The Development of a Sexual Orientation Scale for Males

Sep 2, 2014 | Article, Volume 1 - Issue 3

Sachin Jain, Santiago Silva

One of the major flaws in current psychological tests is the belief that a prediction/diagnosis can be made that would tell an individual whether he is heterosexual, homosexual or bisexual. What is needed within the profession, however, is an assessment that has the sensitivity to help clients explore their sexual orientation. A pilot 100-item Sexual Orientation Scale was developed after interviewing 30 self-identified gay men who considered themselves happy/satisfied. The items summarized the thoughts and feelings of these 30 men during the discovery process and ultimate acceptance of their sexual orientation. The scale was then completed by 208 male participants. The Cronbach’s Alpha Coefficient was calculated for the initial 100-item version of the Sexual Orientation Scale along with item analysis and factor analysis. These statistical manipulations were computed to help eliminate items that did not discriminate well. The final version of the Sexual Orientation contains 43 items. Implications for the use of this scale and future directions in research are further explored.

Keywords: sexual orientation, scale development, males, assessment, exploration

As children grow up in our society, they are introduced to a wide range of knowledge about sexual behavior by their parents, siblings, and peers. Part of their education addresses the ideas of sexual orientation and/or preference. The inherent messages in this education are that a person is either heterosexual (sexually attracted to members of the opposite sex), homosexual (sexually attracted to members of the same sex), or bisexual (sexually attracted to members of both sexes).

Historical Overview of Sexual Orientation

A number of theories on the origin of homosexuality have attempted to define homosexuality. A number of these theories (c.f. Drescher, 2008; Ellis, 1936; Freud, 1922/2010; Krafft-Ebing, 1887/1965; Nuttbrock et al., 2009) place sexual orientation within the context of an individual’s overall sex role identity. These individuals link sexual attraction for men toward women with a masculine sex role orientation and sexual orientation toward men with a feminine sex role orientation (Axam & Zalesne, 1999; Mata, Ghavami & Wittig, 2010; Storms, 1980). Sexual orientation refers to a particular lifestyle (behavior) that an individual displays. Storms (1980) and Moradi, Mohr, Worthington, & Fassinger (2009) found most theories about the nature of sexual orientation emphasize either the person’s sex role orientation or erotic orientation. Although these assumptions have had a major impact on the development of theories, research, clinical practice, and even popular stereotypes, neither assumption has been adequately tested in past research. A homosexual person is one defined as having preferential erotic attraction to members of the same sex and usually (but not necessarily) engaging in overt sexual relations with them (Crooks & Baur, 2008; Marmor, 1980).

Cass (1984) and Harper & Harris (2010) identified four steps in the discovery process that people experience as they begin to identify their sexual orientation:
1. Individuals come to perceive themselves as a homosexual by adopting a self-image of what it means to be homosexual.
2. Individuals take this self-image a step further and allow it, through interaction with others, to become a homosexual identity.
3. Individuals assume the necessary affective, cognitive, and behavioral strategies in order to effectively manage this identity in everyday life.
4. Individuals find a way with which to incorporate the new identity into an overall sense of self.

Assessment of Sexual Orientation

Fergusson & Horwood (2005) wrote a review of the multitude of methods that have been used to assess sexual orientation. Conceptualization of sexual orientation as dichotomous (i.e., heterosexual and homosexual) was overturned over 60 years ago by Kinsey, Pomeroy, and Martin (1948) and by Kinsey, Pomeroy, Martin, and Gebhard (1953). These studies resulted in the development of a 7-point scale in which 0 represented exclusive heterosexuality and 6 represented exclusive homosexuality. Three on the scale indicated equal homosexual and heterosexual responsiveness. Individuals were rated on this continuum based upon their sexual behavior and physical reactions (i.e., physical attraction to desired partners) (Coleman, 1987; Fergusson & Horwood, 2005).

Although this notion that people fall in a continuum better represented the realities of the world (Bagley & Tremblay, 1997; Silenzio, Pena, Duberstein, Cerel, & Knox, 2007), the Kinsey Scale has many limitations for accurately describing an individual’s sexual orientation. The scale assumes that sexual behavior and erotic responsiveness are the same within individuals. In response to this criticism, Bell and Weinberg (1978) used two scales in their extensive study of homosexuality. They examined two scales: one for sexual behavior, and one for erotic fantasies. Bell & Weinberg (1978) found discrepancies between the two ratings. Paul (1984) and Garnets & Kimmel (2003) also reported discrepancies in approximately one-third of their homosexual samples. It was reported that most men saw their behavior as more exclusively homosexual than their erotic feelings (Coleman, 1987; Fergusson & Horwood, 2005; Schwartz, Kim, Kolundzija, Rieger & Sanders, 2008).

Coleman (1987) and Fergusson & Horwood (2005) suggested that while this dichotomous and continuous view of sexual orientation represented an improvement in assessment of sexual orientation, several clinicians and researchers have recommended additional dimensions (Fox, 2003). These dimensions are those based upon both the biological sex of the partner and the biological dichotomous sex of the individual.

As the literature on psychological testing and homosexuality unfolded, it became clear that tests were not very effective in creating special scales, signs or scoring patterns that could differentiate homosexuals from heterosexuals (Garnets & Kimmel, 2003; Paul, Weinrich, Gonsiorek, & Hotvedt, 1982). Homosexuality was no longer being studied as an illness. Contrastingly, literature has brought forth strong data that dismiss the notion that homosexuality is a disorder (Cass, 1984; Coleman, 1982; Harper & Harris, 2010; Henchen & O’Dowd, 1977; Morin & Miller, 1974; Tripp, 1975; Troiden, 1977; Weinberg, 1978).

One of the major flaws in current psychological tests is that there is a belief that a prediction/diagnosis can be made that would tell an individual whether he is heterosexual, homosexual, or bisexual. It is the authors’ belief that it is inappropriate to predict what kind of lifestyle an individual will/should follow. What is more feasible is to assist an individual as he or she explores the experience of uncertainty. Therefore, an instrument is needed that has the sensitivity to help clients explore their sexual orientation, not one that identifies levels of disturbance.

Purpose of the Study

The purpose of the study was to construct an instrument that would help counselors in assisting clients who wish to explore sexual orientation. The instrument was to:
• Identify issues that need to be addressed by the client during the discovery of sexual orientation.
• Focus on issues such as self-definition, self-acceptance, fears, sexual fantasies, and understanding of lifestyle.
• Provide an information base for counselors as they help their clients unfold significant characteristics of their personality.
• Provide counselors a tool for helping clients meet the challenges they face now and will face in the future.

Method

Participants
The volunteer population of this study consisted of males who were either a) receiving personal counseling at a university counseling service, community mental health agency, and/or private practice; b) enrolled in introductory psychology classes at universities or community colleges; or c) participating in local men’s groups (i.e., Jaycees, Lions Clubs, support groups, etc.).

Two universities in California, eight universities in Texas, and one university in Wisconsin assisted in the collection of data. Three mental health agencies and four private counseling centers also were recruited for assistance in data collection. The private counseling centers served primarily gay and lesbian clients from the Dallas/Ft. Worth area.

Directors and/or counselors at the mental health sites mentioned above were visited. The purpose of the study was explained and they were asked if they would approach their clients (straight and gay) to determine their willingness to participate in the study. If the counselors were willing to speak to their clients, they were given instructions to share with clients who agreed to participate. They were instructed to give the client the research packet and return the completed information in the enclosed addressed/stamped envelope. Seventy-five agreed and completed packets from this group of mental health agencies were obtained.

Permission from psychology professors at the universities and/or colleges to address their introductory psychology classes was obtained for recruiting more subjects. The purpose of the study was shared with the class, willing participants were moved to another classroom, and they completed the research packet. One hundred and six packets were completed through this procedure.

Men’s groups were approached to obtain additional participants. Groups such as Jaycees, Lions Clubs, and Gay Men’s Support Groups were contacted and visited. A presentation was made that addressed the purpose of the study. Willing participants were provided with information packets, which they returned in enclosed envelopes. Thirty-three completed packets from representatives of the men’s groups were received. Twenty-eight of the 33 came from gay men’s support groups.

Demographic information from the personal data form was summarized and examined across the variable of sexual orientation on the following factors: educational level, socio-economic status, age, ethnicity, self-rating on the Kinsey Sexuality Scale and whether or not the participant was currently in counseling or psychotherapy. The males in the sample identified themselves as being either homosexual (gay) or heterosexual (straight). The males self-identified as gay or straight by rating themselves on the seven-point Kinsey Sexuality Scale (0=exclusively heterosexual to 6=exclusively homosexual). Straight responses were identified as those of which the men rated themselves as zero (0) or one (1) and gay responses were identified as those in which the men rated themselves as five (5) or six (6) on the Kinsey scale. Only six subjects rated themselves as 2, 3 and 4. The scales completed by these 6 subjects were not used in this study.

The sample consisted of a total of 208 men from cities in Texas, Wisconsin, and California: 132 were between the ages of 18–25 (63.5%); 52 were between the ages of 26–33 (25.0%); and 24 were between the ages of 34–40 (11.5%). According to the Kinsey Scale Rating, 104 were straight (50%) and 104 were gay (50%). Of the men who participated in the sample, 85 (40.9%) had received counseling and 123 (59.1%) had not.

Procedure

The first procedure consisted of the development of the items for the Sexual Orientation Scale. In order to achieve this task, thirty gay men who described themselves as being happy/satisfied with the gay lifestyle were interviewed. The men were identified via personal contacts and gay organizations. Their input was used to develop items for the Sexual Orientation Scale.

Three small group meetings of approximately two hours each with about ten men were scheduled. Each meeting began with a statement of the purpose of the groups and the study. It was explained that data was being collected to formulate a scale that would help people clarify questions about their sexual orientation. It was explained that the scale was not designed to label whether someone was gay or straight, but simply to identify issues surrounding sexual orientation. Time was allotted for questions and answers.

Participants were asked for permission to record the group session. When permission was obtained, participants were asked about their experience of the discovery process of their sexual orientation (e.g., “What struggles did you experience?” “What questions did you ask yourself during this discovery process?” “What were you feeling?” “Did you get in touch with any fears?” “What kind of sexual fantasies did you experience?”). These questions were asked in order to help the participant recall their discovery process. Participants were allowed to ask each other questions and/or identify with what was being shared in a casual and informal atmosphere. Recordings of the three small group meetings provided the source for the 100 items that represented thoughts and feelings the men experienced during their discovery process. These 100 items consisted of Phase 1 of the Sexual Orientation Scale development.

After the pilot scale was developed, packets were sent out to university counseling services, psychotherapists in private practice, and community mental health agencies. The packet consisted of: (a) a personal data form, (b) the 100-item Sexual Orientation Scale, (c) an informed consent form, and (d) an addressed and stamped envelope. Data on the 100-item Sexual Orientation Scale also was collected from different men’s groups and from the introductory psychology classes both at universities and community colleges.

Two hundred and eight packets were completed. Coincidently, 104 responses were from gay individuals, and 104 were straight responses. The responses were then transferred onto Scantrons and submitted for analysis.

Instrument Development
Item construction. Tests are composed of a number of items that are used to measure a particular subject. According to Wesman (1971), an item may be defined as a scoring unit. Creating an item should be taken seriously because each item in a test produces a unit of information regarding the person who takes the test.

Writing a test item is an involved process. Test items need to be subjected to constant evaluation in order to ensure, as much as possible, that they are measuring what they are intended to measure. The items developed for the Sexual Orientation Scale represent two variables: self-image and eroticism. These variables have been continuously identified in sexual-orientation literature (Cass, 1984; Coleman, 1982; Eliason & Schope, 2007; Grace, 1979) as variables that must be examined when attempting to answer questions regarding sexual orientation. Self-image is defined as involving self-definition, self-acceptance, fears and an understanding of lifestyle. Eroticism is defined as sexual fantasies.

Item analysis. According to Anastasi (1988), items on an instrument may be analyzed quantitatively, in regards to their statistical properties. When examining items qualitatively, content validity is considered as well as the evaluation of items in terms of effective item-writing procedures. Quantitative analysis primarily includes the measure of item difficulty and item discrimination (Anastasi, 1988).

Item difficulty answers the question: How hard or easy was a particular item for the group of participants? Item discrimination refers to the degree to which an item differentiates correctly among test takers in that behavior that the test is designed to measure (Anastasi, 1988, p. 210). Item discrimination was calculated as a correlation coefficient between the item score and the total score. Correlation coefficient indicates the strength and direction of a linear relationship between two random variables.

Results and Discussion

Item Design for the Sexual Orientation Scale
In designing the Sexual Orientation Scale, two areas of interests were salient. They were self-images and eroticism. The literature on sexual identity formation strongly supported the examination of these two interest areas during the discovery process of one’s sexual orientation. The importance of examining self-images and eroticism was further supported in the early stages of this study that resulted in the identification of the initial 100 items of the Sexual Orientation Scale.

Thirty self-identified gay men were interviewed regarding their discovery process. While reviewing interviews, items were generated that represented their thoughts and feelings. Examination of items clearly indicated that issues such as self-acceptance, understanding fears, and eroticism were being confronted during the discovery process.

Next, these 100 items were then subjected to an item analysis that resulted in identifying 45 items with item discrimination indices of 0.50 or higher. These 45 items were then further subjected to a factor analysis and an alpha coefficient.

An arbitrary decision was then made to use a 0.5 or higher factor loading in examining items. A strict convention of 0.5 or higher was used in order to identify the most discriminating items. The factor analysis identified the same items the item analysis identified. The alpha coefficients were as follows: overall= 0.924; straights= 0.723, gays= 0.653.

The factor analysis also identified four factors that were consistent with issues identified by both the literature and the initial 100 items. After reviewing the items in these factors, they were labeled as:
attraction to same sex
attraction to opposite sex
self-acceptance of gay behavior/attitudes
fears

Item Analysis
Anastasi (1988) pointed out that items on an instrument may be analyzed qualitatively, in terms of their content and form, and quantitatively, in terms of their statistical properties. The item analysis performed on the initial 100 items of the Sexual Orientation Scale focused on a quantitative analysis and more specifically on the measures of item difficulty and item discrimination.

Item difficulty refers to the percentage of subjects that endorse certain items on the scale. The closer the difficulty level approaches 0.50, the more differentiations the items can make (Anastasi, 1988).

Item discrimination refers to how effective the item discriminates between the two groups. Therefore, the higher the item discrimination score, the more effectively the item will differentiate between the two groups (gays/straights). Table 1 shows how the sample was grouped in order to establish an item-to-total score correlation, which is identified as a useful exercise to select items.

Based on the total score, the respondents were divided into quintiles (groups of approximately 40 subjects). A total score was established by assigning a value of 1 to true responses and a value of 2 to false responses. A true response indicated the way a gay man would respond. An item difficulty, identified in the item analysis as proportion of subjects that responded correctly to the item (PROP) and item discrimination, identified in the item analysis as a point biserial correlation coefficient (RPBI), were calculated for each item.

Table 2 outlines the item difficulty and item discrimination score and the scoring key of the initial 100 items. The asterisks identify the scores for the 43 items on the final version of the Sexual Orientation Scale. Of the final 43 items, approximately 76.7% of the items have a difficulty score that range from 0.40 to 0.60. Since Anastasi (1988) stated that the closer the difficulty level approaches 0.50, the more differentiations the item can make, it is safe to infer that the majority of the items on the Sexual Orientation Scale possessed good potential for differentiating between responses of the two groups. The remaining 23.3% of the items were not far behind. None of the item difficulty scores were less than 0.32 or higher than 0.76. This shows that the result of these items do not differentiate as well, but well enough to contribute to the overall reliability and validity of the Sexual Orientation Scale.

According to Anastasi (1988), the items that have low correlations with total score should be deleted and the items with the highest average inter-correlations will be retained. These items were retained because they are the ones that discriminate well and increase the validity of the test.

Analysis showed that 43 items on the initial 100-item Sexual Orientation Scale scored 0.50 or higher on the item discrimination index. Since the item discrimination refers to the degree to which an item differentiates correctly among test takers in the behavior that the test is designed to measure, one could assume the majority of the items on the Sexual Orientation Scale effectively differentiates between the two groups (gay/straight) that were tested.

Results of Item Analysis

The 45-item version of the Sexual Orientation Scale was a result of an item analysis done on the initial 100-item scale. The original data analysis identified 17 factors. An item discrimination index of 0.50 or higher was used to identify the items for the final version of the scale. Items that exhibited a higher level of commonality were selected. The 55 items that were deleted did not discriminate as well.

The 45 items were then submitted to the following statistical procedures: (a) Cronbach’s alpha coefficients were calculated for the overall sample, for the straight sample, and for the gay sample; and (b) a factor analysis was conducted via the running of five, four, three and two factor solutions on the overall sample (N=208). The factor analysis was done for the purpose of further validating the Sexual Orientation Scale.

Naming of the Factors
After creating and reviewing a SCREE Plot with the Eigen values of the 45 items, the researchers identified a bend that began to occur around the three, four and five factors. All factor solutions were investigated, and a decision was made to use the four-factors solution because (a) the items fit the four factors very well, and (b) the addition of a fifth factor accounted for negligent increase in the total variance. Every item in each factor carried a common theme.

The items in the four-factor solution were reviewed. Finally, two of the 45 items did not have a factor loading of 0.5 or higher. In keeping with the arbitrary decision of only using those items with a 0.5 factor loading or higher (for the purpose of implementing a stricter convention), items 36 and 15 were deleted. The final version of Sexual Orientation Scale resulted in having 43 items.

Table 3 summarizes the four factors solution by identifying the sorted rotated factor loadings of each item in each factor. Items 12, 22, 29, 39, 42, 45, 46, 49, 50, 59, 64, 65, 66, 67, 68, 72, 73, 80, 83, 88, 97, 98, and 99 loaded on Factor One with factor loadings ranging from 0.58 to 0.73. The common theme was sexual attraction to members of the same sex. The items in Factor One identified issues such as being attracted to nude males, erotic thoughts about men, masturbatory fantasies involving men only, relationships with males, etc. Therefore, Factor One was named “Attraction to Same Sex.”

Items 6, 14, 17, 41, 44, 48, 60, 63, 70, and 82 of Factor Two in Table 3 also had sexuality as their common theme. However, the sexual attraction addressed in the above items was towards members of the opposite sex. Their factor loadings ranged from 0.55 to 0.78. The items in Factor Two brought to surface issues dealing with erotic fantasies about women only, thoughts about women that led to sexual arousal, etc. Due to a common theme in these items, Factor Two was named “Attraction to Opposite Sex.”

Factor Three in Table 3 was comprised of items 16, 25, 33, 56, 89, and 91. These items had factor loadings ranging from 0.53 to 0.78. In examining these items, it was evident that the common theme surrounding the items was that of self-image and self-concept. The items in Factor Three addressed issues such as self-expression, expression of affection to another male, the acknowledgement of individual differences and the normalcy of being attracted to other men. Factor Three was named “Self-Acceptance of Gay Behaviors/Attitudes.”

Items 31, 32, 81, and 90 in Table 3 loaded onto Factor Four with loadings that ranged from 0.52 to 0.60. The common theme among these items was fear, which pertained to issues faced more often than not by gay men. The items addressed concerns in areas such as wanting to be sexually active with other men, jealousy, noticeable reactions to other men and fear of being gay. Because of the obvious common theme, Factor Four was named “Fears.”

It is vital to note that the four factors identified via the factor analysis represented those themes continually found in sexual orientation literature. Cass (1979 & 1984), Grace (1979) and Coleman (1982) consistently addressed the importance of examining the variables of self-images and eroticism during the discovery process of one’s sexual orientation. All these factors are clearly identified in the 43 items in the four-factor solution done on the final version of the Sexual Orientation Scale.

Reliability
A Cronbach’s alpha coefficient was performed in order to establish the reliability of the final 43-item version of the Sexual Orientation Scale. An alpha coefficient was done on the overall sample (N=205), the straight sample (N=103), and the gay sample (N=102). The overall sample has an N of 208. Three completed scales (1 straight respondent and 2 gay respondents) were eliminated because they did not complete the initial 100 items. The alphas for the 43-item version were 0.93 for the overall sample, 0.72 for the straight sample and 0.65 for the gay sample.

Construct-Related Validity
Internal consistency is a procedure used to establish construct validity. A statistical procedure used in this study to establish internal consistency was Cronbach’s Alpha Coefficient; this statistic also was used to establish instrument reliability (Miller, 1987). Table 4 shows the alphas which clearly exhibit the homogeneity for the items on the Sexual Orientation Scale.

A factor analysis was performed on the 45 items to identify the prevalent factors. After the factor analysis was done, four factors were identified as the most important factors that need to be examined when struggling with the uncovering discovery process of an individual’s sexual orientation. They are Attraction to Same Sex, Attraction to Opposite Sex, Self-Acceptance of Gay Behavior/Attitudes, and Fears. The items and other data on each factor are summarized in the following table. Normative data also was generated on the overall sample, the gay sample, and the straight sample. This was done for interpretation purposes. Table 4 summarizes the established normative data.

Limitations

This study contained methodological features which resulted in limitations. The major areas of limitations were (a) the sampling procedures and (b) generalizability.

Sampling Procedures
The initial 100-item Sexual Orientation Scale resulted from interviews with self-identified gay men who stated they were happy/satisfied as gay men. Only 30 men were interviewed. Although this number was an acceptable number, a larger number of men interviewed may have provided additional insights.

Of this group of 30 men (participating in the development of the items for the Sexual Orientation Scale) from cities in the Rio Grande Valley (RGV) in South Texas, 90% were Hispanic college graduates. Being a Hispanic gay man in the RGV in South Texas is difficult. The machismo attitude is somewhat prevalent in this area. This, coupled with a strong Catholic belief about homosexuality makes life as a gay man very secretive in this area. Thus, it is important to note that the initial 30 subjects were men who are openly gay, educated, motivated, and obvious risk takers. The sample group, therefore, may not have represented the “typical” gay man in the United States. Moreover, a different or more thorough perspective about what is involved in the discovery process with respect to sexual orientation might have risen if there had been a more diverse group of gay men in terms of ethnicity and geographical area.

The sample size (N = 208) utilized for the statistical item analysis was small. Although acceptable for this study, a much larger sample would likely improve the scale’s reliability and validity. The sample in this study did not include women. Women were excluded because it was suspected that gay men and lesbian women experience a different discovery process and that a parallel, yet different study is necessary for females.

Lastly, the two samples (gay/straight) are not actually directly comparable because, in essence, they were not selected in the same way. For example, a large percentage (65.4%) of the gay sample compared to 16.3% of the straight sample was enrolled in counseling. One can ascertain that most of the gay samples were selected from university counseling centers, mental health agencies, and the private sector. Contrastingly, the straight sample was selected from introductory psychology classes and from the membership of men’s groups (civic and/or support).

Generalizability
The generalizability of the results of this study is limited to men who are between the ages of 18 and 40 and who are either receiving counseling services from university counseling centers, mental health agencies, or the private sector, or who are in introductory psychology classes or members of men’s groups. The generalizability of this study is further limited to Hispanic and Caucasian men who met the research criteria.

Recommendations

The following are recommendations to either improve the present study’s design or identify areas for future research:
• Obtain a more culturally diverse sample by including representatives of other ethnic groups along with representatives from the Hispanic and Caucasian groups. This would increase the potential of gathering different perspectives and insights as well as increase the generalizability of the results.
• Utilize a larger more diverse sample in order to compare the reliability and validity data obtained in this study with other studies. A test re-test might be considered so as to verify the reliability of the Sexual Orientation Scale.
• In order to minimize a client’s tendency to answer the way they think their therapist or counselor wants them to, a lie/consistency scale may need to be established for the Sexual Orientation Scale. This may be done by including items that emphasize the same information, but written in a different manner.

Once the Sexual Orientation Scale has undergone further empirical investigation and eventual modifications, the use of the scale in counselor training programs should be considered. This would be done in hopes of (a) educating future counselors in how to assist clients who are confused about their sexual orientation, (b) increasing one’s sensitivity to and knowledge about gay/lesbian issues, and (c) requiring to some extent that future counselors accept and understand their own biases in regards to individual differences and more specifically to gays and lesbian.

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Sachin Jain, NCC, is an Assistant Professor, Department of Counseling, Oakland University, Rochester, MI. Santiago Silva, is a Clinical Professor & Director of the Counseling Assessment Preparation Clinic (CAP) at the University of Texas-Pan American. Correspondence can be addressed to Sachin Jain, Oakland University, Department of Counseling, 2200 N Squirrel Road, Rochester, MI, 48309, sacedu@yahoo.com.

Perceptions of Professional Counselors: Survey of College Student Views

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

Richard A. Wantz, Michael Firmin

Numerous sources of information influence how individuals perceive professional counselors. The stressors associated with entering college, developmental differences, and factors associated with service fees may further impact how college students view mental health professionals and may ultimately influence when, for what issues, and with whom they seek support. Individual perceptions of professional counselors furthermore impress upon the overall identity of the counseling profession. Two hundred and sixty-one undergraduate students were surveyed regarding their perceptions of professional counselors’ effectiveness and sources of information from which information was learned about counselors. Overall, counselors were viewed positively on the dimensions measured. The sources that most influenced perceptions were word of mouth, common knowledge, movies, school and education, friends, books, and television.

Keywords: professional counselors, perceptions, counselor effectiveness, professional identity, undergraduates

Perception is not reality, but perception is nonetheless a very cogent relative to how humans come to understand reality. Moreover, perception tends to drive behavior and decisions made by consumers. In the present context, we are interested in how college students come to perceive human service providers across a number of variables. The constructs explored are not novel, as this genre of research has been assessed in decades past (e.g., Murray, 1962; Strong, Hendel, & Bratton, 1971; Tallent & Reiss, 1959; West & Walsh, 1975). However, we believe the topic warrants refreshed attention, particularly with the professional licensure acquired among all human service professions: psychiatrists, psychologists, counselors, marriage and family therapists, social workers, and psychiatric nurses.

The media tends to exert a cogent effect on students’ perceptions across multiple life domains, including human service professionals (Von Sydow, Weber, & Christian, 1998). Students also are affected by other information sources such as previous experiences with their high school (guidance) counselors, personal therapy, clergy, family doctors, parental influence, and input from peers (Tinsley, de St. Aubin, & Brown, 1982). Students’ perceptions of human service providers also may be affected by various campaigns, typically receiving information-influence from multiple sources that actively attempt to shape their perceptions of mental health services’ value and efficacy (Hanson, 1998).

Some human service professions have been more aggressive in how they advocate their service value to the public. Fall, Levitov, Jennings, and Eberts (2000) note that psychiatrists and psychologists generally have dwarfed counselors’ efforts at advocacy. Counselors, as a profession, have struggled significantly with their own identity (Garrett & Eriksen, 1999; Eriksen & McAulife, 1999), which likely affects this phenomenon. That is, if one’s identity is unclear to the respective professionals, then probably it will negatively affect its status among the laity (Gale & Austin, 2003). Psychology generally has lagged behind psychiatry in terms of the public’s professional perceptions (Webb & Speer, 1985), although Zytowski et al. (1988) reported that people frequently confused the terms psychiatrist and psychologist relative to function. Counseling psychologists also often seem to be confused with professional counselors in the public’s understanding (Hanna & Bemak, 1997; Lent, 1990).

Social work has existed as a vocation for over a hundred years. Kaufman & Raymond (1995) reported that the public’s awareness of the profession’s perception was somewhat negative in their survey sample. LeCroy and Stinson (2004) and Winston and Stinson (2004) likewise found individuals in their particular sample to be relatively knowledgeable regarding social workers’ responsibilities, although reported attitudes were more positive than those reported by Kaufman and Raymond. This partly may be due to the fact that respondents reported more favorable perceptions of social workers as helping those needing avocation than they did for social workers as therapists. Sharpley, Rogers, and Evans (1984) suggest that marriage and family therapy, as a profession, is relatively cryptic to the general public. That is, people generally deduce what such human service personnel do, as indicated by the title, but do not have as much first-hand knowledge or experience with such professionals as they do with counselors, social workers, psychologists, and other professionals.

Ingham (1985) notes that a helping profession’s overall image affects clinicians in that profession relative to their abilities in helping clients to utilize their services. This conclusion makes logical sense in that consumers’ confidence in the care provided is subjective and highly influenced by psychological variables, such as idiographic perceptions. Attempts at educating the public regarding an apt understanding of what a human service profession has to offer has shown various levels of effectiveness (Pistole & Roberts, 2002). Nonetheless, Pistole (2001) also notes that the general public finds the distinctions among the various human service providers to be bewildering. In short, without periodic reminders, the public’s image of various human service personnel may reconverge in a fog of misperception.

Since many individuals have never experienced the services of mental health clinicians, often their perceptions are based on reports or intuitively acquired opinions. For example, Trautt and Bloom (1982) report that fee structures affect perceptions of status and effectiveness provided by clinicians. The basic understanding, of course, is that the more expensive the treatment, the higher its perceived value and professional status. That, of course, can result in self-fulfilling prophesies—with people paying more money expecting more from therapy—and experiencing better success rates. We are unaware of any studies where clients were randomly assigned to professional therapists and (systematically) charged varying pay rates. Such a study, controlling for fee structures, might yield some valuable data to the present discussion regarding how the public perceives the value of respective human service professionals.

Beyond the public’s general perceptions on this topic, however, we are particularly focused on students’ perceptions. Hundreds of thousands of students annually utilize the services of university counseling centers, as well as private practice therapists and other human service agencies. With the added stress of academics, social pressures, being away from home for the first time, transitioning from teenage to adult responsibilities, dating, drinking alcohol, and other similar stressors, having apt utilization of psychotherapeutic services is paramount for college students. Turner and Quinn (1999) suggest that college students’ perceptions differ from the population-in-general, and research data from one group may not accurately generalize to the other.

Notwithstanding obvious developmental differences between college students and more mature adults from the general population, counseling students may not pay (directly, out of pocket) for the services available to them. Campus counseling centers, for example, typically receive funding from tuition or generic student fees, rather than students paying direct dollars for the services. Additionally, most full-time students remain on their parents’ medical insurance which also offsets financial costs involved in private practice expenses. In short, cost of services seems to be a significant variable for the general population (Farberman, 1997) that may not load with the same degree of importance vis-a-vis college students. Additionally, titles (such as “doctor”) may not have as much bearing with the general public (Myers & Sweeney, 2004) as they do with college students who routinely use such nomenclature with professors and others on a daily basis. In short, while we accommodate research findings that compare the various mental health professionals as perceived by the general public (e.g., Murstein & Fontaine, 1993), we also treat the results with some degree of prudence and believe college students represent a distinct population worthy of particular focus and exploration.

Gelso, Brooks, and Karl (1975) conducted a study that was similar in some respects to our present one. They surveyed 187 students from a large eastern university with a sample of 103 females and 84 males. Subjects were asked to rate perceived characteristics of various human service professionals, including high school counselors, college counselors, advisers, counseling psychologists, clinical psychologists, and psychiatrists. They found that overall college students did not report significant differences relative to professionals’ personal characteristics. However, they did report differences among the human service providers relative to their perceived competencies in treating various hypothetical presenting problems.

In the 30 years subsequent to this study, we are interested in how student perceptions have changed over time. Additionally, the Gelso, Brooks, and Karl (1975) study did not account for students’ perceptions of social workers, marriage and family therapists, or psychiatric nurses. Given the present milieu, we are more interested in these professionals than the categories of school counselors or advisors. Additionally, we also chose to combine the categories of counseling and clinical psychologists into the generic grouping, “psychologist.” The specific questions asked of students also differed in our present study. However, the general tenor of the two studies is similar—and we believe the updating of knowledge in this area has significant importance for those working with college students in various capacities and milieus.

Warner and Bradley (1991) also conducted a study similar to the present one. Their participants included 60 men and 60 women who were undergraduate college students enrolled in a University of Montana introductory psychology course. They assessed student perceptions of master’s-level counselors, clinical psychologists, and psychiatrists on multiple variables. Findings included students reporting their perceptions of counselors as possessing more caring-type qualities. Psychiatrists were seen as most able to address severe psychopathology and psychologists were viewed as more academics and researchers than as therapists.

Method

Participants
We surveyed 261 students from three sections of a general psychology course for this study. The course was selected, in part, because it is included in the university’s general studies core curriculum. Consequently, it represented a relatively wide range of majors from the student body and included students from freshman through senior status. The sample was taken at a selective, private, comprehensive university located in the Midwest with a study body of approximately 3,000 students. It included 167 women and 92 men with ages ranging from 17 to 55. The students were mostly Caucasian with 9% identifying themselves as ethnic minorities representing 34 states.

Procedure
The instrument was first pilot tested (Goodwin, 2005) to a group of undergraduate students at a regional state university prior to utilizing it in the present research project. Modifications were made in clarifying ambiguous terminology, instructions, and time to complete. Due to practical considerations, the instrument was designed to be completed in about one-half of a normal class period. The survey was administered during a normal class period with students having the option to participate at will without reward or penalty for doing so. Two students chose not to complete the surveys for undisclosed reasons.

The survey queried students regarding their perceptions of human service professionals (HSP), taking about 20–25 minutes to complete. Anonymity was provided to all students regarding answers to all items. Questions were asked about the overall perceived effectiveness of various HSPs, for which types of problems they might recommend various HSPs, and overall perceptions about the various HSPs. Although obviously many types of HSPs exist, this particular survey focused on psychiatrists, psychologists, professional counselors, marriage & family therapists, social workers and psychiatric nurses. In order to control for order effects as potential threats to internal validity (Sarafino, 2005), the various HSPs were presented in random order each time they appeared throughout the survey. The amount of data collected from the survey was relatively substantial. However, given the practical number of journal pages that can be reasonably devoted to presenting the information, along with our desire to comprehensively address perceptions of counselors, the present article addresses only this particular segment of the data collection.

Results

We organized the survey’s results in terms of the counseling services utilized, how effective students perceived counseling to be, for what types of problems or issues counselors are thought to be apt, how students came to view their perceptions of professional counselors, and qualities thought to characterize professional counselors. All percentages are rounded for clarity of reading and presentation, except where percentages fall below 1%.

Types of Services Utilized
At the end of the questionnaire, students were asked to confidentially self-disclose whether or not they had received services from a HSP. The question was placed at the end in order to have students already somewhat acclimated to HSPs and to have them somewhat more comfortable with the world of different types of HSPs. Of those answering the question, 28% of the participants indicated having received assistance from a HSP prior to completing the survey. The specific question asked whether or not students received prior professional assistance regarding personal, social, occupational or mental health concerns. About 3% of all the participants chose not to answer this particular question. However, of the 28% only 1% indicated that they did not know the profession of their HSP, indicating that most of the respondents who previously had utilized HSP services were aware whether the professional they saw was a counselor, psychologist, social worker, etc. Relatively few (

States possess a variety of titles by which professional counselors can or should be called (Freeman 2006). Consequently, rather than asking students simply to identify whether or not they had previously utilized the services of a “counselor,” we specified some types of counselors they may have seen. These included professional counselor, pastoral counselor, addictions or chemical dependency counselor, rehabilitation counselor, clinical mental health counselor, professional clinical counselor, and school guidance counselor.

Of the 28% of students who indicated they had previously utilized HSP services, three particular types of counselors were more prominent than the others. Namely, 16% indicated having seen a school counselor, 11% saw a professional counselor, and 9% saw a pastoral counselor. Relatively few students indicated having seen a rehabilitation counselor (0.4%), an addictions counselor (0.8%), or a mental health/clinical counselor (3%).

Perceived Overall Effectiveness
Students were asked to indicate how effective they believed professional counselors are overall. The particular question was worded as follows: In general, what is your opinion about how overall effective professional counselors would be with helping a mental health consumer? The options provided, with descriptors in parenthesis, were 1 (Positive), 2 (Neutral), 3 (Negative), and 4 (Unsure or don’t know). The intent of the question was to capture the gestalt of students’ thinking regarding professional counselors, prior to probing more deeply vis-a-vis types of counselors and for which kinds of issues they might find effective interventions.

Only 3% of the participants indicated having no opinion regarding this question. Another 3% indicated viewing professional counselors negatively. A total of 28% of the participants indicated having neutral views regarding counselors’ overall effectiveness. Sixty-six percent of the participants indicated having a positive view of professional counselors.

Types of Issues for Which Counselors Are Adept
Students were asked to identify for what types of issues they believed professional counselors would be particularly adept. They were provided with 12 different issues and asked to rate them as Yes (I would recommend a professional counselor for this situation), No (I would not recommend a professional counselor for this situation), or NS (Not sure, not familiar). Relatively few students skipped these questions or chose not to respond (range=0.8% to 3.4%). In other words, response rates were consistently high for these questions, obviously adding to the interpretation process. The same is true with students indicating that they were unsure or unfamiliar. Namely, on average 4% or so of students indicated being unsure for the situations presented (range=1.9 to 6.9). Results showed three clusters of participants’ responses.

The first cluster had four prominent responses, exhibited by 80% or more of the respondents—they involved college issues, academic problems, depression, and career counseling. A total of 91% of the participants indicated believing a professional counselor would be effective for helping college students who report homesickness, roommate problems, and falling behind with class assignments. A similar number (88%) believed that a professional counselor would be effective with a depressed individual who reports feeling sad and empty most days, finds little pleasure in daily activities, has insomnia, and is unable to concentrate. Comparable responses (83%) were seen for professional counselors addressing a young person with adequate intellectual capacity, but a pattern of academic problems (e.g., failing grades and significant underachievement). Finally, 80% of participants indicated that a professional counselor would be effective for a person reporting job dissatisfaction and uncertainty about career choices.

The next cluster of responses involved issues of family dysfunction, substance abuse, and attention-deficit hyperactivity disorder (ADHD). Seventy-six percent of participants indicated feeling that professional counselors were effective for a family unit reporting communication problems, negative interactions, criticism, and withdrawal among family members. For cases when a person self-administers and abuses drugs that results in impairment of daily academic, occupational and social functioning, 73% of the respondents in our survey believed a professional counselor would be effective. Sixty-seven percent of participants indicated that a professional counselor would be effective when a person with persistent patterns of inattention and hyperactivity-impulsivity that interferes with academic, occupational, and social function.

The final cluster of participants’ responses involved issues of personality assessment, intelligence testing, psychotic symptoms, physical disabilities, and mental health evaluations. Just over half (53%) of the participants indicated that professional counselors were apt for working with a person who needs personality assessment. Forty-four percent said that a professional counselor would be effective for a person with psychiatric symptoms who experiences delusions, hallucinations, disorganized speech, and is frequently incapable of meeting ordinary demands of life. When asked if an unemployed individual with a physical disability seeking employment would be a target source for a professional counselor, 43% answered affirmatively. Only 40% of participants indicated that a professional counselor would be effective in helping a client who needs a comprehensive mental health evaluation. Fewer (37%) indicated that intelligence testing was germane for a professional counselor.

Table 1

Sources of Perceptions about Counselors

Another line of inquiry addressed the identified sources by which students indicated they developed their perceptions about counselors. In other words, they told us about the factors that influenced them the most regarding how they came to think about professional counselors. The options from which to choose included books, common knowledge, friends or associates, HSPs, insurance company or carrier, Internet, magazines, physician or nurse, movies, newspapers, personal experience, school and education, and television. Only 2% of the participants declined to participate in this section of the survey or marked “none.”

Instructions asked students to complete this section in two steps. First, they were to indicate (by checking a corresponding box) whether or not they learned about a professional counselor from the identified source. Students were told they could select multiple sources. In the second step, they were asked to rate whether the information about the HSP was 1 (positive), 2 (neutral) or 3 (negative). Only 2% of the students marked a box described as “other,” indicating that the categories provided were relatively comprehensive. Results from this portion of the survey showed the data falling into three clusters. The two clusters representing extreme scores were of relatively equal size, while the third or middle was small (only two sources in the category).

The first cluster showed the following items as being relatively influential in how students came to understand the roles of professional counselors: common knowledge (84%), movies (63%), school and education (60%), friends (55%), books (49%) and television (44%). The middle cluster included personal experience (27%) and Internet (24%). The finding that 27% indicated personal experience to be influential is consistent with the demographic portion of the questionnaire where 28% of students said they had personal contact with a HSP prior to completing the survey. The third cluster comprised those sources that participants said were relatively non-influential in generating their perceptions of professional counselors. They included magazines (20%), physician or nurse (18%), newspaper (13%), HSPs (10%) and insurance companies (5%).

Results from the second step in the survey are more difficult to summarize. The data was more dispersed than the first step, although three clusters inductively emerged. Some items received few responses, as they were not selected very frequently in step one. The percentages listed do not add up to 100% for each item because the remaining percentage for each item is accounted by students who did not provide answers for that item. For example, if an item had 1% positive, 1% neutral, and 1% negative, then 97% of the participants simply left the question blank.

The first were items where students indicated that professional counselors were as viewed mostly positive. These included school and education (43% positive, 13% neutral and 3% negative), friends (38% positive, 10% neutral and 6% negative), books (30% positive, 17% neutral and 2% negative), personal experience (17% positive, 7% neutral and 3% negative), physicians (10% positive, 6% neutral and 2% negative), and HSPs (8% positive, 0.8% neutral and 0.8% negative).The second cluster comprised items that were rated as being mostly neutral and with relatively few positive indicators. These included: movies (14% positive, 28% neutral and 19% negative) and television (13% positive, 25% neutral and 6% negative). The third cluster showed a relative spread of responses, although there were few negatives in each category. They included: common knowledge (38% positive, 42% neutral and 3% negative), magazines (10% positive, 8% neutral 3% negative), Internet (10% positive, 12% neutral and 1% negative), newspapers (5% positive, 6% neutral and 3% negative), and insurance companies (0.8% positive, 2% neutral and 2% negative).

Perceived Counselor Qualities

The final portion of the questionnaire addressed how participants viewed various professional counselors’ characteristics. Students were asked to identify statements that they believed to be true about professional counselors, based on their overall knowledge of them. Options included competent, can be in independent private practice, diagnose and treat mental and emotional disorders, doctoral degree required to practice, intelligent/smart, overpaid, prescribe medication and trustworthy. Consistently, only 1% of the participants chose not to respond to this portion of the survey, making interpretation for this section relatively straightforward. The findings fell neatly into two categories: characteristics counselors presumably possess and those they do not.

Characteristics that students believed professional counselors possess include being competent (81%), independent private practice (81%), trustworthy, (79%), and intelligent/smart (77%). Contrariwise, participants identified the following as not characterizing professional counselors, as indicated by the relatively low percentages of marked responses: doctorate required (30%), diagnose and treat mental disorders (22%), overpaid (16%) and prescribe medications (5%).

Discussion

Given the formation and advancement of the American Mental Health Counseling Association (AMCHA), the introduction of state licensure laws that specifically use mental health counselors as formal nomenclature (Freeman, 2006), and particular certifications that have been offered in clinical mental health counseling, we were somewhat surprised that only 3% of the students who had previously used HSP services identified doing so with clinical mental health counselors. Of course, they may have been confused with names, but to the degree that accurate reporting occurred, the numbers were relatively low compared to other types of counselors.

Obviously, school counselors are very important relative to how students perceive professional counselors. They accounted for the largest portion of users (16%). First impressions are not always necessarily lasting impressions. However, they are cogent and school counselors may set the tone for how these students, for the rest of their lives, perceive others using the word “counselor” in their professional titles. This sentiment was illustrated in qualitative research findings by Wantz, Firmin, Johnson, and Firmin (2006).

Three times as many students indicated having seen a pastoral counselor than a mental health counselor (9% and 3%, respectively). Obviously, we do not know if some students actually meant that they saw an ordained clergy person for personal issues, considering this person to be a pastoral counselor, since they received counseling from him/her and the person was clergy. However, assuming accurate reporting, it suggests that graduate training programs should consider giving additional attention to this domain of counseling. Although courses in pastoral counseling sometimes are seen in religiously-oriented universities (e.g., seminaries, Catholic or Christian colleges), the apparent popularity of their use by students, suggested by the present research, provides evidence that more widespread attention to pastoral counseling is warranted.

Students’ overall perception of professional counselors as being effective is heartening. Particularly welcoming is that only 3% viewed counselors negatively. Social psychology research (Myers, 1994) has shown that a few negative, public incidences can have overshadowing effects on a group’s overall positive characteristics. Fortunately for professional counselors, whatever data might feed negative overall impressions seems to be relatively dormant for students in the present sample.

A general continuum emerged vis-a-vis students’ perceptions of what types of issues are most germane for professional counselors to address. Namely, high responses were provided for general, developmental life issues such as academic problems, depression and career counseling. Moderate responses were provided for problems where direct brain-behavior connections are involved such as ADHD or drug counseling. The lowest responses were provided for types of situations where assessment is warranted, such as personality or intellectual assessment and mental health evaluations. These findings are consistent with overall perceptions that students do not think of counselors in terms of being clinical mental health professionals, but rather as more generic, trained counselors. If the field wishes to advance itself toward the direction of diagnosis, assessment, and treating psychopathology, then data from the present survey would suggest that efforts should be redoubled.

Not all media sources appear to be equal in influencing students’ perceptions of professional counselors. For example, newspapers (13%), magazines (20%), and the Internet (24%) were relatively inconsequential when compared to movies (63%), books (49%) and television (44%). Unfortunately for professional counseling organizations, the most potentially influential sources also happen to be the most expensive ones to target. Nonetheless, if organizations such as the American Counseling Association (ACA), American Mental Health Counselors Association (AMCHA), and the National Board for Certified Counselors (NBCC) are going to impact students’ thinking, then they should target the most efficacious sources. It could be, of course, that the reason newspapers, magazines and the Internet were so relatively non-influential is that few inroads have been attempted in these domains. Advertising in university newspapers, posting and promoting user-friendly web sites, and generating informative articles in popular magazines simply may be an important need for professional counseling advocacy at this time.

In a separate study under development, using qualitative methodology, we are attempting to better flesh-out some of the details relating to these sources of impact on students’ perceptions of professional counselors, particularly the concept of “common knowledge.” Although not surveyed in this study, an influential source proved to be word-of-mouth in perception formations regarding counseling. That is, influences of school, friends, personal experience, physicians, and HSPs most likely have some type of personal connections tied to the medium. Evidently, there is some truth to the adage that word-of-mouth is the best means of advertising—assuming, of course, that the messages being relayed are positive.

In the perceived counselor qualities portion of the survey, it was somewhat disheartening that comparatively few (22%) students indicated they saw professional counselors as competent to diagnose and treat mental disorders. This finding was consistent with other data throughout the survey. Namely, students generally view counselors as professionals who address relatively normal, human development issues rather than psychopathology or more severe disorders requiring assessment, diagnosis and treatment. Again, if the counseling profession wishes to move in the latter direction, then findings from the present research suggest that there is some distance to go. Early acquired school counselor perceptions tended to initiate students’ mindsets regarding what counselors do and they seem not to have moved far from those early perceptions.

In summary, we believe that the present study is a strong first step in a line of needed research regarding just how people come to understand counselors. The findings here do not dictate any action on behalf of professional counseling organizations. However, we believe that the findings indicate in which directions the winds of student perceptions are blowing—and that is data which should be considered when making policy decisions. If counselors are going to move to new, future levels of excellence in terms of public perception, then paying attention to this type of data and giving it due consideration is an important initial component.

Limitations and Future Research

All good research studies report limitations (Murnan & Price, 2004) and we indicate four of them here. First, while our sample had several strengths, including adequate size (Patten, 1998), high response rate (Stoop, 2004), and lack of incentives/bribes for participation (Storms & Loosveldt, 2004), it was taken from a single locale. Some compensation exists, such as students coming from 34 states and the relatively broad cross-section of college majors represented. However, future research in this domain should assess students from a wider variety of institutions such as research universities, state universities, and liberal arts colleges—as well as from diverse locales in the country in order to enhance the study’s external validity (Cohen & Wenner, 2006).

Second, our study had relatively low representation from minority students. This simply was an artifact of the university where the data was collected. Specifically, minorities comprised only 6% of the student body population. Further research should contain samples with larger representations of minority individuals. Additionally, replicating this present study with all minority students would provide an interesting comparison among many points of investigation.

Third, some of the items queried were selected a priori. While we believe them to be of interest and germane to our purposes, future research should broaden questionnaires to include questions that are derived empirically from the research literature. Also, organizations such as the Council for Accreditation of Counseling and Related Educational Programs should provide input vis-a-vis questions that directly would enhance their efforts in counselor education preparation. The same is true with potential input from NBCC and ACA as they market professional counselors to the general population as well as college students.

Fourth, in retrospect there are two particular changes we would have made to the survey instrument. One is that we would have added a Likert-scale to the first question, querying the perceived overall effectiveness of counselors. While we believe that rating professional counselors with three choices was useful—and we would keep the question—we also would recommend future researchers add a Likert-scale question that is anchored with descriptions, but to which numeric interval-scale values could be assessed. Second, looking back on our questionnaire, we would have asked how many students saw more than one HSP. That is, did they use more than one type of human service professional’s services (e.g., they saw both a rehabilitation counselor and a school counselor). Accounting for multiple uses within the same clientele could provide potentially useful data.

Future research should take the present study and apply it to the population in general. That is, we produced what we believe to be fairly apt representations of perceptions among students—but they do not represent the population at large. Obviously, college students have unique features of adult development that are not necessarily shared by older adults (Foos & Clark, 2003). The very low reported influence that health insurance companies have on college students’ perceptions is one of many examples of where student ideations and those of more middle-aged adults might differ.

And finally, qualitative research is needed in this area. A prime value of questionnaires, such as the present one, is that more voluminous amounts of data can be collected—providing breadth of understanding (Gall & Borg, 2003). Such research also tends to answer “how many” or “what” types of questions (Hittleman & Simon, 2003). Thicker descriptions are needed to help flesh-out some of the details on which survey research was only able to skim. Answers to some of the “why” and “how” questions that the present findings raise can best be answered with follow-up qualitative research methodology (Flick, 2002).

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Richard A. Wantz, NCC, is a Professor at Wright State University, and Michael Firmin, NCC, teaches at Cedarville University, both in Ohio. Correspondence can be addressed to Richard A. Wantz, Wright State University, Department of Human Services, 3640 Colonel Glenn Highway, Dayton, OH, 45435, richard.wantz@wright.edu.

Wellness in Mental Health Agencies

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

Jonathan H. Ohrt, Laura K. Cunningham

Burnout and impairment among professional counselors are serious concerns. Additionally, counselors’ work environments may influence their levels of wellness, impairment and burnout. This phenomenological study included the perspectives of 10 professional counselors who responded to questions about how their work environments influence their sense of wellness. Five themes emerged: (a) agency resources, (b) time management, (c) occupational hazards, (d) agency culture, and (e) individual differences. Implications for professional counselors and future research are discussed.

Keywords: professional counselors, agencies, wellness, burnout, impairment

Wellness promotion focuses on individual strengths and emphasizes holistic growth and development. For example, Myers, Sweeney and Witmer (2000) defined wellness as:

A way of life oriented towards optimal health and well-being in which body, mind, and spirit are integrated by the individual to live life more fully within the human and natural community. Ideally, it is the optimum state of health and well-being that each individual is capable of achieving. (p. 252)

The authors’ definition of wellness alludes to one’s overall well-being. Counselors often advocate holism, exploration of self and self-actualization for their clients (Cain, 2001). Such aspirations may be achieved through a holistic wellness approach (i.e., attending to intellectual, emotional, physical, occupational and spiritual well-being; Witmer & Young, 1996). Therefore, counselors view wellness as an important aspect of overall human functioning. Although this fundamental view has historically been applied to clients, professional counselors themselves now recognize that they also may benefit from a wellness focus (Maslach, 2003).

Professional counseling organizations (e.g., American Counseling Association [ACA]; American Mental Health Counselors Association [AMHCA]; National Board for Certified Counselors [NBCC]) specifically emphasize the importance of counselor wellness and impairment prevention. For example, counselors are ethically required to recognize when they are impaired. The ACA (2005) ethical standards state that “Counselors are alert to the signs of impairment from their own physical, mental, or emotional problems and refrain from offering or providing professional services when such impairment is likely to harm a client or others” (Standard C.2.g). The AMHCA (2010) ethical standards further state that counselors:

recognize that their effectiveness is dependent on their own mental and physical health. Should their involvement in any activity, or any mental, emotional, or physical health problem, compromise sound professional judgment and competency, they seek capable professional assistance to determine whether to limit, suspend, or terminate services to their clients. (Standard C.1.h)

Furthermore, the NBCC (2005) ethical standards indicate that certified counselors discontinue providing services “if the mental or physical condition of the certified counselor renders it unlikely that a professional relationship will be maintained” (Standard A.15).

The Governing Council of the ACA states that “Therapeutic impairment occurs when there is a significant negative impact on a counselor’s professional functioning which compromises client care or poses the potential for harm to the client” (Lawson & Venart, 2005, p. 3). In 2003, this council became proactive in addressing the issue of counselor wellness by creating a task force on counselor wellness and impairment. The task force seeks to educate counselors about impairment prevention, promote resources for prevention and treatment of impaired counselors and to advocate within ACA and its division to address the broader issue of counselor impairment. As a result, they have distributed information on risk factors, assessment, resources and wellness strategies. Thus, a wellness focus is essential for professional counselors to prevent impairment and provide effective counseling services to clients (Witmer & Young, 1996).

Unfortunately, professional counselors encounter multiple factors that threaten their wellness (Lawson, 2007). For instance, counselors are at a particularly high risk for burnout due to the intense and psychologically close work they do with clients (Skovholt, 2001). Although there are many definitions of burnout, Pines and Maslach (1978) described it as “a condition of physical and emotional exhaustion, involving the development of a negative self-concept, negative job attitude, and loss of concern and feelings for clients” (p. 233). Additional consequences of burnout may include low energy and fatigue, cynicism towards clients, feelings of hopelessness and being late or absent from work (Lambie, 2006). When counselors fail to address burnout it can lead to impairment. Counselors also may experience occupational hazards such as compassion or empathy fatigue and vicarious traumatization (Figley, 2002; Lawson, 2007; Stebniki, 2007). Stebniki (2007) defined empathy fatigue as a state wherein counselors are exhausted by their duties because of their constant exposure to the suffering of others, which induces feelings of hopelessness and despair. Similarly, vicarious traumatization occurs when a counselor becomes emotionally impaired due to being exposed to an accumulation of traumatic stories from multiple therapy sessions (McCann & Perlman, 1990). Therefore, the actual nature of counselors’ work is a potential threat to their ability to be well.

In addition, environmental factors in counselors’ work settings also may be detrimental to their wellness (Ducharme, Knudsen, & Roman, 2008; Knudsen, Ducharme, & Roman, 2006; Vredenburgh, Carlozzi, & Stein, 1999). In a survey that included 501 professional counselors, Lawson (2007) found that those working in community agencies experienced higher levels of burnout and compassion fatigue and vicarious traumatization than those working in private practice. Agency variables that are associated with burnout include: work overload, low remuneration, lack of control over services, unsupportive or unhealthy work peers and ineffective or punitive supervisors (Lloyd, King, & Chenoweth, 2002). For example, low remuneration is a specific concern in many Southeastern states. Lambie and Young (2007) offered the following example of a work environment in a specific agency: “an employee assistance program in this area requires its counselors to conduct sessions for 35 clients a week…the counselor in such an organization faces stresses and work hours similar to a first year lawyer in a large firm, without the mitigating effects of financial compensation” (p.101). Additional stressors stem from nonprofit agencies’ dependence on government and state funding sources to operate. Agency compliance with government and state policies to maintain funding often require administrations to focus on the “bottom line,” sometimes to the detriment of client services and employee wellness (Rupert & Morgan, 2005). Counselors who experience such stressors are at serious risk for burnout. Nevertheless, counselors are ethically expected to avoid burnout because it ultimately reduces the quality of services provided to clients, compromises client care and creates potential for harm to the clients (Lawson & Venart, 2005).

Leaders in the counseling profession strongly encourage counselors to be proactive in maintaining their own wellness and self-care. Counselors need to “fill the well” of their own sense of well-being continually, so they can “pour it out” for their clients (Shapiro, Brown, & Biegel, 2007). For example, Lawson (2007) reported that counselors who endorsed 15 highly valued career sustaining behaviors scored higher on compassion satisfaction and lower on burnout. However, despite individuals’ efforts to maintain a wellness lifestyle, the work environment may have a significant role in impeding or supporting wellness efforts. If the work environment does not allow for rejuvenation, or if wellness is not valued, employees (counselors) may become distressed and impaired (Maslach, Leiter, & Schaufeli, 2008). Witmer and Young (1996) suggested that counselor education programs promote and model wellness for their students so they can prepare themselves to make lasting changes in their life to reduce the risk of impairment. Further, if counselors create an individual sense of wellness, they can advocate for their personal well-being in the agency and redirect energies towards organization wellness (Lambie & Young, 2007).

Previous authors suggested that the agencies in which counselors work can help to create wellness environments that contribute to counselors’ overall functioning. For example, Witmer and Young (1996) posited that counselor education programs, employing organizations and regulatory boards should develop systemic preventative wellness protocols to prevent counselor impairment. Their recommendations to agencies included equally distributing the most difficult cases, providing employee assistance programs that include family counseling, adequate peer support, and supervision and team building exercises. Stokes, Henley, and Herget (2006) offered some concrete suggestions to increase wellness including healthy food options, on-site exercise facilities, smoke-free environments, break stations away from the work areas, wellness challenges, support groups, social activities, health risk assessments, self-care information, employee counseling, financial incentives for long term employees and conflict resolution training for supervisors. Further, Lambie and Young (2007) recommended that mental health agencies reduce stress and promote wellness among their employees (counselors) by reducing paperwork and cutting “red tape,” adopting a collaborative management style, improving interpersonal relationships and teamwork, developing ways to reduce role stress, helping counselors grow on the job (e.g., professional development) and improving environmental conditions.

Although the potential hazards related to counselor’s work have received some attention (Gaal, 2009), there is limited research about how counselors conceptualize their wellness in relation to the influence of their work environment. Thus, the purpose of this exploratory study was to gain a greater understanding of how counselors experience wellness and how their work environment influences their sense of wellness. A qualitative phenomenological approach was the most appropriate method to implement because we were seeking to understand the participants’ lived experience of the phenomena (Creswell, 2007). Following the phenomenological tradition, we sought to uncover the central underlying meaning of their experience by reducing data, analyzing specific statements, searching for all possible meanings and creating meaning units (Creswell, 2009). Thus, we developed two research questions. The first question was, “How do you relate to the concept of wellness as a professional counselor?” and the second question was, “How do you perceive your agency influences your sense of wellness?” The first open-ended question was designed to gain information on each of the counselors’ thoughts about wellness and how they interpret the concept. The second question was designed to obtain information about how they believe their work environment affects their sense of wellness.

Method

Research Team
The research team consisted of two counselor educators who at the time of the study were doctoral students at a university in the southeastern U.S. The first author is a Caucasian male and the second author is a Caucasian female. The first author has previous work experience in a residential treatment setting and in a secondary school setting where he experienced a high level of turnover and burnout among the staff. The second author has previous work experience in a variety of agency settings and experienced different levels of emphasis on wellness in each agency. She became interested in researching in this area to assist counselors in the field. Both authors believe a wellness focus is important for professionals in the helping professions. Furthermore, the authors believe that one’s work environment affects each counselor’s ability to be well.

Procedure
Prior to facilitating the interviews and focus groups, we obtained approval from the Institutional Review Board (IRB) to conduct the study. Next, we recruited the 10 participants through a mixture of criterion-based and snowball-sampling strategies (Teddlie & Yu, 2007). The criterion included contacting counselors or agency directors who were currently or very recently employed at mental health agencies in a southeastern state. The snowball strategy included contacting individuals from the first and second authors’ previous employers, e-mailing invites on group servers for counselors who are alumni from a university that educates counselors and through following up recommendations from other counselors. After we secured participants for the study, we obtained informed consent and confirmed dates for the interviews and focus group.

Participants
The sample included seven female and three male professional counselors whose ages ranged from 25 to 53. Seven of the counselors were Caucasian, one counselor was of Indian descent, one was Latino, and one was of Middle Eastern descent. Two participants were employed by an agency that provides palliative care by way of in-home visits. One participant was a clinical director of an adolescent residential unit. One was previously a clinical director of a domestic violence shelter and a community counseling clinic. One participant worked in a behavioral hospital while another participant worked in an inpatient facility and previously in a residential setting. Three of the participants worked in a university-based clinic. Three counselors were present in the focus group interview and seven counselors were interviewed individually on separate occasions. See Appendix for pseudonyms and demographics.

Data Collection
Demographic questionnaire. Participants completed a demographic questionnaire consisting of questions about their age, race/ethnicity, socioeconomic status, gender, years in the field and work setting prior to participating in the interviews.

Individual interviews. The second author facilitated individual, semi-structured interviews with seven of the participants. Each interview lasted between 60 and 90 minutes. The interview started with the interviewer explaining the purpose of the study and then posing the first question: “How do you relate to the concept of wellness as a professional counselor?” Once this area was completely explored between the researcher and the interviewee, the researcher posed the second question: “How do you perceive your agency impacts your sense of wellness?” The researchers used follow-up, open-ended questions to elicit significant depth for each of the questions.

Focus group. The focus group included three counselors at a university-based counseling clinic and was facilitated by the second author. Prior to the group, the researcher reminded the interviewees about confidentiality and its limitations. The group lasted approximately 90 minutes and followed the same protocol as the individual interviews.

Data Analysis
After completing the interviews, we transcribed the audio-recorded sessions. All identifying information of the participants and location of employment were altered to maintain confidentiality. Next, the first and second authors read through transcripts to find initial categories. We employed inductive coding to devise categories that represented the overall essential message that was being conveyed in each interview and the focus group. The coding categories that emerged were recorded as well as thoughts about possible relationships between the categories (Glesne, 2006). Next, using the qualitative research software ATLAS.ti (Muhr, 2004), we loaded the documents and reduced the data using a chunking method, which requires the researcher to highlight sections of the transcription and assign codes or categories. Finally, we numbered the code list and noted connections among the interviewees’ coded chunks. This procedure consists of the researcher reviewing the codes to determine if a pattern, theme or relationship occurs (Glesne, 2006).

Verification Procedures
We implemented multiple verification procedures in order to ensure the trustworthiness of the study (Creswell, 2008). First, we performed member checks with participants to verify that the themes developed captured the essence of their experience. We addressed the threat of subjectivity through revealing our positionality and attempting to view information as objectively as possible. Additionally, we employed a peer-debriefer who continuously asked the primary author questions about the study, reviewed the relationship between the data and the research questions and reviewed the accuracy of the data analysis in comparison to the transcriptions.

Findings

In this study, we conducted seven individual interviews and a focus group to explore wellness for professional counselors in various mental health agencies. From the two research questions, “How do you relate to the concept of wellness as a professional counselor?” and, “How do you perceive your agency influences your sense of wellness?” five themes emerged: (a) resources, (b) time management, (c) occupational hazards, (d) agency culture, and (e) individual differences. We discuss each theme with thick, rich descriptions.

Agency Resources
Resources within the agency appeared to be a common theme that influenced participants’ sense of wellness. Participants consistently discussed areas such as salary, staff coverage and workloads as barriers to wellness. For example, participants discussed how financial compensation affected their feelings of being valued as well as their means to do things to maintain wellness. One participant, Anne, explained, “I am a 37-year-old woman who has to live with a roommate… I’m paid half of what nurses [at the same facility] are paid for the same amount of time.” When asked how she handled being paid less than other helping professionals, Anne responded, “I commiserate with other people in the field about being underpaid and undervalued. I can’t beat my head against a wall.” Another participant, Brian, discussed how his salary often impeded his ability to engage in wellness activities:
One of the struggles I had at the beginning was pay. Because it didn’t afford me, literally, the chance to do things to take care of myself, that I wanted to do to take care of myself. So if I had a weekend I couldn’t take a trip to the beach for the weekend. It had to be a quick jaunt and back because I couldn’t afford a hotel.

Resources also included counselor workloads, specifically in terms of how many clients each counselor had to see a day to maintain reimbursement policies. Brian discussed the lack of funding and explained that agencies must work “bare bones…skeleton crew basically.” One participant, Helen, commented on her caseload:

Money can drive a lot of things. Like the choices that you could make [before reimbursement] were more about the clients and what was needed, or what you wanted to try, and then you know Medicaid or other external forces enter, and then decisions have to be made on a different basis. The number of people you would even take would change. [before Medicaid]… There was a lot of flexibility, there was no external pressure to take a certain amount of clients and then there were great conversations and the ability to envision what you should do, and there was the time do it, and there was opportunity to review what you have done, and build the relationships and get feedback on your work, and whereas now, you have put in the time and you have to make the numbers and you lose the time to create relationships or talk about what you are doing.

Similarly, Brian discussed how large caseloads and working with clients back-to-back affected his performance when stating:
Basically, it took away from the services I was able to offer. But most of all it took away from me. You know my energy level, and just across the board I wasn’t able to do all of the things you would like to do as a quality counselor like planning…often it was sort of on the cusp.

Participants described the various resources within their agencies that influenced their sense of wellness. They identified the lack of resources as a barrier to their wellness, which also affected the quality of client care and enthusiasm for their work.

Time Management
Participants discussed time constraints as barriers to their wellness and their ability to maintain optimal performance with clients. They mentioned heavy caseloads as well as administrative duties and paperwork requirements as obstacles to their wellness that also reduced the quality of client services. Additionally, they believed that there was not adequate time for other important aspects of their development, such as supervision. One participant, David, discussed his frustration with not being able to sufficiently prepare for sessions, stating, “there was kind of this disconnect with how long it took to prepare for a session to do it right, or how long it would take to do a group, and to do it right.” He further proposed that the problem may be lessened even without reducing the caseload; “maybe it’s not about the number of clients as much as, maybe it’s just about a scheduling thing too, if you could just spread these clients out, thin enough.”

Participants also discussed administrative duties such as paperwork as wellness barriers that take away from the true meaning of their work. For instance, David stated that, “what was most stressful wasn’t working one-on-one with clients, it was just the amount of paperwork and catch up. You literally feel like you’re running a marathon when you walk in the room.” Brian described the draining effects of paperwork by stating, “I found myself very disenchanted because the work that I wanted to do was with people and often I found I was just doing documentation.”

Finally, participants discussed the importance of making time for appropriate supervision and consultation in maintaining their wellness. For example, when comparing an agency where she felt greater wellness to her previous agency, Fatin stated that the difference is:
The support and the peer consultation, and the time to do that. The level of respect is much higher. There is respect for the administrator; you can approach her with feedback. [There are] high ethical standards and consulting, and the open-door policy. Just makes it so you never feel worried that you will make a mistake, because a lot of people are holding you up.

When talking about the need to differentiate client staffing from clinical supervision, Brian explained that supervisors often, “don’t do supervision with their employees…or supervision is staffing. It’s the same.” He further explained, “Ideally, you have a sit-down with a person and do supervision. So they have a chance to talk about how they’re feeling, the problems they are having, in a safe place to do that.” He conceded that time constraints often hinder this process because, “there’s a lot of crisis and things come up at any given moment. So, you have a schedule, but something trumps it very quickly.” David discussed the benefits of having a positive supervisor who made time for clinical supervision with him, stating:
It was a really important part of me so when I was getting close to burnout or when I was stressed out or in a funk or whatever, I could talk to him and that kind of supervision process which was more than just once a week for an hour. It was more of an as needed kind of a thing and was very, very helpful. It was more than just clients, so it was very helpful for personal growth and so I was totally happy to have that.

Participants described time constraints as significant barriers to their wellness and consequently their ability to provide the best care to clients. However, they also discussed how access to human resources (e.g., supervisors) can positively influence their sense of wellness and development.

Occupational Hazards
A second theme that emerged was occupational hazards. This theme involved the psychologically intense characteristics of the work itself that threaten wellness and included concepts such as empathy fatigue, vicarious traumatization, depersonalization, lack of meaning and wounded healing. Participants discussed the challenges of helping difficult clients while attempting to maintain their own wellness.

One participant, Peter, discussed his struggle to not personally take on too much of the clients’ concerns. He stated that:
I think the biggest challenge that I’ve faced, and I can’t say this challenge is gone to this day, is that I took on a lot of my clients’ stuff. You know, you hear as a counselor you develop empathy for your clients with their challenges and their stories and experiences can be very traumatic and you know can be very impactful. So I think the biggest thing that I had that was impactful is I feel I would take on a lot and I would feel a lot more of what others struggled to face, as opposed to be there in the moment and then walk away from it… That was something, if you think about wellness as this bubble around me and that bubble keeps me from taking on too much of people’s stuff and keeps me mentally and personally safe, then my wellness was gone, the bubble was gone.

Another participant, Anne, discussed the burden that builds when occupational hazards are ignored by the agency and/or supervisors:
A lot of vicarious trauma, grief trauma left unprocessed. When a patient dies it is like—okay next. My administrator actually said that we assume you are coming in with the clinical skills and you will take care of yourself with that. There is no facilitative process or it is not acknowledged in our agency—that it could be happening to us as counselors. We are not given a moment to have that time. [The administrators say] be sure your taking care of yourselves out there—it is sort of you take care of yourself out there.

Yet another participant, David, discussed how the quick client turnaround in the inpatient facility led him to question the value and meaning in his work when he stated:
It was a lot of treat and street, so in other words they come in, you’re basically working on discharge paperwork from the first day you meet them, so you are already thinking about where they need to go…I mean they had lost everyone else in their lives and they felt isolated and alone, so the relationship was incredibly crucial and I think most people would agree that the relationship is the most important part of the counseling process, and you can’t build a relationship if basically when they are coming in you are looking at the chart trying to get the form filled out and trying to get them out the door because either insurance won’t pay or it’s a bed that needs to be emptied out so it can be filled with someone who can maybe last longer.

David went on to discuss his resulting emotions:
There is almost like this shame/guilt you are kind of feeling or struggling with where you feel like you can’t seem to get anywhere, or I am not doing anything, or what am I doing…Am I helping?…Does this matter? And I think that once you have lost that meaning in your work, that passion for what you are doing then it just kind of all, it’s a sinking ship at that point and wellness is just kind of out the window, you just get frustrated.

Participants also discussed the potential setbacks that can occur when professional counselors over-identify with their clients (e.g., wounded healer). Helen comments on how unfinished business unfolds in an agency:
It isn’t quite a straight line. In other words, it is whatever the underlying energy of the agency that draws people in. If people come and then they go, they may not relate to it, but those people who stay for a while, for [more than] three years, that is an issue. You have to constantly reflect back ‘why am I here?’ What is it about this job that has pulled me here and what is it that I need to learn. I think you could stay in the field and never reflect or heal from anything.

One participant, Romie, who also does clinical supervision, discussed the importance of processing empathy fatigue and often spends her time processing the “heaviness of the work.” She responded that “managing the occupational hazards is a matter of keeping the counselors happy…if they are happy and they feel good, and if they feel rewarded in their work they are going to produce and stay.”

Participants discussed that intense and emotionally close work they do with clients is a potential barrier to their wellness. They alluded to the need to set personal boundaries while still finding meaning in their work. Additionally, participants discussed needing time to process the emotions that may arise.

Agency Culture
The next theme that emerged was agency culture. The participants expressed that the messages the administration convey as well as the morale of the agency often influence their sense of wellness. Participants discussed wanting to feel valued and respected by their agency. Sarita stated that she felt valued by her agency. When she was asked how that message was conveyed to her, she replied:
I have been made to feel okay about my developmental level, just…you know…. normalizing my learning level. Everyone can speak up about what their opinion is, even if they are new, you feel part of the team. You know you have been selected for a reason to work here. They have confidence in you and they remind you of that.

Romie paralleled Sarita’s statement:
I happen to believe that wellness comes from the agency itself through feeling valued as an employee, [when] someone hears you in the company and that you have a voice. Having a sense that you say things and that they are respected. Feeling like that if there is anything that the company could do to help, they would. People feel happier, more rewarded and better. What that is in an agency I think is different for each one. It is more of a relationship and personal style.

Brian discussed the value when agencies respect the employees’ need to take care of their family:
Most of the programs that I’ve been in—they are more than willing to let you take care of your family as long as you are doing your job. That’s been the biggest piece I think from a wellness standpoint is the understanding of that from the top.

Participants also discussed how the overall morale of the agency and coworker relationships influence their sense of wellness. For example, Helen commented on how one of her previous places of employment communicated messages of wellness through promoting coworker relationships:
A lot that has to do with the attitude with the people running the place, what they valued, that fact they were invested in relationships. They realized we have to have connection with each other in order to give support to do the work here.

Similarly, Peter discussed how he believed staff cohesion plays a role in wellness:
My experience is that when there is a sense of cohesion, a sense of togetherness and teamwork, I think that people get along better and there’s a natural well, not well, but a natural happiness that goes along with it. My experience, where I’ve had the most stable or happy wellness have been places that encourage staff meals or having staff getaways, or doing events that brought the staff together to enjoy one another…not to work, but just to be around one another and enjoy one another and support one another.

Participants also discussed how agency directors and supervisors directly advocate for self-care. Catherine commented about self-care and wellness:
There is an encouragement for self-care. It is double-binded, you have to get your stuff done, but you know it is like it is Friday, let’s go home. They encourage each other to work less and have fun. Other places (agencies) had more pressure to get it done. There is a consciousness of balance.

Peter also discussed positive feelings when his supervisor supported his self-care efforts, “There was one day there was an accumulation of things, a combination of feeling sick, but also in the middle of a stressful time…he said go home, have a great day. So he was in support of wellness.” Peter continued, “he understood the job is not always easy and can bring on a lot of stress and he was willing to let us take care of ourselves if we needed to.”

Overall, when the agency promoted the respect and value of professional counselors and encouraged counselors to have a voice and affect change, it promoted the counselors’ own sense of wellness. Furthermore, sensing an investment in work relationships and promoting a work-life balance influenced the wellness of these counselors.

Individual Differences
The final theme that emerged involved the different perspectives of the participants and how that influenced their feelings of wellness. Two participants from the same agency held very different feelings about how their agencies influenced their sense of wellness. Jill felt very positive about her agency and spoke of the many financial incentives and freedoms allotted and that the agency’s independent scheduling fit her. Anne also mentioned the same financial incentives, but believed that she received negative mixed messages and that her wellness was being negatively affected by the same agency. Conversely, Jill, who felt positive towards her agency, noted, “No one had to tell me to take care of myself.” David also expressed that wellness is often left up to the individual; when speaking about one of his agencies he stated, “it wasn’t really like it was a place of wellness. Wellness is something that happened, or self-care happened long after you left.” Romie responded about her intentionality with wellness:

Personally, what I do is many things. I exercise; I make sure I get plenty of sleep. I take time for myself when I need to. I will do yoga and meditate and do a lot of reading and I am highly spiritual. I have a wonderful home-life, a very supportive love-mate in my life. I am really in a good place.

Throughout the interviews, the participants discussed very different values in terms of their wellness. Some of the participants mentioned spiritual practice and journaling as being important in maintaining wellness. Others expressed time with family as being most important, whereas others discussed setting clear boundaries or finding meaning in their work.

Other participants discussed how wellness initiatives within their agencies often seemed inconvenient to them. When talking about a discounted gym membership that was offered, Brian viewed the offer as superficial, saying “in my experience, most of what they offer in terms of wellness is, in my experience, is somewhat superficial.” He further stated, “Very few people are able to utilize the gym membership because of the hours they work and where it’s located and the cost is still too high for the employees.” Peter discussed the positives and negatives of a wellness initiative:

The book was a 40 week-by-week event where you learned about wellness…physical, mental, spiritual; all these different components. The problem was they had these events that took place scattered all over the district and so for anyone to attend them, they would have to drive half an hour to 45 minutes to attend them and which if you’re trying to have a good basis for wellness, then having people drive 45 minutes after a long day of work is not a good place to start for that.

However, Peter acknowledged that this may be only his view, stating:

The planning of the events I felt could have been better. And of course, not to say other people didn’t go to them and find them successful, but it was just my experience of do I go home or drive 45 minutes then attend a 2-hour meeting on nutrition. I felt like going home was more beneficial for me at that time.

These statements reveal that professional counselors may value different things related to wellness. Other counselors in Brian or Peter’s agency may have appreciated the wellness initiatives.

The participants responded differently in terms of wellness values. One cannot overlook how different individuals will react to the stress of being a counselor. Knowing what type of atmosphere is the best fit for the counselor’s personality and interests can factor in overall well-being. Romie commented, “It is good to know what kind of atmosphere is the best fit for you, if you love it, then that is your wellness, if you don’t, then nothing you do will ever click.”

Discussion

The findings in this study suggest that the environment in which the participants work may play an important role in their overall wellness. This finding is consistent with previous research that suggested agencies directly affect well-being and satisfaction of counselors (Knudsen, Ducharme, & Roman, 2006; Lloyd, King, & Chenowith, 2002; Maslach, 1982, 1986). Participants in this study discussed lack of resources as potential barriers to wellness including unsatisfactory salaries, large caseloads, heavy paperwork and lack of supervision. This finding is consistent with previous research that maintaining caseloads above 15 per week increases chances of occupational hazards (Trippany, Kress, & Wilcoxon, 2004). Additionally, counselors have reported increased salaries as directly relating to their wellness (Bell et al., 2003), and comprised a major setback for counselors in this study. Further, our findings support previous research that poor supervision, little to no peer-to-peer conversations, low salaries, heavy paperwork, lack of control over services and managed care influences are all correlated with decreased wellness and increased likelihood of burnout (Ackerly, Burnell, Holder, & Kurdek, 1998; Gaal, 2009). Clients deserve to receive the best care possible in agencies; therefore, funding sources should be aware of what counselors specifically need to function at their best. However, it is the responsibility of all counseling professionals to organize and advocate for gains such as salary increases, caseload limits, qualified supervisors, and funding for wellness activities. Advocating through joining local, state and national organizations is one way to work toward these goals, as organizations stay abreast of current legislative changes and locate opportunities to improve the counseling profession.

The finding in this study that occupational hazards influenced counselors’ wellness is consistent with previous literature (Skovholt, 2001; Stebnicki, 2007). Additionally, participants in this study discussed the importance of supervision and processing time in order to work through such hazards. This finding reinforces the importance of supportive environments where counselors can obtain peer support and adequate supervision. Consequently, counselors’ wellness may be increased when agencies have consistent treatment-team meetings and supervision sessions, where counselors have an opportunity to process their work with others and obtain consultation. Additionally, supervisors should have appropriate training in supervision to ensure that a quality supervision experience occurs.

Participants in this study expressed that the culture of the agency influenced their sense of wellness. Factors that positively influenced them included feeling valued by administrators, feeling that they had a voice, being respected and feeling cohesion with coworkers. Agencies may assist in counselor wellness by developing employee committees that provide a forum for counselors to express concerns and provide recommendations to the agency. This may help to foster a sense of value among the counselors when their perspectives are heard. Additionally, employee committees may serve to organize wellness activities and professional development opportunities for the staff, encourage peer support and cohesion, and organize advocacy efforts.

Implications for Professional Counselors

The findings in this study suggest that one’s wellness is very personal and is heavily influenced by personally salient values. In this study, the participants mentioned different wellness values. Individually, counselors can develop holistic wellness plans and gain self-knowledge concerning what aids them in performing at their best, while considering the realities of their work environment and resources that are available to them. Counselor educators can model wellness activities and highlight the resilience that stems from a comprehensive wellness plan so new professionals are prepared to attend to wellness when they enter the field. Counselor educators also should educate counselor trainees as to the realities of agency work (e.g., caseloads, paperwork, difficult clients) so they can prepare themselves mentally to enter the system. Counselors and clinical directors can vocalize ways to enhance the well-being of the atmosphere in the agencies by advocating for reasonable caseloads and encouraging wellness days for the staff (e.g., days where the entire staff rejuvenates together through team building or other enjoyable workshops or activities). Given that funding is often mentioned as a factor that influences wellness, agencies and individual counselors may benefit from learning how to secure various types of grants to assist with resources (e.g., additional staff, technology, wellness initiatives). Additionally, agencies may benefit from developing ad-hoc committees that will evaluate processes and procedures (e.g., paperwork, documentation) to potentially reduce workloads and ensure that counselors’ time is used efficiently. Finally, counselors should be proactive in seeking out further training in wellness, self-care and burnout prevention through conferences (e.g., ACA, AMHCA) or other professional development opportunities, and should advocate that their agencies provide these types of trainings.

Limitations and Future Research

Despite the depth and richness of information obtained in this exploratory study, there are multiple limitations. First, we did not spend prolonged time in the field in order to gather further data about wellness practices through observation or document analysis. Future researchers may benefit from direct observations of wellness practices in the natural setting. Additionally, we only utilized one source of data for interpretation (i.e., interview/focus group) which may have affected the depth of information obtained. Finally, although generalizability is not a major goal of qualitative research, readers should be mindful that the findings may not be representative of other counselors in different settings.

Future researchers could explore wellness experiences of more diverse racial/ethnic groups and those at various income levels. Additional studies may include more prolonged engagement in the field by the researcher in order to make observations about wellness practices as well as multiple data sources (e.g., observations, questionnaires, reflective journals). Other studies may include agencies that are currently implementing specific wellness practices in order to evaluate their effect on counselor wellness. Finally, future researchers may benefit from identifying particular agencies that maintain effective wellness practices and exploring them through in-depth analysis.

Conclusion

Counselor wellness is an important aspect of ensuring effective and ethical services to clients (ACA, 2010; NBCC, 2005). The findings in this study provide some initial information about the various aspects of wellness that may be influenced by professional counselors’ work environment. Although agencies may not be able to immediately change all aspects of the work environment (e.g., salary, caseloads, work hours), other aspects such as agency culture and adequate supervision are easier to address. Counselors and clinical directors may benefit from evaluating their current wellness practices through staff questionnaires, focus groups, or needs’ assessments. Attending to professional counselors’ wellness needs may help to improve the morale in the agency, help counselors avoid burnout, and ensure more quality care for clients.

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Jonathan H. Ohrt is an Assistant Professor at the University of North Texas. Laura K. Cunningham, NCC, is an Assistant
Professor at Argosy University. Correspondence can be addressed to Jonathan H. Ohrt, University of North Texas, 1155 Union Circle #310829, Denton, TX 76203, jonathan.ohrt@unt.edu.

Appendix
Participant Demographics

Name (pseudonyms were assigned) Type of Facility Gender Age Race Experience in Field Interview Method

Anne
Palliative Care Facility
Female

37

Caucasian

11 Years
Individual

Jill
Palliative Care Facility Female 40 Caucasian 2 Years Individual
Helen

Clinical Director for Domestic Violence Shelter and Community Counseling Center Female 45 Caucasian 13 Years Individual

Romie

Clinical Director of an Adolescent Residential unit
Female 53 Caucasian 20 Years Individual
Fatin
University Counselor
Female 27 Caucasian/Middle Eastern 1 Year Focus Group
Catherine

University Counselor
Female 28 Caucasian 9 Months Focus Group
Sarita
University Counselor
Female 33 East Indian 1 Year Focus Group
David Behavioral Hospital Male 29 Latino 3 Years Individual
Peter Inpatient & Residential Male 28 Caucasian 3 Years Individual
Brian Adolescent Residential Male 38 Caucasian 13 Years Individual

A Phenomenological Investigation of Adolescent Dating Relationships and Dating Violence Counseling Interventions

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

Danica G. Hays, Rebecca E. Michel, Rebekah F. Cole, Kelly Emelianchik, Julia Forman, Sonya Lorelle, Rebecca McBride, April Sikes

Despite the prevalence of dating violence, incidences often go unreported due to a lack of awareness among students as to appropriate dating behaviors. This phenomenology investigated how adolescents conceptualize and experience dating relationships. We explored adolescent females’ definitions of healthy and abusive relationships, experiences with unhealthy relationships, and responses to dating violence in order to develop effective strategies to intervene with this population. Implications for school counseling and mental health counseling practice, training, interventions and future research are discussed.

Keywords: dating violence, adolescent, female, school counseling, mental health counseling, interventions

Dating violence, which involves actual or threatened emotional, physical, and/or sexual abuse within a dating relationship, has become an increasing concern among counselors working with adolescent populations (Craigen, Sikes, Healey, & Hays, 2009; Hays, Green, Orr, & Flowers, 2007). There are significant mental, physical and behavioral consequences of adolescent dating violence, including depression, anxiety, PTSD, suicidal ideation, poor self-concept, disordered eating, substance use/abuse, risky sexual behavior, and school disengagement (Ackard & Neumark-Sztainer, 2002; Banyard & Cross, 2008; Howard, Beck, Kerr, & Shattuck, 2005; Howard, Wang, & Yan, 2007; Masho & Ahmed, 2007; O’Keefe, 2005; Silverman, Raj, Mucci, & Hathaway, 2001). Due to the severity of negative health outcomes, it is imperative for counselors to understand the experiences of adolescents to facilitate early intervention with this at risk population (Hays et al., 2007). Few studies have given voice to the individuals themselves.

Dating serves as an important developmental milestone as individuals come to understand social and relational goals. For many, dating begins in adolescence, with an estimated 72% of 11- to 14-year-olds dating before age 14 (Teen Research Unlimited, 2008). Unfortunately, young adolescents may be unaware how to behave in a dating relationship, so they are vulnerable to inaccurate messages from their family of origin, peers and the media (Connolly, Friedlander, Pepler, Craig, & Laporte, 2010). With respect to family influences, many individuals are socialized that violence is a normal and appropriate response to conflict in intimate family relationships (Hays et al., 2007). Adolescents living in urban communities or experiencing socioeconomic disadvantages may be exposed to increased levels of family and community violence (Banyard, Cross, & Modecki, 2006; Vézina & Hébert 2007). Compared with their peers, female and male adolescents with a history of family violence are at a greater risk of dating violence victimization and perpetration, respectively (Laporte, Jiang, Pepler, & Chamberland, 2011).

Peers and media also influence behaviors and attitudes. Research suggests between 50 to 80% of adolescents report knowing friends who were involved in dating violence (Ashley & Foshee, 2005; Halpern, Oslak, Young, Martin & Kupper, 2001; Teen Research Unlimited, 2008). Adolescents with friends who experience dating violence are more likely to perpetrate violence against their dating partner (Foshee, McNaughton, Reyes, & Ennett, 2010). Further, media exposure may impact adolescent attitudes surrounding dating violence, specifically the belief that violence is a way to resolve relationship problems (Manganello, 2008; Rivadeneyra & Lebo, 2008). Adolescents who prefer aggressive media such as physical or verbal violence in television, movies, music and video games are likely to exhibit violent relationship patterns (Connolly et al., 2010). When faced with fictional dating situations, the majority of young adolescents resorted to aggressive conflict resolution techniques, such as fighting (Prospero, 2006).

Adolescent perceptions of social dating norms (Sears & Byers, 2010) as well as mental health issues may also impact students’ exposure to dating violence. There is a direct relationship between tolerant attitudes toward violence and becoming a physically violent dating partner (Josephson & Proulx, 2008). Female aggression against peers and depression have also significantly predicted dating violence perpetration (Foshee et al., 2010). Clearly, there are many environmental and personal factors that contribute to relationship violence.

Dating violence is often under reported because students lack awareness about appropriate dating behaviors (Hays et al., 2007; Lewis & Fremouw, 2001). Adolescents may be reluctant to disclose dating violence to adults for fear of a possible confidentiality breach, personal denial of the situation, labeling harmful behaviors as “love” and fear of repercussion from the violent partner (Close, 2005). Others may believe disclosure would impact their academic performance or lead to disciplinary issues (Moyer & Sullivan, 2008). Survey data indicate that dating violence prevalence rates range from 21 to 80%, depending on type of violence (Cyr, McDuff, & Wright, 2006; Harned, 2002; Holt & Espelage, 2005; Sears & Byers, 2010; Wolitzky-Taylor, Ruggiero, Danielson, Resnick, Hanson, & Smith, 2008).

A majority of research indicates that female and male adolescents are equally likely to experience dating violence (Ackard & Neumark-Sztainer, 2002; Sears, Byers, & Price, 2007; Schnurr & Lohman, 2008). While both males and females experience dating violence, research suggests violence has a greater impact on females than on males (Cleveland, Herrera, & Stuewig, 2003). Sears and Byers (2010) found adolescent females report a stronger emotional reaction to dating violence than their male peers. Thus, it is important to assess female adolescent reactions to dating violence.

There is limited research that explores dating violence perceptions and experiences of young adolescents. Previous qualitative studies have either been retrospective or involved adolescents 14 and older. One retrospective study (Draucker, et al., 2010) sought to classify typical violent events within adolescent relationships by interviewing young adults about dating violence experienced between 13 and 18. Draucker and colleagues (2010) also found that jealousy and relationship threats often led to threatening and controlling events in the future. Communication problems, such as an inability to express feelings, often led to additional disagreements among dating partners. Livingston, Hequembourg, Testa, and VanZile-Tamsen (2007) found women who had been sexually victimized as adolescents reported the following areas of vulnerability may have contributed to their victimization: lack of guardianship, inexperience with dating, substance use, social and relationship concerns and powerlessness.

In addition to retrospective studies, other researchers have explored older adolescents’ experiences with dating violence. Lavoie, Robitaille, and Heberts (2000) interviewed individuals between ages 14 and 19 about their dating relationships. Participants provided examples and reasons for teen intimate partner violence. The young adults explained that physical abuse was usually aimed at provoking fear in the victim. Psychological abuse often included gossip and was meant to be damaging to adolescents’ reputations. While participants generally viewed perpetrators negatively, some viewed their own violent behavior as acceptable. For example, females believed using violence in self-defense was preferred over being hurt without reciprocation. Aside from self-defense, other reasons given for abuse included: jealousy, need for power, substance use, previous violent relationships, communication problems, and need for affiliation.

Other researchers explored perceptions of dating violence among females ages 15 to 17 living in Thailand (Thongpriwan & McElmurry, 2009). Major themes that emerged included (a) descriptions of adolescent relationships, (b) influences on relationships, (c) perceptions of dating violence, (d) cycle of dating-violence experiences, and (e) influences on adolescent perceptions of dating violence. The majority of participants were 17, and the authors indicated that younger students may have different views and experiences (Thongpriwan & McElmurry, 2009).

Information gathered from qualitative studies provides researchers with information about perceived risk factors and perceptions of violence, which can aid in the development of age and culturally appropriate interventions to reduce dating violence. Adolescence is an optimal time to intervene with education and skills to promote healthy dating relationships (Collins & Sroufe, 1999) and school and community counselors are well-positioned to help adolescents navigate these relationships (Davis & Benshoff, 1999; Hays, Craigen, Knight, Healey, & Sikes, 2009). To develop effective interventions, researchers must further understand the context of adolescent dating violence. In addition, counselors must be knowledgeable about dating violence indicators, peer influence, and adolescent opinions about healthy and abusive dating relationships in order to appropriately intervene in potentially harmful dating situations (Craigen et al., 2009).

While many adolescents begin dating before age 14, no previous studies to date have explored how adolescents perceive and experience dating relationships. The purpose of this phenomenological study was to capture the essence of young adolescent female conceptualizations and experiences of intimate partner relationships and potentially identify counseling interventions. The following research questions were explored: (a) How do young adolescent females conceptualize healthy and abusive dating relationships? (b) What experiences do young adolescent females identify related to unhealthy relationships? and (c) What methods do young adolescent females identify as helpful in preventing and intervening in dating violence?

Method

Participants

Seven adolescent females ages 11 to 14 who had witnessed intimate violence participated in the study. Participants were recruited from a community group, and the primary researcher (first author) had a rapport with the group facilitator. The primary researcher secured parental consent and child assent for each participant. The females lived in the Mid-Atlantic region of the United States and had been acquainted with each other at least 1 year prior to the research study. Participants were from varying racial backgrounds: four identified as White/European American, two as Asian/Pacific Islanders, and one as Native American. Participant living arrangements were mixed: two lived with a mother and father, two with divorced mothers, one with a divorced father, one with a single-never-married mother, and one with a guardian after being removed from the home due to severe child neglect. Regarding current dating relationships, two participants reported dating and all identified as “liking boys.”

Measures and Procedures

IRB approval, parental consent and child assent were obtained prior to data collection. Data were collected through four independent focus group interviews averaging 45–60 minutes. The researchers utilized semi-structured open-ended questions to focus the interviews. Sample interview questions across the focus group interviews included the following: What do you think makes a good dating relationship? What do you think makes a bad dating relationship? How do you define abuse? How would you respond to abuse in a relationship? Subsequent focus group interviews were used to elaborate or clarify on responses from previous focus groups. All participants attended all focus groups. Research team members transcribed each audio-recorded focus group interview data verbatim. Focus group interviewers developed memos for each session. Participants also completed a demographic sheet that consisted of questions regarding age, race/ethnicity, gender, grade level, sexual orientation, dating behaviors and family status.

Data Analysis

Researchers bracketed their assumptions prior to beginning the study to ensure credibility of the results (Hays & Singh, 2011). Researchers assumed participants would: (a) report minimal knowledge of dating violence prevalence and characteristics; (b) describe instances when female peers were victims of dating violence; and (c) state uncertainty for intervening in dating violence. Each research team member independently analyzed the sentence transcript data using horizontalization. The research team then consensus coded to describe textures (meaning and depths) related to their experiences (textural descriptions) (Hays & Singh, 2012). A final codebook outlining four primary themes and several subthemes was developed from the recursive coding process.

The research team used several practices to establish trustworthiness throughout the study. The research team members maintained prolonged engagement with participants over the course of one year. During meetings, field notes were kept to capture data and self-reflective thoughts and feelings. Simultaneous data collection and analysis occurred in order to further explore themes in each subsequent interview. Each interview was transcribed verbatim and checked by another member for accuracy. During this time, memos were created to organize thoughts and connections emerging from each interview. Researchers provided thick description by incorporating verbatim quotes throughout the data analysis and results, providing interpretive depth and detail.

Results

The following four themes were identified: conceptualization of healthy dating relationships; conceptualization of unhealthy dating relationships; exposure to relationship violence; and dating violence interventions.

Conceptualization of Healthy Dating Relationships

Participants identified several components of healthy relationships, including honesty, trustworthiness, openness, compassion toward animals, fun, holding opposite views and attractiveness. The first component, honesty, was best described by one participant: “If you don’t know everything about that person … you are not going to be happy because you wanted to find it out from them and not someone else.” Trustworthiness was important to participants, as one stated, “you cannot really trust them if [they] are lying behind your back… I am going through that right now.” A third identified component was openness: “he has to be able to be open to what is said… like when you’re talking they’re not judging.” Compassion toward animals and nature was described by a participant: “I am a fan of people who like the earth and animals… people that abuse animals. I hate those kind.” Several participants indicated they enjoyed having fun: “I like people who can make me laugh… can take a joke.” Overall, they valued holding opposite views from their partner: “if you have a person that is different from you, then you can experience different things.” Finally, participants agreed that they looked for attractiveness in relationships: “I want someone that’s good to look at [laughs].”

Participants also identified several components of healthy relationships that related to interpersonal dynamics, including independence, security, and lack of abuse, sexual pressure and conflict. When describing healthy relationships, adolescents mentioned the importance of independence. For example, participants explained, “I need my personal time.” “[Not] always around you, always calling you, always trying to get a hold of you.” Security was also noted as a component of healthy relationships: “Don’t we date for security? Isn’t that kind of why you date? You date because you want to feel safe with someone.” Participants believed physical abuse and sexual pressure should be absent from healthy relationships. A participant explained, “I have learned that the more you get beat in the head, the more brain cells you lose and you can’t get brain cells back.” Another participant noted, “If I didn’t want to have sex then the other person wouldn’t pressure me.”

Participants supported varying views on the role of conflict in healthy relationships. Some participants believed less conflict was indicative of healthier dating relationships. One participant stated: “If you agree with someone there is less confrontation of any kind and it makes things a little bit easier.” However, approximately half of participants viewed conflict as a normal and fun aspect of relationships: “disagreeing is kind of fun because you get to debate… no one agrees on everything, so you have arguments.”

Overall, participants described characteristics of healthy dating relationships similarly to those of healthy peer and family relationships. One participant noted, “I want someone who would be nice and kind, like in any kind of relationship.” Additionally, participants noted healthy dating relationships can be fragile. For example, one participant stated, “if you don’t start it off with truthfulness, then if you are not honest the entire time then you may never actually see that person again if they find out who you really are.” Another participant noted, “like in the movies they are in a marriage and then they get divorced.” While many participants provided examples and descriptions of healthy relationships, initially 2 of the 7 participants could not clearly articulate their opinion: “I don’t know the exact definition. I can see pictures in my head but I can’t put it into words.” As the groups progressed, participants provided additional descriptions and components of healthy relationships.

Conceptualization of Unhealthy Dating Relationships

The second major theme refers to components of unhealthy romantic relationships, conceptualization of dating violence, and dating violence consequences. Participants believed certain components perpetuated unhealthy relationships, including addictions and abuse. Participants reported a connection between unhealthy relationships and addictions. For instance, one participant suggested “you shouldn’t sell her wedding ring for drugs, and don’t get addicted to drugs or cigarettes or anything.” Another participant stated “one time he told her that if he had to choose he said he would choose drugs over his own children.” In addition to addiction, participants indicated abuse served to facilitate unhealthy relationships. One participant discussed how one of her friends was recently a victim of dating violence and as a result ended the relationship. She indicated, “Unhealthy would definitely be abuse, one of them cheating on the other, and unfortunately one of our girls actually had to experience that recently and she broke up with him.”

The young adolescents spent significant time conceptualizing dating violence, notably emotional, physical and sexual abuse. Emotional abuse was described as “when you’re being told that you’re worth nothing.” Another participant conceptualized physical dating violence as a male beating a female just because he can. She stated, “They can just like hurt you, they can beat you up just because…like dating, if the girl doesn’t agree with the guy if he wants to he can just, like, beat her up.” Participants also displayed knowledge of types, signs, and prevalence of dating violence. One participant suggested, “If you are going to be a victim of sexual abuse then look for signs like trying to get you to do things that you don’t want to do or touching you in a certain manner.” Another adolescent reported, “I think it is like 50 or 60% of people like experience or have couples around them that experience dating violence.”

The girls identified numerous perpetrator factors which perpetuated dating violence. Techniques to gain control over a victim included manipulation, peer pressure, and jealousy. Participants indicated perpetrators might make threats or use manipulation to force them to stay in a relationship. One participant suggested a perpetrator might say, “‘I will hurt you if you break up with me…and she says she will be forced to stay because she doesn’t want to get hurt.” Another girl stated, “he said nobody’s going to love you like I do,” displaying the incidence of manipulation and control. Participants also discussed how perpetrators might use peer pressure or isolation to stay in control. One participant said, “Sometimes they try to push you into doing things that [you don’t want to].” When asked by the facilitator why perpetrators may want to keep victims in isolation one participant suggested, “So they can get closer to you…and do more damage.” Further, participants discussed how perpetrators might try to use jealousy to control victims. One participant discussed how she experienced jealousy in a previous relationship. She shared, “He was trying to make me jealous by going out with [name] but it didn’t work.”

The young females brainstormed various consequences of dating violence. Specifically, they described what could happen to them physically, emotionally and behaviorally as a dating violence victim. One participant discussed physical consequences victims may face. She stated, “[one] could, um, get diseases, AIDS, you could get hurt.” Another participant explained, “you could, you could, die” demonstrating the perceived severity of victim consequences. Another participant reported the danger of abuse, “those that are exposed to emotional abuse, they could possibly have, like if they are being told they’re too fat, they could possibly become anorexic.”

When referring to the types of emotions victims may experience, one participant stated, “mixed emotions that you have like sometimes you’ll be sad, and sometimes you’ll be mad, sometimes you’re actually hurt.” Participants indicated victims may turn to substance use to relieve their pain. One participant stated: “they drink because they have a lot of stress. Sometimes people smoke and do drugs because they have too much stress on them and they do it to relieve the stress.” Participants also recognized the consequence of victim self-blame. One participant stated, “I think I know why they would blame themselves because they let themselves be attacked and they could have gone and tried to get help any chance they got.” Another participant stated, “They could have prevented it.” These statements suggest participants perceive dating violence to be the victim’s fault. Participant conceptualizations of perpetrator factors included jealousy, threats and manipulation, isolation, peer pressure, and exposure to violence within the family of origin. Victim consequences associated with dating violence were identified as physical consequence (e.g., disease, AIDS), emotional consequences (e.g., depression, suicide), body image issues, substance use, self-blame, and fear of others.

Exposure to Relationship Violence

Exposure to relationship violence refers to the experiences one has with violence, including witnessing physical, sexual, or emotional violence within the family of origin, media, within the community, and in one’s peer groups. Participants reported violent acts between parents, siblings, and/or relatives. One participant indicated,
Something that happened recently between my brother and my dad, um, my dad
actually threatened to hurt my brother, and, and, so my brother kind of took a hammer
just in case, just in case, cause he wouldn’t hit my dad unless he really needed to and then he left for 2 days but we knew where he was so, or I knew where he was.

Many participants noted exposure to violence in the media, including the witnessing of violence via the television, magazines, the internet, and pop culture. One participant provided an example within pop culture, “what about [two pop stars], she was mad about what he did but…..I think it’s her fault.” Another example of media exposure to violence came from television, “the thing where someone is growing up in an abusive house dating someone from a less hostile home, like it’s um, kind of sounds like [two characters] from Secret Life [television show].”

In addition to pop culture and media exposure to violence, participants reported exposure within the larger community. This includes violence that takes place within neighborhoods and the larger community. For example, one participant shared:
I’ve actually witnessed, like on the corner [near my house] … [The] guy in the relationship keeps grabbing her and taking her back into the car… and I got close enough to be able to see and hear… she looked at me and said help me… I felt good that I helped with the situation but I felt really bad for her.

Participants also noted exposure to violence within their own peer groups, which includes the witnessing or sharing of violence that takes place among friends and peers. Participants made a number of statements, including:
And I’m not going to say names but one of our current girls actually experienced being with one of our girls’ brother. Or almost. But, I don’t know…I guess he had her pinned up against the wall or something.

In addition to peer exposure to dating violence, participants reported direct personal experience with physical, emotional, and sexual relationship violence. Participants discussed violence in dating, familial, and casual relationships. Personal experience within dating relationships includes violence perpetrated or experienced during a dating relationship. One participant shared, “One of my ex-boyfriends one time pulled a knife on me because I wouldn’t do some sexual things with him… he said nobody’s going to love you like I do.” Personal experience of violence in family of origin occurs within families where the adolescent is directly involved in the violent act. For example, one participant reported, “In my family there is a lot of yelling. It was hard because if I did one thing, he would yell at me and I was on restriction like every single day for just doing the littlest thing.” Other areas of personal experience of violence include friends and peer groups. One participant explained, “I am very fun…. I’m pretty kind but I do hit my friends. It is a joke. I don’t hurt them.”

Dating Violence Responses

The research team identified three primary themes regarding how participants recommended responding to dating violence: prevention strategies, factors influencing responses, and dating violence interventions. Participants proposed several methods to prevent dating violence. They suggested to “check your partner’s background” by doing “criminal background” checks or asking friends about their ex-partner’s behavior. It was assumed an individual’s past relationship history is indicative of future behavior. One girl suggested avoiding, “a guy who has had many ex-girlfriends.” They also discussed trusting their instincts about people and stated, “I know he’s just not the right guy. I know that something’s wrong with him, something’s going to happen.”

The participants discussed influences on responding to dating violence. Participants made statements suggesting they view reporting as dangerous. One female explained, “I know people who wouldn’t want to tell because if you go back to that person…they can hurt you even more.” Another girl stated, “What if you’re like scared to see somebody about it? Like you’re just like scared you’re going to get into trouble about it or the person who did what was wrong will come back.” Participants noted gender differences in reporting choices. For example, one participant explained, “[Girls] give in to telling people because they actually want to be safe. But boys … they probably think they’re tough.” Participants also imagined scenarios where someone may choose to not report the violence due to what their friends might think. “People might actually try to cover it up because they don’t want them to see that they are in a bad relationship.” Another participant suggested someone’s own ambivalence about the relationship could cause them to hide the violence, and stated, “They don’t want their friends to know because they might like their partner at certain times.”

While participants noted the challenge others may face when reporting relationship violence, the participants suggested they would actually tell an adult or friend about violence they experience. Several participants identified a particular adult such as a parent, aunt, uncle, teacher or police as someone they would report to. One participant indicated, “I live with someone who talks to me about it all the time. My mom…she is always talking about it.” One participant would tell a friend in order to be able to talk through the problem and stated, “She’s a good listener and that’s sometimes really all you need.”

The girls had a sense if they were not treated well the best option was to end the relationship. One adolescent stated, “If he is going to tease you, he is not right for you because your partner is supposed to be nice and loving.” Several girls suggested there would be warning signs they could respond to. One remarked, “If you sense it coming you can say I want to end it.” Participants also noted that staying may be an option, but suggested different reasons for choosing that alternative. Some participants saw hope in resolving the conflict and suggested to “talk it out” and “ask why he is mad or sad.” Another participant stated she would “try to make them happier.” Other participants suggested they would stay because they would see no other options, “So you don’t know what you’re going to do and they think you’re crazy, so you don’t know what you’re going to do, so you might just stay a little bit longer.”

The most prevalent response to intervening in dating violence included using violence themselves. They reported imagined behaviors in a violent relationship. Participants made statements including, “I always say you abuse me, I abuse you back,” and “If someone tries to, I’m just going to have to cut them.” They also discussed incidents in which they or their friends have used violence in the past to resolve conflict. One girl stated, “My friend…says she kicks guys in the ankles.” Two other participants recollected, “[I] remember almost having to kick this guy’s butt one time.”

Discussion

Findings related to participant conceptualizations of healthy and unhealthy relationships, experienced relationship violence, and potential responses to dating violence. Components of a healthy relationship included openness, trustworthiness, honesty, lack of pressure to become intimate, and humor. Participants cited attractiveness, lack of physical abuse, independence, and kindness to the environment and to animals as being important. Interestingly, participants also identified conflict as a normal component of a healthy relationship. However, participants did specify healthy relationships would have less conflict than unhealthy relationships.

Participants distinguished between healthy and unhealthy dating relationships. Adolescents believed addiction and abuse perpetuated unhealthy relationships, which is similar to previous research findings (Foshee et al., 2010; Livingston et al., 2007). As with other qualitative research, adolescents exhibited awareness of verbal abuse, emotional abuse, physical abuse and sexual abuse (Lavoie et al., 2000; Thongpriwan & McElmurry, 2009). Furthermore, participants displayed knowledge regarding the consequences of various forms of abuse, which have been well documented in the literature (Ackard & Neumark-Sztainer, 2002; Banyard & Cross, 2008). Participants noted physical, mental and behavioral consequences, such as the contraction of AIDS or death, depression, anger, body image issues potentially leading to anorexia, substance abuse and addiction, and self-blame in regards to not being able to prevent or stop an attack.

The young adolescents clearly noted the dynamics of power and control in unhealthy relationships. Participants discussed how a perpetrator could manipulate victims to stay in unhealthy relationships. Others cited that a perpetrator could threaten violence if the victim attempted to disengage. Also noted was how a perpetrator may isolate the victim, therefore reducing the chances of the victim leaving the relationship. Participant conceptualizations of unhealthy relationships mainly focused upon male to female violence and were consistent with forms of abuse and consequences cited in previous literature (Craigen et al., 2009; Cyr et al., 2006; Hays et al., 2007; Holt & Espelage, 2005; Wolitzky-Taylor et al., 2008).

Exposure to relationship violence was also a salient theme throughout the focus group interviews. Participants discussed the following personal exposures to violence: displays of violence in the media, witnessing violence in their communities, peer groups and family of origin, and personal experience with violence. Such exposure has been previously noted in the literature (Ashley & Foshee, 2005; Banyard et al., 2006; Laporte et al., 2011; Manganello, 2008). All participants in the study report exposure to violence in some situation. It is critical to note many of the participants, although aware of the consequences of violent behavior, had themselves resorted to violence. This was especially evident with the perpetration of violence against the opposite sex, which supports findings by Lavoie and colleagues (2000). Female adolescents cited examples of hitting their peers and digging their fingernails into another’s skin to gain attention or to solve a conflict. This type of violent behavior by adolescent girls is alarming, as female aggression against peers has significantly predicted dating violence perpetration (Foshee et al., 2010).

In addition to violence, participants suggested a number of strategies to intervene with dating violence, including prevention strategies, factors influencing reporting, and dating violence interventions. Prevention strategies included knowing your partner’s background, being aware of one’s own safety, and trusting one’s instincts. Consistent with previous research, participants indicated fear and reluctance to report dating violence due to either the potential for incarceration or further harm from the perpetrator (Close, 2005). The participants’ conceptualized personal interventions ranged from hitting or abusing the perpetrator back, leaving the relationship, telling someone, or hiding the violence.

Counseling Implications

This study fills a gap in the research on young adolescent conceptualizations of dating relationships. Adolescents exposed to dating violence are more likely to experience future relationship violence (Close, 2005). Thus, adolescence is an optimal time for school and community counselors to intervene to promote healthy dating relationships (Collins & Sroufe, 1999; Davis & Benshoff, 1999; Hays et al., 2009). Many adolescents are striving to form their identities within relationships. Without intervention, females experiencing dating violence might conceptualize themselves victims and seek future relationships to support this role (Klem, Owens, Ross, Edwards, & Cobia, 2009). However, supportive therapeutic interventions could assist adolescent females to learn healthy ways of relating to others (Klem et al., 2009). Counselors are in a position to recognize and respond to adolescent dating violence (Hays et al., 2009). Carlson (2003) asserted counselors working with youth must not only recognize violent actions, but also seek to understand the underlying issues causing such behavior. As counselors gain access to adolescent conceptualizations of dating violence, they can more appropriately and effectively intervene in harmful situations.

In order to screen, intervene and measure dating violence interventions, counselors must partner with school and community leaders. Standardized dating violence screening could be administered at school, in the community or with a health care provider (Close, 2005). Counselors could modify their language to encourage student disclosure of violence by asking if students have experienced specific events (e.g., disparaging events, violating events, controlling events), rather than broadly asking about abuse (Draucker et al., 2010). Counselors can monitor middle school student behaviors for warning signs of possible dating violence, including physical or emotional complaints without explanation of the problem, depression, and academic decline (Close, 2005). Students experiencing dating violence often have difficulty concentrating and learning in school, as dating violence is most prevalent among adolescents earning low grades (Eaton, Davis, Barrios, Brener, & Noonan, 2007; Howard, Wang & Yan, 2007). When behavioral and emotional changes are witnessed, individuals can be assessed to determine if they are experiencing relationship violence and counselors can intervene accordingly (Draucker et al., 2010).

There is no widely accepted intervention strategy to combat young adolescent dating violence in the schools. However, school counselors can rely on empirically tested prevention and intervention programs to target populations based on dating violence risk. School counselors could develop a three-tier model of support which includes (a) universal prevention programming offered to all students, (b) peer education and classroom guidance for individuals at moderate risk, and (c) support groups, individual response services and referrals for adolescents at the highest risk for dating violence (O’Leary, Woodin, & Fritz, 2006). Since adolescent dating violence is a problem with significant mental and physical health consequences, many prevention programs have been developed to target this vulnerable population (Draucker et al., 2010). Most dating violence prevention programs universally target middle or high school students in a brief, school-based venue (Whitaker et al., 2006). Empirically tested programs strive to increase participant knowledge about dating violence, levels of abuse, warning signs, and community resources using didactic and process-based learning (O’Leary, Woodin, & Fritz, 2006). Such programs alert participants to the deleterious impact dating violence has on both perpetrators and survivors, such as increased mental health issues, substance use and school disengagement (Ackard & Neumark-Sztainer, 2002; Banyard & Cross, 2008; Howard et al., 2007; O’Keefe, 2005). Several programs also incorporate communication and conflict management strategies. Student perceptions of dating violence can be discussed through such school-wide initiatives. Adolescents place a high value on peer and dating relationships; thus, they may be more motivated to develop skills to improve their relationships (Davis & Benshoff, 1999). While many prevention programs demonstrate increases in participant knowledge about dating violence, most do not measure or report significant behavioral change or target at-risk populations (O’Leary, Woodin, & Fritz, 2006). Thus, at-risk students would benefit from additional school counseling interventions.

At the next level of support, counselors could offer peer-support programs and classroom guidance lessons to teach students healthy strategies to interact with peers and partners without resorting to relationship violence (Weisz & Black, 2010). Peer education programs might include didactic presentations, skits, art, creative writing, and public service announcements. Benefits to this modality include peer role-modeling and personal knowledge of effective ways to target peers. However, coordinating peer education programs may be time consuming and require close monitoring in order to be effective (Weisz & Black, 2010).

Classroom guidance interventions for middle school students should be age-appropriate and culturally sensitive, utilizing multiple learning modalities including role-plays, art projects, and interactive games (Close, 2005). The young females in this study affirmed that media outlets impact adolescent attitudes around violence, and research has shown a relationship between tolerant attitudes and perpetrating violence (Connolly et al., 2010; Josephson & Proulx, 2008; Manganello, 2008). Thus, counselors could initiate a dialogue to assess adolescent attitudes about violence by listening to clips from movies, television shows and popular music. Students could brainstorm dating violence prevention and intervention strategies through participation in interactive games. The young females in this study suggested knowing your partner’s background, being aware of one’s own safety, and trusting one’s instincts. The school counselor could discuss the pros and cons of each strategy in order to correct less effective strategies offered, such as resorting to violence or hiding the abuse.

As the interviews suggested, adolescents lack effective communication skills and are likely to resort to aggressive or avoidant strategies to handle conflict (Draucker et al., 2010; Prospero, 2006). These young females could benefit from communication and conflict resolution skill training. Additionally, many young adolescents have friends experiencing dating violence and report relying on peers for support rather than disclosing dating violence to adults (Ashley & Foshee, 2005; Close, 2005). Thus, young adolescents must be prepared with how to appropriately respond when a friend is in trouble. Adolescents may not know how to support their friends, as individuals in this study discussed self-blame as an acceptable response to dating violence. Females often report a stronger emotional reaction to dating violence than males, so it would be important to assess their reactions to possible abuse (Sears & Byers, 2010). Counselors could encourage students to participate in interactive skits with fictional dating scenarios to explore healthy conflict resolution, strategies to intervene when friends are experiencing abuse, benefits of adult disclosure and reactions to abuse.

At the most intensive level of support, school counselors would target individuals at serious risk for relationship violence. These might include individuals experiencing multiple forms of aggression, demonstrating aggression toward their peers, experiencing depression, using substances, or those with a family history of violence (Foshee et al., 2010; Laporte et al., 2011; Sears & Byers, 2010). Group and individual interventions targeted at females can address depression, self-esteem, substance use, aggression against peers, and anxiety, since these concerns are both risk factors and consequences of dating violence (Foshee et al., 2010). Counselors may offer support groups to adolescents experiencing dating violence. Rosen and Bezold (1996) implemented a school-based didactic support group to help young women (a) identify type and levels of abuse, (b) believe they are entitled to relationships without abuse, (c) discuss the personal consequences of dating violence, (d) enhance interpersonal skills, and (e) conceptualize themselves as able to make effective choices.

Individual responsive services may include motivational interviewing, social skills development, anger management and relationship therapy (O’Leary et al., 2006). Counselors could educate students about dating violence risk factors, including peer aggression and family violence. Female adolescents view peer violence as an acceptable self-defense technique (Lavoie et al., 2000). Counselors could teach adolescents about the cycle of violence and healthier techniques to resolve relationship conflict. Counselors working with those witnessing relationship violence might identify areas of strength, enhance self-esteem, and explore problem-solving strategies (Fontes, 2000). Counselors should assess students for known consequences of dating violence, including depression, anxiety, poor self-concept, suicidal ideation, PTSD, disordered eating, and substance use (Ackard & Neumark-Sztainer, 2002; Banyard & Cross, 2008; Mashow & Ahmed, 2007).

One approach counselors might utilize is existential counseling. Using this framework, adolescents could explore meaning, family of origin issues, resistance to change and other existential issues in order to ultimately create new meaning outside of the violent relationship (Klem et al., 2009). However, there are limitations to this approach, notably that adolescents must be cognitively able to discuss existential concerns and must also be committed to accept responsibility for personal choices (Klem et al., 2009). Regardless of the approach, when counselors are welcoming and willing to discuss relationship issues, they can have a lasting impact on students’ current and future relationships (Davis & Benshoff, 1999).

Limitations and Future Directions

While this research provides important information about young adolescent female perceptions of dating violence, the results must be taken into context within the limitations. An expansion of this study to explore adolescent conceptualizations of healthy relationships is warranted. This study focused on views of adolescent females and did not include the voice of males. Future studies could explore the dating perceptions and experiences of young adolescent males. Also, the sample only included seven individuals representing three ethnic groups from the same geographic region. Future research could include a more diverse sample. Study findings may not readily apply to other adolescent females, and thus additional research with various sample types and sizes is needed. Clinicians and researchers are encouraged to examine how young adolescent males and females of various demographics—as victims and perpetrators—describe and experience healthy and abusive relationships in order to effectively intervene and reduce adolescent victimization in our schools and communities.

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Danica G. Hays, NCC, is an Associate Professor and Department Chair at Old Dominion University. Rebecca E. Michel, NCC, is a doctoral candidate and Rebekah F. Cole, NCC, is an Adjunct Professor, both at Old Dominion University. Kelly Emelianchik, NCC is an Assistant Professor at Argosy University-Atlanta. Julia Forman, NCC, is an Instructor at Walden University. Sonya Lorelle, NCC, is an Adjunct Professor at the University of North Carolina–Charlotte. Rebecca McBride, NCC, is an Adjunct Professor at Old Dominion University. April Sikes, NCC, is an assistant Professor at Georgia State University. Correspondence can be addressed to Danica G. Hays Old Dominion University, 110 Education Building, Norfolk, VA, 23529, dhays@odu.edu.