Jul 25, 2025 | Volume 15 - Issue 2
Alexandra Frank, Amanda C. DeDiego, Isabel C. Farrell, Kirby Jones, Amanda C. Tracy
State policies and school district regulation largely shape the roles and responsibilities of school counselors in the United States. The American School Counselor Association (ASCA) provides guidance on recommendations for school counseling practice; however, state policies may not align with guiding principles. Using a rubric informed by the ASCA National Model, we conducted a problem-driven content analysis to explore state policy alignment with the Define, Manage, Deliver, and Assess components of the model. Our findings indicate state policy differences between K–8 and 9–12 grade levels and within each rubric component. School counselors and school counselor educators can use these findings to support strategic advocacy efforts aimed at increased clarity around school counselors’ roles and responsibilities.
Keywords: content analysis, advocacy, state policy, school counseling, ASCA National Model
What is a school counselor? The profession has a long history of attempting to answer this question, not always successfully. Role confusion in school counseling was highlighted by Murray (1995) who stated that the roles of school counselors often vary from the printed job description. Murray attributed unclear counseling duties to misunderstandings about school counselors’ roles by stakeholders, such as administrators, parents, and students. Murray also found that differences in legislative definitions of school counseling contributed to role confusion. As an early act of advocacy in school counseling, Murray suggested developing a uniform definition of school counseling, advocating for that definition, and engaging in effective communication strategies among stakeholders as solutions to role confusion. Since this early movement to define school counseling roles, professional groups (e.g., The American School Counselor Association [ASCA]), academic organizations (e.g., School Counselors for MTSS), and professional conferences (e.g., The Evidence-Based School Counseling Conference and ASCA conference) have joined in the efforts to describe school counselor identity and roles. Despite these efforts, school counselors across the United States struggle with the lack of clarity in their roles (Bardhoshi & Duncan, 2009; Chandler et al., 2018).
School counselors’ impacts on student outcomes are well-documented (O’Connor, 2018). When describing the role and influence of school counselors, researchers point to improved student outcomes, such as decreased student behavior issues (Reback, 2010), increased student achievement (Carrell & Hoekstra, 2014), and increased college-going behavior (Hurwitz & Howell, 2014). School counselors’ roles in supporting student social–emotional health became particularly important when navigating the effects of COVID-19 (McCoy-Speight, 2021). However, Murray’s (1995) concern about legislative differences in defining the role of a school counselor remains. Despite evidence describing positive impacts of school counselors on student outcomes, the school counselor role is often misunderstood and continues to vary from state to state (Carey & Dimmitt, 2012). Recently, state differences were most pronounced in Texas Senate Bill 763 (2023), which proposed to equip chaplains to serve as school counselors, and in Florida’s emphasis on parents as resiliency coaches (Florida Governor’s Press Office, 2023). Additionally, factors such as organizational constraints (Alexander et al., 2022), student–counselor ratios (Kearney et al., 2021), and engagement in non-counseling duties (Blake, 2020; Camelford & Ebrahim, 2017; Chandler et al., 2018) continue to hinder the impact that school counselors can make within their school settings. Intrigued by Murray’s observation regarding the long-standing issues with school counseling roles and duties differing from state to state and recent state initiatives to supplement the role of a school counselor with chaplains or parents (e.g., Texas and Florida), we sought to explore how state-level policies and statutes define school counselor roles and responsibilities and how they align with national recommendations.
Defining School Counseling
Noting the need for a uniform definition of school counseling, we turned to ASCA. Although ASCA is not the only professional organization supporting school counselors, it has the longest history (formed in 1952) and largest membership (approximately 43,000). Additionally, ASCA exists for the explicit purpose of supporting school counselors by “providing professional development, enhancing school counseling programs, and researching effective school counseling practices” (n.d.-a, About ASCA section). ASCA (2023) defines school counseling as a comprehensive, developmental, and preventative support aimed at improving student outcomes. ASCA (n.d.-b) advocates for a united school counseling vision and voice among stakeholders. Despite their efforts, researchers, educational leaders, and state policymakers continue to hold varied perspectives about the definitions, needs, and roles of school counselors. Although ASCA (2019; 2023) clearly delineates appropriate and inappropriate school counseling roles and responsibilities, school counselors often find themselves asked to engage in activities deemed inappropriate by ASCA (Bardhoshi & Duncan, 2009; Chandler et al., 2018).
School counselors can use collaboration and advocacy to promote a more appropriate use of their time (McConnell et al., 2020) and to mediate feelings of burnout (Holman et al., 2019). Researchers have discussed the importance of advocacy as integral to pre–school counselor training (Havlik et al., 2019), individual school counseling practice (Perry et al., 2020), and system-wide professional unity (Cigrand et al., 2015). However, such efforts are often limited to a single school or district and often do not include state-level advocacy.
The ASCA National Model
To support their mission of improving student outcomes, ASCA (2019) recommends a national model as a framework for school counselors. The ASCA National Model is aligned with school counseling priorities, such as data-informed decision-making, systemic interventions, and developmentally appropriate care considerations. Implementation is associated with both student-facing and school counselor–facing benefits. In an introduction to a special issue on comprehensive school counseling programs, Carey and Dimmitt (2012) described findings across six statewide studies highlighting the relationship between program implementation and positive student outcomes, including improved attendance and decreases in rates of student discipline. Pyne (2011) and more recently Fye and colleagues (2022) demonstrated correlations between program implementation and school counselor job satisfaction. Pyne found that school counselors with administrative support and staff collaboration related to program implementation experienced higher rates of job satisfaction. Fye et al. noted that as implementation of the ASCA National Model increased, role ambiguity decreased and job satisfaction increased.
The ASCA National Model consists of four components: Define, Manage, Deliver, and Assess. We outline the model in Table 1 below.
Table 1
Four Components of The ASCA National Model
| Define |
Standards to support school counselors
School counselors are supported in implementation and assessment of a comprehensive school counseling program by existing standards such as the ASCA Mindsets & Behaviors, the ASCA Ethical Standards for School Counselors, and the ASCA School Counselor Professional Standards & Competencies. |
| Manage |
Effective and efficient implementation of a comprehensive school counseling program
ASCA outlines planning tools to support a program focus, program planning, and appropriate school counseling activities. |
| Deliver |
The actual delivery of a comprehensive school counseling program
School counselors implement developmentally appropriate activities and services to support positive student outcomes. School counselors engage in direct (e.g., instruction, appraisal and advisement, counseling) and indirect (e.g., consultation, collaboration, referrals) student services. ASCA (2019) stipulates that school counselors should spend 80% of their time in direct or indirect student services. School counselors should spend 20% or less of their time on school support activities and/or program planning. |
| Assess |
Data-driven accountability measures to assess the efficacy of program delivery
School counselors are charged with evaluating their program’s efficacy and implementing improvements, based on student needs. School counselors should demonstrate that students are positively impacted because of the counseling program. |
We extend the Assess component to also include research-based examples on factors contributing to a school counselor’s efficacy. Such factors include student–school counselor ratios. For decades, ASCA has advocated for a student–school counselor ratio of 250:1 as well as broader support for school counselor roles (Kearney et al., 2021). Yet, data from the 2021–2022 school year put the average national student–school counselor ratio at 408:1 (National Center for Education Statistics [NCES], 2023). Researchers demonstrate that schools with ASCA-approved ratios experience increased student attendance, higher test scores, and improved graduation rates (e.g., Carey et al., 2012; Carrell & Carrell, 2006; Goodman-Scott et al., 2018; Lapan et al., 2012).
Alternatively, Donohue and colleagues (2022) demonstrated that higher ratios relate to worse outcomes for students. Notably, minoritized students and their school communities often face the brunt of increased student–school counselor ratios (Donohue et al., 2022; Education Trust, 2018). Thus, the ASCA alignment is not only concerned with improved student outcomes but also with the equitable provision of mental health services. Given the role ASCA plays in advocating for and structuring the school counselor’s role and responsibilities, we chose to use the components of the ASCA National Model (2019) as a theoretical framework guiding our study. We have incorporated our theoretical framework throughout, including data collection, data analysis, results, discussion, and implications.
Method
The purpose of our study was to understand how state policies align with the ASCA National Model. We analyzed state policies defining and guiding the practice of school counseling. In any inquiry, the type and characteristics of the data available should dictate the research methods (Flick, 2015). Content analysis allows researchers to identify recurring themes, patterns, and trends (Krippendorff, 2019). By systematically coding and categorizing content, researchers can uncover insights that might not be immediately apparent through casual observation. Additionally, it enables researchers to analyze large volumes of data in a systematic and replicable manner, reducing the impact of personal bias and increasing the reliability of findings. Because of these factors, we found content analysis to be the best method for our inquiry. We chose a subtype of content analysis—problem-driven content analysis (Krippendorff, 2019). Problem-driven content analysis aims to answer a research question. The research question guiding our analysis was: How are state policies aligned or misaligned with the ASCA National Model?
Sample
Using the State Policy Database maintained by the National Association of State Boards of Education (NASBE; 2023), we pulled current policies from all 50 U.S. states and the District of Columbia (N = 51) that dictate the role of school counselors and school counseling services. As ASCA (n.d.-c) describes, terms used for school counseling services can vary, and although “school counselor” is favorable to “guidance counselor,” both terms may be found. However, in NASBE’s State Policy Database, the category was specifically listed as “counseling, psychological, and social services,” and the subcategory was listed as “school counseling—elementary” and “school counseling—secondary” (NASBE, 2023). We included policies that govern kindergarten through eighth grade (K–8) and ninth through 12th grade (9–12). Data included all policies related to school counseling delivery and certification, with State Policy Databases sorted into policies governing K–8 (n = 156, 47.42%) and 9–12 (n = 173, 52.58%) levels, for a total of 329 policies.
Design
From our research question to data reporting, we followed the problem-driven content analysis steps (see Figure 1). We collected language from the policies, including policy type and policy name, and then determined if school counseling was encouraged, recommended, or not specified as either. We built a spreadsheet to divide, define, and identify the state policies into sampling units. We divided them into originating state, policy type, requirements for having school counselors in schools, policy name, and summary of the policy. Additionally, we separated the data into K–8 and 9–12 education designations.
Figure 1
Problem-Driven Content Analysis Process (Krippendorff, 2019)
The analytical process began with filtering policies for inclusion outlined in our selection criteria. We built a spreadsheet to divide, define, and identify the legislative bills into sampling units. We focused on dividing them into originating state, bill number, year, subcategory, and summary of the bill. After completing the spreadsheet with all the data, Kirby Jones and Amanda C. Tracy tested our coding frame on a sample of text. Although content analysis does not require piloting, Schreier (2012) suggested piloting around 20% of the data to test the reliability of the coding frame. We used 20% of our data (n = 66) to conduct pilot coding.
We approached the data analysis deductively, with the components of the ASCA National Model (2019) acting as our initial codes. Prior to analysis, we created a coding rubric that we used to analyze each state’s school counseling policy (see Table 2). We used the four components of the ASCA National Model as the rubric criteria: Define, Manage, Deliver, and Assess. Within each criterion, we developed standards ranging from 1 point to 5 points. We chose point ranges based on the information within each criterion. For example, the Define criterion included three standards for 5 total points. We awarded 1 point if a state required (versus recommended) school counselors in school; we awarded 1 point if a state required school counselors to be licensed and/or certified based on a graduate degree; and we awarded 3 points if a state specifically described all three focus areas of school counseling—academic, college/career, and social/emotional.
Alexandra Frank, Amanda C. DeDiego, and Isabel C. Farrell were involved in creating the rubric and completing initial pilot coding to ensure the usability and utility of the rubric. All team members met throughout the process to ensure workability and fidelity. Following initial testing, each coding pair was trained to appropriately analyze state-level policy data using the rubric. Before finalizing rubric metrics for each state, all team members met again to review metrics and to determine final scores for each state. Importantly, individual state-level rubric scores do not indicate grades, but rather demonstrate evidence of alignment between state-level policy as it is written and the ASCA National Model (2019).
Table 2
Rubric to Evaluate State Policy for Adherence to the ASCA National Model
| Aspects of the ASCA National Model |
|
Define
5 points
|
Manage
1 point |
Deliver
1 point |
Assess
2 points |
|
Required
1 point
|
Education
1 point |
Focus
3 points |
Implementation
1 point |
Use of Time
1 point |
Accountability
1 point |
Ratio
1 point
|
| State has provisions requiring school counselors |
Requires school counselors to be licensed/certified |
Areas of focus include:
(1) academic,
(2) college/career,
(3) social/emotional |
Role includes appropriate school counseling activities |
80% of time spent in direct/indirect services supporting student achievement, attendance, and discipline |
Evaluation of school counselor role included |
Maximum
of 250:1
|
Research Team
Our research team consisted of two counselor educators, two counselor education doctoral students, and one master’s-level counseling student. We began meeting as a research team in summer 2023. Conceptualization, data collection, and analysis occurred throughout the fall, ending in December 2023. Frank, DeDiego, and Farrell continued with edits and writing in 2024. Varying counseling backgrounds (including clinical mental health and school counseling), education settings (e.g., urban, rural, research, teaching), and personal identities were represented. All members are united by a passion for mentorship and advocacy. Additionally, DeDiego and Farrell provided expertise in legislative advocacy and content analysis, and Frank and Tracy provided expertise in school counseling. All members are affiliated with counseling programs accredited by the Council for the Accreditation of Counseling and Related Educational Programs. Frank, DeDiego, and Farrell designed the coding frame and trained Jones and Tracy on the coding process. Frank, DeDiego, and Farrell also resolved any coding conflicts. For example, if a state regulation was unclear, Frank, DeDiego, and Farrell met and decided what code would apply. All members of the research team communicated via email, Google Docs, and/or Zoom meetings to build consensus through the data collection and data analysis processes.
Trustworthiness
To enhance trustworthiness in this study, we followed the checklist for content analysis developed by Elo et al. (2014), which includes three phases: preparation, organization, and reporting. The preparation phase involves determining the most appropriate data source to address the research question and the appropriate scope of the content and analysis. In this phase, we determined the focus of the project to be policy defining school counselor roles; thus, state-level legislation was the most appropriate data source. Use of the NASBE (2023) database offered a means of limiting scope and focus of the content. Using deductive coding (McKibben et al., 2022), we first developed the rubric coding framework based on the ASCA National Model (2019) and then conducted pilot coding to test the framework.
During the organization phase, the checklist addresses organizing coding and theming strategies. We first conducted pilot coding to establish how to apply the ASCA National Model (2019) to coding legislation. We evaluated the content using the rubric to determine how the legislation aligned with the ASCA National Model. Elo et al. (2014) suggested researchers also determine how much interpretation will be used to analyze the data. The coding framework using the ASCA National Model offers structure to this interpretation. Data were coded separately for trustworthiness by Jones and Tracy. Then we met to compare coding. If there was discrepancy, one of us reviewed the data in order to reach a two-thirds majority for all of the coding. By the end of the process, all coding met the threshold of two-thirds majority agreement.
In the Elo et al. (2014) checklist, the reporting phase addresses how to represent and share the results of the analysis. This includes ensuring that categories used to report findings capture the data well and that results are clear and understandable for targeted audiences. The use of a rubric framework offers a clear method to represent and share results of the analysis process.
Results
Our results highlighted trends in the scope and practice of school counseling across the United States. We organized results by rubric strands (Table 3) and by state, analyzing results for K–8 (Appendix A) and 9–12 (Appendix B). We further describe our results within each strand of the ASCA National Model (2019): Define, Manage, Deliver, and Assess.
Table 3
Summary of Rubric Outcomes by Category
|
K–8 |
9–12 |
|
Yesa |
Nob |
Yesa |
Nob |
| Required |
37 (72.55%) |
14 (27.45%) |
40 (78.73%) |
11 (21.57%) |
| Education |
40 (78.43%) |
11 (21.57%) |
50 (98.04%) |
1 (1.96%) |
| Focus
Academic
College/Career
Social/Emotional |
35 (68.63%)
37 (72.55%)
35 (68.63%) |
16 (31.37%)
14 (27.45%)
16 (31.37%) |
40 (78.43%)
41 (80.39%)
40 (78.43%) |
11 (21.57%)
10 (19.61%)
11 (21.57%) |
| Implementation |
34 (66.67%) |
17 (33.33%) |
36 (70.59%) |
15 (29.41%) |
| Use of Time |
17 (33.33%) |
34 (66.76%) |
10 (19.61%) |
41 (80.39%) |
| Accountability |
21 (41.18%) |
30 (58.82%) |
29 (56.86%) |
22 (43.14%) |
| Ratio |
2 (3.92%) |
49 (96.08%) |
3 (5.88%) |
48 (94.12%) |
aIndicates awarding of a point, as outcome was represented in the policy.
bIndicates no point was awarded, as outcome was not represented in the policy.
In the state policies, school counselors were designated as required, encouraged, or not specified. For the K–8 level, 72.55% (n = 37) of states required school counselors in schools, 19.61% (n = 10) encouraged the presence of school counselors, and 7.84% (n = 4) of states did not specify a requirement of school counselor presence. At the 9–12 level, 78.73% (n = 40) of states required school counselors in schools, 19.60% (n = 10) encouraged the presence of school counselors, and 1.96% (n = 1) of states did not specify a requirement of school counselor presence.
The category of not specified included policies that were uncodified or policies that did not address the requirement of school counselors at all. The majority of states required school counselors at the K–8 (n = 37, 72.55%) and 9–12 (n = 40, 78.73%) levels. At the K–8 level, one state had a policy that was uncodified (Michigan) and three did not address the requirements of school counselors (i.e., Hawaii, South Dakota, Wyoming). At the 9–12 level, one state had an uncodified policy (Hawaii) and one did not specify a requirement for school counselors (South Dakota). Forty states (80%) for K–8 and 50 states (98.04%) for 9–12 required school counselors to have a license or certification in school counseling. The only state that did not require certification or licensure was Florida. Thirty-five states (70%) for K–8 and 40 states (78.43%) for 9–12 described the role of a school counselor as supporting students’ academic success. Thirty-seven states (72.54%) for K–8 and 41 states (80.39%) for 9–12 described the role of a school counselor as supporting college and career readiness. Finally, 35 states (68.63%) for K–8 and 40 states (78.43%) for 9–12 described the role of a school counselor as supporting students’ social and emotional growth.
Within the Manage aspect of the ASCA National Model (2019), we determined if the state outlined appropriate school counseling activities in alignment with ASCA recommendations in policy or statute (e.g., small groups, counseling, classroom guidance, preventative programs). Thirty-four states (66.67%) for K–8 and 36 states (70.59%) for 9–12 outlined school counseling activities in their policy. For Deliver, only 17 states (33.33%) for K–8 and 10 states (20%) for 9–12 outlined whether or not the majority of school counselors’ time should be spent providing direct and indirect student services.
Moreover, for the Assess category, we evaluated whether the state policy required school counselors to do an evaluation of their role and/or counseling services. Twenty-one states (58.82%) for K–8 and 29 states (56.86%) for 9–12 outlined evaluation requirements. Finally, we evaluated whether the state complied with the ASCA student–school counselor ratio of 250:1. Two states for K–8 (3%; i.e., New Hampshire, Vermont) and three states for 9–12 (5.9%; i.e., Michigan, New Hampshire, Vermont) complied with the recommended ratios. A few states (i.e., Colorado, Illinois, Kentucky, Minnesota, Montana) recommended that state districts follow the ASCA 250:1 recommendation, but it was not a requirement; those state ratios exceeded 250:1.
Next, we examined overall trends of compliance by grade level and by state. For K–8, eight states (15.69%) had higher scores of ASCA National Model (2019) compliance (i.e., Arkansas, Maine, Nevada, New Hampshire, Oregon, Pennsylvania, West Virginia, Wisconsin) compared to other states in our dataset with a score of 8 out of 9. For 9–12, six states (11.76%) scored 8 out of 9 (i.e., Arkansas, Maine, New Hampshire, Pennsylvania, West Virginia, Wisconsin). Excluding Hawaii, South Dakota, and Wyoming, because their state policies did not address the requirements of K–8 school counselors, the states with the lowest scores of ASCA National Model compliance, with 1 out of 9 for K–8 were Alabama, Maryland, Missouri, and North Dakota (n = 4, 7.8%). For 9–12 state policy, two states (3.9%)scored 1 out of 9 (i.e., Massachusetts, South Dakota).
Discussion
Given ASCA’s (n.d.-b) advocacy efforts to develop a unified definition of school counseling, there is a need to assess how those advocacy efforts translate to state policy. Although individual state and district policies shed light on existing discrepancies between school counselor roles and responsibilities, our analysis also provides evidence of alignment with the ASCA National Model (2019) in some areas. These results can inform strategic efforts for further alignment. School counselors can use advocacy to support their role and promote responsibilities more aligned with the ASCA National Model (McConnell et al., 2020). We outline our discussion by again utilizing the four components of the ASCA National Model as a conceptual framework.
Define
Our findings suggest that the Define component of the ASCA National Model (2019) is well-represented in state and district policies. Although our results highlight differences in policy governing practice in K–8 and 9–12 schools, for the most part, all state and district policies required or encouraged the presence of a school counselor. Additionally, the vast majority of states required that individuals practicing as school counselors hold the appropriate licensure and/or certification. Similarly, most state and district policies defined a school counselor’s role as contributing to students’ academic, college/career, and/or social/emotional development. Vigilance in advocacy efforts remains important, as language in policy can change with each legislative session. For example, Texas Senate Bill No. 763 (2023) introduced legislation allowing chaplains to serve in student support roles instead of school counselors. The Lone Star State School Counselor Association (2023) quickly took action with a published brief condemning the language in the bill. As a result of advocacy efforts, lawmakers changed the verbiage in the bill to hire chaplains in addition to school counselors, rather than in lieu of them.
Similarly, Florida’s First Lady, Casey DeSantis (Florida Governor’s Press Office, 2023), announced a shift in counseling services to emphasize resiliency and include resiliency coaches—a role in which “moms, dads, and community members will be able to take training covering counseling standards and resiliency education standards” and provide a “first layer of support to students” (para. 8). Although the Florida School Counselor Association emphasizes advocacy efforts, it has not yet published a response to the changes in Florida’s resilience instruction and support plans (Weatherill, 2023). The legislation in Texas and Florida and the response from state-level school counselor associations highlight, once again, the importance of advocacy for creating and maintaining a uniform definition of school counseling.
Manage
Although ASCA clearly defines appropriate and inappropriate school counseling activities, state policy is less specific on codifying the appropriate use of school counselors’ time and resources. Although most states encouraged appropriate school counseling activities, states did not specifically define appropriate school counseling activities or provide protection around school counselors’ time to implement appropriate school counseling activities. Such findings are consistent with the literature (Bardhoshi & Duncan, 2009; Chandler et al., 2018). Florida’s K–8 policy suggests that school counselors should implement a program that suits the school and department, whereas some states’ K–8 policy, such as New Jersey’s, recommends incorporating the ASCA National Model (2019). Several states include uncodified policy addressing the implementation of a school counseling program. However, as such recommendations are not codified into policy, they do not dictate the day-to-day activities of school counselors. Interestingly, new legislation introducing support roles for chaplains and family/community members only bolsters the need to protect school counselors’ time. Texas Senate Bill No. 763 references the need for support, services, and programming. Florida First Lady Casey DeSantis similarly emphasizes the need for support and mentorship. School counselors are trained professionals equipped to support student outcomes (ASCA, 2019). One wonders whether legislative efforts introducing chaplains and family members would be needed if school counselors’ time was protected in ways to better support students with appropriate school counseling duties. Thus, there remains an opportunity for increased advocacy surrounding the implementation of school counseling programs with specific attention on appropriate versus inappropriate school counseling activities.
Deliver
ASCA suggests that school counselors should spend 80% of their time in direct/indirect services to support student outcomes. Such efforts are pivotal, as research suggests that school counselors play a key role in supporting student outcomes (e.g., Carey & Dimmitt, 2012; O’Connor, 2018). Researchers indicate that school counselors within a comprehensive school counseling program play an integral role in supporting improved student attendance (Carey & Dimmitt, 2012), graduation rates (Hurwitz & Howell, 2014), and academic performance (Carrell & Hoekstra, 2014). However, few states support student outcomes by codifying a school counselor’s use of time into policy. Idaho’s 9–12 policy instructs school counselors to use most of their time on direct services. While not equivalent to ASCA’s 80%, such efforts represent a start to protecting school counselors’ time and ensuring that school counselors are able to make the impact they are well-trained to in their school settings. Similar to Manage, current legislative efforts only highlight the importance of school counselors spending a majority of their time supporting students through direct services.
Assess
ASCA continues to focus their advocacy efforts on student–school counselor ratios with good reason; our findings indicate that 2% of K–8 state and district policies and 3% of 9–12 policies specifically outlined a 250:1 ratio that aligns with ASCA recommendations. Yet, researchers demonstrate that reduced student–counselor ratios support improved student outcomes (Carey et al., 2012; Carrell & Carrell, 2006; Goodman-Scott et al., 2018; Lapan et al., 2012). Further, minoritized students and their communities often face the negative consequences of increased student–counselor ratios (Donohue et al., 2022). As such, further advocacy around student–school counselor ratios is also needed from an equity perspective. Some states, such as Colorado, Illinois, Kentucky, and Montana, recommended ASCA ratios, but as is the case with appropriate versus inappropriate school counseling activities, without policy “teeth” to enforce recommendations, school counselors are often continuing to practice in settings that far exceed ASCA ratios, as is consistent with recent findings (NCES, 2023).
Although many states did not codify policies aligned with the ASCA National Model (2019), several states (North Dakota, New Jersey, Delaware) made reference to the ASCA National Model and recommended alignment. Our analysis supports previous research indicating that advocacy works (Cigrand et al., 2015; Havlik et al., 2019; Holman et al., 2019; McConnell et al., 2020; Perry et al., 2020). Our findings also highlight the value of supporting professional identity through membership in both national organizations and state-level advocacy groups.
Implications
We explored implications for school counselor educators, school counselors, and school counseling advocates. School counselor educators must prepare future school counselors for their roles as advocates. Counselor educators also play an important role in equipping future school counselors with an understanding of the landscape of the profession (McMahon et al., 2009). As such, including state-level policy and district-level conversations in curriculum helps connect counseling students with the evolving policies guiding their work. The rubric created for this research offers a valuable tool to explore state and school district alignment with the ASCA National Model (2019) and demonstrate areas to focus advocacy efforts. Counseling programs often participate in advocacy efforts, such as Hill Day. School counselor educators can use state-level and district-level policy as a springboard to promote specific advocacy efforts with state and local legislation. On a local level, school counselor educators can use our rubric to frame practice conversations for future school counselors to prepare for future conversations with school principals. Finally, school counselor educators can continue engaging in policy-level research to support ongoing school counseling advocacy. School counselor educators can further illuminate the impacts of school counseling policy by describing perspectives of practicing school counselors. School counselor educators can also engage in quantitative research methods to study the relationships between school counselor satisfaction and state policy adherence to the ASCA National Model (2019).
School counselors can use our rubric to analyze alignment of school districts when examining job descriptions during their job searches. School counselors could also use the rubric as part of the evaluation component of a comprehensive school counseling program. From our analysis, it appears most imperative that advocacy efforts focus on school counselors’ use of time and student–counselor ratios. Using data, school counselors can continue to advocate for their role to become more closely aligned to ASCA’s recommendations. Kim et al. (2024) described the “urgent need” (p. 233) for school counselors to engage in outcome research. We hope that our framework provides a tool for school counselors to engage in evaluation and advocacy based on our findings. However, school counselors should not be alone in their advocacy efforts. School counseling advocates, including educational stakeholders, counselors, school counselor educators, and educational policymakers, should continue supporting school counselors by advocating on their behalf at the district, state, and national level.
Future research may focus on the disconnect between state policy and how the districts enact those policies. A content analysis comparing state policy to district rules, regulations, and practices is needed to understand how state policy and district practices align. Finally, although there is frequent legislative advocacy from ASCA, there is a lack of data on state legislators’ knowledge about the ASCA National Model (2019) and ASCA priorities. School counseling researchers can use qualitative methods to interview state legislators, especially after events such as Hill Day, to better detail what legislators understand about the roles and impacts of school counselors.
Limitations
The purpose of content analysis was to discover patterns in large amounts of data through a systematic coding process (Krippendorff, 2019). We are all professional counselors or counselors-in-training with a passion for advocacy. Thus, as with any qualitative work, there is potential for bias in the coding process. Interrater reliability was used to mitigate this risk. There are many factors that impact the practice of school counseling beyond state-level policy. District policies and school leadership vastly impact the ways that state policy is interpreted and enacted in schools. Thus, this content analysis represents only school counseling regulation as described in policy and may not fully represent the day-to-day experiences of school counselors.
Conclusion
Although confusion and role ambiguity muddy the school counseling profession, advocacy efforts and outcome research act as cleansers. By providing a rubric to assess alignment between state policy and the ASCA National Model, we hoped to clarify the current state of school counseling practice and provide a helpful tool for future school counselors, current practitioners, educational leaders, and policymakers.
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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American School Counselor Association. (2023). The role of the school counselor. https://www.schoolcounselor.org/getmedia/ee8b2e1b-d021-4575-982c-c84402cb2cd2/Role-Statement.pdf
Bardhoshi, G., & Duncan, K. (2009). Rural school principals’ perception of the school counselor’s role. The Rural Educator, 30(3), 16–24. https://doi.org/10.35608/ruraled.v30i3.445
Blake, M. K. (2020). Other duties as assigned: The ambiguous role of the high school counselor. Sociology of Education, 93(4), 315–330. https://doi.org/10.1177/0038040720932563
Camelford, K. G., & Ebrahim, C. H. (2017). Factors that affect implementation of a comprehensive school counseling program in secondary schools. Vistas Online, 1–10.
Carey, J., & Dimmitt, C. (2012). School counseling and student outcomes: Summary of six statewide studies. Professional School Counseling, 16(2), 146–153. https://doi.org/10.1177/2156759X0001600204
Carey, J., Harrington, K., Martin, I. M., & Hoffman, D. (2012). A statewide evaluation of the outcomes of the implementation of ASCA National Model school counseling programs in rural and suburban Nebraska high schools. Professional School Counseling, 16(2), 89–99. https://doi.org/10.1177/2156759X0001600203
Carrell, S. E., & Carrell, S. A. (2006). Do lower student to counselor ratios reduce school disciplinary problems? The B.E. Journal of Economic Analysis & Policy, 5(1), 1–24. https://doi.org/10.2202/1538-0645.1463
Carrell, S. E., & Hoekstra, M. (2014). Are school counselors an effective education input? Economics Letters, 125(1), 66–69. https://doi.org/10.1016/j.econlet.2014.07.020
Chandler, J. W., Burnham, J. J., Riechel, M. E. K., Dahir, C. A., Stone, C. B., Oliver, D. F., Davis, A. P., & Bledsoe, K. G. (2018). Assessing the counseling and non-counseling roles of school counselors. Journal of School Counseling, 16(7), n7. https://files.eric.ed.gov/fulltext/EJ1182095.pdf
Cigrand, D. L., Havlik, S. G., Malott, K. M., & Jones, S. G. (2015). School counselors united in professional advocacy: A systems model. Journal of School Counseling, 13(8), n8. https://files.eric.ed.gov/fulltext/EJ1066331.pdf
Donohue, P., Parzych, J. L., Chiu, M. M., Goldberg, K., & Nguyen, K. (2022). The impacts of school counselor ratios on student outcomes: A multistate study. Professional School Counseling, 26(1). https://doi.org/10.1177/2156759X221137283
Education Trust. (2018). Funding gaps: An analysis of school funding equity across the U.S. and within each state.
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Elo, S., Kääriäinen, M., Kanste, O., Pölkki, T., Utriainen, K., & Kyngäs, H. (2014). Qualitative content analysis: A focus on trustworthiness. SAGE Open, 4(1). https://doi.org/10.1177/2158244014522633
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Pyne, J. R. (2011). Comprehensive school counseling programs, job satisfaction, and the ASCA National Model. Professional School Counseling, 15(2). https://doi.org/10.1177/2156759X1101500202
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Appendix A
Breakdown of State Rubric Scores for ASCA Alignment for K–8 Schools
|
Define
(5 points)
|
Manage
(1 point) |
Deliver
(1 point) |
Assess
(2 points) |
State Score
(9 points) |
|
Required
(1 point)
|
Education
(1 point) |
Focus
(3 points) |
Implementation
(1 point) |
Use of Time
(1 point) |
Accountability
(1 point) |
Ratio
(1 point) |
Total |
| AL |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
1 |
| AK |
0 |
1 |
2 |
1 |
0 |
1 |
0 |
5 |
| AZ |
0 |
1 |
3 |
1 |
0 |
1 |
0 |
6 |
| AR |
1 |
1 |
3 |
1 |
1 |
1 |
0 |
8 |
| CA |
1 |
1 |
3 |
1 |
0 |
1 |
0 |
7 |
| CO |
0 |
1 |
3 |
1 |
0 |
1 |
0 |
6 |
| CT |
0 |
1 |
3 |
1 |
1 |
1 |
0 |
7 |
| DE |
1 |
0 |
3 |
0 |
0 |
0 |
0 |
4 |
| DC |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
2 |
| FL |
0 |
1 |
1 |
0 |
0 |
1 |
0 |
3 |
| GA |
1 |
1 |
3 |
1 |
0 |
0 |
0 |
6 |
| HI |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
| ID |
1 |
1 |
3 |
1 |
1 |
0 |
0 |
7 |
| IL |
0 |
1 |
3 |
1 |
1 |
1 |
0 |
7 |
| IN |
1 |
1 |
3 |
1 |
0 |
0 |
0 |
6 |
| IA |
1 |
1 |
3 |
0 |
0 |
0 |
0 |
5 |
| KA |
1 |
0 |
0 |
1 |
0 |
0 |
0 |
2 |
| KY |
1 |
1 |
0 |
1 |
1 |
0 |
0 |
4 |
| LA |
1 |
1 |
3 |
1 |
1 |
0 |
0 |
7 |
| ME |
1 |
1 |
3 |
1 |
1 |
1 |
0 |
8 |
| MD |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
1 |
| MA |
0 |
0 |
3 |
1 |
0 |
0 |
0 |
4 |
| MI |
0 |
1 |
0 |
1 |
0 |
0 |
0 |
2 |
| MN |
0 |
0 |
3 |
1 |
0 |
0 |
0 |
4 |
| MI |
1 |
1 |
3 |
1 |
1 |
0 |
0 |
7 |
| MO |
1 |
0 |
0 |
0 |
0 |
0 |
0 |
1 |
| MT |
1 |
1 |
3 |
1 |
1 |
0 |
0 |
7 |
| NE |
1 |
1 |
0 |
0 |
0 |
1 |
0 |
3 |
| NV |
1 |
1 |
3 |
1 |
1 |
1 |
0 |
8 |
| NH |
1 |
1 |
3 |
1 |
0 |
1 |
1 |
8 |
| NJ |
1 |
0 |
2 |
0 |
0 |
1 |
0 |
4 |
| NM |
1 |
1 |
3 |
1 |
0 |
1 |
0 |
7 |
| NY |
1 |
1 |
3 |
1 |
0 |
1 |
0 |
7 |
| NC |
1 |
1 |
3 |
1 |
1 |
0 |
0 |
7 |
| ND |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
1 |
| OH |
0 |
1 |
0 |
1 |
0 |
1 |
0 |
3 |
| OK |
1 |
1 |
3 |
1 |
0 |
1 |
0 |
7 |
| OR |
1 |
1 |
3 |
1 |
1 |
1 |
0 |
8 |
| PA |
1 |
1 |
3 |
1 |
1 |
1 |
0 |
8 |
| RI |
1 |
1 |
3 |
0 |
0 |
0 |
0 |
5 |
| SC |
1 |
1 |
3 |
0 |
1 |
0 |
0 |
6 |
| SD |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
| TN |
1 |
1 |
3 |
1 |
0 |
0 |
0 |
6 |
| TX |
1 |
1 |
3 |
1 |
0 |
0 |
0 |
6 |
| UT |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
2 |
| VT |
1 |
1 |
3 |
0 |
0 |
0 |
1 |
6 |
| VA |
1 |
1 |
3 |
1 |
1 |
0 |
0 |
7 |
| WA |
1 |
1 |
3 |
1 |
0 |
0 |
0 |
6 |
| WV |
1 |
1 |
3 |
1 |
1 |
1 |
0 |
8 |
| WI |
1 |
1 |
3 |
1 |
1 |
1 |
0 |
8 |
| WY |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
| Total |
37 |
40 |
107 |
34 |
17 |
21 |
2 |
– |
Note. Categories refer to the ASCA National Model (2019).
Appendix B
Breakdown of State Rubric Scores for ASCA Alignment for 9–12 Schools
|
Define
(5 points)
|
Manage
(1 point) |
Deliver
(1 point) |
Assess
(2 points) |
State Score
(9 points) |
|
Required
(1 point)
|
Education
(1 point) |
Focus
(3 points) |
Implementation
(1 point) |
Use of Time
(1 point) |
Accountability
(1 point) |
Ratio
(1 point) |
Total |
| AL |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
2 |
| AK |
0 |
1 |
3 |
1 |
0 |
0 |
0 |
5 |
| AZ |
0 |
1 |
3 |
1 |
0 |
1 |
0 |
6 |
| AR |
1 |
1 |
3 |
1 |
1 |
1 |
0 |
8 |
| CA |
0 |
1 |
3 |
1 |
0 |
1 |
0 |
6 |
| CO |
0 |
1 |
3 |
1 |
0 |
1 |
0 |
6 |
| CT |
1 |
1 |
3 |
1 |
0 |
1 |
0 |
7 |
| DE |
1 |
1 |
3 |
1 |
0 |
1 |
0 |
7 |
| DC |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
2 |
| FL |
1 |
0 |
1 |
1 |
0 |
1 |
0 |
4 |
| GA |
1 |
1 |
3 |
1 |
0 |
1 |
0 |
7 |
| HI |
0 |
1 |
3 |
0 |
0 |
0 |
0 |
4 |
| ID |
1 |
1 |
3 |
1 |
1 |
0 |
0 |
7 |
| IL |
0 |
1 |
3 |
1 |
1 |
1 |
0 |
7 |
| IN |
1 |
1 |
3 |
1 |
0 |
0 |
0 |
6 |
| IA |
1 |
1 |
3 |
1 |
0 |
1 |
0 |
7 |
| KA |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
2 |
| KY |
1 |
1 |
1 |
0 |
0 |
1 |
0 |
4 |
| LA |
1 |
1 |
3 |
1 |
0 |
0 |
0 |
6 |
| ME |
1 |
1 |
3 |
1 |
1 |
1 |
0 |
8 |
| MD |
1 |
1 |
3 |
0 |
0 |
1 |
0 |
6 |
| MA |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
1 |
| MI |
0 |
1 |
3 |
1 |
0 |
1 |
1 |
7 |
| MN |
0 |
1 |
3 |
1 |
0 |
1 |
0 |
6 |
| MI |
1 |
1 |
3 |
1 |
1 |
0 |
0 |
7 |
| MO |
1 |
1 |
3 |
1 |
0 |
1 |
0 |
7 |
| MT |
1 |
1 |
3 |
1 |
0 |
0 |
0 |
6 |
| NE |
1 |
1 |
3 |
1 |
0 |
0 |
0 |
6 |
| NV |
1 |
1 |
3 |
1 |
0 |
1 |
0 |
7 |
| NH |
1 |
1 |
3 |
1 |
0 |
1 |
1 |
8 |
| NJ |
1 |
1 |
3 |
0 |
0 |
0 |
0 |
5 |
| NM |
1 |
1 |
3 |
1 |
0 |
1 |
0 |
7 |
| NY |
1 |
1 |
3 |
1 |
0 |
1 |
0 |
7 |
| NC |
1 |
1 |
0 |
1 |
0 |
1 |
0 |
4 |
| ND |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
2 |
| OH |
0 |
1 |
0 |
0 |
0 |
1 |
0 |
2 |
| OK |
1 |
1 |
3 |
1 |
0 |
1 |
0 |
7 |
| OR |
1 |
1 |
3 |
1 |
0 |
0 |
0 |
6 |
| PA |
1 |
1 |
3 |
1 |
1 |
1 |
0 |
8 |
| RI |
1 |
1 |
3 |
0 |
0 |
0 |
0 |
5 |
| SC |
1 |
1 |
3 |
1 |
0 |
1 |
0 |
7 |
| SD |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
1 |
| TN |
1 |
1 |
3 |
1 |
0 |
1 |
0 |
7 |
| TX |
1 |
1 |
3 |
1 |
0 |
1 |
0 |
7 |
| UT |
1 |
1 |
0 |
0 |
0 |
0 |
0 |
2 |
| VT |
1 |
1 |
3 |
0 |
0 |
0 |
1 |
6 |
| VA |
1 |
1 |
3 |
1 |
1 |
0 |
0 |
7 |
| WA |
1 |
1 |
3 |
1 |
1 |
0 |
0 |
7 |
| WV |
1 |
1 |
3 |
1 |
1 |
1 |
0 |
8 |
| WI |
1 |
1 |
3 |
1 |
1 |
1 |
0 |
8 |
| WY |
1 |
1 |
2 |
0 |
0 |
0 |
0 |
4 |
| Total |
40 |
50 |
121 |
36 |
10 |
29 |
3 |
– |
Note. Categories refer to the ASCA National Model (2019).
Alexandra Frank, PhD, NCC, is an assistant professor at the University of Tennessee at Chattanooga. Amanda C. DeDiego, PhD, NCC, ACS, BC-TMH, LPC, is an associate professor at the University of Wyoming. Isabel C. Farrell, PhD, NCC, LPC, is an associate professor at Wake Forest University. Kirby Jones, MA, LCMHCA, is a licensed counselor at Camel City Counseling. Amanda C. Tracy, MS, NCC, PPC, is a doctoral candidate at the University of Wyoming. Correspondence may be addressed to Alexandra Frank, University of Tennessee at Chattanooga, School of Professional Studies, 651 McCallie Ave, Room 105D, Chattanooga, TN 37403, Alexandra-Frank@utc.edu.
Jul 25, 2025 | Volume 15 - Issue 2
Wendi L. Ferrell, 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, Dr. Barbara Herlihy shared insights from her decades-long commitment to the professionalization of counseling and the evolution of the profession’s ethical standards. Dr. Herlihy’s scholarship and service have had a profound effect on how counseling ethics are taught, applied, and revised to remain relevant in an ever-evolving world. In this interview, she connects counselors’ professional ethical obligations to the advancement of social justice and the internationalization of the profession. We are grateful for Dr. Herlihy’s contributions to our profession and for the wisdom that she shared in this interview.
—J. Richelle Joe, Editor
Barbara Herlihy, PhD, NCC, is Professor Emerita in the counselor education program in the College of Education and Human Development at the University of New Orleans. She is a Fellow of the American Counseling Association and is a recipient of the Chi Sigma Iota Thomas J. Sweeney Professional Leadership Award, the SACES Courtland Lee Social Justice Award, and the ACES Distinguished Mentor Award.
A prolific writer, she is co-author (with Dr. Gerald Corey) of the ACA Ethical Standards Casebook and (with Dr. Theodore Remley) of Ethical, Legal, and Professional Issues in Counseling, and co-editor (with Dr. Cassie Storlie) of Counseling Leaders & Advocates. She has authored or co-authored over 100 journal articles and book chapters, primarily on ethics, social justice, and feminist therapy. She serves as Associate Editor for Ethics for Counseling and Values. She has served twice as Chair of the ACA Ethics Committee, and she currently serves as Chair of the ACA Ethics Appeals Committee. In recent years, she has become passionate about furthering the globalization of the counseling profession and has presented seminars and workshops across the United States and in other countries. She currently serves as Co-Director of Global Issues for the International Institute for the Advancement of Counseling Theory.
1. Can you provide more details about your experience as Chair of the ACA Ethics Appeal Committee? What were your key responsibilities, and how did the committee operate in addressing ethical issues in the counseling profession? What drew you to the field of counseling ethics, and what makes this area so meaningful to you, both personally and professionally?
Looking back, I realize I’ve been engaged consistently with the ACA Code of Ethics in some way for several decades now. I’ve served on the ACA Ethics Committee, the ACA Ethics Appeal Committee, and on Ethics Code Revision task forces; co-authored (first with Larry Golden and then with Gerald Corey) the most recent four editions of the ACA Ethical Standards Casebook; and presented on various ethical issues at numerous professional conferences. With this constant engagement, one might think that I can recite the Code of Ethics from memory. No, not even close! However, I do have a feel for how the Code has evolved over the decades to continue to meet the needs of counselors in a constantly changing and increasingly complex world of practice.
That constant evolution is a major reason why ethics has remained interesting and meaningful to me over the years. Opportunities are constantly being created to ponder new and intriguing ethical dilemmas. I’m routinely challenged to refine how I teach ethics to help students develop finely honed ethical reasoning skills, to research and write about ethical issues as they emerge, and to serve the counseling profession through membership on committees and task forces.
Of all the committees on which I have served, I would say that the ACA Ethics Committee and the Ethics Appeal Committee are the most challenging. Ethics and Ethics Appeals Committee members are charged with reviewing all the evidence provided in a complaint or an appeal and then rendering a judgment. If a counselor is found to be in violation of one or more ethical standards, then the appropriate consequence (which can be anything from a recommendation to change a particular practice to permanent expulsion from ACA) must be chosen and applied. Because counselors are trained to be nonjudgmental and because we gravitate toward forgiveness and compassion rather than imposing punishments, the entire process can be very uncomfortable. In my experience, the ACA members who take on these committee assignments take them very seriously and are keenly aware that their decisions can be consequential. Thankfully, these committees typically have only a very small number of complaints to adjudicate over the course of a year. Formal complaints of ethical violations against counselors are rare, considering the thousands of ACA members who are in practice at any given time, and appeals are even more uncommon. This speaks to the integrity of the practitioners of our profession!
2. Given the current climate, ethical concerns are becoming even more pressing. What are your thoughts on the tension between personal and professional values, and how counselors can uphold ethical standards while respecting cultural diversity and individual client autonomy?
Conflicts between personal and professional values is an issue that jumped into bold relief about 15 years ago as a result of two court cases, Ward v. Wilbanks (2010, 2012) and Keeton v. Augusta State University (2011), in which students were dismissed from their master’s programs in counseling after they refused to counsel clients regarding the clients’ same-sex affectional relationships. The students argued that these relationships were not acceptable according to their religious beliefs. These cases spawned considerable discussion about values conflicts in counseling. Counselor educators grappled with how to best teach students to set aside, or “bracket,” their personal values when entering a counseling session. A body of professional literature developed around managing conflicts between personal and professional values and around the ethical decision-making process when values conflicts exist.
The difficulties associated with counseling clients whose values differ from those of the counselor re-emerged during the run-up to the 2024 presidential election, a time when it seemed that most Americans had such strong political feelings that they found it difficult if not impossible to really hear each other’s viewpoints. Again, counselors struggled when clients expressed views with which the counselors strongly disagreed. Although the specific values-laden issues were different from those that emerged around the students who were dismissed from their training programs, counselors sometimes struggled to set aside their personal values so they could be fully present for their clients. To me, it seems inevitable that in our diverse culture, these issues will continue to emerge. Our work as counselors will be challenged by values conflicts, and I believe we will need to remain vigilant to our own experiences, and work to identify both our explicit and implicit biases so that we can continue to honor and respect our clients without judging their personal value systems. We are a richly diverse society, and as I’ve been saying for many years, multicultural competence and ethical practice go hand in hand—neither one can exist without the other.
3. Given your extensive knowledge and experience in counseling, how do you maintain your motivation and enthusiasm for your work, especially during difficult periods? What aspects of counseling resonate most with you, and are there any particular initiatives or methods that you’re currently excited about?
I have been blessed with the incredibly good fortune of working in what is, for me, the perfect profession. Knowing that as a counselor I may have touched some lives in meaningful ways, and that as a counselor educator I’ve had the privilege of mentoring young professionals who went on to make significant contributions, has been more than enough to maintain my motivation and enthusiasm. Seeking out my own counselor whenever I hit a rough spot on my own personal journey has also sustained me.
Ethics, multicultural competence, social justice, and feminist therapy have been consistent themes throughout my work. At this point in my journey, I am also passionate about the internationalization of counseling. I hope to help find ways to extend helping and healing, whether or not the process is formally called “counseling,” to serve marginalized communities across the globe. I’m also intrigued by the broad spectrum of counseling theory, and how we can connect it more directly to effective practice, particularly with culturally diverse client populations in the United States and internationally.
4. Would you take a moment and share your thoughts on the internationalization of counseling—specifically, how counseling practices are expanding across borders and adapting to different cultural contexts? What are the challenges and benefits of these cross-cultural exchanges, and how does the profession develop effective practice across diverse populations?
One of the exciting projects in which I am currently involved is a “world mapping” initiative, sponsored by the International Institute for the Advancement of Counseling Theory and spearheaded by Dr. Ed Neukrug of Old Dominion University. Along with Dr. Courtland C. Lee, I co-chair the Global Subgroup that is engaged in the mapping project. This year we are exploring South America; our incredible graduate assistant, Kacey Bunting, is presently conducting interviews with leaders who engage in and teach counseling/helping/healing in South American countries. (We refer broadly to “counseling/helping/healing” as many countries don’t have formal counseling professions.) As we analyze Kacey’s interviews, we hope to learn about approaches that are unique to these countries and the extent to which and how Euro-American theories and practices are being adapted. We’re eager to see what we can learn about mental health and the helping process in other countries. Of course, many challenges exist, including language barriers and lack of contact information that would enable us to identify and connect with key people. However, the anticipated benefits far outweigh the challenges. In addition to helping counselors and counseling students improve their “global citizenship,” an attribute that Dr. Lee has emphasized in his writings, this project should provide us with a wealth of information that can be used to improve our counseling practices here in the United States, particularly with culturally diverse clients.
5. How have you seen the counseling profession evolve over the years? What changes, either positive or negative, have you observed?
Over my several decades as a counselor and counselor educator, I have witnessed incredible changes in our profession. I think these changes are reflected in the ways that the ACA Code of Ethics has evolved since it was first published in 1961. The original contained no section on technology, of course, but it also made no mention of diversity or multicultural competence. Early versions made what seem now to be rather simplistic statements like “dual relationships should be avoided.” Over the years, the code has been revised periodically to reflect a constantly changing and increasingly complex world of practice.
Overall, I think the most significant change in a positive direction has been the increased professionalization of counseling. Hard-won battles have resulted in the achievement of counselor licensure in all 50 states, the establishment of training standards, and the inclusion of counselors in diverse work settings like the military, inpatient and outpatient mental health facilities, and business and industry.
6. Looking ahead, what do you envision for the future of counseling, and what do you see as potential challenges or boundaries that might delay progress or limit growth in the profession? How do your relationships with counseling associations and organizations influence or shape the evolution of your practice, and do you see any potential challenges or support coming from these affiliations?
The counseling profession in the United States is, inevitably, a microcosm of our society. I am concerned that relationships among our professional associations seem to be divisive in some ways, and that right now our profession does not seem to speak with one voice to our public. My hope is that we will be able to focus on our common purpose and use our united voice to help ensure that social justice issues have a prominent position in our politics, our lives, and our work. Professional associations such as ACA and NBCC have been instrumental in my own professional development, and they continue to be a source of support. I am honored to have had opportunities to give back, in small measure, what I have received, through service to professional associations. If I may end with a word to early-career counselors and counselor educators—those service opportunities exist for you, as well. I hope you will get involved!
This concludes the 10th interview for the annual Lifetime Achievement in Counseling Series. TPC is grateful to Wendi L. Ferrell, Joshua D. Smith, and Neal D. Gray for providing this interview. Wendi L. Ferrell is a graduate candidate at the University of Mount Olive. Joshua D. Smith, PhD, NCC, LCMHC, is an assistant professor at the University of Mount Olive. Neal D. Gray, PhD, LCMHC-S, is a professor at Lenoir-Rhyne University. Correspondence can be emailed to Joshua Smith at jsmith@umo.edu.
Mar 18, 2025 | Volume 15 - Issue 1
Michael Jones, Stacey Diane Arañez Litam, Latoya Haynes-Thoby
This special issue of The Professional Counselor (TPC) honors the NBCC Foundation’s 2024 Bridging the Gap Symposium: Eliminating Mental Health Disparities. The theme for the symposium emphasized the need for a shift from simply acknowledging disparities to actively working toward equitable mental health care for historically underserved populations. The symposium provided a space for counselors, educators, and advocates to engage in discussions on how to dismantle systemic barriers that disproportionately affect Black, Indigenous, and people of color (BIPOC); lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual identities (LGBTQIA+) individuals; and other marginalized groups. The selected articles in this issue reflect this ongoing effort by offering research, critical perspectives, and strategies for fostering more inclusive counseling practices.
The articles in this issue address the complexities of eliminating mental health disparities by examining issues related to mental health care access, strengthening cultural competence, and the importance of integrating social justice frameworks into counseling practice. Each article brings a unique perspective, yet they collectively emphasize the need for action to challenge outdated models and create meaningful change. The contributions in this issue reinforce the responsibility of mental health professionals to engage in advocacy, ensure culturally responsive care, and elevate the voices of those who have historically been excluded from mainstream mental health discourse.
The first article, “The Power of Decolonizing Research Practices,” by Pham, Perry-Wilson, Holmes, Schroeder, Reyes, and Pollok, focuses on the role of decolonized research methodologies in advancing mental health equity. Traditional research practices have historically marginalized non-White communities by reinforcing Eurocentric perspectives and deficit-based narratives. This article highlights the use of photovoice methodology to amplify the experiences of queer womxn of color (QWoC), shifting the focus from pathology to resilience and community-driven healing. The authors argue that by engaging in decolonized research approaches, scholars and practitioners can challenge oppressive structures within academia and mental health care. The article serves as a call to action for counselors and researchers to adopt ethical, culturally affirming scholarship that prioritizes community engagement and self-determination.
“Applying the Multicultural and Social Justice Counseling Competencies to Eating Disorder Treatment,” by Labarta, Demezier, and Vazquez, challenges the widely held misconception that eating disorders primarily affect White, affluent individuals. This stereotype has contributed to treatment models that often overlook the diverse racial, socioeconomic, and gender identities of those experiencing eating disorders. The authors apply the Multicultural and Social Justice Counseling Competencies (MSJCC) to demonstrate how counselors can challenge biases and implement culturally affirming interventions to address disparities in eating disorder diagnosis and treatment. Through case vignettes, the article illustrates practical applications for creating more inclusive approaches to care and highlights the responsibility of counselors, educators, and supervisors to actively engage in advocacy efforts that promote equitable treatment for all individuals affected by eating disorders.
In the third article, “Operationalizing Microaffirmations for Queer and Transgender People of Color,” Paul, Isadore, Ravi, Lewis, Qisti, Hietpas, Hermanson, and Su examine the role of microaffirmations in reducing the mental health disparities experienced by queer and transgender people of color (QTPOC). Discrimination and systemic oppression continue to impact QTPOC individuals at higher rates, contributing to increased mental health concerns such as depression, anxiety, and suicidal ideation. This article explores how microaffirmations—small but meaningful acts of validation and support—can serve as protective factors, fostering a greater sense of belonging and emotional well-being. The study offers practical guidance for integrating affirming practices into counseling settings at both the individual and systemic levels. By emphasizing the importance of intentional, identity-affirming interactions, this article underscores how counselors can create safer and more inclusive spaces for QTPOC clients.
“‘You Good, Bruh?’: An Exploration of Socially Constructed Barriers to Counseling for Millennial Black Men,” by Cofield, highlights the ongoing challenges Black men face when seeking mental health support. Although there has been a growing awareness of the mental health issues faced within the Black community, millennial Black men remain one of the most underserved groups in counseling. Using critical race theory (CRT), Black critical theory (BlackCrit), and Black masculinity theory, this study identifies three major barriers to counseling engagement: Black masculine fragility, racial distrust, and invisibility. The findings reveal how cultural norms surrounding masculinity, experiences of racial trauma, and systemic biases within mental health services deter Black men from seeking counseling. The article calls for a shift in the field of mental health to better engage and retain Black male clients by implementing culturally responsive strategies, promoting representation, and addressing the deep-rooted historical and societal factors that contribute to counseling avoidance.
The final article, “Shifting Paradigms: Exploring Multicultural Approaches to Psychedelic-Assisted Therapy in Counseling,” by Prioleau and Panjwani, examines the emergence of psychedelic-assisted therapy (PAT) through a multicultural and social justice lens. Although PAT has gained recognition as a promising intervention for various mental health concerns, BIPOC communities remain largely underrepresented in research and clinical practice. The article critiques the Eurocentric framing of psychedelics in Western medicine and highlights the longstanding history of plant medicine within Indigenous healing traditions. By acknowledging the systemic barriers that prevent equitable access to PAT, the authors explore ways to integrate cultural competence, ethical frameworks, and advocacy into psychedelic therapy training and implementation. The article also discusses issues such as cultural appropriation, disparities in research participation, and the need for more inclusive clinical approaches that respect traditional healing practices.
Together, these articles reflect a collective effort to eliminate mental health disparities by addressing critical issues related to access, representation, and culturally responsive care. Each contribution challenges traditional paradigms and offers actionable steps for creating more inclusive and equitable mental health services. The theme of eliminating mental health disparities is not just an abstract ideal; it is a necessary call to action that requires sustained commitment from the counseling profession.
As counselors, counselor educators, and researchers, we must move beyond awareness and take intentional steps toward dismantling systemic barriers that prevent marginalized communities from receiving the mental health support they need. This means integrating social justice frameworks into clinical practice, expanding research methodologies to center diverse perspectives, and advocating for policies that promote accessibility and inclusivity in mental health care. It also requires a willingness to engage in critical self-reflection, challenge biases, and amplify the voices of those who have been historically excluded from conversations about mental health.
As you engage with this special issue, we encourage you to consider how these perspectives can inform your work. How can you integrate the insights from these articles into your own practice, teaching, or advocacy efforts? What steps can you take to ensure that your work actively contributes to the elimination of mental health disparities rather than simply acknowledging their existence? Our hope is that this collection of articles serves as both an educational resource and an inspiration for continued action toward equity in mental health counseling.
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Michael Jones (he/him), PhD, NCC, BC-TMH, LPC-S, is a counselor educator, clinician, and author specializing in clinical supervision and multicultural counseling. Dr. Jones is committed to training ethical and culturally competent counselors and integrating innovative instructional methods, including AI, into graduate education. His research and professional interests include telehealth, Black male mental health, and assessing the effectiveness of clinical supervisors. Dr. Jones has trained over 9,000 clinicians in telemental health, published extensively, and presented at national and international conferences. He is a co-editor of the upcoming book Mental Health and the Black Man: A Mixtape Experience of Hardship and Harmony and is actively involved in professional service, including serving on ethics committees and advisory councils. Dr. Jones was a 2013 NBCC Doctoral Minority Fellowship Program recipient and a member of the Dream Team cohort.
Stacey Diane Arañez Litam (she/her/siya), PhD, NCC, CCMHC, LPCC-S, is an associate professor of counselor education at Cleveland State University, racial equity strategist, and licensed professional clinical counselor and supervisor, as well as a diplomate and clinical sexologist with the American Board of Sexology. Dr. Litam is a member of the Forbes Health Advisory Board, the Advisory Council Chair for the National Board for Certified Counselors (NBCC) Minority Fellowship Program, and a 2023 recipient of Crain’s Cleveland 40 Under 40. Dr. Litam’s work has been featured in the White House, the Substance Abuse and Mental Health Services Administration (SAMHSA), Forbes Health, National Public Radio (NPR), Discovery Magazine, Dutch BBC, Psychology Today, National Institutes of Health, Mental Health Academy, The Daily Mail, and The Filipino Channel, as well as in podcasts, documentaries, and news outlets. She has contributed to over 50 academic publications, and her book, Patterns That Remain: A Guide to Healing for Asian Children of Immigrants, combines research, storytelling, and history to provide a practical framework to heal diasporic wounds, break intergenerational trauma patterns, and strengthen relationships.
Latoya Haynes-Thoby (she/her), PhD, NCC, ACS, LPC, is an assistant professor in the Neag School of Education at the University of Connecticut. Her work explores the benefits of culturally responsive and trauma-informed care that promotes resilience and thriving, especially for marginalized children, adults, families, and communities. Using a critical lens, her research focuses on issues such as individual and community healing from trauma, trauma resilience, and trauma-informed counseling and supervision. Dr. Haynes-Thoby is passionate about counselor training and the operationalization of practices that promote thriving after trauma. She recently co-edited a counselor training textbook, Foundations in Becoming a Professional Counselor: Advocacy, Social Justice, and Intersectionality. Dr. Haynes-Thoby is both a 2015 Master’s Minority Fellow and a 2018 Doctoral Minority Fellow with the NBCC Foundation’s Minority Fellowship Program.
Mar 18, 2025 | Volume 15 - Issue 1
Jessi Pham, Tiffany Perry-Wilson, Kevlyn Holmes, Grace Schroeder, Ana Reyes, Michelle Pollok
Decolonial research helps us move away from extractive research methodologies that maintain the wounded subject position and legitimize oppressive practices. Additionally, decolonial research challenges dominant Eurocentric paradigms that have historically shaped the counseling profession. Thus, we offer this article to demonstrate an approach to decolonizing research practices. This article discusses (a) the limits of traditional research approaches, (b) a demonstration of decolonized research methods in action, and (c) considerations for counselor educators and researchers. In alignment with our goal of shifting the research paradigm away from dominant and often oppressive practices, we use a collective and relatable voice that speaks to both our personal identities and our unity as a team working toward the decolonialization of academic research.
Keywords: decolonizing research, research paradigm, oppressive practices, wounded subject position, counselor educators
Research, particularly within the counseling profession, has historically perpetuated oppressive structures, contributing to the pathologization and marginalization of non-White communities (American Psychological Association [APA], 2021; Singh et al., 2021). Traditional research methodologies often reinforce these power imbalances, reducing marginalized individuals to their experiences of trauma and oppression. In response, there is a growing movement toward decolonial and liberatory research practices that aim to center the voices and experiences of marginalized communities, fostering empowerment and healing (Goodman et al., 2015; Neville et al., 2024; Shin, 2016).
As an example of this, we presented and discussed a photovoice exhibit at the 2024 National Board for Certified Counselors Foundation (NBCCF) Bridging the Gap Symposium, which sought to share the healing experiences of nine queer womxn of color (QWoC). Grounded in intersectionality theory and photovoice methodology, our presentation aimed to highlight the strengths and resilience of QWoC, moving away from deficit-based narratives. This article will discuss the background of our decolonial research approach, the overview and positionality statements of our presentation, the reflections of presenters and attendees, and important considerations for counselor educators and researchers committed to decolonizing their practices.
History of Harm Caused by Research
Mental health research has, directly and indirectly, contributed to hegemonic science, harming marginalized communities by pathologizing anything that has strayed from White, Eurocentric standards (APA, 2021; Singh et al., 2021). Examples of this pathologizing range from the inclusion of homosexuality as a mental disorder in the first edition of the Diagnostic and Statistical Manual of Mental Disorders to the fictitious diagnosis of drapteomania, a type of “mania” that drove enslaved persons to run from their oppressors (Auguste et al., 2023; Ginicola et al., 2017). Mental health professionals used psychological research to support the segregation of Black, Indigenous, and people of color (BIPOC) and the “civilizing programs” that attempted to eradicate Indigenous people’s culture (APA, 2021; Auguste et al., 2023). The mental health field continues to use psychological assessments formulated by and for White cisgender heterosexual men, which in turn contributes to the pathologization and oppression of BIPOC communities and other marginalized groups (Auguste et al., 2023; Lee & Boykins, 2022). All research operates within oppressive structures, some of which include the influences of White supremacy and heterosexism, which impact how we design, conceptualize, analyze, and disseminate research that often informs our clinical and teaching practices (Goodman et al., 2015).
Moving Away From the Wounded Subject Position
Similarly, most of the existing literature on LGBTQ BIPOC solely focuses on the pain and trauma of discrimination and oppression—inadvertently keeping research attendees in the wounded subject position (Brown, 1995). The wounded subject position reduces LGBTQ BIPOC to their experiences of discrimination and oppression. Furthermore, the wounded subject position promotes oppression by reinforcing existing power relations (Hudson & Romanelli, 2020) and deficit-based narratives. Consequently, our work moves away from deficit-based research questions and methodologies that reinforce oppressive and extractive research practices. Our work infuses the work of various Indigenous, anti-racist, anti-oppressive, liberatory, and decolonial scholars (e.g., Audrey Lorde, Dr. Jennifer Mullan, Paulo Freire, Dr. Zuri Tau) to intentionally move away from extractive research methodologies.
Decolonizing Research
Colonization is foundational to many existing research practices that extract from marginalized communities to systemically stratify the value of knowledge based on dominant narratives and structures such as White supremacy. These colonial practices are highlighted by research that benefits from exerting authority and enacting an expert position to extract knowledge from marginalized communities without reciprocity and advocacy (Tau, 2023). Further examples of colonization in research and academia include the use of diagnostic criteria, normality, and baseline behaviors informed by White cisgender heterosexual men to pathologize BIPOC communities; there is also the issue of the predominance of Whiteness in academic spaces, including editorial staff in publication journals (Mullan, 2023). Research and academia also play a role in maintaining colonial and oppressive structures by legitimizing oppressive practices under the guise of various savior narratives (Smith, 2021).
A decolonized research approach may include many practices and values, such as critical reflexivity, dialogue, and catalytic validity (Lather, 1986). One example of critical reflexivity is writing a positionality statement, which involves critical reflection on the various domains of our lives in which we have or lack privilege. Dialogue includes conversing on how our identities impact our work and interactions with community members; in doing so, researchers recognize the power dynamic between researcher and co-researcher and try to centralize consent, mutuality, autonomy, respect, care, and relationships. Additionally, catalytic validity refers to the degree to which collaboration with community members energizes, revitalizes, and fosters the development of critical consciousness. This sociopolitical concept involves the ability to identify and analyze oppressive social, economic, and political forces, and to take action to address them (Freire, 1972; Lather, 1986). By emphasizing catalytic validity, researchers are held accountable to the underlying goals of decolonial and liberatory work.
Further examples of decolonial practices in research include advocacy, power sharing, and rituals (Keikelame & Swartz, 2019; Reyes et al., 2024; Zavala, 2013). Research has the potential to serve as a platform to elevate advocacy and support existing grassroots efforts, creating spaces for and by the community (Zavala, 2013). Researchers can also share their findings with stakeholders and others with the power to make systemic changes to create more equitable conditions for marginalized communities. Researchers who intend to work with marginalized communities must also examine the power differentials between researchers and the populations they hope to learn from. Power sharing is an important practice in decolonial research, in which researchers involve community members in various points of the research process and continually consult and check for their consent while encouraging and honoring autonomy (Keikelame & Swartz, 2019). Decolonial research and advocacy efforts can often be very draining; thus, Reyes et al. (2024) recommend engaging in rituals to remain attuned and grounded and to help connect to material more deeply.
The Liberatory Research Collective
We are an innovative and collaborative research collective, dedicated to pushing the bounds of traditional research methodologies by advancing liberatory, anti-oppressive, and decolonial research in the counseling profession. We started as a university research lab, but chose to honor our growth as a collective of folks dedicated to decolonial and anti-oppressive work by operating independently of any institution that might uphold or be influenced by oppressive and colonial structures. We evolved into the Liberatory Research Collective, comprised of scholars, educators, counselors, and community members from across the country. We aim to co-create a space where anyone interested in research, particularly with marginalized communities, can develop the skills needed to engage in transformative and decolonial research. We challenge the status quo and ask critical questions like: 1) Who has the power to design and conduct research? 2) Who are the researchers? and 3) What qualifies them to engage with marginalized and targeted communities?
Demonstration of Decolonized Research Methods in Action
Our dedication to decolonizing the counseling profession through clinical and research practices is a profound testament to our integrity and purpose. It is a beacon of hope and inspiration, demonstrating how research can be a powerful tool for healing and resistance. One notable example of our impact was a photovoice exhibit, “Through Our Lens: Queer Womxn of Color’s Experiences of Healing and Liberation,” which we curated and hosted in honor of National Coming Out Day (October 11, 2023). This exhibit was part of a photovoice project where we partnered with nine QWoC to explore and celebrate their experiences of healing inside and outside of counseling. The exhibit highlighted and celebrated the diverse ways in which QWoC find healing and resist dominant narratives, both within and beyond the realm of counseling, through the lens of QWoC who beautifully captured their personal stories of resilience and healing, illustrating a narrative often overlooked—a narrative that celebrates their strength and wisdom. We believe this exhibition touched the hearts of all 169 guests and broadened our collective understanding and appreciation for the experiences of QWoC.
This exhibit is an example of our work as researchers committed to pushing the bounds of traditional research methods that have historically oppressed, weaponized, and erased the experiences of marginalized communities. Our work is our love letter to all marginalized communities and an invitation for counselors and counselor educators to practice decolonial and liberatory approaches.
Photovoice Methodology
Photovoice, introduced by Wang and Burris (1997) and grounded in critical consciousness, feminist theory, and documentary photography, extends Paulo Freire’s (1972) notion that visual images can foster critical community reflection. The objectives of photovoice are to showcase the strengths and concerns of marginalized communities, stimulate dialogue about community issues and strength through group discussions of photographs, and spur engagement in advocacy by reaching policymakers and other key stakeholders (Wang & Burris, 1997). Photovoice invites marginalized groups to articulate their perspectives through photography, fostering autonomy and enabling self-advocacy for political and social reforms that address their communal priorities.
Following this philosophy, our research collective advocates for collaborative partnerships with co-researchers to define and address salient identities and issues affecting them. The term “co-researcher” is used here as an indicator for the individuals or community members who are conducting the research with us. The use of this term is a liberatory and decolonial approach, where the power is held not solely by the researcher but also by the community. We continue to define and redefine the terms queer and womxn of color to connect varying perspectives of these terms that are central to our work. Queer is a term with a harmful history that many within the LGBTQIA2S+ community have reclaimed to define someone who lives outside the margins of the socially constructed confines of romantic, sexual, and gender identity, as well as gender expression (The LGBTQ Community Center of the Desert, n.d.). Some members of the LGBTQIA2S+ community also use the term queer as a political stance. Womxn of color refers to people of the global majority who identify with the socially constructed womxn identity; the “e” in “women” is replaced by an “x” to include transgender, genderqueer, non-binary, genderfluid, gender non-conforming, and/or gender expansive people (Kendall, 2008; McConnell et al., 2016).
Through Our Lens Photovoice Project
In June 2023, we started recruitment for the photovoice project to find between eight and 15 self-identified QWoC who were willing to actively participate in this project by 1) meeting with researchers to build rapport, discuss their participation in the project, and obtain verbal consent; 2) taking between eight and 15 pictures that represent their experience(s) of healing inside and outside of counseling as a QWoC; 3) completing the Photovoice Reflection Form and Interview Reflection Form, and participating in three meetings (two of which were required and a third which was optional if they were interested in providing researchers with additional feedback); and 4) actively identifying and listing ways to take action and/or advocate and support with the exploration of how we shared the research findings.
2024 Bridging the Gap Symposium Presentation Overview
Our presentation at the 2024 Bridging the Gap Symposium, titled “Through Our Lens: Exhibiting Decolonized Research and Clinical Practice in Action,” was created as a means to bring our photovoice exhibit to the 2024 NBCCF Symposium while allowing attendees to explore the healing practices of QWoC inside and outside of counseling from a decolonial perspective. By encouraging attendees to explore the experiences of QWoC in our exhibit, we hoped to shed light on how taking a decolonized and liberatory approach to research fosters healing and empowerment for BIPOC co-researchers and researchers. This presentation was intended to showcase the transformative power of decolonized research and provide tangible insights for integrating these practices into counseling. Attendees had the opportunity to engage in a gallery experience and discussions surrounding decolonized research and positionality, as well as how insights gleaned from our partnership with QWoC can be applied to counseling and research practices.
Our Rationale
Traditional counseling methods often fail to address the unique tapestry of cultural, societal, and personal challenges faced by BIPOC individuals, particularly QWoC (Reyes et al., 2022). By integrating a decolonial framework, counselors can create more inclusive and effective healing environments. Our presentation explored various strategies used by QWoC to navigate their healing journeys, emphasizing the importance of cultural sensitivity, community support, and personal empowerment.
Preparing for Our Presentation
In preparation for our presentation, our group met in one of our hotel rooms to assemble easels while reflecting on our salient identities, emotions, concerns, and hopes for the session. During this meeting, we practiced our positionality statements and reflected deeply on what it meant to present the healing experiences of nine QWoC when members of our research team had insider and outsider identities related to the QWoC label. We discussed what it meant for some of our White and cisgender male identities to influence the presentation material and potentially impact presentation attendees. For example, my (sixth author Michelle Pollok) reflective process included dialogue with my colleagues on what our privileges mean and how they can serve or harm the communities we work with. Much of this dialogue focused on the process of being a vessel for QWoC to share their creative methods, showcasing their experiences of healing. For me, this was a crucial piece of this project, as I was cognizant of speaking for, or over, our co-researchers, knowing that I do not understand their experience as BIPOC. I spoke with my colleague (fourth author Grace Schroeder) about our Whiteness in relation to this project and our goals of de-centering it while also sharing our queer identities with our co-researchers and reflecting on what that connection means to us.
We also took the time to acknowledge and explore our insider (shared) identities, some of which are Queer, womxn, and BIPOC, through positionality statements, identity work, and dialogue. For example, I (second author Tiffany Perry-Wilson) consist of multiple minoritized, intersecting identities, such as being a Queer cis-woman within the African Diaspora. I share commonalities with our co-researchers who identify as QWoC themselves, but it is important for me to keep in mind that we are not a monolithic group; we are a beautiful mix of diverse beings. This shared identity is undeniable, but our interpretations or the meaning that we provide to our experiences will forever be uniquely ours as individuals. Maintaining this awareness was part of my reflective process to be sure that my understanding did not override the experiences of our co-researchers.
Our conversation also included how our areas of mixed privilege intersect with our work. Although I (first author Jessi Pham) may share identities such as bisexual and Asian American, I often reflect on how my cisgender male identity impacts my interpretation and influence on our work. I question what it means for a cisgender man to present material created alongside QWoC and find it important to draw from shared commonalities while acknowledging when my privilege may stand in the way. I recognize that even with shared and unshared identities, there are experiences that I can only hope to understand through listening and empathy. As my colleagues state above, the identities I share in common with co-researchers are not monoliths, and I am also merely a vessel through which we share our collective and unique experiences.
Additionally, from a mentoring standpoint, I (fifth author and faculty lead Ana Reyes) encouraged us to explore and release colonial and White supremacist ideals regarding how we should “present as professionals” by asking how and from whom we learned to present and how to dress for “conferences, symposiums, or professional events.” The invitation to release internalized colonial and White supremacist ideals empowered us to present in a way that felt authentic to who we are and the co-researchers whose stories and wisdom we were sharing. We stressed the importance of taking a non-expert role, emphasizing that we are merely the vessels of knowledge and information shared by co-researchers.
Materials Used
Our presentation materials consisted of several poster boards and easels set up in various areas around the room. Each poster board displayed a physical print of a co-researcher’s name, photo, caption, title, and image description. Other materials included pride flag stickers, mini bubble wands, letter-writing materials and envelopes, various crystals and stones, and burlap sacks for attendees to create and take home a blend of herbs with myriad healing properties, including lavender, rose, rosemary, and eucalyptus.
Our Symposium Presentation
We began our session by sharing our positionality statements, broaching our intersecting identities, and centering our relationships with ourselves, each other, and as presenters in academia. We engaged in dialogue with attendees regarding our intentions as researchers, the presence of Whiteness in decolonized research, and our varying queer identities. Opening our presentation with positionality statements allowed us to set the tone for a conversational presentation style that encouraged people in the room to voice their thoughts, experiences, and takeaways.
Moving further into our session, we presented a set of slides to discuss the origins and rationale of photovoice methodology, provide an overview of our study, share the definitions of various key constructs, and give our recommendations for decolonizing counseling research and practices with QWoC. Although the slides served as a guide for our presentation, the core of our session derived from attendees’ feedback, reflections, and observations. Attendees were given time to explore the exhibit and engage with the poster boards thoughtfully and intentionally. We then opened the floor for further reflections and observations connected to their experience engaging with the exhibit. Overall, attendees discussed their feelings, connections, and impressions of the photos that resonated with them. The debrief also included feedback on our process and approach to research, with many attendees expressing their excitement about decolonized research in action.
Our Positionality
Because of the nature of how our identities interact with our work, we decided to start our presentation with positionality statements to demonstrate our reflexive process. Having attended presentations at other conferences with introductions very focused on academic and professional achievements, we decided to stray from that structure in hopes of introducing ourselves in a way that felt more authentic, personal, and related to our work. Here are deeply personal positionality statements with which we center our experiences contextualized through our lineal histories and some of the identities that influence our work as researchers, clinicians, and educators.
Jessi Pham. I am a descendant of ancestors who continue to pass down rich cultural values and guidance accompanied by rituals, incense, and offerings. I dedicate my educational privileges to their sacrifices and perseverance. My experiences as a queer/bisexual, second-generation Chinese/Vietnamese cisgender man underscore my research approach.
Tiffany Perry-Wilson. I am a descendant of powerful and resilient peoples stolen from their lands consisting of wealth, melanated skin tones, and storytelling. Their sacrifice then and now is the foundation of my existence. My experiences as a QWoC within the African Diaspora roots and guides my comprehension and approach to research and clinical work.
Kevlyn Holmes. I am descended from people I do not know and because of this, I often feel unmoored. In my journey to connect to the parts of myself that have been lost to White supremacy culture, I’ve found I am making peace with and understanding words such as White, genderqueer, White woman, disabled, and demisexual. These parts and the desire to learn from the harm of my White ancestors drive my work. I strive to listen and honor every story I witness.
Grace Schroeder. I am the descendant of fierce and strong-headed advocates. I am also a mound of clay, shaped by the hands of my colleagues, co-researchers, and the various folx who share their stories and perspectives with me. My experiences as a White queer womxn underscore the need for me to serve as a platform in which I uplift BIPOC, providing context to how I approach my research and counseling theories.
Ana Reyes. I am a descendant of wise ones who, against all odds, survived and passed down their wisdom. My experiences as a queer, non-binary femme and a child of [un]documented immigrants of Afro-Latinx and Indigenous roots underscore my anti-oppressive and decolonial approach to research, counseling, and teaching.
Michelle Pollok. I am a descendant of strong womxn who walked against the grain, paving the path before me and instilling a sense of justice. As a White, cisgender researcher, I serve solely as a vessel for these unique stories of reclamation and healing.
In sharing these individualized positionality statements, we seek to honor the progression of our lineages and how they interact with the colonial and oppressive systems around us. These declarations are not just personal narratives but also critical reflections that guide our work. They illuminate the diverse perspectives and experiences that shape our collective approach, fostering a deeper understanding and commitment to anti-oppressive and decolonial methodologies. Through this practice, we aimed to co-create a space at the 2024 Bridging the Gap Symposium that acknowledged and respected the complexities of our identities, encouraging others to reflect on their own positionalities and the impact these have on their work and interactions.
The Healing Experiences and Responses of Our Attendees
Our attendees shared many insights with us, ranging from their connection with the material to the impact of our session. We are grateful that our intention behind various aspects of our presentation (i.e., introducing ourselves with our positionality statement and then leading with the exhibit) created an environment where attendees were willing to share their thoughts and critiques. One participant shared their hesitation toward attending our presentation on QWoC because the main presenters were White individuals who would be speaking about the experiences of QWoC; after hearing our introductions, they noted feeling more comfortable openly sharing their hesitation because of how we positioned ourselves in this work. This comment reified the importance of our critical reflexivity and our ongoing commitment to exploring how our identities impact our work. Another participant shared their connection to the first author, who introduced himself as a bisexual person—she revealed that, as someone who has experienced biphobia and bi-erasure, she felt seen and validated by the representation of the bisexual identity. Our introductions, one simple (yet powerful) portion of our presentation, impacted the flow of the presentation in a way that highlighted the importance of reflection and identity work in the realm of research, academia, and professional spaces. Coming into this symposium, we intended to build community and encourage collaboration, and by the end of our presentation, we felt very connected to the people in the room with us.
In discussing our presentation, we reflect with profound gratitude on the opportunity to present research we are passionate about with receptive and introspective attendees. Bearing witness to how attendees opened up and engaged with our presentation and research was incredibly rewarding for all of us. The way attendees embraced our decolonial approach and committed to engaging in vulnerable discussions underscored the importance of co-creating spaces where diverse voices are not only heard but celebrated. This experience reaffirmed that community is everything; it is the cornerstone of healing, growth, and social transformation. The interactions and connections formed left us feeling deeply nourished and inspired, reminding us of the transformative power of collective engagement and support.
We were reaffirmed that positioning ourselves authentically helps create a genuine connection with session attendees. The feedback we received highlighted the importance of showing up authentically and continually questioning how we show up in historically White spaces, reinforcing our commitment to decolonial work. Our experience is a testament to the critical role of introspection, camaraderie, and humility in the way we navigate academic, counseling, and healing spaces. There is significant power in showing up as we are and engaging in vulnerable conversations in academic settings such as presentations, knowing that someone in the audience will resonate with our authentic selves. These lessons will guide us in our ongoing journey to foster inclusive and transformative spaces.
Throughout this journey, we experienced a whirlwind of emotions—fright and excitement intertwined as we prepared and presented our work—yet the love and support we provided each other created a foundation of strength and dependability, allowing us to face our fears with courage. The process was filled with joy, gratitude, and excitement, moments of laughter and even tears, as we shared our feelings and experiences, allowing us to connect on a deep level. We were inspired by the courage to challenge existing systems, driven by our shared commitment to decolonial work and the belief that our authentic presence could inspire change. These feelings collectively enriched our experience and solidified our bond as a team. We hope that session attendees left feeling as enriched and nourished as we did and that, as a reader, you are inspired by this article to engage in critical reflection and decolonial practices.
Considerations for Counselor Educators and Researchers
Implementing decolonial practices in research can be challenging because of existing structures and systems that perpetuate colonized, oppressive, and racist ideologies. These norms have inevitably penetrated academia, clinical practice, and research methodologies, making the task daunting (Goodman et al., 2015). However, with commitment, intentionality, and a willingness to alter internalized theoretical and methodological frameworks, counselor educators (CEs) and researchers can integrate decolonial practices into their respective fields. Applying decolonial practices within academia and research involves significant challenges, necessitating unwavering dedication. This practice requires replacing previously used colonized methods, systems, and structures with decolonial ideologies and practices (Castañeda-Sound et al., 2024; Fish & Gone, 2024; Neville et al., 2024; Quinless, 2022; Tate et al., 2016).
Although this process involves de-centering the self and stepping away from traditional pedagogical approaches, CEs and researchers should build self-awareness through critical reflexivity. This lifelong commitment pairs well with the radical decolonization of oneself, academia, and research approaches. Critical reflexivity is a collaborative practice that involves internal work by CEs and participation from students and colleagues. For instance, Goodman et al. (2015) discussed that providing mentorship and supervision to incoming and current CEs assists in fostering a collaborative approach to critical reflexivity or critical consciousness. This could involve weekly and monthly required meetings to provide support and communal engagement in the self-reflective process. Collective commitment to decolonialize shifts from individualism to collectivism, prioritizing community, and holding each CE accountable within their critical reflexivity process.
Critical reflexivity is best done with an intentional approach. Purposeful selection of course materials, construction of syllabi, and application of research methodologies embedded with decolonized approaches, ideologies, and concepts exemplify intentionality (Castañeda-Sound et al., 2024; Fish & Gone, 2024; Goodman et al., 2015; Neville et al., 2024; Quinless, 2022; Tate et al., 2016). Intentional application of critical reflexivity was evident in our collaborative discussions while preparing for our presentation, where we practiced vulnerability by discussing our fears and worries and how our positionalities inevitably influence how we show up in academic spaces. Challenging inherently colonized frameworks requires commitment and intentionality in dismantling oppressive norms perpetuated in the counseling profession.
Counseling and counselor education programs are part of power structures and systems that contribute to continued inequities, oppression, and colonialism (Castañeda-Sound et al., 2024; Goodman et al., 2015; Shin, 2016). Goodman et al. (2015) emphasized the value of decolonizing traditional pedagogies within counselor education by applying tenets of liberation psychology, such as critical consciousness. They discussed how practices like the banking concept perpetuate colonialism in counselor education programs. This concept positions educators as the sole source of knowledge, depositing it into students, thus maintaining power imbalances and stifling independent thinking and questioning. Consequently, students are not empowered and are forced to rely on the professor, with their perspectives viewed as inadequate if they do not align with Westernized frameworks. The banking concept also applies to research settings, where researchers are seen as the sole providers of knowledge and considered experts on the lived experiences of the populations they study, which can be problematic (Goodman et al., 2015) and often supports the continued use of extractive research methodologies.
Cultivating a space of community and shared learning can nourish not only the students and co-researchers but also the CEs and researchers themselves. By approaching education and research with humility and openness to learning without assuming expertise, the likelihood of causing harm to the communities that we serve significantly diminishes.
Conclusion
Our photovoice exhibit and presentation at the 2024 NBCCF Bridging the Gap Symposium provided session attendees and us with a unique platform to share and reflect on the healing experiences of nine QWoC. By utilizing photovoice methodology in our research and grounding our approach in decolonial and liberatory principles, we were able to conduct and present research in a way that represented the diverse narratives of our co-researchers authentically.
Our work moves away from traditional deficit-based research that often reduces minoritized communities to the wounded subject position (Brown, 1995), thus diminishing queer people of color to their experiences of trauma and oppression. Instead, we focus on the strengths, resilience, and healing processes of QWoC. This shift is informed by intersectionality theory, decolonial scholarship, and participatory action research, inviting us to center the voices and experiences of our co-researchers in a meaningful, empathetic, and socially just manner.
Our presentation at the Bridging the Gap Symposium was not just a display of research findings but a call to action for counselors, researchers, and CEs alike to integrate decolonial practices into counseling and academia. Through an interactive gallery experience and open dialogue, we demonstrated how decolonial and liberatory research methodologies can foster empowerment and healing for all involved in the research process, including those who witness or read the findings. The feedback and reflections from attendees brought focus to the importance of co-creating spaces where diverse voices are heard, honored, and celebrated.
Implementing decolonial practices in research and counseling requires a commitment to self-examination, camaraderie, and humility. It involves challenging existing power structures and embracing authentic connections with the communities we interact with as counseling scholars and fellow human beings. As CEs and researchers, we must continually question how our identities and positionalities influence our work and strive to create inclusive, validating, and supportive environments for all. Our experience at the symposium reaffirmed the transformative power of community and collective engagement. The support and courage we found in each other allowed us to face our fears and present our work with pride.
In conclusion, this photovoice project and our subsequent presentation have not only enriched our understanding of healing experiences but also strengthened our resolve to continue engaging in decolonial and liberatory research. We hope that our work inspires others to embrace these methodologies, challenge oppressive systems, and support the healing and empowerment of minoritized communities.
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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Jessi Pham, BA, is a master’s student at California State University, Fullerton. Tiffany Perry-Wilson, MA, NCC, LPC, is a doctoral candidate at George Washington University and a licensed professional counselor at Psychological & Life Skills Associates. Kevlyn Holmes, BS, is a master’s student at California State University, Fullerton. Grace Schroeder, BA, is a master’s student at California State University, Fullerton. Ana Reyes, PhD, NCC, LPC, CHST, is a core faculty member at Antioch University. Michelle Pollok, BA, is a master’s student at California State University, Fullerton. Correspondence may be addressed to Jessi Pham, 800 N. State College Blvd EC-405, Fullerton, CA 92831, jessihp@csu.fullerton.edu.
Appendix
Recommendations for Self-Directed Learning
Counselor educators can familiarize themselves with liberatory, decolonial, participatory, and action-focused research methodologies that intentionally decentralize their role as researchers and encourage students to do the same. We suggest the following resources to support counselor educators on their journey:
Books
- Decolonizing Epistemologies: Latina/o Theology and Philosophy (1st ) by Ada Maria
Isasi-Dias and Eduardo Mendieta
- Decolonizing Methodologies: Research and Indigenous Peoples by Linda Tuhiwai Smith
- Photovoice Research in Education and Beyond: A Practice Guide from Theory to Exhibition
by Amanda O. Latz
- Research is Ceremony: Indigenous Research Methods by Shawn Wilson
- Research as Resistance: Revisiting Critical, Indigenous, and Anti-oppressive Approaches
(2nd ed.) by Leslie Brown
Websites
Mar 18, 2025 | Volume 15 - Issue 1
Adriana C. Labarta, Danna Demezier, Alyssa A. Vazquez
Scholars, practitioners, and clients in the eating disorder (ED) treatment field emphasize the need for more culturally responsive approaches to improve care for marginalized communities. Treatment barriers, such as counselor biases, lack of access to care, and disempowering approaches, perpetuate these gaps across diverse groups with EDs. We propose that Ratts et al.’s (2016) Multicultural and Social Justice Counseling Competencies (MSJCC) can bridge these gaps by assisting counselors and other helping professionals working in ED treatment settings in deconstructing biases and implementing empowering treatment approaches for marginalized individuals with EDs. Using case vignettes, we illustrate how counselors can apply the MSJCC across counseling settings and engage in advocacy with the broader ED recovery community. We conclude by presenting implications for counselors, counselor educators, and supervisors, who all play a role in empowering clients and improving access to ED treatment for diverse populations.
Keywords: eating disorder, multicultural, social justice, marginalized, advocacy
The SWAG myth has long persisted within the eating disorder (ED) treatment field, informing research and practice and centering the experiences of “skinny, White, affluent, girls” (Sonneville & Lipson, 2018). Abundant evidence highlighting the presence and impact of EDs across diverse cultural identities now discredits this stereotype (Halbeisen et al., 2022; Huryk et al., 2021; Schaumberg et al., 2017; Sonneville & Lipson, 2018). Nonetheless, scholars, practitioners, and clients alike point to prevailing gaps impacting minoritized populations with EDs and call for more inclusive, culturally informed practice (Burke et al., 2020; Hartman-Munick et al., 2021; Labarta et al., 2023). The American Counseling Association (ACA; 2014) Code of Ethics preamble highlights the importance of “honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts” (p. 3). Thus, multicultural competence is essential for the counseling profession to continue addressing the needs of culturally diverse clients, including social justice concerns that shape and contextualize mental health and wellness. The purpose of this article is to illuminate EDs as multicultural concerns that require counselors to challenge common, harmful stereotypes about EDs and to move toward more inclusive, culturally responsive treatment frameworks.
Multicultural Concerns Within Eating Disorders
Culturally responsive counseling requires counselors to understand clients’ diverse cultural and social identities as well as their mental health experiences (Ratts et al., 2016). Similarly, awareness of the intersection between EDs and multicultural concerns is imperative to culturally sensitive treatment. We begin with an overview of ED literature on underserved populations with particular attention to various aspects of cultural identity, including race and ethnicity, sexual orientation, gender identity, socioeconomic status and food insecurity, ability status, body size, and religion and spirituality. We conclude with a brief overview of intersectionality and ED literature.
Race and Ethnicity
Although racial and ethnic minorities experience EDs at similar rates as non-Hispanic, White individuals (Marques et al., 2011), there is a lack of ED research using racial and ethnic minority samples (Burke et al., 2020; Egbert et al., 2022; Mikhail & Klump, 2021). For instance, Egbert et al. (2022) discovered that across 377 peer-reviewed manuscripts published between 2000 and 2020 in the International Journal for Eating Disorders, only 45.2% reported demographic information related to participants’ racial/ethnic identity. In studies that reported racial/ethnic demographic data, White participants comprised about 70% of the samples. Greater representation of racial and ethnic minorities in research is imperative in order to gain insight into the etiological and maintaining factors of EDs in diverse communities (Egbert et al., 2022), particularly because counselors may hold biases that contribute to significant disparities in ED diagnosis for people of color compared to White individuals (Sonneville & Lipson, 2018). Thus, researchers underscore the importance of exploring culturally and contextually relevant factors, such as sociocultural factors and acculturative stress (Kalantzis et al., 2023; Talleyrand, 2012; Warren & Akoury, 2020) and adopting therapeutic approaches that are collaborative and culturally sensitive (Acle et al., 2021).
Sexual Orientation
Sexual minority populations experience increased risk for ED pathology and may present with higher ED pathology at admission to ED treatment compared to their cisgender, heterosexual peers (Mensinger et al., 2020). However, a recent systematic review examining ED literature from 2002 to 2022 revealed that ED risk varies across sexual minority groups (O’Flynn et al., 2023). Therefore, studies that combine sexual minority groups into one sample may provide an incomplete understanding of ED patterns across distinct identities (e.g., bisexual, gay, lesbian, pansexual). Counselors and researchers should assess sociocultural factors that influence ED risk (Engeln-Maddox et al., 2011) and minority stress experiences (Mason & Lewis, 2015; Meyer, 2003), as well as protective factors that serve as buffers against ED pathology, such as social support. It is important to move “away from heteronormative frameworks and toward more liberatory ones” (O’Flynn et al., 2023, p. 13). It is essential for counselors to recognize the expansiveness of sexuality and attraction, as well as how clients’ identities and experiences inform ED assessment and treatment approaches.
Gender Identity
EDs impact people across diverse gender identities, including gender expansive and nonbinary individuals, transgender men and women, and cisgender men and women (Hartman-Munick et al., 2021; Nagata et al., 2020). However, because of assumptions surrounding EDs as female disorders, men may delay seeking treatment (Räisänen & Hunt, 2014) and feel like “the odd one out” (Kinnaird et al., 2019, p. 848). Nonbinary and transgender individuals with EDs also experience barriers to receiving inclusive care because of gender-based stereotypes (Hartman-Munick et al., 2021). Therefore, it is important for counselors to consider gender norms, ideals, and expressions (e.g., masculinity, femininity, androgyny) that may influence ED pathology and related body image concerns. For example, although EDs are typically associated with femininity and the thin ideal, research has shown that masculinity and muscularity ideals are also risk factors (Griffiths et al., 2015). Counselors should also avoid gender binary assumptions, as individuals who adhere to androgynous ideals are often overlooked in ED assessment and treatment (Cusack & Galupo, 2021). Gender-affirming ED treatment requires deconstructing traditional female-oriented approaches and considering the varied experiences of gender-diverse individuals.
Socioeconomic Status and Food Insecurity
Another common harmful stereotype is that EDs primarily impact individuals of higher socioeconomic status (SES). A recent systematic review debunked this myth when it illustrated that EDs present across varied socioeconomic backgrounds (Huryk et al., 2021). Given that the cost of ED treatment is a significant barrier to care (Ali et al., 2017), individuals of lower SES may be less likely to seek treatment or may have limited access to specialized treatment (Huryk et al., 2021; Sonneville & Lipson, 2018). Relatedly, emerging research has drawn connections between food insecurity and EDs. Existing ED assessment tools often conceptualize food restriction as driven by weight or shape concerns (Hazzard et al., 2020; Middlemass et al., 2021). Individuals experiencing food insecurity, however, may engage in periodic dietary restriction because of fluctuations in food availability, which can lead to bingeing or overeating when food is more accessible (Rasmusson et al., 2019). Given the importance of addressing nutrition in ED treatment, counselors should broach the topic of food insecurity with clients in order to understand patterns of restriction and availability of food (Hazzard et al., 2020; Middlemass et al., 2021). Overall, scholars recommend that practitioners conceptualize SES as a multidimensional construct (e.g., income, occupation, wealth) during the assessment process to determine clients’ barriers and improve access to resources (Huryk et al., 2021).
Ability Status
Individuals with disabilities are largely underrepresented in ED literature even though they are at increased risk of disordered eating behaviors (Cobbaert & Rose, 2023; Gesi et al., 2017; Nazar et al., 2016). Recent research has shown that autistic individuals experience more negative outcomes and barriers in ED treatment than neurotypical individuals (Babb et al., 2021). Cobbaert and Rose (2023) issued a call to action for ED health care professionals to engage in neurodiversity-affirming practices, specifically by rethinking the implementation and practice of ED treatment, which has historically centered the medical model and neurotypical experiences. Current recommendations include using strengths-based, trauma-informed approaches, challenging ableist expectations and treatments, and centering human rights and autonomy (Cobbaert & Rose, 2023). Research also suggests that individuals with physical disabilities have nuanced experiences with body image, which in turn can impact the development of EDs (Cicmil & Eli, 2014; Gross et al., 2000). For example, individuals may develop EDs as a means to cope with the psychological and social difficulties they experience related to living with a disability and navigating societal body image ideals and pressures (Cicmil & Eli, 2014). Ultimately, more research that examines the intersection of EDs and ability status is needed.
Body Size
People of size, or larger-bodied individuals, often experience barriers to receiving quality care, including weight bias from clinicians and delays in being referred to ED treatment (Harrop et al., 2021; McEntee et al., 2023; Puhl et al., 2014). Because of fear of experiencing weight stigma in health care settings, people of size are less likely to seek treatment for health concerns, including EDs (Mensinger et al., 2018). Counselors may perpetuate weight loss–related treatment recommendations that can negatively impact clients’ long-term well-being (Chen & Gonzales, 2022; Puhl et al., 2014). Although larger-bodied individuals may experience significant psychosocial and medical consequences as a result of an ED, research demonstrates that fewer patients are referred to appropriate treatment because of assumptions of severity based on body size (Harrop et al., 2021). Scholars and advocates recognize the need for more research among this population (Ralph et al., 2022) and recommend increased training in the use of weight-inclusive and fat liberation frameworks when working with larger-bodied clients (Matacin & Simone, 2019; McEntee et al., 2023; Tylka et al., 2014).
Religion and Spirituality
Religion and spirituality are critical sociocultural factors that can influence EDs and their treatment. Research has shown that religion and spirituality can serve positive, negative, or non-significant roles in ED recovery based on the individual’s lived experience (Akrawi et al., 2015; Buser et al., 2014; Richards et al., 2018). For example, Akrawi et al.’s (2015) systematic literature review revealed that a secure relationship with God was linked to decreased levels of disordered eating, while a doubtful or anxious relationship with God correlated with greater levels of disordered eating. Religious and spiritual coping strategies (e.g., prayer, meditation, meaning-making, and connecting with nature) can be protective in ED recovery (Buser et al., 2014; Richards et al., 2018). On the other hand, some individuals experience feelings of shame and guilt related to religious beliefs and bullying from members of their religious communities because of their ED (Richards et al., 2018). Because religion and spirituality are often personal and unique to the individual, Mintert et al. (2020) recommend that counselors explore their complex roles and potential relationship to clients’ presenting concerns and integrate evidence-based interventions affirming diverse religious and spiritual identities.
Intersecting Identities
Intersectionality theory, which originates from Black feminist scholarship, describes how multiple marginalized social identities interact and impact mental health (Crenshaw, 1989). Because individuals with marginalized social identities experience inequities related to their ED presentation, counselors must consider the intersection of such identities in order to address specific concerns that impact underserved clients’ risk, treatment process, and outcomes (Burke et al., 2020; Burke et al., 2023). An intersectional approach considers the impact of one identity on another, including how several identities work to either place individuals at risk or support their resilience (Burke et al., 2023). Although more research is needed on EDs across diverse intersecting identities (Burke et al., 2020), scholars have started to explore intersectionality (Burke et al., 2023; Calzo et al., 2017; Diemer et al., 2015). Overall, the higher rates of EDs in marginalized individuals with intersecting identities imply a need for interventions that consider the inequities faced by these individuals and the impact on their risk for EDs (Burke et al., 2023).
Applying the MSJCC to Eating Disorder Treatment
Across ED literature, scholars have advocated for the development of culturally responsive models to address ongoing treatment disparities. We believe that the Multicultural and Social Justice Counseling Competencies (MSJCC; Ratts et al., 2016) can serve as a powerful framework for counselors and related helping professionals who work with clients with EDs. The MSJCC, centered on the values of multiculturalism and social justice, attend to essential constructs like intersectionality, including privileged and marginalized statuses within the counseling relationship. Four developmental domains outline essential areas for counselors to explore when working with clients with cultural sensitivity: Counselor Self-Awareness, Client Worldview, Counseling Relationship, and Advocacy Interventions. The first three domains are further organized into four aspirational competencies, namely attitudes and beliefs, knowledge, skills, and action. In the sections below, we review brief case vignettes illustrating various presentations of EDs across diverse intersecting identities, the application of the MSJCC across treatment settings, and relevant resources for counselors.
Counselor Self-Awareness
Paul is a 13-year-old Hispanic, cisgender male with autism spectrum disorder (ASD). He is an only child and lives with his parents and paternal grandmother. Paul’s parents have described him as a picky eater throughout his life. He has an aversion to certain smells and/or textures in food and exhibits rigidity around mealtimes. For example, Paul rarely deviates from his comfort foods and often has the same daily meals, such as plain pasta that his mother prepares for lunch. One day at school, Paul realized that he had forgotten his lunchbox. When his teacher offered to assist him with getting food from the cafeteria, Paul became visibly distressed and began to panic. Paul’s teacher was concerned and contacted the school counselor to check in. Mrs. Walker, the school counselor, called Paul into her office and assessed his concerns, discovering his disordered eating behaviors.
Although Mrs. Walker had experience working with students with ASD, she found herself initially dismissing concerns related to his eating behaviors. After further reflection, Mrs. Walker recognized that her own cultural beliefs and biases related to gender were impacting her ability to fully assess his presenting ED symptoms. For example, she noticed that she held the erroneous belief that males don’t struggle with food. She consulted a colleague on next steps, as she did not want to violate any ethical codes or unintentionally harm Paul. Mrs. Walker began adjusting her attitudes and beliefs. She was surprised to find literature on EDs in males and learned about the unique experiences of those with ASD. Mrs. Walker reflected on internalized stereotypes of gender, disability, and mental health. She was challenged to consider Paul’s unique experience as a young Hispanic male with ASD and the cultural implications of ASD and EDs. To do so, she practiced cultural humility and reflected on her own cultural identities and biases and how they shaped her worldview.
Mrs. Walker sought to learn specific information about the intersection of ASD and EDs, such as their common comorbidity and clinical presentations like sensory sensitivities that may lead to food avoidance (Bourne et al., 2022). Mrs. Walker also used various resources to increase her knowledge of the risk factors of EDs in males, recognizing that risk factors often differ in females. She identified a need to take an individualized approach and developed skills to work with Paul through a culturally responsive lens. Specifically, Mrs. Walker implemented a tailored intervention to empower him and his family to connect with community referrals in order to support his recovery.
Mrs. Walker took action to support her work with Paul by sharing her newly attained knowledge about the intersection of disability and EDs. She initiated a campaign in her school to raise awareness of EDs and gender and disability biases, as well as the challenges that individuals with ASD face during their recovery process. These interventions allowed Mrs. Walker to work toward systemic change surrounding stigma on EDs, males, and people with ASD. She shared a list of local and national organizations that specialize in ASD or EDs (specifically, avoidant/restrictive food intake disorder, or ARFID) with Paul and his family to ensure that they had access to therapeutic support. Examples included Different Brains (https://differentbrains.org) for ASD and the National Alliance for Eating Disorders (https://www.allianceforeatingdisorders.com). Mrs. Walker remains in contact with Paul’s community mental health counselor to understand how she can support him within the school setting. After this experience, Mrs. Walker reflected on the importance of developing her own self-awareness as a counselor, which allowed her to challenge her biases and cultivate more meaningful relationships with diverse students.
Client Worldview
Anita is a 19-year-old Black woman. Growing up in a low-income household, she and her family often struggled with food insecurity, leading to a scarcity mindset around food. Despite these challenges, Anita has always had a close, loving relationship with her family. About one year ago, she came out as pansexual to her parents and a few close friends. Although the experience was positive and empowering, Anita worries about her upcoming transition to college, being away from her family and friends, and connecting with other LGBTQ+ students on her campus. During her first semester, she would binge eat when feeling lonely or stressed. This was usually followed by intense feelings of guilt and shame which led to restriction of food. Anita decided to schedule an intake appointment at her college counseling center; she is scheduled to meet with Dalton, a new counselor who started his position this semester.
Dalton’s goal for the intake appointment is to gain a deeper understanding of Anita’s worldview. Although Dalton has experience working with clients with eating concerns in different settings, he has maintained an assumption that EDs primarily occur in affluent, White populations. Dalton recognizes the importance of challenging his attitudes and beliefs about EDs that could negatively interfere with the treatment process. As Anita shared her story, Dalton intentionally bracketed his biases and remained open to learning about her lived experience. After the session, he engaged in reflective practice by processing his reactions with a colleague at the center with expertise in EDs.
Pulling from his knowledge of culturally responsive theories, Dalton identified the role of intersectionality in Anita’s presenting concerns. As a pansexual woman of color raised in a low-income household, Anita’s experiences may be understood by considering her multiple minority identities. Anita faced significant challenges throughout her life (e.g., food insecurity, the coming out process, and recent transition to college), which may have led to an increased risk of developing an ED. Despite these risk factors, Dalton recognized that an intersectional approach also considers Anita’s strengths and protective factors (Chan et al., 2019), such as strong family support and willingness to seek counseling. Dalton used these insights to conceptualize Anita’s concerns and treatment plan from a strengths-based, culturally responsive lens.
Building on his understanding of theory, Dalton reflected on essential skills to help Anita in counseling. Dalton understood that it may take time for Anita to feel comfortable processing her experiences and sharing parts of her identity. Anita may fear rejection or misunderstanding from Dalton, particularly if he has a different upbringing or cultural background. Dalton understood that experiences of oppression can influence clients’ worldviews and experiences, potentially leading to feelings of disconnection. Given Anita’s complex relationship with food throughout her life, bingeing and restriction may have served as coping mechanisms to deal with uncertainty, loneliness, and fear of rejection. Thus, Dalton remained aware of the inherent power dynamic in the counseling relationship and intentionally shared power with Anita as she navigated her healing process (e.g., co-constructing the therapeutic focus and remaining open to feedback from Anita).
Dalton recognized the need for ongoing commitment, or action, to education and engagement with diverse communities. He sought opportunities to attend workshops or webinars on EDs in underserved populations in order to acquire more awareness, knowledge, and skills related to culturally sensitive approaches. Dalton learned about virtual LGBTQ+ support groups offered by Fighting Eating Disorders in Underrepresented Populations (FEDUP; https://fedupcollective.org) and shared this resource with Anita to expand her social support network. Dalton also reached out to organizations on campus, such as LGBTQ+ and Black, Indigenous, and people of color (BIPOC) student groups, to learn more about their experiences and needs as college students. He consulted with his new colleagues to familiarize himself with student resources, such as on-campus food pantries for food-insecure students. These action-based efforts allowed Dalton to deepen his understanding of Anita’s worldview, immerse himself in the campus community, and advocate for diverse students’ needs.
Counseling Relationship
Jenna is a 40-year-old Jewish Orthodox, heterosexual, cisgender woman who identifies as having a larger body. She experienced significant trauma from her father as a teenager and is now estranged from her immediate family. This has impacted her body image and overall sense of self. Since being estranged, she has struggled with her religious and spiritual identity. Growing up, she learned to cope with difficult emotions with food. She experienced periods of bingeing to help soothe and numb her feelings, as well as periods of significant restriction stemming from attempts to control her body shape. She has reported significant shame regarding her body size and ED symptoms and has avoided seeking counseling because of perceived stigma. Jenna has decided to seek outpatient treatment to help manage ED behaviors after the urging of a friend. When beginning counseling, she realized that she may need to unpack some of her past trauma as well as how religious beliefs have shaped her relationship with food. Jenna began seeing Emily, an agnostic, gay, cisgender female counselor who identifies as “straight-sized,” or a person in a smaller body (Ashwell, 2020). Emily has been working in the field of ED for over 10 years.
While completing the intake assessment with Jenna, Emily asked questions to understand Jenna’s multicultural background. Emily reflected upon her own intersectional identities and how the differences in marginalized and privileged identities may impact the client–counselor relationship. Emily realized that Jenna holds more privilege as a heterosexual woman yet experiences more marginalization because of her Jewish Orthodox identity and larger body size. After the intake session, Emily reflected upon her own attitudes and beliefs about Jenna’s identities, critically evaluating her biases and assumptions, and considered how being in a straight-sized body may impact her client’s comfort or discomfort in the counseling relationship. Emily used curiosity and open communication to strengthen the counseling relationship.
After reflecting on her own attitudes and beliefs, Emily recognized that it was essential to increase her knowledge of her client’s experiences as a Jewish Orthodox woman. Emily learned about Jewish Orthodox beliefs and customs as well as the oppression and discrimination these communities may face. This knowledge was integral to establishing a connection with Jenna and preventing possible microaggressions (Mintert et al., 2020). Because of Jenna’s reported experience with her religious and ethnic background impacting her relationship with food, Emily also focused on exploring intersections between food, body image, and her cultural background.
Emily then explored skills for cultivating an open space for dialogue, particularly those related to addressing how different worldviews between the counselor and client could impact the counseling relationship. Emily demonstrated curiosity and avoided making assumptive statements regarding Jenna’s experiences, understanding the importance of broaching cultural differences in the client–counselor relationship (Day-Vines et al., 2007). Emily’s experience in the ED field prepared her to support clients in challenging diet culture in multiple ways, including discussing the impact of fat-oppressive culture on emotional health, being mindful of her language regarding body size, and creating an inclusive office space for clients in different bodies (Kinavey & Cool, 2019). When Jenna shared discomfort in working on body image issues with an individual in a “straight-sized” body, Emily utilized validation and reflecting skills to process these differences in lived body experiences, which helped Jenna feel safe to further process her body image experiences despite their differences.
Emily took action by holding more conversations with other professionals, joining online communities, and continuing her research to understand how to continue supporting clients of different religious and spiritual backgrounds and body sizes. Emily also supported Jenna in becoming more involved in advocacy, which Jenna found to be empowering and liberating and helped her to improve her relationship with her body. Emily provided resources for Jenna to learn about fat liberation through the Association for Size Diversity and Health (https://asdah.org) and the National Association to Advance Fat Acceptance (https://naafa.org). Emily also connected Jenna to an ED support group, the Larger Bodied Individuals Support Group offered by the National Alliance for Eating Disorders. Emily found that the counseling relationship was strengthened by advocating and taking action with and on behalf of her client.
Advocacy Interventions
Ratts et al. (2016) indicated that counseling and advocacy interventions can occur at several levels (i.e., intrapersonal, interpersonal, institutional, community, public policy, international or global) on behalf of clients or counselors. Counselors are encouraged to consider contextual factors, such as client identities and counseling settings, and to determine the most appropriate and responsive advocacy interventions. The sections above covered several examples of intrapersonal and interpersonal advocacy efforts for counseling clients with diverse intersecting identities. Regarding counselor advocacy, another important intrapersonal consideration is the role of self-care in sustaining social justice and advocacy efforts (Mitchell & Binkley, 2021). The intensive nature of ED treatment (e.g., high mortality and relapse rates; Graham et al., 2020; Warren et al., 2013) emphasizes the need for self-care to maintain vitality and ensure ethical, culturally responsive care. Counselors can also reinforce the significance of wellness practices within their interdisciplinary collaborations that foster interpersonal advocacy within the ED treatment environment.
Counselors can critically evaluate the practices and policies within their institutions and counseling settings to foster inclusion beyond the counseling room. For example, Akoury et al.’s (2019) qualitative study discovered that some women of size experienced physical barriers in therapy waiting rooms, such as unaccommodating furniture. Ensuring that waiting areas and clinical settings accommodate clients of all sizes and abilities is essential to cultivating an affirming environment. It is also worth noting that there are institutional training gaps related to ED education, including within counseling programs (Labarta et al., 2023). Counselor educators and supervisors can address these gaps by adopting a culturally responsive approach to teaching about EDs, improving students’ awareness of EDs across populations, and advocating for the inclusion of ED education across curricula.
Counselors play an essential role in addressing their communities’ mental health needs. The majority of EDs go untreated, especially in minoritized populations (Bryant et al., 2022); thus, community–based advocacy is crucial. One method to more deeply assess these needs is community-based participatory research (CBPR). Because of its strengths-based, collaborative approach, CBPR presents an opportunity for culturally responsive research to address health inequities and disparities impacting underserved groups (Rodriguez Espinosa & Verney, 2021). The core tenets of CBPR involve research with communities, implying shared power in the research process and giving marginalized communities a voice to express their perceptions on gaps and immediate needs (Hays, 2020). CBPR can be a powerful alternative to traditional methods in ED research, which have historically excluded the perspectives and experiences of marginalized groups. Action research methods allow researchers, practitioners, clients, and other stakeholders to collaborate and bridge research–practice gaps, which can improve access to ED and mental health treatment (Rodriguez Espinosa & Verney, 2021).
In addition to CBPR, counselors and other practitioners interested in community-based advocacy for EDs may partner with organizations to raise awareness regarding treatment barriers and challenges. Counselors can support underserved clients with accessing care through organizations like Project HEAL, with its mission to improve equitable treatment access (https://www.theprojectheal.org). Counselors may engage in targeted initiatives (e.g., mental health literacy) to reduce barriers that impact individuals who have an ED that is not yet diagnosed (Griffiths et al., 2018). Culturally responsive awareness campaigns can be initiated and situated within the community to reach individuals who may otherwise not have access to such information. In addition to settings like schools and community agencies, counselors may reflect on specific community venues to support marginalized individuals impacted by EDs, such as barbershops, hair salons, churches, and afterschool centers. Treatment recovery is sustained through early intervention, and increasing awareness may support treatment initiation (Griffiths et al., 2018).
On a larger scale, counselors can engage in public policy initiatives that advocate for improvements in health insurance coverage for ED treatment and research funding (Streatfeild et al., 2021), particularly because ED research remains underfunded compared to other mental health conditions (Austin et al., 2019). Further, remaining up to date on legislation impacting clients with advocacy organizations, such as the National Eating Disorders Coalition (https://www.eatingdisorderscoalition.org), can assist with advancing public policy efforts. Given that EDs are also global issues, international collaborations across disciplines may enhance ED prevention and intervention efforts, allowing for diverse cultural perspectives, deepening our understanding of sociocultural contexts, and extending the impact and reach of social justice and advocacy initiatives.
Implications for Counseling and Counselor Education
Counselors have an ethical responsibility to address the pervasive gaps impacting minoritized clients with EDs (ACA, 2014). The MSJCC are a comprehensive framework that assists counselors with exploring the client’s unique lived experience in addition to relational, systemic, and contextual factors influencing the treatment process (Ratts et al., 2016). The MSJCC can be easily integrated into a counselor’s theoretical approach, leading to a more robust, culturally responsive conceptualization and treatment plan. However, it is essential to note that nuances exist across ED treatment settings, particularly depending on the treatment approach used (e.g., manualized protocols versus individualized treatments). Thus, more extensive conversations within organizations may be necessary, including ways to make the treatment more accessible and inclusive to diverse clients. The MSJCC can serve as a resource to guide these discussions, allowing for a deeper understanding of issues at several levels of treatment (e.g., clients’ experiences, clinicians’ experiences, agency policies and procedures, community issues). For example, FEDUP (formerly Trans Folx Fighting Eating Disorders, 2020) presented a call to action in an open letter to ED organizations, providing essential recommendations, including, but not limited to, the following: hiring more diverse staff at treatment centers, moving away from gender-specific treatment, including inclusive language in handouts and resources (e.g., not defaulting to “she”), establishing scholarships for BIPOC and gender-diverse clients, and developing safe spaces for marginalized clients to connect.
Counselor educators and supervisors also play a role in bridging ED graduate training gaps by utilizing culturally responsive approaches when teaching and supervising ED concerns (Labarta et al., 2023). Suggested pedagogical strategies include applying deliberate practice, addressing countertransference issues, offering specialized coursework, infusing ED education across the curriculum, and collaborating with interdisciplinary professionals to serve as guest lecturers or speakers (Irvine & Labarta, 2024; Labarta et al., 2023; Levitt, 2006). Integrating the MSJCC into the counseling curriculum can assist educators and supervisors in enhancing ED training through a social justice lens. For example, a counselor educator teaching a psychopathology course can encourage counseling trainees to explore how diagnoses can perpetuate weight bias, such as with atypical anorexia nervosa (Harrop et al., 2021), a specified presentation of other specified feeding or eating disorder (OSFED). Counselor educators and supervisors can facilitate discussions on the historical and cultural context of idealized appearance norms, introduce weight-inclusive terminology, explore the limits of research related to weight and health, consider emerging research on fat scholarship, and help trainees remain accountable to their own weight bias and stigmas when working with clients of size (Muzacz et al., 2024; Rothblum & Gartell, 2019). In this way, educators and supervisors encourage trainees to remain critically reflexive of prevalent ED treatment practices and empower their diverse clients with EDs across the lifespan.
Future Research Directions
Scholars have offered several recommendations to enhance culturally informed ED research by creating more inclusive demographic questionnaires and improving reporting in manuscripts (Burnette et al., 2022; Egbert et al., 2022), developing more inclusive assessment tools (Alexander et al., 2024), and designing outcomes-based studies with underrepresented samples (Emelianchik-Key et al., 2023). ED researchers can also use the MSJCC framework to ground their research. For example, counseling researchers have called for more research partnerships between academics and practitioners that can bridge existing research–practice gaps (Barrio Minton et al., 2021; Hays et al., 2019). Related research methods, such as CBPR, can meet this need and incorporate participant perspectives into the research process. Within ED research, this has important implications for marginalized populations who experience barriers to accessing treatment and are often underrepresented in treatment settings. Therefore, moving beyond clinical settings is critical to understanding the unmet needs of community members who may benefit from prevention-based interventions.
Conclusion
In this article, we presented the integration of the MSJCC (Ratts et al., 2016) into the treatment of EDs with marginalized clients. We believe that the MSJCC’s flexibility and social justice lens can assist counselors with bridging the existing gaps and empowering underserved clients across treatment settings. Furthermore, counselor educators and supervisors can utilize the MSJCC as a framework to reconceptualize ED training across counseling curricula, which will play a role in deconstructing dominant narratives on EDs and potentially improving the quality of care for marginalized communities.
Conflict of Interest, Funding Disclosure, and Author Note
The authors reported no conflict of interest or funding
contributions for the development of this manuscript.
The authors would like to thank Hayley Lovelace for
her insights and contributions during the initial
stages of this project.
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Adriana C. Labarta, PhD, NCC, ACS, LMHC, is an assistant professor at Florida Atlantic University. Danna Demezier, PhD, NCC, LMHC, is an assistant professor at Liberty University. Alyssa A. Vazquez, LMFT, is a doctoral student and adjunct faculty at Barry University. Correspondence may be addressed to Adriana C. Labarta, 777 Glades Rd., Bldg. 47, Rm. 274, Boca Raton, FL 33431, alabarta2018@fau.edu.
