Feb 3, 2017 | Volume 7 - Issue 1
Edward Wahesh, S. Elizabeth Likis-Werle, Regina R. Moro
This content analysis includes 210 articles that focused on addictions topics published between January 2005 and December 2014 in the journals of the National Board for Certified Counselors (NBCC), Chi Sigma Iota (CSI), the American Counseling Association (ACA), and ACA member divisions. Results include the types of addictions content and behaviors studied as well as the populations and data analytic techniques used in the addictions research articles. Whereas most articles discussed addictions counseling techniques, addictions issues among non-clinical populations, and professional practice issues, fewer articles addressed clients in treatment, utilized clinical populations, or analyzed intervention outcomes. Implications for addictive behaviors and addictions counseling scholarship in professional counseling are discussed.
Keywords: addictive behaviors, addictions counseling, content analysis, NBCC, ACA
Professional counselors have an ethical obligation to be actively involved in continuing education in order to remain current on relevant professional issues and scientific information related to their client population and setting (American Counseling Association [ACA], 2014). Continuing education also is required by licensing and certification bodies for credential renewal. One way continuing education is achieved is through reading and contributing to peer-reviewed journal articles. Publications can expose professional counselors, counselor educators and counselors-in-training to new and innovative practices grounded in empirical research.
Professional journals represent “the repository of the accumulated knowledge of a field” (American Psychological Association, 2010, p. 9). A number of journals are produced by the major counseling certification and professional organizations, including The Professional Counselor, published by the National Board for Certified Counselors (NBCC); the Journal of Counselor Leadership and Advocacy, published by Chi Sigma Iota International (CSI); and the Journal of Counseling & Development (JCD), which is the flagship journal of ACA. In addition to JCD, there are 20 journals published by ACA member divisions. ACA member division-sponsored journals publish articles that inform counseling practices and contribute to the body of research on topics that are salient to the particular settings, populations, interest areas, and issues associated with the division. An area that is relevant to most professional counselors, regardless of specialty area or setting, is addiction.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2014 there were an estimated 21.5 million Americans (8% of the population aged 12 or older) living with a substance use disorder (SUD; SAMHSA, 2015). It is likely that many individuals with SUDs also have other co-occurring mental health conditions. In fact, 2014 estimates suggest 7.9 million adults (i.e., 18 years and older) in the United States had both a past-year SUD and a mental illness diagnosis. Among adolescents, approximately 1.3 million reported a past-year SUD; 28.4% of these (over 300,000) had experienced a major depressive episode in the past year (SAMHSA, 2015).
While not all professional counselors will specialize in addictions counseling, given this prevalence it is likely counselors will need to provide services to individuals with an SUD (Chandler, Balkin, & Perepiczka, 2011; Harwood, Kowalski, & Ameen, 2004; Salyers, Ritchie, Cochrane, & Roseman, 2006). In addition, professional counselors are more than likely to come into contact with clients of any age who are impacted by someone else’s addiction (e.g., friend, family member). This may explain why the Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2016) requires that all counselors-in-training, regardless of counseling specialty, learn about the theories and etiology of addictions. Salyers et al. (2006) found little consensus among CACREP-accredited programs in how addictions issues were addressed; in fact, when asked where substance abuse was covered in the curriculum, more than 25 different courses were listed by CACREP program representatives. Counselors-in-training learn about addictions in a variety of ways, such as by taking a course in addictions, encountering clients with addictive behaviors in practicum or internship, or learning about addictions in other courses. Since addictions-related training seems to occur throughout the counseling curriculum, all counselor educators, regardless of their particular area of specialty, should maintain an awareness of current trends in addictions science and theory.
Given that knowledge of addictive behaviors is an important aspect of professional counselor identity (CACREP, 2009; 2016), it is necessary that professional counselors have access to scientific information and practice-oriented resources on addiction that are consistent with the philosophical orientation of the profession. Whereas related professions, such as psychology, public health and social work, produce peer-reviewed publications on addictions and addictions treatment that can be utilized by professional counselors, these resources may not reflect the qualities that make professional counseling unique. Examining the state of the counseling literature on addictive behaviors and additions counseling can inform efforts to improve access to scientific information and evidence-based practices that represent the core philosophy of the counseling profession. Further, an assessment of available addictions research can help to shed light on the state of the counseling profession, as production of original research has been regarded as a standard for measuring the identity development of a profession (Mate & Kelly, 1997).
Research on trends in addictions publications in professional counseling is scarce. Moro, Wahesh, Likis-Werle, and Smith (2016) utilized content analysis to investigate the frequency and type of addictions content within a sample of Association for Counselor Education and Supervision conference programs and four ACA-sponsored journals (JCD, Counselor Education and Supervision, Counseling Outcome Research and Evaluation [CORE], and Measurement and Evaluation in Counseling and Development) that appeal to counselor educators. These authors found that about 2% of conference sessions and articles between 2007 and 2011 addressed addictions counseling. Most of the articles identified in this analysis focused on treatment strategies, particularly among diverse populations. Although the study by Moro et al. is informative, it is limited in that it comprised a 5-year time period and included only a small subset of professional counseling journals. Examining all professional counseling journals during a lengthier time frame would provide professional counselors and researchers with a more comprehensive snapshot of what aspects of addictions theory, prevention, intervention and treatment have been discussed within the counseling literature. This information can be used to inform efforts to promote the production of research and publications that address specific areas of addiction that are currently lacking.
The purpose of the present study was to provide an overview of available literature on addictions topics in professional counseling journals published between January 2005 and December 2014. Moreover, the types of addictions content, addictive behaviors and addictions-related research were examined. The research questions that guided this study were: (1) To what extent do counseling journals address addictions topics? (2) What addictive behaviors and types of content were addressed? (3) How much addictions research was published in counseling journals? and (4) What types of populations and data analytic techniques were represented in this research?
Methods
Content analysis was utilized to address the research questions. This methodology was selected because content analysis is a systematic approach to summarize and make valid and replicable inferences from written communication (Krippendorff, 2013). A review of the literature shows that content analysis has served as a valuable methodology to identify publication trends over time and highlight attention on specific topics within the counseling profession. Content analysis has been used in the counseling literature to examine topics such as multicultural counseling (Arredondo, Rosen, Rice, Perez, & Tovar-Gamero, 2005), pedagogy in counselor education (Barrio Minton, Wachter Morris, & Yaites, 2014), and research in counseling (Ray et al., 2011). Studies by Barrio Minton et al. (2014), Arrendondo et al. (2005), and Ray et al. (2011) were of journal articles during a similar time frame as the present study (i.e., 10 years). Content analysis procedures used in this study include identifying articles, generating and refining the content analysis protocol, conducting a pretest, data collection, assessment of reliability and validity, and reporting the results.
The research team consisted of three professors and two master’s-level graduate students. The professors each possess a doctoral degree in counselor education and specialize in addictions counseling. Two professors identify as White females and one professor is a White male. The graduate assistants, both White females, hold bachelor’s degrees in psychology, completed a course in counseling research methods, and participated in a workshop on content analysis facilitated by the first author before joining the research team. The graduate assistants were responsible for searching for applicable articles using predetermined keywords and identifying the total number of articles for each journal during the time period; the three assistant professors (first, second, and third authors) participated in the search for articles as well as in the development of the content analysis protocol and coding process.
The Professional Counselor, published by NBCC, the Journal of Counselor Leadership and Advocacy, published by CSI, and 21 ACA and ACA member division peer-reviewed journals (Table 1) were identified as having published articles on addictions between the years 2005 and 2014. Because the purpose of the study was to present a survey of all available articles on addictions content in professional counseling journals between 2005 and 2014, all journals were included in the analysis even if they were not in press during the entire 10-year period under analysis.
A set of keywords was generated to identify relevant articles to be used in the study. These keywords included: (a) general terms taken from the literature on addiction and addictions treatment (e.g., addiction, prevention, relapse, recovery, abstinence, co-morbidity, behavioral and process addictions, and mutual support groups); (b) terminology drawn from the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013), such as substance use disorders, dependence, intoxication, withdrawal, substance abuse and opioid maintenance; and (c) a list of drug classifications (and common pseudonyms) from the DSM-IV-TR and DSM-5, including alcohol (drinking), amphetamine, cannabis (marijuana), cocaine, hallucinogen, opioid, stimulant, gambling, inhalant, sedative, caffeine and nicotine (tobacco, smoking).
Two graduate assistants independently conducted electronic searches using PsycINFO, EBSCO and ERIC of the keywords, titles and abstracts of all articles (editorial statements, book reviews, errata and advertisements excluded) during the specified time period to identify relevant articles and provide the total number of articles published for each journal. Journals not indexed within these electronic databases were searched by reading the electronic version of each issue’s table of contents and article abstracts and keywords. Following this process, the first author met with the graduate assistants in order to reconcile any differences between their lists of applicable texts and total number of journal articles found. A preliminary list of 226 articles was identified and reviewed by each author to determine suitability for the study. Fifteen articles were removed from the analysis because they did not discuss addictions or addictions treatment; for example, two articles included the keyword “substance abuse” in the abstract, but not in the article itself. To maintain independence, one article was removed because it had been published twice.
The authors developed a content analysis protocol that included definitions and categories for each coding variable. To address research questions 1–3, the following variables were developed: (a) addiction-related content topic, (b) addictive behavior and (c) type of research article. In order to assess research question 4, (d) data analytic technique and (e) research population also were included as variables. Categories of each variable were initially developed by the authors based on their knowledge of the addictions literature as well as past content analysis research of counseling journals. The authors then pretested the protocol by coding 40 randomly selected articles within the sample (approximately 20%) to purify the coding scheme and conduct a preliminary assessment of coder agreement. Following this process, the authors met to refine existent category definitions, agree on the inclusion of additional variable categories and determine which variables would be single versus multiple classification. High inter-rater agreement (85% or higher) across all five study variables was observed among the three coders during the pilot phase. A pattern was not observed in the disagreements among the coders, suggesting that the framework possessed acceptable construct validity (Insch, Moore, & Murphy, 1997).
Once the protocol was refined, all articles were coded independently by two members of the research team (first, second, and third authors). Krippendorff’s alpha (Krippendorff, 2013), with a minimum acceptable value set at α = .80, was utilized to assess agreement among the coders. This coefficient was selected to capture inter-rater reliability because it estimates error in observed agreement attributable to chance and accounts for small sample sizes. Using a reliability measure designed for small samples was an important consideration because research question 4 relates only to a smaller subset of the sample used in the study. Further, the use of two coders for each article was to ensure that the total number of observations for each variable in this study exceeded the minimum number recommended by Krippendorff (2013) for an alpha value greater than .80 at the .01 level of significance (i.e., according to Krippendorff [2013] two coders would have to code at least 103 units). The “odd-man-out” procedure recommended by Insch et al. (1997), in which a third coder determined the final category when differences emerged, was used to reconcile disagreements between coders.
Coding Variables
Five variables were identified by coders in the study. All articles (N = 210) were coded utilizing three of the variables: addiction-related content topic, addictive behavior and type of research. Two variables were used to code research articles identified within the sample. Percentage of agreement (observed agreement [OA]) and Krippendorff’s alpha (α) were calculated for each variable.
Addiction-related content topic. The purpose of this variable was to identify the area of addictions counseling and research that the article addressed. Categories were initially drawn from content analyses by Ray et al. (2011) and Moro et al. (2016) and modified for the present study. Because the purpose of this variable was to identify the main content focus of the articles, a single classification system was used, which meant that coders were required to assign each article to one category. The use of a single classification system is recommended when coding variables that represent latent meaning and require greater interpretation by the coder (Insch et al., 1997). The variable included the following categories: approaches to counseling, professional practice, population variables, client variables, counselor variables, measurement, and effectiveness of counseling and preventative interventions (OA = 87.6%; α = .85). Approaches to counseling included articles that presented specific addictions-related counseling techniques, models or treatment programs. The professional practice issues category contained articles that described addiction-related counselor training, credentialing, ethics, diagnosis or trends in the field. Population variables included articles that described characteristics of a non-clinical population; the client variables category contained articles that addressed addictions or addictions counseling within a clinical population. Articles on the characteristics or perceptions of professional counselors were assigned to the counselor variables category. The measurement category included any article with a focus on instrument development, formal assessment or psychometrics. Effectiveness of counseling and preventative interventions represented articles that focused on evaluating an intervention or prevention program or technique.
Addictive behavior. This variable represented the types of addictive behavior addressed in the articles. Coders were instructed to record all addictive behaviors and substances described in each article (i.e., multiple classification) using a list of categories that included relevant keywords developed by the researchers for the text search. If a specific type of behavior or substance was not discussed, coders labeled the article as general substance use. Categories representing specific behaviors and substances included: general substance use, alcohol, nicotine, opioids, cannabis, stimulants, ecstasy and behavioral addictions (OA = 95%; α = .90).
Type of research. Each article was coded as non-research, qualitative, quantitative or mixed methods (OA = 98.5%; α = .98). Classifications were based on past content analysis research of counseling journals (Moro et al., 2016; Ray et al., 2011), and coders were required to assign each article to one category. Articles that were assigned to the three research categories (i.e., qualitative, quantitative and mixed methods) were used to address research question 4.
Data analysis. All research articles were coded in order to determine the types of data analytics used by the authors. The coding variable included 15 categories (i.e., descriptive statistics, regression analysis, theme analysis and coding, chi-square test, multivariate analysis of variance/multivariate analysis of covariance, correlation, analysis of variance/analysis of covariance, structural equation modeling, t-test, confirmatory factor analysis, exploratory factor analysis, other nonparametric test, discriminant analysis, canonical analysis, and cluster analysis), and coders were instructed to assign each article to multiple categories when appropriate (e.g., case where a single research article included multiple types of analysis; multiple classification). The scheme for grouping different types of data analysis was based on a framework by Erford et al. (2011) in their content analysis of articles published in JCD. Percentage of agreement among coders in the present study was 82.4% and α = .79. Because inter-rater reliability is slightly below the recommended minimum of .80 (Krippendorff, 2013), readers are encouraged to interpret these results with caution.
Research population. The various populations examined in the research articles were recorded using this variable (OA = 91%; α = .88). Because an article could potentially include multiple populations (e.g., African American, male, college students), coders were instructed to code each article with as many categories as necessary (i.e., multiple classification). When coding, research team members used a preliminary list of possible categories derived from several previous content analysis studies of counseling journals (Byrd, Crockett, & Erford, 2012; Smith, Ng, Brinson, & Mityagin, 2008). This resulted in 11 discrete categories: undergraduates, children and adolescents, adults (non-college, 18 years and older), families, men only, women only, clients in addictions treatment, addictions professionals, counseling students, multicultural populations and LGBT populations. To improve the conciseness of the findings, several smaller categories were combined to create the multicultural populations category. A twelfth category was designated for articles that did not include a research sample.
Results
Research Question 1: To What Extent Do Counseling Journals Address Addictions Topics?
Table 1 provides a listing of counseling journals as well as the number of addictions-related articles in relationship to total publication. The percentage of the total number of addictions-related articles in comparison to total number of published articles was 4.5%. As expected, the Journal of Addiction & Offender Counseling (JAOC) published the highest percentage of addictions articles (76.1%). The journal with the next highest percentage of addictions articles was the Journal of Military and Government Counseling (13.8%), followed by the Journal of LGBT Issues in Counseling (9.6%), the Journal of College Counseling (8.6%), and CORE (8.3%). Six journals published less than 1% of their articles on addictions: The Career Development Quarterly (0.0%), Journal of Counselor Leadership and Advocacy (0.0%), Journal for Social Action in Counseling and Psychology (0.0%), Counselor Education and Supervision (0.5%), Journal of Multicultural Counseling and Development (0.5%), and Professional School Counseling (0.9%).
The authors also examined the first research question by calculating the percentage of addictions-related articles during each year of publication. The number and percentage of addictions articles published for each year is as follows: 2005 (n = 18; 4.0%), 2006 (n = 20; 4.5%), 2007 (n = 20; 4.7%), 2008 (n = 14; 3.0%), 2009 (n = 17; 3.9%), 2010 (n = 21; 4.5%), 2011 (n = 30; 6.3%), 2012 (n = 30; 6.4%), 2013 (n = 20; 4.0%), and 2014 (n = 20; 4.7%). The percentage of addictions articles remained relatively stable during this period; however, a slight increase in the percentage of articles published on addictions was observed in 2011 and 2012.
Research Question 2: What Types of Addictive Behaviors and Content Topics Were Addressed?
All seven categories included in the addiction-related content topic variable were represented in the data. The highest number of addictions articles focused on population variables (n = 57; 27%), or addictions issues within non-clinical groups. The content topics approaches to counseling (n = 43; 20%) and professional practice issues (n = 39; 19%) were the second and third most represented categories. Fewer addiction-related articles were published on the following content topics: client variables (n = 20; 10%), measurement (n = 18; 9%), effectiveness of counseling and preventative interventions (n = 17; 8%), and counselor variables (n = 16; 7%).
Additional analysis revealed that among the 18 articles in the measurement category, 14 different assessment instruments were represented. Whereas most instruments (n = 10) were discussed in only one article each, the Substance Abuse Subtle Screening Inventory-3 (SASSI-3; Miller & Lazowski, 1999) was included in eight of the articles in this category. Three instruments were included in two articles: the Core Alcohol and Drug Survey (Core Institute, 1994), CAGE questionnaire (Ewing, 1984) and the Michigan Alcohol Screening Test (Selzer, 1971). Further, additional analysis of the effectiveness of counseling and preventative interventions category found that only four articles addressed prevention; three of these articles discussed a similar intervention to prevent college student drinking and one presented findings of an evaluation of a school-based substance abuse prevention program.
Table 1
Addiction Articles in Professional Counseling Journals, 2005–2014
| Journal |
No. of Addiction Articles Found
|
No. of Total
Possible Articles
|
% Addiction to No. of Total
Articles
|
| The Professional Counselor |
5
|
113
|
4.4
|
| Journal of Counselor Leadership & Advocacy |
0
|
13
|
0.0
|
| Journal of Counseling & Development |
9
|
561
|
1.6
|
| Adultspan Journal |
5
|
101
|
5.0
|
| The Career Development Quarterly |
0
|
282
|
0.0
|
| Counseling and Values |
6
|
191
|
3.1
|
| Counselor Education and Supervision |
1
|
199
|
0.5
|
| Journal of Addiction & Offender Counseling |
70
|
92
|
76.1
|
| Journal of College Counseling |
14
|
163
|
8.6
|
| Journal of Employment Counseling |
5
|
182
|
2.8
|
| Journal of Humanistic Counseling |
3
|
175
|
1.7
|
| Journal of Multicultural Counseling and Development |
1
|
194
|
0.5
|
| Counseling Outcome Research and Evaluation |
4
|
48
|
8.3
|
| The Family Journal |
17
|
554
|
3.1
|
| Journal of Creativity in Mental Health |
15
|
251
|
6.0
|
| Journal of LGBT Issues in Counseling |
13
|
136
|
9.6
|
| Journal of Mental Health Counseling |
11
|
244
|
4.5
|
| Journal for Social Action in Counseling and Psychology |
0
|
87
|
0.0
|
| The Journal for Specialists in Group Work |
5
|
209
|
2.4
|
| Measurement and Evaluation in Counseling and Development |
8
|
176
|
4.6
|
| Professional School Counseling |
4
|
432
|
0.9
|
| Rehabilitation Counseling |
10
|
208
|
4.8
|
| Journal of Military and Government Counseling |
4
|
29
|
13.8
|
| Total |
210
|
4,640
|
4.5
|
| Note. The first issue of The Professional Counselor was published in 2011; Counseling Outcome Research and Evaluation was first published in June 2010; Journal of LGBT Issues in Counseling was first published in October 2008; Journal for Social Action in Counseling was first published in April 2007; Journal of Creativity in Mental Health was first published in September 2007; the first issue of Journal of Military and Government Counseling was published in January 2013; the first issue of the Journal of Counselor Leadership and Advocacy was published in 2014. |
The addictive behavior coding variable also was used to assess this research question. General substance use was by far the most represented addictive behavior in the articles (n = 142; 68%), followed by alcohol consumption (n = 46; 22%) and behavioral addictions (n = 11; 5%). Specific substances were addressed in fewer articles: nicotine (n = 8; 4%), opioids (n = 4; 2%), stimulants (n = 4; 2%), cannabis (n = 3; 1%) and ecstasy (n = 1; 0.5%). The total values exceed the actual number of research articles included in the analysis because some articles addressed more than one addictive behavior. In the behavioral addictions category, sex addiction was addressed in three articles, three articles included a general discussion of behavioral addictions, and addictions to gambling, gaming, Internet, self-injury and food were each mentioned once.
Research Question 3: How Much Addictions Research Was Published in Counseling Journals?
This research question was addressed using the type of research coding variable. Approximately 60% of addictions-related articles (n = 127) were original research. Among these articles, 82% were quantitative (n = 104) and 13% were qualitative (n = 17). Mixed methods was the smallest category (n = 6), representing 5% of all addictions research. Articles coded as “non-research” (n = 83) included innovative methods papers, professional practice papers, interviews, and literature reviews on topics such as counseling theory and special populations.
Research Question 4: What Types of Populations and Data Analytic Techniques Are Represented in the Addictions Research?
Research population and data analysis were the coding variables used to assess this research question. Table 2 lists the various types of participants used in the addictions-related research articles. The most common population examined was adults (n = 49; 40%), or individuals (18 years and older) not enrolled in college, followed by undergraduates (n = 36; 29%) and addictions professionals (n = 26; 21%). The total values exceed the actual number of research articles included into the analysis because some articles included more than one population. The multicultural populations category represented a number of ethnic groups including African Americans, Native Americans and Hispanic Americans, as well as a sample of participants in Korea. Three articles were not included in this analysis because they did not involve research with human subjects (e.g., content analysis of substance use screenings).
| Table 2 Types of Participants Used in Addictions Research Articles |
| Population |
Count |
%
|
| Adults |
49
|
40
|
|
| Undergraduates |
36
|
29
|
|
| Addictions Professionals |
26
|
21
|
|
| Clients in Addictions Treatment |
18
|
15
|
|
| LGBT Populations |
13
|
10
|
|
| Children and Adolescents |
9
|
7
|
|
| Multicultural Populations |
9
|
7
|
|
| Men Only |
8
|
6
|
|
| Families |
5
|
4
|
|
| Women Only |
4
|
3
|
|
| Counseling Students |
2
|
2
|
|
| Note. Three articles were removed because they did not include human subjects (n = 124). Some articles include more than one population. Therefore, the total values may exceed the actual number of research articles accepted into the analysis. |
|
|
|
|
|
All 15 data analytic techniques were represented within the addiction-related research articles (Table 3). Descriptive statistics (n = 34; 27%), regression analysis (n = 31; 24%) and theme analysis/coding (n = 22; 17%) were the most used techniques. Data strategies less likely to be utilized include discriminant analysis (n = 4; 3%), canonical analysis (n = 3; 2%) and cluster analysis (n = 1; 1%). The total values exceed the actual number of research articles included in the analysis because some articles utilized more than one data analysis strategy.
| Table 3 Type of Data Analysis Used in Addictions Research Articles |
| Data Analytic Procedure |
Count
|
%
|
| Descriptive Statistics |
34
|
27
|
|
| Regression Analysis |
31
|
24
|
|
| Theme Analysis/Coding |
22
|
17
|
|
| Chi-Square Test |
16
|
13
|
|
| MANOVA/MANCOVA |
14
|
11
|
|
| ANOVA/ANCOVA |
13
|
10
|
|
| Correlation |
12
|
9
|
|
| Structural Equation Modeling |
10
|
8
|
|
| t-test |
9
|
7
|
|
| Confirmatory Factor Analysis |
7
|
5
|
|
| Exploratory Factor Analysis |
5
|
4
|
|
| Other Nonparametric |
5
|
4
|
|
| Discriminant Analysis |
4
|
3
|
|
| Canonical Analysis |
3
|
2
|
|
| Cluster Analysis |
1
|
1
|
|
| Note. Some articles used more than one procedure. Therefore, the total values may exceed the actual number of research articles accepted into the analysis (n = 127). MANOVA = multivariate analysis of variance; MANCOVA = multivariate analysis of covariance; ANOVA = analysis of variance; ANCOVA = analysis of covariance. |
|
|
|
|
|
Discussion
Articles published in 23 professional counseling journals between January 2005 and December 2014 were examined to assess the scope with which addictions were represented in the professional counseling literature. Overall, 210 (4.5%) of the 4,640 articles published addressed addictions content. Not surprisingly, JAOC, a publication sponsored by the International Association of Addictions and Offender Counselors, contained the most articles on addictions. It also is noteworthy that several journals with higher percentages of addictions articles were launched within the period of time the analysis was conducted (e.g., Journal of Military and Government Counseling and Journal of LGBT Issues in Counseling). The introduction of these journals may suggest that increased attention is being given to addictions issues or, at the very least, to populations that are more vulnerable to experiencing the consequences of addictive behaviors.
The higher percentage of articles in 2011 and 2012 may have been associated with changes to addictions-related professional training and diagnostic considerations that occurred around these years. In 2009, CACREP introduced an addictions counseling specialty area and added language in their standards requiring all students to learn about the etiology, prevention and treatment of addictions; therefore, it is possible that during the years following these changes, there was an increased interest in the teaching of addictions content to counselors-in-training. Alternatively, the revised formulation for the diagnosis of SUD in the DSM-5, published in 2013, also may have contributed to the increase in addictions articles. Leading up to the publication of the DSM-5 there may have been greater discussion as to how addictive disorders are conceptualized and assessed.
The most common type of article published addressed addiction-related issues within non-clinical populations; fewer articles focused on topics specific to individuals receiving addictions counseling. Even fewer articles included research on outcomes of prevention and counseling interventions. The presence of only four articles in the sample (1.9%) that assessed the efficacy of prevention efforts is concerning given that prevention has been found to be a key facet of professional counselor identity (Mellin, Hunt, & Nichols, 2011) and is considered by CACREP (2016) as “foundational knowledge” (p. 8) for all counseling professionals. This discrepancy may suggest that despite being regarded as an important component of professional training and identity, little is actually done pertaining to prevention practice and research by professional counselors.
Although relatively few articles in the sample included addictions outcomes research, it is promising that CORE was established by the Association for Assessment and Research in Counseling in 2010 as a venue for outcomes research and program evaluation findings (Hays, 2010). Since the inception of CORE, its publication of addiction research has resulted in it being one of the top five journals in our study publishing on addiction topics.
Among the assessment instruments in articles that focused on addictions-related measurement issues, the SASSI-3 (Miller & Lazowski, 1999) was the most commonly discussed. The amount of attention given to the use of the SASSI-3 appears to be warranted considering the popularity of this instrument among professional counselors and clinical mental health counselors in particular. In a national survey of counselor assessment practices by Peterson, Lomas, Neukrug, and Bonner (2014), the SASSI-3 was the highest ranked test of addictive behaviors among all professional counselors. Among clinical mental health counselors, it was the third highest ranked inventory overall, behind the Beck inventories for depression and anxiety. Further, Neukrug, Peterson, Bonner, and Lomas (2013) found that more than three-quarters of counselor educators who teach assessment use the SASSI-3 in their courses. Despite the widespread use of the SASSI-3, it does have its limitations; the SASSI-3 can be cost prohibitive for some clients and requires that those who use it receive specialized training. As a result, examining the psychometric properties of other instruments, specifically measures that are free or more cost effective and do not require specialized training to interpret, seems prudent.
The limited number of articles addressing specific types of addictive behaviors is problematic. Although common physiological and psychosocial processes exist across all addictive behaviors, there also are unique factors associated with the etiology, prevention and treatment of the various drug classifications and behavioral addictions (Brooks & McHenry, 2015). Indeed, prevention and intervention efficacy often correlate with information tailored to each need. In light of the current opioid and prescription drug epidemic—a 137% increase in drug overdose deaths and 200% increase in opioid deaths from 2000 to 2014 (Rudd, Aleshire, Zibbell, & Gladden, 2016)—examining the prevention and treatment of this specific classification of substances would be a prudent area of research.
Analysis of addictions-related research revealed that nearly two-thirds of all articles in the sample represented original empirical research. This is higher than what Ray et al. (2011) found in their content analysis of 15 counseling journals in print between 1998 and 2007; these authors found that approximately one in three articles published included original research. These findings suggest that despite addictions not being a topic commonly discussed across counseling journals, there may be greater attention to conducting research on addictive behaviors by counseling researchers. Or, this may reflect an overall trend among counseling journals to publish research since the final year (2007) of the content analysis conducted by Ray et al. (2011). The level of sophistication of data analysis in the articles in this sample is comparable to findings from past content analyses of long term publication trends in specific counseling journals; for instance, descriptive statistical techniques were among the most commonly used methods of analysis in JCD (Erford et al., 2011) and Journal of College Counseling (Byrd et al., 2012).
One of the most commonly used groups in addictions research was college students, which may indicate an over-reliance on the use of convenience sampling across institutions of higher education. A concerning trend observed in the data was that addictions professionals were utilized more as research participants than were clients in addictions treatment. Greater attention to understanding individuals who are enrolled in treatment can help researchers and professional counselors identify successful ways to tailor and personalize counseling interventions to fit the needs of specific client populations. In addition, although several articles used diverse populations, fewer studies examined addictions issues among discrete groups of men and women only. Moreover, twice as many articles were found that focused on men compared to women only. Additional research examining gender differences is necessary considering that men and women face unique issues related to the development and treatment of addictive behaviors (National Institute of Drug Abuse, 2015).
Limitations
The findings of this study should be viewed within the context of several limitations. An advantage of content analysis is that it can be used to help organize and summarize large quantities of information; however, by assigning each individual article to a category, it is possible that some distinctive characteristics of the articles in the sample may have been lost or trivialized (Riffe, Lacy, & Fico, 2014). In addition, the process of creating categories for the articles is researcher-driven and, even though efforts were made to develop the coding framework using the available literature, it is possible that different researchers would not have created the same levels of the study variables.
Other limitations relate to data collection and the coding process. Since the purpose of the present study was to analyze articles that focused on addictions, the sample was developed through a review of journal titles, abstracts and keywords only—an approach utilized in previous content analyses of specific topics within the counseling literature (Barrio Minton et al., 2014; Evans, 2013). In the unlikely event that an article focusing on addictions did not include one of the search terms in these three areas, it would not have been included in this study. Also, this study did not include articles in counseling journals that are affiliated with regional or statewide counseling organizations, such as The Journal of Counselor Preparation and Supervision, published by the North Atlantic Region Association for Counselor Education and Supervision, or the Virginia Counselors Journal, which is the journal of the Virginia Counseling Association. The authors chose to restrict their data collection to include only journals produced by NBCC, CSI, ACA and ACA member divisions because they believed that a content analysis of articles sampled from these national publications would provide a general overview of the addictions-related content discussed throughout the counseling literature.
Although inter-rater agreement among coders for most variables was satisfactory, reliability for coding the data analysis variable was lower than the minimal acceptable threshold suggested by Krippendorff (2013). Possible reasons for low concordance include the number of categories for this variable and the inconsistencies in how data analytic techniques were described within the various articles in the sample. Finally, as this study presented an overview of the types of addictions-related articles published in counseling journals, the quality of the publications was not evaluated during the coding process. This may be a possible next step for counseling researchers that could yield more rigor and, subsequently, evidence-based practices for addictions prevention and counseling.
Implications for Professional Counselors
According to the ACA Code of Ethics (2014), “Counselors have a responsibility to the public to engage in counseling practices that are based on rigorous research methodologies” (Section C, p. 8). When addressing issues related to addictive behaviors, professional counselors have a modest yet relatively diverse literature available to help guide their practice. Despite the fact that a large number of articles in the sample described approaches to addictions counseling, many of these papers were conceptual in nature and did not include original empirical research to assess counseling outcomes. To better assist professional counselors in using research-informed approaches, it is necessary for greater attention to be given by counselor educators and researchers to producing addictions-related intervention research and program evaluations.
The limited number of articles that evaluated treatment approaches also may represent a more endemic issue in counseling and counselor education. Many professional counselors report not feeling adequately prepared to operationalize and measure client outcomes, despite recognizing the need for these skills in their work (Peterson, Hall, & Buser, 2016). Although these skills have been identified as key research competencies in counselor education (Wester & Borders, 2014), it is unclear how these competencies are addressed in entry-level and doctoral research curricula. Researchers may wish to examine the ways in which professional counselors and counselor educators learn how to evaluate treatment outcomes. This may help inform the development of new pedagogical strategies that lead to an increased production of outcomes research on approaches to counseling and prevention in counseling journals.
In addition to a call for research on counseling outcomes, it also seems apparent that there is a need for more sophisticated research questions and hypotheses in research conducted on addictive behaviors. Addiction is a multifaceted phenomenon that involves the interplay of multiple biological, psychological and social determinants (American Society of Addiction Medicine, 2011); therefore, the use of descriptive statistics or univariate procedures may not capture the complexities of how addictive behaviors are initiated, maintained and extinguished. The use of more sophisticated data analytic techniques by researchers may help address this issue. Structural equation modeling can be utilized to simultaneously test the fit of an explanatory model of addictive behavior comprised of multiple independent and dependent variables. For example, Wahesh, Lewis, Wyrick, and Ackerman (2015) utilized structural equation modeling to evaluate the fit of a mediational model of collegiate drinking that included multiple determinants of alcohol use. Alternatively, qualitative methods can be used by researchers to provide an in-depth understanding of how various interpersonal, social and cultural variables shape individual behavior (Likis-Werle & Borders, 2017).
One way that counseling journals can increase the publication of articles that address specific issues related to addiction is by offering a special issue or section on these topics. Journal editors can develop a call for papers that focus on addictions-related issues salient to their publication’s readership. Depending on the particular journal’s audience, this can include examining prevention, a specific classification of addictive behaviors, or intervention outcomes, areas that were not well represented in the current sample of articles. For example, in 2011 CORE dedicated a special section (Volume 2, Issue 1) to substance abuse outcome research and measures. The use of special issues or sections across counseling journals can ensure that professional counselors have access to information that is germane to their work. JAOC may seem like a natural venue for topics related to addictions in counseling; however, that perception is problematic because JAOC is geared toward addictions and offender counselors, making it possible that the particular populations studied, findings and implications in articles published in this journal are not as relevant to professional counselors in other settings.
Although journal articles represent an important source of professional development, it is possible that professional counselors utilize other venues for continuing education. Future researchers can examine continuing education practices of counselors to determine the particular sources of education and whether or not the information provided through these venues is consistent with the typical scope of practice and professional identify of the counseling profession. Relatedly, it also seems necessary to determine where else counseling researchers and counselor educators publish their research on addictions counseling. While counselor educators in CACREP-accredited programs are expected to demonstrate scholarly activity in counseling (CACREP, 2016), it is possible that some addictions counselor educators publish in journals outside of counseling that specialize in addictions or have higher impact factors. Journal impact factors are a method of determining a journal’s significance in comparison to other journals in the field. Some counselor educators may seek to publish in journals with a more favorable impact factor for evaluation purposes related to faculty tenure and promotion (Fernando & Barrio Minton, 2011). Assessing author publication trends by reviewing the curriculum vitae of addictions counselor educators can help identify the journals in which they most frequently publish. Examining these trends can identify the types of addictions-related research and other scholarly work that are being produced by counselor educators and counseling researchers but are not appearing in counseling journals.
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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Edward Wahesh, NCC, is an Assistant Professor at Villanova University. S. Elizabeth Likis-Werle is an Assistant Professor at East Tennessee State University. Regina R. Moro, NCC, is an Assistant Professor at Boise State University. Correspondence can be addressed to Edward Wahesh, Villanova University, Education and Counseling (SAC 302), 800 E. Lancaster Avenue, Villanova, PA 19085, edward.wahesh@villanova.edu.
Jan 24, 2017 | Book Reviews
Dr. Chad Luke’s book, Neuroscience for Counselors and Therapists: Integrating the Sciences of Mind and Brain, is an excellent addition to any student’s, professor’s, or practicing clinician’s library. The book is written as a textbook but is surprisingly readable and has utility beyond the walls of the classroom. As neuroscience seems to be a force in the field of mental health, it is important for counselors to learn to integrate new knowledge rather than feel pressured to study a completely different discipline . This book is a first step in learning the basics about the brain and how this information could be integrated into counseling practice, without promising to be a “fix” or replacement for the techniques and skills already utilized by counseling professionals.
The structure of the text lends itself well to reading the book cover to cover and using the index to read the sections most applicable to your current practice. The beginning of the book sets the foundation for principles of neuroscience that are incorporated throughout the text. The field of neuroscience can be intimidating, especially because of the jargon and complex concepts that are outside the realm of social science. The first section discusses the physical structures of the brain, including neurotransmitters and basic brain functions. Any counselor who graduated more than a year or two ago and has not pursued continuing education in neuropsychology or neuroscience would find the first two chapters very helpful. Even if you have some knowledge of the brain, these chapters provide examples of how the information translates into the counseling relationship and case conceptualization, which is helpful when trying to incorporate the information into your own practice.
The second section of the book consists of four chapters that speak directly to theoretical orientations and the integration of neuroscience principles into those orientations. Dr. Luke assumes that most counselors reading the text have a solid understanding of theory prior to reading the book. He works from this assumption to pull major tenets from each theory and explain them in the context of neuroscience. These sections are well organized and full of client in session vignettes to bring the information to life.
The third and final section of the book is trans-theoretical and addresses commonly diagnosed or sub-clinical symptomology in the field of counseling through the lens of neuroscience. For counselors who identify more with an eclectic theoretical orientation, this section will hold special appeal. Dr. Luke examines anxiety, depression, stress and stress disorders, and substance abuse through the lens of neuroscience. He speaks to what these commonly diagnosed disorders look like in the brain and how neuroscience could be integrated into treatment options.
I appreciate that Dr. Luke isn’t claiming to be a neuroscientist but rather is a counselor educator interested in the clinical implications that neuroscience can have for his clients and students. This book is written by a counselor, for counselors, which makes it unique among the neuroscience literature. He has taken the time to read, digest and translate the information for counselors.
One of the few limitations I see in this text is the lack of information concerning how trauma affects the brain. Some sections left me feeling that I needed more information or that the author could have gone more in depth; more on multicultural issues and poverty would be a helpful addition. Trauma and poverty can have significant effects on the brain, and the symptomology can be seen within the counseling relationship. More on these topics could have been useful, especially for counselors working in community mental health settings or with underserved populations. The book itself is relatively short and thus a manageable read for a busy student or an equally as busy clinician or professor. The possible downside to having a manageable book is that it isn’t comprehensive; but then again, it could be argued that it should not be comprehensive. After all, we are counselors, not neuroscientists. We need to know enough information about neuroscience to support our clients on their path to wellness, which I believe this book fulfills.
Luke, C. (2016). Neuroscience for Counselors and Therapists: Integrating the Sciences of Mind and Brain. Thousand Oaks, CA: Sage.
Reviewed by: Charmayne R. Adams, The University of Tennessee, Knoxville
The Professional Counselor
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Oct 28, 2016 | Volume 6 - Issue 4
Neal D. Gray, Lindsay Kozak
This interview begins the Lifetime Achievement in Counseling Series at TPC that will present an annual interview with a seminal figure who has attained outstanding achievement in counseling over a career. Although there are many people in counseling who deserve to be designated as the first interviewee, I am honored to present the inaugural interview of Dr. Theodore P. Remley, Jr. I have known Ted for 25 years and consider him to be a mentor, a colleague and foremost, a friend. His contributions to the counseling profession, from teaching, research and scholarship to mentoring and introducing students to the globalization of counseling, is laudable. Dr. Neal Gray and Lindsay Kozak are no less worthy in accepting my editorial assignment of interviewing Dr. Remley. What follows are thought-provoking reflections from an outstanding counseling leader and visionary. —J. Scott Hinkle, Editor
Theodore P. Remley, Jr. is an author or editor of three counseling textbooks, a monograph series, numerous book chapters, and over 40 refereed journal articles, most of which are related to law and ethics in counseling. His co-authored textbook with Dr. Barbara Herlihy, Ethical, Legal, and Professional Issues in Counseling, is the most widely used ethics text in the counseling profession. He also has published books on ethical and legal issues in school counseling and marriage and family therapy. Dr. Remley has been a professor of counseling for over 35 years and currently holds the position of Professor of Counseling and Booth-Bricker Endowed Professor at the University of Holy Cross in New Orleans. In addition, he has held full-time faculty positions at Old Dominion University, where he was also the Batten Endowed Chair, the University of New Orleans, Mississippi State University and George Mason University. He is a former Executive Director of the American Counseling Association. Dr. Remley held the rank of Captain in the United States Army and has practiced as a school counselor, college counselor and private practitioner in both counseling and law.
Dr. Remley received a PhD in counselor education and supervision from the University of Florida and holds a JD degree from Catholic University in Washington, DC. He is a National Certified Counselor and a Licensed Professional Counselor in Louisiana, Mississippi and Virginia, as well as a Marriage and Family Therapist in Louisiana. He also is licensed to practice law in Florida and Virginia. Dr. Remley is a Fellow in the American Counseling Association and is the recipient of a Lifetime Achievement Award from the Association for Counselor Education and Supervision. He was selected as a counseling leader and featured in the book Leaders and Legacies: Contributions to the Profession of Counseling, edited by West, Osborn and Bubenzer (2003).
Dr. Remley has directed international counseling institutes in Ireland, Bhutan, Argentina, Africa and Italy. He was President of the Virginia Counselors Association and Chair of the Southern Region of the American Counseling Association. He was one of the leaders involved in getting the first licensure bill for counselors passed in Virginia in 1976. He has served on four state counseling licensure boards and chaired the boards in Virginia and Louisiana. He helped draft regulations for the District of Columbia board when it was first established and chaired the ethics committee for the boards in Virginia, Mississippi and Louisiana. He is the Founding President of the American Association of State Counseling Boards, the organization that provides a forum for counseling licensure boards in all states and jurisdictions to communicate with each other and work toward appropriate and fair regulation of the counseling profession. He served as a trustee on the board of Divine Word College in Epworth, Iowa, and was a member of the TRICARE study panel for the National Academy of Sciences Institute of Medicine. Dr. Remley offers readers a valuable perspective on the counseling profession based on his extensive experiences.
In this interview, Dr. Remley responded to seven questions formulated to explore his career, his impact on the counseling profession, and his thoughts about the current state and future of the counseling profession:
1. The counseling profession has made substantial progress during the time you have been a member of the profession. In your opinion, what are the three major accomplishments of the profession?
I earned my master’s degree in counseling from the University of Florida in 1971. More than 45 years ago the counseling profession was in a much different place than it is today. At that time, counselors in schools were called guidance counselors and most had minimal preparation in the field of counseling; there was little conversation about the professional identity of counselors; cultural differences were not acknowledged in the counselor preparation curriculum; almost all counselor educators were counseling or clinical psychologists; and employment possibilities for master’s- level counselors were limited primarily to schools, higher education, and rehabilitation agencies. Counselors who earned doctoral degrees in counselor education and supervision at the time would obtain licenses as psychologists because there were no licenses for counselors. The profession has indeed come a very long way in the past 45 years.
The most significant accomplishment the counseling profession has made during my career has been achieving licensure for counselors in all 50 states plus the District of Columbia and Puerto Rico (American Counseling Association [ACA], 2010). I was involved in lobbying the Virginia Legislature, which resulted in the first counselor licensure bill being passed in 1976. At that time in Virginia, counselors had been accused of practicing psychology without a license, and we thought the best response to that injustice was to create a separate license for counselors. We were fortunate to have Dr. Carl Swanson, who at the time was a counseling faculty member at James Madison University in Harrisonburg, Virginia, lead the effort that resulted in the first counselor license in the United States being established. In addition to being a counselor, Dr. Swanson also was an attorney and an Episcopal priest. I’m not sure whether it was his legal preparation or his spiritual connections that helped us get the bill passed, but we were successful in Virginia and the rest of the United States followed our lead. California was the last state to pass a bill to license counselors in 2009 (ACA, 2010). So, the effort to establish counselor licensure in all states took from 1976 to 2009 . . . a total of 33 years.
The second most significant accomplishment of the counseling profession has been the successful accreditation of counseling graduate programs through the Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2015). My international work in counseling has taught me that to be a recognized profession in any country, counselors have to be educated at universities. In most of Europe and in some other places in the world, counselors are prepared in private schools outside university settings, as indicated in Counseling Around the World: An International Handbook (Hohenshil, Amundson, & Niles, 2013). But requiring university degrees in the United States to become counselors was not enough. We had counseling master’s degree programs long before CACREP was established, but most programs were weak in that many required only 30 to 36 credits; there was no standardized curriculum, and clinical practica and internships were rare. CACREP has led the profession in establishing minimum standards for counselor preparation. Today in the United States, when a counselor graduates from a CACREP-accredited program, employers and the general public know the counselor is well-prepared to provide counseling services to clients. I am proud that my graduate advisor and mentor, Dr. Robert Stripling at the University of Florida, was a major leader in establishing CACREP for the benefit of the counseling profession.
The third major accomplishment of the counseling profession is the success of the National Board for Certified Counselors (NBCC, 2015). NBCC was created in 1982 when counselor education programs varied in quality and only a few states had licensure laws that provided a credential that demonstrated a counselor was well-educated and knowledgeable. Now that state licensure for counselors has been accomplished in all states, NBCC has developed into a major force in the continued development of the counseling profession. When the American Counseling Association is mired down by an impossible division-based governance structure and is pondering whether ACA can take a stand on important issues, NBCC, with its small board that has a strong commitment to advancing the counseling profession, has provided lobbying in Washington, DC, and throughout the United States to ensure counselors have the right to practice their profession and have access to jobs for which they are qualified. NBCC also has led the profession in supporting the development of the counseling profession throughout the world. By administering federal scholarships and creating their own scholarships, NBCC has supported the continued growth of the profession and encourages entry into needed areas in counseling (e.g., rural, minority services, military).
2. Which of the major accomplishments that you listed above was the most difficult to achieve for the counseling profession, and why?
Achieving counselor licensure in the 50 states, the District of Columbia, and Puerto Rico was the most difficult accomplishment. Counselors had to organize separately in 52 political jurisdictions, work together cooperatively and settle differences among themselves, overcome external resistance, particularly from psychologists and social workers, and often go year after year to state legislatures in order to get a state counselor licensure bill passed. Accomplishing such a monumental and difficult task in only 33 years still amazes me.
There was tremendous resistance to counselor licensure from many organizations, including state legislatures, psychologists, social workers and special interest groups. Ironically, the psychology profession actually started the counselor licensure movement by default because counselors were forced to seek licensure (or state regulation) when they started being accused by psychologists of practicing psychology without a license.
Generally, states do not favor regulating professions. In order to convince legislators that the counseling profession needed to be regulated, counselors argued that the general public cannot distinguish a qualified counselor from one who is not qualified and that unregulated counselors have the potential of doing significant harm to the public. State regulation of a profession defies the concept of free enterprise and has the potential of keeping qualified individuals from practicing a profession for which they have been prepared. Once a state starts regulating a profession, the process is quite expensive and must be monitored by legislatures to ensure that applicants and licensees are being treated fairly. Paradoxically, counselors who consider themselves helpers had to present arguments to legislators that some counselors had the potential of inflicting substantial harm upon members of the public who did not have the capacity to determine whether a particular counselor was competent. Providing examples of counselor incompetence to legislators was a painful but necessary task that was required to convince state lawmakers that regulation of the counseling profession was needed to protect the public.
In order to get counselor licensure bills passed, we also argued that counseling was a unique profession that was distinct and different from psychology and other helping professions. In Virginia, after the counselor licensure law was passed and implemented, we went back to the state legislature to argue that counseling was quite similar to the profession of psychology in that counselors had the proper training to diagnose and treat mental disorders, in order to be qualified to receive third party insurance company payments for services. Interestingly, legislative processes and politics often require compromise and even making seemingly contradictory arguments from time to time.
When state counselor licensure bills were being considered, psychologists, supported financially by the American Psychological Association (APA) and state psychological associations, argued before state legislators that counselors did not have adequate education to provide counseling services. Social workers essentially agreed with psychologists. Of course it was to the advantage of psychologists and social workers to keep counselors out of the job market so that counselors could not compete for professional positions and clients in private practices.
But psychologists and social workers were not the only groups who opposed counselor licensure—some counselors opposed it as well. Counselors who did not meet the minimum requirements state licensure bills established to become licensed argued that counselor licensure would take away their ability to practice in their respective states. As a result, almost all states grandfathered in the counselors who were already practicing, whether or not they met the minimum licensure requirements. While many counselors at the time were distressed that unqualified counselors were allowed to be licensed, this was one of the many compromises that had to be reached in order for counselor licensure bills to be passed.
Other compromises included the number of credits required for a counseling master’s degree (which ranged from 30 to more than 60), the required post-degree supervised experience (which ranged from none to 3 years), and the type of exam required (which varied from state to state). The result of such compromises was counselor licensure laws varying widely from one state to another. The differences in state counselor licensure laws is currently having an adverse effect on counselors who move from one state to another and also confuses the public because of the lack of standardization regarding the requirements for practicing the profession of counseling. It would be possible to rewrite state statutes to align with one another, but that would need to be accomplished state by state over time.
3. What do you consider to be your major contribution to the development of the counseling profession and why?
While I was Executive Director of the American Counseling Association (between the years 1990 and 1994), I wrote a column in the ACA newsletter called Guidepost, in which I listed the elements of professional counselor identity. That column has been quoted often and the statements of professional counselor identity being published today look very similar to what I wrote about more than 20 years ago. In my opinion, these are the four critical elements of professional counselor identity: (a) counselors approach mental health from a wellness (rather than an illness) perspective, (b) counselors believe that most mental health problems are related to a person’s developmental stage in life and therefore are transitory in nature, (c) counselors value prevention of mental health problems and early intervention when possible, and (d) counselors strive to empower clients to live independently and help them avoid becoming reliant on counseling services. After consultation with my colleagues in rehabilitation counseling, I added the fourth empowerment component of my counselor identity statement.
Counselors-in-training and counselors who interact with the public at large have to be able to articulate in a positive manner who counselors are and what we believe. We should never say that counseling is similar to psychology or social work, but instead should focus on statements that define our philosophy of helping others. When we fully explain our beliefs about helping, we are able to assist the members of the public to choose practitioners who are best suited to address their mental health needs. By providing counselors the four areas listed above that define our beliefs about counseling, I believe I have helped to advance the counseling profession and I am pleased I was able to publish that statement.
4. What three challenges to the counseling profession as it exists today concern you most?
The American Counseling Association’s (ACA) Ineffectiveness. ACA officers and staff members are dedicated and capable professionals who are not able to be effective in advancing the counseling profession because of the flawed structure of the organization. Our national counseling professional association has an organizational structure ineffective in moving the counseling profession forward; this is arguably the most significant challenge to the profession today. The major divisions of ACA have created very successful independent specialization organizations at the expense of the success of ACA. Unfortunately, we have the impossible situation in which specialty associations are actually in control of ACA, and whose interests likely include maintaining a weak national counseling association. Currently, divisions are allowed to include members who are not members of ACA, which increases their membership at the expense of ACA membership numbers. Divisions can operate independently of ACA, holding their own revenue-generating conferences and being involved with other activities that directly compete with similar ACA revenue-generating activities. This independence of divisions allows them to reap the benefits of being under the ACA umbrella without having any responsibilities and enables them to compete directly with ACA for members and revenue. Our professional association should have the ability to stand firm on professional issues that affect the livelihood of all professional counselors and should not be limited and held back by those who appear to want ACA to be a weak organization so that specialization organizations can prosper.
Unfortunately, the governing body of ACA is made up primarily of division representatives whose first allegiance is to promote their specialization organizations, not to promote the counseling profession as a whole. The unfortunate governance structure of ACA that allows divisions the power to make decisions for ACA as a whole is the result of the history of ACA, an umbrella association that was created as a federation of independent counseling associations. Although the profession of counseling has moved beyond the specialties controlling the overall counseling profession, ACA is stuck in the past with a governance structure that allows specialty divisions to make decisions for ACA. The profession of counseling currently lacks one singular, strong professional association presence. ACA should provide the united voice for all counselors and not allow special interest viewpoints to keep the profession from moving forward. We have worked hard to create the recognized and viable profession of counseling. CACREP and NBCC have done an excellent job of strengthening the counseling profession as a whole. However, the fact that the specialization divisions of ACA have separate administrators, offices, conferences and programs that compete directly with ACA threatens the future of the counseling profession. For each professional issue affecting counselors, for ACA to take a position, all specializations have to agree, which is almost impossible to accomplish. ACA as an organization is paralyzed and must be restructured or replaced with an effective association for all counselors if the counseling profession is to continue to prosper.
Failure to Standardize. A second concern is the inability of the counseling profession to standardize. CACREP has provided a model for preparing capable counselors and now the CACREP standards need to become the standard for state licensure. CACREP has already been adopted by NBCC as the standard for future national certification (NBCC, 2014). A lack of standardization has led to current issues and problems, including portability of counseling licenses from state to state, that in turn keep the profession from agreeing upon a strong professional identity, which in turn confuses the general public. If we want the public to embrace the counseling profession, we must standardize the profession and agree upon what is required to be a professional counselor.
The current attention given to complaints from psychologists about excluding them from holding faculty positions in counselor education programs and the response of some leaders trying to accommodate these complaints is a symptom of the counseling profession not having the ability or courage to take the steps necessary to standardize. Of course, as the counseling profession becomes stronger, there will be individuals who are dissatisfied. But those who are not supportive of strengthening the counseling profession should not be given the power to limit the counseling profession from moving forward. All counselors should be supportive of CACREP and NBCC, and those who are not supportive should refrain from negatively affecting the future of the counseling profession.
Job Categories. A third concern is that there continue to be many governmental agencies at all levels (federal, state and local) that lack job categories for counselors. As a result, counselors are sometimes not eligible for jobs they are qualified to perform where such positions are filled only by psychologists, social workers, or other non-counselors. In some agencies, counselors take jobs that include titles such as psychological technician, psychological assistant, social assistant, or even psychologist or social worker. With such inappropriate job titles, counselors often have no opportunity for advancement and their professional identity as counselors is compromised. We have made some progress in getting job categories for counselors established in some agencies, but there is much more work to be done in this arena.
5. What needs to change in the counseling profession for these three concerns to be successfully resolved?
ACA’s Ineffectiveness. Unfortunately, ACA is a dysfunctional association that has been paralyzed by its governance structure. The specialization divisions have control over the association that should be representing all counselors. The only solution, in my opinion, would be to restructure ACA so that the association would be governed by a small board of directors that is elected from the general membership and is responsive to the counseling profession, instead of being controlled by specializations within the profession. Interestingly, the TPC editor discussed this point at the Association for Counselor Education and Supervision conference 20 years ago (Hinkle & Kline, 1996), yet ACA continues to have an ineffective governance structure. Those in control of ACA should have a commitment to the best interests of the counseling profession as a whole. Currently, individuals whose main allegiance is to counseling specializations are in control of ACA. In order for the ACA governance to be restructured, the current ACA Governing Council members, who represent counseling specializations, would have to vote to give up their power over ACA, which I doubt they would consider. In my opinion, the division representatives who hold ACA Governing Council seats do not represent the view of the vast majority of ACA members who want ACA to be a strong association that promotes the overall counseling profession. If ACA cannot restructure so that it represents the counseling profession as a whole, then perhaps a new association that is not controlled by specializations should be formed that would replace ACA.
Failure to Standardize. State counseling licensure boards need to work together to achieve standardization in licensure laws and rules. The current movement to require that those licensed hold master’s degrees from CACREP-accredited programs is the best way to achieve standardization. NBCC has already announced that in the future only graduates of CACREP-accredited programs will be eligible for national counselor certification. The American Association of State Counseling Boards (AASCB; 2015) is encouraging state licensure boards to standardize counselor licensure requirements and to recognize counselor licenses from state to state. When AASCB was formed in 1986, a major goal of the new association was to standardize state counseling statutes, but obviously it is a difficult task since 30 years later that goal has not been accomplished.
Job Categories. In order to create job categories for counselors, each federal, state, and local agency and all private companies that hire mental health professionals must be lobbied individually. A massive effort to create job categories should be supported by NBCC and all counseling professional associations, and that effort should become a top priority.
6. Assuming some challenges will get resolved and others will not, what do you think the counseling profession will look like 20 years from now?
In 20 years, if the current challenges I have identified can be met and resolved successfully, I believe the public will have a better understanding of who counselors are, what their training is, and what services they are capable of delivering. Counselors will be the preferred mental health providers of the public because counselors are better prepared than other mental health professionals to deliver high quality counseling services. If the current challenges for the counseling profession are not resolved, in 20 years we will be where we are today, stalled on the road to establishing counseling as a strong profession in American society and being left behind in the arena of public recognition compared to other mental health professions.
7. If you were advising current counseling leaders, what advice would you give them about moving the counseling profession forward?
I see several contemporary leaders in the counseling profession already providing strong positive leadership. So I would say to other counselors that they should follow the lead of counselors who are arguing that ACA should be restructured so that it represents the counseling profession as a whole, who are advocating that state licensure boards adopt CACREP-accredited master’s degrees as the standard for licensure, and who are strongly and continually urging ACA to recognize that CACREP is the only legitimate organization that accredits counseling graduate programs. At the state level, counselor leaders should work toward getting counselor licensure board members appointed by governors who support adopting CACREP-accredited master’s degrees as the minimum standard for state counselor licensure. I appreciate the courageous leaders in counseling today who are willing to take the steps necessary to advance the counseling profession even when they lack the support they deserve.
This concludes the initial interview for the annual Lifetime Achievement in Counseling Series. TPC is grateful to Dr. Neal Gray and Lindsay Kozak for providing this interview. Neal D. Gray is an Associate Professor at Lenoir-Rhyne University. Lindsay Kozak is a counselor at Crossroads Counseling Center. Correspondence can be mailed to Neal Gray, Lenoir-Rhyne University, LR Box 7409, 625 7th Avenue NE, Hickory, NC 28601,
neal.gray@lr.edu.
References
American Association of State Counseling Boards. (2015). Welcome to AASCB. Broken Arrow, OK: Author. Retrieved from http://www.aascb.org
American Counseling Association. (2010). Licensure and certification. Alexandria, VA: Author. Retrieved from http://www.counseling.org/docs/licensure/72903_excerpt_for_web.pdf?sfvrsn=2
Council for Accreditation of Counseling and Related Educational Programs. (2015). Welcome to CACREP. Alexandria, VA: Author. Retrieved from http://www.cacrep.org
Hinkle, J. S., & Kline, W. B. (1996, October). Issues in mental health counselor education and certification: Why are we doing what we are doing? Paper presented at the National Meeting of the Association for Counselor Education and Supervision, Portland, OR.
Hohenshil, T. H., Amundson, N. E., & Niles, S. G. (Eds.) (2013). Counseling around the world: An international handbook. Alexandria, VA: American Counseling Association.
National Board for Certified Counselors. (2014). Important announcement. Greensboro, NC: Author. Retrieved from http://www.nbcc.org/assets/Change-announcement-flyer_2014.pdf
National Board for Certified Counselors. (2015). Understanding national certification and state licensure. Greensboro, NC: Author. Retrieved from http://www.nbcc.org/Certification/CertificationorLicensure
Remley, T. P., Jr., & Herlihy, B. P. (2016). Ethical, legal, and professional issues in counseling (5th ed.). Boston, MA: Pearson.
West, J. D., Osborn, C. J., & Bubenzer, D. L. (Eds.) (2003). Leaders and legacies: Contributions to the profession of counseling. New York, NY: Brunner-Routledge.
Oct 28, 2016 | Volume 6 - Issue 4
Emily Goodman-Scott, Jennifer Scaturo Watkinson, Ian Martin, Kathy Biles
School counselors’ job roles and preferences reportedly vary by educational level (i.e., elementary, middle and high school); however, several organizations, such as the American School Counselor Association, conceptualize and recommend school counseling practice and preparation through a K–12 lens. Little is known about how or if school counseling faculty members vary their preparation for specific educational levels. In this article, we discuss a national, mixed methods study of school counseling faculty (N = 132) experiences and perceptions regarding school counselor preparation for the elementary level. We focused on elementary school counselors due to their unique roles. Findings included faculty’s varied experiences and perceptions of differentiation, prioritizing a K–12 preparation focus, and several external factors driving their preparation such as state licensure and mandates, school counseling job opportunities, and student enrollment, motivation and interest in elementary school counseling.
Keywords: school counseling, elementary school, elementary school counseling, school counselor preparation, school counseling faculty
School counselors meet students’ academic, career, social and emotional needs through comprehensive school counseling programs (CSCPs) such as the American School Counselor Association (ASCA) National Model (2012, 2014a; Gysbers & Henderson, 2012). CSCPs have existed for the last 40 years and are frameworks for facilitating data-driven, student-focused, preventative, systemic and developmental school counseling services implemented in schools from preschool through 12th grade (ASCA, 2012; Gysbers & Henderson, 2012). According to student reports, CSCP implementation has been associated with higher student achievement scores (Sink, Akos, Turnbull, & Mvududu, 2008; Sink & Stroh, 2003); higher student grades and a more positive school climate (Lapan, Gysbers, & Sun, 1997); and students feeling safer, having better relationships with teachers, and earning higher grades (Lapan, Gysbers, & Petroski, 2001). Additionally, researchers found CSCP implementation was associated with higher student math and reading achievement scores; increased college and career readiness; lower suspension, discipline and truancy rates; and higher attendance, graduation and retention rates (Burkard, Gillen, Martinez, & Skytte, 2012; Carey, Harrington, Martin, & Hoffman, 2012; Carey, Harrington, Martin, & Stevenson, 2012). In summary, “when highly trained, professional school counselors deliver ASCA National Model comprehensive school counseling program services, students receive measurable benefits” (Lapan, 2012, p. 88).
Typically, school counselors are first equipped to implement CSCPs through their pre-service preparation programs. School counselor preparation, licensure and practice are often recommended as uniform across educational levels (i.e., elementary, middle, and high school). The Council for Accreditation of Counseling and Related Educational Programs (CACREP), the primary counseling accrediting organization, provides school counselor preparation standards P–12 (CACREP, 2015); most U.S. states and territories (N = 43/55) certify and license school counselors K–12 (American Counseling Association [ACA], 2012); and the ASCA National Model also describes their CSCP as K–12 (ASCA, 2012). However, many researchers have found differences in school counselors’ reported perceptions and job activities by educational level and have highlighted the unique role of the elementary school counselor (Dahir, Burnham, & Stone, 2009; Hatch & Chen-Hayes, 2008; Perera-Diltz & Mason, 2008; Rayle & Adams, 2008; Scarborough, 2005; Scarborough & Culbreth, 2008; Studer, Diambra, Breckner, & Heidel, 2011).
Compared to school counselors at other educational levels, elementary school counselors reported performing and placing greater emphasis on delivering classroom lessons and curriculum (Dahir et al., 2009; Perera-Diltz & Mason, 2008; Rayle & Adams, 2008; Scarborough, 2005; Studer et al., 2011), counseling interventions (Dahir et al., 2009; Perera-Diltz & Mason, 2008; Rayle & Adams, 2008; Scarborough, 2005), and school counseling program coordination and management activities (Dahir et al., 2009; Rayle & Adams, 2008; Scarborough, 2005). Further, elementary school counselors reported a greater emphasis on personal and social development and focused less on academic and career development when compared to high school counselors (Dahir et al., 2009); spent more time on parent planning, teacher consultation and collaboration, non-CSCP activities, and CSCP implementation based on the ASCA National Model (Rayle & Adams, 2008); were the most likely level to conduct activities aligned with CSCPs (Scarborough & Culbreth, 2008); and performed the least individual student planning (i.e., individual and group advisement) of all the levels (Perera-Diltz & Mason, 2008). Thus, despite the K–12 focus in school counselor preparation, licensure, certification and practice, school counselors reported significant differences between job activities at the elementary and secondary levels.
While much is known about differences among the educational levels, there has been little research directed toward investigating school counselor preparation by level. In this article, our research team reports the perceptions and experiences of a national sample of school counseling program faculty (N = 132) regarding elementary level preparation and discusses potential implications and future research. The aim of this study was to gain preliminary data and provide a foundation for future in-depth research and potential advocacy. Next, we will review literature on school counselor preparation.
School Counselor Preparation
General trends in school counselor preparation are sparse within the literature. School counseling faculty are members of master’s- and doctoral-level school counselor preparation programs who prepare pre-service school counselors through related academic, supervision and practical experiences (ASCA, 2014b; CACREP, 2015). Examining how school counseling students are prepared, Pérusse, Poynton, Parzych, and Goodnough (2015a) published the results of a national survey of school counselor preparation programs (N = 131) to identify trends in school counselor preparation credit hours, faculty professional experience, and course content required for school counseling students, comparing data collected in 2010 to similar data collected in 2000 (Pérusse, Goodnough, & Noël, 2001). When comparing trends in previous course offerings to those more recent, the researchers found substantial decreases in the percentage of school counseling preparation programs offering elementary (from 14.3% to 1.6%) and secondary (from 13.8% to 1.6%) school counseling specific courses (Pérusse et al., 2015a).
Next, Pérusse and Goodnough (2005) examined school counselors’ perceived preparation by educational level. In this national study, school counselors (N = 568) ranked the importance of 24 course content areas that prepared them for school counseling jobs; results included both similarities and differences in elementary and secondary school counselors’ responses. Both elementary and secondary school counselors ranked the same top five course content items as most important: individual and small group counseling, parent and teacher consultation, child growth and development, and legal and ethical issues in counseling. However, elementary school counselors ranked the following course content items as having a higher importance than secondary school counselors: understanding child growth and development; theories in counseling; psychopathology, DSM-IV and diagnosis; play therapy; curriculum and instruction, including classroom management; individual counseling, including crisis interventions; small group counseling; consultation with parents and teachers; coordination between teachers, parents and community; classroom guidance curriculum; program evaluation and developmental needs assessment; parent education; and writing research and grant proposals. Several participants recommended distinguishing elementary from secondary school counselor preparation. In analyzing participants’ anecdotal comments, researchers reported: “preparation should reflect that elementary school counseling is different from secondary school counseling” (Pérusse & Goodnough, 2005, p. 115).
In contrast, Goodman-Scott (2015) conducted a national survey that examined school counselors’ perceptions of their preparation and actual job activities (N = 1052), using a modified version of the School Counselor Activity Rating Scale (Scarborough, 2005). She found no significant difference by educational level in regards to participants’ reported preparation or job activities. Findings from Goodman-Scott, as well as those of Pérusse et al. (2015a), denote school counseling preparation and job activities could be shifting toward uniformity across K–12 settings, rather than differentiation by educational level.
Rationale and Purpose of This Study
Scarborough and Culbreth (2008) proposed that school counselors “may receive more generic training that covers grades K through 12 and lack exposure to the differences that exist between school levels” (p. 457). However, there is very little published research on school counselor preparation by educational level. The present study was developed by members of the Elementary Advocacy Task Force for the Association for Counselor Education and Supervision School Counseling Interest Network. We sought to conduct a study to investigate the current status of elementary school counselor preparation and lay the groundwork for future research and advocacy. We collected data from a national sample of school counseling faculty regarding their perceptions and experiences preparing school counseling students for the elementary level. The following mixed methods research question guided our study: What are school counseling faculty members’ perceptions and experiences preparing school counseling students for the elementary level?
Method
Mixed method designs employ both qualitative and quantitative methods, which can provide a rich and comprehensive understanding of a phenomenon (Creswell & Plano Clark, 2010; Frels & Onwuegbuzie, 2013). Researchers in the past have used descriptive studies to gather preliminary data and summarize trends on under-researched areas within counseling (Holcomb-McCoy, 2010; Lambert et al., 2007). Further, studies often employ qualitative methods to explore a phenomenon (Hunt, 2011). Due to the lack of research on school counselor preparation by educational level, we adopted similar approaches within a convergent mixed methods design. We analyzed demographic data and descriptive closed-ended survey responses (quantitative), and performed a qualitative thematic analysis on open-ended survey responses (Braun & Clarke, 2006). Then we used triangulation to converge the results of all analyses, with the overall goal of expansion, increasing the depth and breadth of the study due to multiple methods (Creswell & Plano Clark, 2010; Greene, Caracelli, & Graham, 1989). We prescribed to a social constructivist paradigm and relied heavily upon relativistic theory. Within this perspective, reality is subjective, there exists no absolute truth, and gathering multiple perspectives across sources is a research priority (Hays & Singh, 2012; Schwandt, 2007).
The Survey
We used a Web-based survey as a low-cost, rapid-return data collection method (Fowler, 2014). Through this survey, we gathered quantitative and qualitative data: participant and program demographics, descriptive information regarding school counseling topic differentiation, and open-ended responses regarding school counselor preparation by level. All data for this study were collected via Qualtrics, a university-sponsored, Web-based survey tool. We pilot-tested the survey for content and procedures with two leaders in school counselor education (Dillman, Smyth, & Christian, 2008) and made several related changes based on their feedback.
We collected a range of participant and program demographic and background information. Specifically, we gathered participant personal and professional demographics, and background information on their preparation programs and state requirements. Further, participants reported their related opinions and preferences regarding elementary school counselor preparation.
We examined school counseling faculty members’ perceptions of their differentiation of topics for elementary school counseling using 24 descriptive items. On the survey, we defined differentiation as school counselor preparation programs tailoring or modifying school counseling topics and program requirements, such as academic advisement and internship, respectively, by educational level (i.e., elementary, middle or high school). Based on the literature and national foci, we created these 24 items based on topics that elementary school counselors frequently conducted and current school counseling trends. These 24 descriptive items were two-part questions in which participants responded using two 5-point Likert scales: one to report their current level of differentiating each topic for elementary school counseling (0 = no current differentiation; 4 = highly differentiated; n/a = not applicable), and the second to communicate their preferred level of differentiating topics for elementary school counseling (0 = no differentiation; 4 = high differentiation; n/a = not applicable). Lastly, participants responded to open-ended questions regarding their perceptions and experiences pertaining to school counselor preparation by level.
Data Collection and Procedures
We solicited participants after obtaining approval from the primary researcher’s university institutional review board and recruited participants through several e-mail lists and professional contacts. For instance, we e-mailed the following individuals and organizations approximately twice, requesting they complete and distribute the survey to their membership: (a) the Association for Counselor Education and Supervision national and regional leadership, as well as the corresponding School Counseling Interest Network; (b) the Counselor Education and Supervision Network Listserv; (c) professional school counseling faculty contacts; and (d) counselor educators listed in the American School Counselor Association online membership directory. Our e-mail solicitations included a description of the participation criteria and study, informed consent, participants’ rights, researchers’ contact information and a survey link.
After closing the survey, we cleaned the data, including participants who met the inclusion criteria: participants who (a) identified as full-time school counseling faculty in the United States whose job description included teaching and supervising students in school counseling master’s programs, (b) completed 90% or more of our survey, and (c) agreed to the informed consent. Regarding survey completion, 271 participants started the survey, 192 completed the survey, and 132 met the inclusion criteria. We were unable to calculate a response rate due to the unknown number of individuals who received the request and were eligible for participation.
Participants
Participants were 74% female and 26% male. Their races and ethnicities included: 85% Caucasian, 4% African American, 3% Latino and 2% Asian and Pacific Islander, and 2% self-identified as multi-ethnic. Participants worked in 37 different states within the United States, representing all regions (19% West, 24% Midwest, 32% South and 25% Northeast).
Ninety-eight percent of the participants had earned a doctorate; doctorates included counselor education (64%), counseling psychology (11%), and either doctorates in educational leadership, educational psychology or clinical psychology (22%). Fifty-three percent of participants earned their doctorates from CACREP-accredited programs. Many participants described previously working as a full-time school counselor (94%), while approximately 63% of participants reported that either they, or another full-time school counseling faculty member in their program, had paid work experience as an elementary school counselor. Lastly, most participants (94%) believed school counseling professional organizations should advocate for elementary school counselors to be mandated in every state. In Table 1 we list additional reported participant, program and state information.
Table 1
School Counseling Program Demographics
|
School Counseling Program Demographics
|
%
|
| Require Clinical Experience at All Three Educational Levels |
31
|
| Clinical Requirements Are Based Upon State Certification/Licensure Standards |
83
|
| Group Supervision Is Separated by Educational Level |
15
|
| Internship Group Supervision with Other Counseling Specialties [e.g., mental health] |
26
|
| Program Has a Concentration for Students Who Desire to Be Elementary SC |
15
|
| State Mandates Elementary School Counselors |
27
|
| K–12 Certification/Licensure |
86
|
| Program Meets State’s School Counseling State Certification/Licensure Requirements |
100
|
| Program Is Accredited by CACREP |
66
|
| ASCA National Model Is Taught |
93
|
Data Analysis
As is common with convergent mixed methods studies (Creswell & Plano Clark, 2010), our data analyses involved independently analyzing each type of data (demographic and descriptive) and conducting the qualitative thematic analysis. We then merged the data in the interpretation. We concurrently organized demographic data and analyzed descriptive data using Microsoft Excel 2013 to examine participants’ reported current and suggested differentiation of school counseling topics for elementary school counseling.
Simultaneously, we also analyzed the open-ended survey data through Braun and Clarke’s (2006) thematic analysis (TA) methodology to analyze participants’ perceptions and experiences related to elementary school counselor preparation. Scholars have described TA as an independent method and a “flexible and useful research tool, which can potentially provide a rich and detailed, yet complex account of data” (Braun & Clarke, 2006, p. 5). Braun and Clarke outlined TA as a six-step process to identify, analyze and report qualitative data, including: (1) becoming familiar with the data, (2) creating initial codes through systematically coding the data, (3) developing initial themes, (4) reviewing the themes, (5) defining and naming the themes, and (6) creating a corresponding research report. We began TA by first becoming familiar with and immersing ourselves in the data—reading and re-reading the content, discussing our overarching reactions, and deciding on data analysis within the TA framework. Next we, the four members of the research team, each independently open coded the data (Creswell, 2013) and compared our results through consensus coding (Hays & Singh, 2012). During in-depth research meetings over the span of several months, we engaged in the iterative and consensual process of creating, defining and reviewing codes and themes until reaching consensus, or agreement between all team members. During this analysis, we used several TA strategies: theoretical theme development (i.e., analysis driven by the research question), a semantic approach (i.e., codes created from the data—we analyzed the concrete words/descriptions), and utilizing an essentialist-realist method to communicate participants’ realities (Braun & Clarke, 2006). Concurrent with the last stage of TA, we discussed our results and created this manuscript.
Lastly, we used data triangulation to compare several survey data sources. For instance, we triangulated demographics and background information, descriptive data and qualitative TA results to gain information about varied aspects of elementary school counselor preparation and create a more multifaceted understanding of the specified phenomenon (Maxwell, 2013). Overall, triangulation “is both possible and necessary because research is a process of discovery in which the genuine meaning residing within an action or event can best be uncovered by viewing it from different vantage points” (Schwandt, 2007, p. 298).
Strategies for Trustworthiness
We used a myriad of trustworthiness strategies to strengthen rigor of the qualitative thematic analysis (Hays & Singh, 2012). First, we utilized investigator triangulation to analyze data through many in-depth collaborative research meetings over the span of several months (Creswell, 2013; Hays & Singh, 2012), and we engaged in consensus coding–intercoder agreement through verbally reaching shared agreement on codes and themes (Creswell, 2013; Hays & Singh, 2012). Next, we created an audit trail to document our data analysis and research processes (Hays & Singh, 2012; Schwandt, 2007), and enlisted an external auditor who reviewed our codes, themes and data analysis to provide feedback and confirm systematic data analysis (Creswell, 2013; Hays & Singh, 2012). We participated in research team discussions at the start of and during data analysis to identify and bracket our assumptions and researcher biases (Schwandt, 2007).
The research team. A crucial component of the methodology was the establishment of the research team (Creswell, 2013). The research team was comprised of four individuals who met regularly for 2 years as part of the Elementary Advocacy Task force for the Association for Counselor Education and Supervision School Counseling Interest Network. This research project was initiated as part of the named task force. All authors were counselor educators and had previous school counseling experience. Specifically, the first author completed 2 years as a counselor educator and 3 years as a school counselor; the second author was a counselor educator for 8 years and a school counselor for 14 years; the third author was a counselor educator for 7 years and had 5 years of school counseling experience; and the fourth author had 12 years of experience as a counselor educator and 4 years of experience as a school counselor. The first three authors identified as Caucasian of European descent and had previous elementary school counseling experience; the fourth author identified as multi-ethnic (Caucasian of European descent and Native American) and had experience as a secondary school counselor. Additionally, the primary author was a female in her mid-30s; the second author was a female in her mid-40s; the third author was a male in his 40s; and the fourth author was a female in her mid-50s. We utilized the research team to challenge each other’s assumptions and biases during data analysis, as well as engage in researcher triangulation.
Results
In this study, we examined school counseling faculty members’ perceptions and experiences regarding school counselor preparation for the elementary level. To examine the research question, we triangulated three data sources: demographic and background information, descriptive data (Table 2), and qualitative thematic analysis results. Three themes resulted from the data analysis: Varying Conceptualizations of Differentiation, K–12 Preparation Focus and Factors Driving Elementary School Counseling Preparation. We will subsequently describe the themes and provide the results of the triangulation.
Table 2
School Counseling Faculty’s Highest Five Means and Lowest Five Means for Perceived Current and Preferred Differentiation of Elementary School Counseling Topics
| Current Elementary School Counseling Topic Differentiation |
M
|
SD
|
Preferred Elementary School Counseling Topic Differentiation |
M
|
SD
|
| Highest Five Items |
|
|
Highest Five Items |
|
|
| Classroom Lessons |
2.62
|
1.38
|
Classroom Lessons |
3.26
|
1.03
|
| Social/Emotional Issues |
2.50
|
1.46
|
Career Exploration |
3.20
|
1.20
|
| Human Growth and Development |
2.48
|
1.62
|
Human Growth and Development |
3.05
|
1.37
|
| Career Exploration |
2.41
|
1.51
|
Classroom Management Techniques |
3.04
|
1.89
|
| Creative Counseling Techniques |
2.37
|
1.41
|
College Readiness |
3.02
|
1.22
|
| Lowest Five Items |
|
|
Lowest Five Items |
|
|
| Educational Policies (Federal and State) |
1.36
|
1.34
|
Educational Policies (Federal and State) |
2.01
|
1.50
|
| Professional Identity |
1.24
|
1.40
|
School Counselor Leadership |
1.90
|
1.58
|
| School Counselor Leadership |
1.19
|
1.38
|
Professional Identity |
1.80
|
1.57
|
| Cultural Competency |
1.18
|
1.40
|
Social Justice/Advocacy |
1.73
|
1.58
|
| Social Justice/Advocacy |
1.09
|
1.34
|
Cultural Competency |
1.69
|
1.60
|
Note. M = mean; SD = standard deviation. Perceived Current Differentiation of Elementary School Counseling Topics items: 0 = no current differentiation; 4 = highly differentiated. Perceived Preferred Differentiation of Elementary School Counseling Topics: 0 = no differentiation; 4 = high differentiation.
Varying Conceptualizations of Differentiation
Participants described their perceptions and experiences regarding the differentiation of school counseling preparation through descriptive and open-ended qualitative data. In looking at the current and preferred descriptive items, participants ranked the degree to which they were currently and preferably differentiating school counseling topics for elementary school counseling, using a 0–4 point scale (0 = no differentiation and 4 = high differentiation). Participants’ current differentiation means were fairly moderate to low (means ranged from 1.09–2.62), meaning participants perceived providing little to average elementary school counseling topic differentiation. At the same time, participants communicated differences between their current level of differentiation and their preferred level of differentiation (preferred means ranged from 1.69–3.26). For example, participants’ means for each preferred item were higher than the means for each current item. Thus, participants reported low to moderate differentiation for the elementary level, but desired to differentiate elementary school counseling content to a greater degree than they were actually doing. Further, participants reported conducting and desiring greater differentiation among practical or application-based topics (e.g., developing classroom lessons, addressing social and emotional issues) compared to theoretical or philosophically geared topics (e.g., professional identity, cultural competency).
Through the open-ended responses, participants described their perceptions of and experiences with differentiating school counselor preparation for educational levels. For example, one participant described a practicum experience specific to the elementary level:
Our program adopted a K–5 charter school who has no school counseling services. We . . .
provided supervised classroom lessons pre-practicum in this elementary school. . . . The experience has been phenomenal for my students to learn about developmentally appropriate classroom management, curriculum design, lesson planning and delivery, as well as the social-emotional needs of kids.
Another participant described differentiation as modifying class discussions according to level: “The discussion in a class will of course be different depending on the level being addressed.” A different participant described differentiation occurring for assignments, based on students’ interests, yet also provided an alternative strategy for viewing the concept of differentiation:
Students can often tailor assignments so that they are most relevant to the [desired] level(s). . . .
Readings that have to do with specific levels are generally required for everyone [because] . . . it’s good to know what’s happening at other levels. I wonder if differentiation is what’s called for or if instead, inclusion and gauging the needed depth of exposure and skill?
A separate participant conceptualized differentiation as, “separate courses by level or that the instructor differentiates within the course by providing examples or options for various levels.” Yet, another participant described differentiation within the context of school counseling compared to other counseling tracks such as mental health counseling: “I have seen programs with ‘concentrations’ by which students take only one standalone course in SC [school counseling], MH [mental health], CC [college counseling] and the rest of the program is generic counseling.” Overall, participants’ responses to open-ended questions revealed varying conceptualizations and the implementation of differentiation.
K–12 Preparation Focus
Through demographic data and open-ended responses, participants relayed exposure to and a preference for using a K–12 focus when preparing school counseling master’s students. First, the majority of participants conveyed graduating from a CACREP-accredited doctoral program (53%) and current employment in a CACREP-accredited school counseling master’s program (66%). Nearly all participants reported teaching the ASCA National Model in their preparation program (95%). Additionally, most participants (86%) reported working within states with K–12 school counseling certification and licensure, and all (100%) participants’ preparation programs met their states’ certification and licensure requirements.
Through open-ended responses, several participants also described preferring and implementing a K–12 focus in preparing school counseling students. One participant said:
I think we are doing a disservice to our SC graduate students if we specialize too much during their master’s programs. It is important that they really understand the full range of developmental challenges and educational transitions so they can best collaborate across a comprehensive K–12 SC program.
Further, another participant stated: “Clearly there are level differences, but comprehensive programming needs to be K–12 and counselor education programs need to teach as such.” A different participant described:
I like that we prepare our students for elementary and secondary levels. This gives them the confidence to work at all levels once they graduate. I also think that training across levels is important to promote vertical articulation in school counseling programs and services.
Within the K–12 school counseling focus, participants valued some topic differentiation for elementary school counseling to reflect the unique components of that level. For example, two participants described the distinct differences between levels within a K–12, unified professional identity:
In our state, our students earn a K–12 certification. . . . We try to do the best job we can in preparing students for working at ALL levels. . . . There are some areas where we need to provide specific differentiated knowledge or skills just for elementary-age, but there are many things that cut across all levels (e.g., strong collaboration, teaching, listening, meeting facilitation, student advocacy, partnering skills and clear sense of school counselor identity, professional advocacy, comprehensive planning).
Another participant suggested providing a unified professional identity overall, despite some differentiation for each level:
The expectations . . . and the emphasis on specific roles, skills are different [for each level], and that needs to be addressed. . . . At the same time, too much differentiation can lead to more splintered identity and a less general skills set, which in the long run may not serve our graduates or their students well. [We are] striving for a balance of knowledge, skills and supervision that is level-specific with enough breadth of experience to solidify a professional identity.
Factors Driving Elementary School Counseling Preparation
Through open-ended responses and demographic data, participants described various drivers or influencing elements that impacted their decisions and beliefs regarding elementary school counselor preparation. Examples of drivers included state licensure and mandates; school counseling job opportunities; and student enrollment, motivation, and interest in elementary school counseling. According to participants, several external drivers impacted their school counseling preparation.
Several participants conveyed that various state licensing requirements and mandates influenced their elementary level preparation. For example, the majority of participants (86%) reported their state certified or licensed school counseling K–12, and all participants (100%) identified that their preparation programs met the state certification or licensure requirements. Thus, most participants’ school counselor preparation was driven by their state’s K–12 certification and licensing requirements. Several participants echoed these sentiments in their open-ended responses, including: “The certificate [is] K–12 so students must be prepared for all levels,” and “When I first started teaching about 13 years ago, there seemed to be a greater differentiation in levels. But within our state over the past year, the cert has moved to a PK–12, which better aligns with ASCA model roles and functions.”
Next, most participants’ states (70%) did not mandate elementary school counseling; thus, many participants did not feel they could prioritize elementary school counselor preparation. One participant stated: “Elementary school counselors are not required [in my state].” Another participant noted, “but for those of us in states with no mandate for ESC [elementary school counseling] positions, it’s [focusing on elementary school counseling] not feasible.”
Participants further described school counseling job availability as a driving force in their elementary school counselor preparation. A participant said, “we cannot offer courses specific to level based on the limited opportunities for elementary school counselors in our state,” and “[it] would be hard to justify an elementary school counseling focus in my program . . . locally few school districts have them [elementary school counselors].” Similarly, another participant stated: “Our students get 90% of their jobs in high schools.” Thus, participants may focus little on elementary school counseling due to the lack of available jobs.
Additionally, job availability and student interests were co-mingled driving forces. Some participants described implementing a K–12 focus in order to expose their students to a range of levels, in the event they cannot secure a job at their desired level. According to one participant:
Frequently, students leave our program hoping to work at a particular level but due to job scarcity in the region where they chose to live, they need to obtain a job at a different level. Sometimes they end up loving the level where they end up even though it was not their first choice.
Another participant mentioned: “I find that some of our students don’t necessarily go on to work at the level they interned at (or thought they would work at) and [the students] indicate they benefitted by being in courses that address all levels.”
According to several participants, student interest in pursuing jobs at the elementary school level was low and offering courses specific to preparing the elementary school counselor was not feasible. According to one participant: “We cannot offer courses specific to level based on enrollment issues.” Other participants stated the following: “We have a small program so we would not be able to offer classes for specific levels of school counseling practice,” and “We also have very few students interested in elementary. For some reason, only about two students or less tend to be interested in elementary every year. Most prefer secondary.” According to participants, students’ preferences were driving forces in school counselor preparation programs’ elementary school counseling focus. Generally speaking, participants’ decisions and preferences regarding elementary school counseling differentiation and preparation were influenced by the driving factors, or contextual realities, associated with certification and licensure, state mandates, job availability, and student interests.
Discussion
The school counseling faculty in our study reported conducting and preferring a K–12 focus in preparing school counselors, which is similar to preparation standards, certification and licensure requirements, and suggested school counseling job activities (ACA, 2012; ASCA, 2012; CACREP, 2015). The K–12 school counseling preparation focus in this study also is consistent with findings from recent studies from Pérusse et al. (2015a) and Goodman-Scott (2015), in which participants reported little difference in preparation by educational level. Thus, despite school counselors in several studies reporting differences in job activities and perceptions by level, school counseling preparation programs may incorporate a K–12 focus.
However, within a K–12 preparation focus, participants did see the necessity for differentiating certain educational topics to the elementary school level more than others. The highest means for current and preferred differentiation items included classroom lessons, classroom management techniques, social and emotional issues, human growth and development, career exploration, and creative counseling techniques. In comparison with the literature, school counselors at the elementary level report performing classroom instruction and management more often than school counselors at the secondary level (Dahir et al., 2009; Perera-Diltz & Mason, 2008; Rayle & Adams, 2008; Scarborough, 2005; Studer et al., 2011). Additionally, Dahir and colleagues (2009) reported that elementary school counselors spend more time on personal and social development as compared to their secondary counterparts. Furthermore, Pérusse and Goodnough (2005) found that elementary school counselors placed more priority on human growth and development and creative counseling techniques, such as play therapy, than secondary school counselors. Differentiating topics specific to career exploration and college readiness suggest that the participants believed these topics to be developmental, or K–12 in nature. A developmental perspective related to college and career counseling is widely discussed within the school counseling literature (Gysbers, 2013; Pérusse, Poynton, Parzych, & Goodnough, 2015b; Trusty & Niles, 2004). For instance, the College Board National Office for School Counselor Advocacy (2010) differentiates college and career readiness objectives by educational level with a strong focus on career exploration at the elementary level, where high school counseling attends to college admission and post-secondary transition to college. In addition to a career exploration, Trusty, Mellin, and Herbert (2008) contended that elementary school counselors should focus on building caring school cultures and increasing opportunities for family engagement as part of the college and career focus.
Content topics that participants perceived as requiring little differentiation at the elementary school level were the professional skills and knowledge associated with leadership, cultural competency, social justice and advocacy, professional identity, and knowledge of federal and state policies. Hence, the school counseling faculty in our study conducted and suggested less differentiation for broad, philosophical topics often addressed in the literature as spanning K–12. For example, within the ASCA National Model (2012), leadership, social justice and advocacy are addressed within a K–12 framework for program implementation. The most recent version of the ASCA National Model (2012) does not distinguish the role responsibilities of elementary school counselors differently than the secondary level. Additionally, within school counseling literature, professional identity (Gibson, Dollarhide, & Moss, 2010; Konstam et al., 2015), leadership (Mason, 2010), social justice and advocacy (Ratts, Dekruyf, & Chen-Hayes, 2007) and cultural competency (Moore-Thomas & Day-Vines, 2010) are not discussed specific to the role responsibilities of counselors at different educational levels.
Not only did participants express differentiating some educational topics, but through their open-ended responses they conveyed varied perceptions of and experiences with the overall differentiation construct, including differentiating class discussions and assignments, specific courses, practical experiences, and differentiating school counseling courses from other counseling tracks, such as mental health counseling. The examination of the school counseling preparation differentiation construct has been nearly nonexistent in the literature. The results of this study demonstrate initial insight to school counseling faculty’s perceptions and experiences regarding differentiation and the need for further related research.
Lastly, according to the school counseling faculty in our study, their preparation was driven by several external factors. Participants described their desire and actions to prepare school counseling students for all educational levels, K–12, which was often driven by K–12 state licensure and certification requirements. However, due to a lack of state-level elementary school counseling mandates, as well as limited job opportunities and student enrollment and interests, many school counseling faculty expressed concerns with and a lack of focus specifically on elementary school counselor preparation. In light of these external forces, it appears that the preparation of elementary school counselors may be less prioritized within a K–12 focus. Similarly, with the heightened national focus on college and career readiness, including the Reach Higher (The White House, n.d.) and Race to the Top (U. S. Department of Education, 2016) initiatives, and increased emphasis on college application rates, we wonder if elementary school counseling could be de-emphasized in national school counseling conversations.
Future Research and Implications
This study provided preliminary data on school counseling faculty members’ perceptions of and experiences with preparing school counselors for the elementary level. The most substantial implication is our hope that this study will provide a springboard for future research, which may inform teaching and advocacy. First, we suggest future studies utilize qualitative interviews to gain in-depth information regarding school counseling faculty processes and conceptualizations of differentiation in pre-service school counseling preparation. Researchers also could develop an instrument to measure differentiation in school counselor preparation to better understand the construct and its application. Further, more research is needed to examine the impact of external drivers and how school counseling faculty and preparation programs address such external drivers, including state-level school counseling mandates, job opportunities and national initiatives. Specifically, how do these external drivers influence school counseling preparation, practice and policy? Finally, future research can examine school counselor preparation for all levels. For instance, are certain levels prioritized within a K–12 focus?
This study also contains interesting implications for teaching and advocacy. Our findings suggest that many school counselor preparation programs wrestle with preparing students for aspirational practice versus preparing students for the realities of the field. Research shows the benefits of implementing a school counselor-run CSCP from kindergarten through graduation; however, there are many barriers to doing so. School counseling faculty must teach students best practices and cultivate their professional identity, while also preparing students to navigate the current educational climate and advocate for systemic change, bridging the gap between ideal and real school counseling. Further, school counseling faculty also must advocate for systemic change, supporting state-level mandates requiring school counselors at all levels and ensuring that national school counseling conversations and initiatives are inclusive of a K–12 focus.
Limitations
We identified several study limitations. Web-based surveys reach a limited sample due to the need for e-mail addresses (Fowler, 2014), and e-mail solicitations may be undeliverable due to e-mail filters (Dillman et al., 2008). We attempted to mitigate these concerns by soliciting participants through various school counselor education outlets. Next, we enlisted a convenience sample, and participants may have been motivated to complete the survey due to their interests and experiences; thus, our sample is not necessarily representative of all school counseling faculty across states. At the same time, the goal of this study was not to generalize findings but to gather exploratory data to guide future inquiry. Lastly, despite providing a definition of differentiation in the survey, participants expressed differing views on this construct, which turned out to be one of our primary themes.
Conclusion
Scholars have shown that students benefit from fully implemented CSCPs, which are facilitated at the elementary, middle and high school levels. Elementary school counseling is a crucial foundation of K–12 school counseling, especially in regard to proactive prevention activities for all students. Thus, school counseling students should be prepared for school counseling across all three levels. While little research has been conducted on differentiating school counselor preparation for the three levels, this study provides findings regarding school counseling faculty’s perceptions and experiences differentiating preparation for the elementary level, finding varying conceptualizations of differentiation, a K–12 preparation focus generally with some differentiation of school counseling topics, and factors driving elementary school counseling preparation. While more research is needed to further examine and expand on our study, there also exists a need to take stock of these preliminary findings. Participants reported several barriers to school counseling preparation at the elementary level. School counselors and school counseling leaders must investigate and advocate for the role and existence of the elementary school counselor to ensure that K–12 school counseling truly remains K–12, and that all students in K–12 can be served by a school counselor.
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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Emily Goodman-Scott, NCC, is an Assistant Professor at Old Dominion University. Jennifer Scaturo Watkinson is an Associate Professor at Loyola University Maryland. Ian Martin is an Associate Professor at the University of San Diego. Kathy Biles, NCC, is a Senior Instructor at Oregon State University, Cascades Campus. Correspondence can be addressed to Emily Goodman-Scott, Old Dominion University, 110 Education Building, Norfolk, VA 23529, egscott@odu.edu.
Oct 28, 2016 | Article, Volume 6 - Issue 4
Mehmet A. Karaman, Richard J. Ricard
Movements such as the Arab Spring (as described by popular media) and recent regional conflicts have forced people to leave their homes and flee to other countries or regions. Syrian refugees are currently the second largest refugee group worldwide, with half of them resettled in Turkey. Turkish government and non-governmental civil organizations have mobilized efforts to address the immediate survival needs of these refugees such as food, shelter and other provisions. Despite efforts to manage the complexity of mental health and social service needs of forcibly displaced people, counseling services are still lacking. This expository article addresses the mental health needs of Syrian refugees and provides implications for counseling professionals working with displaced people from a crisis intervention approach built on principles and perspectives of humanistic mental health. In addition, programs of support, such as the Mental Health Facilitator program, are discussed.
Keywords: Syrian refugees, mental health, Turkey, displaced people, Arab Spring
The Arab Spring has affected many Arabic countries in the region and resulted in regime changes and general disruption in people’s lives (Khan, Ahmad, & Shah, 2014). The Arab Spring refers to a wave of revolutionary civil unrest, riots, demonstrations and protests in the Arab world that began in December 2010 in Tunisia, and spread throughout the countries of the Arab League and its surroundings (“Arab Spring”, n.d.). The Syrian Republic is embroiled in a civil war in which separatists have been protesting for more democratic rights and the imposition of a civilian government. The region has been further destabilized by the conflict surrounding ethnic origin, and the political and religious activities of the Islamic State of Iraq and Syria (ISIS).
Approximately 6 million people have taken refuge in Turkey, Lebanon, Jordan, Iraq and Egypt since the Syrian conflict began in 2011 (United Nations High Commissioner for Refugees [UNHCR], 2016). According to the UNHCR (2016), the Republic of Turkey (Turkey) has accommodated the largest number of Syrian refugees in the region. The Turkish government quickly took the necessary steps, such as opening the border and providing food and shelter, after the first group of Syrian refugees entered Turkey on April 9, 2011. To date, there are roughly 2.8 million refugees living in camps and urban areas; half of these refugees are children (UNHCR, 2016). The majority of refugees (90%) live outside of camps and are surviving under challenging circumstances compared to the refugees who live in camps. Refugee camps offer health care, education, food, security and social services. However, refugees who live outside of camps have limited access to information and public services such as education and health care.
Syrian refugees are enduring daily challenges to physical and mental survival. In addition to the extreme needs for physical and nutritional interventions, mental health professionals recognize the urgent need for counseling services based on widespread documented reports of refugees’ exile experiences and exposure to multiple sources of trauma (Sirin & Rogers-Sirin, 2015). This crisis has resulted in a population of displaced people suffering from a number of mental health issues (Alpak et al., 2014; Betancourt et al., 2015; Clarke & Borders, 2014; Özer, Şirin, & Oppedal, 2013). For example, Önen, Güneş, Türeme, and Ağaç (2014) conducted a quantitative study on Syrians who resettled in refugee camps. The results indicated that 19% of refugees reported high levels of anxiety and 9% experienced high levels of depression. In a recent study, Alpak et al. (2014) reported that approximately one third (33.5%) of Syrian refugees showed symptoms consistent with a diagnosis of post-traumatic stress disorder (PTSD).
The fact that many of the displaced Syrians are especially vulnerable children living far from their homes, cultures and countries further highlights the magnitude of the crisis (Özer et al., 2013). Recent reports indicate that up to 50% of the Syrian refugees are children suffering from exposure to severe traumatic events at rates higher than their adult counterparts (Sirin & Rogers-Sirin, 2015). Özer et al. (2013) reported that 74% of Syrian children in a refugee camp have experienced the loss of a family member or a loved one, and 60% of children felt their lives were in danger. These self-reports of distress and concern are consistent with another recent study of 8,000 displaced Syrian children who reported constant fears (15.1%) and suicidal thoughts (26%; James, Sovcik, Garoff, & Abbasi, 2014).
Several indicators suggest that the severity of the current Syrian refugee crisis is unprecedented. A recent meta-analysis compared the relative rates of mental health disorders between refugees from different world regions and ultimate country of relocation (Fazel, Wheeler, & Danesh, 2005). Fazel et al. (2005) found that while up to 10% of refugees who relocated in Western countries experienced symptoms of PTSD, major depression and generalized anxiety disorder, the frequency of these diagnoses is significantly greater among the current Syrian refugee population (Alpak et al., 2014; Önen et al., 2014). For example, Syrian refugees who resettled in Turkey had a higher incidence of mental health disorders when compared to refugees from Southeast Asia, former Yugoslavia, and Central America who settled in Western countries (i.e., United States, Australia or Canada) collectively referred to as the Organization for Economic Cooperation and Development.
Recognizing the severity of the crisis, Turkey has initiated legal reform, established programs and practices, and requested humanitarian assistance from the international community to help manage the influx of Syrian refugees (Özden, 2013). Turkish government and non-governmental civil organizations have mobilized efforts to address the immediate survival needs of refugees, such as providing food and shelter. Despite these efforts, the available resources, including the number of counselors and other qualified mental health professionals, are inadequate to deal with the constant flow of Syrian refugees (Sahlool, Sankri-Tarbichi, & Kherallah, 2012). The vestiges of war have resulted in an increase in the prevalence of a number of psychosocial stressors and disorders (e.g., PTSD) as well as total desolation of social networks of family, friends and loved ones (Akinsulure-Smith & O’Hara, 2012). These challenges underscore the complexity of mental health and social service needs of forcibly displaced people in the region (Alpak et al., 2014).
This article highlights the challenges faced by the Turkish government related to a humanitarian response to the Syrian refugee crisis. Suggestions are provided for designing appropriate responsive counseling services for refugees from a diversity of sociocultural and geopolitical contexts. Principles and best practices (grounded in humanistic counseling theory) for addressing the mental health needs of diverse displaced people are discussed. Opportunities for generalization and specific cultural applications and adaptations are presented as well.
The Syrian Culture
Syria is located in Southwestern Asia at the eastern end of the Mediterranean Sea. It has its longest border with Turkey on the north, and is bordered by Israel and Lebanon on the west, Iraq on the east, and Jordan on the south. The majority of Syria’s population consists of Arabs (90.3%) and the remaining 9.7% consists of Kurds, Armenians and others (The World Factbook, n.d.). Religiously, Syria is a mosaic society. The vast majority of the population (87%) consists of Muslims (74% are Sunni and 13% are Alawi, Ismaili and Shia). Christians (Orthodox, Uniate, and Nestorian) are the largest single minority religious group (10%), and 3% of the population consists of Druzes (The World Factbook, n.d.). Before the beginning of the civil conflict (between the Syrian government and groups of citizens), positive intergroup relationships, for example between Christians and Muslims, were readily observed. However, the current situation of intergroup relationships is unknown since the political equilibrium has changed and continues to change rapidly.
Adherence to religious principles and cultural edicts are fundamental to a typical Syrian’s daily life. Islamic creeds and beliefs, such as Iman (faith) and Qadar (destiny), are elemental and strictly proscriptive of Muslim lifestyle (Eltaiba, 2014). Accordingly, traditions and customs associated with family life (relationships, marriages and future plans) are rooted in cultural and religious traditional practices. Family life is the center of Syrian social structure and extended families are the most common family type (Mahdi, 2003). Intermarriages between ethnic groups, religions and social classes are rare. As an authority figure, the father or the eldest man (grandfather) in the household has the power and is the foundation of a patriarchal structure, giving an advantage to males (Mahdi, 2003).
Addressing the Needs of the Syrian Refugees
Turkish officials have utilized a physiological and psychological needs-based approach (Inter-Agency Standing Committee [IASC], 2007) in the planning for a response to the refugee crisis. The approach has largely been adapted from humanitarian organizations (e.g., Red Crescent, UNHCR) that provide relief, crisis interventions and emergency services. Counseling services are usually not the immediate priority of refugees; most refugees will not seek available counseling or even be able to take part in counseling activities if they do not have a roof over their heads or food in their stomachs and are struggling to survive (International Federation of Red Cross and Red Crescent Societies [IFRCRCS], 2009). Consistent with Maslow’s (1943) original theory, crisis intervention efforts need to address the most immediate needs that threaten basic survival (e.g., hunger, safety) first. Once these basic needs have been met, individuals can address other difficulties associated with the experience of trauma (IFRCRCS, 2009). In this respect, the crisis level and needs of refugees determine the priority of counseling and psychosocial support services. National and international mental health crisis intervention organizations (IASC, 2007; IFRCRCS, 2009), such as the Turkish Red Crescent organization, have adopted IASC guidelines (2007) and the recommended four-level approach, which is described below, to assess the urgency of needs for refugees and victims of natural disasters.
Level 1: Basic Needs and Security
Syrian refugees are in need of basic services such as shelter, nutrition, education, medication and health care services. Approximately 1.4 million Syrian refugees are children (Orhan & Gündoğar, 2015; UNHCR, 2016), and the United Nations Children’s Fund (UNICEF; 2014) has reported that these children are at risk of being a “lost generation.” Moreover, security is a source of distress because of recurring aggression towards refugees who live out of the camps. These events continue along the border with Turkey. For example, a car bombing killed 57 refugees and wounded at least 80 Syrians near a border crossing between Turkey and Syria (UNICEF, 2014).
Level 2: Situation of the Community and Family Support
There is a sense of distrust within the Syrian refugee community that is rooted in the ongoing conflict in Syria (Chammay, Kheir, & Alaouie, 2013). Displaced persons from both sides of the conflict are often resettled together, despite differing political affiliations. Refugee families are struggling to survive in the midst of widespread fragmentation. For instance, Özer et al. (2013) reported that 74% of children in the Islahiye refugee camp had experienced the loss of a family member, affecting the well-being of the whole family.
Level 3: Focused, Non-Specialized Counseling Support
According to the Disaster and Emergency Management Presidency (DEMP; 2013), 51% of Syrian refugees report a need for some form of psychological support. In the same report, approximately 26% of refugees indicated dissatisfaction with the mental health care they received. In parallel with this finding, Chammay et al. (2013) stated that Syrian refugees felt disrespected by the mental health professionals.
Level 4: Specialized Counseling Services
In Turkey, counseling services are different than those in the United States and other developed countries. Turkish counseling services have focused exclusively on school settings and most counselors work as school counselors (Korkut, 2007; Stockton & Yerin Güneri, 2011). When compared to the United States, there are no specializations in the counseling education system in Turkey, such as clinical mental health, career counseling and addictions counseling. In Turkey, mental health services are provided within the medical field; thus, the majority of professionals who work in mental health have consisted of psychiatrists and nurses (Yilmaz, 2012). This situation has affected the availability of counseling and mental health services for Syrian refugees seeking assistance. The efforts of DEMP, Red Crescent, UNHCR, and other non-government and non-profit humanitarian organizations (e.g., Humanitarian Relief Foundation, Support to Life) are not enough to meet the counseling and mental health needs of Syrian refugees.
Mental Health Needs
Empirically validated research on the mental health needs of the Syrian refugees in Turkey and other countries (e.g., Lebanon) is limited due to a lack of focus on the assessment procedures and diagnostic reporting (Chammay et al., 2013). As documented by previous reports of forcible displaced peoples, Syrian refugees are at especially high risk for mental health problems as well as social and physical concerns and uncertainty about the future and current situation in Syria. Individual accounts of extensive violence, death and war illustrate the distress of refugee life at the personal level. For example, the following illustrates one refugee’s account of witnessed chaos in Syria:
The soldiers were gathering men in some areas. They interrogated a father, “Which one is your son?” the soldier demanded. The desperate man pointed out his son. The soldier then cut the man’s son’s throat first, then they shot the father. They were killing and burning so many people that the smell of burning bodies spread through the entire city, like a blanket of death smothering any hope of survival. (Korucu, 2013, p. 90)
This story highlights not only the experience of physical pain, but also fears, losses and spiritual wounds associated with protracted exposure to physical and emotional trauma. Although all refugees did not experience traumatic events or witness a massacre, they fled with other refugees who experienced loss, trauma and torture. The stories spread to others in camps and in the media, and as a result many fled to other countries to protect themselves and their loved ones.
Each refugee client has different needs, and “not every refugee who seeks counseling will require individual therapy for psycho-emotional issues. Counselors should not assume simply because of a traumatic background, intense loss, and other aspects of refugee experience that a refugee is necessarily psychologically impaired” (Baker, 2011, p. 122). In addition to basic physical needs, counselors need to be aware of and focus on the wellness and psychological needs of refugees. Research on well-being (Davidson, Murray, & Schweitzer, 2008) has highlighted the fact that health and wellness is indicated by more than a “lack of diagnosis” (Savolaine & Granello, 2002). There are common concerns that affect refugees in general. For instance, distress about the future, housing, employment, and separation from the family and the culture of the host country or community are predominant issues in refugees’ lives. These factors affect their emotions and holistic wellness (Clarke & Borders, 2014; Tempany, 2009). There are specific situations that affect the mental health of Syrian refugees. First, 83% of Syrian refugees have experienced a traumatic event (Chammay et al., 2013). The intensity of the experience and duration of exposure may affect the level of mental health. Stories and experiences of refugees who were exposed to the traumatic events can frighten other refugees who did not experience a traumatic event, triggering anxiety and stress. Second, unmet physiological needs may exacerbate feelings of insecurity and affect healthy psychological responses. Moreover, refugees’ lack of personal awareness of their own mental health needs can affect help-seeking behaviors. Third, there may be acculturative stress stemming from cultural differences and adaptation to the host culture, which can adversely affect mental health factors after immigration. Specifically, high risks exist for children who lost one or both of their parents in the war. Last, hearing about and seeing people continuing to die in the conflict through news and social media can increase or sustain depression and PTSD symptoms (Alpak et al., 2014).
These compounding mental health issues exacerbate the daily struggles faced by Syrian refugees and underscore the need for mental health intervention (Alpak et al., 2014; James et al., 2014; Özer et al., 2013). One of the most important counseling services would be multicultural transition and adaptation to a new (even if only temporary) living situation.
The Availability of Multiculturally Competent Mental Health Counselors
The impact of a counselor’s awareness of personal cultural values and a client’s worldview is foundational to multicultural counseling competence (Arredondo et al., 1996). We believe that mental health professionals in Turkey will be better able to provide culturally sensitive counseling support to refugees when they make efforts to understand and appreciate the customs and traditions of their Syrian clients (Arredondo et al., 1996). Despite the proximity and often shared religious ideology, considerable differences between Turkish and Syrian citizens (e.g., language, beliefs, cultural practices) may influence the quality of social services refugees receive in their host country. Although Turkey is the neighbor of Syria and shares many cultural and historical ties, a healthy process of cultural transition and adaptation is needed for refugees. More counselors, mental health facilitators (MHFs) and interpreters are needed to provide adequate mental health services, guide the refugee community in meeting their physiological needs, and inform the host culture to decrease prejudice.
Barriers, Challenges and Implications for Counseling
Counseling professionals need to be mindful of the diversity of displaced people. The majority of Syrian refugees fleeing to another country for survival bring different political experiences, levels of education, religions, ethnicities and levels of income to the resettled environment (DEMP, 2013). Counselors may face some challenges and barriers to providing services when working with this unique population. These challenges may include, but are not limited to, language, culture and dependence on Western-based counseling interventions. For example, some refugees might not attend group counseling if they are assigned to the same group with refugees who have different religious beliefs or ethnicity (Eltaiba, 2014). In such cases, counselors’ sensitivity and skills for addressing issues of cultural heritage and historical background of culturally different clients can transform disadvantages into advantages (Sue, Arredondo, & McDavis, 1992). There are effective resources and handbooks that provide detailed guidelines for working with refugees and forced migrants (Hinkle, 2014; IFRCRCS, 2009; UNHCR, 2013). A counselor can create his or her own guidelines for specific or general challenges of working with a refugee population. Specifically, when counselors work with Syrian refugees to create treatment plans, they should consider clients’ culture, religion, ethnicity, worldview and language in order to be more effective.
Language Barriers
The majority of Syrian refugees have resettled in Jordan, Lebanon, Iraq, Egypt and Turkey (UNHCR, 2016). While Syria, Jordan, Lebanon, Iraq and Egypt are Arabic countries and have a common culture and language, the majority of people in Turkey have a Turkish heritage and speak Turkish. Furthermore, the availability of Arabic-speaking counselors in Turkey is limited. Government organizations and social service agencies have experienced difficulty finding bilingual personnel as well (e.g., medical doctors, counselors; DEMP, 2013). Providers have responded by employing language interpreters to facilitate counseling contacts with refugees. Language barriers may create trust issues due to the existence of a third person in the session and it may be difficult for the counselor to establish rapport with the refugee client (Akinsulure-Smith & O’Hara, 2012; Baker, 2011). In this respect, several best practice approaches for maximizing the beneficial usefulness of interpreters are warranted. First, counselors may need to meet with the interpreter to explain confidentiality and the goals of the counseling interview; discuss the interpreter’s cultural background and cultural expectations; explain the need for detailed translation in the assessment; and discuss seating positions in the session (Baker, 2011; Paone & Malott, 2008).
When counselors work with interpreters they also need to consider interpreters’ citizenship status. Interpreters who are themselves refugees may be vicariously vulnerable to experiences reported by clients. Therefore, a program of careful screening, ongoing training, supervision and support for interpreters is vital (Miller, Martell, Pazdirek, Caruth, & Lopez, 2005). Programs of support, such as the National Board for Certified Counselors’ (NBCC) Mental Health Facilitator (MHF) program (Hinkle, 2014), would be helpful for Turkish counselors and interpreters. The MHF program covers the global aspects of community-based mental health training. The MHF initiatives are designed to empower local community members with skills for providing basic mental health services to people who are in crisis (Hinkle, 2014). By working with local volunteers, the MHF programs bridge the gap created by limited access to mental health services provided by mental health professionals, such as professional counselors, psychiatrists, social workers and clinical psychologists. The MHF curriculum includes implementation strategies for nonclinical, basic assessment, social support and referral services (Hinkle, 2014). While the current MHF curriculum and materials are available in the Arabic language, recent reports indicate that materials have not yet been translated to Turkish. Access to culturally sensitive training programs like MHF may be a crucial element to increasing the impact of mental health initiatives targeting refugee populations. Turkish governmental authorities and non-profit organizations would be wise to take immediate action with NBCC to adapt this program to Turkish.
Language immersion efforts are one promising approach to minimizing the impact of linguistic barriers. For example, approximately 87% of the Syrian refugees in Turkey reported that they wanted to learn Turkish (DEMP, 2013). The government and non-profit organizations have Turkish courses for refugees in the camps and cities. Counselors may use these classes as one of their referral sources. The classes also give an opportunity for clients to attend an activity, engage in the society, meet with new people from their own cultures and communicate with local residents.
Challenges Due to Refugee-Host Community Relations
A rapid influx of migrants can place considerable stress on the fiscal and emotional resources of the host country (Orhan & Gündoğar, 2015). The current Syrian refugee crisis has shifted from a humanitarian to a political crisis for other countries (e.g., Germany, Sweden, France; Hebebrand et al., 2016). Many refugees who live in Turkey are trying to fly to other European countries. However, politicians of those countries are not willing to accept refugees because of security, resources and possible dissent of their citizens (Hebebrand et al., 2016).
Although Turkey and Syria have longstanding historical ties and similar cultural and religious orientations, refugees will almost certainly experience acculturative stress, oftentimes as a result of negative reception from the host country (Betancourt et al., 2015). For instance, residents of the Gaziantep province, which has the second highest number of Syrian refugees in Turkey, protested against refugees and initiated physical attacks on them. The conflict increased the tension in the city and forced authorities to resettle some refugees in other provinces.
Bektaş (2006) has indicated that attempts at a multicultural curriculum in Turkish counseling education programs are not enough, and there is not a current mechanism or system (e.g., CACREP) to promote multicultural counseling competencies among Turkish counselors. Governmental and non-profit organizations need to consider diversity and ethical considerations when recruiting counselors for counseling and mental health services. The Turkish government’s policies toward the ongoing situation in Syria might polarize the government officials and mental health professionals who work with the Syrian refugees. At this point, counselors should be aware of their own personal views, biases and political ideas. They should be able to focus on their role as counselor rather than as resident or citizen.
With respect to provision of clinical mental health services, tensions between residents and refugee groups may interfere with effective receipt of counseling interventions by refugees. These events might cause mistrust towards counselors since they can be seen as part of the system, members of the host culture or representatives of the authorities (Vanguard, 2014). Holistic and advocacy-based services are more beneficial for refugees to cope with cultural difficulties (Baker, 2011; Clarke & Borders, 2014). These services include psychosocial support, counseling, referral sources, education and programs for the host community. Furthermore, counselors can provide additional services, which are not listed here, based on the needs of refugee clients.
Cultural and Spiritual Challenges
Syria represents an Eastern culture with dominant collectivist characteristics (Samovar, Porter, & McDaniel, 2010). The religion of Islam plays a role not only in individuals’ personal lives, but also in social life and society. Religion and spirituality are a way of life for Muslims across different cultures (Eltaiba, 2014). Religion determines the relationship between men and women, social roles, laws of inheritance, what people can and cannot eat, childcare, marriage and more. In addition to the culture of religion, traditions guide people’s lives as well. As mentioned before, the Syrian culture has a patriarchal structure. In this situation, men have more rights and freedom than women (Mahdi, 2003). For example, this patriarchy can create problems when counselors plan for group counseling. It can be difficult for women to talk about or share their problems in front of men. In this respect, dividing groups based on gender can be more effective.
In such cases, religion and spirituality can be explored in individual counseling sessions. Research has shown that religious coping can be used effectively by refugees (Clarke & Borders, 2014). For example, a Muslim refugee client might think that he or she deserves the current circumstances and whatever happens is Allah’s will. This belief represents the basic idea of Qadar – destiny or fate – and should be addressed carefully by the counselor because Qadar includes the individual’s will and belief that everything comes from Allah/God, and since refugees are under stress they can give up all the responsibility to Allah or God. A holistic approach that focuses on both the individual’s and society’s values and needs should be implemented since culture and religion provide significant means for coping.
Challenges With Counseling Interventions
Many migrants and forced refugees are not familiar with the concepts of counseling, which might seem strange to them (Akinsulure-Smith, 2009; Akinsulure-Smith & O’Hara, 2012). Refugees need to understand the services available in order to benefit maximally from them. The government and humanitarian agencies need to use terms that make sense for Syrians. When organizations prepare brochures, handbooks, reports and name plates, they should explain available mental health and counseling services, define counselor, and explain their services. Most Turkish counselors who work with Syrians were educated in Turkish counseling programs, which were modeled on U.S. programs and included Western-based counseling theories (Mocan-Aydin, 2000). This Western-based education and theories might decrease the effectiveness of counseling and challenge counselors because Syrians come from an Eastern culture. Since they have moved to a new culture, been separated from families, and experienced pressure and persecution, many refugees do not understand their new culture or know where to find help. In this respect, a group of Syrian mental health facilitators trained with the NBCC MHF program can be a valuable resource for working with this population (Hinkle, 2014). The inclusion of trained community volunteers will likely increase refugees’ access to mental health services while simultaneously decreasing the work load of professional counselors.
Conclusion
Over 2.8 million Syrian refugees have resettled in Turkey in the period of 2011 to 2016 (UNHCR, 2016). As the refugee population continues to grow, host nations will need to prepare a systematic response to this continuing humanitarian crisis in ways that support the basic human needs of forcibly displaced people. The Turkish government has responded to the presence of Syrian refugees with interventions that support basic survival needs (i.e., food and shelter). The availability of mental health and social services for refugees is limited and remains a focus of humanitarian assistance. Counselors should be cognizant of the traumatic experiences refugees often endure in the context of displacement and ongoing conflict. Counselor training and facilitation of community-based mental health advocates such as those provided by MHF can increase the impact of available counseling interventions for refugees. In addition, the IASC four levels crisis intervention approach, which is used by the Turkish Red Crescent organization, can be beneficial to address traumatic experiences and the needs of refugees.
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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Mehmet A. Karaman is an Assistant Professor at the University of Texas Rio Grande Valley. Richard J. Ricard is a Professor at Texas A&M University-Corpus Christi. Correspondence can be addressed to Mehmet A. Karaman, EDUC 1.642, 1201 West University Dr., Edinburg, TX 78539-2999, Mehmet.Karaman@utrgv.edu
