May 22, 2024 | Volume 14 - Issue 1
Rebekah Cole, Christine Ward, Taqueena Quintana, Elizabeth Burgin
Military spouses face many challenges as a result of the military lifestyle. Much focus has been placed on enhancing the resilience of military spouses by both the military and civilian communities. However, no research currently exists regarding spouses’ perceptions of their resilience or how they define resilience for themselves and their community. This qualitative study explored the perceptions of eight military spouses regarding their resilience through individual semi-structured interviews. The following themes emerged: 1) shaped by service member and mission priority; 2) challenges within the military lifestyle; 3) outside expectations of spouse resilience; 4) sense of responsibility for family’s resilience; 5) individual resilience; and 6) collective resilience. We discuss ways military leadership and the counseling profession can best understand and enhance the resilience of military spouses.
Keywords: military spouses, resilience, military lifestyle, perceptions, counseling
Because of the unique stressors associated with the military lifestyle, military spouses are at an increased risk for poor mental health (Donoho et al., 2018; Mailey et al., 2018; Numbers & Bruneau, 2017). They may experience mental health concerns, such as anxiety and depression, due to a number of reasons, including separation from their deployed service member, loss of support networks after a relocation, or issues with adjusting to the uncertain and frequent changes of the military (Cole et al., 2021). Additional concerns that arise, such as employment, marital, and financial issues, can also negatively affect the military spouse’s mental health (Cole et al., 2021; Mailey et al., 2018). Dorvil (2017) reported that 51% of active-duty spouses experience more stress than normal. Furthermore, 25% of military spouses meet the criteria for generalized anxiety disorder (Blue Star Families [BSF], 2021). Depression in military spouses is also higher than the rate found within the general population (Verdeli et al., 2011). As a military spouse casts aside their own personal needs to support their service member, stressors may continue to increase, which can contribute to the rise of mental health needs of military spouses (Moustafa et al., 2020).
Resilience and Military Spouses
Nature of Resilience
Given the challenges inherent in the military lifestyle and the associated mental health risks, military spouse resilience is essential. Resilience is a complex and multifaceted construct, significant to researchers, practitioners, and policymakers across numerous disciplines, including mental health and military science. The American Psychological Association (2020) defined resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress” (para. 4). Within the military community, resilience has been defined as the ability to withstand, recover, and grow in the face of stressors and changing demands (Meadows et al., 2015). Importantly, determinants of resilience include the interaction of biological, psychological, social, and cultural factors in response to stressors (Southwick et al., 2014). In addition to these salient variables embedded in resilience science, resilience may be operationalized as a trait (e.g., optimism), process (e.g., adaptability in changing conditions), or outcome (e.g., mental health diagnosis, post-traumatic growth; Southwick et al., 2014).
Resilience may also vary on a continuum across domains of functioning (Pietrzak & Southwick, 2011) and change as a function of development and the interaction of systems (Masten, 2014). Accordingly, a definition and operationalization of resilience may vary by population and context (Panter-Brick, 2014). During the post-9/11 era, the resilience of service members and their families received significant attention from stakeholders, including the Department of Defense (DoD) and National Academies of Sciences, Engineering, and Medicine (NASEM), both of which expressed a commitment to conducting research and establishing programming to enhance service member and military family resilience, resulting in increased awareness of the importance of service member and family resilience throughout the military community (NASEM, 2019).
Military Family Resilience
Though military families share the characteristics and challenges of their civilian counterparts, they additionally experience the demanding, high-risk nature of military duties; frequent separation and relocation; and caregiving for injured, ill, and wounded service members and veterans (Joining Forces Interagency Policy Committee, 2021). In recognition of the constellation of military-connected experiences military families face, the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) commissioned a review of family resilience research and relevant DoD policies to inform a definition of resilience for appropriate application to military spouses and children (Meadows et al., 2015). Meadows and colleagues (2015) proposed family resilience may be best defined as “the ability of a family to respond positively to an adverse situation and emerge from that situation feeling strengthened, more resourceful, and more confident than its prior state” (see Simon et al., 2005, for a further exploration of family resilience). Further, Meadows and colleagues identified two groups of policies delineated at the Joint Chiefs of Staff or DoD levels, or within individual branches of the military: 1) existing programs modified to augment resilience or family readiness, and 2) new programs developed to target family resilience. Programs established by these policies support access to mental health services (e.g., DoD Instruction [DoDI] 6490.06); parenting education (e.g., New Parent Support Program, DoDI 6400.05); child welfare (e.g., Family Advocacy Program, DoD Directive 6400.1); and myriad physical, psychological, social, and spiritual resources. The well-being of military families represents a critical mission for the DoD, extending beyond provision and access for families to meet their basic needs to individual service member and unit readiness, and the performance, recruitment, and retention of military personnel (NASEM, 2019).
Military Spouse Resilience
Though service member and family resilience are critical for accomplishing the DoD’s mission, focusing on the unique nature of military spouse resilience is key for understanding and supporting this population’s resilience. Counseling, psychology, sociology, and military medical professional research related to military spouse resilience has focused primarily on characteristics associated with resilience. In a study by Sinclair et al. (2019), 333 spouse participants completed a survey regarding their resilience, mental health, and well-being. The results revealed that spouses who had children, were a non-minority, had social support, had less work–family conflict, and had a partner with better mental health were more resilient. Another survey study examined the characteristics associated with resilience in Special Operations Forces military spouses, determining that community support and support from the service member was essential for spouse resilience (Richer et al., 2022). A study conducted within the communication field also explored spouses’ communicative construction of resilience during deployments. Qualitative data analysis of interviews with 24 spouses indicated how spouses use communication to reconcile their contradictory realities, which increases their resilience (Villagran et al., 2013). This resilience has also been found to be a protective factor against depression and substance abuse during military deployments (Erbes et al., 2017). Finally, a survey study of Army spouses (N = 3,036) determined that spouses who were less resilient were at higher risk for mental health diagnoses (Sullivan et al., 2021). While these studies explored the nature of resilience demonstrated by military spouses, our searches in JSTOR, PubMed, ERIC, PsycINFO, and Google Scholar did not reveal any studies regarding spouses’ perceptions of their own resilience or how they define this resilience for themselves and their community. Our study fills that research gap by exploring active-duty spouses’ perceptions and definitions of resilience.
Methods
The purpose of this qualitative study was to explore the perceptions of active-duty spouses regarding their resilience. This study was guided by the following research questions: 1) What are military spouses’ perceptions of their own resilience? and 2) How do military spouses define “resilience?” Phenomenology seeks to present a certain phenomenon in its most authentic form (Moustakas, 1994). In order to most authentically and openly describe our participants’ experiences, we chose a qualitative transcendental phenomenological approach to frame our study. This tradition of qualitative research focuses on portraying a genuine representation of the participants’ perceptions and experiences. However, the distinct feature of transcendental phenomenology is its first step, which involves the researchers recognizing and bracketing their biases so they can analyze the data without any interference (Moerer-Urdahl & Creswell, 2004). We selected this design because each of our research team members were military spouses. We therefore recognized the need to mitigate our biases in order to give a true representation of the participants’ perceptions, free from our own preconceived notions.
Participants
The participants in this study were selected based on their status as active-duty military spouses and their willingness to participate in the study. There were no other inclusion or exclusion criteria for the participants in this study. After gaining IRB approval, we used convenience sampling to recruit eight participants. In qualitative research, convenience sampling is used to recruit participants who are closely accessible to the researchers (Andrade, 2021). Our research team emailed participants that we knew through living, working, and volunteering on military bases throughout the United States and at overseas duty stations who fit the active-duty military spouse criteria for this study and asked them if they were willing to participate in the study. Once the participants expressed interest, they were provided with an information sheet regarding the study’s purpose and the nature of their involvement in the study. Participant demographics are included in Table 1. All of the participants were female and all were between the ages of 30–40. Four branches of the U.S. military, including Army, Navy, Air Force, and Marine Corps, were represented in the sample. No reservist, Coast Guard, or Space Force military spouses participated in our study. Five of our participants were White and three were Black. Their tenure as military spouses ranged from 4 years to 17 years. Five of the spouses were married to a military officer, while three of the participants were married to an enlisted service member. After interviewing these eight participants, our research team met and determined that because of the distinct common patterns we found across each of the participants’ transcripts, we had reached saturation and did not need to recruit any additional participants for our study (Saunders et al., 2018).
Table 1
Participant Demographics
Participant |
Age |
Ethnicity |
Gender |
Branch |
Spouse’s Rank |
Years as a Spouse |
1 |
33 |
Black |
Female |
Air Force |
Enlisted |
4 |
2 |
36 |
Black |
Female |
Navy |
Enlisted |
17 |
3 |
31 |
White |
Female |
Army |
Officer |
7 |
4 |
34 |
Black |
Female |
Navy |
Enlisted |
14 |
5 |
36 |
White |
Female |
Marine Corps |
Officer |
12 |
6 |
35 |
White |
Female |
Marine Corps |
Officer |
14 |
7 |
40 |
White |
Female |
Navy |
Officer |
16 |
8 |
34 |
White |
Female |
Navy |
Officer |
10 |
Data Collection
Our research team first developed the interview protocol for the study based on a thorough review of the literature regarding resiliency within military culture as well as the challenges of the military lifestyle for military spouses. Our research team members interviewed each of the participants for 1–2 hours. These semi-structured interviews were audio recorded and transcribed verbatim by an automated transcription service. The interview questions were open-ended and focused on the spouses’ definitions of resilience and their perceptions of their resilience within the military lifestyle and culture (see Appendix for interview protocol). In addition, probing questions such as “Can you explain that a bit more?” or “Can you give any examples of what you mean by that?” were used to gather more in-depth data throughout the interviews.
Data Analysis
We followed the steps of the transcendental phenomenological data analysis process to analyze our study’s results (Moerer-Urdahl, 2004). First, each member of our research team engaged in epoche, in which we bracketed our biases as military spouses so that our own thoughts, feelings, perceptions, and experiences did not influence our interpretation of our participants’ experiences. The next step in the process was horizontalization. During this step, each member of our research team read through the interview transcripts and noted significant statements throughout so we could better understand how the participants perceived, understood, and experienced resilience. Next, we met as a research team to discuss these significant statements and organize them into themes (Moustakas, 1994). Our research team then developed textual and structural descriptions of the themes, describing not only a list of the participants’ perceptions, but also an in-depth analysis of what their perceptions of resilience entailed and how they have experienced it throughout their tenure as military spouses (Moerer-Urdal, 2004; Moustakas, 1994). We then constructed a comprehensive description of the participants’ perceptions of resilience, encapsulating the “essence of the experience” (Moerer-Urdal, 2004, p. 31).
Research Team and Strategies to Increase Trustworthiness
Our research team consisted of four university faculty members, all of whom possessed extensive experience in conducting qualitative research. Three of our research team members possess PhDs in counseling and one research team member possesses an EdD in counseling. All team members had extensive experience conducting research with military-connected communities. In addition, all of our research team members were active-duty military spouses, with years of experience as a military spouse ranging from 1–23 years.
We used several strategies to increase the credibility of our results. First, the use of an experienced research team to collectively analyze the data resulted in diverse perspectives on the emerging themes of the study. However, because each member of our research team was a military spouse, we recognized the need to bracket our own experiences and biases so that they did not interfere with our interpretation of the data. Each team member took notes on their individual biases, and our research team discussed these biases when interpreting themes. Biases held by research team members included a predisposition to believe that spouses of special warfare service members endured greater stressors and were better supported by their military communities; a belief that spouses of higher-ranking service members possessed greater knowledge of and access to resources to support social, behavioral, and mental health needs; and personal experience within the military spouse community. These biases were challenged throughout the research process by each member of the team. As each theme was identified, the team referenced individual transcripts to ensure that the interpretation was justified. We found that our biases were rightfully challenged.
Additionally, to avoid leading questions, our research team made the conscious decision not to define resilience as part of the interview and follow-up process. The team wanted to derive an organic definition of spouse resilience that was not clouded by a formal definition. In addition, we used member checking, in which we emailed the interview transcripts to the participants and asked them to verify the data. The participants responded to our request with minimal change requests related to grammatical errors in the transcriptions and validated our data. Several offered additional insight related to their definition of resilience, which was included in our data analysis.
Results
The following themes emerged from our data: 1) shaped by service member and mission priority; 2) challenges within the military lifestyle; 3) outside expectations of spouse resilience; 4) sense of responsibility for family’s resilience; 5) individual resilience; and 6) collective resilience.
Theme 1: Shaped by Service Member and Mission Priority
Military/Service Member Definition
When discussing their definition of resiliency, the spouses first considered what resiliency meant for their active-duty spouse. The participants varied in their perceptions of what resilience meant for their active-duty service member, though all defined resilience as an active process of adapting or persevering when faced with adversity, rather than a personal trait or characteristic the service member possesses. Participant 3 noted that, for their spouse, resilience was “the ability to adapt to changes that are beyond your control . . . adapting to situations in an optimistic and positive way.” Participant 6 stated that resilience for their spouse meant an “ability to bounce back from a hardship.” One participant asked their spouse to comment specifically about their definition and provided the following definition in a follow-up with the interviewer: “Resilience is how you persevere in difficult circumstances. It’s not about how hard you fall, but how quick you can get back up from being knocked down” (Participant 2 [P2]).
Some participants cited specific notions of resilience that are embedded in the service members’ military community. One Navy spouse remarked that resilience, to their spouse, meant “Don’t give up the ship” (P8). Another Navy spouse mentioned that for their spouse, resilience was “knowing how to weather the storm” (P7). Yet another spouse noted that resilience “the Marine Corps way” meant their service member must “do their job” (P4). Other participants noted that the root of resilience for the military service member stems from a place of selfless service. Participant 8 commented that the resiliency of their spouse was “more about the man standing next to me, the family I’m fighting for at home, the country I’m fighting for at home, than about their own personal needs.”
Adapting, Overcoming, and Persevering
Like their active-duty members, spouses indicated that resilience was about adapting, overcoming, and persevering in the face of obstacles. Resilience to one spouse was “being able to rebound or to overcome an obstacle” (P1); to another, resilience meant they must “be flexible, adapt with whatever, overcome whatever it is that you’re going through” (P2). Spouses noted that resilience was not a one-time event. Instead, spouses suggested that their own resilience stemmed from continually persevering. Participant 6 stated that for them, resilience meant not just “going through something difficult and making it out on the other side,” but that they then had to “keep pushing forward.” One participant indicated that their personal definition of resilience and the notion to persevere stemmed directly from their spouse: “I’ve almost kind of adopted a bit of my husband’s thought process, I guess. You just keep going to get things done” (P8).
Mindset
Our participants indicated that resilience was a mindset that one must choose and that when faced with difficulties, they chose to focus on gratitude, positivity, and growth. For example, Participant 8 stated that, although they had faced and would continue to face challenging and stressful experiences as a result of being a military spouse, they believed that “whatever may come, we’ve been very blessed in our life and we should always be thankful for the life that we have.” Another participant noted that for them, overcoming and persevering meant adopting an optimistic attitude. Specifically, the spouse stated, “sometimes you just have to kinda look at the bright side of things, and you have to find the things that work for you at each place” (P5). One participant drew resilience from a growth mindset:
I think it [resilience] is really a mindset switch. I think it’s changing from “oh this is happening to me, how horrid” to like “how can I take this horrid situation and turn it into something good?” And I think that is a big mindset switch. (P7)
Resilience Variations
Walsh (2012) described risk and resilience as a process of balancing risk and protective factors over the life span. Participants in our study expanded on that idea by suggesting that they reacted to situational challenges along a continuum:
I think what I’m saying is there’s different levels of resilience, like sometimes you have to tap into that different part of yourself. Sometimes you have to let it go and just accept the things that come, and sometimes you just gotta pick yourself up and keep on trucking. (P8)
Likewise, Participant 3 suggested that resilience takes different forms depending on the situation:
Sometimes resiliency just means like surviving day to day and other times, it means figuring out how to continue with your passions to the best of your ability while also supporting your family and your [service member spouse]. I think it’s just super unique to every situation. (P3)
Our participants also recognized that their understanding of resilience was often focused on the here and now of their situation but that their reactions to stressors had long-term effects. One participant indicated that resilience is a learning process and recognized that the stressors they overcome now prepare them to address stressors they will face in the future: “I think being able to come out of extremely, extremely stressful situations, be able to come out on the other side and [know] I’m okay and I survived this, and now I’m kind of better prepared for next time” (P6). Participant 3 wondered about the long-term ramifications of resilience in the face of prolonged adversity, stating “I may be resilient right now in the moment, but in the long term, like, how will this affect me?”
Individualized
Finally, participants defined resilience as an individualized process, stating things such as “everybody has their own unique ways of being resilient, and I think that they do what works best for their families” (P7) and “my resiliency may look different than someone else’s resiliency” (P2). One participant elaborated on this individualized approach to resilience by recognizing that each person has different risk factors that affect their response to stressors, thus affecting the way each person demonstrates resilience. This participant stated that, when viewing resilience among military spouses as a whole, it is important to
take into consideration somebody’s upbringing and the baggage that they bring into this life. We don’t know what people have gone through as kids, and that I think would have a big impact on whether or not someone can be resilient, so I don’t think it’s a one-size-fits-all. (P6)
Theme 2: Challenges Within the Military Lifestyle
Lack of Control
The spouses described the common challenges of the military lifestyle to their resilience. First, they discussed the stress of the feeling of a lack of control in their lives. One participant described how she
just found out yesterday that my husband was getting deployed and he’s leaving Sunday. And I keep hearing people say, “You have to be resilient. You’re gonna be okay!” You’re resilient, but right now, what it feels like is how much can you endure for the sake of the mission? (P1)
Another echoed this sentiment: “I have no control if the Navy says they’re going to deploy my husband. There’s nothing I can do to change that” (P8).
Constant Changes
Another common challenge mentioned among all of the participants was the constant changes they experience in their lives, including moving, career changes, and changes within their family dynamics. Because they move every few years, the spouses described how they are constantly separated from their support systems: “Even though you meet these great people, you don’t get to stay with them . . . and you’re generally not near your family, which is very hard” (P5). Another described how “Once I have started on something and I’m like, ‘This is it, we gon’ be here for a while,’ then my husband is like ‘nope. Military said we got to shift and move again’”(P2).
These constant changes resulted in career struggles for the spouses. One asked, “How can I get this [job] if I’m never at one place for long? . . . How do I uproot everything that I know or everything that I am doing to follow my service member?” (P2). Another described how “moving, changing jobs, not being able to have a secure profession, you do it because you have to . . . but that doesn’t mean that there’s not a whole lot of emotional and mental load that goes with it” (P3).
Another challenge for military spouses was constantly changing family dynamics. One described the difficulty in constantly changing work schedules: “We have to kind of get into this routine without him and then when he comes back, because it’s different while he’s away. We gotta kind of try to fit him back into our routine when he gets back” (P4). Another discussed the challenge of transitioning to being the sole caregiver during a deployment: “If I go down with COVID, what am I going to do? Because, like, I was literally IT. No one is going to want to take my kids. . . . That was the first time I ever felt, like, fearful” (P7).
Mission Priority
In addition to constant change, the spouses also mentioned the challenges of the military’s clear prioritization of the mission above military members and their families: “If something is going on at home, we’re going to take care of our active person first and worry about your family later” (P2). The participants described how this focus on the mission is so intense that it affects service members physically, which increases the burden on military spouses to care for them: “My husband’s health suffers because the mission is most important to him” (P1).
Theme 3: Outside Expectations of Spouse Resilience
Expectation to “Suck It Up”
The spouses described others’ expectations for their resilience. First, they described the military’s expectation that they “suck it up.” One described how “you have a lot of the ‘suck-it-up’ mentality, and I would say when you have the leaders who kind of fall under that, whether it’s seeking the mental health treatment or having stigmas with that” (P6). Another explained that “there’s so much focus and emphasis on just being resilient and sucking it up” so there is often a mindset of “‘Oh well, military spouses are resilient so they signed up for this, they know what it takes and they just have to get over it’” (P3). Another spouse described how “they put so much pressure on you to be like, just make it work, that you’ve gotta figure out the way to make yourself happy, and that’s hard to do” (P5). Participant 7 summed up the military spouse mentality as a whole: “You toughen up and you make it work. You know?”
The participants felt their overall resilience would be enhanced if individuals outside the military community better understood the challenges faced by military families. One participant felt the “suck it up” mentality stemmed less from the military community itself and more from outside communities who might not understand the struggles of military family life: “So when . . . you’re going through another stress of a PCS [permanent change of station], you can’t find a house, they say, well, at least you get a house allowance, at least you get free health care” (P6). Participant 3 expanded on this idea by stating, “I just honestly think that a greater understanding of what sacrifices that military spouses make . . . would increase resiliency, because there’s just so much lack of understanding what it actually entails.” Lastly, one participant mentioned a sentiment they frequently hear from others in a civilian community, expressing that it was frustrating when friends outside the military told her, “I don’t know how you do it,” to which the participant responded, “I don’t know, you just do it!”
Pressure to Be Resilient
The spouses also expressed frustration at others’ misperceptions of the expectation that they and their families demonstrate resilience: “When we call military spouses or children resilient, it just seems like a cop out and relinquishes any type of burden . . . or feeling of guilt about a situation that may cause emotional or mental damage” (P3). Another participant echoed this frustration: “Sometimes I don’t feel like I’m being resilient. Sometimes I feel like I’m just doing what needs to be done because that’s what needs to be done” (P8). Another participant described how her friends
call me Superwoman because I have all these different things going on and I always seem like I got it together. . . . It’s like saying to me that I have to keep going, no matter what, and I think people should be able to just feel defeated sometimes. Or be able to say “that was just too much for me” or “I don’t really feel like being resilient today, I kind of want to lay in bed and just be upset or sad.” (P4)
Given these expectations, one spouse pointed out the danger of expecting military children to consistently demonstrate resilience:
It’s so easy for everyone to say that military kids are always so resilient and sometimes they’re not. Sometimes they are stressed out. They are feeling the crushing weight. They feel sad but everyone keeps telling them that they’re resilient. So it almost makes it seem like . . . they aren’t allowed to feel those hard things or talk about those things or act on those feelings and emotions. (P8)
One spouse proposed a solution to these misperceptions, emphasizing that resilience is unique for military spouses and should be defined to accurately reflect the way they uniquely overcome challenges:
I think it’s important for military spouses to reappropriate that term [resilience] so that it is not weaponized, and I would like to see some sort of guidance as to how we can be resilient but in a way that positively impacts our mental health and physical health and not having to endure all of the things and all of the frustration and uncertainty that comes with the onset of having to be resilient. (P1)
Theme 4: Sense of Responsibility for Family’s Resilience
With their partners focused on the mission, the spouses described their sense of responsibility to maintain their resilience so they can care for their children in the absence of their active-duty spouse: “We have our husband or our spouses gone so much, we need to be a solid parent at home for our kiddos or our family” (P7). Participant 4 likewise described how “I kind of see myself as holding down the fort, you know, because when my husband is not home it is just me and the kids.” Another explained how “I have three little ones that’s looking up to me and I can’t slip away, depressed, because daddy’s not home” (P2). In the end, the spouses defined resilience as an obligation to their families. Participant 3 described that “I have to be that way for my children.” Participant 4 added that “I think that’s what resilience is like, knowing that you kind of have to carry the load, you know, for your whole family to try to keep us afloat.”
The participants described how this resilience is especially obligatory when the active-duty spouse is unable to be resilient:
I’m kind of taking the lead with our kids . . . but I’ve also kind of had to pour into my husband, you know, because he has those times you know where things are really, really hard for him. I’ve also been like his counselor and his doctor sometimes. (P4)
Theme 5: Individual Resilience
In response to being unable to control many aspects of the military lifestyle, most of the spouses described how they have become independent in order to withstand the constantly changing variables within the military lifestyle. One described being “pretty independent, and I think that helps a lot because I don’t rely on my spouse to do all these things I do” (P5). Another described how being independent resulted in self-confidence and resilience:
You gotta figure out how to do all of it just because you can’t ever rely on the spouse being able to help. But I think being able to come out of extremely, extremely stressful situations, be able to come out on the other side and say “I’m okay, and I survived this, and now I’m kind of better prepared for next time.” (P6)
Another spouse described how maintaining an independent identity was key to separating herself from the stressors of the military lifestyle: “That’s a really important part of being a military spouse. It doesn’t have to be a job specifically, but just something that you can be your own person separate from your husband or your spouse’s job” (P8).
The spouses also described the importance of taking care of themselves physically and mentally in order to maintain their resilience. Many described exercise as key to their mental health and wellness: “My biggest coping mechanism is exercise. I’ve found that no matter where I go, I can exercise” (P5). Another spouse described how she “tried to find a kickball team every place we’ve been to since Okinawa because I figured out it’s a stress relief” (P6). Participant 7 echoed that “working out . . . just helps me. It lowers my stress.” One spouse explained how she defaults to exercise when facing the challenges of the military lifestyle because she knows her “ability to recover quickly is directly tied to the way in which I care for myself” (P1).
Theme 6: Collective Resilience
The participants described their reliance on the collective military spouse community for their survival. One spouse, for example, described a connection with other military spouses as the difference between “doing well and barely surviving” (P6). Another spouse described her reliance on the military spouse community: “Community is what it’s all about. I can’t get through anything without community” (P7). Another spouse echoed this survival mechanism: “This is a beautiful community. It’s an amazing place . . . we all get each other. So I think there are times where it’s really hard . . . but we survive, we get through it. We’re resilient. We got the grit” (P7). Participant 1 explained exactly how the military spouse community offers this support to help spouses survive the challenges of the military lifestyle: “When time calls for it, I think, collectively, we bring our resources together to help pull other military spouses up and try to just forewarn them about what the obstacles are and what may have worked for our family” (P1).
The military spouses also described the comfort they found in other military spouses’ understanding of the challenges they face: “I think the most important part and coping is finding your community, so making sure you’re surrounding yourself with women who are going through similar experiences, or who have gone through similar experiences and similar life stages” (P3).
In the midst of this supportive community, the spouses discussed how they actively seek to comfort each other: “You’re not the only one who’s in it who’s having this issue, I understand that you’ll get through this, that we know we’ve been there, we understand how it goes” (P5). This outreach seemed to be especially helpful from spouses who were more experienced with the military lifestyle: “Having that senior spouse example has been so good. . . . She’s always been somebody who said, ‘Hey, I’ve been through a lot. If you ever have any questions, I’m always here for you’” (P8).
In addition to relying on other spouses for their own wellness and resilience, the spouses expressed pride in their ability to contribute to the military spouse community. One described how “I feel like I am a better team player. I feel like I’m more committed to helping others than I have in the past because I know that others will do the same for me” (P7). The participants also described increased self-growth as a result of being a part of a community: “I really don’t think I would have allowed myself to receive help if I hadn’t been part of this phenomenal community that is constantly supporting each other” (P7). Participant 5 echoed this sentiment: “Learning to get that help from other people is something that I feel like you have to kind of get when you are a military spouse because, otherwise, you’re going to have to do everything and you don’t have to.”
Finally, our participants frequently indicated that they felt a “sense of pride” (P7), “connection” (P4), or “camaraderie” (P8) from belonging to a group of military spouses who understood their unique situation. When asked how the military could enhance resilience for military spouses, participants commonly indicated that peer support and fostering connections with senior spouses should be a priority for military commands. One participant noted that their ability to be resilient in difficult times was related to the “opportunities” they had “to connect with other people who are going through similar stuff and who are a part of the same small community” and recommended that the military facilitate more opportunities to connect (P7). Another participant suggested that military commands should “have someone that [the spouse] can talk to” that would “help them to understand the military life whether you are a new spouse or a seasoned spouse” (P2).
Discussion
The purpose of this study was to explore military spouses’ perceptions of their resilience and the ways in which they define resilience for their community. Our study’s results indicate that spouses’ definitions of resilience are currently shaped by service member and mission priority. Our participants also described how they often felt burdened by outside expectations of their resilience as well as by a sense of responsibility for their family’s resilience. Overall, the spouses relied on themselves and the military spouse community to overcome the challenges they faced. Participants expressed a desire for resources aimed specifically at enhancing spouse resilience and more awareness about resilience resources already in place throughout the military.
While past research has examined resilience factors in spouses such as communication skills, social support, and spousal support (Erbes et al., 2017; Richer et al., 2022; Sinclair et al., 2019; Villagran et al., 2013), our study provided new insight into military spouses’ perspectives of their resiliency. This revelation of the spouses’ worldview aids our understanding of ways to best support spouses and areas to focus on to support their resilience. Our participants’ definitions of their resilience were shaped by their relationship with their service member and the influence of the military’s mission. In addition, while past research has indicated that the military lifestyle and culture is challenging for spouses to navigate (Cole et al., 2021; DaLomba et al., 2021; Donoho et al., 2018; Mailey et al. 2018), our participants’ description of their feelings of responsibility for their family’s well-being reveals the added burden that military spouses face as they help their families navigate the military lifestyle. Finally, our participants confirmed that resiliency should be viewed as a variation and is unique to each individual (Pietrzak & Southwick, 2011). As outlined in the professional literature (Masten, 2014; Southwick et al., 2014), the participants confirmed the dynamic nature of resiliency, recognizing that sometimes they felt more resilient than at other times.
In the midst of these challenges, our participants emphasized that the military spouse community serves as a protective factor and a source of their resilience against mental health challenges. This perception of the military spouse community aligns with previous research highlighting the supportive role that spouses play for each other, so much so that it is a protective factor against suicide (Cole et al., 2021). Therefore, military leadership and the counseling community might focus on enhancing this community and connecting spouses with one another—especially more seasoned spouses with newer spouses. In addition, because military-sponsored resilience programs are often targeted to better support service member outcomes, community providers might find ways to focus on supporting the spouses and helping them to overcome the challenges they face in their daily lives.
Finally, the participants discussed how they overcame the challenges of the military lifestyle, including constant moving, deployments, and overall uncertainty, through their own individual and collective resilience. These lifestyle challenges that the participants described correspond to career struggles and shifting family dynamics that cause ongoing stress to the military spouse, both of which have been previously documented in the professional literature (Borah & Fina, 2017; Cole et al., 2021; DaLomba et al., 2021; Donoho et al., 2018; Mailey et al., 2018; Numbers & Bruneau, 2017). Currently, since the withdrawal of troops from Afghanistan, the United States is experiencing peacetime, whereas the nature of future conflicts is uncertain (Marsh & Hampton, 2022). Enhancing the resiliency of military spouses and finding solutions to ongoing stressors is key during this time of peace so that spouses are ready and able to face the stressors of future, potentially large-scale wars (Sefidan et al., 2021).
Implications for Counselors
Professional counselors are called to be trained and ready to meet the unique needs of military spouses, especially in understanding the nature of military culture and its impact on spouse mental health and well-being and enhancing spouse resilience in times of adversity (Cole, 2014). Our study echoes the continued struggles of military spouses described in the professional literature (Cole et al., 2021; Lewy et al., 2014; Runge et al., 2014), suggesting that new and innovative ways of understanding and approaching military spouse resilience is needed within the counseling community. For example, counselors might encourage spouses to explore how their resilience is shaped by the military community in order to increase self-awareness and understanding. They might also help spouses develop their independence and sense of self-efficacy while simultaneously seeking collective support within the military community. Counselors can help spouses examine their social support and help them develop their social skills so they can connect with others around them. Counselors should also help military spouses unpack their perceptions of outsiders’ expectations of their resiliency. Encouraging spouses to reflect on others’ expectations, and the ways in which these expectations impact their sense of well-being, may help define resilience for themselves and capitalize on their unique resiliencies during challenging times. Ultimately, because the military culture is so unique, counselors should seek out professional development so they can better understand how to help military spouses navigate this culture and enhance their resilience. When working with military spouses, professional counselors might explore spouses’ feelings of responsibility for their family members’ health and well-being that were described in our results. In addition, counselors can equip spouses with supportive mental health resources for their family members so they do not feel as if they need to care for them on their own. School counselors, in particular, can provide support for military-connected students at school and can connect military families with resources within both the civilian and military communities to support their mental health and resilience (Cole, 2017; Quintana & Cole, 2021).
Our participants revealed that often the expectation of resilience is burdensome for spouses, which serves as a contradiction to its purposes. Counselors are called to acknowledge the challenges of the military lifestyle and provide support for navigating these challenges, rather than expecting spouses to face these hurdles alone. In addition, counselors might focus on more holistic manifestations of resilience, recognizing that some spouses can be resilient, yet still struggle. Approaching spouses from a strengths-based perspective, rather than from a deficit perspective, can be empowering within the counseling relationship (Smith, 2006).
Limitations
Our recruitment strategy limited our sample size as we only sought participants that we knew through our military spouse networks. In addition, our sample lacked gender diversity, with all of the participants being female. Approximately 91% of active-duty service member spouses are female (DoD, 2022). However, the lack of male participants in the present study is a limitation, and the experience of male spouses is undoubtedly unique and worth exploring in greater depth. Research suggests that stressors and characteristics of resilience transcend gender categories (NASEM, 2019).
Finally, in qualitative research, the researcher’s biases may impact their interpretation of the data. As military spouses, our own experiences may have impacted the way in which we described our participants’ experiences. We took several steps to mitigate these biases, including intentionally bracketing them and engaging in peer debriefing throughout the research process.
Implications for Future Research
The participants in our study described a need for resources and programs geared specifically toward military spouses. Future research might determine how to best develop and implement these programs that will help to enhance spouse resilience. Key areas of focus may be ways to leverage the military spouse community and enhance spouse sense of self, which were two protective factors that emerged from our data. In addition, existing resilience programs within the military that are currently aimed at the active-duty population should undergo a program evaluation to determine their effectiveness with military spouses.
As a follow-up to our qualitative research, future quantitative research studies should address limitations noted previously. Specifically, future research should target a larger sample size and broader demographic of military spouses to further explore their understanding and definition of resilience. This larger and more diverse sample size would allow for greater generalizability and would assist with advocacy within the military. Finally, future qualitative research might explore the perceptions of male spouses, in particular, in order to determine their perception of resiliency and any unique areas of needed support.
Conclusion
Military spouses face a wide range of challenges as a result of the military lifestyle. They are expected to be resilient so as to overcome these challenges. However, our study reveals the often burdensome impact of these expectations on military spouses. Our results also illuminate how spouses uniquely conceptualize their own resilience, recognizing the resilience continuum and focusing on the positive impact of their protective community. Overall, the spouses took pride in themselves and their communities for their ability to overcome obstacles. These revelations are key for both the military and the counseling profession in their work to support military spouses wherever they are on this continuum and enhance their community, which is key to their well-being.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript. The opinions and assertions
expressed herein are those of the authors and
do not reflect the official policy or position of
the Uniformed Services University of the Health
Sciences or the Department of Defense.
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Rebekah Cole, PhD, MEd, NCC, LPC, is a research associate professor at the Uniformed Services University. Christine Ward, PhD, is an associate professor at Walsh University. Taqueena Quintana, EdD, NCC, ACS, BC-TMH, LPC, is an associate professor at Antioch University. Elizabeth Burgin, PhD, NCC, LPC, RPT, CCCPTS, is an assistant professor and program coordinator of the Military and Veterans Counseling program at William & Mary. Correspondence may be addressed to Rebekah Cole, rebekah.cole@usuhs.edu.
Appendix
Interview Protocol
- Tell me a little about your identity as a military spouse?
- What have been some of your rewarding experiences as a military spouse?
- What have been some of your stressful experiences as a military spouse?
- How have you coped with the more stressful experiences as a military spouse?
- How would you describe the military’s definition of “resilience?”
- What does the term “resilience” mean to you?
- What does the term “resilience” mean for your military partner/family?
- How would you describe the resilience of military spouses?
- In what ways have you, personally, been resilient as a military spouse?
- What would enhance the resilience of military spouses and their families, from your perspective?
- How, if at all, has your military experience enhanced your resilience?
- How, if at all, has the military’s focus on resilience presented you with challenges during your military spouse experiences?
- How, if at all, can resilience be a negative way to describe military spouses/families?
- Is there anything else about military resilience that is important to you that I did not ask about?
May 22, 2024 | Volume 14 - Issue 1
Ashley Ascherl Pechek, Kristin A. Vincenzes, Kellie Forziat-Pytel, Stephen Nowakowski, Leandrea Romero-Lucero
In counselor education programs, students acquire clinical experience through both practicum and internship; this time frequently marks students’ first counseling experiences working with suicide in a clinical context. Often, students in practicum or internship working with clients who may be experiencing suicidal ideations do not feel properly equipped to deal with suicide. This study aimed to develop a practice model for online counselor education programs that increases counseling students’ self-efficacy to work with clients who may present with suicidal ideations. Sixty online graduate-level clinical mental health counseling students completed a pre- and posttest self-efficacy assessment. Findings showed that students’ self-efficacy increased due to taking the online basic counseling skills class that included teaching activities related to suicide screening, assessment, and intervention.
Keywords: self-efficacy, suicide, assessment and intervention, online counselor education, practice model
Despite a growing body of research and evidence-based interventions, suicide remains the 11th leading cause of death in the United States (Centers for Disease Control and Prevention [CDC], 2021). A 2014 World Health Organization report (WHO; 2014) estimated that more lives were lost to suicide than to war, conflict, and natural disasters combined. More recently, the American Foundation for Suicide Prevention (AFSP; 2023) estimated that in 2021 there were 1.7 million suicide attempts; more than 48,000 Americans died by suicide. In 2023, trends showed about 130 suicides per day (AFSP, 2023).
To address the ongoing concern of suicide risk, counselor education programs are expected to prepare students for work with diverse clients who experience suicidal ideations (Wachter Morris & Barrio Minton, 2012). Specifically, the Council for the Accreditation of Counseling and Related Educational Programs (CACREP; 2023) requires counseling programs to provide counselors-in-training (CITs) with skills in crisis intervention, suicide prevention, and response models and strategies, as well as proper assessment and management of suicidal ideations. There are no consistent suicide prevention or intervention training standards or models among counselor education programs. Organizations such as the American Association of Suicidology have recommended that suicide knowledge and assessment be at the forefront of health care by having (a) graduate programs require suicide knowledge and skills acquisition in their curriculum, (b) state licensure boards require suicide-specific education for renewal of licenses, (c) government-funded health care systems and hospitals require staff training in suicide assessment and management, and (d) staff appropriately trained to assess, manage, or treat patients who experience suicidal thoughts (Schmitz et al., 2012).
The current study aimed to determine if a practice model used in an online basic counseling skills course was effective at increasing counseling students’ self-efficacy when working with clients who present with suicidal ideations. Results from the study were used to determine if the skills-based online course effectively taught suicide assessment and intervention skills to graduate students. Discussion and implications regarding the need to establish best practices in prevention and intervention training for CITs are included. Additional considerations are given for both online and brick-and-mortar counseling programs.
Competencies and Principles
To assist counselor educators with how to best address the ongoing concern of suicide risk in clients, the Suicide Prevention Resource Center (2006) identified several core competencies and skills needed to assess and manage individuals at risk for suicide. These competencies can be used as a framework for extensive suicide training (Granello, 2010). Other models, such as a core competency–based training workshop in suicide screening, assessment, and management, have been developed to assess the effectiveness of suicide training, including pre- and post-workshop self-assessments, evidence-based instruction, role-playing, expert demonstration, group discussions, and video-recorded risk assessments of trainees intended to provide feedback (Cramer et al., 2017). Together, these competencies and principles can be used to develop a practice model in graduate counselor education programs and to better assist CITs in preparing to work with a client experiencing suicidal thoughts.
Despite the Suicide Prevention Resource Center (2006) identifying core competencies and skills needed to properly assess and manage individuals for risk of suicide, the research from counseling graduate programs on the implementation of suicide training remains sparse (Wasylko & Stickley, 2007). Therefore, we looked at other graduate programs of similar disciplines (e.g., social work, school psychology, and school counseling) to gain a better idea of best practices in related fields. Unfortunately, literature related to best practices within graduate programs of similar disciplines also demonstrates a lack of training in suicide risk assessment and intervention (Becnel et al., 2021; LeCloux, 2021; Liebling-Boccio & Jennings, 2013). This expanded look into other mental health professions further supports the notion that limited research exists regarding training in suicide screening, assessment, and intervention at the graduate level; thus, more attention is needed in these areas.
Suicide Training in Graduate Programs
Graduates of other counseling programs have indicated that there were limitations in the suicide prevention training that they received (Wakai et al., 2020). In a national sample of American School Counselor Association members, Becnel et al. (2021) found that 38% of school counselors (N = 226) did not receive suicide prevention training during their graduate programs and 37% received no training in crisis intervention. Similar results were found in a study of 193 professional counselors; over a third reported no classroom training in crisis preparation, and 30% reported no or minimal preparation in suicide assessment (Wachter Morris & Barrio Minton, 2012).
Schmidt (2016) evaluated the confidence and preparedness of 339 mental health practitioners (i.e., professional counselors, school counselors, social workers, psychologists). Results indicated that 52% of participants had graduate course work in suicide intervention and assessment, but 19% reported feeling not very confident in working with clients who had suicidal ideations. Conversely, Binkley and Leibert (2015) found that students who received training before their practicum working with clients who experience suicidal thoughts had lower anxiety and a greater level of confidence in addressing those issues compared to those who did not receive training.
The results of these studies look at counselor training and confidence or preparedness, to support the need for additional training in this area and research on best practices in preparing CITs to work with clients who present with suicidal ideation. Studies report training levels associated with practice outcomes (e.g., confidence), but there is a lack of literature explaining how suicide assessment and intervention training occurs in counselor education programs. Although there is literature that demonstrates that self-efficacy directly influences a counselor’s development (Barbee et al., 2003; Barnes, 2004; Kozina et al., 2010; Lent et al., 2003; Pechek, 2018; Vincenzes et al., 2023), literature that specifically addresses self-efficacy as it relates to working with a client who experiences suicidal ideation is sparse. However, the literature supports that additional training is needed on this topic and that self-efficacy is an important concept to consider when developing training protocols for CITs.
Self-Efficacy
Self-efficacy is dynamic and plays a significant role in counselor training and skill development. Bandura (1986) first introduced self-efficacy as an individual’s judgment on their capabilities to execute an action to achieve a certain performance or goal. Later the term was linked to behavioral motivation in the academic setting and was defined as a student’s belief in their ability to accomplish and succeed on an academic-related task (Bandura, 1989). Bandura (1997) also found that self-efficacy beliefs can be altered through four primary sources: (a) personal performance accomplishments, (b) vicarious learning, (c) social persuasion, and (d) physiological and affective states. While self-efficacy is dynamic (Lent, 2020) and can be impacted by personal interpretation of these primary sources (Lent & Brown, 2006), research has found that self-efficacy is an important factor in counselor competency (Barbee et al., 2003; Barnes, 2004; Kozina et al., 2010; Pechek, 2018; Vincenzes et al., 2023). More specifically, Lent et al. (2003) found that CITs’ initial clinical work and experience with more difficult skills (e.g., managing a session, handling the role of the counselor) increased counselor self-efficacy (Kozina et al., 2010).
Self-Efficacy in Suicide Training
Counselors who lack self-efficacy in their ability to work with a client who is experiencing suicidal thoughts may conduct suicide screening, assessments, and interventions ineffectively (Douglas & Wachter Morris, 2015; Jahn et al., 2016). In addition, counselors with low self-efficacy are more likely to subconsciously choose not to see suicide warning signs (Douglas & Wachter Morris, 2015) or avoid the topic of suicide altogether (Jahn et al., 2016). It is important that CITs are exposed to the topic of suicide and that they gain more counseling experience involving this issue during their training so that they will feel more confident working with a client experiencing suicidal thoughts. More exposure to this topic leaves CITs feeling better equipped to address suicide in sessions and is also likely to increase their self-efficacy (Elliott & Henninger, 2020; Pechek, 2018; Sawyer et al., 2013; Shea & Barney, 2015).
Clear evidence of the positive effects of including training on suicide within counselor education programs has been documented, demonstrating a reduction of fear and more success in helping clients manage suicide-related issues (Jahn et al., 2016). CITs who had prior training in suicide experienced lower levels of anxiety and higher levels of confidence in working with a client with suicidal thoughts (Binkley & Leibert, 2015). Similarly, professional counselors who expressed confidence in their academic training on suicide experienced lower levels of fear related to negative client outcomes and had higher levels of confidence in their skills and abilities (Jahn et al., 2016).
Self-Efficacy in Suicide Training for Online Learning. Although the topic of self-efficacy in counselor education has been studied (Barbee et al., 2003; Barnes, 2004; Conteh et al., 2018; Fakhro et al., 2023; Kozina et al., 2010; Pechek, 2018; Suh et al., 2018; Vincenzes et al., 2023), the literature does not focus on how best to teach for improved self-efficacy related to suicide assessment and intervention in the online setting. Specifically, it is not clear how counselor educators can best teach suicide screening, assessment, or intervention skills online. Two recent studies in counselor education programs have tried to better explain self-efficacy in suicide training during online learning (Elliott & Henninger, 2020; Gallo et al., 2019).
Elliott and Henninger (2020) showed that different online teaching strategies (e.g., a combination of a written module, role-plays/observations, and a facilitated discussion) in an online counselor education program showed no between-group differences, while all teaching strategies showed significant improvements in self-efficacy of CITs. Another study found that a 15-hour youth suicide prevention course that included didactic and experiential activities in a master’s counseling program increased participants’ knowledge and perceived ability to help clients who experienced suicidal ideations, as well as increased their self-efficacy in screening, assessment, and intervention (Gallo et al., 2019).
Purpose of the Study
With the influx of online counselor education programs, it is essential to determine how to improve suicide training and intervention skills (Allen & Seaman, 2014) so that CITs are better prepared to address the topic of suicide. The current quantitative study examined the influence of an online counseling practice model on CITs’ self-efficacy when it came to the utilization of suicide assessment and intervention with clients. The research question was: Do CITs’ perceived levels of self-efficacy in suicide assessment and intervention change because of practicing these skills through role-plays in an online counseling course? By better understanding these findings, implications can be made for how counselor educators can teach suicide screening, assessment, and intervention skills online.
Method
Procedures
Prior to beginning this study, our research team received full approval from the IRB. Participants were then recruited from an online clinical mental health counseling program. Only students enrolled in the online basic counseling skills course were recruited to ensure that all participants were at the same place in the program regarding knowledge and skills learned. An electronic announcement was posted in the 10 online basic skill course shells. The announcement included a hyperlink directing participants to an informed consent document, which detailed their requirements and rights and allowed them to indicate their consent to participate. Before completing any survey questions, the participants created a username for data comparison in the pre- and posttests, which was also an avenue for dropping participants if they requested to leave the study. After providing their username, participants completed a brief demographic questionnaire and the Counselor Suicide Assessment Efficacy Survey (CSAES; Douglas & Wachter Morris, 2015). To protect participant anonymity, no additional identifying information was collected.
Structure of the Basic Skills Class
Once students completed the pretest consent form, demographic questionnaire, and assessment, the counselor educators (i.e., faculty) started the class by providing participants with a variety of technology-assisted counseling experiences and activities (e.g., role-play demonstrations, best practices in telemental health counseling, lecture videos on specific counseling skills, guidelines for a preferred topic for the role-plays). To ensure consistency of content across courses, the faculty made sure to include the same teaching resources in each section of the class and continuously consulted each other to make sure that the classes were taught as similarly as possible. In addition, they decided that all students should receive the same training and teaching activities, ensuring that they were equally prepared to address the topic of suicide during their clinical courses and after graduation.
The topic of self-care was addressed with participants, as this was the first opportunity students had to practice counseling skills within the program. This focus on self-care was an important step toward decreasing the potential of significant deep-rooted issues surfacing without sufficient time or training to properly address them. Students would learn about a new basic counseling skill each week and were instructed to incorporate that skill into the week’s role-play. In addition to reading about the skill in the course textbook, students were required to view weekly lecture videos and role-plays that specifically explained and demonstrated the skill that the students would be practicing that week during their role-play. For role-plays, participants were randomly paired with other participants within the same basic counseling skills course to practice basic foundational counseling skills. Each pair of students participated in five weekly role-plays as both the counselor and the client. Two of these role-plays occurred during class and three occurred outside of class. Each role-play occurred via Zoom and lasted approximately 10–15 minutes during class or 30 minutes when completed outside of class. For in-class role-plays, participants utilized breakout rooms in Zoom. Faculty provided each participant in the counselor role with feedback at the end of each role-play. Role-plays outside of the class required participants to send their partner a Zoom link and password. The role-plays were recorded in Zoom. Participants identified one role-play to submit to the instructor for formal assessment of their basic counseling skills and to provide formative feedback to each participant when acting in the counselor role.
Preparation for Suicidal Ideation Role-Plays
After the initial five role-plays were completed, participants prepared for role-plays that focused on crisis counseling. They read a chapter from their textbook on crisis counseling and various supplemental articles on working with a client with suicidal ideations. In addition, they viewed pre-recorded role-plays on suicide assessment created by faculty in the program. Participants remained in the same randomly assigned pairs from earlier in the semester and then completed an additional five role-plays (one weekly), which allowed for them to gain experience working with a client with suicidal ideations.
Suicidal Ideation Role-Plays
Prior to beginning the role-plays, participants were provided with a brief synopsis for the topic of suicide and were also given the instructor’s phone number in case they needed immediate support or guidance. Like the previous role-plays, each of these lasted approximately 10–15 minutes during online classes or 30 minutes outside of class. Again, role-plays completed outside of class were recorded so that faculty could provide detailed feedback to students. The first in-class role-play was completed in a fishbowl format, allowing students in the class to observe. Instead of utilizing multiple breakout rooms, students remained in one room and observed one role-play at a time. This allowed students to learn vicariously from one another and to observe the ways that suicide screening, assessment, and intervention skills were demonstrated. The initial role-play also served as a way for participants in the counselor role to gain experience completing a suicide assessment while practicing other basic counseling skills. Four additional role-plays occurred and offered an opportunity for participants to continually reassess the risk of suicide of their partners, develop a safety plan, establish treatment goals, and practice other basic counseling skills. During the last role-play, participants in the counselor role conducted a termination session in which the counselor reviewed the client’s safety and treatment plans. Additionally, they reviewed the client’s goals and objectives and provided time for the client to reflect on the counseling experience.
Faculty Supervision and Learning Activities
During the semester, faculty supervision was an essential component of the process. If additional support or guidance was needed for participants, faculty were available via phone between 8 am–8 pm, Monday through Friday. Faculty were available to all role-play participants regardless of their role (i.e., counselor, client, or observer). While supervision can look different for each instructor, the counselor educators in this study regularly consulted with one another to ensure that they were conveying the same expectations to the students enrolled in the courses. This extended to making sure they discussed similar topics at the same time during the course; included the same teaching activities, readings, and assignments; and consulted with one another when a concern arose that may have changed course plans.
In addition to completing the virtual role-plays during the semester, participants completed a variety of activities and assignments that were intended to prepare them for realistic experiences needed upon graduation. For example, participants completed components of a treatment plan after each counseling session which were submitted to the instructor immediately following the role-play. Additionally, they submitted video tapes of role-plays for faculty feedback. Finally, participants transcribed one 30-minute role-play. This assignment allowed them to identify and reflect on specific foundational skills that they used when working with a client reporting suicidal ideations. At the conclusion of the semester, participants were asked to complete the posttest using the same username they created at the beginning of the semester. The posttest included the same assessment as the pretest (CSAES).
Participants
A convenience sample was used for this study. Master’s-level counseling students enrolled in the spring 2021 and spring 2022 counseling skills courses (10 sections total) in an online clinical mental health counseling graduate program were recruited via news announcements and emails to participate in this study. A total of 120 students were invited to participate in the study; however, only 60 were included because they completed both the pretest and posttest self-efficacy assessment. Included students’ ages ranged from 21–61 years old. The average age of participants was 29.03 (SD = 8.49). The sample consisted of the following racial identities: 80.0% White or Caucasian (n = 48), 10.0% Black or African American (n = 6), 6.7% Hispanic or Latino (n = 4), 1.7% Asian or Asian American (n = 1), and 1.7% did not indicate their racial identities (n = 1). Most participants identified as female (90%, n = 54) and were enrolled in the mental health counseling program full-time (51.7%, n = 31). When asked about prior experience in the mental health field, 60% (n = 36) had this experience; however, only 45% (n = 27) had prior professional experience or training in suicide risk assessment. Table 1 contains all participant demographics.
Measure
The study participants completed the CSAES (Douglas & Wachter Morris, 2015). The CSAES measures self-efficacy in suicide assessment and intervention. According to the developers (Douglas & Wachter Morris, 2015), the CSAES is comprised of 25 items that may make suicide assessment or intervention difficult for a counselor. These items are rated on a confidence scale that ranges from 1 (not confident) to 5 (highly confident). The confidence items are organized into four subscales:
- General Suicide Assessment, which has seven items and a maximum score of 35
- Assessment of Personal Characteristics, which has 10 items and a maximum score of 50
- Assessment of Suicide History, which has three items and a maximum score of 15
- Suicide Intervention, which has five items and a maximum score of 25
Sample items include the following: Q1 “I can effectively inquire if a student has had thoughts of killing oneself” (General Suicide Assessment); Q11 “I can effectively ask a student about his or her history of mental illness” (Assessment of Personal Characteristics); Q18 “I can effectively ask a student about his or her previous suicide attempts” (Assessment of Suicide History); and Q25 “I can appropriately intervene if a student is at imminent risk for suicide” (Suicide Intervention).
Table 1
Participant Demographics

The total score for the scale is 125, with higher scores representing higher levels of self-efficacy associated with suicide assessment and intervention (Douglas & Wachter Morris, 2015). The CSAES can be scored two ways. First, the assessment can be scored individually for a more detailed understanding of what differences, if any, in self-efficacy exist between differing aspects of suicide assessment. The second way is to calculate the total sum of the assessment-related subscales and the intervention subscale. In doing so, each subscale would have a mean for the individual scale (Douglas & Wachter Morris, 2015).
The assessment developers have reported internal reliability for the CSAES as a calculation for each of the four subscales and the second-order factor of Suicide Assessment using Cronbach’s α: General Suicide Assessment α = .882, Assessment of Personal Characteristics α = .88, Assessment of Suicide History α = .81, Suicide Intervention α = .83, and Suicide Assessment α = .93 (Douglas & Wachter Morris, 2015).
The CSAES was noted for showing “structural aspects of validity and sensitivity to detect differing levels of self-efficacy” (Douglas & Wachter Morris, 2015) based on the utilization of a four-factor model that was cross-validated. The scale was validated with a total of 324 participants. Of the participants, 258 (79.63%) were female. Unfortunately, a limitation of the instrument is that the diversity of participants was unknown due to ethnicity inadvertently being left off the demographic questionnaire while it was being developed (Douglas & Wachter Morris, 2015).
The current study assessed the internal reliability of the CSAES using Cronbach’s α and omega (ω) using test-retest reliability because the measure of consistency was between two measurements of the same construct to the same group at two different times. The overall CSAES has strong reliability (α = .978; ω = .978), and each subscale had the following reliability scores: General Suicide Assessment (α = .943; ω = .946); Assessment of Personal Characteristics (α = .947; ω = .947); Assessment of Suicide History (α = .896; ω = .890); and Suicide Intervention (α = .920; ω = .915). All subscale reliability coefficients were high when looking at both α and ω, meaning that good internal consistency was found among items of the scale (Green & Salkind, 2014).
Data Analysis
Before running any analyses, we screened the data using SPSS version 26.0.0.1 software to check for (a) missing data, (b) average expected scores per the outcome variables, (c) standard deviations within range, and (d) normality of data (Green & Salkind, 2014). The initial sample included 108 surveys; however, only 60 of these could be paired with posttest data, using the username data point. Therefore, individuals with their missing pair were deleted along with any others that included missing data (i.e., listwise deletion). The final sample included 60 respondents. A power analysis using a statistical power analysis program (G*Power 3.1) for paired t-test showed an N of 54 was needed for 95% power with an alpha level of .05 and a moderate effect size of .5. Next, scales were computed, and univariate testing occurred. Data met all assumptions for conducting a paired t-test (i.e., dependent variable was continuous, normally distributed, and without outliers and the observations were independent of one another). The paired t-test was used to test the effectiveness of training for suicide assessment and intervention in a basic skills class using a single-group (pretest/posttest) design, including demographics and the CSAES. To ensure that all students received the same teaching activities and assignments, we decided not to utilize a control group. We wanted to ensure that all students were equally prepared and trained to address the topic of suicide upon entering their clinical courses and upon graduation.
Results
The purpose of the study was to compare counseling students’ pretest and posttest self-efficacy assessments when taking a basic skills course that highly emphasized skills related to suicide training and assessment. The results of a paired-samples t-test on the General Suicide Assessment subscale indicate that on average, students scored significantly higher (Mpost = 28.57, SD = 4.80) after taking the basic skills class (Mpre = 21.20, SD = 7.80), t(59) = −9.15, p < .001. A large effect was found (d = 1.182, 95% CI [−1.51, −.85]). The results of a paired-samples t-test on the Assessment of Personal Characteristics subscale indicate that on average, students scored significantly higher (Mpost = 41.17, SD = 6.59) after taking the basic skills class (Mpre = 33.80, SD = 8.75), t(59) = −8.77, p < .001. A large effect was found (d = 1.133, 95% CI [−1.46, −.81]). The results of a paired-samples t-test on the Suicide History Assessment subscale indicate that on average, students scored significantly higher (Mpost = 13.07, SD = 2.22) after taking the basic skills class (Mpre = 9.95, SD = 3.33), t(59) = −8.38, p < .001. A large effect was found (d = 1.081, 95% CI [−1.40, −.76]). The results of a paired-samples t-test on the Suicide Intervention subscale indicate that on average, students scored significantly higher (Mpost = 19.00, SD = 4.32) after taking the basic skills class (Mpre = 14.63, SD = 5.46), t(59) = −7.21, p < .001. A large effect was found (d = .931, 95% CI [−1.23, −.63]). In summary, students’ level of self-efficacy related to suicide assessment and intervention increased in all areas as a result of taking the basic counseling skills class.
Because this study had a small sample size, the risk increases that at least one test is statistically significant just by chance. Therefore, a Bonferroni correction was applied to adjust the significance levels: Bonferroni correction = .05/4 = .0125 (.05 = acceptable significance level; 4 = number of subscales of CSAES). Therefore, the familywise error value is .0125. Because the above results are looking at significance at the p <.001 value, all results remain significant.
Discussion
The initial research question was: Do CITs’ perceived levels of self-efficacy in suicide assessment and intervention change because of practicing these skills through role-plays in an online counseling course? According to the results of the current study, on average, students felt significantly more prepared and confident in their ability to counsel someone experiencing suicidal ideations after practicing the skills in their basic counseling skills online course. Prior research indicated that many students were either not taught these skills (Becnel et al., 2021) or did not feel prepared to address these issues in counseling (Schmidt, 2016). The current study points to the vitality of both teaching students about suicide screening and assessment, as well as providing them with a safe space to practice the skills. By offering students opportunities to practice suicide screening, assessment, and intervention skills, instructors could help reduce their students’ anxiety in addressing the topic during their clinical courses, which Binkley and Leibert (2015) found to be a significant student concern.
Furthermore, it is important for counselor educators to observe and provide students with feedback regarding these essential skills. Past research points to the concern that students are not adequately conducting suicide screening, assessments, and interventions (Jahn et al., 2016); therefore, it would behoove counselor educators to infuse various opportunities throughout the curriculum to strengthen these skills. In turn, feedback and practice opportunities combined may help to enhance students’ levels of self-efficacy (Elliott & Henninger, 2020; Gallo et al., 2019), thus helping them to address the issues with clients in a timely and direct manner.
Implications for Training
While CACREP (2023) requires counselor educators to prepare students to work with clients who present with suicidal ideations, there is no clear criteria as to the best way of preparing students to work with these clients. Research on the topic is limited; however, the results of this study can provide a framework for helping to inform key training areas in counselor education and future research.
As counselor educators continue to expand on the didactic knowledge of suicide screening, assessment, and intervention, more intentional efforts need to be embedded throughout the curriculum to continuously expose students to experiential opportunities for practicing these skills. This idea coincides with the recommendation from the American Association of Suicidology that proposes suicide knowledge and assessment be at the forefront of graduate program curricula (Schmitz et al., 2012). First, in foundational courses, students could become more comfortable with the topic of suicide. These courses could help break down barriers and possibly calm nerves that tend to surround the topic of suicide. In assessment courses, students could role-play giving a partner various suicide screenings and assessments and gain experience interpreting the results. These role-plays could occur during class or be recorded for faculty feedback. In skills courses, students could practice suicide intervention by broaching the topic with their classmate-clients to help them feel more comfortable with directly asking clients if they are experiencing suicidal ideations. In addition, it may be helpful if a trauma and crisis counseling course was required within the core curriculum. This course could have content devoted to suicide screening, assessment, and intervention, including both didactic and experiential opportunities. By offering these opportunities throughout the curriculum, similar to ethical and cultural considerations, students may feel more comfortable and confident as they enter their clinicals (Binkley & Leibert, 2015; Guillot Miller et al., 2013). This intentional, consistent exposure to practicing these skills could help more students gain foundational knowledge and experience with this topic. In turn, as their self-efficacy and comfort levels increase, they may be more confident addressing this topic with clients. Ultimately, this may increase client welfare by ensuring effective assessment and treatment of client needs.
Implications for Counselor Education Training Research
The topic of suicide screening, assessment, and intervention in counselor education and supervision could benefit significantly from continued outcome-based research. For example, longitudinal studies could track students’ perceived levels of self-efficacy on suicide screening, assessment, and intervention as they go through a counseling program. This may help educators become more intentional about when and how the topic is infused within the curriculum. In addition, research could compare different types of teaching methods (e.g., role-play versus lecture) that expose students to the topic and assess which methods are more influential in building students’ skills and self-efficacy. Finally, researchers could interview current mental health therapists to identify knowledge and skill gaps to help educators teach students about crisis counseling more intentionally.
Limitations
There are a few limitations to the current study that are important to discuss. First is the variability in teaching and supervision styles across different instructors, which may impact the students’ overall feelings of self-efficacy. Although the same procedures were followed, educators inevitably have different styles of giving feedback. How the feedback is perceived by the student may impact their confidence in using the acquired skills.
Another limitation involves the notion of social desirability bias. The participants in the current study were students in the program; therefore, they may have felt pressured to identify increases in their self-efficacy around suicide assessment and intervention. This pressure may have been experienced because some of their current professors also served as researchers in the study and the students may have wanted to gain favor with them.
With regard to external validity, there are a few limitations. First, our research team did not account for prior experience in suicide screening, assessment, or intervention; thus, the results could have been impacted by external experiences versus the sole experience of the course activities. Additionally, there was a large portion of the data that could not be used because the pre- and post- surveys could not be aligned. Although the current study had 60 viable pre- and post- surveys, the data could have been more reliable and generalizable with a larger dataset. Furthermore, there was a lack of diversity in the research sample. Because the participants were primarily White females, the results may be limited in its generalizability to other cultures and genders.
Future studies should attempt to better isolate these variables (i.e., teaching styles, feedback, participant recruitment, prior experience in suicide training, cultural background) and find ways to improve response rates. In addition, it would be beneficial to have a comparison course or data from other counseling programs’ basic skills classes to further determine if this practice-based model was effective. Results could be linked to more general self-efficacy increases because of growing more comfortable with learning and using interviewing skills (Holladay & Quiñones, 2003).
One final limitation worth noting is the effect size estimates of the pre- and posttest scores. All effect sizes are large. Some reasons why the effect sizes may be large in the paired-samples t-tests include: (a) large differences between paired observations (the mean scores between the pre- and posttest scores were extremely different), and (b) small within-group variability (if the within-group variability is small, then even small differences between the paired observations could result in a large effect size).
Conclusion
As counselor educators prepare students for the profession, intentional inclusion of suicide screening, assessment, and intervention skills is vital to increasing students’ confidence and preparation to address this topic with their future clients. But it is not enough for students to learn about screening, assessment, and interventions; they need experiential opportunities to practice and develop these skills. In turn, feedback and practice will increase their comfort levels to directly and adequately support their clients’ needs.
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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Ashley Ascherl Pechek, PhD, NCC, ACS, LPC, is an associate professor at Commonwealth University of Pennsylvania. Kristin A. Vincenzes, PhD, NCC, ACS, BC-TMH, LPC, is a professor at Commonwealth University of Pennsylvania. Kellie Forziat-Pytel, PhD, NCC, ACS, LPC, is an assistant professor at Commonwealth University of Pennsylvania. Stephen Nowakowski is a graduate student at Commonwealth University of Pennsylvania. Leandrea Romero-Lucero, PhD, ACS, LPCC, CSOTS, is an associate professor and Clinical Mental Health Counseling Program Director at Commonwealth University of Pennsylvania. Correspondence may be addressed to Ashley Ascherl Pechek, 401 N. Fairview Street, Lock Haven, PA 17745, aap402@commonwealthu.edu.
May 22, 2024 | Volume 14 - Issue 1
Joshua D. Smith, Neal D. Gray
Each year TPC presents an interview with an influential veteran in counseling as part of its Lifetime Achievement in Counseling series. This year I am honored to introduce Dr. Kathleen Brown Rice, a clinician, supervisor, and counselor educator with expertise in substance use disorders and historical trauma. In this interview, she discusses the personal and professional motivations for her work and her perspective on the future of counseling and counselor education. I am grateful to Dr. Joshua Smith and Dr. Neal Gray for highlighting the ongoing contributions of leaders in the profession for the TPC readership. —Richelle Joe, Editor
Kathleen Brown Rice, PhD, NCC, ACS, LPC-S (TX), LPC (SD), LCMHC (NC), is a professor of counselor education in the College of Education at Sam Houston State University. She obtained her CACREP-accredited PhD in counselor education and supervision from the University of North Carolina at Charlotte and her CACREP-accredited Master of Science in counseling from South Dakota State University. Dr. Rice is a Licensed Professional Counselor-Supervisor in Texas, a Licensed Professional Counselor in South Dakota, and a Licensed Clinical Mental Health Counselor in North Carolina. Additionally, she holds the National Certified Counselor and Approved Clinical Supervisor credentials. She has worked as a professional counselor in various clinical settings and currently operates a private practice assisting clients with mental health, trauma, and substance abuse issues. Dr. Rice’s scholarly research activity focuses on counselor supervision and training with an emphasis in ethical considerations; the implications of historical and generational trauma; and the impact of substance abuse on individuals, families, and the community. She also incorporates the use of biomarkers in her research to understand emotional regulation, risky behaviors, and resiliency. As part of her extensive scholarship, she serves as an expert peer reviewer on the TPC Editorial Review Board.
In this interview, Dr. Rice provides her analysis of the current state of the counseling profession and the possibilities for its future, in addition to discussing the importance of social justice, access to online education, and service.
- As a counselor educator with experience in both traditional (face-to-face) and online delivery, what do you see as the benefits and challenges of both? Additionally, in your opinion, how can online delivery for skills courses ensure counselor competency?
During my master’s and doctoral studies, not one online class was offered. Things have changed immensely. According to the Council for the Accreditation of Counseling and Related Educational Programs website (CACREP; 2024), there are 12 CACREP-accredited online doctoral programs and 118 CACREP-accredited online master’s programs. I believe as telecounseling in the field increases, the number of online programs and online course offerings in face-to-face programs will also continue to grow. A 2021 Ruffalo Noel Levitz Graduate Student Recruitment Report surveyed prospective students who planned to enroll in graduate school and found that 48% preferred hybrid programs, 32% preferred fully online programs, and 20% wanted a traditional classroom program. When looking at within-group differences, doctoral students preferred traditional classroom instruction and master’s students preferred hybrid or online programs (Ruffalo Noel Levitz, 2022).
Courses and programs being offered online provide greater flexibility for our students to schedule around work and personal commitments. This can provide students with a better school–life balance. Online counseling programs can provide access to learners who would not otherwise be able to pursue their graduate education and search out specialty tracks that may not be available in their own geographical area. Online programming diversifies the learning environment by providing the opportunity for students from different backgrounds, worldviews, and cultures to engage and collaborate. While these virtual learning environments increase opportunities, there are also struggles we need to consider with this learning modality. Students in online programs may feel isolated and have fewer or qualitatively different opportunities to engage. This can result in a loss of community and feelings of being unsupported, and even have implications on their professional identity development. Given the differences in jurisdictional requirements for licensure, every program might not lead to the educational requirements for licensure where the student lives or wants to practice. There are also legal considerations related to mandatory reporting and limits of confidentiality that vary across jurisdictions. Lastly, online instruction can restrict assessment related to professional comportment issues. This can lead to students’ gate-slipping to the detriment of clients and the counseling profession.
When looking at how to best support skills courses to ensure we are training competent and ethical counselors, it is important to consider the traits of the student, faculty, and program. Vineyard (2019) recommended that a successful virtual student is one who has good time management skills, has the ability to self-regulate, and is self-motivated. Thus, we must be honest with ourselves as educators and administrators that online programming is not the right fit for every student. Additionally, to best support virtual students, educators need to think about different types of support such as providing regular live supervision of sessions and consistently reviewing recordings. Further, faculty should seek out training and continuing education to enhance their online instruction and understand gatekeeping strategies. For programs, they should be committed to providing the required online platforms and training for both students and faculty to support an online counseling training program. Also, there should be a residency component built into the program. My personal experience and the results of my research on problems of professional competency prove that having face-to-face personal contact is how most disposition problems are discovered. I believe observing how our students interact with us and each other is a crucial part of the gatekeeping process.
- Having an extensive research and publication record aimed toward understanding racial and generational trauma, particularly with Indigenous, tribal, and Native American populations, could you speak about the importance of advocacy and social justice in the counseling profession?
We have great privilege being counselors and counselor educators. Those initials behind our names have inherent power. Thus, advocacy should be embedded in everything we do from our practice, teaching, research, and mentorship. Our training and education provide us a seat at the table to promote equity and inclusion and advocate with others—and we should take full advantage. Advocacy also relates to us being engaged with the population that we are advocating for. In that, to advocate for any population, you have to know them, understand them, and ask them if and how they want your support—this is how we advocate with. Many groups that have been historically marginalized in the United States were done so under the guise of helping. One example of this relates to the Indian boarding schools.
From the beginning of the formation of the United States into the 19th century, a central agenda for many government officials was to acquire Indigenous lands (e.g., Indian Removal Act of 1830). By 1876, the majority of lands had been seized, and native people were forced to either relocate or live on reservations. Captain Richard H. Pratt believed that this segregation was wrong and supported better treatment for the native people. He delivered a speech at the Nineteenth Annual Conference of Charities and Correction regarding how to reeducate Native Americans/American Indians, where he proclaimed the only course was to “Kill the Indian, and Save the Man.” In that, to save the Indian, full assimilation into White European culture was required. Thereafter, the government and religious organizations established boarding schools (for more information, see this article). General Platt would have seen himself as an advocate. However, his actions led to the abuse of many children under the care of these schools, loss of cultural identity, and disruption of the parental relationship, and are seen as the prominent predecessor to many of the existing problems for some American Indians/Native Americans. Advocacy is crucial in the counseling profession. However, it needs to be done in a culturally competent and collaborative manner. I have been approached by researchers to ask for my assistance working in the Indigenous populations. However, when I ask them if they reached out to the community they want to research in, they most often say “no.” I believe it is crucial to be part of the community before you engage in research with the community. Learn what would be beneficial to the community, not just what will get the researcher published and/or grant funding.
- As a follow-up to the previous questions, where did this passion and pursuit originate for you?
For me, it has a both personal and professional origination and intersection. I am a linear descendent of the Chickasaw tribe. I grew up not knowing a lot about my heritage because my father was trying to protect our family. His lived experience was that it was not safe to let people know. So, our heritage remained closeted the majority of my life. For almost 20 years I worked as a paralegal. The majority of my work supported lawyers focusing on criminal and family law, which included federal law related to reservation crimes. I saw so many judicial problems occurring with many American Indian/Native American individuals, which made me curious about the reasons. I was repeatedly told “that is just how those people are.” Now, I knew that was not true because I was one of those people. I got frustrated with the pattern of what I was seeing and felt I was more part of the problem than the solution. At the age of 39, I decided to go back to school to pursue a different career.
During my undergraduate studies, I chose to take an American Indian/Native American history class to understand more. My father supported my quest for knowledge and started to share our heritage with me. This class helped me understand more about the historical components of the why. During my master’s studies, I first heard the term historical trauma. I began to research this concept and more parts of the why were answered for me. For my doctoral studies, I sought a program that specialized in multicultural competency to assist me in gaining more knowledge. However, I was still struggling with truly embracing my biracial identity—then fate interceded. I was the director of clinical experiences at the university where I was working. I received an email from a local reservation that they lost funding and had to let some counselors go and they wondered if we had any interns. No interns were available, so I said I would go. I was assigned a supervisor and during our first supervision session she said to me, “So, when are you going to tell me you’re Indian?” I started stumbling over excuses about how I was only part, and that I was not really raised a part of the culture. And she said two pivotal things to me: “You are not part, your Indian blood flows through all of you” and “Do you know how powerful it would be for the adolescents that you are going to work with to see someone from their people that is a counselor and doctor? How much you can encourage them?” She was right. I do this work to advocate for my people. That is my passion.
- Having a background in mental health and substance use counseling, what has been your experience navigating comorbidity? What changes have you seen socially and culturally as a result of the ever-changing landscape in our current society?
When I co-led my first substance abuse group as a practicum student 17 years ago, the focus was on the substance of abuse (i.e., consequences of use, identifying triggers, and changing behavior to not use). There was little discussion regarding trauma or other comorbid mental health disorders. All therapy work was done in group format. This did not leave space for individual counseling to assist clients with working through their own personal mental health struggles. When I was working at a large urban treatment facility, we were not allowed to engage in individual therapy. To meet the needs of my clients, I requested to conduct individual counseling with my group members who met the criteria for comorbidity. I was told that I could, but I would not be paid for the individual sessions and offered to clients pro bono. I agreed. Once I started working with my clients in both individual and group sessions, I saw so much improvement.
I have slowly been seeing a change in this perspective and clients getting counseling for both their substance use and other mental health concerns with the inclusion of holistic interventions. However, lately I have seen a focus more on mental health counseling only. In fact, through survey research by the Substance Abuse and Mental Health Services Administration (2022), it was found that of the 5.8 million adults aged 18 or older who reported a co-occurring mental health and illicit drug or alcohol use disorder in the past year, most (81.5%) received only mental health services. I think it is important that if a counselor is going to work with individuals who meet the criteria for comorbidity, they should be trained in both specialties. I know my educational training and clinical supervised experiences in both have been crucial to successful client outcomes.
The emergence of reality shows (e.g., Addicted, Intervention, Celebrity Rehab) and scripted shows (e.g., Euphoria, Mom, Nurse Jackie, Painkiller) related to addiction have changed how our society views addiction. These shows have allowed the general public to understand more about drug use, how people become addicted, and the consequences of addiction. I believe this has resulted in our society understanding that addiction is a disease and the person with the addiction needs treatment and support, not punishment and disdain. While media has brought some insight to substance use, words such as addict, alcoholic, drunk, and junkie are still being regularly utilized. Rather than these labeling words that are shame producing, person-first language (e.g., person with a substance use disorder) is critical to creating a therapeutic environment.
- It appears service is also an integral part of your counseling identity. What does service mean to you at the local, community, national, and international level?
Service for me encompasses two main concepts: 1) leaving things better than how I found them and 2) working for a cause not for applause. Active involvement in the department, college, university, profession, and community is an important component of service for me as a faculty member. However, I believe all service should first start on the local level. The analogy of putting your oxygen mask on first applies here. First give oxygen to your local stakeholders. I actively volunteer where gaps have been identified in my microsystem and work to fill these breaches to better serve clients and students. I then move onto service in the macrosystem. I strive to be strategic with the opportunities. We cannot be everything to everyone. Throughout my career, I have said no to roles because I knew that I did not have the bandwidth to do them competently. Service, to me, means making sure that I am only taking on those roles for which I have the time and energy to do well.
I have been honored to be appointed and elected to leadership roles in state and national organizations, serve on several editorial boards, and be selected to present at numerous national and international conferences. I value these opportunities and appreciate these roles and opportunities to provide service to the profession. However, I believe the most impactful service I have done relates to service that has no recognition by a title or line of my curriculum vitae (e.g., pro bono counseling, supervision for licensure, and workshops; consultation; mentorship). This also connects back to advocacy and leaving people with more than what they had, which are core values for me and how I hope to always operate as a counselor educator.
- What three challenges to the counseling profession as it exists today concern you most?
Counselors-in-training, professional counselors, and counselor educators not doing their own counseling work. I see the concept of the wounded healer being manifested more and more in our profession. In my opinion, this is strongly related to the aftermath of the COVID-19 pandemic. The pressure counselors, clinical supervisors, and educators had on them to immediately adjust to the new norm of telecounseling, online education, and the increase in individuals seeking service caused a perfect storm. In connection with the above is the predatory use of pre-licensed counselors. Given the jurisdictional differences related to the scope of practice and insurance companies’ view of pre-licensed counselors, the ability to bill or bill under a supervisor varies widely. This can lead to some agencies and practices over-scheduling pre-licensed counselors or bringing in too many supervisees to be supervised and, thus, supervision quality is compromised. The financial costs of a graduate education and the need to get those required hours results in many students and those working on their hours toward licensure being in a vulnerable position with little recourse to do anything regarding these situations. Lastly, there seems to be a lack of focus on evidence-based practices and research being conducted with clients. In the academic world, we have access to the latest peer-reviewed articles, and there is a research culture that motivates and encourages us to research and add to the literature. However, in the practice world, there may not be as much encouragement of counselor research engagement, consumption, and production. Therefore, there is a need to continue to find ways to bridge the research-to-practice gap and promote more counselors conducting research and gathering data with clients.
- What needs to change in the counseling profession for these three concerns to be successfully resolved or addressed?
As educators and supervisors, we need to do better with talking about going to counseling. I still do tune-ups with my counselor. We need to acknowledge what we do is difficult and that it is important that we continue our own self-care and our own work. I think we talk the talk about self-care; however, how often do we walk the walk? Are we providing space for our students and supervisees? Are we providing space for ourselves? Professional counselors, whether in training or practicing, need to remember counselor heal thyself first and to do their own work to avoid burnout and unethical practice. As our profession continues to grow, the need for good training sites and competent supervisors will continue to be a concern. I believe the responsibility for developing support for supervisors in the field is with counselor educators. We have resources and time allotted to us to work on strategies to better train and guide supervisors in the field and to advocate for more financial support for counselors-in-training. Lastly, in order for more practitioners in the field to gain access to the new developments in evidence-based practices, more counseling-related journals need to be open-access. We also need to find more ways to disseminate counseling research where counselors may tend to access information such as at scholarly conferences, in Counseling Today, and on social media platforms like the Mental Health Research Facebook page. Additionally, to get counselors more involved with conducting research and gathering data with their clients, more educators need to include practitioners as co-researchers on their studies. Ultimately, research to develop evidence-based practices should be seen as part of our service to our profession and advocacy for the clients we serve.
This concludes the ninth 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 at Lenoir-Rhyne University. Correspondence can be emailed to Joshua Smith at jsmith@umo.edu.
References
Council for Accreditation of Counseling and Related Educational Programs. (2024). Find a program. https://www.cacrep.org/directory
Ruffalo Noel Levitz. (2022). 2021 graduate student recruitment report. https://www.ruffalonl.com/papers-research-higher-education-fundraising/graduate-student-recruitment-report-2
Substance Abuse and Mental Health Services Administration. (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report
Vineyard, T. E. (2019). The use of an online readiness assessment to determine necessary skills, aptitude, and propensities for successful completion in a secondary online credit course [ProQuest Information & Learning]. In Dissertation Abstracts International Section A: Humanities and Social Sciences (Vol. 80, Issue 2–A(E)).
May 15, 2024 | Book Reviews
edited by James P. Sampson, Jr., Janet G. Lenz, Emily Bullock-Yowell, Debra S. Osborn, and Seth C. W. Hayden
I don’t know how to make this choice. While working in a university career center, I have heard these words of distress countless times from students who were feeling the unbearable weight of making a decision that they saw as having the power to shape their future, their lives, and their identities in significant and lasting ways. Fortunately, during a vocational psychology course, I studied cognitive information processing (CIP) theory, the pyramid of information processing, and the CASVE cycle, which gave me the confidence and competence to navigate the complicated decision-making process with students who felt emotionally and mentally overwhelmed by academic and career choices.
The need to make occupational decisions is universal. Cognitive Information Processing: Career Theory, Research, and Practice provides a comprehensive exploration of CIP theory, which serves as the theoretical framework for understanding the cognitive processes that affect how individuals interpret and utilize career-related information to guide their career choices.
Drawn from both cognitive and counseling psychology, CIP theory underscores the various mental processes involved in career decision making, including information gathering, self-awareness, and goal setting. As a career intervention, CIP theory is intended to assist individuals with career-related problems by enhancing their understanding of both problem solving and decision making. One tool used to accomplish this goal is the CASVE cycle. With each letter representing a step in the decision-making model, readers are guided through a structured process that helps them make informed choices. By following this model, individuals can be supported in avoiding impulsive decisions, minimizing risks, and increasing the likelihood of achieving their desired outcomes.
Published in 2023, this book focuses on integrating theory, research, and practical applications, making it an invaluable resource with applicability across a multitude of domains. Educators and researchers studying vocational behavior and aspiring to understand the future direction(s) of CIP theory would benefit from consulting Chapter 21. Likewise, practitioners seeking evidence-based career interventions and individuals navigating the complexities of career decision-making will discover instrumental guidance in the chapters dedicated to understanding occupational, educational, and training choices, as well as those exploring the psychological and developmental factors influencing an individual’s readiness to make career decisions. For employment agencies and government policymakers aiming to establish career-focused initiatives, Chapter 16 offers both a comprehensive blueprint and essential resources for developing and executing successful career services programs.
One of the book’s strengths, as stated above, is its integration of theory with practical applications. Each chapter provides insights into how CIP theory can be translated into effective career counseling interventions. The authors lay out the discussion of complex factors that affect career decisions in a straightforward and digestible manner. Practitioners and individuals will find a set of easily understandable concepts that will equip them with the knowledge and skills needed to inform effective and satisfying academic and career decision making. Through case studies, reflective exercises, practical guidelines, and summaries offered at the end of each chapter, readers will find that these skills can also be applied to a myriad of decision-making opportunities.
In addition to its theoretical and practical contributions, this book’s attention to the impact of systemic inequalities and cultural factors on career opportunities and outcomes is also notable. The authors expertly promote a culturally sensitive approach to career counseling that recognizes, respects, and affirms the diversity of individuals’ identities, values, and beliefs. They further emphasize the significance of an inclusive and empowering counseling atmosphere that fosters clients’ self-awareness and agency while making career choices. Case examples and reflective activities are presented to encourage readers to examine their own biases and assumptions that may hinder a culturally competent approach to career counseling.
Cognitive Information Processing: Career Theory, Research, and Practice is published through Florida State Open Publishing as an open-access resource. By making the book available for free, the authors have eliminated the financial barrier to accessing this invaluable asset aimed at equipping readers with theory-based knowledge of vocational behavior and career interventions. This accessibility benefits students, educators, researchers, practitioners, and anyone wanting to establish cost-effective and evidence-based career development intervention programming that helps individuals to make informed career decisions across their life span.
Sampson, J. P., Jr., Lenz, J. G., Bullock-Yowell, E., Osborn, D. S., & Hayden, S. C. W. (Eds.). (2023). Cognitive information processing: Career theory, research, and practice. Florida State Open Publishing. https://manifold.lib.fsu.edu/projects/cognitive-information-processing-career-theory-research-and-practice
Reviewed by: Nikkie Bailey, MS, LCSW
Mar 18, 2024 | Volume 13 - Issue 4
Jennifer M. Cook, Camille Y. Humes
This special issue of The Professional Counselor (TPC) is in honor of the NBCC Foundation (NBCCF)’s 2023 Bridging the Gap Symposium: Eliminating Mental Health Disparities. The theme for the 2023 Symposium, From Awareness to Action, represented the importance of attendee reflection on current issues and the need for intentional engagement in meaningful work that empowers underserved and never-served clients and communities. The event was attended by over 500 counselors and counselors-in-training who connected with peers and had the opportunity to learn from presenters of 70 sessions. Unique to this year’s Symposium was the celebration of the 10th anniversary of the Minority Fellowship Program (MFP). Members of the inaugural cohort, affectionately known as the Dream Team, came together to share memories of receiving their awards and spent time engaging in discussions about their remarkable contributions to the counseling profession over the past decade.
In this special edition of TPC, guest editors from the first and second cohorts of the MFP reviewed submissions and selected articles for publication. Keeping the 2023 Symposium theme in mind, we worked hard to ensure that the articles in this issue reflect the purpose and vision of the event. Submissions covered a wide range of topics that provided perspectives about mental health disparities across diverse populations. Our hope is that this issue, like Symposium, will provoke thought and promote action.
We divided the articles in this issue into two sections: The first section is comprised of articles that align with the special issue theme but were not presented at Symposium. The second section is comprised of articles that were written by authors who presented at this year’s Symposium and transformed their presented work into articles.
The three articles in the first section of this issue are those that align with the Symposium’s theme. Although the authors of these articles did not present at Symposium, we think you will find what the authors share captures the Symposium’s purpose beautifully. In “‘A Learning Curve’: Counselors’ Experiences Working With Sex Trafficking,” the authors present findings from their qualitative study with clinicians who work with clients who have experienced sex trafficking to offer recommendations for working with this population. “Ableist Microaggressions, Disability Characteristics, and Nondominant Identities” reveals how ableist microaggressions manifest most frequently for people with a range of disabilities and sociocultural identities, and the authors suggest ways to better support clients with disabilities. In the third article of the issue, “Using the Cultural Formulation Interview with Afro Latinx Immigrants in Counseling: A Practical Application,” the authors utilize a case study to demonstrate how to use this assessment tool with an Afro Latinx immigrant client from Mexico.
In the second section of the issue, “Diondre Also Has Bad Days: Cannabis Use and the Criminalization of Black Youth” and “Utilizing Collective Wisdom: Ceremony-Assisted Treatment for Native and Non-Native Clients” introduce readers to communities, concepts, and skills with which they may be less familiar. The authors convey clearly that counselors must develop these skills in order to serve populations who are in need of their identity-affirming, empathetic services. In “Diondre Also Has Bad Days,” the author challenges readers to examine how they treat Black and White youth and to overcome potentially biased approaches that have traditionally served one group more affirmatively than the other. “Ceremony-Assisted Treatment for Native and Non-Native Clients” presents readers with intervention options that integrate Indigenous practices, such as smudging and drumming.
The final three articles in the second section are “Taking Action: Reflections on Forming and Facilitating a Peer-Led Social Justice Advocacy Group,” “Comorbidity of Obsessive-Compulsive Disorder in Youth Diagnosed With Oppositional Defiant Disorder,” and “Bridging the Gap Between Intentions and Impact: Understanding Disability Culture to Support Disability Justice.” In “Reflections on Forming and Facilitating a Peer-Led Social Justice Advocacy Group,” the authors provide their individual insights about their experiences as students who established a social justice advocacy group for peers in their counseling program. “Comorbidity of Obsessive-Compulsive Disorder in Youth Diagnosed With Oppositional Defiant Disorder” gives readers insight into the complexity of distinguishing between OCD and ODD in youth and the potential for misdiagnosis, while “Bridging the Gap Between Intentions and Impact” offers counseling professionals strategies for competent care and allyship for disabled clients through a disability justice framework.
As you read the articles in this issue, we hope you will accept the opportunity to discover new ways to engage in the profession and to reflect on the why behind your commitment to your work. May this special issue serve as an inspiration for lifelong learning and lasting impact in the spaces where it is needed the most.
Jennifer M. Cook, PhD, NCC, ACS, LPC, is an associate professor in the Department of Counseling at the University of Texas at San Antonio. Dr. Cook is a multiculturally focused counselor educator who utilizes strength-based methods, culturally relevant practices, and social justice advocacy in her work and teaching. Her research focuses on counselor preparation and counselor cultural competence development, with emphasis on social class, socioeconomic status, and multiple identities. Dr. Cook has published extensively, completed over 40 national and international peer-reviewed presentations, and will publish a co-edited multicultural counseling textbook, Multicultural and Social Justice Counseling: A Systemic, Person-Centered, and Ethical Approach, later this year. Dr. Cook is a 2013 NBCC doctoral Minority Fellowship Program recipient, part of the Dream Team cohort.
Camille Y. Humes, EdD, NCC, LCPC (IL), LPC (MI), I/ECMH-C, is an assistant professor in the School of Counseling at Divine Mercy University in Sterling, Virginia. Dr. Humes holds an Endorsement® from the Michigan Association for Infant Mental Health, where she currently serves on the Board of Directors. For over 20 years Dr. Humes has worked as a counselor, mental health consultant, and leader in the mental health profession, advocating both nationally and internationally to inform policies that support mental health services. She is a writer, professor, and a regular grant reviewer for the United States Department of Education. Dr. Humes enjoys speaking to audiences about various topics, including the social/emotional health of young children.