Adverse and Positive Childhood Experiences of Clinical Mental Health Counselors as Predictors of Compassion Satisfaction, Burnout, and Secondary Traumatic Stress

Eric M. Brown, Kristy L. Carlisle, Melanie Burgess, Jacob Clark, Ariel Hutcheon

Despite an emphasis on self-care to avoid burnout and increase compassion satisfaction within the counseling profession, there is a dearth of research on the developmental experiences of counselors that may increase the likelihood of burnout. We examined the impact of mental health counselors’ (N = 140) experiences of adverse childhood experiences and positive childhood experiences on their present rates of compassion satisfaction, burnout, and secondary traumatic stress. We used a cross-sectional, non-experimental correlational design and reported descriptive statistics as well as results of multiple regression models. Results indicated significant relationships among counselors’ rates of adverse childhood experiences, positive childhood experiences, and compassion satisfaction and burnout. We include implications for the use of both the adverse and positive childhood experiences assessments in the training of counseling students and supervisees. 

Keywords: counselors, burnout, childhood experiences, compassion satisfaction, secondary traumatic stress

 

Over the past 20 years, public health research on adverse childhood experiences (ACEs) and their deleterious effects on physical and mental health has proliferated and branched out to various disciplines (Campbell et al., 2016; Frampton et al., 2018). More recently, the importance of understanding the implications of ACEs for the mental health of clients has entered the counseling literature (Wheeler et al., 2021; Zyromski et al., 2020), yet the ways in which a counselor’s own experience of ACEs may affect their work have not been examined. The absence of such research is significant given the report that mental health workers have the highest rates of ACEs among those in the helping professions (Redford, 2016).

A thorough literature search of PsycINFO, ProQuest, and Google Scholar using terms including, but not limited to, adverse childhood experiences, positive childhood experiences (PCEs), compassion satisfaction (CS), burnout, secondary traumatic stress (STS), and mental health counselors (MHCs), found no peer-reviewed articles that examined the relationship between ACEs or PCEs and counselors’ rates of CS and burnout. Therefore, we chose to examine the effects of early developmental adversity, as well as early protective factors, on the professional quality of life of counselors, as measured by assessing the counselor’s levels of CS, burnout, and STS.

Adverse Childhood Experiences (ACEs)
In the mid-nineties, Felitti et al. (1998), with the support of the Centers for Disease Control, created the ACE Study Questionnaire to study early childhood trauma and deprivation experiences. The ACE Study Questionnaire consists of 10 questions related to whether a person before the age of 18 experienced emotional or physical abuse, substance addiction in the home, parental divorce or separation, a caretaker with mental illness, or emotional deprivation. Each question that is answered in the affirmative results in one “ACE,” with respondents’ scores ranging from 1 to 10. Studies have found that ACEs have a dose-response effect; therefore, every point increase can significantly raise the chance of experiencing negative mental and physical health effects into adulthood (Boullier & Blair, 2018; Campbell et al., 2016; Merrick et al., 2017). Additionally, individuals with four or more ACEs are significantly more likely to suffer from mental illness or substance addiction, be further traumatized as adults, and succumb to an early death (Anda et al., 2007; Metzler et al., 2017).

More recently, researchers have found that Black and Latinx individuals have significantly higher rates of ACEs compared to White individuals (R. D. Lee & Chen, 2017; Merrick et al., 2017; Strompolis et al., 2019). In a study involving 60,598 participants, R. D. Lee and Chen (2017) discovered not only that Black and Hispanic participants had higher rates of ACEs, but also that there was a correlation between ACEs and drinking alcohol heavily. In a sample of 214,517 participants across 23 states in the United States, Merrick et al. (2017) found that racially minoritized individuals, sexual minorities, the unemployed, those with less than a high school education, and those making less than $15,000 a year had significantly higher rates of ACEs than White individuals, heterosexuals, the employed, and those with higher education and income, respectively. Zyromski et al. (2020) noted that the preponderance of ACEs within marginalized communities, such as ethnic minority populations, make ACEs “a social justice issue” (p. 352).

There is scarce research related to the potential impact of ACEs on practitioners and graduate students in helping professions. Thomas (2016) evaluated the rates of ACEs with Master of Social Work (MSW) students, discovering that MSW students were 3.3 times more likely to have four or more ACEs compared to a general sample of university students. Similarly, counselors-in-training are not immune to the effects of childhood adversity; in fact, researchers noted that counselors-in-training may pursue a counseling degree because of personal trauma that drives their aspirations to help others (Conteh et al., 2017). Evans (1997) found that 93% of counselors-in-training reported at least one traumatic experience in their lives, while Conteh et al. (2017) discovered that 95% of counselors-in-training reported between one and eight traumas throughout their lifetime. Considering these results, researchers have suggested that practitioners with a history of trauma may be vulnerable to re-experiencing trauma with clients, which could negatively impact client care and increase the rate of counselor burnout (Conteh et al., 2017; Thomas, 2016). Because the rates of ACEs in practicing MHCs are unknown, it is difficult to determine how ACEs may play a role in impacting CS, burnout, and STS. Furthermore, we lack research on early developmental factors that may contribute to CS, burnout, and STS.

Positive Childhood Experiences (PCEs)
In recent years, childhood development researchers have explored protective factors that may reduce the harmful effects of ACEs. In 2018, Crouch et al. (2019) examined the relationship between two protective factors and their mitigating effects on individuals reporting at least four ACEs. In a sample of 7,079 respondents, the researchers discovered that individuals who reported growing up “with an adult who made them feel safe and protected were less likely to report frequent mental distress or poor health” (Crouch et al., 2019, p. 165). Bethell et al. (2019) found significant correlations between seven positive interpersonal experiences with family and friends and decreased negative effects of ACEs. They also discovered that these factors have a dose-response effect in relation to ACEs so that with each additional PCEs, the harmful effects of ACEs are lessened. The discovery of PCEs has become important in understanding developmentally protective factors that guard from the damaging effects of childhood adversity. Specifically, higher rates of PCEs decrease the chances of mental health disorders of adults, even in those with higher numbers of ACEs (Bethell et al., 2019). An examination of the rates of PCEs in MHCs may provide insight into the well-being of counselors.

Counselor Well-Being
As defined by the American Counseling Association (ACA; 2014), professional counselors work to empower diverse clients to achieve their personal goals. Specifically, MHCs provide client-driven services in agencies, hospitals, and private practices (American Mental Health Counselors Association [AMHCA], 2020). Counselors are trained to cultivate and monitor their own sense of well-being while providing their expertise and leadership to clients and students who have experienced difficulties related to trauma, injustice, abuse, loss, violence, and distress (Council for Accreditation of Counseling and Related Educational Programs [CACREP], 2015; S. M. Lee et al., 2010). Self-care, or the act of cultivating a subjectively defined state of health, is now ubiquitous in counselor education programs and promoted among practitioners (ACA, 2014; CACREP, 2015); however, scholars note that many counselors do not routinely prioritize their own sense of well-being and monitor CS, burnout, and STS (Coaston, 2017). While working closely with clients, practitioners may benefit from reflecting on how their own experiences of personal adversity may influence their work and possibly create a predisposition toward burnout.

Burnout of Counselors
Burnout is defined as the emotional and physical response to chronic stressors in the workplace that lead to substantial negative consequences (Maslach et al., 2001). Scholars have evaluated the external facets of professional counselors’ work that lead to increased burnout, such as time spent on non-counseling duties, lack of on-the-job support, and negative working environments (Thompson et al., 2014); however, internal factors that lead to burnout, such as counselors’ experiences of adversity, remain unstudied. The ubiquitous nature of trauma and its lifelong impact on clients has gained more attention over the past 20 years (Bemak & Chung, 2017; Debellis, 2001; Webber et al., 2017), yet researchers are only beginning to explore the impact of trauma on the lives and professional experiences of counselors (Conteh et al., 2017; McKim & Smith-Adcock, 2014).

Recently, scholars have sought to understand contributing factors that diminish CS and increase burnout (S. M. Lee et al., 2010). In a study of 86 counselors-in-training, Can and Watson (2019) found that a trainee’s degree of resilience and wellness predicted burnout, whereas empathy and supervisory working alliance did not. They did not assess for internal or experiential factors that may have contributed to burnout.

Cook et al. (2021) conducted a qualitative inquiry with 246 novice counselors to explore symptoms of burnout that may not be captured in commonly used assessments. The researchers found several predominant themes, including negative emotional experiences such as anxiety, depression and crying spells; fatigue and tiredness; and unfulfillment in work. Participants also reported physical illness and weight gain or loss, self-perceived ineffectiveness as a counselor, and cognitive impairment. Close to 10% of participants stated that an unhealthy environment contributed to their experience of burnout. Cook et al. did not inquire about any personal history that may have also contributed to symptoms of burnout.

Counselors and STS
Distinct from but related to burnout, STS has been discussed in the literature relating to the well-being of helping professions across numerous disciplines (Branson, 2019; Butler et al., 2017; Molnar et al., 2017). Secondary traumatic stress, also called vicarious trauma, is distinguished from burnout by its symptoms overlapping with post-traumatic stress disorder (PTSD), such as intrusive thoughts, hypervigilance, and avoidance of distressing memories (Ivicic & Motta, 2017; Molnar et al., 2017). In a study of 220 counselors, Lanier and Carney (2019) discovered that 49.5% of counselors experienced symptoms of vicarious trauma, with 85.5% reporting “I thought about my work with clients when I didn’t intend to” and 80.5% confirming that “I felt emotionally numb” (p. 339). Lakioti et al. (2020) found in a study of 163 Greek mental health practitioners that there was a significant positive correlation between burnout and STS (r = .48) and that practitioners who scored high in empathy also scored high in STS (r = .34). In their meta-analysis of 38 studies examining risk factors for STS in therapeutic work, Hensel et al. (2015) found small yet significant effect sizes for “trauma caseload volume (r = .16), caseload frequency (r = .12), caseload ratio (r = .19), and having a personal trauma history (r = .19)” in relation to STS (p. 83).

Research regarding counselors’ own personal trauma is still emerging and a consensus is not yet formed. In a recent study of 90 psychotherapy trainees, Klasen et al. (2019) indicated that secure attachments play a modifying role in limiting the severity of trauma’s expression. McKim and Smith-Adcock (2014) evaluated characteristics of trauma counselors to understand how frequent exposure to indirect trauma might influence burnout and CS, as assessed by the Professional Quality of Life Scale (ProQOL; Stamm, 2010). Their results indicated that higher levels of exposure to client trauma, in combination with less perceived control over the workplace, led to increased burnout (McKim & Smith-Adcock, 2014). Consistent with the ACA Code of Ethics (2014), counselors are expected to self-monitor for impairment issues that could impact clients such as burnout, STS, and the decrease of CS.

Compassion Satisfaction
CS has been studied nominally and may serve as a protective factor against burnout (Coaston, 2017). Compassion satisfaction is defined as a psychological benefit derived from working effectively with clients to produce meaningful and positive change in their lives (McKim & Smith-Adcock, 2014; Stamm, 2010). McKim and Smith-Adcock (2014) discovered that trauma counselors who experienced higher levels of personal trauma also exhibited higher levels of CS or fulfillment derived from their role in the helping alliance. Although these emergent results contradict older literature that demonstrates how counselors with more personal trauma have higher levels of burnout (Baird & Kracen, 2006; Nelson-Gardell & Harris, 2003), presently, the relationship between CS, burnout, and STS in counselors in relation to ACEs is still unclear.

Purpose of Study
The purpose of this study was to examine the effects of early developmental adversity as well as early protective factors on the CS, burnout, and STS of MHCs. Despite the ongoing concern for factors that contribute to the CS, burnout, and STS of counselors, there is a dearth of research on personal experiences that may predispose counselors to burnout (Conteh et al., 2017; McKim & Smith-Adcock, 2014). Considering the detrimental effects of burnout on counselors’ health and well-being, as well as the decrease in empathy that often accompanies burnout, it is imperative that we understand the various causes of burnout (Can & Watson, 2019; Cook et al., 2021; Maslach et al., 2001). This knowledge will assist clinical MHCs, supervisors, and counselor educators in knowing which professional counselors or counselors-in-training may be more susceptible to burnout, STS, and decreased CS.

Research on ACEs within the counseling profession, as proposed by the original Felitti et al. (1998) study, is scant. Zyromski et al. (2020) discovered in their content analysis of ACA and American School Counselor Association journals that only three articles contained any focus on ACEs as defined in the original study. They suggested that by incorporating such a well-defined and researched concept as ACEs, counselors will be better equipped to address the deleterious effects of early adverse experiences. In order to address the gap within the literature, we chose to focus on the rates of ACEs and PCEs of counselors and how they potentially impact CS, burnout, and STS. After conducting an exhaustive search of the literature, we found no other study that examined the potential relationship between counselors’ developmental history using the ACEs and PCEs assessments and their levels of burnout, CS, and STS.

Method

This study entailed a cross-sectional, non-experimental correlational design and reported descriptive statistics, as well as results of multiple regression models. Relationships among MHCs’ ACEs, PCEs, CS, burnout, and STS were examined. Research questions (RQs) guiding the study were: RQ1 (descriptive): What are the mean scores of MHCs for ACEs, PCEs, CS, burnout, and STS constructs? and RQ2 (regression): To what extent do MHCs’ ACEs, PCEs, gender, race, socioeconomic status, and educational level predict CS, burnout, and STS?

Power Analysis
The target number of participants for the study was at least N = 138, based on a power analysis. Researchers used G*Power 3.1.9.6 (Faul et al., 2009) to calculate an a priori power analysis with a .05 alpha level (Cohen, 1988, 1992), a medium effect size for multiple R2 of .09 (Cohen, 1988), and a power of .80 (Cohen, 1992).

Participants
The eligibility criteria for this study were to be a clinical MHC, 18 years or older, who worked 30 hours or more per week in the field of mental health counseling. After soliciting participants nationally through emails, we collected data from 140 participants who met the criteria. MHCs ranged in age from 22 to 72 years old with an average age of 38 (SD = 11.01). Table 1 shows the diverse sample. Slightly more than half (n = 71) identified as female and a little less than half (n = 66) as male. More than three-quarters (n = 108) identified as White. The majority of participants (n = 85) reported their childhood SES as lower or working class, while more than half (n = 78) reported their current social class as middle class. Our sample with predominantly female and predominantly White participants is similar both to known counselor demographics (Norton & Tan, 2019) and to the Felitti et al. (1998) ACEs study.

Instrumentation
Three instruments with good validity and reliability were used to measure ACEs, PCEs, CS, burnout, and STS. We created a demographic questionnaire to collect information on participants’ identities (e.g., race, gender) and childhood backgrounds (e.g., ACEs, PCEs, SES).

Adverse Childhood Experiences (ACE) Study Questionnaire
The ACE Study Questionnaire (Felitti et al., 1998) is a 10-item survey of the most common examples of childhood abuse and neglect. It was developed out of research that connected childhood trauma to subsequent mental and physical ailments. Subsequent research found good test-retest reliability of the measure in an adult population (Dube et al., 2004; Frampton et al., 2018) and a Cronbach’s alpha score of .78 (Ford et al., 2014). The survey produces self-report scores between 0 and 10. The higher the score, the greater the risk for mental and physical health issues as well as decreased quality of life. Consistent research (e.g., Anda et al., 2006; Dube et al., 2004; Hughes et al., 2017) shows that a score of 4 or more indicates serious risk.

Table 1

Participant Demographics

Positive Childhood Experiences (PCE) Questionnaire
The PCE Questionnaire (Bethell et al., 2019) is a 7-item survey of PCEs (i.e., connection with family, friends, and community) that are statistically predictive of good mental health in adulthood. After accounting for ACEs, higher PCE scores reduce mental health and interpersonal problems later in life. Specifically, scores in the 6 to 7 range are most protective from harmful effects of ACEs, and scores in the 3 to 5 range are moderately protective. A Cronbach’s alpha score of .77 reported in the original 2019 study indicates good reliability.

Professional Quality of Life Scale (ProQOL)
The ProQOL (Stamm, 2010) is a 30-item survey with good construct validity measuring both positive and negative responses to the work of helping professionals. It measures three constructs: CS, which has a Cronbach’s alpha score of .88; burnout, which has a Cronbach’s alpha score of .75; and STS, which has a Cronbach’s alpha score of .81. For CS, or positive feelings about one’s ability to help, a score below 23 indicates problems at work. For burnout, or feelings of exhaustion, frustration, anger, or depression, scores below 23 indicate feeling good about work, while scores above 41 indicate feeling ineffective. For STS, or feelings of fear related to trauma in the workplace, scores above 43 indicate something frightening at work.

Procedure
After IRB approval, we used purposeful sampling methods to recruit participants. We emailed over 6,000 MHCs from a data set purchased from a national data bank. Furthermore, we posted invitations to participate on Facebook groups for MHCs. Invitations included informed consent, as well as a link to a Qualtrics survey containing all instruments and demographic questions. Researchers cleaned all collected data leading to 140 usable cases, computed instruments and transformed variables into usable form, and checked for assumptions for multiple regression. For each instrument, we assessed for reliability with Cronbach’s alpha tests. The ACEs instrument produced a Cronbach’s alpha of .89, the PCEs instrument produced .81, and the ProQOL produced .79, all within the good to excellent range. We used SPSS 28 for all analyses.

Data Analysis and Results

To answer our first research question, we evaluated the mean scores for ACEs, PCEs, CS, burnout, and STS. Respondents in the study had a mean ACE score of 3.42, 95% CI [2.8577, 3.9852], beneath the threshold of 4 and just below the range for significant risk. Their mean PCE score of 5.34, 95% CI [5.0006, 5.6957], was at the upper end of moderately protective. White MHCs had a lower average ACE score and higher average PCE score than minoritized MHCs. Male MHCs had higher average ACE and PCE scores than females, and MHCs with lower childhood SES had lower average ACE scores and higher average PCE scores than those with higher SES (see Tables 2 and 3).

Table 2

Average Adverse Childhood Experience Scores by Demographics

Table 3

 Average Positive Childhood Experience Scores by Demographics

Type of scores are shown in percentages for each type of ACE and PCE to show what percentage of MHCs reported an adverse or protective childhood experience (see Tables 4 and 5).

Table 4

Type of Adverse Childhood Experience Score

Table 5 

Type of Positive Childhood Experience Score

 

Next, we analyzed MHCs’ scores related to CS, burnout, and STS. Participants’ mean CS score of 31.81, 95% CI [30.6005, 33.0138], was well above the threshold of 23, which indicates a positive level of CS. Their overall mean burnout score of 24.59, 95% CI [23.5793, 25.5921], was well below the threshold of 41, which indicates that the average MHC was not suffering from burnout. Their overall mean STS score of 26.37, 95% CI [25.0346, 27.7083], was also well below the threshold of 43, which indicates the average MHC was not experiencing STS.

For RQ 2, we also tested whether and to what extent MHCs’ ACEs, PCEs, and demographic variables predict CS, burnout, and STS. We ran three linear regression models to assess significant predictors of CS, burnout, and STS. In the first model, a regression of CS on ACEs, PCEs, gender, race/ethnicity, and childhood SES explained a significant 40.5% of the variance in CS, F (5, 134) = 17.558, p < .001. Specifically, significant predictors of CS were ACEs (β = −.550), gender (β = −.218), race/ethnicity (β = −.160), and childhood SES (β = −.171). PCEs were nonsignificant in relation to CS. Items negatively related to CS were ACEs (i.e., higher ACE scores predicted lower CS), gender (i.e., being female predicted higher CS), race/ethnicity (i.e., being minoritized predicted higher CS), and childhood SES (i.e., lower levels of SES predicted higher CS; see Table 6).

In the second model, a regression of burnout on ACEs, PCEs, gender, race/ethnicity, and childhood SES explained a significant 18.9% of the variance in burnout, F (5, 134) = 6.032, p < .001. Specifically, both ACEs and PCEs were significant predictors of burnout (β = .309 and β= −.197, respectively). Gender, race/ethnicity, and SES were nonsignificant predictors of burnout. ACEs were positively related to burnout (i.e., higher ACE scores indicated higher burnout), and PCEs were negatively related to burnout (i.e., higher PCEs indicated lower burnout; see Table 7).

In the third model, a regression of STS on ACEs, PCEs, gender, race/ethnicity, and childhood SES explained a significant 8.5% of variance in STS, F (5, 134) = 2.402, p < .001. Only race/ethnicity was a significant predictor of STS (β= −.222; i.e., being White indicated lower STS). ACEs, PCEs, gender, and SES produced nonsignificant results related to STS (see Table 8).

Table 6

Regression Results Using Compassion Satisfaction as the Criterion

Table 7

Regression Results Using Burnout as the Criterion

Table 8

Regression Results Using Secondary Traumatic Stress as the Criterion

 

Discussion

After conducting an exhaustive literature review, we found no other study that examined the relationship between a counselor’s personal history of childhood adversity and protective factors (i.e., ACEs and PCEs) and their professional experience with burnout, STS, and CS. As the counseling profession is placing a greater emphasis on counselors becoming trauma-informed (e.g., Bemak & Chung, 2017; Debellis, 2001; Webber et al., 2017), recent research has examined counselor wellness, burnout, PTSD symptoms, and possible contributing factors (Can & Watson, 2019; Cook et al., 2021; Lanier & Carney, 2019). In line with other studies, we found that some individuals drawn to the profession of counseling are more likely to have had adversity and hardship events in their personal histories (Conteh et al., 2017; McKim & Smith-Adcock, 2014). What is unique in this study is the examination of how both adverse and positive childhood experiences may impact the CS, burnout, and STS of MHCs.

Similar to Thomas (2016), who found that social work students had higher rates of ACEs than the general population, the results of this study indicated that counselor participants had higher rates of ACEs for all 10 experiences than the original Felitti et al. (1998) ACEs study. This was also aligned with Conteh and colleagues (2017), who found that counselors-in-training may have higher rates of trauma than the average population. The results also indicated that almost 43% (n = 60) of MHCs scored four or more ACEs, which placed them at high risk for mental and physical health problems (Boullier & Blair, 2018; Campbell et al., 2016; Merrick et al., 2017). As may be surmised from other studies on the deleterious effects of ACEs on emotional well-being, having higher numbers of ACEs was a significant predictor of burnout. Lower ACEs scores also significantly predicted CS with a high effect size (.55). Similarly, higher PCEs were linked to lower burnout. However, PCEs were not found to significantly predict CS.

We examined the average rates of and relationships between ACEs, PCEs, CS, burnout, and STS in a sample of MHCs. McKim and Smith-Adcock (2014) examined the burnout rates of trauma counselors, finding that counselors with more personal trauma had an increase in CS, perhaps due to personal growth. In contrast, this study found that counselors with more ACEs were more likely to experience less CS. This difference may be a result of this study utilizing the ACE Study Questionnaire (Felitti et al., 1998) whereas McKim and Smith-Adcock (2014) used Stamm’s (2008) Stressful Life Experiences – Short Form to assess for experiences that may have happened in adulthood or to someone outside of the family. Developmentally, painful childhood experiences may be harder to process, which may in turn produce further-reaching negative outcomes. McKim and Smith-Adcock also found that having a sense of control in the workplace and the number of years of experience as a counselor also positively correlated with CS. The results from our analysis indicated that greater attention needs to be given to the traumatic experiences of counselors and how these events may impact professional resilience.

This study may also be the first to examine the demographic factors of counselors, including gender, racial identity, and childhood SES, as potential predictive factors of burnout, STS, and CS. All three demographic variables were found to be predictive of CS, but none were predictive of burnout. The results from our analysis indicated that greater attention needs to be given to the traumatic experiences of counselors and how these events may impact CS, burnout, and STS.

It should be noted that ethnically minoritized counselors had higher rates of CS than their White peers. Given that higher ACEs scores had a negative relationship with CS with a high effect size, and that minoritized counselors had higher average rates of ACEs and lower average rates of PCEs when compared to White counselors, we expected minoritized counselors to experience lower CS. However, the current study found that being a minoritized counselor actually predicted higher CS and lower burnout. It may encourage all counselors to know that greater CS among minoritized counselors indicates that ACEs and PCEs are not determinative of whether a person experiences burnout or satisfaction.

Our findings that female counselors were more likely to have higher CS than their male peers, and that counselors from low-income or working-class SES had higher CS than those from middle and upper classes, are also noteworthy. It is possible that the more collectivist tendencies of minoritized individuals in general, and of female counselors regardless of race, may help foster greater professional resilience or quality of life (Graham et al., 2020; Jordan, 2017). Counselors from lower- or working-class childhood SES may also maintain the collectivist orientation of their upbringing. This proposition is supported by previous research, which indicates that social support is a significant factor that promotes CS in therapists (Ducharme et al., 2008). This may also relate to Crouch et al.’s (2019) finding that the most significant PCE that mitigates the effects of ACEs is having a safe relationship with an adult. These results are further supported by research indicating that secure attachments in adulthood moderate the effect of childhood adversity (Klasen et al., 2019). Despite a limited sample size, Conteh et al. (2017) found that 95% of their sample of 86 counselors-in-training reported having experienced at least one trauma. Although male participants in Conteh’s study were significantly more likely to report more traumas than women—4.93 to 3.46 respectively—women reported more post-traumatic growth than men. Similar to our findings, this may indicate why female counselors were more likely to experience greater CS than male counselors.

Although close to half of our participants (42.9%) met the critical threshold of four ACEs, it is encouraging that the average participant indicated that they were not experiencing burnout. This may be the result of more than half of our participants having five or more PCEs, with PCEs predicting lower burnout. It should also be noted that in this study, ACEs were not significantly correlated with STS, which may be counterintuitive as one may assume that childhood adversity may leave one more susceptible to STS. The strongest findings in the current study, as demonstrated by high effect sizes, are that lower ACE scores predict higher CS and lower burnout. However, the potentially mitigating influence of PCEs only predicted burnout, not CS, with a lower effect size.

Limitations
Threats to internal and external validity are unavoidable in descriptive studies. As such, one limitation of this study is that it focused on descriptive and predictive relationships and therefore does not describe causation. Furthermore, this study used self-report data which may threaten internal validity. Finally, selection bias may be a risk to generalizability. However, the sample in this study is demographically similar to other studies examining the counseling population, so this risk may be minimal.

Implications
Both professional organizations (e.g., ACA, AMHCA) and CACREP can promote counselor wellness by putting policies in place recognizing that individuals going into the counseling profession are likely to have personal histories shaped by adverse experiences. These policies may include a more systemic understanding of wellness strategies for counselors. Self-care is often conceptualized as a personal endeavor achieved outside of work hours, yet policies may be put in place to promote organizational wellness by providing space and emotional support for counselor wellness. For example, far too often grants require caseloads that are too heavy to foster and maintain the well-being of counselors.

The results of this study may also have implications for counselor education. Given that 42% of our participants had four or more ACEs, it may be likely that close to half of students within counseling programs have also suffered from a significant amount of childhood adversity. This may have implications for how we educate counselors to work with trauma. Trauma-informed training generally focuses on the effects of trauma on the life of clients and supports evidence-based practices that aid in recovery, resilience, and improved quality of life. Training that is trauma-attuned may focus more on the counselor’s awareness of how their own history of adversity may shape their professional stamina. This may also lead to more research on trauma-attuned supervision.

Considering the substantial percentage of MHCs who may have four or more ACEs, it is possible that many clinical supervisors have also been greatly affected by their personal histories. Trauma-attuned supervisors will continually reflect on how their past adversity may be influencing the supervisory relationship while also monitoring both their own as well as their supervisee’s levels of burnout and emotional reactivity toward clients.

As Zyromski et al. (2020) posited, the use of ACEs as a construct can provide clarity and focus to the harmful experiences that may impede the healthy development of a client. Likewise, knowledge about ACEs and PCEs can help supervisors and counselor educators train counselors who are at greater risk for burnout. It is important that the privacy of the counselor’s childhood experiences be protected, but trainees can be given the ACE and PCE assessments and told of the risk factors that high ACE and low PCE scores have with regard to burnout and CS. Furthermore, clinical and faculty supervisors can provide assessments for CS and burnout at key points during a trainee’s internship or first few years of postgraduate experience. Counselor educators and supervisors may then help trainees develop a self-care plan that will help to foster CS.

Directions for Future Research
Future studies may further examine the difference between demographic groups based on gender, race, and education in relation to potential protective factors that female and minoritized MHCs have that may decrease the likelihood they will experience burnout. Further research may also examine which ACEs, if any, may have higher correlations with burnout and which PCEs are more likely to serve as protective factors. Furthermore, our results indicate a need to study the CS and burnout of minoritized counselors, female counselors, and those coming from lower childhood SES. Examination of potential cultural and protective factors of these groups may contribute significantly to the literature on burnout prevention.

Given the percentage of counselors who have ACE scores that fall within the range of concern, future research may examine potential differences of counselors who are trauma-attuned and not simply trauma-informed. As stated above, ACEs were not significantly correlated with STS. It may be helpful for future researchers to use different measurements of secondary stress to further assess whether there is any correlation between ACEs and STS.

Conclusion
The purpose of this study was to examine personal factors in the developmental history of clinical MHCs that may influence their likelihood of experiencing professional burnout. This is the first known study we can identify using the ACE Study Questionnaire as a measure to inquire about a potential relationship between the counselors’ developmental adversity and their rates of burnout, CS, and STS. Results indicated that higher ACE scores correlate positively with burnout, and yet PCEs may serve as protective factors. Finally, we found that women and minoritized counselors were more likely to experience compassion satisfaction than males and White counselors. This was true for minoritized counselors despite their having slightly higher rates of ACEs and lower rates of PCEs. We recommend that counselors become aware of how their own experiences of ACEs and PCEs may be impacting their current practice.

 

Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.

 

References

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Eric M. Brown, PhD, LPC, is an assistant professor at DePaul University. Kristy L. Carlisle, PhD, is an assistant professor at Old Dominion University. Melanie Burgess, PhD, is an assistant professor at the University of Memphis. Jacob Clark, BS, is a graduate student at Old Dominion University. Ariel Hutcheon, MA, is a doctoral student at Old Dominion University. Correspondence may be addressed to Eric M. Brown, 2247 N. Halsted St., Chicago, IL 60614, ebrow107@depaul.edu.

A Call for Action: School Counselor Competence in Working With Trans Students

Clark D. Ausloos, Madeline Clark, Hansori Jang, Tahani Dari, Stacey Diane Arañez Litam

 

Trans youth experience discrimination and marginalization in their homes, communities, and schools. Professional school counselors (PSCs) are positioned to support and advocate for trans youth as dictated by professional standards. However, an extensive review of literature revealed a lack of confidence and competence in counselors working with trans youth and their families. Further, there is a dearth of literature that addresses factors leading to increased school counselor competence with trans students. The current study uses a cross-sectional survey design to contribute to the extant literature and explore how PSCs in the United States work with students in the K–12 public school system. Results from multiple regression analyses indicate that PSCs who have had postgraduate training and report personal and professional experiences with trans students are more competent in working with trans students. Implications for PSCs and school counselor education programs are discussed.

Keywords: trans youth, school counselors, competence, counselor education, multiple regression analysis

 

Trans people experience an incongruence between their sex assigned at birth and their gender identity (GI; Ginicola et al., 2017; McBee, 2013). The term trans encompasses a wide range of gender-expansive identities, including trans (transgender), nonbinary (one who identifies outside the gender binary of male or female), genderqueer or gender-fluid (one who identifies with gender in a fluid, dynamic way) and agender (one who does not identify as having a gender). Trans people face pervasive discrimination and marginalization (Whitman & Han, 2017), leading to severe physical and mental health disparities, like depression, anxiety, and suicidality (James et al., 2016). In schools, trans students face 4 times higher rates of discrimination when compared with cisgender peers (Kosciw et al., 2020; Williams et al., 2021). Trans students are more vulnerable to mental health disorders, a lack of social support, and an increase in self-harm, suicidal ideations, and suicide attempts (Kosciw et al., 2020; Reisner et al., 2014), especially among transmale and nonbinary students (Toomey et al., 2018). These rates are increasing in national trends and are even higher among Black and Latinx trans students (Vance et al., 2021). The COVID-19 pandemic further exacerbated barriers and inequities for trans students, with increasing health concerns, isolation, economic hardships, issues with housing, and limited access to essential clinical care (Burgess et al., 2021).

Increasingly, trans students face systemic legal barriers to their health and well-being (Wang et al., 2016). States including Arkansas, Idaho, Montana, South Dakota, and Tennessee have introduced bills that ban trans students from participating in sports that are congruent with their GI (Transgender Law Center, 2021). In April of 2021, Arkansas banned medical gender-affirming services to students under 18 years of age (American Civil Liberties Union [ACLU], 2021). New Hampshire’s House Bill 68 proposed adding gender-affirming treatments to the definition of child abuse (ACLU, 2021). Beyond political oppression, trans youth experience overt discrimination, verbal abuse, physical and sexual assault, and marginalization within their homes, schools, and places of employment (Human Rights Campaign [HRC], 2018; James et al., 2016). Trans youth additionally face disaffirming and incompetent teachers and medical professionals (Grant et al., 2011; James et al., 2016; Whitman & Han, 2017) and embedded systemic transmisia (the hatred of trans persons; Simmons University Library, 2019). Despite the pervasive mental health concerns faced by trans students (i.e., depression, anxiety, disordered eating, self-harm, suicide), professional school counselors (PSCs) continue to be ill equipped in supporting and advocating for this marginalized population within schools (Simons, 2021). Based upon an analysis of the extant body of research, we found that counselor education training programs lack rigor in working with trans students (O’Hara et al., 2013; Salpietro et al., 2019), counselor educators may hold biased views about trans students (Frank & Cannon, 2010), and there is an absence of quality professional development opportunities on trans issues (Salpietro et al., 2019; Shi & Doud, 2017). It is therefore of paramount importance for PSCs and counselor education programs to obtain a deeper understanding of how to better prepare for and support trans students in schools.

Professional School Counselors and Trans Students
     PSCs focus on academic, career, and social-emotional growth and work as leaders alongside teachers, administration, families, and other stakeholders. PSCs are therefore well positioned to provide safety and support for trans students, promote change, and act as social justice advocates within schools (Bemak & Chung, 2008). The American School Counselor Association (ASCA) mandates that PSCs “promote affirmation, respect, and equal opportunity for all individuals regardless of . . . gender identity, or gender expression . . . and promote awareness of and education on issues related to LGBT students” (2016a, p. 37). PSCs who work with trans students may provide services through the Multitiered Systems of Support lens (MTSS; ASCA, 2019), through collaboration, by supporting school administration and staff (e.g., trainings, meetings, workshops), and through provision of direct student services (e.g., individual and group counseling, working with families). More specifically, PSCs advocate for and with students for name and pronoun changes within schools, trans-inclusive school policies, and increased visibility and normalization of trans people and issues.

ASCA (2016b) adopted a position that PSCs recognize that “the responsibility for determining a student’s gender identity rests with the student rather than outside confirmation from medical practitioners . . . or documentation of legal changes” (p. 64). It is clear that PSCs should possess knowledge and skills in working with and advocating for trans youth through a range of services at various levels and in coordination with other stakeholders in schools, all while respecting students’ autonomy and authenticity (ASCA, 2016a, 2016b, 2019; Bemak & Chung, 2008).

Counselor Education Programs
     Although professional standards provide best practices (ALGBTIC LGBQQIA Competencies Taskforce, 2013; ASCA, 2016a), many PSCs never receive the training necessary to effectively serve trans students (Bidell, 2012; O’Hara et al., 2013; Salpietro et al., 2019). Salpietro and colleagues (2019) reported that counselor incompetence was related to a lack of rigorous training that attends to family systems, intersectionality, and medical issues through gender-affirming therapies (i.e., blockers, hormones, or surgeries). These researchers indicated a need for comprehensive, standardized, and thorough formal training (i.e., graduate school) and informal professional development opportunities. These findings are consistent with Shi and Doud (2017), who recommended PSCs specifically take advantage of conferences and workshops to supplement formal educational curricula. The Gay, Lesbian, and Straight Education Network (GLSEN) conducted a survey that reported about 81% of school mental health professionals received “little to no competency training in their graduate programs related to working with [trans] populations,” and about 74% of participants rated their graduate training programs as “fair or poor” in preparing them for work with trans students (GLSEN et al., 2019, p. xviii). GLSEN and other professional organizations additionally reported about two-thirds of school professionals do not feel prepared to work with trans students (GLSEN et al., 2019). Although there are some professional development opportunities, such as those offered through the World Professional Association for Transgender Health (WPATH), the HRC, and the Society for Sexual, Affectional, Intersex, and Gender-Expansive Identities (SAIGE), there is still a lack of concrete training within graduate programs and through fieldwork experiences and an overall lack of accessible, professional trainings. There is a clear need for increased attention to trans issues in formal educational programs and professional development offerings.

Purpose of the Study and Research Questions

This study examines factors that contribute to PSC competence in working with trans students in K–12 public schools. We highlight the need for PSCs and counselor education training programs to better focus on and support trans students. More specifically, we examine the following PSC factors: (a) the PSC’s GI, (b) whether the PSC has received postgraduate training on trans issues or populations, (c) whether the PSC has worked with self-identified trans students, and (d) whether the PSC knows someone who identifies as trans outside of the school setting.

PSC Gender Identity
     Researchers recommend that special attention is given within a category of interest (i.e., gender identity) to historically marginalized groups, encouraging counselor-researchers to view all samples “in terms of their particularity and to attend to diversity within samples” (Cole, 2009, p. 176). We were intentional in using PSC GI demographic factors in data analysis, attending to diversity among PSC gender identities, as research indicates there may be relationships between counselor GI, privilege and oppression, and multicultural counselor competence (Cole, 2009). Culturally competent counselors engage in self-reflection, examine their own biases and stereotypes, consider how their positions of privilege or oppression impact the therapeutic alliance, and deliver culturally responsive counseling interventions.

Postgraduate Training Addressing Trans Issues
     Researchers note that graduate programs in counselor education are not adequately preparing school counseling students to work with trans students (Bidell, 2012; Farmer et al., 2013; Frank & Cannon, 2010; GLSEN et al., 2019; O’Hara et al., 2013) and that much of the awareness, knowledge, and skills gained in working with this population are result of counselors’ self-seeking professional trainings, education, and workshops that are focused on trans issues and students (Salpietro et al., 2019; Shi & Doud, 2017).

Professional Experiences With Trans Students
     O’Hara and colleagues (2013) reported no significance on scores of competence in working with trans clients between counseling students who completed practicum or internship and those who did not. In the present study, our variable relates to PSCs who have already graduated, reflecting on their professional tenure as PSCs, and if these experiences provided opportunities to work with trans students.

Personal Relationships With Trans People
     O’Hara and colleagues (2013) reported that participants in their study identified informal sources as necessary for gaining trans-affirming knowledge and skills, such as “exposure to or personally knowing someone who [is trans]” (p. 246). Research supports the concept that increasing affirming attitudes and mitigating negative attitudes and beliefs toward trans individuals can be accomplished by exposure and intentional engagement in fostering personal and professional relationships with trans people (Salpietro et al., 2019; Simons, 2021). In forming relationships with trans people, we can listen to and learn from the lived experiences of this community, examine our own biases, and position ourselves as supportive allies, personally and professionally.

Research Questions
     With these factors in mind, the following research questions were identified:

  1. What is the relationship between PSC factors (GI, postgraduate training, PSC work with trans students, and PSC personally knowing someone who is trans) and levels of PSC self-perceived competence in working with trans students in schools?
  2. What is the relationship between PSC factors (GI, postgraduate training, PSC work with trans students, and PSC personally knowing someone who is trans) and PSC awareness in working with trans students in schools?
  3. What is the relationship between PSC factors (GI, postgraduate training, PSC work with trans students, and PSC personally knowing someone who is trans) and PSC knowledge in working with trans students in schools?
  4. What is the relationship between PSC factors (GI, postgraduate training, PSC work with trans students, and PSC personally knowing someone who is trans) and PSC skills in working with trans students in schools?

We hypothesized there would be a statistically significance difference (p > .05) between PSC factors (GI, postgraduate training, PSC work with trans students, and PSC personally knowing someone who is trans) and levels of PSC self-perceived competence in working with trans students in schools. More specifically, we hypothesized that cisfemale PSCs who have had postgraduate training on trans issues, who have worked with trans students, and who personally know someone who is trans, would report higher scores in measures of awareness, knowledge, skills, and overall competence. Cisgender (cis) refers to someone who experiences congruence between their sex assigned at birth and their GI. Research demonstrates that cismales may express more negative attitudes and hold restrictive views toward queer and trans people when compared with cisfemales (Landén & Innala, 2000; Norton & Herek, 2012).

Method

Participants
     With an anticipated medium effect size of 0.15, a desired statistical power level of 0.95, and desired probability level of 0.05 (Israel, 2013), we determined an appropriate minimum sample size for the proposed study was 120 PSCs. Initially, 499 responses were recorded. Of those, 110 were incomplete or had missing data, yielding a total of 389 fully completed surveys. Participants in this study (N = 389) were PSCs with a valid school counseling license working in a public school setting, from kindergarten through 12th grade, in the United States. Participant demographic information can be found in Table 1.

Table 1

Demographic Characteristics of Professional School Counselors (PSCs)

 

Procedures
     For ease of use and accuracy of representation, we used probability sampling, more specifically, a simple random sample selection process (Creswell, 2013). Upon approval by the IRB, we posted a series of three recruitment letters (with 2 weeks between each posting) to PSCs through an online professional forum, ASCA Scene. We also posted our recruitment letter on ASCA Aspects, a monthly e-newsletter. Data were collected over a period of 6 weeks. PSCs who elected to participate were directed to the electronic informed consent document and the survey.

Instrumentation
Demographic Questionnaire
     Participants completed a questionnaire with write-in options for both age and gender and forced-choice responses to gather racial-ethnic identity, years working as a licensed school counselor, the region in which they practiced, and grade levels in which the participants worked. Our four independent variables were collected through the demographic questionnaire. Participants indicated their experiences, if any, with trans students, experiences with postgraduate training on trans issues, and personal relationships with trans people. 

Gender Identity Counselor Competency Scale
     The Gender Identity Counselor Competency Scale (GICCS), a revised version of the Sexual Orientation Counselor Competency Scale (Bidell, 2005), was used to assess PSC competence, the dependent variable in the study. This is the instrument best suited for intended measurement of self-perceived competence (Bidell, 2012; O’Hara et al., 2013). Bidell (2005) developed the instrument based on Sue and colleagues’ (1992) research of multicultural counseling competencies, with the domains of attitudinal awareness, knowledge, and skills. Bidell (2005) reported the Cronbach’s alpha of .90, with subscale scores for internal consistency of .88 for the Awareness subscale, .71 for the Knowledge subscale, and .91 for the Skills subscale (Bidell, 2005, 2012). Test-retest reliability for the overall instrument was found to be .84, with .85 for the Awareness subscale, .84 for the Knowledge subscale, and .83 for the Skills subscale (Bidell, 2005). The GICCS is a 29-item self-report assessment on a 7-point Likert scale (where 1 is not at all true and 7 is totally true). Examples of questions include: “I have received adequate clinical training and supervision to counsel transgender clients” and “The lifestyle of a transgender client is unnatural or immoral” (O’Hara et al., 2013, p. 242). Cronbach’s alpha in the present study was .70, adequate for our analysis.

Awareness Subscale. The Awareness subscale consists of 10 items focused on counselors’ attitudinal awareness and prejudice about trans clients, including statements like “It would be best if my clients viewed a [cisgender] lifestyle as ideal” and “I think that my clients should accept some degree of conformity to traditional [gender] values” (Bidell, 2005, p. 273). Cronbach’s alpha for the Awareness subscale has been reported as .88 (Bidell, 2005) and was .89 in the present sample. Self-awareness and reflection are critical skills for counselors in examining deeply held biases and beliefs and in asking culturally responsive questions to strengthen the therapeutic alliance.

Knowledge Subscale. This subscale of the GICCS consists of eight items focused on counselors’ experiences and skills with trans clients, including statements like “I am aware that counselors frequently impose their values concerning [gender] upon [trans] clients” and “I am aware of institutional barriers that may inhibit [trans] clients from using mental health services” (Bidell, 2005, p. 273). Cronbach’s alpha for the Knowledge subscale was reported as .76 (Bidell, 2005), and was .73 in the present sample. Counselors who impose their own values on a client may cause rifts in the therapeutic alliance and could potentially even harm clients.

Skills Subscale. This subscale of the GICCS consists of 11 items focused on counselors’ experiences and skills with trans clients, including statements like “I have experience counseling [trans male] clients” and “I have received adequate clinical training and supervision to counsel [trans] clients” (Bidell, 2005, p. 273). Cronbach’s alpha for the Skills subscale was reported as .91 (Bidell, 2005) but was .75 in the present sample. Counselors working with trans students need to understand the importance of evolving language and terminologies; utilize affirmative, celebratory, and liberating counseling; and have knowledge of and connection to medical providers who support gender-affirming interventions.

Data Analysis Procedures
Data Cleaning
     We first screened the data to ensure it was usable, reliable, and valid to proceed with statistical analyses. We continued data cleaning by coding the demographic variable of GI 1 through 4: cisfemale (1); cismale (2); nonbinary, trans, and/or genderqueer (3); and agender (4). Racial-ethnic identities were coded 1 through 10: American Indian or Alaska Native (1); Asian or Asian American (2); Black or African American (3); Hispanic, Latino, or Spanish Origin (4); Middle Eastern or North African (5); Native Hawaiian or Other Pacific Islander (6); White (7); Some Other Race, Ethnicity, or Origin (8); Prefer Not to Answer (9); and Multiracial Identity (10). PSC location was also coded 1 through 6: Midwest (1), Northeast (2), South (3), West (4), Puerto Rico or other U.S. Territories (5), and Other (6). Last of the demographic variables, we coded PSC School Level 1 through 4: Elementary (1), Middle School (2), High School (3), and Other (4). In addition, we cleaned variables highlighting PSC professional and personal training and experiences with trans persons. The first variable was dummy coded to reflect participants who had worked with trans students (1; n = 297, 76.3%) and participants who indicated not working with trans students (0; n = 92, 23.7%). The next variable, PSC postgraduate training, was dummy coded for use in data analyses, reflecting those who indicated they engaged in postgraduate training (1; n = 193, 49.6%) and participants who indicated they did not engage in postgraduate training (0; n = 196, 50.4%). The final variable was dummy coded to reflect participants who know someone who is trans outside of the school setting (1; n = 93, 23.9%) and those participants who do not know someone who is trans outside of the school setting (0; n = 296, 76.1%). Per Bidell (2005), we started by reverse scoring coded GICCS items and created new variables for the GICCS total mean score, attitudinal Awareness, Skills, and Knowledge subscales.

Data Analysis
     Post–data cleaning, we entered all the data from the demographic questionnaire and the GICCS into SPSS 26. To best answer the research questions, we used a series of standard multiple regression analyses to determine “the existence of a relationship and the extent to which variables are related, including statistical significance” (Sheperis et al., 2017, p. 131). Although multiple regression analysis can be used in prediction studies, it can also be used to determine how much of the variation in a dependent variable is explained by the independent variables, which is what we intended to measure (Johnson, 2001). Our independent variables were four categorical variables measured by our demographic questionnaire: PSC GI, postgraduate training, PSC work with trans students, and PSC personal relationships with someone who is trans. Our dependent variable was school counselor competence in working with trans students, as measured by the GICCS (Bidell, 2005).

There are many assumptions to consider when conducting a multiple regression analysis, including (a) two or more continuous or categorical independent variables, (b) a continuous dependent variable, (c) independence of residuals (or observations), (d) linearity (both between dependent variable and each of the independent variables, and between the dependent variable and the independent variables as a whole), (e) homoscedasticity, (f) absence of multicollinearity, (g) no significant outliers, and (h) normally distributed residuals (Flatt & Jacobs, 2019). The research variables met assumptions (a) and (b) in conducting multiple regressions. In analyzing data in SPSS, independence of residuals was determined by using the Durbin-Watson statistic, which ranges in value from 0 to 4, with a value near 2 indicating no correlation between residuals. Assumption (c) was met, as the Durbin-Watson value found was 1.46 (Savin & White, 1977). Additionally, we plotted a scatterplot using variables, as well as a partial regression with each of the independent variables and the dependent variable, and observed linear relationships, attending to the assumptions of linearity (d; i.e., a linear relationship between dependent and independent variables) and homoscedasticity (e; i.e., residuals are equal for all values of the predicted dependent variable). Homoscedasticity was also assessed by visual inspection of a plot of studentized residuals versus unstandardized predicted values. To assess the absence of multicollinearity (f), we considered the variance inflation factors (VIF) indicated in the coefficients table (Flatt & Jacobs, 2019). We found VIF values ranging from 1.01 to 1.05, indicating an absence of multicollinearity (f). VIF is a measure of the amount of multicollinearity in a set of multiple regression variables (Flatt & Jacobs, 2019). We checked for unusual points (g): outliers, high leverage points, and highly influential points. We did identify a significant outlier (−3.10) in case number 133 by examining the range of standardized residuals ([−3.10 to 2.34]), which is outside the common cut-off range of three standard deviations (SD). We then inspected the studentized deleted residual values and found a value in case number 133 (−3.15), which falls outside the common cut-off range of 3 SD.

Additionally, we determined two cases of problematic leverage values that were greater than the safe value of 0.2 (0.36 and 0.23). The cases that violated assumptions were filtered out and the standard multiple regression analysis was run again. This time, the data did not violate assumptions (a) through (g). Last, we observed normally distributed standardized residuals (h). To determine if any cases were influential in the data, we examined the Cook’s Distance values, which ranged from .000 to .090. As there were no values above 1, there were no highly influential points. To answer the first research question (the relationship between PSC factors and levels of PSC self-perceived competence in working with trans students in schools as measured by total scores on the GICCS), we used a standard multiple regression analysis (Sheperis et al., 2017). To answer research questions 2 through 4, we conducted standard multiple regression analyses using the Awareness, Knowledge, and Skills subscales as the dependent variables, respectively.

Results 

Correlations Between Variables of Interest
     Prior to the regression analysis, we examined correlations between the variables: PSC GI (cisfemale, cismale, trans, agender), having worked with trans students, postgraduate training experiences, personally knowing someone who is trans, the GICCS Awareness subscale, the GICCS Skills subscale, the GICCS Knowledge subscale, and the GICCS total score. Correlations of variables of interest are found in Table 2. There were multiple significant correlations as determined by Pearson product moment correlations (r). The GICCS total score was significantly correlated with the Awareness subscale (r = −.65, p < .001), the Skills subscale (r = .83, p < .001), and the Knowledge subscale (r = .66, p < .001). The Awareness subscale was significantly correlated with the Skills subscale (r = −.26, p < .001) and the Knowledge subscale (r = .30, p < .001). The Knowledge subscale was also significantly correlated with the Skills subscale (r = .30, p < .001). In examining demographic factors, cisfemale GI was significantly correlated with cismale GI (r = −.90, p < .001), trans GI (r = −.37, p < .001), and agender GI (r = −.21, p < .001). Additionally, cisfemale GI was significantly correlated with having worked with trans students (r = −.12, p = .036), as well as the GICCS total score (r = −.14, p = .005), the Skills subscale (r = −.14, p = .005), and the Knowledge subscale (r = −.15, p = .003). Cismale GI was significantly correlated with the GICCS total score (r = .11, p = .038), the Skills subscale (r = .12, p = .017), and the Knowledge subscale (r = .11, p = .003). Trans GI was significantly correlated with personally knowing someone who is trans (r = .12, p = .002), as well as with the GICCS total score (r = .12, p = .034). Having worked with trans students was significantly correlated with the GICCS total score (r = .41, p <.001), the Skills subscale (r = .55, p < .001), and the Awareness subscale (r = −.11,
p = .032). Postgraduate training was significantly correlated with many variables, including personally knowing someone who is trans (r = .14, p = .005), and with the GICCS total scores (r = .36, p < .001), the Skills subscale (r = .41, p < .001), the Knowledge subscale (r = .19, p < .001), and the Awareness subscale (r = −.10, p = .040). Last, personally knowing someone who is trans was significantly correlated with the GICCS total score (r = .35, p < .001), the Skills subscale (r = .29, p < .001), the Knowledge subscale
(r = .25, p < .001), and the Awareness subscale (r = −.22, p < .001).

 

Table 2

Correlation Table for Variables of Interest

 

Model 1: PSC Competency
     R² for the overall model was 35.2%, with an adjusted R² of 34.1%, a small to moderate size according to Cohen (1988). PSC factors significantly predicted levels of PSC self-perceived competence in working with trans students in schools, F(6, 381) = 34.430, p < .001. In examining beta weights (β), having worked with trans students received the strongest weight in the model (β = .35), followed by postgraduate training (β = .29) and personally knowing someone who is trans (β = .27). The variable with the most weight, having worked with trans students, had a structure coefficient (rs) of .67, and rs2 was 45.2%, meaning that of the 35.2% effect (R2), this variable accounts for 45.2% of the explained variance by itself. This shows that PSCs’ competence is increased by experiences with trans students, engaging in postgraduate trainings, and personally knowing someone who is trans. A summary of regression coefficients and standard errors can be found in Table 3.

 

Table 3

Multiple Linear Regression Analyses Exploring Professional School Counselor Competence

Model 2: PSC Awareness
     R² for the overall model was 5.8%, with an adjusted R² of 6.2%, a very small effect size (Cohen, 1988). PSC factors (GI, postgraduate training, PSC work with trans students, and PSC personal relationship with someone who is trans) significantly predicted awareness of PSC self-perceived competence in working with trans students in schools, F(6, 380) = 3.873, p = .001. Personally knowing someone who is trans was the only significant predictor in this model. We examined the regression coefficients and corresponding data (β = −.20, rs = −0.90, rs2 = 80%). Of the 5.8% effect (R²), personally knowing someone who is trans accounted for 80% of the explained variance by itself.

Model 3: PSC Knowledge
     R² for the overall model was 10.3%, with an adjusted R² of 8.9%, a small effect size (Cohen, 1988). PSC factors (GI, postgraduate training, PSC work with trans students, and PSC personal relationship with someone who is trans) significantly predicted knowledge of PSC self-perceived competence in working with trans students in schools, F(6, 379) = 7.257, p < .001. Personally knowing someone who is trans, postgraduate training, and cismale GI were all significant in this model. Personally knowing someone who is trans received the strongest weight in the model (β = .20, rs = .76), followed by postgraduate training (β = .16, rs = .58) and cismale GI (β = .12, rs = .35). After examining regression coefficients and corresponding data, we determined that of the 10.3% effect (R2), personally knowing someone who is trans accounted for 58.3% of the explained variance by itself. These findings demonstrate that PSC knowledge is strongly supported through fostering personal relationships with trans people.

Model 4: PSC Skills
     R² for the overall model was 50.2%, with an adjusted R² of 49.5%, a medium effect size according to Cohen (1988). PSC factors (GI, postgraduate training, PSC work with trans students, and PSC personal relationship with someone who is trans) significantly predicted self-perceived PSC skills in working with trans students in schools, F(6, 380) = 63.945, p < .001. Having worked with trans students, postgraduate training, and personally knowing someone who is trans were all significant in this model. Having worked with trans students received the strongest weight in the model (β = .51), followed by postgraduate training (β = .35) and personally knowing someone who is trans (β = .20). After examining regression coefficients and corresponding data, we determined that of the 50.2% effect (R2), having worked with trans students accounted for 79% of the explained variance by itself. Counselors can augment their skills by staying updated on appropriate language and terminologies and by fostering relationships with affirming providers and medical professionals in the community.

Discussion

The most salient finding in this model is that PSCs who worked with trans students were strongly positively correlated with GICCS total scores (r = .61, p < .001). This finding may indicate that increased exposure to trans students may subsequently increase competency in working with trans populations. Our research findings supplement existing studies that reported a relationship between affirming attitudes toward trans students and professional exposure to trans people (Salpietro et al., 2019; Simons, 2021). Avoidance of counseling trans students because of discomfort is not only unethical (ASCA, 2016b) but inhibits a PSC’s ability to develop their GI competence (Henry & Grubbs, 2017). Thus, it is imperative that PSCs receive opportunities to work with trans students (through practicum or internship experiences); consult with experienced, gender-affirming PSCs who have worked with trans students; and “expose themselves to published texts . . . films . . . [and] service-learning activities . . . to gain a better understanding of the experiences of [trans] persons” (O’Hara et al., 2013, p. 251). Additionally, PSCs must engage in constant self-reflection, introspection, and processing of biases and worldviews to provide culturally competent care to trans students.

Counseling Competence
     Postgraduate training was moderately positively correlated with GICCS total score (r = .43, p < .001), indicating that additional postgraduate training in trans issues increased competence in the present sample (Model 1). This is consistent with extant literature, which demonstrated that PSCs who received postgraduate training were more competent in providing affirming services to trans students compared to PSCs who had not received the training (Salpietro et al., 2019; Shi & Doud, 2017). Finally, the presence of personal relationships with trans people was moderately positively correlated with GICCS total scores (r = .47, p < .001). These results support current literature in that PSCs who currently have or have had personal relationships with trans people were more competent in providing affirming services to trans students (GLSEN et al., 2019; O’Hara et al., 2013; Salpietro et al., 2019; Simons, 2021).

Awareness
     We explored the relationship between PSC factors on the Awareness subscale of the GICCS in the second research question (Model 2). In examining coefficients for the model, having personal relationships with trans people is associated with a decrease in GICCS Awareness subscale scores, a weak, negative correlation (r = −.19, p = .001). This finding may indicate that people who did not know someone personally who is trans would score slightly higher on the Awareness subscale. These unexpected findings are contrary to existing research, which reported that engaging in personal relationships with trans people increased affirming attitudes and mitigated negative attitudes (Henry & Grubbs, 2017; Salpietro et al., 2019). Because of the lack of practical significance of PSC factors (i.e., GI, postgraduate training, PSC work with trans students, and PSC personal relationship with someone who is trans) on the Awareness subscale, these results should be considered with caution.

Knowledge
     In the third research question, we explored the relationship between PSC factors on the Knowledge subscale of the GICCS (Model 3). In examining coefficients for the model, PSC cisgender male GI was moderately positively correlated with the Knowledge subscale scores (r = .476, p = .032), indicating that cismale PSCs scored moderately higher on the Knowledge subscale when compared with other PSC gender identities in the present sample. One possible explanation is the present study’s sample of cisfemales (N = 368, 94.6%) and cismales (N = 17, 4.4%). Within this sample, the ages of the cismale PSCs could reflect a time in which counselor education programs increased attention to diversity, whereas this was not always a main tenet in training among older PSCs (who may be more represented by cisfemale PSCs in this sample [Bemak & Chung, 2008]). Presently, the Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2015) requires accredited counselor education programs to deliver a counseling curriculum that includes specific attention to social and cultural diversity, an essential foundation of competent counselors. Additionally, PSC postgraduate training was weakly positively correlated with Knowledge subscale scores (r = .292, p = .002), which supports the literature that PSCs who engage in professional training opportunities outside of graduate school increase their knowledge of trans students and trans issues (Salpietro et al., 2019; Shi & Doud, 2017). Having personal experiences with trans people was moderately positively correlated with Knowledge subscale scores (r = .434, p < .001), indicating that those PSCs who personally knew a trans person felt more confident and competent in their knowledge about trans students and issues. This supports current literature (GLSEN et al., 2019; Henry & Grubbs, 2017; O’Hara et al., 2013; Salpietro et al., 2019) showing that PSCs who intentionally engaged in and fostered personal relationships with trans people reported greater competence.

Skills
     Finally, we explored the relationship between PSC factors (GI, postgraduate training, PSC work with trans students, and PSC personal relationship with someone who is trans) on the Skills subscale of the GICCS in research question 4 (Model 4). In examining coefficients for the model, having worked with trans students was moderately positively correlated with Skills subscale scores (r = .545, p < .001), which may indicate that PSCs who work with trans students will be more likely to employ the necessary supports to ensure growth in “academic, career and social/emotional development” (ASCA, 2016a, para. 1). This is supported by literature in which researchers reported number of students worked with and “interpersonal contact” (personal exposure) as positive predictors of affirmative counselor competence (Bidell, 2012; Farmer et al., 2013). PSCs play an essential role in advocating for and removing barriers for trans students, which improves trans students’ well-being, academic success, and interpersonal growth. PSC postgraduate training was strongly positively correlated with Skills subscale scores (r = .845, p < .001), which may indicate that PSCs who engage in professional development opportunities and trainings gain essential skills for working with trans students. This finding is consistent with extant research that reported the importance of postgraduate training and professional development opportunities on trans topics (Bidell, 2012; Frank & Cannon, 2010; GLSEN et al., 2019; O’Hara et al., 2013). Finally, knowing someone personally who is trans was moderately positively correlated with Skills subscale scores (r = .576, p < .000), which may mean that having familiarity and exposure to trans folks increases PSC’s self-perceived skills.

Implications

Professional School Counselors
     Based on the results of our study, PSCs who worked with trans students reported significantly higher scores of overall self-perceived competence compared to PSCs who had not worked with trans students. Specifically, our results indicate a link between PSCs having worked with trans students and higher scores on the Knowledge subscale. The GICCS Knowledge subscale addresses PSC knowledge of trans psychosocial issues (Bidell, 2005). This supports the idea that PSCs who work with self-identified trans students have a deeper understanding of the social and psychological challenges faced by trans people, and these experiences increase their comfort in working with trans students. All PSCs are required to protect and support the well-being of queer and trans youth and must have foundational knowledge and familiarity with trans students and issues (ASCA, 2016b). PSCs must attend professional development offerings on trans issues, and counselor education programs must provide increased time and attention to discussing trans issues, clients, and students.

PSC postgraduate training experiences are significantly linked to an overall increase in scores on the GICCS, indicating that PSC postgraduate experiences contribute to PSCs feeling more confident and competent in working with trans students. We conceptualized postgraduate training experiences as any training or education focused on trans persons or issues that a PSC received after their graduate program education. These results indicate that to increase competence and provide affirming, ethical care to trans students, PSCs should engage in some type of postgraduate training on trans issues and students, especially if they are unfamiliar with trans issues. These results are congruent with other studies, which found no significance in the relationship between groups on the Awareness subscale, but significant relationships on both the Knowledge and Skills subscales, with professional training experiences (Bidell, 2005; Rutter et al., 2008). PSCs are therefore encouraged to join professional organizations that promote best practices in working with trans students, like WPATH, the HRC, and SAIGE, as these organizations often offer professional development opportunities. It is essential that PSCs seek out trainings that are specific to trans students and issues, attend to unique psychosocial barriers, outline best practices, describe social/medical affirming care, and provide an overview of ethical and legal issues.

Of all the variables in the present study, PSCs knowing someone who identifies as trans was significantly linked to an increase in overall confidence and competence, as well as a significant increase in both Knowledge and Skills. Surprisingly, PSCs who indicated they did not know someone who identified as trans scored slightly higher on the Awareness subscale scores when compared with PSCs who did. The Awareness subscale of the GICCS examines a PSC’s self-awareness of anti-trans biases and stigmatization (Bidell, 2005). This result is contrary to existing research, which reported that engaging in personal relationships with trans folks increased affirming attitudes and mitigated negative attitudes (Henry & Grubbs, 2017; Salpietro et al., 2019). The link between a PSC personally knowing someone who is trans and a counselor’s competence in knowledge and skills supports extant literature that speaks to the importance of non–work-related experiences with trans people (e.g., personal, familial, social) and an increase in counselors’ competence in working with trans students (Whitman & Han, 2017). It is important that PSCs continue to monitor and increase their personal engagement with trans communities, as this significantly links to PSCs feeling more comfortable and more competent in working with trans students. Personal experiences may include fostering connections to trans family members, friends, and trans people through community organizations (GLSEN et al., 2019; Henry & Grubbs, 2017; Salpietro et al., 2019). Given the findings of our study, it is important for PSCs to connect to affirming resources in their communities. PSCs may consider exploring the multitude of resources offered by GLAAD (glaad.org), the National Center for Transgender Equality (NCTE; transequality.org), and PFLAG (pflag.org).

Counselor Education Programs
     Our results indicate that those PSCs who engage in professional development are more competent than those who do not. Professional counseling organizations (i.e., ASCA) and accrediting bodies (i.e., CACREP) mandate that school counselors-in-training receive formal training in social and cultural diversity (F.2; CACREP, 2015), including multicultural counseling competencies (F.2.c.; CACREP, 2015), and deliver a comprehensive “counseling program that advocates for and affirms all students . . . including . . . gender, gender identity and expression” (ASCA, 2016a, para. 3). Although current standards call for the inclusion of LGBTQIA+ issues within counselor education curricula, the reality is that counselors-in-training receive minimal training in working with trans and gender-expansive students (Frank & Cannon, 2010; O’Hara et al., 2013). It is imperative that CE programs and counselor educators broaden the scope of learning about trans issues, going beyond the minimal requirements (CACREP, 2015) and providing depth and rigor in gender-related coursework in diversity courses. This research supports other emergent literature which recommends that counselor education programs offer additional, specific courses related to affectional and sexual identities (LGBQ+), and gender-expansive identities (trans, nonbinary), as covering specific issues and populations increases counselor competency (Bidell, 2012; Henry & Grubbs, 2017; O’Hara et al., 2013, Salpietro et al., 2019).

Limitations and Directions for Future Research
     Limitations of the study include potential social desirability factors and inattentive responding, which may influence the quality of the data, as the study relied on self-report. Particularly, we note that the findings of higher self-awareness for PSCs who did not know someone who identified as trans could be a potential result of social desirability factors. Although the present study confirms that certain professional and personal factors contribute to PSCs increased competence in working with trans students in the present sample, additional research should be conducted. Also, much of our sample consisted of White ciswomen and, therefore, we caution readers about generalizing these findings to school counselors outside of those identities. The revised GICCS has not been used in many studies focusing on trans populations and additional research is needed to assess its validity with PSCs and trans youth (Bidell, 2005, 2012). Future researchers should consider additive studies that more deeply examine the types of professional development opportunities that promote PSC competency, including length, location, modality, themes, and expertise of presenter(s). Knowing these factors is important for crafting and delivering meaningful and competence-fostering professional development opportunities for PSCs. Also, future studies should examine unique nuances within trans groups, such as nonbinary and gender-fluid students (Toomey et al., 2018), and highlight the voices of trans students of color (Vance et al., 2021). Finally, future studies should also include demographic factors like religiosity and spirituality and their correlation to PSC GI competence, building on the work of Farmer and colleagues (2013).

Conclusion

This study highlights the need for increased attention to trans issues in many domains: among PSCs, within school counseling training programs, and in existing professional development offerings. ASCA mandates that PSCs be advocates for trans students, but there is a lack of attention to trans issues in school counseling training programs, leading PSCs to feel unprepared and to seek outside professional development offerings. The study also highlights the importance of building community and connections with trans people in and outside of professional settings, leading to increased PSC competence in professional settings. PSCs should continue to learn about the evolving language, trends, and needs of the trans community, ideally from those who are part of that community. Additionally, PSCs should engage with and use resources from professional trans-affirming organizations, such as WPATH, HRC, SAIGE, GLAAD, NCTE, and PFLAG.

 

Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.

 

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Clark D. Ausloos, PhD, NCC, LPC, LPSC, is a clinical assistant professor at the University of Denver. Madeline Clark, PhD, NCC, ACS, LPC (VA), LPCC (OH), is an associate professor at the University of Toledo. Hansori Jang, PhD, NCC, is an assistant professor at Hankuk University of Foreign Studies. Tahani Dari, PhD, NCC, LPC (MI), LPSC, is an assistant professor at the University of Toledo. Stacey Diane Arañez Litam, PhD, NCC, CCMHC, LPCC-S, is an assistant professor at Cleveland State University. Correspondence may be addressed to Clark D. Ausloos, 15578 John F. McCarthy Way, Perrysburg, OH 43551, clark.ausloos@du.edu.

A Case Study Exploring Supervisee Experiences in Social Justice Supervision

Clare Merlin-Knoblich, Jenna L. Taylor, Benjamin Newman

 

Social justice is a paramount concept in counseling and supervision, yet limited research exists examining this idea in practice. To fill this research gap, we conducted a qualitative case study exploring supervisee experiences in social justice supervision and identified three themes from the participants’ experiences: intersection of supervision experiences and external factors, feelings about social justice, and personal and professional growth. Two subthemes were also identified: increased understanding of privilege and increased understanding of clients. Given these findings, we present practical applications for supervisors to incorporate social justice into supervision.

Keywords: social justice, supervision, case study, personal growth, practical applications

 

Social justice is fundamental to the counseling profession, and, as such, scholars have called for an increase in social justice supervision (Ceballos et al., 2012; Chang et al., 2009; Collins et al., 2015; Dollarhide et al., 2018, 2021; Fickling et al., 2019; Glosoff & Durham, 2010). Although researchers have studied multicultural supervision in the counseling profession, to date, minimal research has been conducted on implementing social justice supervision in practice (Dollarhide et al., 2021; Fickling et al., 2019; Gentile et al., 2009; Glosoff & Durham, 2010). In this study, we sought to address this research gap with an exploration of master’s students’ experiences with social justice supervision.

Social Justice in Counseling
     Counseling leaders have developed standards that reflect the profession’s commitment to social justice principles (Chang et al., 2009; Dollarhide et al., 2021; Fickling et al., 2019; Glosoff & Durham, 2010). For instance, the American Counseling Association’s ACA Code of Ethics (2014) highlights the need for multicultural and diversity competence in six of its nine sections, including Section F, Supervision, Training, and Teaching. Additionally, in 2015, the ACA Governing Council endorsed the Multicultural and Social Justice Counseling Competencies (MSJCC), which provide a framework for counselors to use to implement multicultural and social justice competencies in practice (Fickling et al., 2019; Ratts et al., 2015). All of these standards reflect the importance of social justice in the counseling profession (Greene & Flasch, 2019).

Social Justice Supervision
     Although much of the counseling profession’s focus on social justice emphasizes counseling practice, social justice principles benefit supervisors, counselors, and clients when they are also incorporated into clinical supervision. In social justice supervision, supervisors address levels of change that can occur through one’s community using organized interventions, modeling social justice in action, and employing community collaboration (Chang et al., 2009; Dollarhide et al., 2021; Fickling et al., 2019). These strategies introduce an exploration of culture, power, and privilege to challenge oppressive and dehumanizing political, economic, and social systems (Dollarhide et al., 2021; Fickling et al., 2019; Garcia et al., 2009; Glosoff & Durham, 2010; Pester et al., 2020). Moreover, participating in social justice supervision can assist counselors in developing empathy for clients and conceptualizing them from a systemic perspective (Ceballos et al., 2012; Fickling et al., 2019; Kiselica & Robinson, 2001). When a supervisory alliance addresses cultural issues, oppression, and privilege, supervisees are better able to do the same with clients (Chang et al., 2009; Dollarhide et al., 2021; Fickling et al., 2019; Glosoff & Durham, 2010). Thus, counselors become advocates for clients and the profession (Chang et al., 2009; Dollarhide et al., 2021; Gentile et al., 2009; Glosoff & Durham, 2010).

Chang and colleagues (2009) defined social justice counseling as considering “the impact of oppression, privilege, and discrimination on the mental health of the individual with the goal of establishing equitable distribution of power and resources” (p. 22). In this way, social justice supervision considers the impact of oppression, privilege, and discrimination on the supervisee and supervisor. Dollarhide and colleagues (2021) further simplified the definition of social justice supervision, stating that it is “supervision in which social justice is practiced, modeled, coached, and used as a metric throughout supervision” (p. 104). Supervision that incorporates a focus on intersectionality can further support supervisees’ growth in developing social justice competencies (Greene & Flasch, 2019).

Literature about social justice supervision often includes an emphasis on two concepts: structural change and individual care (Gentile et al., 2009; Lewis et al., 2003; Toporek & Daniels, 2018). Structural change is the process of examining, understanding, and addressing systemic factors in clients’ and counselors’ lives, such as identity markers and systems within family, community, school, work, and elsewhere. Individual care acknowledges each person within the counseling setting independent of their environment (Gentile et al., 2009; Roffman, 2002). Scholars advise incorporating both concepts to address power, privilege, and systemic factors through social justice supervision (Chang et al., 2009; Gentile et al., 2009; Glosoff & Durham, 2010; Greene & Flasch, 2019; Pester et al., 2020).

It is necessary to distinguish social justice supervision from previous literature on multicultural supervision. Although similar, these concepts are different in that multicultural supervision emphasizes cultural awareness and competence, whereas social justice supervision brings attention to sociocultural and systemic factors and advocacy (Dollarhide et al., 2021; Fickling et al., 2019; E. Lee & Kealy, 2018; Peters, 2017; Ratts et al., 2015). For instance, a supervisor practicing multicultural supervision would be aware of a supervisee’s identity markers, such as race, ethnicity, and culture, and address those components throughout the supervisory experience, whereas a supervisor practicing social justice supervision would also consider systemic factors that impact a supervisee, in addition to being culturally competent. The supervisor would use that knowledge in the supervisory alliance and act as a change agent at individual and community levels (Chang et al., 2009; Dollarhide et al., 2021; Fickling et al., 2019; Gentile et al., 2009; Glosoff & Durham, 2010; E. Lee & Kealy, 2018; Lewis et al., 2003; Peters, 2017; Ratts et al., 2015; Toporek & Daniels, 2018).

Researchers have found that multicultural supervision contributes to more positive outcomes than supervision without consideration for multicultural factors (Chopra, 2013; Inman, 2006; Ladany et al., 2005). For example, supervisees who participated in multicultural supervision reported that supervisors were more likely to engage in multicultural dialogue, show genuine disclosure of personal culture, and demonstrate knowledge of multiculturalism than supervisors who did not consider multicultural concepts in supervision (Ancis & Ladany, 2001; Ancis & Marshall, 2010; Chopra, 2013). Supervisees also reported that multicultural considerations led them to feel more comfortable, increased their self-awareness, and spurred them on to discuss multiculturalism with clients (Ancis & Ladany, 2001; Ancis & Marshall, 2010). Although parallel research on social justice supervision is lacking, findings on multicultural supervision are a promising indicator of the potential of social justice supervision.

Models
     In recent years, scholars have called for social justice supervision models to integrate social justice into supervision (Baggerly, 2006; Ceballos et al., 2012; Chang et al., 2009; Collins et al., 2015; Glosoff & Durham, 2010; O’Connor, 2005). However, to date, only three formal models of social justice supervision have been published. Most recently, Dollarhide and colleagues (2021) recommended a social justice supervision model that can be used with any supervisory theory, developmental model, and process model. In this model, the MSJCC are integrated using four components. First, the intersectionality of identity constructs (i.e., gender, race/ethnicity, socioeconomic status, sexual orientation, abilities, etc.) is identified as integral in the supervisory triad between supervisor, counselor, and client. Second, systemic perspectives of oppression and agency for each person in the supervisory triad are at the forefront. Third, supervision is transformed to facilitate the supervisee’s culturally informed counseling practices. Lastly, the supervisee and client experience validation and empowerment through the mutuality of influence and growth (Dollarhide et al., 2021).

Prior to Dollarhide and colleagues’ (2021) model for social justice supervision, Gentile and colleagues (2009) proposed a feminist ecological framework for social justice supervision. This model encouraged the understanding of a person at the individual level through interactions within the ecological system (Ballou et al., 2002; Gentile et al., 2009). The supervisor’s role is to model socially just thinking and behavior, create a climate of equality, and implement critical thinking about social justice (Gentile et al., 2009; Roffman, 2002).

Lastly, Chang and colleagues (2009) suggested a social constructivist framework to incorporate social justice issues in supervision via three delineated tiers (Chang et al., 2009; Lewis et al., 2003; Toporek & Daniels, 2018). In the first tier, self-awareness, supervisors assist supervisees to recognize privileges, understand oppression, and gain commitment to social justice action (Chang et al., 2009; C. C. Lee, 2007). In the second tier, client services, the supervisor understands the clients’ worldviews and recognizes the role of sociopolitical factors that can impact the developmental, emotional, and cognitive meaning-making system of the client (Chang et al., 2009). In the third tier, community collaboration, the supervisor guides the supervisee to advocate for changes on the group, organizational, and institutional levels. Supervisors can facilitate and model community collaboration interventions, such as providing clients easier access to resources, participating in lobbying efforts, and developing programs in communities (Chang et al., 2009; Dinsmore et al., 2002; Kiselica & Robinson, 2001).

Each of these supervision models serves as a relevant, accessible tool for counseling supervisors to use to incorporate social justice into supervision (Chang et al., 2009, Dollarhide et al., 2021; Gentile et al., 2009). However, researchers lack an empirical examination of any of the models. To address this research gap and begin understanding social justice supervision in practice, the present qualitative case study exploring master’s students’ experiences with social justice supervision was undertaken.

We selected Chang and colleagues’ (2009) three-tier social constructivist framework in supervision for several reasons. First, the social constructivist framework incorporates a tiered approach similar to the MSJCC (Ratts et al., 2015) and reflects social justice goals in the profession of counseling (Ceballos et al., 2012; Chang et al., 2009; Collins et al., 2015; Glosoff & Durham, 2010). Second, the model is comprehensive. In using three tiers to address social justice (self, client, and community), the model captures multiple layers of social justice influence for counselors. Finally, the model is simple and meets the developmental needs of novice counselors. By identifying three tiers of social justice work, Chang and colleagues (2009) crafted an accessible tool to help new and practicing school counselors infuse social justice into their practice. This high level of structure matches the initial developmental levels of new counselors, who typically benefit from high amounts of structure and low amounts of challenge in supervision (Foster & McAdams, 1998).

Method

The research question guiding this study was: What are the experiences of master’s counseling students in individual social justice supervision? We used a social constructivist theoretical framework and presumed that knowledge would be gained about the participants’ experiences based on their social constructs (Hays & Singh, 2012). The ontological perspective reflected realism, or the belief that constructs exist in the world even if they cannot be fully measured (Yin, 2017).

We selected a qualitative case study methodology because it was the most appropriate approach to explore the experiences of a single group of supervisees supervised by the same supervisor in the same semester. In this approach, researchers examine one identified unit bounded by space, time, and persons (Hancock et al., 2021; Hays & Singh, 2012; Yin, 2017). Qualitative case study research allows researchers to deeply explore a single case, such as a group, person, or experience, and gain an in-depth understanding of that identified situation, as well as meaning for the people involved in it (Hancock et al., 2021; Prosek & Gibson, 2021).

In this study, we selected a case study methodology because the study’s participants engaged in the same supervisory experience at the same counseling program in the same semester, thus forming a case to be studied (Hancock et al., 2021). Given the research question, we specifically used a descriptive case study design, which reflected the study goals to describe participants’ experiences in a specific social justice supervision experience. Case study scholars (Hancock et al., 2021; Yin, 2017) have noted that identifying the boundaries of a case is an essential step in the study process. Thus, the boundaries for this study were: master’s-level school counseling students receiving social justice supervision from the same supervisor (persons) at a medium-sized public university on the East Coast (place) over the course of a 14-week semester (time).

Research Team
     Our research team for this study consisted of our first and third authors, Clare Merlin-Knoblich and Benjamin Newman, both of whom received training and had experience in qualitative research. Merlin-Knoblich and Newman both identify as White, heterosexual, cisgender, middle-class, and trained counselor educators/supervisors. Merlin-Knoblich is a woman (pronouns: she/her/hers) and former school counselor, who completed master’s and doctoral coursework on social justice counseling and studied social justice supervision in a doctoral program. Newman is a man (pronouns: he/him/his) and clinical mental health/addictions counselor, who completed social justice counseling coursework in a master’s counseling program before completing a doctorate in counselor education and supervision. Our second author, Jenna L. Taylor, was not a part of the research team, but rather was a counseling student unaffiliated with the research participants who assisted in the preparation of the manuscript. Taylor identifies as a White, heterosexual, cisgender, and middle-class woman (pronouns: she/her/hers) with prior experience in research courses and on qualitative research teams. Merlin-Knoblich was familiar with all three participants given her role as the practicum supervisor. Taylor and Newman did not know the study participants beyond Newman’s interactions while recruiting and interviewing them for this study.

Participants and Context
     Although some scholars of some qualitative research methodologies call for requisite minimum numbers of participants, in case study research, there is no minimum number of participants sufficient to study (Hays & Singh, 2012). Rather, in case study research, researchers are expected to study the number of participants needed to reflect the phenomenon being studied (Hancock et al., 2021). There were three participants in this study because the supervisory experience that comprised the case studied included three supervisees. Adding additional participants outside of the case would have conflicted with the boundaries of the case and potentially interfered with an understanding of the single, designated case in this study.

All study participants identified as White, heterosexual, cisgender, middle-class, and English-speaking women (pronouns: she/her/hers). Participants were 23, 24, and 26 years old. All the participants were students in the same CACREP-accredited school counseling program at a public liberal arts university on the East Coast of the United States. Prior to the study, the participants completed courses in techniques, group counseling, school counseling, ethics, and theories. While being supervised, participants also completed a practicum experience and coursework in multicultural counseling and career development.

All participants completed practicum at high schools near their university. One high school was urban, one was suburban, and one was rural. During the practicum experience, participants met with Merlin-Knoblich, their supervisor, for face-to-face individual supervision for 1 hour each week. They also submitted weekly journals to Merlin-Knoblich, written either freely or in response to a prompt, depending on their preference. Merlin-Knoblich then provided weekly written feedback to each participant’s journal entry, and, if relevant, the journal content was discussed during face-to-face supervision. Simultaneously, a university faculty member provided weekly face-to-face supervision-of-supervision to Merlin-Knoblich to monitor supervision skills and ensure adherence to the identified supervision model. The faculty member possessed more than 15 years of experience in supervision and was familiar with social justice supervision models.

Merlin-Knoblich applied Chang and colleagues’ (2009) social constructivist social justice supervision model in deliberate ways throughout the supervisees’ 14-week practicum experience. For example, in the initial supervision sessions, Merlin-Knoblich introduced the supervision model and explained how they would collaboratively explore ideas of social justice in counseling related to their practicum experiences. This included defining social justice, discussing supervisees’ previous background knowledge, and exploring their openness to the idea.

Throughout the first 5 weeks of supervision, Merlin-Knoblich used exploratory questions to build participants’ self-awareness (the first tier), particularly around their experiences with privilege and oppression. During the next 5 weeks of supervision, Merlin-Knoblich focused on the second tier, understanding clients’ worldviews. They discussed sociopolitical factors and examined how a client’s worldview impacts their experiences. For example, Merlin-Knoblich discussed how a client’s age, race/ethnicity, socioeconomic status, family structure, language, immigrant status, gender identity, sexual orientation, and other factors can influence their experiences. Lastly, in the final 4 weeks of supervision, Merlin-Knoblich focused on the third tier of social justice implications at the institutional level. For instance, Merlin-Knoblich initiated discussions about policies at participants’ practicum sites that hindered equity. Merlin-Knoblich also explored the role that participants could take in making resources available to clients, advocating in the community, and using leadership to support social justice. Table 1 summarizes how Merlin-Knoblich implemented Chang and colleagues’ (2009) social justice model.

 

Table 1

Social Justice Supervision in Practice

 

Merlin-Knoblich addressed fidelity to the supervision model in two ways. First, in weekly supervision-of-supervision meetings with the faculty advisor, they discussed the supervision model and its use in sessions with participants. The faculty advisor regularly asked about the supervision model and how it manifested in sessions in an attempt to ensure that the model was being implemented recurrently. Secondly, engagement with Newman occurred in regular peer debriefing discussions about the use of the supervision model. Through these discussions, Newman monitored Merlin-Knoblich’s use of the social justice model throughout the 14-week supervisory experience.

Data Collection
     We obtained IRB approval prior to initiating data collection. One month after the end of the semester and practicum supervision, Newman approached Merlin-Knoblich’s three supervisees about participation in the study. He explained that participation was an exploration of the supervisees’ experiences in supervision and not an evaluation of the supervisees or the supervisor. Newman also emphasized that participation in the study was confidential, entirely voluntary, and  would not affect participants’ evaluations or grades in the practicum course, which ended before the study took place. All supervisees agreed to participate.

Case study research is “grounded in deep and varied sources of information” (Hancock et al., 2021) and thus often incorporates multiple data sources (Prosek & Gibson, 2021). In the present study, we identified two data sources to reflect the need for varied information sources (Hancock et al., 2021). The first data source came from semistructured interviews with participants, a frequent data collection tool in case study research (Hancock et al., 2021). One month after the participants’ practicum experiences ended, Newman conducted and audio-recorded 45-minute individual in-person interviews with each participant using a prescribed interview protocol that explored participants’ experiences in social justice supervision. Newman exercised flexibility and asked follow-up questions as needed (Merriam, 1998).

The interview protocol contained 12 questions identified to gain insights into the case being studied (Hancock et al., 2021). Merlin-Knoblich and Newman designed the interview protocol by drafting questions and reflecting on three influences: (a) the overall research question guiding the study, (b) the social constructivist framework of the study, and (c) Chang and colleagues’ (2009) three-tier supervision model. Questions included “In what ways, if any, has the social justice emphasis in your supervision last semester influenced you as a counselor?” Questions also addressed whether or not the emphasis on social justice at each tier (i.e., self, client, institution) affected participants. Appendix A contains a list of all interview questions.

The second data source was participants’ practicum journals. In addition to interviewing the participants about experiences in supervision, we also asked participants if their practicum journals could be used for the study’s data analysis. The journals served as a valuable form of data to answer the research question, given their informative and non-prescriptive nature. That is to say, although participants knew during the study interviews that the interview data would be used for analysis for the present study, they wrote and submitted their journals before the study was conceptualized. Thus, the journals reflected in-the-moment ideas about participants’ practicum and social justice supervision. Furthermore, this emphasis on participant experiences during the supervisory experience aligned with the methodological emphasis on studying a case in its natural context (Hancock et al., 2021). All participants consented for their 14 practicum journal entries (each 1–2 pages in length) to be analyzed in the study, and they were added to the interview data to be analyzed together. Such convergent analysis of data is typical in case study research (Prosek & Gibson, 2021).

Data Analysis
     We followed Yin’s (2017) case study research guidelines throughout the data analysis process. We transcribed all interviews, replaced participants’ names with pseudonyms, and sent participants the transcripts for member checking. Two participants approved their interview transcripts without objection. One participant approved the transcript but chose to share additional ideas about the supervisory experience via a brief email. This email was added to the data. The case study database was then formed with the compiled participants’ journal entries, the additional email, and the interview data (Yin, 2017).

Next, we read each interview transcript and journal entry twice in an attempt to become immersed in the data (Yin, 2017). We then independently open coded transcripts by identifying common words and phrases while maintaining a strong focus on the research question and codes that answered the question (Hancock et al., 2021). We compared initial codes and then collaboratively narrowed codes into cohesive categories representing participants’ experiences. This process generated a list of tentative categories across data sources (Yin, 2017). Throughout these initial processes, we attended to two of Yin’s (2017) four principles of high-quality data analysis: attend to all data and focus on the most significant elements of the case.

We then independently contrasted the tentative categories with the data to verify that they aligned accurately. We discussed the verifications until consensus was met on all categories. Lastly, we classified the categories into three themes and two subthemes found across all participants (Stake, 2005). During these later processes, we were mindful of Yin’s (2017) remaining two principles of high-quality data analysis: consider rival interpretations of data and use previous expertise when interpreting the case. Accordingly, we reflected on possible contrary explanations of the themes and considered the findings in light of previous literature on the topic.

Trustworthiness
     We addressed trustworthiness in three ways in this study. First, before data collection, we engaged in reflexivity through acknowledging personal biases and assumptions with one another (Hays & Singh, 2012; Yin, 2017). For example, Merlin-Knoblich acknowledged that her lived experience supervising the participants might impact the interpretation of data during analysis and noted that these perceptions could potentially serve as biases during the study. Merlin-Knoblich perceived that the supervisees grew in their understanding of social justice, but also acknowledged doubt over whether the social justice supervision model impacted participants’ advocacy skills. She also noted her role as a supervisor evaluating the three participants prior to the study taking place. These power dynamics may have influenced her interpretations in the analysis process. Newman shared that his lack of familiarity with social justice supervision might impact perceptions and biases to question whether or not supervisees grew in their understanding of social justice. We agreed to challenge one another’s potential biases during data analysis in an attempt to prevent one another’s experiences from interfering with interpretations of the findings.

In addition, we acknowledged that our identities as White, English-speaking, educated, heterosexual, cisgender, middle-class researchers studying social justice inevitably was informing personal perceptions of the supervisees’ experiences. These privileged identities were likely blinding us to experiences with oppression that participants and their clients encountered and that we are not burdened with facing. Throughout the study, we discussed the complexity of studying social justice in light of such privileged identities. We spoke further about our identities and potential biases when interpreting the data.

Second, investigator triangulation was addressed by collaboratively analyzing the study’s data (Hays & Singh, 2012). Because data included both interview transcripts and journals, we confirmed that study findings were reflected in both data sources, rather than just one information source (Hancock et al., 2021). This process helped prevent real or potential biases from informing the analysis without constraint. We also were mindful of saturation of themes while comparing data across participants and sources during the analysis process. Lastly, an audit trail was created to further address credibility. The study recruitment, data collection, and data analysis were documented so that the research can be replicated (Hays & Singh, 2012; Roulston, 2010).

Findings

In case study research, researchers use key quotes and descriptions from participants to illuminate the case studied (Hancock et al., 2021). As such, we next describe the themes and subthemes identified in study data using participants’ journal and interview quotes to illustrate the findings. Three overarching themes were identified in the data: 1) intersection of supervision experiences and external factors, 2) feelings about social justice, and 3) personal and professional growth. Two subthemes, 3a) increased understanding of privilege and 3b) increased understanding of clients, further expand the third theme.

Intersection of Supervision Experiences and External Factors
     One theme evident across the data was that participants’ experiences in social justice supervision did not occur in isolation from other experiences they encountered as counseling students. Coursework, overall program emphasis, and previous work experiences were external factors that created a compound influence on participants’ counselor development and intersected with their experiences of growth in supervision. Thus, external factors influenced participants’ understanding of and openness to a social justice framework. For example, concurrent with their practicum and supervision experiences, participants completed the course Theory and Practice of Multicultural Counseling. While discussing their experiences in supervision, all participants referenced this course. For example, Casey explained that exposure to social justice in the multicultural counseling course while discussing the topic in supervision made her more open and eager to learning about social justice overall.

Participants’ experiences prior to the counseling program also appeared to intersect with and influence their experiences in social justice supervision. Kallie, for instance, previously worked with African American and Latin American adolescents as a camp counselor at an urban Boys and Girls Club. She explained that social justice captured the essence of viewpoints formed in these experiences, saying, “I really like social justice because it kind of is like the title for the way I was looking at things already.” Casey grew up in California and reported that growing up on the West Coast also exposed her to a mindset parallel to social justice. Esther described that though she was not previously exposed to the term “social justice,” studying U.S., women’s, and African American history in college influenced her pursuit of a counseling career. This influence is evident in Esther’s third journal entry, in which she described noticing issues of power and oppression:

My own attention to an “arbitrarily awarded power” and personal questioning as to what to do with this consciousness has been at the forefront of my mind over the past two years. Ultimately this self-exploration led me to school counseling as a vehicle to advocate and raise consciousness in potentially disenfranchised groups.

This quote highlights how Esther’s previous studies in college may have primed her for the content she was exposed to in social justice supervision.

Feelings About Social Justice
     The second theme was a change in participants’ feelings toward social justice over the course of the semester. Two of the participants expressed that their feelings toward social justice changed from intimidation and fear to comfort and enthusiasm. Initially, Casey explained that social justice supervision created feelings of intimidation. Casey felt fear that the supervisor would instruct her to be an advocate at the practicum site, and that in doing so, Casey would upset others. However, Casey reported that she realized during supervision that social justice advocacy does not necessarily look one specific way. Casey said, “I think a lot of that intimidation went away as I realized that I could have my own style integrated into social justice.” Kallie expressed a similar pattern of emotions, particularly regarding examining clients from a social justice perspective. When asked to explore clients through this lens in supervision, an initial uncomfortable feeling emerged, but over the course of practicum, Kallie reported an attitude change. In the sixth journal entry, Kallie explained that she was focusing on examining all clients through a social justice lens, and “found it to be significantly easier this week than last week.”

Esther also shared evidence of changed emotions during social justice supervision. Initially, Esther reported feeling excited, but later, she was confused as to how counselors could use social justice practically. Despite this confusion, Esther shared that she gained new awareness that social justice advocacy is not only found in individual situations with clients, but also in an overall mindset:

Something I will take from it [supervision] . . . is you incorporate that sort of thinking into your overall [approach]. You don’t necessarily wait for a specific event to happen, but once you know the culture of a place, you have lessons geared towards whatever the problem is there.

Despite these mixed feelings, Esther’s experience aligns with Casey’s and Kallie’s, as all reported experiencing a change in emotions toward social justice over the course of supervision.

Personal and Professional Growth
     Participants also demonstrated changes in professional and personal growth throughout the supervision experiences, the third theme identified. In early journal entries, they reported nervousness, doubt, and insecurity regarding their counseling skills and knowledge. Over time, the tone shifted to increased comfort and confidence. This improvement appeared not only related to overall counseling abilities, but specifically to participants’ understanding of social justice in counseling. For example, in Esther’s second journal entry, she noted the influence that social justice supervision had on the ability to recognize oppression and bring awareness to it at practicum. Esther wrote, “Just having this concept be explicitly laid out in our plan has already caused me to be more attentive to such issues.”

Similarly, professional growth was evident in Kallie’s journal entries over time. In the fourth journal entry, Kallie described discomfort and nervousness when reflecting on clients’ sociopolitical contexts. However, in the ninth journal entry, Kallie described an experience in which she adapted her counseling to be more sensitive to the client’s multicultural background. Casey also highlighted growth with an anecdote about a small group she led. Casey explained that the group was for high-achieving, low-income juniors intending to go to college:

In the very beginning, I remember thinking—this sounds terrible now, but—“It’s kind of unfair to the other students that these kids get special privileges in that they get to meet with us and walk through the college planning process.” ’Cause I was thinking, “Wow, even kids who are high-achieving but are middle-class or upper-class, they could use this information, also. And it’s not really fair that just ’cause they’re lower class, they get their hand held during this.” But, throughout the semester, realizing that that’s not necessarily a bad thing for an institution to give another one a little extra help because they’re gonna have a deficit of help somewhere else in their life, and it really is fair. It’s more fair to give them more help ’cause they likely aren’t going to be getting it at home. . . . So, by having that group, it actually is making a greater degree of equity . . . through supervision and through processing all of that, [I learned] it was actually evening the board out more.

     Participants also expressed that their professional growth in social justice competencies was intertwined with personal growth. Casey reported that supervision increased her comfort when talking about social justice issues and led to the reevaluation of personal opinions. Similarly, Kallie summarized:

I am very thankful that I had that social justice–infused model because it changed the way I think about people. . . . It kinda opened my eyes in a way I had not anticipated practicum opening my eyes. I didn’t expect that—social justice. I didn’t realize how big of an impact it would actually have.

Increased Understanding of Privilege
     Participants reported that understanding their privilege was one area of growth. During practicum, participants considered their areas of privilege and how these aligned or contrasted with those of clients. For example, in Esther’s third journal entry, she noted that interactions with clients made her more aware of personal privileges, which led her to create a list regarding gender identity, socioeconomic background, and sexual orientation. Casey and Kallie further described initially feeling resistant to the idea of White privilege. Casey explained:

I was a little resistant to the idea of White privilege originally, which I’ve since learned is a normal reaction. ’Cause I’ve kind of had the thought of “No! It’s America! All of us pull ourselves up by our bootstraps and everyone has the same opportunity,” which just isn’t the case. And so that definitely had a huge influence on me—realizing that I have huge privileges and powers that I did not, maybe didn’t want to, recognize before.

After initial resistance, participants reported that they transitioned from feeling shame about White privilege to an increased understanding and excitement to use privilege to create change.

Increased Understanding of Clients
     Lastly, participants also reported specific growth in their understanding of the clients whom they counseled. Participants believed they were better able to understand clients’ backgrounds and experiences because of social justice supervision. Kallie described how reflecting on clients’ sociopolitical contexts helped her better understand clients. She noted that the practice became a habit, saying, “It just kinda invaded the way I look at different people and see their backgrounds.” Casey also described an increased understanding of clients by sharing an example of a client who was highly intelligent, low-income, and Mexican American. Casey learned that the client intended to go to trade school to become a mechanic and was not previously exposed to other postsecondary education options like college. Casey described this realization as “a big moment” and said, “My interaction with him, for sure, was influenced by recognizing that there was social injustice there.”

Discussion

The purpose of this study was to explore counseling students’ experiences in social justice supervision. Findings indicated that participants had meaningful experiences in social justice supervision that impacted them as future counselors. Topics of privilege, oppression, clients’ sociopolitical contexts, and advocacy were reportedly prominent in the participants’ supervision and influenced their experiences.

Despite many calls for social justice supervision in the counseling profession (Baggerly, 2006; Ceballos et al., 2012; Chang et al., 2009; Collins et al., 2015; Glosoff & Durham, 2010; O’Connor, 2005), this is the first known study about supervisees’ experiences with social justice supervision. It represents a new line of inquiry to understand what social justice supervision may be like for supervisees. Findings indicate that participants wrestled with understanding social justice and viewed it as a complex topic. They also suggest that participants found value in making sense of social justice and using it as a tool to better support clients individually and systemically. Similar to research on multicultural supervision, participants indicated that receiving social justice supervision was a positive experience and impacted personal and professional growth (Ancis & Ladany, 2001; Ancis & Marshall, 2010; Chopra, 2013; Inman, 2006; Ladany et al., 2005).

Notably, findings align with some, though not all, of Chang and colleagues’ (2009) delineated tiers in the social justice supervision model. Some of the themes reflect the first tier, self-awareness. For example, participants’ feelings about social justice (Theme 2) and increased understanding of privilege (Theme 3a) highlight how the supervisory experience enhanced their self-awareness as counselors. As their feelings changed and knowledge of privilege grew, their self-awareness improved, a critical task in becoming a social justice–minded counselor (Chang et al., 2009; Dollarhide et al., 2021; Fickling et al., 2019; Glosoff & Durham, 2010). Participants’ increased understanding of clients (Theme 3b) reflects the second tier in Chang and colleagues’ (2009) model, client services. In demonstrating an enhanced understanding of clients and their world experiences, the participants reported thinking beyond themselves and into how power, privilege, and oppression affected those they counseled.

The final tier of the social justice supervision model, community collaboration, was not evident in participant data about their experiences. Despite the supervisor’s intent to address this tier through analyses of school and district policies, as well as community advocacy opportunities, themes about this topic did not manifest in the data. This theme’s absence may suggest that the supervisor’s efforts to address the third tier were not strong enough to impact participants. Alternatively, the absence may suggest that participants were not developmentally prepared to make sense of social justice at a systemic, community level. Instead, their development matched best with social justice ideas at the self and client levels.

Participant findings did align with previous research about supervision. For example, Collins and colleagues (2015) studied master’s-level counseling students and found that their lack of experience in social justice supervision led them to feel unprepared to meet the needs of diverse clients. In this study, the presence of social justice supervision helped participants feel more prepared to support clients, as evidenced in the subtheme of increased understanding of clients. Furthermore, this study reflects similar findings from multicultural supervision research. We found that multicultural supervision was associated with positive outcomes of being prepared to work with diverse clients and engaging in effective supervision (Chopra, 2013; Inman, 2006; Ladany et al., 2005). This pattern is reflected in the current study, as participants reported positive experiences in social justice supervision. Ancis and Ladany (2001) and Ancis and Marshall (2010) found that incorporating multicultural considerations into supervision increases supervisees’ self-awareness and encourages them to engage clients in multicultural discussions. These same results were evident in the present study, with participants reporting personal and professional growth, such as stronger awareness of White privilege and greater willingness to examine clients’ sociopolitical contexts. Findings also reflect general research on supervision, which indicates that supervisees typically experience personal and professional growth in the process (Association for Counselor Education and Supervision, 2011; Watkins et al., 2015; Young et al., 2011).

Furthermore, study findings also align with assertions from supervision scholars regarding the value of social justice supervision. They support Chang and colleagues’ (2009) claim that social justice supervision can increase counselor self-awareness and build an understanding of oppression. Additionally, the findings also reflect Glosoff and Durham’s (2010) assertion that social justice in supervision helps supervisees gain awareness of power differentials. Finally, Ceballos and colleagues (2012) posited that social justice supervision will help counselors develop empathy for clients as counselors conceptualize clients in a systemic perspective. The participants’ enhanced understanding of White privilege and their clients’ contexts supports each of these ideas. Though findings are not generalizable, they appear to confirm scholars’ ideas about social justice supervision and suggest that the approach can be a positive, beneficial experience for counselors-in-training.

Limitations
     Study findings ought to be considered in light of the study’s limitations. First, although case study research focuses on a single identified case by definition and is not designed for generalization (Hays & Singh, 2012), the case in this study consisted of a demographically homogenous population of only three participants lacking racial, gender, and age diversity. This lack of diversity influenced participants’ experiences and study findings. Second, although the supervisor in this study did not conduct the semistructured interviews with participants in an attempt to prevent bias, participants were aware that Merlin-Knoblich was collaborating on the study, and this knowledge may have influenced their reported experiences. Merlin-Knoblich and Newman also began the study with acknowledged biases toward and against social justice supervision, and although they engaged in reflexivity and dialogue to prevent these biases from interfering with data analysis, there is no way to verify that this positionality did not influence the interpretation of findings. Lastly, our privileged identities served as a potential limitation while studying a topic like social justice supervision. Our racial, educational, class, language, and sexual identity privileges continually blind us to the experiences of oppression that others, including supervisees and clients, face. Seeking to know these perspectives better can increase our understanding of the implications of social injustices in society.

Implications for Counselor Educators and Supervisors
     The positive participant experiences illuminated through this study suggest that supervision based on this model may yield positive experiences for counselors-in-training, such as supporting students in developing self-awareness, understanding of clients’ sociopolitical contexts, and advocacy skills (Chang et al., 2009). Although the supervisor in this study used social justice supervision in individual sessions with participants, counselor educators may choose to apply social justice supervision models to group or triadic supervision. Counseling supervisors in agency, private practice, and school settings may also want to consider using social justice supervision to support counselors and subsequently clients (Baggerly, 2006; Ceballos et al., 2012; O’Connor, 2005). Furthermore, counselor educators teaching doctoral students may want to incorporate social justice supervision models into introductory supervision courses. Including these models into course content may in itself increase student interest in social justice (Swartz et al., 2018).

Regardless of the setting in which supervisors implement social justice supervision, the findings suggest practical implications that supervisors can consider. First, supervisors appear to benefit from considering social justice supervision models in their work (Chang et al., 2009; Dollarhide et al., 2021; Gentile et al., 2009). The findings in this study, plus previous research indicating positive outcomes for multicultural supervision (Chopra, 2013; Inman, 2006; Ladany et al., 2005), suggest that social justice supervision may potentially benefit counseling. Second, supervisors using social justice supervision may encounter supervisee confusion, discomfort, and/or enthusiasm when introduced to social justice supervision. These feelings also may change over the course of the supervisory relationship when learning about social justice. Third, supervisors ought to be mindful of all three tiers of Chang and colleagues’ (2009) social justice supervision model and a supervisee’s developmental match with each tier. As seen in this study, supervisees may be best matched for the first and second tiers of the model (self-awareness and client services), but not the third tier (community collaboration). Supervisors would benefit from assessing a supervisee’s potential for understanding community collaboration before deciding to infuse its focus in supervision.

More research is needed to understand social justice supervision. A variety of future studies, including different models, methods, and settings, would benefit the counseling profession. For example, a study implementing the social justice supervision model proposed by Dollarhide and colleagues (2021) can add to the needed research in this field. Additional qualitative studies with diverse supervisees in different counseling settings would be helpful in understanding if the experiences participants reported encountering in this study are common in social justice supervision. Quantitative studies on social justice supervision interventions would also add to the profession’s knowledge on the value of social justice supervision. Lastly, studies on supervisees’ experiences in social justice supervision compared to other models would highlight benefits and drawbacks of multiple supervision models (Baggerly, 2006; Chang et al., 2009; Glosoff & Durham, 2010).

Conclusion

In this article, we explored master’s-level counseling students’ experiences in social justice supervision via a qualitative case study. Through this exploration, we identified three themes reflecting participants’ experiences in social justice supervision: intersection of supervision experiences and external factors, feelings about social justice, and personal and professional growth, as well as two subthemes: increased understanding of privilege and increased understanding of clients. Findings suggest that social justice supervision may be a beneficial practice for supervisors and counselor educators to consider integrating in their work (Chang et al., 2009; Dollarhide et al., 2021; Gentile et al., 2009; Pester et al., 2020). Further research across contexts and with a range of methodologies is needed to better understand social justice supervision in practice.

 

Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.

 

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Appendix A

Semistructured Interview Questions

  1. What brought you to this counseling program?
  2. Overall, how would you describe your practicum experience last semester?
    1. Where did you complete your practicum?
    2. How would you describe the population you worked with at your practicum?
  3. What previous experience, if any, did you have with social justice prior to individual practicum supervision?
  4. During individual practicum supervision on campus last semester, what were some of your initial thoughts and feelings about a social justice–infused supervision model?
  5. In what ways, if any, did those thoughts and feelings about social justice change throughout your
    supervision experience?

These next three questions address three areas of social justice that were incorporated into your individual practicum supervision model: self, students (clients), and institution (school or school districts).

6. Do you think that the emphasis on social justice related to self (i.e., your power, privileges, and experience with oppression) in individual practicum supervision on campus had any influence on you?

    1. If yes, what influence did this emphasis have on you?
    2. If no, why do you think that’s the case?

7. Do you think that the emphasis on social justice related to others (i.e., the sociopolitical context of students, staff, etc.) in individual practicum supervision on campus had any influence on you?

    1. If yes, what influence did this emphasis have on you?
    2. If no, why do you think that’s the case?

8. Do you think that the emphasis on social justice related to institution (i.e., your practicum site, school district) in individual practicum supervision on campus had any influence on you?

    1. If yes, what influence did this emphasis have on you?
    2. If no, why do you think that’s the case?
  1. In what ways, if any, has the social justice emphasis in your individual practicum supervision influenced you as a counselor?
  2. In what ways, if any, has the social justice emphasis in your individual practicum supervision influenced your development as a person?
  3. How would you define social justice?
  4. Is there anything else you would like to add regarding your experience in a social justice–infused model of supervision last semester?
  5. Is there anything else you’d like to share?

 

Clare Merlin-Knoblich, PhD, NCC, is an associate professor at the University of North Carolina at Charlotte. Jenna L. Taylor, MA, NCC, LPC-A, is a doctoral student at the University of North Texas. Benjamin Newman, PhD, MAC, ACS, LPC, CSAC, CSOTP, is a professional counselor at Artisan Counseling in Newport News, VA. Correspondence may be addressed to Clare Merlin-Knoblich, 9201 University City Blvd., Charlotte, NC 28211, cmerlin1@uncc.edu.

 

Lifetime Achievement in Counseling Series: An Interview With Mariaimeé Gonzalez

Joshua D. Smith, Neal D. Gray

 

Each year TPC presents an interview with a seminal figure in counseling as part of its Lifetime Achievement in Counseling series. This year I am honored to introduce Dr. Mariaimeé Gonzalez. She is a professor of counselor education, the chair of the Clinical Mental Health Counseling Program at Antioch University Seattle, and a transformational leader and advocate. Collectivism grounds and infuses her work and her practice of mentorship as community building and a key strategy for increasing diversity in the counseling profession. I am grateful to Dr. Joshua Smith and Dr. Neal Gray for bringing the contributions and vision of Dr. Gonzalez to TPC readers. —Amie A. Manis, Editor

 

     Mariaimeé “Maria” Gonzalez (she/her/ella), PhD, LPC, was born in Puerto Rico and raised in the United States. She earned both her master’s and doctoral degrees from the University of Missouri–St. Louis and moved to Seattle, Washington, in 2014 to become a faculty member at Antioch University Seattle (AUS), located on the traditional land of the first people of Seattle, the Duwamish People, past and present. Dr. Gonzalez is the chair of the Master of Arts in Clinical Mental Health Program and is the co-founder of the Antioch University Latinx Mental Health & Social Justice Institute, which brings together community-engaged research, service, training, and community partnerships to promote the mental health and well-being of Latinx/e people. She truly enjoys teaching in the master’s and doctoral programs at AUS and is passionate about her work with other accomplices in liberation. She is a licensed professional counselor in the state of Missouri and an approved supervisor in the state of Washington. Dr. Gonzalez currently serves as the president of the American Counseling Association (ACA) of Washington (2020–22), chair of ACA’s International Committee (2022), president elect-elect for the Western Association for Counselor Education and Supervision (WACES), and ACA parliamentarian for 2021–22. She served as coeditor of Experiential Activities for Teaching Social Justice and Advocacy Competence in Counseling and is a board member for the WACES Journal of Technology in Counselor Education and Supervision. Her research passions are global mental health, clinical supervision, Latinx/e human rights, counselor and counselor educator professional identity development, correctional counseling, liberation psychology, social justice and advocacy counseling, and anti–human trafficking advocacy. She has been involved with global mental health and advocacy for about 15 years and served as a United Nations delegate to advocate for global mental health, especially during the COVID pandemic. Dr. Gonzalez has spent over 20 years working through the paradigm of mental liberation, which includes global community and mentorship. She is currently a WACES mentor and enjoys spending time with her loved ones and community.

In this interview, Dr. Gonzalez discusses her work as a mentor, barriers facing the Latinx/e community, and advice for future counseling professionals.

 

  1. You have recently been recognized for your work in mentorship. What is the role of a successful mentor in counselor education?

The role of mentorship in counselor education is essential for creating community and supporting the future generation of mental health professionals. The Council for Accreditation of Counseling and Related Educational Programs (CACREP) mentions mentorship in the standard section 6.B.3.i, “the role of mentoring in counselor education.” Based on its importance, I believe mentorship should be promoted more often in the counseling profession and in programs.

A successful mentor in counselor education is someone who can provide a deeper perspective to a mentee on how to navigate counselor education and counseling environments through a lens of liberation. Mentorship can be conceptualized as a form of community building that allows for the mentor and mentee to learn from one another. The mentor can be a steward of the profession and provide support for the mentee to move forward with their professional and personal goals, values, and community building.

Research suggests that women and Black, Indigenous, and People of Color (BIPOC) folx are more likely than other groups to share that mentoring was an important component of their career. It is important that counseling professionals build their village of trusted colleagues to accompany them on their journey and foster the path of liberation as a counselor and/or counselor educator. Mentors can be part of this village and provide an environment that is supportive of mentees’ growth as individuals and as members of the counseling profession. By learning from one another, we can continue to be bound in our liberation and help the counseling profession evolve toward reducing oppression, creating space for all our gifts and stories, and lifting each other up.

  1. What are the benefits and challenges associated with mentorship that you have experienced? How did you navigate these challenges?

The primary benefit I have experienced with mentorship is community. As someone who leans into community for strength and support, I find mentorship to be an expansion of this concept. It can be healing to have someone there to listen to or consult with us about a variety of professional issues. I have noticed over the years more students and new professionals intentionally looking for mentors because they want someone with whom they can discuss professional goals and someone who will provide a brave place for conversations about how to navigate cultural spaces and tap into their own cultural capital. More BIPOC folx and women seek out mentors to help them learn how to fully utilize their own cultural knowledge, values, and gifts in the counseling profession. Another benefit of mentorship is being present for one’s story. As a mentor, it is an honor to walk beside someone on their journey. I feel I learn so much from my mentees and get excited about ways we can continue to encourage this profession to evolve and create community for future professionals.

Mentorship, like any relationship, takes time and nurturing. I have found that it is helpful to discuss with your mentee their goals, personal expectations of the relationship, personal learning styles, cultural values, time commitment, and their support system/village. At times, mentees have had a need for personal support that was more suited for their counselor or therapist. Understanding the boundaries of the role of the mentor–mentee relationship is part of understanding our roles and being ethical professionals.

  1. What do you consider to be your major contribution to the development of the counseling profession and why?

My voice is part of the collective consciousness of my loved ones and my community, including my ancestors. I think we all have power in our voices, and we each bring a unique perspective to this profession. My journey through mental health counseling, social justice, and higher education took roots early in my personal life as I overcame a series of challenging life events. Transitioning from Puerto Rico to the United States as a young child, overcoming poverty, and enduring the tragic loss of a loved one were mile markers along the path that has led me toward a career focused on social justice, mental health counseling, and counselor education. From my humble origins to chairing a clinical mental health counseling program at AUS, my professional and personal journey has prepared me to be deeply engaged in a profession that has provided purpose and an opportunity to create change in my world. As a lifelong social justice advocate, I have been passionate to live a life rooted in liberation and have used different paths to implement this. Over my career, I have had the honor to teach thousands of counselors-in-training and counselor educators-in-training, work with clients from all walks of life, publish research to foster social justice and advocacy, supervise and mentor, and be involved with leadership on many levels.

In my current state and national leadership roles, I work to promote a community in which we all strive to honor one another while creating a collective bond. Within this bond, we meet at the center of compassion while implementing our individual and communal gifts, strengths, commonalities, and differences. With this collective unity, we discover what connects us as professionals so we can expand our existing journeys, thus impacting how we interact with our counseling profession. The counseling profession reflects who we are and vice versa. This includes our voices, our stories, and our truths; therefore, if we evolve, we can continue to grow as a counseling profession. I have the honor to be the co-founder and co-director of a Latinx social justice mental health institute, ACA of Washington board chair, ACA parliamentarian 2021–22, president-elect-elect of WACES, chair of a counseling program, and chair of ACA’s International Committee 2021–22. In all these roles, the goal has been to create a community in which we can provide support, resources, and opportunity for voices to be heard and for change to occur. I believe my main contributions are part of a larger story, much greater than myself. This includes honoring those who have paved the way for me and many others to be part of this profession, and as a way to keep their legacy alive, I work to co-create communities rooted in social justice within our profession and in supporting the next generation of counselors as they focus on helping the professional landscape evolve to a place of more liberated thought.

  1. As the co-founder and director of the Latinx Mental Health & Social Justice Institute, what current barriers do you see this population facing and what does advocacy look like in your current role?

More than 19% of the U.S. population self-identify as Hispanic or Latine/x, making people of Latin origin the nation’s largest racial/ethnic minority (Lopez et al, 2021). Approximately 1 in 10 Latine/x individuals with a mental health issue uses mental health services from a general health care provider. Current barriers impacting the Latine/x population with regard to mental health are lack of accessible health services, lack of Spanish-speaking professionals, lack of culturally responsive treatment that aligns with Latine/x values, stigma in the community around mental health, and the need for better health care policies for all Latine/x individuals, including those who are undocumented (American Psychiatric Association & Lisotto, 2017). To tackle these barriers, we need to address systemic inequities on the macro, meso, and micro levels.

Currently, my advocacy is focused on growing our Latinx Mental Health & Social Justice Institute at AUS (https://latinxinstitute.antioch.edu). The Institute provides leadership for community-engaged research and service through capacity building and authentic partnerships with community stakeholders to promote impactful improvements in the health and well-being of Latine/x communities regionally, nationally, and internationally. We hope to help address barriers by creating a community of Latine/x professionals who will be accomplices in our liberation, working together to dismantle the oppressive systems that have impacted our communities, create opportunities for change rooted in liberation, and use our cultural stories, strengths, and values to guide our practices. We offer a master’s-level certificate in Latinx mental health and social justice, workshops to learn culturally responsive practices, partnerships with different nonprofit organizations, continuing education opportunities, an annual symposium during Hispanic Heritage Month, counseling services at our university’s clinic, community building, research, mentorship, training, global engagement, and cultural justice and advocacy. All efforts and roles I participate in are based on principles of social justice, human rights, and inclusion respective to intersections of one’s cultural Latinx narrative.

  1. What three challenges to the counseling profession as it exists today concern you most?

In the last 20 years, the average college tuition has increased by 30%. With the rising costs of higher education, more students are taking out student loans, and this debt is a burden that weighs more heavily on today’s college graduates than any generation that came before them. Due to the financial barriers, this impacts the demographic landscape of who enters the profession, quality of life, job satisfaction, and other factors. As a profession, we need to continue working on advancing and ensuring that licensed professional counselors can have seamless portability of their licenses when moving to other states, practicing across state lines, and engaging in telecounseling. This issue was illuminated during the COVID pandemic. We need to also work toward eliminating barriers that build a wall between our profession and the needs of our communities. Specifically, we need to work on decolonizing our profession. This includes recognizing that for many BIPOC individuals, the trauma from colonization and oppression impacts the mental health of individuals, families, and communities and the process of freeing ourselves from mental and systemic oppression. And last, we need to ensure adequate and equitable reimbursement for professional counselors in all settings. This means that all professional counselors need to be included as providers under all public and private insurance plans, especially Medicare.

  1. What needs to change in the counseling profession for these concerns to be successfully resolved?

We need to find a way to provide financial options for students pursing degrees in counseling and counselor education. This means intentionally creating a diverse pipeline of counselors and counselor educators through offering more scholarships, setting up state funding programs for counseling programs—more grants and university initiatives—and offering more easily accessible public service student loan forgiveness. In addition to eliminating financial barriers, we need to engage in practices to decolonize our profession. This includes decolonizing counseling theories, clinical practices, training programs, policies, research practices, leadership models, financial structures, and other systemic factors that create oppressive barriers. By dismantling systems of oppression, we can move toward a place of mental liberation and support liberatory practices in collaboration with the clients and communities in which we live and serve. When I think of liberation, I lean into the words of activist, Indigenous Australian (or Murri) artist, and academic, Lilla Watson, which she presented in a speech to the UN and attributed to her work with an Aboriginal Rights group in Queensland: “If you have come here to help me, you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together” (1985). As a profession, let’s continue to work toward a place in which we are bound in our liberation, freeing ourselves from oppression, and continue to heal collectively.

For the opportunity to heal, accessibility and inclusion are important for our profession to create community and connections. Currently, ACA has a strategic plan to address the challenges of licensure portability. They are working on a Counseling Compact, which “is an interstate compact, or a contract among states, allowing professional counselors licensed and residing in a compact member state to practice in other compact member states without a need for multiple licenses” (National Center for Interstate Compacts, 2022). The Counseling Compact is to help counselors have easier access to practice across state lines, which includes telehealth options, which will also allow clients more access to a diverse range of professional mental health counselors.

ACA and NBCC have been working for years on lobbying efforts to pass legislation that would allow for licensed professional mental health counselors to be reimbursed by Medicare. ACA’s and NBCC’s Government Affairs teams are working hard to get this legislation passed, but we should also get involved. We urge counselors to contact their state senators and ask for their support on this initiative. Medicare is the nation’s largest health insurance program. Opening its access to licensed professional counselors would increase access to services for BIPOC folx, people of lower socioeconomic status, and the older population. Medicare covers more than 43 million people age 65 or older and more than 10 million Americans with disabilities. Many of these folx are in communities with limited access to mental health services and/or the services lack diversity in professionals. As professional counselors in and around these communities, we should strive to create and then join the solution to accessible health care.

  1. If you were advising current counseling leaders, what advice would you give them about moving the counseling profession forward?

Listen. I would advise leaders to listen to the members and stakeholders. There are many ways in which we can work toward evolving our profession, but we need to listen to one another in order to do this together. I would encourage current leaders to support and mentor leaders from communities that have been silenced or not invited to the table. As leaders, we need to think of the next generation and be thoughtful about supporting all communities, especially BIPOC leaders. As BIPOC leaders, we have many gifts to offer and need to bring our villages with us. As stated earlier, we are all bound together in liberation, so let’s collectively lead into a more inclusive future of our profession.

 

This concludes the seventh interview for the annual Lifetime Achievement in Counseling Series. TPC is grateful to Joshua D. Smith, PhD, NCC, LCMHC, and Neal D. Gray, PhD, LCMHC-S, for providing this interview. Joshua D. Smith is an assistant professor at the University of Mount Olive. Neal D. Gray is a professor and Chair of the School of Counseling and Human Services at Lenoir-Rhyne University. Correspondence can be emailed to Joshua Smith at jsmith@umo.edu.

 

References

American Psychiatric Association, & Lisotto, M. (2017). Mental health disparities: Hispanics and Latinos. Council on Minority Mental Health and Health Disparities. https://www.psychiatry.org/File%20Library/Psychiatrists/Cultural-Competency/Mental-Health-Disparities/Mental-Health-Facts-for-Hispanic-Latino.pdf

Lopez, M. H., Krogstad, J. M., & Passel , J. S. (2021, September 23). Who is Hispanic? Pew Research Center. https://www.pewresearch.org/fact-tank/2021/09/23/who-is-hispanic

National Center for Interstate Compacts. (2022, January 30). Counseling compact. https://counselingcompact.org

Watson, L. (1985, July 15–26). The World Conference to Review and Appraise the Achievements of the United Nations Decade for Women: Equality, Development and Peace 1985. United Nations.

 

Book Review—Integrative Behavioral Couple Therapy: A Therapist’s Guide to Creating Acceptance and Change, Second Edition

by Andrew Christensen, Brian D. Doss, and Neil S. Jacobson

 

Any counselor working with individual clients should also develop competence for working with couples. Because we have instinctual needs to love and be loved, relationship issues are not foreign to the dialogue counselors have with patients in individual therapy sessions. Even when individual treatment plans do not delineate clear objectives for improving a relationship, counselors often explore solutions for relationship issues with their individual clients. So, why not look for those solutions in the work of three esteemed mental health experts with over 40 years of research and clinical practice in couples therapy?

The book Integrative Behavioral Couple Therapy: A Therapist’s Guide to Creating Acceptance and Change by Andrew Christensen, Brian D. Doss, and Neil S. Jacobson, includes a description of theoretical principles of Integrative Behavioral Couple Therapy (IBCT) along with differences and similarities to other evidence-based treatments. The authors’ description is supported by evidence of the efficacy of IBCT and the application thereof. IBCT is a contingency-shaped application rather than rule-governed. Christensen, Doss, and Jacobson encourage clinicians to use their best judgment when applying IBCT principles. For clinicians working under any capacity of experience, the IBCT concepts are thoroughly explained for the advanced practitioner and the intern therapist or practicum student.

Introduced in the book are two core concepts that promote acceptance and change: empathic joining and unified detachment. Empathic joining facilitates acceptance by kindling compassion and empathy. This leads to forgiveness and support from both individuals of a couple. This is described strategically through observing couple interacting patterns with intention to shift partners away from dissecting actions of the other and toward looking at their own reactions and feelings. Then, using empathic listening skills, IBCT therapists sensitively summarize “hard” and “hidden” emotions to the couple. With unified detachment, partners reduce negative affect by engaging in discussion in the sessions, and then thereafter, about salient incidents and issues in a nonjudgmental way. This kind of dyadic mindfulness allows for a safe, non-blaming analysis of problematic communication and behavior between a couple. IBCT happens in phases, but the core concepts are drawn upon through the entire course of IBCT therapy.

Phases include Evaluation and Assessment—joint session then individual sessions for formulating a DEEP analysis (Differences, Emotional sensitivities, External stressors, and Pattern of communication); Feedback session—conceptualizing problems and description of the intervention; and Intervention sessions. Interventions are both acceptance-focused and change-focused and executed by employing empathic joining and unified detachment, tolerance building, dyadic behavioral activation, and communication and problem-solving training.

Limitations for the IBCT guidebook and the counselor using the principles are that although the knowledge of the theories explained in this work are clearly presented, they still require training, consultation, and supervision to administer. The book includes many case examples of real issues (patient names have been changed to protect identities) presented in real IBCT therapy sessions (some with session videos on the American Psychological Association’s video library website). The case examples cover a rainbow of issues (including clinical consideration for diversity, violence, sexual problems, infidelity, and psychopathology); however, they do not replace the valued learning experience from working with a certified IBCT trainer (which the authors imply). Certified IBCT training involves “extensive observation” of actual sessions. More information is available at https://ibct.psych.ucla.edu/, another online tool that has a chapter devoted to IBCT in brief format using the OurRelationship program—an IBCT website intervention for distressed couples (OurRelationship.com).

 

Christensen, A., Doss, B. D., & Jacobson, N. S. (2020). Integrative behavioral couple therapy: A therapist’s guide to creating acceptance and change (2nd ed.). W. W. Norton.

Reviewed by: Evan P. Guetz, MA, LPC

The Professional Counselor

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