling/Therapy

Family counseling or therapy is often a necessary component of an effective treatment plan for children with selective mutism. Meyers (1984) noted dysfunction within the families of children with selective mutism. Other studies have cited higher rates of marital conflict and divorce among families of children with selective mutism when compared to controls (Viana, Beidel, & Rabian, 2009). Researchers from the family systems perspective have hypothesized that a child’s mutism serves a certain function within the family (Anstendig, 1998). Therefore, it may be beneficial for all members of the family to participate in counseling in order to resolve underlying family issues that may have maintained the mutism. In general, the goal of family intervention in relation to selective mutism is to identify faulty family relationships and communication patterns that may have contributed to the development of the child’s anxiety. The counselor would subsequently aim to help family members remove conditions that are causing the child’s anxiety and maintaining the mutism (Cohan et al., 2006).

While research concerning the effectiveness of family counseling is scarce, it is evident that the cooperation and participation of parents in the treatment has a positive impact on recovery (e.g., Kumpulainen, 2002; Mendlowitz & Monga, 2007; Sharkey et al., 2007). In fact, Sharkey and McNicholas (2008) deemed parental involvement as the “key ingredient in treatment success” (p. 544). Acceptance and understanding of the disorder is crucial, and parents should not place emphasis on the lack of verbal communication. Shipon-Blum (2007) emphasizes the importance of parent participation during the treatment process: “Praise should be given for the child’s accomplishments and efforts, and support and acknowledgement should be given for their difficulties and frustrations” (p. 5). Treatment programs often require parents to modify their parenting styles as well as develop healthy coping skills for handling stress and fear. Anxiety management education is often integrated with treatment so that parents are equipped to model healthy coping abilities for their children (Mendlowitz & Monga, 2007).

Counselors also may encourage parents to consider the amount of attention that is given to the child’s nonverbal behavior (Beidel & Turner, 1998). A child’s lack of verbal responses can result in a sibling or parent consistently answering for the child or overcompensating by frequently calling attention to the child’s strengths or talents. In a case study by Sharkey et al. (2008), researchers trained parents to ignore their child’s mutism and reinforce verbal behaviors by consistently responding to these behaviors with empathy, enthusiasm, and warmth. Shifting attention to verbal behaviors rather than nonverbal behaviors provides positive reinforcement for such actions.

Multifaceted Approaches

Due to the complex nature of this disorder, there exists strong support for treatment programs for selective mutism to be multifaceted, address anxiety in a variety of settings, and involve teachers, peers, parents, and other family members during the treatment process. Therefore, an eclectic approach is the most common treatment option currently used by counselors. Countless researchers have successfully combined psychodynamic, behavioral, cognitive-behavioral, pharmacological, and/or family counseling interventions. An example of a successful eclectic treatment approach was described by Wright, Cuccaro, Leonhardt, Kendall, and Anderson (1995) in a preschool-aged child. This treatment included behavioral interventions, play therapy, family therapy, and pharmacotherapy. Jackson, Allen, Boothe, Nava, and Coates (2005) also used a multifaceted approach consisting of shaping, systematic desensitization, play therapy, parent journaling, and relaxation training to successfully treat a six-year-old boy with selective mutism. While this type of treatment approach has consistently appeared to be effective in published case studies, more research is needed to reveal which components of these programs are essential.

Importance of Early Diagnosis and Intervention

Early, accurate diagnosis and intervention are crucial to overcoming selective mutism regardless of the type of treatment program. Research suggests that treatment for this disorder is most effective if it begins as soon as symptoms of the disorder become apparent, thus minimizing the amount of negative reinforcement for these behaviors (e.g., Schwartz et al., 2006; Stone & Kratochwill, 2002). Shipon-Blum (2007) explains: “The earlier a child is treated for selective mutism, the quicker the response to treatment and the better the overall prognosis. If a child remains mute for many years, his or her behavior can become a conditioned response where the child literally becomes accustomed to nonverbalization as a way of life” (p. 5).

Shipon-Blum (2007) warns that if selective mutism is left untreated, the academic, social, and emotional repercussions may include depression, social isolation, poor academic performance, self-medication with drugs and alcohol, and suicide. Furthermore, Chansky (2004) points out that untreated anxiety associated with selective mutism also can lead to adverse health effects including cardiac, immune, and respiratory problems. Thus, early intervention provides more opportunity for successful treatment and, in the long term, a healthier, more functional child.

Role of School Personnel in Treatment

School personnel, especially teachers, play crucial roles in the treatment of selective mutism. Because the symptoms of this disorder are more evident once the child begins school, teachers often become responsible for making a referral for diagnosis. Most school personnel do not have the expertise or experience to deal with this disorder single-handedly, but it is important that teachers recognize anxious tendencies among these children and solicit the help of a school psychologist or counselor in order to make prompt referrals. Once an accurate diagnosis is made, studies (e.g., Kumpulainen, 2002; Lescano, 2008; McHolm et al., 2005) have shown that the willingness of the teacher and other school personnel to collaborate with the parent(s) and counselor affects the outcome of the treatment program. A multidisciplinary team that includes the child’s teacher, principal, school counselor, and/or school psychologist may collaborate with the parent and contribute observations and feedback to the counselor (Lescano, 2008; McHolm et al., 2005). Vecchio and Kearney (2007) indicated that this team approach may be helpful in treatment “because of the widespread nature of the child’s [speech] avoidance” (p 41).

Teachers may assist in reinforcing behavioral treatment techniques as well. For example, a teacher may provide positive reinforcement for verbalizations in school or participate in a video recording which the child will use to practice formulating verbal responses to questions. The teacher also may help to minimize anxiety while the child is in school. Shipon-Blum (2003) emphasizes the importance of a caring classroom teacher who understands the behavioral characteristics of the disorder and allows the child to communicate by nonverbal means as long as necessary. A nurturing, comforting classroom environment and flexibility within the classroom setting and schedule also are important factors in a multifaceted treatment program (Shipon-Blum, 2003). Overall research, therefore, supports both an individual and systematic approach that includes school personnel for the treatment of selective mutism.

Summary and Commentary

As described in this article, selective mutism is a complex psychological disorder with an unknown origin. There is general agreement that selective mutism is characterized by a child’s inability to speak in certain social settings despite the ability to speak in other situations. Nonetheless, there is disagreement among researchers regarding the most efficient and definitive treatment approach. Treatment has included a variety of psychodynamic, behavioral, cognitive-behavioral, pharmacological, and family systems methods. It seems that these approaches are rarely used in isolation; rather treatment programs for selective mutism are usually multifaceted. The cooperation of parents and school personnel during treatment is crucial for positive outcomes, and early intervention can minimize the long-term psychological effects (Kumpulainen, 2002; Shipon-Blum, 2007).

Suggestions for Counselors

While the main purpose of this article is to raise awareness of this disorder and its varying treatment options, counselors who are treating children with selective mutism should prioritize goals during treatment. Less emphasis should be placed on the absence of verbal communication, especially during the initial stages of counseling. An immediate goal is to build rapport and a trusting counseling relationship with the child. Once rapport is established, anxiety reduction is a vital component of any treatment plan for selective mutism. Behavioral strategies, such as stimulus fading and systematic desensitization, that are implemented before healthy coping skills are established will likely increase a child’s anxiety and delay further treatment. In addition, it is important that the counselor and parent(s) work together to build the child’s self-esteem and confidence, especially in social settings. Once anxiety levels are lowered and a child’s confidence is established, verbal communication interventions will likely follow.

Additionally, it is vital that counselors design multifaceted therapy programs when treating children with selective mutism. Due to the complex nature of this disorder, eclectic treatment addresses varying symptoms and psychological effects caused by selective mutism. A multidisciplinary team should be established to assist the child in treatment. As discussed earlier, school personnel play an important role on this treatment team since the child’s mutism is likely to be most apparent at school. These professionals may aid the counselor by providing regular monitoring of progress and implementation of behavioral interventions.

Lastly, it is important that a counselor take into consideration the amount of time and patience required to implement a treatment program for selective mutism. A thorough and detailed assessment is first required to determine factors affecting the child’s mutism. Jackson et al. (2005) recognized “an in-depth analysis of the client and his or her environment” as a precursor for treatment (p. 107). After the initial stages of treatment and assessment, it is anticipated that the counselor will spend a considerable amount of time working outside of the office (Vecchio & Kearney, 2007). The counselor may conduct observations at the child’s school, meet with the child’s teacher and school counselor, and interact with the child in various social settings in order to effectively monitor and adjust treatment goals and implement appropriate interventions. If the counselor is unwilling or unable to devote such a level of time and dedication, a referral to another counseling professional with knowledge of this disorder should be provided to the client.

Suggestions for Future Research

Selective mutism has gained considerable national and global attention, particularly due to several magazine and professional articles recently published about this disorder. As a result, awareness is increasing while quality research on this serious disorder is scarce. Evidence for effective treatment has been predominantly presented in the form of single-case studies using a variety of techniques. Within these studies, the duration of treatment and follow-up time is brief and the age range is narrow, usually addressing only the needs of younger elementary school children (Cohan et al., 2006). In order to better understand selective mutism and the treatment approaches that best minimize its associated symptoms, it is imperative that large-scale studies are conducted with a focus on the efficacy of isolated techniques.

Beare, Torgerson, and Creviston (2008) described interventions used to increase the verbal behavior of a 12-year-old boy with selective mutism. These researchers exclusively utilized positive reinforcement to successfully increase verbalizations in three different settings. This is the only known case study where a single intervention was isolated and its effectiveness examined. It is important to note that case studies have limitations, involve a limited number of participants, and often lack control groups, as did this study. Despite such limitations, this study provides a springboard for further research on isolated interventions and will hopefully precipitate large-scale research devoted to examining effective treatment interventions for selective mutism.

In addition, research should be specifically devoted to examining the impact selective mutism has on long-term social development. It is logical to expect some level of social maladjustment regarding development of social relationships with peers given that children with selective mutism have limited social interactions. This is supported by research that has linked anxiety disorders, specifically social phobias, with social withdrawal and other difficulties regarding sociability (Beidel, Morris, & Turner, 2004). Nonetheless, case studies (e.g., Cunningham et al, 2004; Kumpulainen, 1998; Pelligrini, Bartini, & Brooks, 1999) imply that children with selective mutism are not bullied or victimized more than children who do not have selective mutism. More research is needed in this area to determine the extent of social maladjustment among children with selective mutism. Additionally, research should be devoted to investigate long-term effects of this disorder after the mutism is overcome. For example, exploring the ability to form relationships during teenage and adult years may help clarify the impact of mutism on long-term social development.

While an increasing amount of literature on selective mutism has been published during the last fifteen years, studies involving school personnel are virtually nonexistent. Children with selective mutism spend several hours each day with school professionals who are often involved in treatment interventions. More importantly, school is frequently the setting in which these children have the highest level of anxiety and mutism. Research has shown that teachers’ involvement in the treatment process is vital to positive treatment outcomes (e.g., Kumpulainen, 2002; Lescano, 2008), yet their role in the treatment process is rarely described in the research. There is an urgent need to carefully examine these children’s behaviors and interactions in the classroom during treatment, as well as interventions performed by the teacher. Such information would be vital to determining the overall effectiveness of treatment programs, specifically within the school setting.

Suggestions for Counselor Training

In addition to the recommendations pertaining to research and the counseling profession, it is important that counselor education provide training for treating this disorder. It is imperative that counselors, especially school counselors or counselors working with children, be trained in identifying the signs and symptoms of selective mutism. This training should stress that selective mutism be treated as an anxiety disorder, and the difference between this disorder and shyness, autism, or speech/language disorders should be emphasized. Additionally, instruction on non-verbal assessment tools should be provided as this is an ongoing aspect of treatment. Finally, counselors should be trained to work cooperatively with school personnel and parents when treating children with anxiety-related disorders, including selective mutism, because empathetic and knowledgeable school personnel are assets to successful treatment programs.

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Lisa Camposano is a fourth grade teacher at Millstone Township Elementary School, Millstone Township, NJ, and a graduate student in the CACREP-accredited program in School Counseling at The College of New Jersey, Ewing, NJ. The author thanks Dr. Mark Kiselica, The College of New Jersey, for his mentorship and encouragement throughout the writing process. The author also thanks the Sciscente family (with permission) for the inspiration to write this article. Correspondence can be addressed to Lisa Camposano, 308 Millstone Rd, Millstone, NJ, 08510,
LisaCamposano@yahoo.com.

Through a Glass Darkly – Envisioning the Future of the Counseling Profession: A Commentary

Sep 4, 2014 | Article, Volume 1 - Issue 3

Shannon Hodges

The counseling profession has experienced significant growth and diversification to become a viable member of the global mental health profession. Originally founded in the U.S. as the American Personnel and Guidance Association (APGA), the profession has expanded to the flagship American Counseling Association, 19 divisional affiliates, and licensure in all 50 states, Washington D.C., and Puerto Rico, the National Board for Certified Counselors, the International Association of Counselling (IAC) and numerous other global professional organizations. This manuscript will outline the counseling profession’s genesis, growth, enumerate current challenges, speculate on the profession’s future and offer concrete suggestions to ensure the profession’s continued viability in a rapidly evolving global age.

Keywords: counseling profession, professional organizations, global age, professional identity, future development

During its nearly six decades, the counseling profession has experienced significant growth, struggle, and division to emerge as a viable mental health profession. The world’s largest counseling organization, the American Counseling Association (ACA), began as the American Personnel and Guidance Association (APGA). Conceived in 1952 by a loose confederation of organizations, APGA was primarily “concerned with vocational guidance and other personnel activities” (Harold, 1985, p. 4). ACA has evolved from its “guidance” infancy into a multifaceted profession of over 45,000 members (D. Kaplan, personal communication, April 8, 2011) and 19 divisional affiliates (American Counseling Association, [ACA] 2010). In 1976 the State of Virginia passed the first counselor licensure law and 49 other states, the District of Columbia and the territory of Puerto Rico have since followed, making the counseling profession credentialed in all states and major territories. Most states have passed legislation establishing a counselor’s right to bill private health insurance (Remley & Herlihy, 2007) and recently the Veteran’s Administration has approved licensed counselors to work in VA hospitals. Currently, some 635,000 counselors work in schools, addictions, corrections, and public and private agency settings (Bureau of Labor Statistics, 2010–2011). The U.S. Bureau of Labor Statistics (2010) projects “employment for counselors is expected to grow much faster than the average for all occupations through 2016” (p. 209). Relative to its mental health colleagues, the counseling profession has achieved a stakeholder position in a shorter timeframe than the psychology and social work professions (Remley & Herlihy, 2007). The counseling profession also has expanded to Europe, Asia, Africa, Australia and South America. Achievements notwithstanding, the global counseling profession faces numerous pressing challenges. This manuscript will address key issues confronting the counseling profession and offer concrete suggestions to twenty-first century realities. Since the past, present, and future are interconnected, speculation on the counseling profession’s future requires a brief review of its past.

The Past: From Genesis to the Present

Frank Parsons created the guidance movement by opening an office for vocational counseling in 1909. By creating an approach where the counselor actively attended to what adolescents said about themselves, he countered the prevailing distant, Freudian orthodoxy. Parson’s approach was soon adopted by schools in 35 U.S. cities and collegiate training in counseling began at Harvard University in 1911. University counseling emerged as a specialty in the 1930s when E.G. Williamson published How to Counsel Students: A Manual of Techniques for Clinical Counselors (1939). Williamson’s method was diagnostic in orientation and soon became the prevailing approach in colleges, schools and agencies (Nugent & Jones, 2009).

Carl Rogers (1942) moved the mental health field in a radically different direction with the publication of Counseling and Psychotherapy. Rogers advocated a more process oriented nondirective approach referred to as client-centered therapy (Rogers, 1951). Though schooled in Freudian analysis, Rogers developed an approach focused on a present, humanistic encounter between counselor and client. Additional theoretical approaches emerged in the post-Holocaust era, as many prominent European Neo-Freudian analysts and existentialists such as Alfred Adler, Karen Horney, Eric Fromm, Erik Erikson and Victor Frankl immigrated to the United States, challenging leading humanistic theorists such as Maslow and Rogers (Nugent & Jones, 2009).

The proliferation of diverse philosophical approaches and disparate organizations splintered the field resulting in various organizations representing the “guidance” movement. Finally, in 1952 four independent associations, The National Vocational Guidance Association (NVGA), the National Association of Guidance and Counselor Trainers (NAGCT), the Student Personnel Association for Teacher Education (SPATE), and the American College Personnel Association (ACPA) convened in Los Angeles for the purpose of building a stronger, unified coalition (Sheeley & Stickle, 2008). This meeting gave birth to the American Personnel and Guidance Association (APGA). APGA’s founding is usually referenced as the birth of the counseling profession, though as evidenced by the fact that “counseling” was absent from the title, it was an inauspicious start. APGA was primarily focused on high school academic and vocational counseling and training college student personnel (Aubrey, 1977). The fledging profession faced numerous obstacles: qualifications to become a “guidance” professional were ambiguous; there was no uniform program of study; no written code of ethics; no accreditation standards; and no credential such as licensure. Judging by contemporary standards, the early guidance movement was arguably a semi-profession (Etzoni, 1969).

Despite challenges, the counseling movement demonstrated remarkable resilience during the period from the 1950s through the 1960s. Humanistic approaches spearheaded by Rogers and Fritz Perls became readily accessible to the general public through the group encounter movement (Corey, 2009). The phrase “third force” in psychology was coined to differentiate existential-humanistic approaches from psychoanalytic and behavioral ones (Nugent & Jones, 2009). In the late 1950s notables like Murray Bowen and Virginia Satir, members of related mental health professions, popularized family counseling (Gladding, 2009). The school counseling movement, buoyed by the Soviet’s launch of Sputnik, escalated from around 7,000 counselors to nearly 30,000 (Aubrey, 1977). All these various forces within and outside the counseling profession resulted in popularizing counseling with the general public. By the mid-1970s the counseling profession and counselor education programs had grown exponentially (Nugent & Jones, 2009). Despite counseling’s proliferation however, ethical standards, accreditation, and credentialing still lagged behind related mental health professions (Remley & Herlihy, 2007).

The 1980s to 2000: The Post-Modern Era

In the early 1980s counselor education leaders created the Council for the Accreditation of Counseling and Related Programs (CACREP) to provide standardization and accreditation (Hollis & Dodson, 2001). CACREP, which began as part of the Association of Counselor Educators and Supervisors (ACES), is now an independent agency recognized by the U.S. Council for Higher Education Accreditation (CHEA) to accredit masters’ degrees in six counseling specialties and doctoral programs in counselor education and supervision (CACREP, 2009). Although counselor education programs are not required to be accredited, CACREP’s curricular guidelines form the basis for most states’ licensure laws (Remley & Herlihy, 2007).

During the same time frame as CACREP’s inception, the National Board for Certified Counselors (NBCC) was created. NBCC established a national credential for professional counselors that preceded states seeking licensure. As of November 2009, all 50 states, Washington D.C., Puerto Rico, and Guam have passed counselor licensure laws. Counselor certification, a credential offered by the National Board for Certified Counselors, has consequently transitioned from “licensure substitution” to identifying counseling specialty areas. The advantage of national certification over licensure, however, is that certification is a credential with uniform standards, unlike licensure where requirements vary from state to state. NBCC offers certifications in three professional counseling specialty areas (National Board for Certified Counselors, 2011). Though NBCC’s utility has been debated in the post-licensure era (Emner & Cottone, 1989; Weinrach & Thomas, 1993), Remley (1995) has argued that a license should be for general practice while national certification should identify specialty areas. NBCC also advocates for the counseling profession on a national level (J. S. Hinkle, personal communication, May 12, 2011). The field has moved towards Remley’s specialization model and NBCC credentials have become popular with professional counselors.

Previous to the post-modern era, the counseling profession was based on Eurocentric models and was almost exclusively a U.S. profession (Corey, 2009; D’Andrea & Arrendondo, 2002). Since the late-1980s, however, multicultural considerations have become mainstream, and counseling is becoming an international profession. Often called the fourth force in counseling (D’Andrea & Arredondo, 2002) multiculturalism has had a profound impact on the profession, especially regarding culturally and linguistically diverse populations (Arthur & Pedersen, 2008). Since the late 1980s multicultural task forces have been set up and special editions of various counseling journals have addressed issues such as culture, ethnicity, gay, lesbian and transgender issues. Counseling Today, a monthly magazine published by ACA, also features a regular column on diversity. Multicultural competencies developed by Sue, Arrendondo and McDavis (1992) were adopted in the early 1990s by the Association for Multicultural Counseling and Development (AMCD) and adopted by all 19 ACA division affiliates. CACREP identifies diversity as one of the eight core counseling areas (CACREP, 2009) and coursework in multicultural counseling is a staple in counselor education curricula. Although debate regarding its parameters continues (Dunn, Smith, & Montoya, 2006; Weinrach, 2003), multiculturalism will continue to play a pivotal role in shaping the counseling profession, particularly given the globalization of the field (Arthur & Pedersen, 2008).

The Current Situation: Success and Strife

The counseling profession has achieved numerous goals (e.g., name recognition, licensure, third party billing, emerging international presence, etc.) in nearly 60 years of existence. Nevertheless, concerns loom large over the counseling horizon. One of the most pressing issues is the counseling profession’s attempts to achieve marketplace parity with their mental health colleagues (Gladding, 2009; Remley & Herlihy, 2007). In the U.S., the first significant steps on this long journey towards parity were the profession’s successes in achieving state licensure. Historically, achieving rights coincides with long-term struggle against established forces who seldom abdicate power and privilege willingly (Marx & Engels, 1985). The counseling profession’s experience has been no exception to this maxim, as psychiatrists, psychologists, and social workers have vigorously opposed the counseling profession with regard to licensure, third-party billing, Medicare reimbursement, use of psychological tests and many other areas. Undaunted, the American Counseling Association, American Mental Health Counselors Association (AMHCA), American School Counselors Association (ASCA), and the National Board for Certified Counselors (NBCC) have pressed forward in the aforementioned areas. Such efforts have yielded considerable success (e.g., licensure and third-party billing) while leaving some major privileges unachieved (e.g., Medicare billing rights). Although ACA and its affiliates’ lobbying efforts have witnessed a Medicare reimbursement bill for counselors passing both houses of Congress at separate times, Medicare reimbursement remains unachieved, though well within reach. TRICARE, the U.S. military’s version of Medicare, recognizes licensed counselors as reimbursable providers, and recently has agreed to waive requiring physician referral for soldiers and their dependents desiring to access services of a licensed counselor (Barstow & Holt, 2010). The Veteran’s Administration also has approved licensed counselors to work in VA hospitals, although the VA has been very slow to hire counselors.

Challenges from Within the Counseling Profession: A Commentary

As indicated above, the counseling profession has struggled with many “turf” battles, namely with psychology and social work. But perhaps the counseling profession’s most serious challenge is the splintering of membership and resources among the various counseling organizations. For most of its existence, ACA required members to join one affiliate divisions. For example, applicants desiring membership in, say, the American School Counselor Association (ASCA), also were required to join ACA. For years the requirement to join the flagship organization was the source of controversy, bickering and threats of disaffiliation (B. Collison, personal communication, June 4, 2008). ACA’s membership numbers had already been reduced in the early 1990s when the American College Personnel Association (ACPA) disaffiliated, taking more than 10,000 members from ACA (B. Collison, personal communication, June 4, 2008).

The case of ASCA illustrates an important question for counselors: does the identity and loyalty of a school counselor lie with the flagship organization (i.e., ACA), or with the division/professional organization for school counselors (i.e., ASCA)? This splintering among the professional organizations operating under the counseling umbrella creates the possibility of further reduction, division, and disaffiliation. While ASCA and AMHCA remain divisional affiliates, each collects separate membership dues, holds separate national conventions, retains their own lobbyists and publicizes themselves as primary organizations representing their respective counseling specialties. From an outside perspective, ASCA and AMHCA’s relationship with ACA appears tenuous and one can only speculate whether they will remain divisional affiliates. Since ACPA’s disaffiliation, ACA membership has plunged from a high near 60,000 to the current number of just over 45,000 (D. Kaplan, personal communication, April 8, 2011). It’s also likely that most of the members who left ACA retained their membership in a divisional affiliate. Splintering may partly explain why such a small percentage of the 655,000 U.S. counselors (Bureau of Labor Statistics, 2010–2011) join neither ACA nor their respective divisional affiliate. The high degree of counselor non-affiliation with the profession’s established organizations is alarming and illustrates a disconnect between counseling professionals and the organizations that ostensibly represent them.

Fortunately, there has been recent good news regarding ACA’s membership, which has grown 8% over the past 18 months (D. Kaplan, personal communication, April 8, 2011). Most of this growth in membership has been graduate student members who now receive liability insurance as student members. While any growth in membership is a positive sign, whether graduate students will continue their membership in ACA after graduation is uncertain. The fact also remains that ACA’s membership is composed of a small percentage of counseling professionals cited by the Bureau of Labor Statistics (2010–2011). A more robust sign of growth would be an increase in the numbers of professional counselors currently unaffiliated with ACA.

ACA’s composition has been compared to a “ball of multi-colored yarn with an emphasis on the specialties of counseling as opposed to the overall profession” (Bradley & Cox, 2001, p. 39). This phenomenon of separatism seems likely to continue for the foreseeable future. For example, I regularly receive mailings from national, regional, state, and local counseling organizations, all of whom actively and separately solicit membership. Which of these various organizations to join can be confusing and expensive, and further illuminates the question of where professional loyalty should lie: with the national organization, specialty division, state affiliate, state specialty affiliate or local organization. In many states, separate organizations representing school counselors, mental health counselors, rehabilitation counselors and the state affiliates of ACA compete for membership, hold separate conventions, publish separate state journals and engage in separate lobbying efforts. Such duplication and splintering cannot be healthy for the profession.

Duplication concerns are not confined to the U.S. In Australia, where this author taught in a counseling program, three different organizations claimed to represent the counseling profession. It is likely such scenarios are common worldwide. While there is no easy resolution to this complex identity dilemma, it would seem prudent for leaders of all counseling organizations to recognize antagonism, division and duplication of resources that are working against the overall goal of establishing counseling as a strong, unified, and influential profession. Ironically, counseling’s most insidious adversary may not be psychiatrists, psychologists, or social workers, but the counseling profession itself. Unification is arguably the counseling profession’s most pressing challenge and if left unresolved, potentially leads to the counseling profession’s own “Tower of Babel” with confusion over what’s being said, who’s speaking, and which organization actually represents the profession. Perhaps former ACA president Samuel Gladding (2009) said it best:

“Since 1952 most counselors in the United States and a number of other countries have held membership in ACA…with an emphasis on the specialties of counseling as opposed to the overall profession…other professions, such as medicine, have overcome the divisiveness that comes within a profession where there is more than one professional track practitioners can follow. ACA has not been as fortunate (pp. 26–27).”

The motto “e pluribus unum” (one out of many) has much relevance for the counseling profession as a large, vibrant flagship likely is in a stronger advocacy position than numerous smaller ones. The American Psychological Association (APA) is one professional model to emulate as APA, despite representing scores of branches, remains a vibrant flagship organization. For any hope of achieving parity with its mental health colleagues, the various counseling “professions” must set aside differences and unite around core national organizations. Fortunately, there has been recent movement in this direction. The 20/20 counseling initiative, composed of 29 different counseling-related organizations, has recently reached consensus on how counseling is defined and ACA as the flagship organization (Cashwell, 2010). Unfortunately, ASCA, the largest divisional affiliate, has yet to sign onto the 20/20 initiative. The 20/20 initiative likely represents the counseling profession’s best chance at unity. One can only hope the initiative will be an opportunity seized and not one missed.

Besides splintering, the profession faces additional “in-house” challenges. During the 1960s and 1970s a significant debate involved humanistic versus behavioral approaches. Different views of mental health counseling have evolved, including those that are developmental (Ivey, 1989); relationship focused (Ginter, 1989); and slanted towards treatment, advocacy, or personal and environmental coping (Gladding, 2009; Hershenson, Power, & Seligman, 1989). The argument has now shifted to one of maintaining counseling’s traditional developmental, wellness approach moving towards an outcomes-oriented, pathology-based medical model (McAuliffe & Eriksen, 1999), or yet to be defined approach (J. S. Hinkle, personal communication, May 12, 2011). In the U.S., the influence of insurance corporations (e.g., HMOs) has moved the field towards cheaper, time-limited therapy, requiring particular Diagnostic & Statistical Manual-Fourth Edition-Text Revised (DSM-IV-TR; 2000) Axis I diagnoses to bill for counseling services (Remley & Herlihy, 2007). Faculty educated in a traditional wellness model are likely dismayed when counselor education programs adopt a pathology-based approach (Hansen, 2005; Remley & Herlihy, 2007). CACREP accreditation standards for mental health counselors appear to be aligned to a psychiatric rather than a developmental philosophy (CACREP, 2009) and credentialing boards (e.g., for licensure and certification) and influential organizations such as the World Health Organization (WHO) and related mental health professionals (e.g., psychiatrists, psychologists) create pressure on counselor education programs to educate their students in the DSM-IV-TR nomenclature. Accreditation standards and the marketplace demand adherence to a psychiatric model making it critical for counselors to become facile in understanding and applying the DSM-IV-TR. Although the psychiatric model has many critics (Gladding, 2009; Glasser, 2003) it remains the standard within the mental health field (Maddux & Winstead, 2010; Gladding, 2009; 2008; Remley & Herlihy, 2007).

University counselor education departments also have expanded and diversified. School counseling programs frequently are offered alongside mental health counseling programs; two counseling disciplines moving in radically different directions. Given that the emphasis in counseling divisions varies from a developmental model (e.g., school counseling) to a DSM-driven model (e.g., mental health counseling), can traditionally-minded, developmentally-oriented counselor education faculty ethically support a pathological, DSM-based approach? Conversely, can mental health counseling faculty support a non-pathology driven approach? What about the potential confusion among graduate counseling students enrolled in programs offering these disparate philosophies? Do the philosophical differences dividing the various counseling specialties mean such divisions will be perpetuated in the classroom and among the faculty? Furthermore, what should be the driving force in shaping counselor education programs: philosophical orientation or marketplace demands (e.g., the need to be facile with and use the DSM-IV-TR)? According to Hansen (2003), “It is not unreasonable to assume that the juxtaposition of these completely opposite models in counselor training has an impact on the development of counselor trainees and the profession as a whole” (p. 98).These foundational fault lines within counselor education have yet to be adequately resolved, as developmental approaches are taught alongside medical-pathological approaches, likely resulting in confusion for students and disharmony among faculty. Perhaps the most realistic statement to make is that counseling is a broad profession encompassing both developmental approaches (e.g., school counseling) and clinical, diagnostic approaches (e.g., mental health counseling) for the purposes of insurance reimbursement.

Gazing into the Future: Challenges and Opportunity

Besides fractionalization, differences in training and concerns regarding marketplace parity, additional challenges have recently emerged. The highly technical nature of the twenty-first century has created challenges and opportunities unforeseen in previous eras. In his seminal opus The World is Flat, Friedman (2005) argues the Internet age has transformed the media, financial markets, the military, education and virtually everything else. For the counseling profession, the Internet represents more tidal wave than ripple effect, impacting types of institutions offering programs (e.g., traditional vs. virtual), where and how they are offered (e.g., residential vs. web delivery) and who will teach them (e.g., full-time faculty or adjunct faculty). In June 2010, a national conference titled “Who Needs a College Campus” was held (EduComm, 2011).The past decade has seen a spike in the numbers of college students enrolled in virtual institutions. The University of Phoenix, primarily a virtual, for-profit institution, sports a CACREP-accredited counseling program and though they hold counseling classes in-person, one wonders if this will soon change. The University of Phoenix now boasts the largest collegiate enrollment in the U.S. with over 400,000 students (Lederman, 2010). Many elite brick-and-mortar institutions including Harvard University now offer virtual degrees. Small liberal arts institutions have begun offering web degrees and using satellite campuses. For example, Tiffin University, a small institution in the U.S. Midwest, has doubled the number of its graduate students and seen its total enrollment rise more than 50% in five years (Blumenstyk, 2008). The increasing options and delivery methods for course offerings and degrees are likely to change the number and types of counselor education programs as well.

Internet delivery means institutions and programs are no longer thwarted by geography, nationality, enrollment restrictions, number of faculty, distance, language, culture, etc. Instead of strolling through ivy-covered campuses, students can simply walk across their living room to access a college or graduate education through numerous virtual options. Besides the University of Phoenix, several online universities such as Capella University (2011) and Walden University (2011) also offer CACREP-accredited counseling programs. Web-based education poses several challenges for the counseling profession: advising and mentoring are virtual, not in person; web programs are staffed primarily by part-time faculty; when courses are delivered across state and international borders, which state or nation’s rules apply? Technology occasionally fails, leaving students and faculty “virtually” stranded. Finally, given huge enrollments and reliance on adjuncts as opposed to full-time faculty, questions regarding for-profit institutions’ principal concern (e.g., profit over academic quality) are likely to be raised.

There also is pressure for U.S. institutions to establish international partnerships to educate students on diverse cultures and plan for a global, interconnected world (American Council on Education, 2008). The Under Secretary of Commerce recently was quoted saying, “Education is one of our most valuable exports” (Sanchez, 2011). Numerous U.S. institutions have built satellite campuses in Europe, the Middle-East, Asia and Australia. Madeline Green, Vice President for the American Council on Education’s International Initiatives, along with her colleagues, opined current international initiatives are insufficient and pressed further: “Every institution needs to pay attention to internationalization if it is to prepare students for the multicultural and global society of today and tomorrow” (American Council on Education, 2008, p. 2). Even non-elite institutions have heeded Green’s message. A job advertisement in a recent edition of The Chronicle of Higher Education (Chronicle Careers, 2010) revealed that Troy University in rural Alabama has locations in 15 states and 14 countries.

The counseling profession also has begun to heed the call for globalization. Edith Cowen University in Perth, Western Australia, offers an off-shore counseling program in Singapore (Edith Cowen University, 2011) and California State University-Fullerton offers a joint counseling doctoral program with the University of New England in Australia (J. Kottler, personal communication, July 23, 2010). International partnerships offer numerous advantages. For example, perhaps a program in New York doesn’t offer a specialty course in trauma counseling, but a cooperating institution in New Zealand does. In this scenario, students could access the missing course via the Internet. Furthermore, students could travel to, say, Bhutan for an internship, profoundly enhancing a student’s multicultural experience. International partnerships also pose challenges for accrediting organizations such as CACREP (e.g., creating global, unifying standards), sponsoring institutions (e.g., differing guidelines), credentialing boards (e.g., licensure and certification bodies), faculty (e.g., full vs. part-time), ethical codes (e.g., cultural variations), and the future direction of the counseling profession (from Euro-American to an international focus). CACREP’s response was to create the International Registry of Counsellor Education Programs (IRCEP) in 2008 (IRCEP, 2011). IRCEP is not a credentialing body like CACREP, but a branch of CACREP designed to empower international counselor education programs appropriate to their country (IRCEP, 2011). IRCEP represents CACREP’s recognition that a uniform accreditation credential may not be realistic given the wide variation in global social and cultural norms.

Widely varying social and cultural norms inherent in the emerging global counseling movement also pose numerous challenges for the profession. Western counseling organizations have taken a social justice stance in promoting multiculturalism, gender equality, freedom of and from religion, and pluralism for sexual minorities in their various codes of ethics. ACA’s support in a high-profile court case involving the Eastern Michigan University counseling program and a conservative Christian dismissed from the program for refusing to counsel a gay client is a notable example of advocacy (Shallcross, 2011. “The EMU ruling upheld the ideals of the profession,” (Kaplan, 2011, p. 33). Such advocacy is commendable, especially as culturally relevant counseling practice is imperative in a global age (Arthur & Pedersen, 2008; Sue & Sundberg, 1996). Nevertheless, even within segments of Western civilization, issues of ethnicity, gender, religion and sexual orientation often form contentious points of debate. Though tensions can run high, Western academia offers a forum for discussing controversial issues. But what happens when constructivist, post-modern, pluralistic-oriented counselor education programs are offered in countries where discrimination plays a pivotal role? Saudi Arabia, for example, is an absolute monarchy that prohibits men and women from sharing the same classroom, restricts women’s movement outside the home, prohibits women from divorcing their husbands and provides no legal protection against domestic abuse. Furthermore, homosexuality and a Saudi’s practice of a religion other than Islam are potentially punishable by death (Saudi Arabia Guide, 2011). How will a Western social justice-oriented counseling profession address such restrictions on gender roles, religious identity, and sexual orientation in restrictive societies? Equally problematic, how will the counseling profession advocate equality without, ironically, appearing culturally insensitive in societies with rigid social caste systems? Moreover, is it even realistic to expect unilateral agreement on social and cultural issues in an increasingly internationalized counseling profession spread across diverse cultures? A larger question remains, however: are there some universal social justice principles the counseling profession should promote regardless of culture (e.g., gender and sexual equity, religious freedom, freedom to have no religion, etc.)? In this writer’s opinion, ACA, AMHCA, NBCC, etc. should encourage an ongoing dialogue about the realities and parameters of Western, social justice-oriented counseling expectations, particularly with regard to nonwestern societies.

Ironically, the counseling profession’s advocacy of pluralism, although noble and well-intentioned, is a concept framed largely through a Western mindset. This gulf between a pluralistic counseling profession and rigid, non-democratic societies creates great potential for conflict. Consequently, debate regarding cultural competence will likely become more complex and contentious with the counseling profession’s continued global expansion. The point is not that the profession should abandon its support for equality, nor should it force our social justice model on other societies, but rather it must be strategic in where and how it advocates pluralism.

Counselor education also must make programmatic adaptations in this new era. In the 1970s, Psy.D. programs emerged as an alternative to the traditional research-oriented doctorate for psychologists seeking careers outside higher education. Psy.D. programs have become quite popular and psychologists with such degrees now hold academic appointments. As the counseling profession evolves, it may be worthwhile to develop a Psy.D.-like degree. Some counseling programs already offer practitioner-oriented doctorates. In 2007, I taught as a visiting counselor education scholar at the University of Notre Dame–Australia (UNDA). UNDA’s counselor education program offers a Doctorate of Counselling (D.Coun.) modeled roughly on the Psy.D. (M. Philpott, personal communication, February, 18, 2008). Traditionally, the Ph.D. in counselor education has been a research degree specifically developed and marketed for counseling professionals planning academic careers. A D.Coun. doctorate with an emphasis on professional practice, clinical supervision, and developing management expertise, and less on research might seem more compelling to masters’ level counselors in community clinics or schools who desire a doctorate, but are not contemplating research careers. Moreover, doctoral students in counselor education are largely supervised in clinical internships by non-counselors due to a dearth of clinical counselors at the doctoral level (J. S. Hinkle, personal communication, May 12, 2011).

Along similar educational lines, the front end of the higher educational spectrum also presents opportunity for the counseling profession. For decades, bachelor’s-level addictions counselors have worked at the margins of the profession. In many countries, BA/BS degree professionals are the norm, not the exception (Arthur & Pedersen, 2008; Selles et al., 2007). The University of Notre Dame–Australia offers a baccalaureate counseling degree, with a job placement rate for graduates approaching 100% (M. Philpott, personal communication, February, 18, 2008). Although the profession maintains the masters’ degree is the entry-level degree, large numbers of bachelor’s degree counselors continue to work in addictions. Perhaps it’s time to recognize baccalaureate counselors as legitimate professionals. Counselor education programs could create baccalaureate programs, market them for entry-level positions, educate undergraduates regarding the counseling profession, and steer them into graduate counselor education programs. While counselor educators may be aghast at such a proposal, it’s worth remembering that our social work colleagues have long maintained bachelor’s degree programs with no noticeable detriment to their profession. In addition, bachelor’s degrees in human services are dramatically on the rise (J.S. Hinkle, personal communication, May 12, 2011).Undergraduate psychology departments also are among the most vibrant on any college campus even though the American Psychological Association maintains that psychology is a doctorate-level profession (APA, 2002). Moreover, undergraduate social work and psychology programs provide a forum to guide and mentor future social workers and psychologists. Counselor education’s undergraduate mentoring role has been abdicated to social work and psychology faculty, neither of whom have a stake in supporting a separate, competing profession. Undergraduate counseling programs would create a stronger professional identity at the baccalaureate level, provide early mentoring for future counselors, and preferably increase membership in national as well as affiliate counseling organizations.

Rapid changes brought about by our technologically advanced era require an increasing need for the counseling profession to develop flexible, visionary leadership and set planning priorities (Gladding, 2009; Glasser, 2005). While on one hand graduate counseling programs do a good job providing leadership and clinical skills training, on the other hand, performance reviews, political networking, and entrepreneurship are seldom covered in the curriculum (Curtis & Sherlock, 2006). Curtis and Sherlock (2006) use the term managerial leadership (p. 121) as a means of becoming more strategic with regard to future development. ACA certainly is engaged in leadership development regionally and nationally, and strategic planning has recently become a major focus of the ACA’s 20/20 initiative (Gladding, 2009). Given its importance, strategic planning and management training should become an integrated part of counselor education curricula as counselors essentially are managers in schools, community clinics, university and community college counseling centers, and in professional organizations such as ACA.

Summary

APGA’s original narrow, guidance-oriented, Eurocentric profession now consists of multiple identities, numerous theoretical approaches, a comprehensive research base, Internet-based institutions, and a global, multicultural presence (Arthur & Pedersen, 2008; Herr, 2004). Multiculturalism and a social justice approach to counseling have become ubiquitous in counseling, permeating professional organizations, ethical codes, and mission statements, and they are prominently featured in journal articles and textbooks. Though disagreement on multicultural parameters continues (Dunn, Smith, & Montoya, 2006; Weinrach, 2003) with the profession’s internationalization, cultural issues will become even more significant and complex given the broad social, geographic, ethnic, religious, and political variations among global societies.

Because of the dynamic, interconnected, global nature of the 21st -century marketplace (Friedman, 2004), the counseling field is likely to undergo dramatic change. Some 150 years ago Charles Darwin (1859) theorized it wasn’t necessarily the smartest or strongest organisms that survive, but those most willing to adapt to external demands. Demands challenging the counseling field include unifying a fractious profession, achieving market place parity, maintaining relevant counselor education programs, addressing global cultural conflicts, and proactively responding to the vast challenges and opportunities of a dynamic era. To flourish, the counseling profession must chart a bold, progressive, global, strategic course of action to address post-modern challenges. An effective course of action is likely to result in numerous changes both for counselor education training and in the delivery of counseling services to an increasingly diverse, global clientele. How effectively the counseling profession adapts to meet 21st-century demands will largely determine its future success and viability.

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Shannon Hodges, NCC, is an Associate Professor of Counseling in the College of Education at Niagara University. Correspondence concerning this article can be addressed to Shannon Hodges, Niagara University, College of Education, Niagara University, NY, 14109, shodges@niagara.edu.