Volume 11 - Issue 1 - The Professional Counselor

A Q Methodology Study of Supervisee Roles Within a Counseling Practicum Course

Feb 26, 2021 | Volume 11 - Issue 1

Eric R. Baltrinic, Ryan M. Cook, Heather J. Fye

Counseling students often experience clinical supervision for the first time during their participation in practicum courses. Counseling practicum supervisees new to supervision rely on their supervisors to provide direction and structure in supervision experiences to help them grow professionally and personally. Yet little is known about how students view their roles as new supervisees. Supervisors can benefit from structuring and delivering their courses informed by new supervisees’ perspectives on their roles. Accordingly, the authors conducted a Q methodology study with a purposeful sample of seven counseling practicum students, a doctoral co-instructor, and a counseling practicum instructor engaged in a first-semester counseling practicum course. Principal components analysis with varimax rotation of Q-sort data revealed three factors depicting supervisee roles (i.e., Dutiful, Discerning, and Expressive Learners). Implications for applying findings to improve supervision instruction and student learning are discussed, including limitations and future research suggestions.

Keywords: counseling practicum supervisees, supervisee roles, Q methodology, counseling practicum instructors, student learning

Supervision is generally understood as a relational and evaluative process between a senior and junior member of a profession, which is intended to foster the junior member’s learning and professional skill development while also ensuring the welfare of clients they serve (Bernard & Goodyear, 2019). Supervision is also a key pedagogical and curricular feature of counseling training programs (Council for Accreditation of Counseling and Related Educational Programs [CACREP], 2015) within which students develop into entry-level counselors. Although supervision is often considered a hierarchal relationship, supervisees are active participants in the supervision process (Stark, 2017). Thus, as part of counselor training, it is important for counseling students to understand what supervision is and what is expected of them (Bernard & Goodyear, 2019). Counseling students’ learning about the supervision process and supervisee roles commonly begins during their participation in field experience courses, the first of which is the counseling practicum course (CACREP, 2015). However, little is known about how counseling practicum supervisees come to understand their roles (Pearson, 2004) and, consequently, how counseling students use their understanding of roles to contribute to the learning process in supervision (Borders, 2019; Stark, 2017). This lack of understanding is compounded by a preponderance of supervision research grounded in expert perspectives and less so from the perspectives of counseling students new to supervision (Stark, 2017).

Thus, there are clear advantages to investigating counseling practicum supervisees’ understanding of their supervisee roles, particularly while they are engaged in their first field experience (i.e., practicum) course. First, practicum experiences offer supervisees applied learning environments (CACREP, 2015) where they can apply prior learning under supervision to their work with actual clients (Moate et al., 2017). To that end, this is the first time that these novice supervisees are ethically responsible for their clients’ care, which includes adequately conveying their professional needs to their supervisors (Bernard & Goodyear, 2019). Second, practicum supervisees may become anxious if they are unsure of their roles and what is expected of them by their supervisors and want to feel competent regardless of their actual competency levels (Ellis et al., 2015). Third and finally, the focus and process of supervision changes over time as supervisees develop (Stoltenberg & McNeill, 2010), including changes to how they function in their expected roles (Bernard & Goodyear, 2019). These early learning experiences are important for supervisees because they shape their understanding of clinical supervision (Borders, 2019), which they will engage in throughout their field placement experiences and post-degree, pre-licensure clinical training (Cook & Sackett, 2018). Therefore, it is important to understand supervisees’ initial understanding of their roles within the counseling practicum environment, including the degree to which these views align with or diverge from their supervisors’ (Bernard & Goodyear, 2019).

Student Learning and the Counseling Practicum Classroom
For supervision to be a valuable learning experience, it is assumed that supervisees will be able to adequately self-identify and articulate their client concerns as well as their own developmental needs to supervisors (Cook & Sackett, 2018). However, because practicum supervisees have no prior supervision experience, the way in which they come to understand their roles as supervisees is largely informed by the framework created by the instructor within a practicum course. To that end, practicum course instructors may align their course structure and requirements with accreditation standards (e.g., CACREP, 2015) and professional best practices (e.g., Association for Counselor Education and Supervision Best Practices in Clinical Supervision; Borders et al., 2014) in order to ensure that supervisees are informed of their responsibilities. This information is often conveyed to supervisees via an informed consent or supervision contract (Borders et al., 2014) as well as a course syllabus (CACREP, 2015). However, some supervisees may not fully understand the purpose of supervision nor grasp their roles as supervisees, even though they reviewed an informed consent with their supervisors (Cook et al., 2019).

Counseling practicum courses present students with new opportunities to apply learning from content courses (Moate et al., 2017), refine reflective practice (Neufeldt, 2007), and work with actual clients under supervision (Bernard & Goodyear, 2019). During this unique and critical learning time, supervisees are closely monitored by supervisors whose expectations and responsibilities are rooted in both supervisors’ and supervisees’ roles (Bernard & Goodyear, 2019; CACREP, 2015). Practicum course instructors are charged with facilitating supervisees’ learning to develop as professional counselors while safeguarding the welfare of the clients they serve (Borders et al., 2014). Borders (2019) delineated seven process-of-learning principles for use by training supervisors in the supervision classroom. This model is rooted in learning theories, with a particular focus on understanding how supervisors help supervisees in training based on the process of how students learn. We contend that implementation of practicum instruction guided by learning principles could help instructors to scaffold learning processes and teach counseling practicum supervisees about their supervisee roles, which is needed to help them navigate early career challenges (Loganbill et al., 1982).

Ultimately, if supervisees are to be effective with clients, more examination of their understanding of roles and related learning is needed. This information will provide instructors with the necessary knowledge to build effective learning environments and scaffold supervisees’ learning experiences in the supervision classroom (Borders, 2019; Moate et al., 2017). Thus, by examining how supervisees understand their supervisee roles, instructors can better teach them how to eventually self-direct their supervision experiences (Stoltenberg & McNeill, 2010) and effectively utilize supervision (Norem et al., 2006; Pearson, 2004), with the goal of transferring learning from supervision to counseling encounters with clients.

Counseling Practicum Supervisee Roles
Novice supervisees (i.e., practicum supervisees) desire to quickly acquire skills so that they can best serve their clients by utilizing the “correct” counseling technique or approach (Stoltenberg & McNeill, 2010). Further, supervisees experience a high degree of anxiety and confusion as they begin to develop their own counseling style and competencies (Rønnestad & Skovholt, 2003). Relatedly, Loganbill et al. (1982) suggested that novice supervisees, like counseling practicum supervisees, regularly feel “stuck” in their work with clients and confused as to how best to make progress with their clients. To that end, supervisees benefit from instructors who provide supportive feedback and explicit instructions in a highly structured supervision environment (Ellis et al., 2015; Loganbill et al., 1982; Stoltenberg & McNeill, 2010) that promotes role clarity (i.e., clearly understanding what is expected and how to meet those expectations).

Failure to determine whether there is alignment between supervisees’ and instructors’ perspectives on roles may yield unintended but potentially detrimental consequences (Stark, 2017). For example, from an educational perspective, instructors can best attend to their students’ learning needs when they understand what it is that their students perceive as being important to their learning (Moate et al., 2017). Furthermore, asking supervisees to engage in evaluations of their performance based on poorly understood roles (Ladany & Friedlander, 1995) could undermine the purposes of clinical supervision (e.g., professional development, client welfare; Borders et al., 2014) and threaten their right to a fair evaluation as students and supervisees (American Counseling Association [ACA], 2014; CACREP, 2015). Providing supervisees with clear information on their roles can assist with reducing nondisclosure (Cook et al. 2019) and lowering anxiety about their performance (Ellis et al., 2015). These practices allow for safeguarding supervisees and clients, fair supervision evaluation practices (Stark, 2017), and assuring quality supervision instruction grounded in student and instructor perspectives and adult learning processes (Borders, 2019).

Much of the current supervision literature contains guidelines for instructors to effectively conduct supervision (Stark, 2017). For example, Best Practices in Clinical Supervision (Borders et al., 2014) offers specific recommendations for those providing clinical supervision (i.e., supervisors). The expectations of supervisees are implied in the guiding document (e.g., arrive on time to supervision, engage in the supervision process), but the specific roles and responsibilities for supervisees are not explicitly addressed. Whereas others (e.g., Homrich et al., 2014) have conceptualized standards relevant to supervisees’ roles in clinical supervision, including self-reflection and self-exploration, communicating information truthfully and accurately, and engaging actively in opportunities for personal and professional development. The importance of supervisees’ contributions have also been noted by scholars (e.g., Norem et al., 2006; Stark, 2017; Wilcoxon et al., 2005). For instance, several authors identified supervisee characteristics that are helpful to the learning process in supervision, such as being self-directed, motivated, mature, autonomous, proactive, and open to new learning experiences, all of which are perceived as helping supervisees successfully navigate supervision (Norem et al., 2006; Stark, 2017; Wilcoxon et al., 2005). In an earlier effort to clarify roles and expectations for the supervision process, Munson (2002) identified several supervisee rights, including (a) meeting consistently and regularly with a supervisor, (b) engaging in growth-oriented supervision that considers one’s personal privacy, (c) participating in theoretically grounded supervision, (d) receiving clear evaluation criteria and evaluations informed by direct observation, and (e) having a supervisor who is adequately trained. Additionally, Munson suggested that supervisees ought to be able to speak freely in supervision, need encouragement to integrate prior learning from other counseling classes (which supports Borders, 2019), and should remain open and curious about the learning process. Overall, the author’s work supports the need for providing supervision based on expectations for both supervisor and supervisee performance. Despite these documented guidelines and expectations, there is a notable lack of input from supervisees’ perspectives of their roles and related expectations. This is concerning because instructors need to structure their learning environments grounded in evidence supporting student engagement (Malott et al., 2014), which is strengthened by identifying students’ prior learning experiences (Borders, 2019).

The Current Study
Learning to be a supervisee is a process in which counseling students gain experience starting in their practicum courses. It is critical for the supervisor (i.e., instructor) to understand their supervisees’ perceptions of their roles in supervision, which have been informed by accreditation requirements (e.g., CACREP, 2015), professional standards (e.g., Best Practices in Clinical Supervision, Borders, 2014), and scholarly literature (e.g., Munson, 2002). Yet, supervisors lack access to information from student perspectives for increasing supervisee engagement and meaningfulness of roles, particularly from the counseling practicum course context where students often experience supervision for the first time. In the current study, we sought to understand the expected roles and responsibilities of new supervisees from the perspectives of supervisees within a counseling practicum course. We also included perspectives from the instructional team (i.e., a doctoral student co-instructor, and a counseling practicum instructor) to illustrate the degree of alignment between instructors and students and to illustrate any nuances between instructor and co-instructor views. Using this research, supervisors and counselor educators may be able to offer developmentally appropriate solutions to address supervisee concerns and to provide support to counseling practicum instructors based on both expert and novice perspectives. Accordingly, our study was guided by the following research question: What are counseling practicum supervisees’ views of their roles and responsibilities in the practicum classroom environment?

Method

Q methodology is a unique research method containing the depth of qualitative data reduction and the objective rigor of by-person factor analysis (Brown, 1996), which can be used effectively in the classroom setting to facilitate students’ subject matter understanding (Watts & Stenner, 2012). Specifically, students’ self-perspectives can be revealed in relation to their peers’ and instructors’ views using Q methodology (Good, 2003). Q methodology has also been used successfully to investigate phenomena in the counselor education classroom (Baltrinic & Suddeath, 2020) and program settings (Baltrinic et al., 2013) that favor both student and instructor views. Accordingly, we selected Q methodology for this study to obtain perspectives from a participant sample of counseling practicum supervisees and their instructional team.

Concourse and Q Sample
Specific steps were taken to develop a rigorous Q sample, which is the set of statements used to assist participants with expressing their views on supervisee roles via the Q-sorting process (Brown, 1980). The first step was selecting a concourse, which is a collection of opinion statements about any topic (Stephenson, 1978). Many routes of communication contribute to the form and content of a concourse (Brown, 1980). The concourse for this study was composed of statements we took from select supervision literature and documents (i.e., Borders et al., 2014; Homrich et al., 2014; Kangos et al., 2018; Munson, 2002; Stark, 2017). We searched within these sources and selected concourse statements specifically containing supervision experts’ views on supervisees’ roles. We needed 100% consensus on each statement for it to be included in the concourse. The concourse selection process resulted in over 240 concourse statements, which was too many for the final Q sample (Paige & Morin, 2016).

Second, we proceeded with selecting, evaluating, and reducing the final Q sample items in line with Brown (1980) and Paige and Morin (2016). Initially, we had our first and second authors, Baltrinic and Cook, eliminate all duplicate, unclear, fragmented, or unrelated statements from the 240 concourse statements, which resulted in 160 statements. Baltrinic and Cook then used a structured sample design (Brown, 1980) to reduce the 160 concourse statements to a representative 48-item Q sample (Brown, 1980; see Appendix). Representativeness of a Q sample refers to whether the subset of items represent the broader population of statements in the concourse. Third, the 48-item Q sample was then evaluated by three experts (two supervision experts and one Q methodology expert) using a content validity index (Paige & Morin, 2016). The expert reviewers rated each of the 48 items on a 4-point scale using three criterion items: 1) Is the statement clear and unambiguous for counselor educators? 2) Is the statement clear and unambiguous for counseling practicum students? and 3) Is the statement distinct from the other statements? Scores across expert reviewers’ item ratings were averaged with only scores of 3 (mostly) or 4 (completely) indicating consensus on the content validity index. Items receiving a score of 3 or 4 were included, items receiving a score of 2 (somewhat) were reviewed and modified by our research team for appropriateness, and items receiving a score of 1 (not at all) were discarded from the sample. Accordingly, 45 items received scores of 3 or 4. Baltrinic completed additional Q sample refinements for the remaining three items that received scores of 2 (n = 2) and 1 (n = 1); two items were rewritten to improve clarity, one duplicate item was eliminated, and one new item was added. All refinements were confirmed by the second author before accepting the items in the final Q sample. For the final step, two of the experts completed Q sorts to ensure the final Q sample facilitated the expression of views on supervisee roles. The results of these two pilot Q sorts were not included in the data analysis.

Participant Sample
We followed McKeown and Thomas’s (2013) recommendations for selecting an intensive participant sample. Therefore, we purposefully selected an intensive participant sample composed of seven master’s-level clinical mental health counseling practicum supervisees, one doctoral co-instructor, and one faculty instructor; all of whom represented a purposeful sample of individuals (Patton, 2015) holding similar theoretical interests and having the ability to provide insight into the topic of investigation (Brown, 1980; McKeown & Thomas, 2013).

Three of the master’s-level counseling students identified as male and four identified as female, and their ages ranged from 23 to 37 years old (M = 30, SD = 10.06). Regarding race/ethnicity, five of the counseling students identified as European American and two identified as African American. The counselor educator and course instructor identified as a European American male. He holds a PhD in Counselor Education with 5 years of counseling experience and 6 years of supervision experience. Additionally, the instructor is a licensed professional counselor and an Approved Clinical Supervisor, and he publishes regularly on the topic of clinical supervision. The doctoral student co-instructor identified as a European American female who has 3 years of clinical experience as a school counselor and 1 year of supervision experience.

Data Collection
After receiving IRB approval, Baltrinic collected the initial consents, demographics, Q sorts, and post–Q sort interview data. The students and course instructors (N = 9) were asked to rank-order the 48 items under the following condition of instruction: “Select the statements with which you most agree (+4) to those with which you most disagree (-4) that represent a beginning counselor practicum student’s supervisee roles.” After completing the Q sorts, each participant was asked to provide written responses for the top three items with which they most and least agreed and were asked to comment on any other items of significance. Baltrinic obtained these post-sort questionnaires in person. The purpose of gathering post-sort data is to provide qualitative context for the factor interpretations (Brown, 1996).

Data Analysis
Nine Q sorts were completed by the instructional team and the counseling practicum students under a single condition of instruction, all of which were entered into the PQMethod software program V. 2.35 (Schmolck, 2014). A 3-factor solution was selected using the principle components method with varimax rotation, which yields the highest number of significant factor loadings and because Baltrinic, who analyzed the data, was blinded from participants’ identifying information (Watts & Stenner, 2012). Being blinded to participant information renders approaches such as theoretical rotation moot in favor of varimax rotation, given the lack of contextual information related to factor exemplars (i.e., those participants with the highest factor loading on a factor; McKeown & Thomas, 2013).

Results

Data analysis revealed three significantly different viewpoints (i.e., Factors 1, 2, and 3) on supervisee roles. For Q methodology, factor loadings are not used for factor interpretation. Instead, the individual significant factor loadings associated with each of the factors are weighted and averaged, resulting in an ideal Q sort representing each factor, which are presented chronologically in a factor array. Factor arrays contain the scores that are used for factor interpretation (see Appendix). Parenthetical reference to specific Q-sample items and their associated factor scores located in the factor array (e.g., Item 23, +2) will be provided within the factor interpretations below. Select participant quotes from post-sort questionnaires are incorporated into the factor interpretations.

Factor 1: The Dutiful Learner
Factor 1, which we have named the Dutiful Learner, represents a conceptualization of supervisee roles as predominantly adhering to the ethical codes, guidelines, and models of ethical behavior (Item 15, +4). One of seven supervisees, the course co-instructor, and the course instructor were significantly associated with Factor 1 (i.e., had factor loadings of .50 or higher; Brown, 1996) with factor loadings of .70, .82, and .70, respectively. Supervisee roles attributed to the Dutiful Learner are understood as aspects of the learning process provided that student learning adheres to the code of ethics. Additionally, supervisee roles were viewed in terms of supervisees following the procedures and policies of their graduate programs (Item 36, +4), which as one participant noted “are really non-negotiable.” Supervisee roles, including the demonstration of healthy professional boundaries in supervision sessions and with clients, were also highly preferred by participants aligning with this factor (Item 25, +4). When reflecting on Item 25, the supervisee participant emphasized, “Healthy boundaries are paramount for legally and emotionally protecting oneself.” Finally, the Dutiful Learner viewpoint entails emphasis on the importance of supervisees arriving on time for supervision (Item 7, +3), including the need to be prepared for every supervision session (e.g., individual, triadic, group; Item 18, +2).

Participants ascribing to the Dutiful Learner view of supervisee roles were less concerned about the demonstration of awareness of strengths and weaknesses to instructors (Item 1, 0), which according to one participant would “occur as part of the process over time.” Dutiful Learners are viewed as favoring ethically guided supervisee roles versus simply being pleasant to work with in supervision (Item 30, -4) or gratuitously asking questions regarding counseling-related issues (Item 32, -3). Dutiful Learner viewpoints may be related to having a sense of responsibility for other supervisees’ learning that includes a desire for students to develop a strong ethical compass, which is needed “throughout their development as counselors.” For example, according to the co-instructor, who noted in her post-sort interview questionnaire, “It seems items I ranked highest were ‘rules’ and ‘guidelines,’ which I feel is influenced by the need to be an ethical practitioner and influenced by being in the co-teacher role.” Overall, supervisees, according to the course instructor, are reminded to “trust the process” in their beginning roles, given it is most critical that they have a “willingness” to learn.

Factor 2: The Discerning Learner
Factor 2 characterized supervisees as having a penchant for seeking feedback, a spirit of willingness, and thoughtful reasoning; therefore, we have named this factor the Discerning Learner. For Factor 2, three of the seven supervisees had significant factor loadings (.67, .83, and .58, respectively). In general, the Discerning Learner represents a conceptualization of supervisee roles in which supervisees feel their supervisors provide them with feedback about counseling skills (Item 40, +4), which according to one participant is the “purpose of supervision.” The supervisees whose viewpoints aligned with this factor valued supervisee roles that included asking for help when needed (Item 35, +4), which is related to recognizing and regularly seeking feedback from their supervisors (Item 20, +2). Throughout the supervision process, Discerning Learners are viewed as valuing organization and exercising good judgement when approaching supervision situations (Item 43, +4). Overall, a willingness to work with their supervisors (Item 33, +3) was deemed important given the interpersonal nature of the supervision process.

Further, the Discerning Learner view favored the acquisition of counseling skills as central to supervisee roles. With a focus on skill acquisition, the need to manage ambiguity and uncertainty as a function of their roles was considered less important for Discerning Learners (Item 14, -4). As one participant noted, “The whole point of supervision is to take what the supervisor is telling us and apply it to our practice.” Additionally, for participants whose views aligned to this factor, recognizing and managing anxiety (Item 12, -4) was not considered central to supervisee roles in practicum because anxiety is commonly accepted as “part of the learning process in supervision.” One participant normalized the presence of anxiety and the need to “discuss it in supervision,” further suggesting, “It is good to express anxiety about the supervision process instead of bottling it in.” Overall, supervisees who view supervisee roles from the viewpoint of the Discerning Learner accept anxiety and ambiguity as those things that “should be expected” when using good judgement to acquire and refine counseling skills and initiate discussions about the process in supervision.

Factor 3: The Expressive Learner
Factor 3 favored the personal and interpersonal expression of needs in the interest of learning; therefore, we have named this factor the Expressive Learner. Three of seven supervisees had significant factor loadings on Factor 3 (.73, .50, and .63, respectively). Supervisees whose views aligned with the Expressive Learner factor favored supervisee roles emphasizing opportunities to be vulnerable in sessions with their supervisor (Item 34, +4). This factor entailed supervisee acknowledgment of the emotional context for learning and growth; as suggested by one supervisee, “If I don’t feel vulnerable, then I’m not going to have an experience where I truly learn.” Another non–traditional age male supervisee elaborated, “Older students often bring work experience and personal experience to the supervisee role,” which according to another participant (also a non-traditional male student) means that “If a supervisee is unable to be open and honest (despite previous experiences), then no progress is made towards professional growth.” Additionally, managing personal and interpersonal issues was deemed important for supervisee roles (Item 22, +4). As one supervisee noted, “Although it can be difficult to manage various life roles, it is important not to let those life roles interfere.” The Expressive Learner is further conceived as valuing the demonstration of verbal communication skills (Item 28, +3) and having the ability to take multiple perspectives (Item 21, +3), both of which were deemed essential for “welcoming and responding to supervisors’ critical feedback,” especially with challenging cases. The underlying sentiment of feeling empowered by supervisors (Item 45, +2) was deemed important because “feeling empowered will drive you to continue growing your skills.” Overall, the personal and interpersonal nature of supervision and supervisees’ roles was distinguishing for this factor.

Supervisees ascribing to the Expressive Learner factor expected that the ability to speak freely in supervision (Item 2, -3) is an assumed role of supervisees. As one participant explained, “It is important for me to say exactly what I’m feeling so my supervisor can give me their perspective and help me work through any issues.” Similarly, identifying supervisee developmental needs (Item 9, -4) is viewed as part of all supervision that should be initiated by the instructor at the beginning stage of supervision. For example, as one supervisee noted, “Because I am a student, I want my supervisor to initiate discussions” related to developmental needs “and then guide me with questions.” Finally, active participation in supervision (Item 42, -2) was viewed as less important because it is “expected,” and although supervisees should work collaboratively, “establishing tasks and goals should first be initiated by the supervisor,” a point echoed by all supervisees associated with Factor 3. It seems then that Expressive Learners are interpersonally attuned and focused and most responsive when supervisee roles are activated through initial supervisor prompts.

Discussion

The purpose of the current study was to examine the roles of supervisees as perceived from the multiple viewpoints of counseling practicum supervisees, a doctoral co-instructor, and a faculty instructor. Collectively, our findings reveal three different viewpoints (i.e., factors) of supervisees’ roles and responsibilities. Interestingly, only one of the seven supervisees’ views of these roles aligned with the views of the doctoral co-instructor and practicum course instructor. Even though the instructors acculturated the supervisees to their responsibilities in relatively the same way (e.g., university supervision contract, course syllabus) and used methods that aligned with accreditation guidelines, professional standards, and best practices in supervision, the majority of students still made meaning of these roles as supervisees in ways that differed from the instructors’ viewpoint. At the same time, supervisees deemed it important to convey their own professional competencies to their evaluative supervisors (Cook et al., 2019). As we will discuss below, course instructors who hope to better attend to the learning needs of all students and understand how their students perceive their own roles in clinical supervision can integrate details from the three factors (the Dutiful Learner, the Discerning Learner, and the Expressive Learner) into their instruction practices.

Participants whose views most strongly aligned to the Dutiful Learner factor perceive the most important aspect of supervisee roles as adhering to ethical codes and course requirements. For Dutiful Learners, supervisee roles parallel the concrete expectations often outlined in a supervision contract (Ellis, 2017) or course syllabus. That is, having clear expectations of clinical supervision and an operational understanding of the structural aspects of clinical supervision were endorsed as the strongest expectations of Dutiful Learners. Additionally, participants who conceptualized supervisee roles in terms of Factor 1 believe supervisees will gain insight into their own skills and competencies over time as they develop in their roles (Loganbill et al., 1982). However, having a foundational understanding of how to utilize clinical supervision as well as their rights as supervisees in clinical supervision (Munson, 2002) may be most critical for Dutiful Learners (Stoltenberg & McNeill, 2010). Accordingly, Dutiful Learners may find the explicit instructions for supervision helpful for managing the anxieties and uncertainties that are often experienced by new supervisees (Loganbill et al., 1982). Specific aspects to focus on for Dutiful Learners’ roles would be to review ethical guidelines, course requirements, and strategies for coming prepared to supervision.

Discerning Learners (Factor 2) favor their roles as active participants in the supervision process, which they perceive as a relational process between supervisee and supervisor, and student and instructor. That is, Discerning Learners perceive a collaborative relationship between supervisee and supervisor as being central to their professional development and their counseling work with clients. This factor best reflects the supervisee working alliance (Bordin, 1983), in which creating a strong emotional bond between supervisors and supervisees and mutual agreement on goals and tasks is most important to positive outcomes in supervision (e.g., intentional nondisclosure, role ambiguity; Cook & Welfare, 2018; Ladany & Friedlander, 1995). Discerning Learners also acknowledge that anxiety is a common characteristic of being a supervisee, which is somewhat expected given the participants’ developmental level (i.e., novice supervisees; Rønnestad & Skovholt, 2003; Stoltenberg & McNeill, 2010). However, they view acknowledging this anxiety to their supervisors as helpful. Finally, Discerning Learners perceive discussing cultural identities as being relevant to their role as supervisees, although one supervisee stated culture should only be discussed with a client “when relevant to their counseling work.”

Expressive Learners (Factor 3) perceive the role of a supervisee as being vulnerable with and openly disclosing information to their supervisor, demonstrating the ability to take multiple perspectives with their clients, and feeling empowered by their supervisors. These findings align with Cook et al. (2018), who investigated supervisees’ perceptions of power dynamics in clinical supervision. Further, the Expressive Learner factor represents views most aligned with tenets of feminist supervision (e.g., Porter, 1995; Porter & Vasquez, 1997). Porter (1995) noted that supervisors empower their supervisees by creating a safe environment and valuing their supervisees’ perspectives with the goal of facilitating their supervisees’ autonomy, although there is substantial evidence that counseling students, such as practicum supervisees, withhold information from their supervisors (e.g., Cook & Welfare, 2018; Cook et al., 2019). Expressive Learners view learning as a self-directed process within supervision, which also suggests they perceive themselves as active contributors to clinical supervision (Stark, 2017). At the same time, Expressive Learners also look to their supervisors to initiate discussion about their developmental needs and to provide insights into their opportunities for professional growth. This viewpoint aligns with that of Stoltenberg and McNeill (2010), who contend that supervisors can help novice supervisees to gain awareness into their own developmental needs through questioning and supportive feedback.

Implications for Practicum Instructors
Practicum course instructors often have the responsibility to teach supervisees about their roles and responsibilities as they align with accreditation standards (i.e., CACREP, 2015), professional standards (i.e., ACES Best Practices in Clinical Supervision; Borders et al., 2014), and ethical guidelines (i.e., ACA, 2014). To that end, practicum instructors must convey their expectations for students in their classroom and attend to the diverse learning needs of all their students. Our findings suggest supervisees understand their roles and responsibilities in three different ways, which at times differ from those of the course instructors. Instructors must be able to provide sufficient, appropriate, and meaningful feedback to all supervisees in their class (Borders, 2019) to ensure they are adequately able to successfully navigate supervision in the classroom and in future supervision experiences. Thus, we offer practicum instruction strategies based on the three supervisees’ viewpoints of their roles (i.e., factors). For example, instructors can assess supervisees’ understanding of their prior experiences with evaluative relationships (i.e., educational, personal, professional; Borders, 2019) and how those experiences might be similar or different to their current experience in the counseling practicum course.

Our findings also connect with evidence-based processes for how students learn. As you may recall from the literature review, Borders (2019) delineated seven principles rooted in learning theories, with a particular focus on understanding how to help supervisees based on the process of how students learn. These seven principles are connected to our findings and noted in parentheses (e.g., Principle 1) within the text that follows. Specifically, instructors can use characteristics of the three factors, along with the seven learning principles, to inform counseling practicum instruction and doctoral supervision strategies. For example, instructors can help Dutiful Learners identify ethical dilemmas (e.g., risk assessment, mandated reporting, healthy boundaries between client and counselor) and ways to discuss solutions with their supervisors by watching segments of counseling sessions (Principle 1). Instructors can then ask supervisees to use ethical decision-making models to connect practice to theory (Principle 2), and they can help supervisees to identify needed skills, including situations in which these skills are most needed (Principle 4 and 7). Instructors can observe supervisees’ skills practice and direct doctoral co-teachers to identify ways for the supervisees to improve practice and convey ethical dilemmas to supervisors (e.g., site supervisor, course instructor). As supervisees understand their roles, they can pursue role-playing ethical dilemmas and learn how to receive and respond to feedback after each role-play within a low-risk classroom setting (Principle 3). Overall, supervisees and doctoral co-teachers should receive scaffolded instructor feedback to help them better correct any errors (Principle 5).

Discerning Learners prefer presenting counseling work to their supervisors and discussing related feedback about their counseling skills, which can be done based on a mutual understanding and appreciation of supervisees’ roles. Thus, instructors should consider reviewing with supervisees the counseling skills learned in previous classes (Principle 1; Borders, 2019), including assessing supervisees’ comfort level with using specific counseling skills. To that end, instructors can ask supervisees to identify and name specific skills in their counseling work as well as their peers’ counseling work during role-plays or actual counseling sessions (Principle 5). Additionally, because Discerning Learners value discussing their anxiety and issues of culture with their supervisors, instructors can include a question about supervisees’ anxiety in case presentation forms, which could then be used as a starting point to facilitate any individual or group discussions. Identifying and addressing anxiety (Bernard & Goodyear, 2019) is important because supervisees need to know how to broach difficult topics with clients (Day-Vines et al., 2020), and instructors need to model that broaching for doctoral co-teachers and supervisees (Principle 6).

Of the factors identified in the current study, the Expressive Learners prefer a self-directed role when engaging in their supervision experience. Expressive Learners prefer a learning environment in which disclosure is encouraged, vulnerability is validated, and empowerment is facilitated. Accordingly, instructors need to assess Expressive Learners’ motivation level, which is a critical driver for learning new content (Principle 3; Borders, 2019) and for understanding supervisees’ capacities to self-direct their learning experiences (Principle 7). Instructors can assist Expressive Learners with developing learning goals that can include strategies for both collaboration and self-direction (Principle 7). Additionally, instructors may use specific supervision techniques, such as interpersonal process recall (Kagan, 1980), to gain insight into supervisees’ perceptions of their skills and to encourage their disclosure-related skill acquisition (Principle 4). This is important because Expressive Learners are willing to discuss their concerns when prompted by supervisors. Finally, instructors may also consider using the Power Dynamics in Supervision Scale (Cook et al., 2018) to assess supervisees’ perspectives of being vulnerable or empowered.

Limitations and Future Research
Researchers who use Q methodology gather and analyze data to reveal common viewpoints among participants, and in this case within a single counseling practicum course. As such, the Q factors in this study do not generalize (Brown, 1980) similarly to the findings in widescale quantitative studies. We caution readers against interpreting factors as being “better or worse” or “right or wrong” for other practicum courses. However, similar factors may plausibly exist among supervisees’ views in other counselor education practicum courses. In this way, any similarities from our findings to other sites is seen more as a matter of shared experiences rather than generalized findings (Stephenson, 1978). The low number of participants in the current study may be viewed as a limitation. However, similar to Baltrinic and Suddeath (2020), the instructors and student participants in the current study represented a purposeful sample of sole interest (Brown, 1980), revealing robust factors within a counselor education classroom (i.e., the unit of analysis). Nevertheless, future research could include larger numbers of participants across multiple practicum courses, which may increase the potential for revealing the existence of additional factors. Researchers are encouraged to test propositions by having supervisees complete Q-sorts with the current Q sample within and across other counseling subspeciality areas as well. Researchers can also use qualitative or case study methods to investigate supervisees’ views from practicum through the completion of internship.

Conclusion
In conclusion, practicum course instructors can incorporate the current findings into their supervision pedagogy. Using student-generated factors can help practicum course instructors guide supervisees to (a) develop skills grounded in a clear understanding of their roles and related approaches to learning, (b) select and incorporate supervisor feedback about the goals and tasks of supervision, and (c) identify areas of growth based on the alignment of supervisees’ and instructors’ role perspectives.

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

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Appendix
Q Sample Statements and Factor Array

Eric R. Baltrinic, PhD, LPCC-S (OH), is an assistant professor at the University of Alabama. Ryan M. Cook, PhD, ACS, LPC, is an assistant professor at the University of Alabama. Heather J. Fye, PhD, NCC, LPC, is an assistant professor at the University of Alabama. Correspondence may be addressed to Eric Baltrinic, The University of Alabama, Box 870231, Tuscaloosa, AL 35487, erbaltrinic@ua.edu.

Suicide Protective Factors: Utilizing SHORES in School Counseling

Feb 26, 2021 | Volume 11 - Issue 1

Diane M. Stutey, Jenny L. Cureton, Kim Severn, Matthew Fink

Recently, a mnemonic device, SHORES, was created for counselors to utilize with clients with suicidal ideation. The acronym of SHORES stands for Skills and strategies for coping (S); Hope (H); Objections (O); Reasons to live and Restricted means (R); Engaged care (E); and Support (S). In this manuscript, SHORES is introduced as a way for school counselors to address protective factors against suicide. In addition, the authors review the literature on comprehensive school suicide prevention and suicide protective factors; describe the relevance of a suicide protective factors mnemonic that school counselors can use; and illustrate the mnemonic’s application in classroom guidance, small-group, and individual settings.

Keywords: suicide prevention, protective factors, school counselors, SHORES, mnemonic

Rates of youth suicide have increased tremendously in the last decade. A report by the National Center for Health Statistics in 2019 indicated that suicide rates among American youth ages 10–24 increased 56% from 2007 to 2017, making it the second leading cause of death in this age group; during this same time period, the rate almost tripled for those ages 10–14 (Curtin & Heron, 2019). Additionally, the Centers for Disease Control and Prevention (CDC; 2017) reported that suicide is now the ninth leading cause of death for children ages 5–11.

The suicide rates for children as young as 5 can seem alarming and impact school counselors at all grade levels. Sheftall et al. (2016) stated that children who died by suicide in this younger age range were frequently diagnosed with a mental health disorder. In children, this diagnosis was usually attention deficit disorder with or without hyperactivity, and in young adolescents the diagnosis was most often depression or dysthymia. Researchers have also found that certain risk factors, such as childhood trauma, bullying, and academic pressure, can increase suicidal risk for youth (Cha et al., 2018; Jobes et al., 2019; Lanzillo et al., 2018).

Researchers agree that early prevention and intervention is essential to reduce youth suicides
(Cha et al., 2018; Lanzillo et al., 2018; Sheftall et al., 2016). Similarly, postvention efforts, or crisis response strategies following a student’s suicide, can lessen school suicide contagion and support future prevention efforts (American Foundation for Suicide Prevention [AFSP] et al., 2019). In this article, we review the literature on youth suicide and efforts to address it including leveraging protective factors, and we introduce the relevance of a suicide protective factors mnemonic that school counselors can apply in classroom guidance, small-group, and individual settings (American School Counselor Association [ASCA], 2019).

School Suicide Prevention
Curtin and Heron (2019) called for proactive efforts to help address the rising statistics for youth suicide, and schools are a natural place for prevention, intervention, and postvention to occur. Students spend the majority of their waking hours at school and have frequent contact with teachers, counselors, administrators, and peers. School efforts to address suicide risk must include these stakeholders, as well as parents and community members (Ward & Odegard, 2011).

A suicide prevention effort is a strategy intended to reduce the chance of suicide and/or possible harm caused by suicide (U.S. Department of Health and Human Services [HHS], Office of the Surgeon General and National Action Alliance for Suicide Prevention, 2012). Best practice for suicide prevention in schools includes training all stakeholders, including students (Wyman et al., 2010). This training, frequently referred to as gatekeeper training, should include information about suicide warning signs and risk factors, as well as suicide protective factors, such as seeking help and having social connections. The World Health Organization’s (WHO; 2006) booklet for counselors on suicide prevention lists several suicide warning signs, including ones with relevance to school-age youth, such as decreased school achievement, changed sleeping and eating, preoccupation with death, sudden promiscuity, or reprieve from depression (pp. 5–6). Another important component of school suicide prevention is training and practice on how to help a student who exhibits these and/or other suicidal warning signs (AFSP et al., 2019). Institutional efforts, such as forming crisis teams (AFSP et al., 2019), and anti-bullying programs can also contribute to school suicide prevention efforts (HHS, 2012).

Other school prevention efforts involve small-group and whole classroom lessons on resiliency, coping skills, executive functioning skills, and help-seeking behavior (Sheftall et al., 2016). Many programs exist and are beneficial at elementary, middle, and high school levels. The Suicide Prevention Resource Center (SPRC; 2019a) listed many options: Signs of Suicide, More Than Sad, Sources of Strength, and Kognito. Of these examples, only Signs of Suicide contains training for warning signs, suicide risk factors, and suicide protective factors. Some suicide prevention programs are state and population specific, but all include the information needed to help stakeholders to know the risks and signs, and to have a plan on how to help youth with suicidal thoughts. Talking about suicide prevention with all stakeholders promotes increased help-seeking behavior in children and adolescents (Wyman et al., 2010).

School Suicide Intervention
Suicide is an ongoing issue that many school counselors handle via intervention efforts. A suicide intervention effort is a strategy to change the course of an existing circumstance or risk trajectory for suicide (HHS, 2012). School counselors are a natural choice for helping to implement suicide prevention and intervention programs, as they often have training on working with students at risk for suicidal ideation (Gallo, 2018). Additionally, school counselors are ethically responsible to help create a “safe school environment . . . free from abuse, bullying, harassment and other forms of violence” and to “advocate for and collaborate with students to ensure students remain safe at home and at school” (ASCA, 2016, pp. 1, 4). One key component of school suicide intervention is suicide risk assessment. Gallo (2018) researched 200 high school counselors representing 43 states and found that 95% agreed it was their role to assess for suicidal risk, and 50.5% were conducting one or more suicide risk assessments each month. Other aspects of intervention include potential involvement of administrators, parents, and emergency or law enforcement services; referral to outside health care providers; and safety planning, including lethal means counseling (AFSP et al., 2019). School and other counselors are also involved in ongoing check-ins with students, re-entry planning after a mental health crisis, and responses to in-school and out-of-school suicide attempts.

School Suicide Postvention
Suicide postvention involves attending to those “affected in the aftermath of a suicide attempt or suicide death” (HHS, 2012, p. 141). ASCA, in collaboration with AFSP, the Trevor Project, and the National Association of School Psychologists, released the Model School District Policy on Suicide Prevention that outlines policies and practices for districts, schools, and school professionals to protect student health and safety (AFSP et al., 2019). The model policy addresses postvention by summarizing a 7-step action plan involving school counselors and other professionals: 1) get the facts, 2) assess the situation, 3) share information, 4) avoid suicide contagion, 5) initiate support services, 6) develop memorial plans, and 7) postvention as prevention (pp. 11–13). The latest edition of a suicide postvention toolkit for schools (SPRC, 2019a) highlighted counselors’ collaborative work for crisis response and suicide contagion; how they help students with coping and memorialization; and their involvement with community, media, and social media.

Addressing factors that protect against suicide is an important component of school district policies to combat suicide (AFSP et al., 2019) and of comprehensive school suicide prevention (Granello & Zyromski, 2018). Leveraging suicide protective factors is one way for school counselors to fulfill professional obligations and recommendations concerning student suicide risk. What remains unclear from the literature is how school counselors explore and enhance protective factors in their suicide prevention, intervention, and postvention efforts.

Suicide Risk and Protective Factors
The SPRC (2019b) defined suicide risk factors as “characteristics that make it more likely that individuals will consider, attempt, or die by suicide” and protective factors as those which make such events less likely (p. 1). High suicide risk involves a combination of risk factors. Examples of suicide risk factors include a prior attempt, mood disorders, alcohol abuse, and access to lethal means, whereas examples of suicide protective factors include connectedness, health care availability, and coping ability (SPRC, 2019b). Protective factors “are considered insulators against suicide,” which can “counterbalance the extreme stress of life events” (WHO, 2006, p. 3). Both risk and protective factors have varying levels of significance depending on the individual and their community (SPRC, 2019b).

Guidance from multiple sources stresses the salience of incorporating attention to suicide risk and protective factors into school counseling. The AFSP et al. (2019) Model School District Policy on Suicide Prevention notes risk and protective factors as crucial content in staff development and youth suicide prevention programming. In addition to the risk factors named above, the policy names high-risk groups, such as students who are involved in juvenile or child welfare systems; those who have experienced homelessness, bullying, or suicide loss; those who are lesbian, gay, bisexual, transgender, or questioning; or those who are American Indians/Alaska Natives (AFSP et al., 2019).

School counselors should know suicide protective factors that are specific to school settings and to the ages of students that they serve. The Model School District Policy on Suicide Prevention (AFSP et al., 2019) also highlights the role that accepting parents and positive connections within social institutions can play in a student’s resiliency. Despite suicide prevention policy guidelines, numerous structured programs, and growing research on youth suicide protective factors, very little guidance is offered on practical methods for school counselors to address students’ suicide protective factors. The purpose of this manuscript is to introduce to school counselors a recently published, research-based mnemonic—SHORES (Cureton & Fink, 2019). The acronym of SHORES stands for Skills and strategies for coping (S); Hope (H); Objections (O); Reasons to live and Restricted means (R); Engaged care (E); and Support (S). SHORES equips school counselors with a promising tool to guide suicide prevention, intervention, and postvention via direct and indirect school counseling services.

SHORES

Cureton and Fink (2019) created a mnemonic device called SHORES for counselors to utilize when working with clients. SHORES represents protective factors against suicide and the letters in the acronym were carefully selected based on support in the literature.

Figure 1

Cureton, J. L., & Fink, M. (2019). SHORES: A practical mnemonic for suicide protective factors. Journal of Counseling &
Development, 97(3), 325–335.

In the following sections, the authors define each part of the acronym and discuss how school counselors may apply SHORES with students. After discussing each of the protective factors in the mnemonic, we present a case example to demonstrate how school counselors may implement the SHORES tool with students in their school.

S: Skills and Strategies for Coping
First, school counselors can explore with students what skills and strategies for coping (S) with adversity they might already have in place, work to strengthen these, and also foster development of new coping skills and strategies. Cureton and Fink (2019) shared that some of the skills and strategies for coping that counter thoughts of suicide include emotional regulation, adaptive thinking, and engaging in one’s interests (Berk et al., 2004; Fredrickson & Joiner, 2002; Law et al., 2015). For youth, such engagement includes academic and non-academic pursuits (Taliaferro & Muehlenkamp, 2014). School counselors often meet with students to discuss coping strategies and stress management; therefore, this step can easily be incorporated into working with students demonstrating signs of stress or even suicidal ideation.

Mindfulness skills and strategies may be particularly impactful for schools to incorporate. Research findings support the importance of a student’s emotional regulation skills, as dysregulation is associated with children’s suicidal thoughts (Wyman et al., 2009) and adolescents’ suicide attempts (Pisani et al., 2013). There is substantial research evidence on the positive effect of mindfulness interventions in children and adolescents, particularly for decreasing depression and anxiety (Dunning et al., 2019). Flook et al. (2010) used a school-based mindful awareness program with elementary school children that incorporated sitting meditation; a brief visualized body scan; and games for sensory awareness, attentional regulation, awareness of others, and awareness of the space around them. They found improvements in elementary school children’s metacognition, behavioral regulation, and executive control. Broderick and Jennings (2012) posited that mindfulness practice is an effective coping strategy for adolescents because it “offers the opportunity to develop hardiness in the face of uncomfortable feelings that otherwise might provoke a behavioral response that may be harmful to self and others” (p. 120). Teaching or practicing mindfulness with students might include helping them with body awareness, understanding and working with thoughts and feelings, and reducing harmful self-judgements while increasing positive emotions.

H: Hope
Cureton and Fink (2019) suggested that hope (H) can protect against suicide because it may counterbalance negative emotions and cognitions. Studies have demonstrated that hope can help to safeguard the influence of hopelessness on suicidal ideation and that hope could, in turn, relieve a person’s feelings of being a burden and not belonging (Davidson et al., 2009; Huen et al., 2015). Researchers have found that adolescents with hope have lower suicide risk (Wai et al., 2014) and that hope moderates depression and suicidal ideation, even among adolescents who experienced childhood neglect (Kwok & Gu, 2019).

Furthermore, Tucker and colleagues (2013) discovered that establishing hope can also decrease some of the adverse impacts of rumination on suicidal ideation. Classroom guidance lessons could help school counselors to assess if there are individual students who seem to lack hope; these students might be good candidates for small-group or individual counseling. If school counselors wanted to implement a schoolwide comprehensive program, they might look at implementing Hope Squads. Over 300 schools in Utah have implemented peer-to-peer suicide prevention programs called Hope Squads, which work to instill hope and create a school culture of connectedness and belonging (Wright-Berryman et al., 2019). Hope Squads could also be utilized in the final stage of SHORES as a source of Support (S).

Another way that researchers found to decrease suicidal ideation was building hope through goal-setting (Lapierre et al., 2007). School counselors are in a prime position to help with goal-setting and could incorporate the topic of hope when helping students to set goals. One evidence-based intervention that can be utilized by school counselors to help students with goal-setting is Student Success Skills. School counselors teaching the Student Success Skills lessons not only encourage students to set wellness goals, but also teach attitudes and approaches that will help students socially and to reach their academic potential (Villares et al., 2011).

O: Objections
Cureton and Fink (2019) included another supported protective factor: moral or cultural objections (O) to suicide. Researchers have found that individuals with fewer moral objections to suicide were more likely to attempt suicide (Lizardi et al., 2008), while those with a religious objection may have fewer attempts (Lawrence et al., 2016). Ibrahim and colleagues (2019) discovered that the role of religious and existential well-being was a protective factor for suicidal ideation with adolescents.

Research shows that school counselors feel ready to address spirituality with students, and at least one suicide prevention program could help with that focus. Smith-Augustine (2011) found that 86% of the 44 school counselors and school counseling interns who participated in a descriptive study had spirituality and religious issues arise with students, and 88% reported they felt comfortable addressing these issues with students. Although the focus is not on religion, this topic may come up when discussing spirituality, and school counselors working in public schools will want to be mindful of any restrictions from their district about discussing religion and/or spirituality with students. One evidence-based suicide prevention program that addresses spirituality is Sources of Strength (2017).

Sources of Strength has been used primarily in high school settings, but guidance for its application in elementary schools is also available. While participating in Sources of Strength, youth are asked to reflect on and discuss a range of spiritual practices, ways they are thankful, and how they view themselves as “connected to something bigger” (Sources of Strength, 2017). Wyman and colleagues (2010) discovered that participating in Sources of Strength helped increase students’ perceptions of connectedness at school, in particular with adults in the building. Implementing this program would allow school counselors to seek out those students at risk and have further individual conversations and tailor any necessary interventions to that student’s cultural and religious/spiritual beliefs. School counselors could also refer students and families to therapists outside of the school setting who may be able to further explore spiritual and cultural beliefs and resources.

More research is needed about how cultural objections to suicide impact youth. For instance, there is a longstanding belief that the view in the Black community of suicide as “a White thing” (Early & Akers, 1993) acts as a suicide protective factor. But in the wake of rising suicide rates among Black youth, Walker (2020) challenged this notion, arguing that Black youth are at risk for suicide because mental health stigmas in their communities result in them keeping their distress to themselves. Other researchers (Sharma & Pumariega, 2018) have echoed the concern that guilt and/or shame about suicidal ideation may result in isolation in youth of color, including those from Black, Latinx, Asian, and other cultural groups. Another cultural objection in youth of color that may serve as a protective factor is culturally informed beliefs about death and the afterlife (Sharma & Pumariega, 2018). School counselors can focus on “normalizing suicidal ideation and acceptance of internal and external problematic events” (Murrell et al., 2014, p. 43) and on ways to include family members and other cultural representatives who are accepting of mental health issues in suicide-related conversations and programs with students of color.

R: Reasons to Live and Restricted Means
A fourth protective factor refers to two areas: reasons to live and restricted means (R). Reasons for living (RFL) are considered drives one might have for staying alive when contemplating suicide (Linehan et al., 1983). Bakhiyi et al. (2016) established in a systematic review of research literature that RFL serve as protective factors against suicidal ideation and suicide attempts in adolescents and adults. In a study with over 1,000 Chinese adolescents, the correlation between entrapment and suicidal ideation was moderated by RFL; adolescents with a higher RFL score had lower suicidal ideation even when experiencing high levels of entrapment (Ren et al., 2019). School counselors might consider giving students the RFL Inventory when presenting on suicide prevention or assessing for suicidal ideation, either the adolescent version (Osman et al., 1998) or the brief adolescent version (Osman et al., 1996). School counselors can also heighten students’ awareness of their RFL by asking them what or whom they currently cherish most or would miss or worry about if they suddenly went away.

The second part of this protective factor is restriction (R) of lethal suicide means, such as firearms, poisons, and medications (Cureton & Fink, 2019). There is evidence to support that restriction of means is effective for decreasing suicide (Barber & Miller, 2014; Kolves & Leo, 2017; Yip et al., 2012). For children and adolescents ages 10–19, the most frequent suicide method was hanging, followed by poisoning by pesticides for females and firearms for males. These findings were based on 86,280 suicide cases from 101 countries from 2000–2009 (Kolves & Leo, 2017).

Given this information, it is important for school counselors to not only assess for lethal weapons access but also to inquire about students’ access to and awareness of how everyday items might be used to attempt suicide. Although it may be impossible to restrict all means that could be utilized for hanging or poisoning, school counselors can discuss with guardians various ways to reduce access to these means and provide more supervision for any youth exhibiting thoughts of suicide. Kolves and Leo (2017) also discussed the high number of youth who learn about ways to attempt suicide from media and the internet; therefore, restriction, reduction, and supervision of media and internet usage could also be something school counselors suggest to guardians.

E: Engaged Care
Another protective factor across populations is engagement (E) with caring professionals (Cureton & Fink, 2019; SPRC & Rodgers, 2011). School counselors often have hundreds of students on their caseloads, and this can become overwhelming, especially when dealing with crises such as suicide. At the same time, it is imperative that school counselors actively engage with students in a caring and supportive way. Often the school counselor might be the first person to intervene with a suicidal youth; Cureton and Fink (2019) emphasized the importance of the client being able to feel empathy and care from the counselor.

School counselors can view engaged care as an effective and collaborative approach for suicide prevention by working with students and families to leverage a variety of services. According to Ungar et al. (2019), “Students who reported high levels of connectedness to school also reported significantly lower rates of binge drinking, suicide attempts, and poor physical health compared to youth with low scores on school engagement” (p. 620). However, school counselors cannot be solely responsible for the ongoing engaged care of suicidal youth and will need to make referrals to outside counselors and/or physicians. Comprehensive engaged care might include mental health treatment and ongoing support and management from health care providers (Brown et al., 2005; Fleischmann et al., 2008; Linehan et al., 2006). Researchers found that comprehensive services that connect parents, schools, and communities result in decreased suicide attempts when compared to hospitalization for youth (Ougrin et al., 2013).

S: Support
The final element of the SHORES mnemonic emphasizes the importance of students having supportive (S) environments and relationships (Cureton & Fink, 2019). As mentioned above, the school counselor is only one source of support. The support and involvement of family can also serve as a protective factor (Jordan et al., 2012). Diamond et al. (2019) noted that “when adolescents view parents as sensitive, safe, and available, they are more likely to turn to parents for support that can buffer against common triggers for depressive feelings and suicide ideation” (p. 722).

In a study with 176 Malaysian adolescents, support from family and friends was found to be a protective factor against suicidal ideation (Ibrahim et al., 2019). Youth seek support for suicidal thoughts from peers more than from adults (Gould et al., 2009; Michelmore & Hindley, 2012; Wyman et al., 2010). Many suicide prevention programs, such as Hope Squads and Sources of Strength, are addressing the need for positive peer support by incorporating a peer-to-peer component into their interventions (Wright-Berryman et al., 2019; Wyman et al., 2010). Working to increase peer support along with support from school personnel, family, and community could be lifesaving for students contemplating suicide.

Case Example Applying SHORES

The SHORES tool is meant to be comprehensive and can be used in classroom guidance, small-group, and individual counseling. A case example is provided for how SHORES might be employed in a middle school setting; however, this example could be adapted to work with elementary or high school students.

A middle school counselor attended a training on SHORES and incorporates this into her comprehensive school counseling program. Each year when she delivers her lessons on suicide prevention, she brings the SHORES poster to each classroom and shares with her students about protective factors and ways to reach out and seek help if they have a concern about suicide.

During her second lesson on suicide prevention, the school counselor notices that one of her new seventh-grade students, Jesse, seems unusually withdrawn and disengaged. The counselor is reviewing skills and strategies for coping (S) and asks each of the students to write down three to four ways that they have learned to cope with stress. In addition, she asks them to report how well each of these strategies and coping skills are working for them on a scale of 1–10. When she collects the papers, she notices that Jesse has written only one coping skill: “Locking myself in my room away from all of the noise and the pain.” He then stated his coping skill “is a 10 and works great because people will just forget about me and I can disappear.”

The school counselor is concerned about these remarks and decides to bring Jesse in for an individual counseling session. As she is asking Jesse about whether he has hope (H) that things will get better, she learns that his father has been deployed for the past year, his mother recently went to prison, and his grandmother, who is his primary guardian, had a recent health scare. Jesse shares that he is afraid he is going to lose the people closest to him and he feels angry and alone. He states that being a “military brat” who is new to the school makes him feel even more isolated, and he worries what others will think if they find out his mom is a felon.

When the school counselor expresses her concern for his safety and asks if he has ever thought about killing himself, Jesse is adamant that suicide is against his religion and he would never do it. He adds, “My mom would break out of jail and whoop me if she even knew I had thoughts like that.” Although Jesse voices his objections (O) and denies any current suicidal ideation, the school counselor is concerned about his social–emotional well-being and suggests he join a small counseling group she has for students experiencing changes in their families. Jesse agrees to check it out and gets his grandmother to sign a permission form for him to attend.

During his first small counseling group, Jesse is quiet but does confide in the group what is happening in his family and that he has been feeling “depressed.” Two of the other group members share that they also feel depressed. The school counselor asks them to define what they mean by feeling depressed. As they answer, she creates a list on the board of their definitions: “I feel hopeless and alone,” “I sometimes don’t know why I’m even here,” and “Sometimes I want to just fall asleep and never wake up.”

After they explore these definitions and the underlying feelings, the school counselor writes “Reasons to Live” (R) on the whiteboard. She shares that sometimes when kids are feeling depressed or hopeless, it can be helpful to think about the different reasons that they want to live and things they enjoy about their lives. She gives the students time to come up with lists and keeps track of what each of the students came up with during the brainstorming session. Although all of the other students in the group are able to come up with four to five reasons to live, the school counselor notes that Jesse only came up with one: “I get to visit my mom each Sunday.”

The school counselor decides to keep Jesse a few minutes after group to check in on his safety again. First, she asks him if he had other reasons to live before he moved to his new school. Jesse said that he used to play soccer and that he loved it and it made him feel excited each day to be part of the team. The school counselor encourages Jesse to look into joining the school soccer team and offers to talk to the coach to see if this is a possibility.

When asked about suicidal ideation, he is again adamant that he would never do it, but he admits that a couple of years ago it did occur to him that he could take his grandfather’s gun and “end it all.” The school counselor discovers that Jesse’s grandmother kept her late husband’s gun at her house. After discussing this with Jesse and getting his consent to contact his grandmother, she decides to err on the side of caution and follow up. Jesse’s grandmother shares that she does not believe the gun even works anymore and that there are no bullets in the home. However, after speaking with the school counselor about restricting means (R) she decides to donate the gun to a local hunting club.

During this conversation, the grandmother also shares that she is concerned about Jesse, especially his lack of a male role model. She shares that Jesse’s biological father is active military and might only see Jesse once or twice a year, and his grandfather died when he was 2. The school counselor lets the grandmother know that she plans to contact the soccer coach (who is male) about getting Jesse to join the team. After some further conversation, the school counselor and grandmother agree that it would also be helpful for Jesse to have some ongoing engaged care (E) with a counselor outside of school. She also inquires about the family’s religious affiliation because Jesse has mentioned to her that this is important to him. The school counselor compiles a list of Christian male counselors and sends the list home at the end of the day.

Over the next few weeks, Jesse continues to attend the small group. He joined the soccer team and has also been working with an outside counselor. He reports he is feeling more hopeful, even though he still worries about his mom and misses her. The school counselor delivered a classroom lesson on sources of support (S) earlier that week and follows up with each of the students during group. Each member creates a list of current sources of support in their lives and shares it. The school counselor notes that Jesse’s paper is filled with names of people both in and outside of school; he has listed friends at school, on his soccer team, and in his neighborhood; his soccer coach; his mother and grandmother; a neighbor; two teachers; and both of his counselors.

As the small group begins to wrap up toward the end of the school year, the school counselor checks in with Jesse for an individual counseling session. She reminds him about their classroom lesson on skills and strategies for coping (S). Jesse shares that he and his other counselor have been working a lot on mindfulness and that he really enjoys this. With his counselor’s encouragement, Jesse has also pursued a few new interests such as joining a club for military kids and joining an after-school program. When the school counselor revisits the question about reasons to live (R), Jesse shares that he needs more than one sheet of paper to write down all the good things in his life. The school counselor follows up with Jesse’s grandmother to share these updates and promises to continue engaged care (E) with Jesse when he returns for eighth grade.

Implications for School Counseling Practice, Training, and Research

There are implications for the use of and research on this promising tool across counseling specialties, and we focus on school settings in alignment with the scope of this manuscript. Guidelines and recommendations for school counseling practice concerning suicide include attending to both risk factors and protective factors in work with students via comprehensive suicide prevention (ASCA, 2019; Granello & Zyromski, 2018). The SHORES tool has utility as a standard and recognizable component for a comprehensive school suicide prevention program; an adjunct to current interventions such as risk screening and safety planning measures; and a strengths-based framework for prevention, intervention, and postvention. Future research is necessary to explore these applications and their impact.

Although some school suicide prevention programs address suicide protective factors, SHORES offers school counselors a simple and practical tool that they can apply across behavioral elements of a comprehensive school counseling program (ASCA, 2019). This consistent integration may support deeper understanding and broader use among school counselors and other faculty/staff, as well as students. The case example illustrated how SHORES may be applied and useful in classroom, small-group, and individual settings.

School counselors may use interventions such as risk screening and safety planning, and SHORES can fill the gap for suicide protective factors in both. Most suicide risk screening focuses solely on risk factors or does not fully explore suicide protective factors (McGlothlin et al., 2016). The most well-known safety plan template (Stanley & Brown, 2012) does not include all elements of the SHORES mnemonic (Cureton & Fink, 2019). School counselors who add SHORES to their risk screens and safety plans will be engaging in more comprehensive and protective interventions for students who may be at risk for suicide.

SHORES derives from a positive, strengths-based mindset regarding suicide prevention, intervention, and postvention. School counselors can use the tool to guide wellness programming before a suicide by considering how current and future efforts serve to enhance each element of the acronym. School counselors are also key to suicide postvention or response following a suicide (AFSP & SPRC, 2018). A school’s suicide postvention plan has three aims (Fineran, 2012), and embedding SHORES into the plan may help minimize distress, reduce contagion, and ease the return to school routines in place before the crisis. Additionally, the SHORES tool addresses several of the assets and barriers for successful school reintegration after a student’s psychiatric hospitalization (Clemens et al., 2011), so potential applications also include postvention after suicide attempts.

There are also training implications for SHORES in counselor education and supervision and practitioner professional development. Although school counselors’ training on suicide appears to have improved over the last 25 years, Gallo (2018) found that only 50% of high school counselors felt adequately prepared to identify suicidal students and assess their risk. Counselors-in-training have described the specific need for more training on child and adolescent suicide assessment (Cureton &
Sheesley, 2017). Counselors-in-training (Cureton & Sheesley, 2017) and educators (Cureton et al., 2018)
have also acknowledged the benefit of practicing suicide response in supervised counseling (i.e., internship), as well as the potential to miss opportunities simply because no clients present with suicide risk during such experiences. However, a recent assessment (Cureton et al., 2018) demonstrated that the counselor education and supervision field has only modest readiness to address the issue of suicide in its master’s-level training programs, in part because of negative views about suicide as a topic that is too scary, serious, advanced, and taxing to cover in class (Cureton et al., in press).

The strengths-based, preventative nature of SHORES positions it as a tool that can be easily introduced in classroom role-plays as well as during conversations with students being served during practicum and internship. Reframing these conversations, and more broadly all suicide-related efforts in counseling, as both challenging and potentially positive and life-affirming may partially address the negative stigma within and beyond the counselor education and supervision field (Cureton et al., 2018, in press). Finally, adding SHORES to existing school personnel training offerings like those listed by the SPRC (2019a) would deepen professional development for school counselors and other staff, faculty, and administration.

Future Research
Despite the numerous possibilities to apply the SHORES tool in K–12 and other educational settings (Cureton & Fink, 2019), research is needed to establish its utility and effectiveness. Primary investigations include studies with school counselors who are considering adopting and implementing SHORES in their schools to understand perceptions of its apparent value and barriers to use. Evaluative studies about training offerings and investigations into memory recall of acronym components among school counselors would also aid in conceptualization of true functionality of the SHORES tool.

Research on students’ perceptions and outcomes studies are also needed. Students’ reactions to and generalized use of the SHORES tool would be beneficial in order to examine its appeal, as would those of families, teachers, and stakeholders. It is also important to explore how to be developmentally appropriate across grade levels. Finally, outcomes studies on SHORES for prevention, intervention, and postvention are necessary to determine its practical worth. For instance, a comparison between a school counseling department’s existing safety planning procedure and a SHORES-enhanced procedure would be valuable. Studies about SHORES and counselor self-efficacy to address suicide would also add to the literature.

Conclusion

As rates of youth suicide have increased in recent years, the need for school counselors to adopt tools to better assess suicide risk in their students has taken on more urgency. SHORES provides a strengths-based assessment tool that can be used by school counselors to quickly examine the protective factors that potentially mitigate against suicide in their students. Offering a comprehensive overview of existential, behavioral, and interpersonal factors that have been identified as bolstering defenses against suicidality, each letter of the SHORES acronym is rigorously supported by research and provides clear implications for the tool’s utility in K–12 settings. Given that only roughly half of school counselors feel sufficiently prepared to assess suicide risk in their students, the SHORES tool provides a practical resource for screening and safety planning. Even so, more research is needed to illustrate and verify the SHORES tool’s ease of use and adoption into other existing school-based approaches to addressing suicide in student populations.

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

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Diane M. Stutey, PhD, NCC, LPC, RPT-S, is a licensed school counselor and an assistant professor at the University of Colorado Colorado Springs. Jenny L. Cureton, PhD, LPC (TX, CO), is an assistant professor at Kent State University. Kim Severn, MA, LPC, is a licensed school counselor and instructor at the University of Colorado Colorado Springs. Matthew Fink, MA, is a doctoral student at Kent State University. Correspondence may be addressed to Diane Stutey, 1420 Austin Bluffs Parkway, Colorado Springs, CO 80918, dstutey@uccs.edu.

Self-Reported Symptoms of Burnout in Novice Professional Counselors: A Content Analysis

Feb 26, 2021 | Volume 11 - Issue 1

Ryan M. Cook, Heather J. Fye, Janelle L. Jones, Eric R. Baltrinic

This study explored the self-reported symptoms of burnout in a sample of 246 novice professional counselors. The authors inductively analyzed 1,205 discrete units using content analysis, yielding 12 categories and related subcategories. Many emergent categories aligned with existing conceptualizations of burnout, while other categories offered new insights into how burnout manifested for novice professional counselors. Informed by these findings, the authors implore counseling scholars to consider, in their conceptualization of counselor burnout, a wide range of burnout symptoms, including those that were frequently endorsed symptoms (e.g., negative emotional experience, fatigue and tiredness, unfulfilled in counseling work) as well as less commonly endorsed symptoms (e.g., negative coping strategies, questions of one’s career choice, psychological distress). Implications for novice professional counselors and supervisors are offered, including a discussion about counselors’ experiences of burnout to ensure they are providing ethical services to their clients.

Keywords: novice professional counselors, burnout, content analysis, conceptualization, symptoms

The term high-touch professions refers to the fields that require professionals to provide ongoing and intense emotional services to clients (Maslach & Leiter, 2016). Although such work can be highly rewarding, these professionals are also at risk for burnout (Bardhoshi et al., 2019). In counseling, professionals are called to provide ongoing and intensive mental health services to clients with trauma histories (Foreman, 2018) and complicated needs (Freadling & Foss-Kelly, 2014). The risk of burnout is exacerbated by the fact that counselors often work in professional environments that are highly demanding and lack resources to serve their clients (Freadling & Foss-Kelly, 2014; Maslach & Leiter, 2016).

The consequences of burnout for counselors and clients can be considerable (Bardhoshi et al., 2019). Potential impacts include a decline in counselors’ self-care, strain of personal relationships, and damage to their overall emotional health (Bardhoshi et al., 2019; Cook et al., 2020; Maslach & Leiter, 2016). Unaddressed burnout might also lead to more serious professional issues like impairment (e.g., substance use, mental illness, personal crisis, or illness; Lawson et al., 2007). Thus, self-monitoring symptoms of burnout is of the utmost importance for counselors to ensure they are providing ethical services to their clients (American Counseling Association [ACA], 2014).

Although burnout is an occupational risk to all counselors (e.g., Bardhoshi et al., 2019; J. Lee et al., 2011; S. M. Lee et al., 2007), novice professional counselors may be especially vulnerable to burnout (Thompson et al., 2014; Westwood et al., 2017; Yang & Hayes, 2020). In the current study, we define novice professional counselors as those who are currently engaged in supervision for licensure in their respective states. Novice professional counselors face a multitude of challenges, such as managing large caseloads, working long hours for low wages, and receiving limited financial support for client care (Freadling & Foss-Kelly, 2014). Even though their professional competencies are still developing (Freadling & Foss-Kelly, 2014; Rønnestad & Skovholt, 2013), these counselors receive minimal direct oversight from a supervisor (Cook & Sackett, 2018). However, to date, no study has exclusively examined novice professional counselors’ descriptions of their experiences of burnout. Input from these counselors is important to understand their specific issues of counselor burnout. Other helping professionals have studied a rich context of practitioners’ burnout experiences. For example, Warren et al. (2012) examined open-ended text responses of people who treated clients with eating disorders and found nuanced contributors to burnout among these providers, including patient descriptors (e.g., personality, engagement in treatment), work-related descriptors (e.g., excessive work hours, inadequate resources), and therapist descriptors (e.g., negative emotional response, self-care). Accordingly, we employed a similar approach to examine the open-ended qualitative responses of 246 novice professional counselors’ self-reported symptoms of burnout.

Conceptual Framework of Burnout
Burnout is defined as “a psychological syndrome emerging as a prolonged response to chronic interpersonal stressors on the job” (Maslach & Leiter, 2016, p. 103). Although there are multiple conceptual frameworks of burnout (e.g., Kristensen et al., 2005; S. M. Lee et al., 2007; Maslach & Jackson, 1981; Shirom & Melamed, 2006; Stamm, 2010), the predominant model used to study burnout is the one developed by Maslach and Jackson (1981), which is measured by the Maslach Burnout Inventory (MBI). Informed by qualitative research, Maslach and Jackson (1981) developed the MBI and conceptualized burnout for all human service professionals as a three-dimensional model consisting of Exhaustion, Depersonalization, and Decreased Personal Accomplishment. Exhaustion is signaled by emotional fatigue, loss of energy, or feeling drained. Depersonalization is characterized by cynicism or negative attitudes toward clients, while Decreased Personal Accomplishment is indicated by a lack of fulfillment in one’s work or feeling ineffective. This conceptualization of burnout has been used to develop several versions of the MBI that are targeted for different professions (e.g., human services, education) and for professionals in general.

Despite the prominence of the MBI model in the burnout literature (Koutsimani et al., 2019), other scholars (e.g., Kristensen et al., 2005; Shirom & Melamed, 2006) have argued for a different conceptualization of burnout, noting several shortcomings of Maslach and Jackson’s (1981) three-dimensional model. Shirom and Melamed (2006) criticized the lack of theoretical framework of the MBI and noted that the factors were derived via factor analysis. They developed the Shirom-Melamed Burnout Measure (Shirom & Melamed, 2006), a measure informed by the Conservation of Resources theory (Hobfoll, 1989), which measures burnout as a depletion of physical, emotional, and cognitive resources using two subscales: Physical Fatigue and Cognitive Weariness.

Kristensen et al. (2005) also criticized the utility of the MBI for numerous reasons, including the lack of theoretical underpinnings of the instrument. Therefore, they developed the Copenhagen Burnout Inventory to capture burnout in professionals across disciplines, most notably human service professionals. From Kristensen et al.’s perspective, the underlying cause of burnout is physical and psychological exhaustion, which occurs across three domains: Personal Burnout (i.e., burnout that is attributable to the person themselves), Work-Related Burnout (i.e., burnout that is attributable to the workplace), and Client-Related Burnout (i.e., burnout that is attributable to their work with clients; Kristensen et al., 2005).

Stamm (2010) conceptualized the construct of professional quality of life for helping professionals, which included three dimensions: Compassion Satisfaction, Burnout, and Secondary Traumatic Stress. Burnout, as theorized by Stamm, is marked by feelings of hopelessness, frustration, and anger, as well as a belief that one’s own work is unhelpful to others, which results in a decline in professional performance. The experience of burnout may also be caused by an overburdening workload or working in an unsupportive environment (Stamm, 2010). Stamm’s model is reflected in the Professional Quality of Life Scale (ProQOL), and this instrument has been used by counseling scholars (e.g., Lambert & Lawson, 2013; Thompson et al., 2014).

A reason for variations in the conceptualization of burnout is that it manifests differently across professions (Maslach & Leiter, 2016). The only counseling-specific model of burnout is conceptualized by S. M. Lee et al. (2007), who developed the Counselor Burnout Inventory (CBI). The CBI was informed by the three dimensions of the MBI and additionally captured the unique work environment of professional counselors and its impact on their personal lives. As such, the CBI poses a five-dimensional model consisting of Exhaustion, Incompetence, Negative Work Environment, Devaluing Client, and Deterioration in Personal Life. In recent years, the CBI has been the instrument predominantly used by researchers to study counselor burnout (e.g., Bardhoshi et al., 2019; Fye et al., 2020; J. Lee et al., 2011).

The Current Study
J. Lee et al. (2011) noted the challenges of studying counselor burnout across diverse samples. They encouraged scholars to examine burnout within homogenous samples of counselors in order to offer more nuanced implications for each group. Prior scholarship (e.g., Freadling & Foss-Kelly, 2014; Thompson et al., 2014) suggested that novice professional counselors may be at risk of burnout, and despite the aforesaid vulnerabilities (e.g., low wages, work with high need clients, professional competency limitations), their self-reported manifestation of burnout symptoms have yet to be studied.

We acknowledge the critical importance of studying burnout in the profession of counseling. However, repeatedly relying on data from similar instruments to measure burnout may fail to capture new or relevant information about the phenomenon (Kristensen et al., 2005) for human service professionals (e.g., Maslach & Jackson, 1981) or professional counselors (e.g., S. M. Lee et al., 2007). Alternatively, content analysis, which focuses on the analysis of open-ended qualitative text (Krippendorff, 2013), may better capture the intricacies of burnout that could not be measured using quantitative instruments (e.g., Warren et al., 2012). Thus, we aimed to address the following research question: What are novice professional counselors’ self-reported symptoms of burnout?

Methodology

Participants
Participants in the current study were 246 postgraduate counselors who were currently receiving supervision for licensure. The age of participants ranged from 23 to 69, averaging 36.91 (SD = 10.15) years. The majority of participants identified as female (n = 195, 79.3%), while 22 participants identified as male (8.9%), four identified as non-binary (1.6%), nine indicated that they did not want to disclose their gender (3.7%), and 16 participants did not respond to the item (6.5%). The participants’ race/ethnicity was reported as follows: White (n = 186; 75.6%), Multiracial (n = 15, 6.1%), Latino/Hispanic (n = 7, 3.3%), Black (n = 6, 2.4%), Asian (n = 6, 2.4%), American Indian or Alaska Native (n = 3, 0.8%), Native Hawaiian or Pacific Islander (n = 1, 0.4%), and Other (n = 7, 3.3%), while 15 participants declined to respond to the item (6.1%). The self-reported race/ethnicity demographic information is comparable to all counselors in the profession, based on DataUSA (2018). The participants’ client caseload ranged from 1 to 650 (M = 41.88; Mdn = 30.0; SD = 53.74). On average, participants had worked as counselors for 5 years (Mdn = 3.3; SD = 4.87). The provided percentages may not total to 100 percent because of rounding and because participants were afforded the option to select more than one response.

Procedure
To answer our research question, we used data from a larger study of novice professional counselor burnout, which included both quantitative and qualitative data. After receiving IRB approval, we obtained lists of names and email addresses of counselors engaged in supervision for licensure from the licensing boards in seven states: Florida, Nebraska, New Mexico, Oregon, Utah, Washington, and Wisconsin. We aimed to recruit a nationally representative sample by purposefully choosing at least one state from each of the ACA regions. In addition, states were selected based upon our ability to obtain a list of counselors who were engaged in supervision for licensure from the respective licensure boards. We were able to survey at least one state from each ACA region except the North Atlantic Region. After removing invalid email addresses, we invited 6,874 potential participants by email to complete an online survey in Qualtrics. This survey was completed by 560 counselors, yielding a response rate of 8.15%. This response rate is consistent with other studies that employed a similar design (Gonzalez et al., 2020). All participants were asked, Do you believe you are currently experiencing symptoms of burnout?, to which participants responded (a) yes or (b) no. Participants who responded yes were then prompted with the direction, Describe your symptoms of burnout, using an open-ended text box, which did not have a character limit. A total of 246 participants (43.9%) responded yes and qualitatively described their symptoms of burnout. On average, participants provided 30.31 words (SD = 36.30). We answered our research question for the current study using only the qualitative data, which aligns with the American Psychological Association’s Journal Article Reporting Standards for Qualitative Research (JARS-Qual; Levitt et al., 2018).

Data Analysis
To answer our research question, we analyzed participants’ open-ended responses using content analysis, which allows for systematic and contextualized review of text data (Krippendorff, 2013). As recommended by Krippendorff (2013), we followed the steps of conducting content analysis: unitizing, sampling, recording, and reducing. We first separated the responses of the 246 participants into discrete units. For example, “feeling exhausted and back pain” was coded as two units: (a) feeling exhausted and (b) back pain. This process resulted in a total of 1,205 discrete units. We reduced our data into categories using an inductive approach, which allowed for new categories to emerge from the data without an a priori theory (Krippendorff, 2013). Although there are multiple conceptualizations of burnout (Maslach & Jackson, 1981; S. M. Lee et al., 2007) that could have informed our analysis (i.e., deductive approach; Krippendorff, 2013), we chose an inductive approach to capture the conceptualization of burnout for novice professional counselors—generating categories based on participants’ explanations of their own symptoms of burnout (Kondracki et al., 2002).

To that end, we developed a codebook by randomly selecting roughly 10% of the discrete units to code as a pretest. Our first and third authors, Ryan M. Cook and Janelle L. Jones, independently reviewed the discrete units, met to discuss and develop categories and corresponding definitions, and coded the pretest data together to enhance reliability. This process yielded a codebook that consisted of 12 categories. Cook and Jones then used the codebook (categories and definitions) to independently code the remaining 90% of the data across three rounds (i.e., 30% increments). After each round, Cook and Jones met to discuss discrepancies and to reach consensus on the final codes. The overall agreement between Cook and Jones was 97% and the interrater reliability was acceptable (Krippendorff α = .80; Krippendorff, 2013), which was calculated using ReCal2 (Freelon, 2013). At the end of the coding process, Cook and Jones reviewed their notes for each code and further organized them into subcategories based on commonalities. The second author, Heather J. Fye, served as the auditor (see Researcher Trustworthiness section) and reviewed the entire coding process.

Researcher Trustworthiness
The research team consisted of four members, three counselor educators and one counselor education and supervision doctoral student. The first and third authors, Cook and Jones, served as coders, while the second author, Fye, served as the auditor and the fourth author, Eric R. Baltrinic, served as a qualitative consultant. The counseling experience of the four authors ranged from 4 to 18 years, and the supervision experience of the authors ranged from 3 to 9 years. Cook, Fye, and Baltrinic are licensed professional counselors and three of the authors are credentialed as either a National Certified Counselor or Approved Clinical Supervisor.

We all acknowledged our personal experiences of burnout to some degree as practicing counselors as well as observing the consequences of burnout to our students and supervisees. All members of the research team had prior experience studying counselor burnout. Although these collective experiences enriched our understanding of the subject matter, we also attempted to bracket our assumptions and biases throughout the research process. To increase the trustworthiness of the coding process, the auditor, Fye, reviewed the codebook, categories and subcategories, discreteness, and two coders’ notes coding process after the pretest and rounds of coding. Fye provided feedback on the category definitions, coding process, and coding decisions during the analysis process.

Results

Using an inductive approach, 12 categories and related subcategories emerged from the 1,205 discrete self-reported symptoms of burnout. Full results, including the 12 categories and subcategories, as well as the frequencies of the categories and subcategories, are presented in the Appendix. We discuss each category in detail and provide illustrative examples of each category using direct participant quotes (Levitt et al., 2018).

Negative Emotional Experience
Of the 1,205 coded units, 218 units (18.1%) were coded into the category negative emotional experience. This category reflected participants’ descriptions of experiencing negative feelings related to their work as counselors (e.g., anxiety, depression, irritability) or unwanted negative emotions (e.g., crying spells). This category included 15 subcategories, and the units coded into these subcategories reflected the participants’ descriptions of a wide range of negative feelings. For example, one participant reported she was “struggling to feel happy,” while another participant shared that she “is carrying a heavy burden [that] no one understands or is aware of.” Some participants also reported crying spells. One participant shared she “has fits of crying,” while another reported she “[cries] in the bathroom at work.”

Fatigue and Tiredness
The category fatigue and tiredness was coded 195 times (16.2%) and included four subcategories. This category captured participants’ descriptions of feeling exhausted, fatigued, or tired. Units coded into this category included the participants’ indications that they feel exhausted, despite sleeping well. For example, one participant described feeling perpetually exhausted—“nothing recharges my batteries”— while another participant stated that her fatigue worsened as the week progressed: “[I feel] more and more exhausted throughout the week.”

Unfulfilled in Counseling Work
The category unfulfilled in counseling work captured the participants’ descriptions of no longer deriving joy at work, dread in going to work or completing work-related responsibilities, or lacking motivation to do work. This category was coded 140 times (11.6%) and subcategories included five subcategories. Avoidance of burdensome administrative responsibilities (e.g., paperwork) were commonly reported units that were captured in this category. For example, a participant noted “putting off doing notes.” Units also captured in this category reflected participants’ self-report of no longer feeling motivated or deriving joy from their work, which ultimately led some participants to stop seeking training. For instance, a participant described herself as “going through the motions at work,” and another added that she was no longer “motivated to improve [her] skills.”

Unhealthy Work Environment
Across all coded units, 128 units (10.6%) were coded in the category unhealthy work environment, which included 15 subcategories. This category captured participants’ descriptions of their work environment that contribute to a counselor experiencing burnout. For example, units captured in this category commonly described participants’ reports of working long hours with few or no breaks throughout the day, and participants feeling pressured to take on additional clients. Some participants described managing large client caseloads or caseloads with “high risk or high needs” clients. The units reflecting participants’ perceived lack of supervisor support were also coded into this category. For example, a participant noted that she was “scared to make a mistake or ask questions about doing my job,” while another participant described a supervisor as not “supportive or trustworthy.” Finally, units that signaled participants’ feelings of being inadequately compensated were coded into this category, such as this participant’s response: “I do not get paid enough for the work that I do.”

Physical Symptoms
The category physical symptoms reflected participants’ descriptions of physical ailments, physical manifestations of burnout (e.g., soreness, pain), physical illnesses, or physical descriptors (e.g., weight gain, weight loss). There were 107 coded units (8.9%) that referenced physical symptoms. The seven subcategories captured in this category reflected a wide range of physical ailments. The most commonly coded units were participants’ descriptions of headaches, illnesses, and weight changes, although some less commonly coded units reflected more serious physical and medical issues. For example, a participant noted, “I have TMJ [temporomandibular joint dysfunction] pain most days from clenching my jaw,” while another participant stated that she “recently began to have debilitating stomach symptoms, which were identified as small ulcerations.”

Negative Impact on Personal Interest or Self-Care
Across all coded units, 101 units (8.4%) were coded in the category negative impact on personal interest or self-care, which included eight subcategories. This category reflected the participants’ descriptions of reduced self-care or inability to engage in self-perceived healthy behaviors (e.g., cannot fall asleep), or lacking personal interest. Units coded in this category most commonly reflected participants’ experience of sleep issues—difficulty either falling asleep or staying asleep. Other units reflected participants’ lessening desire to engage in once-enjoyable activities. For example, one participant noted, “I find myself knowing that I need more time for play, rest, recovery, socializing, and personal interests, but [I am] feeling confused about how to fit that in.” Another participant described her self-care as unconstructive: “It often feels like no amount of self-care is helpful, which makes it more difficult to engage in any self-care.”

Self-Perceived Ineffectiveness as a Counselor
We coded 127 units (10.5%) into the category self-perceived ineffectiveness as a counselor, which included six subcategories. This category reflected the participants’ descriptions of their self-perceived decrease in self-efficacy as a counselor, difficulty in developing or maintaining therapeutic relationships with clients, decreased empathy toward clients, or questioning of their own abilities as counselors (e.g., ability to facilitate change). For example, one participant noted that she did not “have as much empathy for clients as before,” while another participant expressed, “I often feel like clients are being demanding and trying to waste my time.” Units coded into this category also reflected participants’ feelings of inadequacy or struggles to develop a meaningful professional relationship with clients. One participant stated that she must “reach very deep every morning for the presence of mind and spirit to pay close attention and to care deeply for each of these people.” Although less frequently coded, some units described participants’ feelings of compassion satisfaction or self-reported secondary traumatic stress. For example, one participant shared that she was “personally disturbed” by her work.

Cognitive Impairment
Across all coded units, 75 units (6.2%) were coded in the category cognitive impairment, and this category included seven subcategories. The units coded into this category reflected the participants’ descriptions of their cognitive abilities being negatively impacted in different ways. For example, one participant described “feeling like I am in a fog at work,” while another participant shared that she found it “hard to concentrate at work.” Some units captured in this category reflected participants’ rumination of clients or work; for example, one participant noted “shifting my attention to ruminating about dropouts at times, when I need to be present with a [current] client.”

Negative Impact on Personal Relationships
The category negative impact on personal relationships captured 63 coded units (5.2%). Participants’ descriptions of strained relationships as a result of their self-reported burnout were coded into this category, which included three subcategories. For example, one participant described “not [feeling] available for emotional connects with others in my personal life,” while another participant said that they “lashed out sometimes at family members after a stressful day of work.” Another example of the negative impact on personal relationships was a participant’s description of “struggling to find joy at home with my wife and two kids.”

Negative Coping Strategies
We coded 22 units (1.8%) into the category negative coping strategies. This category included five subcategories that captured participants’ descriptions of using unhealthy or negative coping strategies to cope with burnout. Units coded into this category described participants’ use of a variety of negative coping strategies. For example, participants noted an increase in “alcohol consumption” or “smoking.” Relatedly, a participant expressed one of her coping strategies was “the excessive use of Netflix,” while another participant stated that she was “not eating or eating way too much.”

Questioning of One’s Career Choice
Units that reflected participants’ descriptions of the questioning of one’s career choice and potential or planned desire to leave the profession were coded into the category questioning of one’s career choice. There were 21 coded units (1.7%) for this category, which included two subcategories. An example of units coded into this category is a participant who stated that she has “thoughts that I have made a mistake in pursuing this line of work.” Another participant shared feelings of “wanting to quit [my] job.” Some units coded into this category captured participants who were already making plans to leave their jobs or the field. For example, one participant shared that she “recently put in [my] notice at agency,” while another participant stated plans to leave the profession “within one year.”

Psychological Distress
The least number of units were coded into the category psychological distress, which was coded eight times (0.7%) and included two subcategories. This category captured the participants’ discussions of a mental health diagnosis, which they attributed as a symptom of burnout, or suicidal ideations. For example, one participant shared, “I have been diagnosed with major depressive disorder and my job is a factor,” while another participant stated, “I sought therapy for myself and I had to increase my anti-depressant medication.” Finally, two participants endorsed experiencing suicidal ideations at some previous point related to their burnout.

Discussion

The content analysis yielded insights of self-reported burnout symptoms by capturing the phenomenon in novice professional counselors’ own words. Many of the 12 categories that emerged from the data generally aligned with prior conceptualizations of burnout for human service professionals (e.g., Maslach & Jackson, 1981) and counselors (S. M. Lee et al., 2007), while some categories provided novel insights into how burnout manifested in this sample. Further, we observed trends in common self-reported descriptors of burnout for novice professional counselors (negative emotional experiences) to the least commonly endorsed descriptors (psychological distress). We assert that these findings enrich the scholarly understanding of the burnout phenomenon in novice professional counselors.

Discussion of the Conceptual Framework of Burnout
Maslach and Jackson (1981) emphasized in their earlier work that exhaustion and fatigue are core features of burnout, and the category of fatigue and tiredness was the second most commonly coded category (16.2% of all coded units) in our study. Our findings reaffirm exhaustion (or fatigue or tiredness) as a central feature of burnout, and specifically self-reported symptoms of burnout in novice professional counselors. Scholars (e.g., Kristensen et al., 2005; Maslach & Jackson, 1981; Shirom & Melamed, 2006) have conceptualized that the interconnectedness between the emotional, physical, and psychological fatigue of burnout is different. Shirom and Melamed (2006) distinguished emotional, physical, and cognitive resources, while Kristensen et al. (2005) made no distinction between physical and psychological exhaustion. Stamm (2010) also viewed exhaustion as a feature of burnout but did not specify how this exhaustion manifested in human service professionals. In the current study, we chose to distinguish emotional, physical, and cognitive symptoms to best capture the participants’ experiences in their own words (Kondracki et al., 2002). However, we found supportive evidence that novice professional counselors’ burnout included emotional, physical, and cognitive symptoms. Our findings suggest that all three components should be examined to adequately capture this phenomenon.

The category negative emotional experience, which reflected participants’ reports of experiencing negative feelings associated with their work as counselors, was the most commonly endorsed symptom of burnout (18.1% of all coded units). In other models of burnout (e.g., Kristensen et al., 2005; Shirom & Melamed, 2006), feelings or emotions are most often conceptualized as emotional exhaustion, emotional fatigue, or emotional distress. However, the participants in the current study richly described their negative emotional experiences, as captured in the subcategories, with irritability, anxiety, depression, and stress being the most commonly endorsed negative emotions. These findings most closely align with Stamm’s (2010) conceptualization of burnout, which suggested that feelings of hopelessness, anger, frustration, and depression are evidence of burnout. Relatedly, a similar content analysis performed with eating disorder treatment professionals also found that their participants most frequently described emotional distress (61% of their sample, n = 94) as a way in which their worry for clients impacts their personal and professional lives (Warren et al., 2012). Scholars (e.g., Maslach & Leiter, 2016) have postulated about the relationship between workplace burnout and affectional distress (e.g., depression, anxiety, stress); however, such an investigation has yet to be conducted in the profession of counseling. Our findings suggest that novice professional counselors commonly describe their manifestation of burnout as an emotional experience, and as such, this represents a gap in the current conceptualization of counselor burnout.

Two other categories captured in the current study were physical symptoms and cognitive impairment symptoms. Physical symptoms were coded for 8.9% of the 1,205 units coded, while cognitive symptoms were coded for 6.1% of all coded units. In the existing burnout literature (e.g., Maslach & Jackson, 1981; Shirom & Melamed, 2006), physical symptoms of burnout often paralleled or referenced fatigue or exhaustion. For example, in Shirom and Melamed’s (2006) model, physical symptoms were reflective of feeling physically tired. However, in the current study, participants most commonly described their physical symptoms as back pain, illnesses, and headaches. This finding aligns with Kaeding et al. (2017), who found that counseling and clinical psychology trainees attributed their back and neck pain to sitting for long periods of time. We assert that specific physical symptoms may have been inadequately captured by the existing models of burnout.

Relatedly, Shirom and Melamed (2006) suggested that psychological fatigue or psychological manifestations of burnout should be distinguished from those of emotional and physical symptoms, while Kristensen et al. (2005) made no such distinctions. The participants in the current study described numerous cognitive manifestations of burnout, and the most commonly coded subcategories included concentration or focus, rumination, and forgetfulness. These self-reported symptoms closely align with the model of Shirom and Melamed, which describes psychological fatigue as an inability to think clearly and difficulty processing one’s own thoughts. Further, Kristensen et al. described one symptom of personal burnout as being at risk of becoming ill. However, no items of cognitive impairment or worsening cognitive abilities are included in the CBI. Informed by our findings, descriptors of cognitive impairment should be considered to understand burnout in novice professional counselors.

Two of the three dimensions of burnout as conceptualized by Maslach and Jackson (1981) were Depersonalization (i.e., cynicism or negative attitudes toward clients) and Decreased Personal Accomplishment (i.e., diminished fulfillment in one’s work or feeling ineffective in their work). These two dimensions are similar to Stamm’s (2010) conceptualization of burnout for human service professionals, which included the features of perceiving that one’s own work is unhelpful and no longer enjoying the work. In the current study, two of the categories that emerged closely aligned with these conceptualizations of burnout: unfulfilled in counseling work (11.6% of all coded units) and self-perceived ineffectiveness as a counselor (10.5% of all coded units). Collectively, these two categories and related subcategories provide rich descriptors of how novice professional counselors experience their own depersonalization and diminished personal accomplishment (Maslach & Jackson, 1981).

Our findings align with qualitative studies of novice professional counselors’ experiences (e.g., Freadling & Foss-Kelly, 2014; Rønnestad & Skovholt, 2013). For example, Freadling and Foss-Kelly (2014) found that novice professional counselors sometimes question if their graduate training adequately prepared them for their current positions. As such, questioning of one’s clinical abilities by counselors at this developmental level was also a common experience by participants in our study (Freadling & Foss-Kelly, 2014).

Our findings were consistent with the counselor-specific burnout model in which S. M. Lee et al. (2007) noted the importance of including the unique work environment of counselors and related impact on their personal life. Our findings support the burnout conceptualization with novice professional counselors. For example, participants in the current study described an unhealthy work environment (10.6% of all coded units). The most commonly coded subcategories included unsupportive employer or supervisor, frustrated with system, burdened by documentation, and overburdened by amount of work or multiple roles.

In terms of the impact of counseling work on their personal lives (S. M. Lee et al., 2007), evidence of this dimension was captured in the current study in two categories: negative impact on personal interest or self-care and negative impact on personal relationships. There is a high degree of interconnectedness between burnout and self-care (Maslach & Leiter, 2016; Warren et al., 2012). Thus, it is unsurprising that participants reported a decrease in their self-care; however, some of the specific self-care behaviors that are affected as a result of novice professional counselors experiencing burnout are less understood. In the current study, the most commonly coded subcategory was difficulty falling asleep or staying asleep, followed by lack of interest in hobbies, poor work/life balance, and general decrease in self-care. As defined in the CBI, lack of time for personal interest and poor work/life balance are both indicators of Deterioration in Personal Life. While sleep onset and maintenance issues are associated with burnout (Yang & Hayes, 2020), counselors’ experiences with sleep issues appears to be a novel finding. Another indicator of deterioration in counselors’ personal lives as theorized by S. M. Lee et al. was a lack of time to spend with friends, which was also observed in our study. Relatedly, some participants indicated that they isolated from their social support system. Other participants described strained personal relationships (i.e., conflict in personal relationships, poor emotional connection with others), which are unique findings.

Counselor Burnout Versus Counselor Impairment
Although uncommonly reported, some participants in the current study described using negative coping strategies (1.8% of all coded units) and psychological distress (0.7% of all coded units) as evidence of their self-reported burnout. Examples of negative coping strategies reported by participants included increased substance use (e.g., alcohol, caffeine, nicotine) and overeating or skipping meals, while examples of psychological distress included having received a psychological diagnosis and experiencing increased suicidal ideations, which participants attributed to burnout. These self-reported symptoms of burnout align more closely with the definition of counselor impairment (Lawson et al., 2007) as opposed to the definition of counselor burnout. Our findings are significant for two reasons. First, any study of counselor burnout that utilized one of the commonly used instruments of burnout (e.g., CBI, MBI) would have failed to capture these participants’ experiences. Second, these findings suggest that a small number of counselors may be experiencing significant impairment in their personal and professional lives, despite being early in their professional careers. Finally, another infrequently coded category was questioning of one’s career choice (1.7% of all coded units). Coded units in this category indicated that some counselors were wondering if counseling was a good professional fit for them, while others expressed their intention to seek employment in another profession. It is possible that prolonged disengagement from one’s professional work (i.e., cynicism; Maslach & Jackson, 1981) could result in counselors wanting to explore other career options.

Limitations

There are limitations of this study which we must address. The purpose of content analysis is not to generalize findings, so our findings may only reflect the experiences of burnout for the participants in the current study. Their experiences may be influenced by developmental levels, experiences in their specific state, or other reasons that we did not capture.

Another limitation is our response rate of 8.15%. A possible reason for our low response rate is self-selection bias—counselors who were currently experiencing burnout responded to the open-ended items as opposed to those who were not feeling burnout. Future research is needed to see how burnout presents in larger or different populations of counselors. It might also be important to study the career-sustaining behaviors and work environments of those counselors who did not endorse burnout. The final limitation is that this study was descriptive in nature. Future researchers are encouraged to explore the factors that may predict burnout while also considering the novel findings generated from this study.

Implications

Our findings offer implications for counseling researchers, counselors, and supervisors. Although many of the findings from the current study align with prior research, there appears to be some degree of discrepancy between how burnout is conceptualized by scholars and how novice professional counselors describe symptoms of burnout. We implore scholars to further examine the specific descriptors of burnout as reported by participants in this study and to see if the frequency of these self-reported symptoms can be duplicated. Specifically, scholars should focus on the emotional experience of novice professional counselors, fatigue and tiredness, and feeling unfulfilled in their work, which were the most commonly reported symptoms. It also seems critically important to explore the less commonly reported descriptors of burnout, like negative coping strategies, questioning of one’s career choice, and psychological distress. Each of these categories could signal counselor impairment and would have been otherwise missed by scholars who relied exclusively on existing Likert-type burnout inventories.

Novice professional counselors sometimes experience self-doubt about their counseling skills or even the profession (Rønnestad & Skovholt, 2013), given the difficult work conditions in which these counselors practice (e.g., low wages, long hours; Freadling & Foss-Kelly, 2014). Novice professional counselors should understand that experiences of burnout appear to be commonly occurring. The illumination of these descriptors may encourage other novice professional counselors to seek guidance from their supervisors on how best to manage these feelings. For those novice professional counselors who are experiencing more serious personal and professional issues associated with burnout (e.g., using negative coping strategies and psychological distress), they should consider whether they are presently able to provide counseling services to clients and seek consultation from a supervisor (ACA, 2014).

Our findings have implications for supervisors. For example, supervisors should be willing to openly discuss burnout with their supervisees. Our results can provide supervisors with descriptors that capture novice professional counselors’ experiences of burnout. Supervisors might find it helpful to disclose some of their own experiences of burnout (or mitigating burnout) with their supervisees, which can normalize the supervisees’ experiences (Knox et al., 2011). Finally, to the extent that supervisors are able, they should protect novice professional counselors from experiencing an unhealthy work environment or potentially harmful behaviors. For example, in response to supervisees’ self-reported symptoms of burnout, supervisors could limit caseloads, allow counselors time to complete documentation, or mandate regular breaks throughout the day (including lunchtime).

Conclusion

There are many novice professional counselors experiencing a wide range of symptoms of burnout. A career in counseling can be rewarding, but prolonged burnout can lead to both personal and professional consequences, as evidenced by the findings from this study. Counselors must attend to their own symptoms of burnout in order to provide quality care to their clients and lead a fulfilling personal life. Supervisors and educators can support these counselors by discussing the experiences of burnout, and future scholars can better understand the experiences of counselor burnout by studying the phenomenon using definitions and symptoms in the words of counselors as opposed to generic definitions.

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

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Ryan M. Cook, PhD, ACS, LPC, is an assistant professor at the University of Alabama. Heather J. Fye, PhD, NCC, LPC, is an assistant professor at the University of Alabama. Janelle L. Jones, MS, NCC, is a doctoral student at the University of Alabama. Eric R. Baltrinic, PhD, LPCC-S (OH), is an assistant professor at the University of Alabama. Correspondence may be addressed to Ryan M. Cook, 310A Graves Hall, Box 870231, Tuscaloosa, AL 35475, rmcook@ua.edu.

University Student Well-Being During COVID-19: The Role of Psychological Capital and Coping Strategies

Feb 26, 2021 | Volume 11 - Issue 1

Priscilla Rose Prasath, Peter C. Mather, Christine Suniti Bhat, Justine K. James

This study examined the relationships between psychological capital (PsyCap), coping strategies, and well-being among 609 university students using self-report measures. Results revealed that well-being was significantly lower during COVID-19 compared to before the onset of the pandemic. Multiple linear regression analyses indicated that PsyCap predicted well-being, and structural equation modeling demonstrated the mediating role of coping strategies between PsyCap and well-being. Prior to COVID-19, the PsyCap dimensions of optimism and self-efficacy were significant predictors of well-being. During the pandemic, optimism, hope, and resiliency have been significant predictors of well-being. Adaptive coping strategies were also conducive to well-being. Implications and recommendations for psychoeducation and counseling interventions to promote PsyCap and adaptive coping strategies in university students are presented.

Keywords: university students, psychological capital, well-being, coping strategies, COVID-19

In January 2020, the World Health Organization declared the outbreak of a new coronavirus disease, COVID-19, to be a public health emergency of international concern, and the effects continue to be widespread and ongoing. For university students, the pandemic brought about disruptions to life as they knew it. For example, students had to stay home, adapt to online learning, modify internship placements, and/or reconsider graduation plans and jobs. The aim of this study was to understand how the sudden changes and uncertainty resulting from the pandemic affected the well-being of university students during the early period of the pandemic. Specifically, the study addresses coping strategies and psychological capital (PsyCap; F. Luthans et al., 2007) and how they relate to levels of well-being.

University Students and Mental Health
Although mental health distress has been an issue on college campuses prior to the pandemic (Flatt, 2013; Lipson et al., 2019), COVID-19 has and will continue to magnify this phenomenon. Experts are projecting increases in depression, anxiety, post-traumatic stress disorder, and suicide in the United States (Wan, 2020). Johnson (2020) indicated that 35% of students reported increased anxiety associated with a move from face-to-face to online learning in the spring 2020 semester, matching the early phases of the COVID-19 outbreak. Stress associated with adapting to online learning presented particular challenges for students who did not have adequate internet access in their homes (Hoover, 2020).

Researchers have reported that high levels of technology and social media use are associated with depression and anxiety among adolescents and young adults (Huckins et al., 2020; Primack et al., 2017; Twenge, 2017). Given the current realities of physical distancing, there are fewer opportunities for traditional-age university students attending primarily residential campuses to maintain social connections, resulting in social fragmentation and isolation. Research has demonstrated that this exacerbates existing mental health concerns among university students (Klussman et al., 2020).

The uncertainties arising from COVID-19 have added to anticipatory anxiety regarding the future (Ray, 2019; Witters & Harter, 2020). From the Great Depression to 9/11 and Hurricane Katrina, victims of these life-shattering events have had to deal with their present circumstances and were also left with worries about how life and society would be inexorably altered in the future. University students are dealing with uncertain current realities and futures and may need to bolster their internal resources to face the challenges ahead. In this context, positive coping strategies and PsyCap may be increasingly valuable assets for university students to address the psychological challenges associated with this pandemic and to maintain or enhance their well-being.

Coping Strategies
Coping is often defined as “efforts to prevent or diminish the threat, harm, and loss, or to reduce associated distress” (Carver & Connor-Smith, 2010, p. 685). There are many ways to categorize coping responses (e.g., engagement coping and disengagement coping, problem-focused coping and emotion-focused coping, accommodative coping and meaning-focused coping, proactive coping). Engagement coping includes problem-focused coping and some forms of emotion-focused coping, such as support seeking, emotion regulation, acceptance, and cognitive restructuring. Disengagement coping includes responses such as avoidance, denial, and wishful thinking, as well as aspects of emotion-focused coping, because it involves an attempt to escape feelings of distress (Carver & Connor-Smith, 2010; de la Fuente et al., 2020). Findings on the effectiveness of problem-focused coping strategies versus emotion-focused coping strategies suggest the effectiveness of the particular strategy is contingent on the context, with controllable issues being better addressed through problem-focused strategies, while emotion-focused strategies are more effective with circumstances that cannot be controlled (Finkelstein-Fox & Park, 2019). In general, problem-focused coping strategies, also known as adaptive coping strategies, include planning, active coping, positive reframing, acceptance, and humor (Carver & Connor-Smith, 2010). Other coping strategies, such as denial, self-blame, distraction, and substance use, are more often associated with negative emotions, such as shame, guilt, lower perception of self-efficacy, and psychological distress, rather than making efforts to remediate them (Billings & Moos, 1984). These strategies can be harmful and unhealthy with regard to effectively coping with stressors. Researchers have recommended coping skills training for university students to modify maladaptive coping strategies and enhance pre-existing adaptive coping styles to optimal levels (Madhyastha et al., 2014).

Flourishing: The PERMA Well-Being Model
Positive psychologists have asserted that studies of wellness and flourishing are important in understanding adaptive behaviors and the potential for growth from challenging circumstances (Joseph & Linley, 2008; Seligman, 2011). Flourishing (or well-being) is defined as “a dynamic optimal state of psychosocial functioning that arises from functioning well across multiple psychosocial domains” (Butler & Kern, 2016, p. 2). Seligman (2011) proposed a theory of well-being stipulating that well-being was not simply the absence of mental illness (Keyes, 2002), but also the presence of five pillars with the acronym of PERMA (Seligman, 2002, 2011). The first pillar, positive emotion (P), is the affective component comprising the feelings of joy, hope, pleasure, rapture, happiness, and contentment. Next are engagement (E), the act of being highly interested, absorbed, or focused in daily life activities, and relationships (R), the feelings of being cared about by others and authentically and securely connected to others. The final two pillars are meaning (M), a sense of purpose in life that is derived from something greater than oneself, and accomplishment (A), a persistent drive that helps one progress toward personal goals and provides one with a sense of achievement in life. Seligman’s (2011) PERMA model is one of the most highly regarded models of well-being.

Seligman’s multidimensional model integrates both hedonic and eudaimonic views of well-being, and each of the well-being components is seen to have the following three properties: (a) it contributes to well-being, (b) it is pursued for its own sake, and (c) it is defined and measured independently from the other components (Seligman, 2011). Studies show that all five pillars of well-being in the PERMA model are associated with better academic outcomes in students, such as improved college life adjustment, achievement, and overall life satisfaction (Butler & Kern, 2016; DeWitz et al., 2009; Tansey et al., 2018). Additionally, each pillar of PERMA has been shown to be positively associated with physical health, optimal well-being, and life satisfaction and negatively correlated with depression, fatigue, anxiety, perceived stress, loneliness, and negative emotion (Butler & Kern, 2016). At a time of significant stress, promoting the highest human performance and adaptation not only helps with well-being in the midst of the challenge but also can provide a foundation for future potential for optimal well-being (Joseph & Linley, 2008).

Psychological Capital (PsyCap)
PsyCap is a state-like construct that consists of four dimensions: hope (H), self-efficacy (E), resilience (R), and optimism (O), often referred to by the acronym HERO (F. Luthans et al., 2007). F. Luthans et al. (2007) developed PsyCap from research in positive organizational behavior and positive psychology. PsyCap is defined as an

individual’s positive psychological state of development characterized by (1) having confidence (self-efficacy) to take on and put in the necessary effort to succeed at challenging tasks; (2) making a positive attribution (optimism) about succeeding now and in the future; (3) persevering toward goals and, when necessary, redirecting paths to goals (hope) in order to succeed; and (4) when beset by problems and adversity, sustaining and bouncing back and even beyond (resilience) to attain success. (F. Luthans et al., 2015, p. 2)

Over the past decade, PsyCap has been applied to university student development and mental health. There is robust empirical support suggesting that individuals with higher PsyCap have higher levels of performance (job and academic); satisfaction; engagement; attitudinal, behavioral, and relational outcomes; and physical and psychological health and well-being outcomes. Further, they have negative associations with stress, burnout, negative health outcomes, and undesirable behaviors at the individual, team, and organizational levels (Avey, Reichard, et al., 2011; Newman et al., 2014). Researchers have also examined the mediating role of PsyCap in the relationship between positive emotion and academic performance (Carmona-Halty et al., 2019; Hazan Liran & Miller, 2019; B. C. Luthans et al., 2012; K. W. Luthans et al., 2016); relationships and predictions between PsyCap and mental health in university students (Selvaraj & Bhat, 2018); and relationships between PsyCap, well-being, and coping (Rabenu et al., 2017).

Aim of the Study and Research Questions
The aim of the current study was to examine the relationships among well-being in university students before and during the onset of COVID-19 with PsyCap and coping strategies. The following research questions guided our work:

Is there a significant difference in the well-being of university students prior to the onset of COVID-19 (reported retrospectively) and after the onset of COVID-19?
What is the predictive relationship of PsyCap on well-being prior to the onset of COVID-19 and after the onset of COVID-19?
Do coping strategies play a mediating role in the relationship between PsyCap and well-being?

Method

Participants
A total of 806 university students from the United States participated in the study. After cleaning the data, 197 surveys were excluded from the data analyses. Of the final 609 participants, 73.7% (n = 449) identified as female, 22% (n = 139) identified as male, and 4.3% (n = 26) identified as non-binary. The age of participants ranged from 18 to 66 (M = 27.36, SD = 9.9). Regarding race/ethnicity, most participants identified as Caucasian (83.6%, n = 509), while the remaining participants identified as African American (5.3%, n = 32), Hispanic or Latina/o (9.5%, n = 58), American Indian (0.8%, n = 5), Asian (3.6%, n = 22), or Other (2.7%, n = 17). Fifty-four percent of the participants were undergraduate students (n = 326), and the remaining 46% were graduate students (n = 283). The majority of the participants were full time students (82%, n = 498) compared to part-time students (18%, n = 111). Sixty-three percent of the students were employed (n = 384) and the remaining 37% were unemployed (n = 225).

Data Collection Procedures
After a thorough review of the literature, three standardized measures were identified for use in the study along with a brief survey for demographic information. Instruments utilized in the study measured psychological capital (Psychological Capital Questionnaire [PCQ-12]; Avey, Avolio et al., 2011), coping (Brief COPE; Carver, 1997), and well-being (PERMA-Profiler; Butler & Kern, 2016). Data were collected online in May and June 2020 using Qualtrics after obtaining approval from the IRBs of our respective universities. An invitation to participate, which included a link to an informed consent form and the survey, was distributed to all university students at two large U.S. public institutions in the Midwest and the South via campus-wide electronic mailing lists. The survey link was also distributed via a national counselor education listserv, and it was shared on the authors’ social media platforms. Participants were asked to complete the well-being assessment twice—first, by responding as they recalled their well-being prior to COVID-19, and second, by responding as they reflected on their well-being during the pandemic.

Instruments
Demographic Questionnaire
A brief questionnaire was used to capture participant information. The questionnaire included items related to age, gender, race/ethnicity, relationship status, education classification, and employment status.

Psychological Capital Questionnaire – Short Version (PCQ-12)
The PCQ-12 (Avey, Avolio et al., 2011), the shortened version of PCQ-24 (F. Luthans et al., 2007), consists of 12 items that measure four HERO dimensions: hope (four items), self-efficacy (three items), resilience (three items), and optimism (two items), together forming the construct of psychological capital (PsyCap). The PCQ-12 utilizes a 6-point Likert scale with response options ranging from strongly disagree to strongly agree. Cronbach’s alpha coefficients as a measure of internal consistency of the HERO subscales in the current study were high—hope (α = .86), self-efficacy (α = .86), resilience (α = .73), and optimism (α = .83)—consistent with the previous studies.

Brief COPE Questionnaire
Coping strategies were evaluated using the Brief COPE questionnaire (Carver, 1997), which is a short form (28 items) of the original COPE inventory (Carver et al., 1989). The Brief COPE is a multidimensional inventory used to assess the different ways in which people generally respond to stressful situations. This instrument is used widely in studies with university students (e.g., Madhyastha et al., 2014; Miyazaki et al., 2008). Fourteen conceptually differentiable coping strategies are measured by the Brief COPE (Carver, 1997): active coping, planning, using emotional support, using instrumental support, venting, positive reframing, acceptance, denial, self-blame, humor, religion, self-distraction, substance use, and behavioral disengagement. The 14 subscales may be broadly classified into two types of responses—“adaptive” and “problematic” (Carver, 1997, p. 98). Each subscale is measured by two items and is assessed on a 5-point Likert scale. Thus, in general, internal consistency reliability coefficients tend to be relatively smaller (α = .5 to .9).

PERMA-Profiler
The PERMA-Profiler (Butler & Kern, 2016) is a 23-item self-report measure that assesses the level of well-being across five well-being domains (i.e., positive emotion, engagement, relationships, meaning, accomplishment) and additional subscales that measure negative emotion, loneliness, and physical health. Each item is rated on an 11-point scale ranging from never (0) to always (10), or not at all (0) to completely (10). The five pillars of well-being are defined and measured separately but are correlated constructs that together are considered to result in flourishing (Seligman, 2011). A single overall flourishing score provides a global indication of well-being, and at the same time, the domain-specific PERMA scores provide meaningful and practical benefits with regard to the possibility of targeted interventions. The measure demonstrates acceptable reliability, cross-time stability, and evidence for convergent and divergent validity (Butler & Kern, 2016). For the present study, reliability scores were high for four pillars—positive emotion (α = .88), relationships (α = .83), meaning (α = .89), accomplishment (α = .82); high for the subscales of negative emotion (α = .73) and physical health (α = .85); and moderate for the pillar of engagement (α = .65). The overall reliability coefficient of well-being items is very high (α = .94).

Data Analysis Procedure
The data were screened and analyzed using Statistical Package for the Social Sciences (SPSS, v25). Changes in PERMA elements were calculated by subtracting PERMA scores reported retrospectively by participants before the pandemic from scores reported at the time of data collection during COVID-19, and a repeated-measures ANOVA was conducted to examine the difference. Point-biserial correlation and Pearson product moment correlation coefficients were calculated to examine the relationships of demographic variables, PsyCap, and coping strategies with change in PERMA scores. Multivariate multiple regression was carried out to understand the predictive role of PsyCap on PERMA at two time points (before and during COVID-19). Structural equation modeling in Analysis of Moment Structures (AMOS, v23) software was used to test the mediating role of coping strategies on the relationship between PsyCap and change in PERMA scores. Mediation models were carried out with bootstrapping procedure with a 95% confidence interval.

Results

Prior to exploring the role of PsyCap and coping strategies on change in well-being due to COVID-19, an initial analysis was conducted to understand the characteristics and relationships of constructs in the study. Correlation analyses (see Table 1) revealed significant and positive correlations between four PsyCap HERO dimensions (i.e., hope, self-efficacy, resilience, and optimism; Avey, Avolio et al., 2011) and the six PERMA elements (i.e., positive emotion, engagement, relationships, meaning, accomplishment, and physical health; Butler & Kern, 2016). Further, PsyCap HERO dimensions were negatively correlated to negative emotion and loneliness. Age was positively correlated with change in PERMA elements, but not gender. Similarly, approach coping strategies such as active coping, positive reframing, and acceptance (Carver, 1997) were resilient strategies to handle pandemic stress whereas using emotional support and planning showed weaker but significant roles. Similarly, religion also tended to be an adaptive coping strategy during the pandemic. Behavioral disengagement and self-blame (Carver, 1997) were found to be the dominant avoidant coping strategies that were adopted by students, which led to a significant decrease in well-being during the pandemic. Overall, as seen in Table 1, all three variables studied—PsyCap HERO dimensions, eight PERMA elements, and coping strategies—were highly related.

Table 1

Relationship of Demographic Factors, Psychological Capital, and Coping Strategies With Change in PERMA Elements

Variables	Mean	SD	P	E	R	M	A	N	H	L
Age	27.36	9.91	.15^**	.11^**	.14^**	.16^**	.14^**	.01	.03	-.17^**
Course ^Ф	–	–	.19^**	.10^*	.19^**	.16^**	.06	-.05	.09^*	-.14^**
Nature of course ^Ф	–	–	.06	.06	.12^**	.13^**	.09^*	.03	.03	-.10^**
Gender ^Ф	–	–	-.01	-.06	.01	-.02	-.02	.02	-.02	.03
Employment ^Ф	–	–	-.17^**	-.11^**	-.13^**	-.19^**	-.10^*	.04	-.11^**	.11^**
Self-Efficacy	13.80	3.21	.11^**	.13^**	.14^**	.18^**	.16^**	-.05	.15^**	-.03
Hope	18.68	3.92	.24^**	.26^**	.20^**	.34^**	.40^**	-.17^**	.21^**	-.10^*
Resilience	13.41	3.08	.23^**	.22^**	.20^**	.32^**	.33^**	-.16^**	.15^**	-.13^**
Optimism	8.61	2.39	.21^**	.27^**	.23^**	.32^**	.30^**	-.11^**	.16^**	-.10^*
Self-Distraction	6.32	1.41	-.09^*	.01	.03	-.02	.01	.08^*	.02	.11^**
Active Coping	5.83	2.01	.24^**	.28^**	.20^**	.28^**	.32^**	-.09^*	.23^**	-.08^*
Denial	2.96	1.42	-.19^**	-.14^**	-.18^**	-.16^**	-.16^**	.24^**	-.16^**	.12^**
Substance Use	3.60	2.02	-.18^**	-.15^**	-.15^**	-.20^**	-.20^**	.11^**	-.09^*	.17^**
Using Emotional Support	5.07	1.81	.12^**	.11^**	.32^**	.18^**	.11^**	.04	.10^*	-.02
Using Instrumental Support	4.35	1.70	.01	.04	.20^**	.07	.02	.10^*	.04	.07
Behavioral Disengagement	3.96	2.11	-.43^**	-.37^**	-.40^**	-.46^**	-.44^**	.31^**	-.26^**	.27^**
Venting	4.58	1.54	-.24^**	-.16^**	-.08^*	-.17^**	-.16^**	.29^**	-.09^*	.16^**
Positive Reframing	5.12	1.78	.28^**	.27^**	.21^**	.26^**	.25^**	-.15^**	.18^**	-.14^**
Planning	5.42	1.75	.07	.12^**	.11^**	.13^**	.11^**	.08	.08^*	-.04
Humor	4.93	2.00	-.02	-.02	-.02	-.04	-.06	-.02	.02	.05
Acceptance	6.47	1.43	.33^**	.27^**	.27^**	.34^**	.31^**	-.25^**	.21^**	-.15^**
Religion	3.93	2.03	.21^**	.16^**	.16^**	.22^**	.13^**	-.08	.15^**	-.05
Self-Blame	4.08	1.72	-.33^**	-.27^**	-.29^**	-.36^**	-.36^**	.29^**	-.22^**	.20^**

Note. P = Positive Emotion, E = Engagement, R = Relationships, M = Meaning, A = Accomplishment, N = Negative Emotion, H = Physical Health, L = Loneliness.
^Ф Point-biserial correlation
* p < .05, ** p < .01

Research Question 1
Results of a repeated-measures ANOVA presented in Figure 1 indicate that mean scores of PERMA decreased significantly during COVID-19: λ = .620; F (5,604) = 73.99, p < .001. Partial eta squared was reported as the measure of effect size. The effect size of the change in well-being for PERMA elements was 38%, η_p² = .380, a high effect size (Cohen, 1988). As expected, negative emotion and loneliness significantly increased during the period of COVID-19, impacting overall well-being in an adverse manner. The average scores of negative emotion and loneliness increased from 4.46 and 3.86 to 5.85 and 5.94, respectively. Physical health significantly reduced from 6.58 to 5.91. The effect size of the change in the scores of individual PERMA elements ranged between 12.1% and 32.5%. Among the PERMA elements, engagement and physical health were least impacted by COVID-19, whereas students’ experiences of positive emotion and negative emotion were the factors that were largely affected.

Figure 1

Changes in the PERMA Prior to the Onset of COVID-19 and After the Onset of COVID-19

Note. P = Positive Emotion, E = Engagement, R = Relationships, M = Meaning, A = Accomplishment, N = Negative Emotion, H = Physical Health, L = Loneliness.

Research Question 2
The predictive role of PsyCap on well-being at two time points (before and after the onset of COVID-19) was analyzed using multivariate multiple regression (see Table 2). Coefficients of determination for models predicting well-being from PsyCap dimensions ranged from 4% to 28%. Before the onset of COVID-19, 23% of the variance in well-being was explained by the PsyCap dimensions (R² = .23, p < .001), with self-efficacy and optimism as the most significant predictors of well-being. However, during the pandemic, the covariance of the PsyCap dimensions with well-being increased to 39% (R² = .39, p < .01). Interestingly, after the onset of the pandemic, the predictor role of certain PsyCap dimensions shifted. For example, optimism became the strongest predictor of overall well-being and hope emerged as a predictor of engagement, meaning, accomplishment, and physical health during the pandemic. The predictive role of hope was negligible before COVID-19. The predictive role of resilience on positive emotion, accomplishment, negative emotion, and loneliness also became significant during COVID-19. Self-efficacy was a consistent predictor of PERMA elements before COVID-19. But during COVID-19, the relevance of self-efficacy in predicting PERMA elements was limited to controllable factors—relationships, meaning, and physical health—and the predictive role of self-efficacy overall was no longer significant (see Table 2).

Table 2

Predicting PERMA Elements From Psychological Capital Prior to the Onset of COVID-19 and After the Onset of COVID-19

	PERMA	Self-Efficacy	Hope	Resilience	Optimism	Adj. R²	F
Before COVID-19
	Positive Emotion	.10^*	-.06	-.01	.44^**	.19	37.66^**
	Engagement	.10^*	.06	.01	.11^*	.05	8.80^**
	Relationships	.10^*	.07	-.09	.29^**	.12	21.33^**
	Meaning	.21^**	.06	-.03	.38^**	.28	58.68^**
	Accomplishment	.24^**	.06	.04	.13^*	.14	25.62^**
	Negative Emotion	-.13^**	.10	-.05	-.29^**	.11	18.97^**
	Physical Health	.16^**	.08	-.04	.12^*	.07	12.16^**
	Loneliness	-.10^*	0	-.01	-.19^**	.04	7.36^**
	Well-Being	.19^**	.04	-.02	.35^**	.23	45.41^**
During COVID-19
	Positive Emotion	.04	.09	.10^*	.41^**	.30	67.05^**
	Engagement	.02	.21^**	.05	.26^**	.21	40.86^**
	Relationships	.09^*	.1	-.01	.33^**	.19	36.72^**
	Meaning	.11^**	.18^**	.09	.38^**	.39	99.93^**
	Accomplishment	.05	.37^**	.14^**	.17^**	.39	96.96^**
	Negative Emotion	-.03	-.07	-.13^*	-.23^**	.14	26.80^**
	Physical Health	.16^**	.19^**	-.03	.14^**	.15	27.25^**
	Loneliness	-.04	.01	-.11^*	-.20^**	.08	13.34^**
	Well-Being	.07	.22^**	.08	.37^**	.39	97.48^**

* p < .05, ** p < .01

Research Question 3
Structural equation modeling was used to examine whether coping strategies mediate PsyCap’s effect on well-being. Coping strategies that predicted change in PERMA were used for mediation analysis. Indirect effects describing pathways from PsyCap factors to PERMA factors through identified coping strategies were tested for mediating roles. Results indicated that PsyCap affected well-being both directly and indirectly through coping strategies. Optimism had a significant indirect effect on change in well-being compared to hope and resilience (see Table 3). Among adaptive coping strategies, active coping, positive reframing, and using emotional support mediated the relationship between optimism and overall well-being. Interestingly, using emotional support also showed a similar mediating link between resilience and PERMA, but not for the factors of loneliness and negative emotion. On the other hand, self-blame and behavioral disengagement were two problematic coping strategies that mediated the relationship between optimism and all PERMA elements. Specifically, we found coping through self-blame playing a mediating role between PERMA factors and two of the HERO dimensions—resilience and hope.

Table 3

Indirect Effect of Psychological Capital on PERMA Factors Through Coping Strategies (Mediators)

PsyCap		Standardized Beta (ß, Indirect effect)
L			H	N	A	M	R	E	P
Active Coping ^Ф
	Optimism	-.016^*	.043^**	-.017^*	.06^**	.052^**	.037^**	.052^**	.044^**
	Resilience	-.005	.014	-.006	.02	.017	.012	.017	.015
	Hope	-.007	.018	-.007	.025	.022	.015	.022	.018
	Self-Efficacy	-.009	.025	-.01	.034	.03	.021	.03	.025
Positive Reframing ^Ф
	Optimism	-.047^**	.06^**	-.05^**	.085^**	.088^**	.07^**	.094^**	.096^**
	Resilience	-.005	.007	-.006	.01	.01	.008	.011	.011
	Hope	.003	-.003	.003	-.005	-.005	-.004	-.005	-.005
	Self-Efficacy	-.005	.006	-.005	.009	.009	.007	.01	.01
Using Emotional Support ^Ф
	Optimism	-.007	.02^*	.012	.03^*	.049^**	.086^**	.029^*	.032^**
	Resilience	.003	-.012	-.005	-.013^*	-.021^*	-.037^*	-.012^*	-.014^*
	Hope	0	0	0	0	0	0	0	0
	Self-Efficacy	-.001	.006	.002	.006	.01	.018	.006	.007
Self-Blame ^Ф
	Optimism	-.038^**	.043^**	-.056^**	.07^**	.07^**	.056^**	.054^**	.065^**
	Resilience	-.03^**	.034^**	-.044^**	.055^**	.055^**	.044^**	.042^**	.051^**
	Hope	-.023^*	.025^*	-.033^*	.042^*	.041^*	.033^*	.032^*	.038^**
	Self-Efficacy	-.005	.006	-.007	.009	.009	.007	.007	.008
Behavioral Disengagement ^Ф
	Optimism	-.07^**	.067^**	-.081^**	.113^**	.118^**	.104^**	.097^**	.112^**
	Resilience	-.02	.02	-.023	.033	.034	.03	.028	.033
	Hope	-.032	.03	-.036	.051	.053	.047	.044	.051
	Self-Efficacy	-.009	.009	-.011	.015	.016	.014	.013	.015

Note. Coping strategies with insignificant mediating role are not included in the table. P = Positive Emotion,
E = Engagement, R = Relationships, M = Meaning, A = Accomplishment, N = Negative Emotion, H = Physical Health,
L = Loneliness.
^Ф Mediator coping strategies.
* p < .05, ** p < .01

Discussion

The current study investigated the PERMA model of well-being (Seligman, 2011) with university students before and during the COVID-19 pandemic, as well as the relationships between PsyCap (F. Luthans et al., 2007), coping strategies, and well-being of university students. We examined whether the COVID-19 context shaped the efficacy of particular strategies to promote well-being. Findings are discussed in three areas: reduction in well-being related to COVID-19, shift in predictive roles of PsyCap HERO dimensions, and coping strategies as a mediator.

Reduction in Well-Being Related to COVID-19
Well-being scores across all PERMA elements, including physical health, were lower than those reported retrospectively prior to the pandemic. Such a decline in well-being following a pandemic is consistent with previous occurrences of public health crises or natural disasters (Deaton, 2012). Participants reported higher levels of negative emotion and loneliness after the onset of COVID-19, and a decrease in positive emotion. It is this balance of positive and negative emotions that contributes to life satisfaction (Diener & Larsen, 1993), and our findings support the notion that fostering particular positive psychological states (PsyCap), as well as engaging in related coping strategies, promotes well-being in the context of this large-scale crisis.

Shift in Predictive Roles of PsyCap HERO Dimensions
Consistent with prior research (Avey, Reichard et al., 2011; F. Luthans & Youssef-Morgan, 2017; Youssef-Morgan & Luthans, 2015), we found that PsyCap predicted well-being. PsyCap’s positive psychological resources (HERO dimensions) may enable students to have a “positive appraisal of circumstances” (F. Luthans et al., 2007, p. 550) by providing mechanisms for reframing and reinterpreting potentially negative or neutral situations. There was however an interesting shift in the predictive role of PsyCap dimensions before and after the onset of COVID-19. Prior to COVID-19, self-efficacy and optimism were the two major psychological resources that predicted university student well-being. However, after COVID-19, self-efficacy did not present as a predictor of well-being in this study. Although the reason for this result is uncertain, it is conceivable that attending to an uncertain future (i.e., hope) and recovering from immediate losses (i.e., resilience) became more salient, and one’s self-efficacy in managing normal, everyday challenges receded in importance. Indeed, optimism and hope each uniquely predict a major proportion of variance of the change in well-being and may together help students to face an uncertain future (M. W. Gallagher & Lopez, 2009). Resilience, the ability to recover from setbacks when pathways are blocked (Masten, 2001), had a predictive role on positive emotion and accomplishment in this study.

Coping Strategies as a Mediator
While PsyCap directly relates to well-being and coping strategies relate to well-being, our findings indicated that coping strategies also played a significant mediating role in the relationship between PsyCap and well-being. Specifically, adaptive coping strategies played a significant role in enhancing the positive effects of PsyCap on well-being. Adaptive coping strategies—such as active coping, acceptance, using emotional support, and positive reframing—were found to better aid in predicting well-being. In this study, accepting the realities, using alternative affirmative explanations, seeking social support for meeting emotional needs, and engaging in active problem-focused coping behaviors seem to be the most helpful ways to counter the negative effects of the pandemic on well-being. Conversely, when individuals employed problematic coping strategies such as behavioral disengagement and self-blame (Carver, 1997), the negative impacts were much stronger than the positive effect of adaptive coping strategies.

Implications for Counselors

Given findings of the relationship between PsyCap and well-being in the current study, as well as in prior research (F. Luthans et al., 2006; F. Luthans et al., 2015; McGonigal, 2015), counselors may wish to focus on developing PsyCap to help university students flourish both during the pandemic and in a post-pandemic world. Two significant challenges to counseling professionals on college campuses are the lack of resources to adequately respond to mental health concerns among students and the stigma associated with accessing services (R. P. Gallagher, 2014; Michaels et al., 2015). Thus, efficient interventions that are not likely to trigger stigma responses are helpful in this context. Several researchers have found that relatively short training in PsyCap interventions, including web-based platforms (Dello Russo & Stoykova, 2015; Demerouti et al., 2011; Ertosun et al., 2015; B. C. Luthans et al., 2012, 2013) have been effective. Recently, the use of positive psychology smartphone apps such as Happify and resilience-building video games such as SuperBetter have been suggested and tested as motivational tools, especially with younger adults, to foster sustained and continued engagement with PsyCap development (F. Luthans & Youssef-Morgan, 2017; McGonigal, 2015). These are potential areas of practice for college counselors and counselors serving university students.

Interventions that are described as well-being approaches rather than those that highlight pathologies are less stigmatizing (Hunt & Eisenberg, 2010; Umucu et al., 2020) than traditional deficit-based therapeutic approaches. There are a number of research-based approaches offered in the field of positive psychology to guide mental health professionals to facilitate development of PsyCap and other important well-being correlates. These include approaches to building positive emotions (Fredrickson, 2009); coping strategies, which were found in this study to boost well-being (Jardin et al., 2018; Lyubomirsky, 2008); and effective goal pursuits (F. Luthans & Youssef-Morgan, 2017). One of the distinguishing characteristics of PsyCap is its malleability and openness to change and development (Avey, Reichard et al., 2011; F. Luthans et al., 2006). Thus, there is potential for counselors to develop well-being promotion initiatives for students on university campuses targeting PsyCap and its constituting positive psychological HERO resources with the end goal of strengthening well-being (Avey, Avolio et al., 2011; F. Luthans et al., 2015; F. Luthans & Youssef-Morgan, 2017).

Strategies and programming to develop wellness can be delivered in one-on-one sessions with students, as well as in group settings, and may have either a prevention or intervention focus. They could also be adapted to provide services online. A variety of free online assessments are also available for use by counselors, including tools that measure well-being, positive psychological resources, and character strengths of university students in addition to existing assessment batteries. By administering the PERMA-Profiler to university students, counselors could identify and understand what dimension of well-being should be further developed (Umucu et al., 2020). With each PERMA element individually rendering to flourishing mental health, specific targeted positive psychology interventions might be offered as domain-specific interventions.

Counselors could help university students benefit from attending to, appreciating, and attaining life’s positives (Sin & Lyubomirsky, 2009) and from enhancing the strength and frequency of employing positive coping strategies through targeted psychoeducational or counseling interventions. Teaching university students active coping strategies, such as positive reframing and how to access emotional support, could help them cope with adverse situations. Sheldon and Lyubomirsky (2006) indicated that practicing gratitude helps people to cope with negative situations because it enables them to view such situations through a more positive lens. Among university students, healthy coping strategies could buffer them from some of the unique challenges associated with acculturating and adjusting to college experiences (Jardin et al., 2018), especially during a pandemic.

Limitations and Directions for Future Research

The findings of this study should be considered in light of certain limitations. Foremost among these is that data were collected using self-report measures, and in the case of the PERMA-Profiler, data were collected using the retrospective recall of participants as they considered their well-being prior to the onset of COVID-19. Retrospective recall may be inaccurate (Gilbert, 2007) with participants under- or overestimating their well-being. Given the ongoing repercussions of the pandemic, we recommend continued and longitudinal studies on well-being, coping strategies, and PsyCap. Additionally, data collection methods and sample demographics would likely limit generalizability. We utilized a correlational cross-sectional study design; therefore, although PsyCap was predictive of change in well-being before and during COVID-19, neither causation nor directionality can be assumed. In future, researchers may wish to investigate whether PsyCap predicts longitudinal changes in well-being in the COVID-19 context.

A further consideration is that the PERMA model of well-being (Seligman, 2011) may not be associated with similar outcomes for people of other cultures and backgrounds during COVID-19. Future researchers examining well-being in university students in different regions of the country or internationally may wish to further investigate the applicability of the PERMA model as a measure of university students’ well-being during the pandemic. Finally, the moderate Cronbach’s alpha reliability scores of < .70 (Field, 2013) for the subscales of the Brief COPE inventory and the engagement subscale of the PERMA-Profiler are of concern, which has also been expressed by prior researchers (Goodman et al., 2018; Iasiello et al., 2017). Future researchers should consider issues of internal consistency as they choose scales and interpret results.

Conclusion

To conclude, the present findings contribute to existing literature on PsyCap and well-being, using the PERMA model of well-being (Seligman, 2011) among university students in the United States in the context of COVID-19. Key findings are that the optimism, hope, and resilience dimensions of PsyCap are significant predictors of well-being, explaining a large amount of variance, with adaptive coping being conducive to flourishing. Further, the present findings highlight the importance of examining the relationships between each element of well-being and with each HERO dimension. Both individual counseling and group-based programming focused on PsyCap and positive coping strategies could support the well-being of university students as they experience ongoing stressors related to the pandemic or as they face other setbacks.

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

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Priscilla Rose Prasath, PhD, MBA, LPC (TX), is an assistant professor at the University of Texas at San Antonio. Peter C. Mather, PhD, is a professor and department chair at Ohio University. Christine Suniti Bhat, PhD, LPC, LSC (OH), is a professor and the interim director of the George E. Hill Center for Counseling & Research at Ohio University. Justine K. James, PhD, is an assistant professor at University College in Kerala, India. Correspondence may be addressed to Priscilla Rose Prasath, 501 W. Cesar E. Chavez Boulevard, Durango Building, University of Texas at San Antonio, San Antonio, TX 78207, priscilla.prasath@utsa.edu.

The Professional Counselor : Author and Article Characteristics From 2011 to 2019

Feb 26, 2021 | Volume 11 - Issue 1

Dorrie Williams, Marcella Melanson, Bradley T. Erford

This meta-study evaluates publication patterns and trends occurring in the first 9 years of The Professional Counselor (TPC). Both author (e.g., gender, domicile, employment setting, top individual and university contributors) and article characteristics (e.g., topic, research design, participant type, sample size, statistics) are identified, with a particular focus on research articles. Almost 64% of lead authors and all authors were women, 92.1% of lead authors were affiliated with universities, and 3.4% of lead authors were internationally domiciled. From 2011–2019, the University of Central Florida featured the greatest number of lead authors, and the top author overall was Dr. Kathleen Brown-Rice. About 58% of published works were research articles, and of those, 69% used quantitative design methodology. Nearly all coded research variables were stable over time, except for participant types, as the proportion of adult participant samples increased while undergraduate participant samples decreased over time.

Keywords: meta-study, author characteristics, article characteristics, publication patterns, quantitative design

The Professional Counselor (TPC) is an electronic journal published by the National Board for Certified Counselors (NBCC; The Professional Counselor, n.d.). Beginning publication in 2011, this peer-reviewed and open-access journal publishes research and practice-based articles related to school counseling, marriage and family counseling, counseling supervision, theory development, counseling ethics, mental and behavioral health counseling, and multicultural and international counseling. The primary goal of this quarterly journal is to provide relevant and interesting resources and information for individuals all across the counseling profession, including counselors, counselor educators, mental health practitioners, graduate students, and supervisors. Thus, TPC is meant to address the professional development and informational needs of all counselors, regardless of specialty, work setting, or discipline. Each issue of TPC is released alongside a digital reader’s digest, a collection of summaries of the articles that are included within the issue.

Myriad characteristics within the counseling profession have evolved over the last decade, and along with this evolution, counseling research also has changed. Just as it is important to periodically review changes to the counseling profession, it also is vital to review journal characteristics to observe and analyze how journals evolve in relation to societal and cultural changes (Erford et al., 2010). Such an analysis informs the editorial board, authors, and readership about who and what is published in a journal, characteristics of methodological considerations, and the trajectories of those characteristics. As TPC began publication in 2011, this is the first multi-year review of the journal’s characteristics, providing an opportunity to examine trends within this journal that have yet to be studied. Historical reviews such as this allow for longitudinal monitoring of the advancement of, and challenges occurring within, the counseling profession.

Erford et al. (2010) identified several viable processes for analyzing and recording journal publication patterns. These methods include content analysis of published special issues and sections, qualitative synthesis, and quantitative meta-studies. From 2011–2019, five special issues were published in TPC—Counseling the Military and Their Families (Volume 4, Issue 2); Counseling and the DSM-5 (4.3); School Counseling (4.5); Counseling Children With Special Needs and Circumstances (5.2); and School Counselors and a Multi-Tiered System of Supports: Cultivating Systemic Change and Equitable Outcomes (6.3)—along with one special section (Counselor Education and Supervision [5.1]). To date, no qualitative syntheses of TPC content have been published in TPC. Qualitative syntheses are usually conducted by a scholar with expertise in qualitative analysis and provide an in-depth scholarly treatise of the content published by a journal.

This current article is the first meta-study of TPC content. A meta-study involves conducting a quantitative review and trend analysis of patterns found within the published literature. Quantitative meta-studies typically include an analysis of the author and article characteristics, as well as the use of descriptive and univariate statistical procedures in order to identify trends over time within the characteristics analyzed. These studies can be as narrowly focused as a single journal or topic or can span across multiple journals focusing on specific concepts. Quantitative meta-studies have the advantage of allowing objective, numerical, statistical analysis of changing trends across a large variety of variables using hypothesis testing to determine statistical significance and effect sizes. This quantitative meta-study focused on the scholarly content of TPC from the first nine volumes (2011–2019) and attempted to answer two basic questions: (a) What is published within The Professional Counselor (article characteristics), particularly with regard to research? and (b) Who publishes in The Professional Counselor (author characteristics)? These questions are also analyzed for trends to determine changes occurring in journal characteristics over time.

Method

Mirroring the methods of Saks et al. (2020), all articles published from 2011 through 2019 in TPC were examined, analyzed, and coded to describe article and author characteristics in order to answer the primary research questions of who and what is published in TPC and how those characteristics have changed over time. This systematic approach also allowed comparisons of these variable displays across journals. Scholarly contributions were accepted into the analysis while less scholarly works were rejected and not included in the analysis (e.g., editorials, introductions to special issues, biographies, profiles). Identified author characteristics included the number of authors, name, gender, and employment setting of all authors, and university and domicile (national or international) of the lead author. Identified article characteristics included type of article (i.e., expository/other and research), topical content (e.g., professional issues, symptoms/disorders, technique/theory, multicultural issues), and focus (i.e., research or not research). Additional characteristics were identified specifically in research articles. These research characteristics included: intervention or nonintervention; research paradigm (i.e., quantitative or qualitative); type of research design (i.e., qualitative, true or quasi-experimental, test development, descriptive/survey, comparative, correlational, meta-analysis/other); use of random or nonrandom sampling/assignment procedures; types of participants (i.e., adults, counselors/providers, youth, undergraduate students, graduate students or counselor trainees, nonhuman); sample size; sample size category (i.e., small, medium, large, or very large); sophistication of statistical applications (basic, intermediate, or advanced); primary statistical analyses used (i.e., descriptive, correlation, regression analysis, t-test/ANOVA/ANCOVA, nonparametric, MANOVA/MANCOVA, factor analysis); and inclusion of sample effect size estimate, reliability, and validity as indicators of quantitative reporting standards. Qualitative designs (e.g., grounded theory, phenomenological, case study) were further disaggregated and analyzed.

Our first two authors, Dorrie Williams and Marcella Melanson, independently coded each article for these characteristics into separate Microsoft Excel spreadsheets, sequenced by article release date. The data were then assessed for discrepancies and resolved by consensus. Analysis included descriptive statistics and one-way ANOVA using weighted proportions to analyze trends over time. Post hoc tests of significant results were conducted using Scheffe tests and significance for Type I error was set at α < .05. The interpretive guidelines of .01 = small effect, .09 = medium effect, and .25 = large effect were used to report ANOVA effect sizes (η²). These effect size estimates help demonstrate the power or relevance of the observed effects; larger effect sizes indicate more important or relevant changes being observed.

Results

From 2011–2019, 272 articles were published in TPC. Of these, 265 articles were accepted into this analysis, with only seven articles rejected because they were less scholarly submissions (e.g., editorials, introductions to special issues, biographies, profiles). Results were analyzed for trends over time using ANOVA with weighted proportions after being aggregated into two time windows (2011–2014 and 2015–2019). The following results were segmented by author and article characteristics.

Author Characteristics
Author demographic variables, such as the gender of the lead author and all authors and employment setting and domicile of lead author, were used to assess TPC author characteristics. We also identified the most prolific author contributors and sponsoring institutions and monitored collaboration trends by computing the average number of authors per article. A consistent, solid majority of lead and all authors from 2011–2019 self-identified as women. Women lead authors formed a proportion of 64.2%—F(1, 263) = 0.543, p = .462, η² = .002—with a similar result for all authors (63.8% women): F(1, 703) = 1.134, p = .287, η² = .002. Reflecting a slight collaboration trend, the average number of authors per article has risen slightly over time. In 2011–2014, TPC reflected an average of 2.43 authors per article, while in 2015–2019, the average increased slightly to 2.83 authors per article.

TPC lead author employment affiliation in university and non-university settings was very stable over time: F(1, 263) = 0.953, p = .330, η² = .004. A consistent proportion of 92.1% of all lead authors were employed or primarily affiliated within a university work setting. During 2011–2019, only 3.4% (n = 9) internationally domiciled lead authors published in TPC: F(1, 263) = 2.80, p = .133, η² = .009.

The most frequently contributing individual authors (weighted as the lead author receives 3 points, second author receives 2 points, and subsequent authors receive 1 point each) from 2011–2019 included the following, listed from highest rank to lowest: Kathleen Brown-Rice, with 17 points; Jeffrey M. Warren, with 15 points; Robert C. Reardon, with 12 points; Patrick R. Mullen, with 11 points; Sejal M. Barden, Ashley J. Blount, and Emily Goodman-Scott, with 10 points each; M. Ann Shillingford-Butler, with nine points; Randall M. Moate, with eight points; and Simone Lambert, James P. Sampson, Jr., Richard A. Wantz, and Laura E. Welfare, with seven points each. Using a weighted point system allows more credit to be allotted to primary article contributors over time, whereas a unit weighting system (one point of credit per article authored) benefits contributors who served in secondary or tertiary capacities. From 2011–2019, the following universities supported the highest number of TPC lead authors, listed from highest to lowest: the University of Central Florida, with 12 articles; the University of South Dakota, with 10 articles; Virginia Tech, with six articles; East Carolina University, Florida State University, University of North Carolina – Charlotte, and University of North Carolina – Pembroke, each with five articles; and Wake Forest University and Walden University, with four articles each. These universities align well with productive contributing authors in the list above or clusters of contributing authors, representing counseling faculty and counselor education programs with high degrees of dedication to enhancing the counseling literature in TPC.

Article Characteristics
Table 1 shows that topical content appearing in TPC publications from 2011–2019 was consistent and diverse: F(1, 530) = 0.666, p = .415, η² = .001. The topics of counselor education and training, school counseling, and multicultural issues each occurred in more than 10% of TPC articles, each benefitting as foci in special issues/sections over the years. When inspecting article typology from the perspective of the tables of contents, it is noted that TPC only designates two major categories of articles: research and expository, the latter of which we combined with an “other” category, as specialized, non-research articles do appear in TPC from time to time. This TPC table of contents bi-factor typology was consistent from 2011–2019: F(1, 263) = 2.033, p = .155, η² = .008. Given this result, it is then not surprising that TPC also displayed a consistent proportion of published research articles (58.1% from 2011–2019): F(1, 263) = 2.357, p = .126, η² = .009. The remainder of this Results section reviews various characteristics of the 154 research articles published in TPC between 2011 and 2019.

Table 1

Issue Categories in TPC Articles From 2011–2019

Content Topic	2011–2014	2015–2019	Total
Counselor Education/Training	35 (16.9%)	52 (16.0%)	87 (16.4%)
Multicultural Issues	26 (12.6%)	29 (8.9%)	55 (10.3%)
School Counseling	19 (9.2%)	36 (11.1%)	55 (10.3%)
Health/Wellness	15 (7.2%)	30 (9.2%)	45 (8.4%)
Treatment/Intervention	11 (5.3%)	32 (9.8%)	43 (8.1%)
Counseling Process	7 (3.4%)	33 (10.2%)	40 (7.5%)
Symptoms/Disorders	21 (10.1%)	15 (4.6%)	36 (6.8%)
Professional Issues	16 (7.7%)	16 (4.9%)	32 (6.0%)
Ethical/Legal Issues	10 (4.8%)	19 (5.8%)	29 (5.4%)
Academic/Career	7 (3.4%)	18 (5.5%)	25 (4.7%)
Career Development	12 (5.8%)	13 (4.0%)	25 (4.7%)
Assessment/Evaluation	11 (5.3%)	13 (4.0%)	24 (4.5%)
Supervision	10 (4.8%)	9 (2.8%)	19 (3.6%)
Identity Development	7 (3.4%)	10 (3.1%)	17 (3.2%)
Totals	207	325	532

Note. Many articles were coded to reflect multiple content issues. Thus, totals exceed the number of accepted articles.

The proportions of quantitative and qualitative research studies appearing in TPC have changed significantly over time—F(1, 176) = 9.025, p = .003, η² = .049—constituting the highest effect size of any analysis in this study, albeit still a small effect. Quantitative designs shifted from a slight minority (46.9%) of research designs in 2011–2014 to a substantial proportional majority (69.3%) in 2015–2019, while the qualitative studies displayed converse proportions. We noted that about one-third of the qualitative studies did not specify an approach or methodological tradition. When qualitative approaches/methodologies were specified: 15.4% used a generic “content analysis”, 30.7% were phenomenological, 9.6% used grounded theory, 7.7% used case study, 5.8% used consensual qualitative research, 5.8% used narrative, 3.8% used constant comparative, and 1.9% simply specified an ethnographic approach.

Intervention studies maintained a stable presence among TPC research articles at 12.3%: F(1, 152) = 0.020, p = .889, η² = .000. Likewise, the types of research designs appearing in TPC research articles (see Table 2) have been relatively stable over time: F(1, 156) = 1.232, p = .269, η² = .008. Non-experimental designs dominated TPC research articles and were heavily weighted toward descriptive/survey (42.4%), qualitative (18.4%), and correlational designs (18.4%). The most rigorous experimental designs (true/quasi-experimental designs) comprised only 4.4% of TPC research studies.

Table 2

Proportion of Research Designs Used in TPC Research Studies

Time	2011–2014	2015–2019	Total
Descriptive/Survey	22 (35.5%)	45 (46.9%)	67 (42.4%)
Qualitative	16 (25.8%)	13 (13.5%)	29 (18.4%)
Correlation	17 (27.4%)	12 (12.5%)	29 (18.4%)
SSRD	1 (1.6%)	7 (7.3%)	8 (5.1%)
Comparative	2 (3.2%)	5 (5.2%)	7 (4.4%)
True/Quasi-Experiment	3 (4.8%)	4 (4.2%)	7 (4.4%)
Meta-Analysis/Other	0 (0.0%)	6 (6.2%)	6 (3.8%)
Test Development	1 (1.6%)	4 (4.2%)	5 (3.2%)
Totals	62	96	158

Note. SSRD = Single-subject research design

Proportions of types of participants have shifted significantly across TPC research studies—F(1, 224) = 5.573, p = .019, η² = .024—the second highest effect size of this meta-study. From the 2011–2014 to 2015–2019 time windows, adult participant samples increased from 28.0% to 41.7%, while undergraduate samples dropped from 17.3% to 6.0% (see Table 3). TPC research article sample sizes by category were consistent over time: F(1, 153) = 0.901, p = .344, η² = .006. Small samples (< 30 participants) composed 33.5% of all studies, medium samples (30–99 participants) 20.0%, large samples (100–499 participants) 36.1%, and very large samples (500+ participants) only 10.3% of research studies. At the same time, the median sample size increased from 65 participants in 2011–2014 to 107 participants in 2015–2019, commensurate with the slight decrease in qualitative studies. Finally, the proportions of use of randomization in assignment procedures was also consistent—F(1, 152) = 1.172, p = .281, η² = .008—holding steady at 11.7% of studies.

Table 3

Types of Participants Used in TPC Research Articles

Time	2011–2014	2015–2019	Total
Adults	21 (28.0%)	63 (41.7%)	84 (37.2%)
Counselors/Providers	14 (18.7%)	39 (25.8%)	53 (23.5%)
Graduate Students/Trainees	15 (20.0%)	19 (12.6%)	34 (15.0%)
Undergraduates	13 (17.3%)	9 (6.0%)	22 (9.7%)
Youth	9 (12.0%)	15 (9.9%)	24 (10.6%)
Nonhumans	3 (4.0%)	6 (4.0%)	9 (4.0%)
Totals	75	151	226

Categorization of statistical procedures into basic, intermediate, or advanced designations was used as an indicator of statistical sophistication, which remained stable over time: F(1, 152) = 0.141, p = .707, η² = .001. Articles were specifically categorized as research and non-research articles, and all types of statistical procedures from Table 4 were aggregated into the collapsed categories of basic, intermediate, and advanced statistics. Based on this categorization, over the 9 years, 59.1% of TPC research studies used basic statistical procedures (e.g., descriptive, correlation, t-test, chi-square), 31.8% used intermediate statistical procedures (e.g., ANOVA, regression analysis, other nonparametric), and only 9.1% used advanced procedures (e.g., MANOVA, factor analysis). Likewise, when specific statistical procedures used were analyzed, no significant shifts over time occurred (see Table 4): F(1, 290) = 0.055, p = .814, η² = .000. Descriptive statistics were used in 29.8%, ANOVA/t in 13.4%, and content analysis or thematic coding in 21.2% of TPC research studies.

Table 4

Proportion of Various Statistical Procedures Used in TPC Research Studies

Time	2011–2014	2015–2019	Total
Descriptive	29 (27.4%)	58 (31.2%)	87 (29.8%)
Content Analysis	25 (23.6%)	37 (19.9%)	62 (21.2%)
Correlation	14 (13.2%)	29 (15.6%)	43 (14.7%)
ANOVA/t	18 (17.0%)	21 (11.3%)	39 (13.4%)
Regression	10 (9.4%)	19 (10.2%)	29 (9.9%)
Factor Analysis	3 (2.8%)	13 (7.0%)	16 (5.5%)
MANOVA	3 (2.8%)	7 (3.8%)	10 (3.4%)
Nonparametric	4 (3.8%)	2 (1.1%)	6 (2.1%)
Totals	106	186	292

TPC consistently reported study effect sizes at a rate of 23.5% of all research articles published from 2011–2019: F(1, 152) = 1.172; p = .281; η² = .008. Sample reliability and validity reports were also stable over time with reports of sample reliability at a steady rate of 39.2%—F(1, 151) = 1.961; p = .161; η² = .012—and sample score validity at a consistent proportion of 36.6% from 2011–2019: F(1, 151) = 0.299; p = .585; η² = .002.

Discussion

TPC published an average of about 30 articles per year from 2011–2019, 57.7% of which have been research articles. TPC mirrors the evolution of the counseling profession and through research and expository articles helps to address new professional issues, topics, and challenges that contribute to the advancement and growth of the counseling profession (TPC, 2020). The online publishing format makes this information freely available to professional counselors and the public; no print edition exists. This section discusses TPC author and article characteristics from the journal’s inception in 2011 to 2019. Interestingly, only two variables displayed trends between the two time windows, demonstrating an admirable focus and stability of decision making among TPC editorial board members for a new counseling journal. That is, in just 9 years, TPC already appears to have attracted and published broadly consistent types of articles from authors with similar characteristics.

Author Characteristics: Who Publishes in TPC?
In the first 9 years of publication, only nine (3.4%) TPC lead authors were domiciled outside the United States. Other counseling journals have also historically displayed international publishing rates of less than 5%, including the Journal of Addictions & Offender Counseling (MacInerney et al., 2020), The Journal of Humanistic Counseling (Sylvester et al., in press), the Journal of College Counseling (Milowsky et al., in press), and the Journal of LGBT Issues in Counseling (Gayowsky et al., in press). Still, TPC has an opportunity to reach out to the international counseling community and invite more diverse expository and research contributions, thereby expanding into the international counseling domain. Perhaps a call for articles from international authors could form a special issue of TPC, contributing multicultural insights, evaluating cross-cultural perspectives, or helping to establish a focus for global connectivity. This is particularly important given NBCC’s historic leadership in developing international counseling initiatives through its International Capacity Building department (NBCC, n.d.). International outreach is consistent with the mission of NBCC’s international collaborations with organizations such as the African Union – Southern Africa Regional Office (AU-SARO) and around the world, and TPC is positioned to aid in that international scope of activities. As such, TPC could become a leader in international focus among counseling journals. Currently, two counseling journals do exceptional jobs attracting international scholars. The Journal of Employment Counseling (Siegler et al., in press) featured a 53% internationally domiciled lead author proportion from 2010–2019, and Measurement and Evaluation in Counseling and Development published 28% of its articles from international lead authors over the same period (Saks et al., 2020).

A consistent majority of women composed the lead authors (64.2%) and all authors (63.8%) of published TPC articles from 2011–2019. A near 2-to-1 proportion is acknowledgement of the importance and majority standing of women counselor educator scholars in the United States (U.S. Census Bureau, 2016). A nearly two-thirds majority is consistent with many other counseling journals and indicates the rise to prominence of women scholars in counselor education (Johnson et al., 2021; MacInerney et al., 2020; Menzies et al., 2020; Milowski et al., in press; Saks et al., 2020; Sylvester et al., in press).

At the same time the vast majority of lead authors (92.1%) listed primary affiliations in university work settings. Although a non–university-affiliated participation rate of only 7.9% seems low overall, compared to other counseling journals, it actually is comparable with counseling journal leaders in this category like the Journal of Mental Health Counseling (Menzies et al., 2020) and Counseling Outcome Research and Evaluation (Johnson et al., 2021), and higher than most other counseling journals (MacInerney et al., 2020; Milowsky et al., in press; Saks et al., 2020; Sylvester et al., in press). This low level of participation from non–university-affiliated authors across counseling journals is curious given the powerful and necessary voices practitioners can lend to real-world counseling issues and interventions.

But there are certainly barriers and constraints on practitioner motivations to engage in scholarship. First, practitioners are rarely compensated for research, nor are employee evaluations substantively impacted by scholarly contributions. If more incentives like compensation and evaluation were tied to practitioner scholarship efforts, we could expect practitioners to have a larger presence in counseling scholarship and collaborations. Practitioners are also incredibly busy providing counseling services to clients and students, and research and program evaluation becomes a lower priority as time constraints tighten. In contrast, employee scholarship production often is rewarded by universities through salary increases, promotions, and tenure. Likewise, professors are expected to, and often rewarded for, scholarship, including collaboration with graduate students and colleagues in research projects. Graduate students often engage in research to enhance their levels of qualification for doctoral study and future opportunities to join the professoriate. It is also possible that authors who are practitioner-students or scholar-practitioners simply default to a university affiliation for some reason—perhaps believing that university affiliations are more prestigious or may be given greater consideration in a positive disposition. In any case, journal editorial boards should encourage authors to list multiple affiliations to better gauge the prevalence of practitioners among contributing authors.

Counselor scholars should continue to search for opportunities to collaborate with practitioners, both to access rich sources of field-based data and to amplify the valuable voices of experienced clinicians. In just the first 9 years, TPC experienced increased author collaboration, from 2.43 authors per article in 2011–2014 up to 2.83 in 2015–2019. This trend toward more collaboration was seen in all other counseling journals, with many in the same vicinity of average author contributions as TPC, including AdultSpan (Rippeto et al., in press), the Journal of Employment Counseling (Siegler et al., in press), The Journal of Humanistic Counseling (Sylvester et al., in press), and others far higher, exceeding 3.10 authors per article, such as Measurement and Evaluation in Counseling and Development (Saks et al., 2020) and the Journal of College Counseling (Milowsky et al., in press).

Collaboration is essential to the future of counseling research as the profession and our domain of knowledge become larger and at the same time more specialized. This trend toward increased collaboration is very positive, perhaps reflecting a greater focus on mentorship and partnership. It will not be a surprise to note that simultaneous with this rise in collaboration was a proportional rise in publishing research articles. Research ventures are great opportunities for collaboration and building research partnerships with colleagues, graduate students, and practitioners. In particular, partnering with practitioners promotes meaningful field-based studies that enrich practice and document promising evidence-based interventions. Finally, as counselor educator–scholars, we must recommit to training practitioners who can collect, conduct, and collaborate in the publication of field-based research. Field-based studies are critical in counseling research because that is where the overwhelming majority of clients and students are counseled and treated. Conducting studies in research labs must generalize to implementation in the field; studies conducted in the field already have bridged that gap. Melding field-based innovations, counseling research, and practitioner voices will help the counseling profession evolve into a more evidence-based practice accountable to, and valued by, clients and other stakeholders.

Article Characteristics: What Is Published in TPC?
Over the first 9 years of TPC publications, articles were quite well balanced over a broad range of topical content (see Table 1). When combined, over one-third of the articles focused primarily on three topics: counselor education/training (16.4%), multicultural issues (10.3%), and school counseling (10.3%). However, an appropriate and even spread of topic coverage was observed in the other areas, ranging from a low of 3.2% for identity development to 8.4% for health/wellness. Thus, the TPC editorial board is approving a broad swath of important and meaningful topical content for the readership of TPC. It will be important to maintain this balance in the decade ahead as TPC fulfills its goal as a journal of value to all professional counselors, regardless of work setting and counseling sub-discipline.

Research articles are critical components of professional journals. Research articles form the scientific foundation of a profession, and the more we know about the clients we serve, the better prepared we are to serve them. At 58.1%, the proportion of research studies published in TPC is typical when compared with other counseling journals, most of which are in the range of 50%–68%, including Counseling and Values: Spirituality, Ethics, and Religion in Counseling (Alder et al., in press); the Journal of LGBT Issues in Counseling (Gayowsky et al., in press); the Journal of Mental Health Counseling (Menzies et al., 2020); and Adultspan (Rippeto et al., in press). The proportion of research studies in TPC is albeit far lower than the more research-focused counseling journals like Measurement and Evaluation in Counseling and Development (80.7%; Saks et al, 2020), Counseling Outcome Research and Evaluation (75.6%; Johnson et al., 2021), the Journal of Employment Counseling (86.4%; Siegler et al., in press), and Counselor Education & Supervision (90.4%; Johnsen et al., in press) produced during the 2015–2019 time window. Still, TPC has made great inroads in the proportion of research articles published in its first decade, and it will be interesting to see where this trajectory will lead in the next decade.

The research designs used in TPC research studies are heavily weighted toward non-experimental designs, including descriptive or survey (42.4%), qualitative (18.4%), and correlational (18.4%) designs (see Table 2). Descriptive/survey research simply seeks to describe the characteristics of participants and their interactions or performance on variables. True- and quasi-experimental designs appeared in only 4.4% of all TPC research articles, which is a low rate among the family of counseling journals. At the same time, the 12.3% proportion of intervention-focused articles is quite good when compared to other counselor journals (Menzies et al., 2020), as Ray et al. (2011) reported that only about 6% of all research articles published in counseling journals focus on the efficacy of interventions. Intervention research studies tend to be among the most valuable studies published in the counseling profession because intervention studies inform the reader on what efficacy counselors can expect when implementing the intervention with clients or students. Thus, intervention studies help inform us about what we know that works in counseling. In summary, TPC should strive to increase the proportion of intervention articles, as well as true- and quasi-experimental designs, as these approaches help counselors understand what works in counseling related to the effectiveness of counseling practice. True- and quasi-experimental designs also enhance generalizability of sample results to the population, which gives counselors confidence that the more robust experimental results from these studies are more applicable to the broader populations of clients served by counselors.

During its first 4 years of publication, TPC produced one of the highest proportions of qualitative tradition articles seen in the family of counseling journals (53.1%), before declining significantly in 2015–2019 (30.7%). Qualitative research has consistently accounted for 30–45% of research publications in some counseling journals over the last 20 years (Alder et al., in press; Gayowsky et al., in press; MacInerney et al., 2020), but is much lower in other journals like Measurement and Evaluation in Counseling and Development (Saks et al, 2020) and Counseling Outcome Research and Evaluation (Johnson et al., 2021), which produce more quantitative, generalizable research. It will be interesting to see if the significant decline in qualitative articles continues over the next decade or stabilizes in the 30% range.

The significant increases in adults and counselors or other mental health service providers as participants in TPC research studies was interesting, as these two groups comprised more than two-thirds (67.5%) of participant types in the 2015–2019 time window (see Table 3). This was accompanied by a significant decline in the use of undergraduate and graduate students. The use of adult participants in counseling research is a welcome occurrence, as adults comprise the majority of clients seen in counseling agencies and private practice. And the focus on counseling practitioners is very appropriate for a journal whose mission it is to meet the professional needs of all counselors across diverse work settings and disciplines.

Although the median sample sizes did increase from 65 to 107 participants across the two time windows, that observation is expected given the increase in the proportion of quantitative compared to qualitative studies, as quantitative studies generally have higher sample sizes. Still, the overall consistency in the proportions of small, medium, large, and very large sample sizes is a sign of maturation in such a young journal.

Statistical procedures appearing in TPC articles were very well balanced across categories and across the two time windows. Not surprisingly, basic approaches like descriptive analyses and thematic coding comprised about half of all procedures. Descriptive statistics are the most basic type of statistics and are often used to convey results in surveys and nonexperimental studies. MANOVA, ANOVA, and t-tests combined for a very respectable total proportion of 16.8%. TPC should strive to increase the prominence of these more sophisticated statistical tests. Among counseling journals, Counseling Outcome Research and Evaluation (Johnson et al., 2021) leads the way in use of these tests of difference statistics at more than 20%, but TPC is not far behind.

Finally, TPC editors have a great deal of progress to make in improving the proportions of reporting standards. In the first 9 years of publication, TPC authors reported effect size estimates in only 23.5% of articles, sample reliability estimates in only 39.2%, and sample validity estimates in 36.6% of research articles published. Reports of effect size, score reliability, and score validity are indications of study rigor and meaningfulness. For example, authors should always report on the reliability of scores of standardized dependent variables used in a study so readers know how much error variance in measurement occurred. Likewise, statistical significance is important in hypothesis testing, but effect sizes give readers an indication of how important and meaningful the results are in a grander context. These effect size and reliability reports are among the lowest rates of any counseling family journal (MacInerney et al., 2020; Milowsky et al., in press; Rippeto et al., in press; Saks et al., 2020; Siegler, in press; Sylvester et al., in press), so the TPC editorial board is encouraged to add these reporting standard aspects to review protocols and author requirements to insure inclusion in future articles.

Limitations and Conclusion
This synthesis and analysis of the first 9 years of TPC publications has several limitations that should be explicated. First, no causal inference may be derived from these results. This means that one cannot determine the cause of any of the analyses indicated because the design of the study was not experimental; we were able to describe the variables, not determine what caused the results. This meta-study used descriptive and comparative statistical analyses to summarize proportions aggregated across time windows to discern trends occurring over time. However, no inference is offered as to why the proportions and trends were observed.

Second, despite the use of independent coders and robust, standardized coding procedures, the potential for coding errors always exists. Thus, some categorization or classification errors may have occurred. This is a particular risk within categories that are more subjective or when the descriptions provided by TPC authors lacked clarity or essential information. Third, we chose to segment the 9 years of TPC publications into two periods to bolster analytic power, although others might prefer smaller time windows when engaging in trend analysis.

Fourth, while this meta-study combined the quantitative and qualitative designs into a larger analysis and then took a closer look at just the quantitative designs, there is value in conducting a parallel analysis of the methodological rigor of both the quantitative and qualitative studies published in TPC to date. This will help address or at least acknowledge the possible limits of a positivist epistemological lens.

Finally, we were not able to code important author demographics such as race, ethnicity, age, or other attributes. We instead focused on readily available information like lead author domicile and author institutional affiliations and gender. For future analyses, it would be helpful if authors would self-identify a wider variety of demographic descriptors (e.g., self-identified gender, race, nationality) or at least designate all university and non-university affiliations. This would help clarify the degree to which practitioners and authors of diverse backgrounds are represented within author configurations.

In summary, TPC has made great progress across many dimensions over its first 9 years of publication. Also, it appears that TPC is well on its way to fulfilling its mission to provide valuable research and practice information to all professional counselors regardless of work setting or sub-discipline. We look forward to seeing the continued progress of this new counseling journal in the decades ahead and hope this meta-study is of use to the TPC editorial board, authors, and readership as a description of who and what is published in TPC.

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

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Dorrie Williams is a master’s candidate at Vanderbilt University. Marcella Melanson is a master’s candidate at Vanderbilt University. Bradley T. Erford, PhD, NCC, LPC, LCPC, is a professor in the Peabody College at Vanderbilt University. Correspondence may be addressed to Bradley T. Erford, PMB 90, Vanderbilt University, Nashville, TN 37202-5721, Bradley.t.erford@vanderbilt.edu.

Mental Health Equity of Filipino Communities in COVID-19: A Framework for Practice and Advocacy

Feb 26, 2021 | Volume 11 - Issue 1

Christian D. Chan, Stacey Diane Arañez Litam

The emergence and global spread of COVID-19 precipitated a massive public health crisis combined with multiple incidents of racial discrimination and violence toward Asian American and Pacific Islander (AAPI) communities. Although East Asian communities are more frequently targeted for instances of pandemic-related racial discrimination, multiple disparities converge upon Filipino communities that affect their access to mental health care in light of COVID-19. This article empowers professional counselors to support the Filipino community by addressing three main areas: (a) describing how COVID-19 contributes to racial microaggressions and institutional racism toward Filipino communities; (b) underscoring how COVID-19 exacerbates exposure to stressors and disparities that influence help-seeking behaviors and utilization of counseling among Filipinos; and (c) outlining how professional counselors can promote racial socialization, outreach, and mental health equity with Filipino communities to mitigate the effects of COVID-19.

Keywords: Asian American, Filipino, mental health equity, COVID-19, discrimination

Asian Americans represent the fastest-growing ethnic group in the United States (Budiman et al., 2019). Following the global outbreak of COVID-19, many Asian Americans and Pacific Islanders (AAPIs) have experienced a substantial increase in race-based hate incidents. These incidents of racial discrimination have included verbal harassment, physical attacks, and discrimination against Asian-owned businesses (Jeung & Nham, 2020), which multiply the harmful effects on psychological well-being and life satisfaction among AAPIs (Litam & Oh, 2020). According to Pew Research Center trends (Ruiz et al., 2020), about three in 10 Asian adults reported they experienced racial discrimination since the outbreak began. Proliferation of anti-Chinese and xenophobic hate speech from political leaders, news outlets, and social media, which touted COVID-19 as the “Chinese virus,” further exacerbate instances of race-based discrimination (U.S. Department of Justice, 2020) and echo the Yellow Peril discourse from the late 19th century (Litam, 2020; Poon, 2020).

Although the community is often aggregated, Asian Americans are not a monolithic entity (Choi et al., 2017; Jones-Smith, 2019; Sue et al., 2019). The term Asian American encompasses over 40 distinct subgroups, each with distinct languages, cultures, beliefs, and migration histories (Pew Research Center, 2013; Sue et al., 2019). It is no surprise, therefore, that specific ethnic subgroups would be more affected by the pandemic than others. For example, instances of COVID-19–related racial discrimination disproportionately affect East Asian communities, specifically Chinese migrants and Chinese Americans. An analysis of nearly 1,500 reports of anti-Asian hate incidents indicated approximately 40% of Chinese individuals reported experiences of discrimination as compared to 16% of Korean individuals and 5.5% of Filipinos (Jeung & Nham, 2020). Although Chinese individuals disproportionately experience overt forms of COVID-19–related discrimination, Filipino migrants and Filipino Americans are not immune to the deleterious effects of the pandemic.

With over 4 million people of Filipino descent residing in the United States (Asian Journal Press, 2018), it is of paramount importance for professional counselors to recognize how the Filipino American experience may compound with additional COVID-19 exposure and related stressors in unique ways that distinctively impact their experiences of stress and mental health. The current article identifies how the racialized climate of COVID-19 influences Filipino-specific microaggressions and the presence of systemic and institutional racism toward Filipino communities. The ways in which COVID-19 exacerbates existing racial disparities across social determinants of health, help-seeking behaviors, and utilization of counseling services are described. Finally, the implications for counseling practice and advocacy are presented in ways that can embolden professional counselors to promote racial socialization, outreach, and health equity with Filipino communities to mitigate the effects of COVID-19.

Health Disparities Among Filipino Americans

The unprecedented emergence of COVID-19 has affected the global community. As of January 5, 2021, a total of 21,382,296 cases were confirmed and 362,972 deaths had been reported in the United States (Worldometer, n.d.). Although information about how racial and ethnic groups are affected by the pandemic is forthcoming, emerging data suggests that specific groups are disproportionately affected. Professional counselors must be prepared to support communities that may be more vulnerable to pandemic-related stress and face challenges related to medical and mental health care access because of intersecting marginalized identities, such as age, race, ethnicity, gender identity, sexual identity, social class, and migration history (Chan & Henesy, 2018; Chan et al., 2019; Litam & Hipolito-Delgado, 2021). For example, the AAPI population may be especially in need of mental health support because of ongoing xenophobic sentiments from political leaders that combine with intergenerational trauma, racial discrimination, and racial trauma (Litam, 2020).

Underutilization of Mental Health Services
Compared to other Asian American subgroups, Filipinos are the least likely to seek professional mental health services. In a study of 2,230 Filipinos, approximately 73% had never used any type of mental health service and only 17% sought help from friends, community members, peers, and religious or spiritual leaders (Gong et al., 2003). Since the Gong et al. (2003) study, a multitude of researchers have documented the persistent disparity of mental health usage and unfavorable attitudes toward professional help-seeking among Filipinos (David & Nadal, 2013; David et al., 2019; Nadal, 2021; Tuazon et al., 2019), despite high rates of psychological distress (Martinez et al., 2020).

The experiences of Filipino communities uniquely influence aspects of mental health and wellness. Compared to other subgroups of Asian Americans, Filipino Americans with post-traumatic stress experiences tend to exhibit poorer health (Kim et al., 2012; Klest et al., 2013), and report higher rates of racial discrimination (Li, 2014). As a subgroup, Filipino Americans present to mental health counseling settings with high rates of depression, suicide, HIV, unintended pregnancy, eating disorders, and drug use (David et al., 2017; Klest et al., 2013; Nadal, 2000, 2021). Compared to other Asian subgroups, Filipinos may experience lower social class and employment statuses, which may increase the prevalence of mental health issues (Araneta, 1993). Among Filipinos, intergenerational cultural conflicts and experiences of racial discrimination were identified as significant contributors to depression and suicidal ideation (Choi et al., 2020). The underutilization of professional mental health services and help-seeking among Filipino communities is unusual because of their familiarity with Western notions, systems, and institutions, which surface as traits that are typically associated with mental health help-seeking within the broader AAPI community (Abe-Kim et al., 2002, 2004; Shea & Yeh, 2008).

Distinct Experiences of Oppression
Aspects of Filipino history are characterized by colonization, oppression, and intergenerational racial trauma (David & Nadal, 2013) and have been rewritten by White voices in ways that communicate how America saved the Philippines from Spanish rule through colonization (Ocampo, 2016). These sentiments remain deeply entrenched within the mindset of many Filipinos in the form of colonial mentality (David & Nadal, 2013; Tuazon et al., 2019). Colonial mentality refers to the socialized and oppressive mindset characterized by beliefs about the superiority of American values and denigration of Filipino culture and self (David & Okazaki, 2006a, 2006b). Colonial mentality is the insidious aftermath galvanized through years of intergenerational trauma, U.S. occupation, and socialization under White supremacy (David et al., 2017). Professional counselors must recognize the interplay between colonial mentality and the mental health and well-being of Filipino clients to best support this unique population.

The internalized experiences of oppression perpetuate the denigration of Filipinos by Filipinos as a result of the internalized anti-Black sentiments and notions of White supremacy that remain at the forefront of American history (Ocampo, 2016). The Filipino experience is one that is characterized by forms of discrimination by individuals who reside both within and outside of the Filipino community (Nadal, 2021). For example, Filipinos who espouse a colonial mentality disparage those with Indigenous Filipino traits (i.e., dark skin and textured hair) as unattractive, undesirable, and worthy of shame (Angan, 2013; David, 2020; Mendoza, 2014). Filipinos also experience a sense of otherness within the AAPI community and from other communities of color because their history, culture, and phenotype combine in ways that “break the rules of race” (Ocampo, 2016, p. 13). Although Filipinos are sometimes confused with individuals from Chinese communities, they are not typically perceived as Asian or East Asian (Lee, 2020) and are often mistaken for Black or Latinx (Ocampo, 2016; Sanchez & Gaw, 2007). These pervasive experiences render the Filipino identity invisible (Nadal, 2021). Ultimately, Filipinos remain among the most mislabeled and culturally marginalized of Asian Americans (Sanchez & Gaw, 2007). Professional counselors who work with Filipino clients must obtain a deeper understanding of how these unique experiences of invisibility and colonial mentality continue to affect the minds and the worldviews of Filipinos and Filipino Americans.

Risk Factors for COVID-19 Exposure
The burgeoning rate of COVID-19 cases has devastated hospitals and medical settings. The overwhelming strain faced by medical communities uniquely affects Filipino migrants and Filipino Americans who are overrepresented in health care and disproportionately at risk of COVID-19 exposure (National Nurses United, 2020). The overrepresentation of Filipinos in health care, particularly within the nursing profession, is directly tied to the history of U.S. colonization. Following the U.S. occupation of the Philippines from 1899 to 1946, the Filipino zeitgeist became imbued with profound cultural notions of American superiority and affinity for Westernized attitudes, behaviors, and values (David et al., 2017). For example, the introduction of the American nursing curricula by U.S. Army personnel during the Spanish-American war (McFarling, 2020) instilled pervasive cultural influences that positioned the nursing profession as a viable strategy to escape political and economic instability in pursuit of a better life in the United States (Choy, 2003). These cultural notions have culminated to make the Philippines the leading exporter of nurses in the world (Choy, 2003; Espiritu, 2016). Of the immigrant health care workers across the United States, an estimated 28% of registered nurses, 4% of physicians and surgeons, and 12% of home health aides are Filipinos (Batalova, 2020). About 150,000 registered nurses in the United States are Filipino, equating to about 4% of the overall nursing population (McFarling, 2020; National Nurses United, 2020). According to the National Nurses United (2020) report, 31.5% of deaths among registered nurses and 54% of deaths among registered nurses of color were Filipinos. Based on these statistics, Filipinos face disproportionate exposure to pandemic-related stressors and death that may increase the risk for mental health issues.

Individuals of Filipino descent may also face significant COVID-19–related challenges, as they are predisposed to several health conditions that have been linked with poorer treatment prognosis and outcomes (Ghimire et al., 2018; Maxwell et al., 2012). Compared to other racial and ethnic subgroups, Filipinos residing in California had higher rates of type II diabetes, asthma, and cardiovascular disease (Adia et al., 2020). High rates of hypertension, cholesterol, and diabetes were also noted in studies of Filipino Americans residing in the greater Philadelphia region (Bhimla et al., 2017) and in Las Vegas, Nevada (Ghimire et al., 2018). One study of Filipinos residing in the New York metropolitan area indicated rates of obesity significantly increased the longer Filipino immigrants resided in the United States (Afable et al., 2016). The Centers for Disease Control and Prevention (2021) associated each of these underlying medical conditions with a greater likelihood for hospitalization, intensive care, use of a ventilator, and increased mortality. Filipino Americans also tend to report lower social class and employment statuses as compared to other Asian Americans, which may contribute to higher rates of mental health issues and create barriers to health care access (Adia et al., 2020; Sue et al., 2019).

Cultural Barriers to Professional Mental Health Services
Filipinos face culturally rooted barriers to seeking professional mental health services that may include fears related to reputation, endorsement of fatalistic attitudes, religiousness, communication barriers, and lack of culturally competent services (Gong et al., 2003; Nadal, 2021; Pacquiao, 2004). The presence of mental illness stigma is also deeply entrenched within Filipino communities (Appel et al., 2011; Augsberger et al., 2015; Tuazon et al., 2019). In many traditional Filipino families, mental illness is mitigated by addressing personal and emotional problems with family and close friends, and through faith in God (David & Nadal, 2013). Rejection of mental illness is based on the belief that individuals who receive counseling or therapy are crazy, dangerous, and unpredictable (de Torres, 2002; Nadal, 2021).

Connection and Kinship
Given the central prominence of family, it is no surprise that Filipino individuals’ mental health begins to suffer when their connection to community and kinship is compromised. Although relatively few studies on Filipino mental health exist, Filipinos and Filipino Americans consistently report family-related issues as among the most stressful. In one study of Filipino and Korean families in the Midwest (N = 1,574), the presence of intergenerational family conflict significantly contributed to an increase in depressive symptoms and suicidal ideation (Choi et al., 2020). In another study of Filipino Americans, quality time with family, friends, and community was identified as an important factor in mitigating the effects of depression (Edman & Johnson, 1999). The centralized role of Filipino families uniquely combines with a group mentality in ways that may additionally hinder rates of professional help-seeking.

Hiya and Amor Propio
Notions of hiya and amor propio each represent culturally specific barriers to seeking mental health care. According to Gong and colleagues (2003), hiya and amor propio are related to the East Asian notions of saving face. While hiya emphasizes the more extensive experience of shame that arises from fear of losing face, amor propio is associated with concepts of self-esteem linked to the desire to maintain social acceptance. A loss of amor propio would result in a loss of face and may compromise the cherished position of community acceptance (Gong et al., 2003). Filipino Americans may thus avoid seeking professional mental health services because of combined feelings of shame (hiya) linked to beliefs that one has failed or is unable to overcome their problems independently, and fears of losing social positioning within one’s community (amor propio). To experience amor propio would put a Filipino—or worse, their family—at risk for tsismis, or gossip. Indeed, avoiding behaviors that may lead others within the Filipino community to engage in tsismis about the client or their family is a significant factor that guides choices and behaviors. Engaging in behaviors that result in one’s family becoming the focus of tsismis is considered highly shameful and reprehensible among Filipino communities.

Bahala Na
The Tagalog term bahala na refers to the sense of optimistic fatalism that characterizes the shared experiences of many Filipinos and Filipino Americans. Bahala na can be evidenced through Filipino cultural expectations to endure emotional problems and avoid discussion of personal issues. This core attitude may have deleterious effects on mental health and help-seeking, as many Filipinos are socialized to deny or minimize stressful experiences or to simply endure emotional problems (Araneta, 1993; Sanchez & Gaw, 2007). A qualitative analysis of 33 interviews and 18 focus groups of Filipino Americans indicated bahala na may combine with religious beliefs to create additional barriers to addressing mental health problems (Javier et al., 2014). For example, virtuous and religious Filipinos and Filipino Americans may endorse bahala na attitudes by believing their higher power has instilled purposeful challenges that can be overcome by sufficient faith and endurance (Javier et al., 2014).

Hindi Ibang Tao
Moreover, many Filipinos and Filipino Americans demonstrate hesitance to trust individuals who are considered outsiders. When interactions with those considered other cannot be avoided, traditional Filipinos tend to be reticent, conceal their real emotions, and avoid disclosure of personal thoughts, needs, and beliefs (Pasco et al., 2004). Filipino community members place a large value on in-group versus out-group members and largely prefer to seek support from helping professionals within the Filipino community, rather than from others outside of the group (Gong et al., 2003). Individuals who are hindi ibang tao (in Tagalog, “one of us”) are differentiated from those who are ibang tao (in Tagalog, “not one of us”), which influences interactions and amount of trust given to health care providers (Sanchez & Gaw, 2007). White counselors may be able to bridge the cultural gap with Filipino clients to become hindi ibang tao by exhibiting respect, approachability, and a willingness to consider the specific influences of Filipino history and the importance of family (Sanchez & Gaw, 2007). Professional counselors who overlook, minimize, or disregard these cultural values risk higher rates of early termination and may experience their Filipino clients as exhibiting little emotion (Nadal, 2021). Filipino clients who are not yet comfortable with professional counselors may interact in a polite, yet superficial manner because culturally responsive relationships and trust have not been developed (Gong et al., 2003; Pasco et al., 2004; Tuazon et al., 2019).

Pakikisama and Kapwa
Another Filipino cultural barrier is pakikisama, or the notion that when one belongs to a group, one should be wholly dedicated to pleasing the group (Bautista, 1999; Nadal, 2021). Filipino core values extend beyond the general notion of collectivism and include kapwa, an Indigenous worldview in which the self is not distinguished from others (David et al., 2017; Enriquez, 2010). Thus, Filipinos do not solely act in ways that benefit the group; they are also expected to make decisions that please other group members, even at the expense of their own desires, needs, or mental health (Nadal, 2021). The cultural notions of pakikisama and kapwa interplay with amor propio in ways that have detrimental effects on Filipinos in dire need of mental health support. For example, a second-generation Filipino American may recognize that their suicidal thoughts and experiences of depression may be worthy of mental health support, but recognition of cultural mistrust toward those deemed other may risk their family’s social acceptance (amor propio). Risking the family’s social acceptance could ultimately violate group wishes (pakikisama) and may subject their family to stigma and gossip (tsismis).

Implications for Practice and Advocacy in Professional Counseling

The COVID-19 pandemic and increased visibility to discrimination against Asian Americans illuminates the importance of addressing the presence of mental health barriers among Filipino communities. Filipino communities face complex barriers rooted in colonialism, racism, and colorism that negatively affect their overall mental health (David & Nadal, 2013; Tuazon et al., 2019; Woo et al., 2020). The combination of educational, health, and welfare disparities culminate in poorer health outcomes for Filipino American communities compared to other ethnic Asian groups (Adia et al., 2020). Many of these identifiable barriers and forces of oppression increase the racial trauma narratives incurred among Filipino communities (David et al., 2017; Klest et al., 2013); deny the impact of microaggressions and discrimination (Nadal et al., 2014); divest resources that support economic, educational, and social well-being (Nadal, 2021; Smith & Weinstock, 2019); and discourage the utilization of needed counseling spaces (Tuazon et al., 2019).

Cultivating cultural sensitivity in health care providers can buffer the psychological toll and emotional consequences of negative health care encounters for historically marginalized communities (Flynn et al., 2020), including Filipinos. Findings associated with health equity and help-seeking behaviors (e.g., Flynn et al., 2020; Ghimire et al., 2018) have significant ramifications for Filipino communities that face a litany of barriers to counseling services (Gong et al., 2003; Tuazon et al., 2019). In light of COVID-19, professional counselors are encouraged to employ culturally responsive interpersonal and systemic interventions that promote the sustainable mental health equity of Filipino communities.

Promoting Racial Socialization and Critical Consciousness
Reducing barriers for mental health access is connected to protective factors, actions, and cultural capital instilled across generations of Filipino communities (David et al., 2017). Filipino communities draw from several generations of colonization, which continues to affect second-generation Filipinos living in the United States (David & Okazaki, 2006a, 2006b). Experiences of historical colonization, forced assimilation into other cultures, and the erasure of Filipino cultural values have resulted in a range of Eurocentrically biased and historically oppressive experiences (Choi et al., 2020; David & Nadal, 2013). These experiences have prepared Filipino communities, intergenerationally and collectively, to respond to experiences of discrimination in ways that preserve their cultural values (David et al., 2017). The preservation of Filipino cultural values across generations has bolstered a type of protective factor through racial socialization, where parents and families teach future generations of children about race and racism (Juang et al., 2017). Ultimately, preparing future generations of Filipinos to respond to racial oppression can protect cultural assets (David et al., 2017). In fact, a study by Woo and colleagues (2020) indicated Filipino parents who prepared their children to respond to racial discrimination prepared them for bias and strengthened their ethnic identity.

One strategy that professional counselors can use to infuse social justice in their work is to help Filipino clients raise their critical consciousness. Critical consciousness is an approach that helps clients to recognize the systemic factors contributing to their barriers with mental health utilization and mental health stressors (David et al., 2019; Diemer et al., 2016; Ratts & Greenleaf, 2018; Seider et al., 2020) and to feel empowered to take part in action (Ratts et al., 2016; Watts & Hipolito-Delgado, 2015). Professional counselors can raise Filipino clients’ critical consciousness by engaging in conversations about how the history of colonization, endorsement of colonial mentality, and systemic factors continue to marginalize Filipinos (David et al., 2019). Connecting critical consciousness to COVID-19, professional counselors can highlight how public anti-Asian discourse echoes centuries of oppression and leads to cultural mistrust of health care providers, particularly professional counselors (Litam, 2020; Ratts & Greenleaf, 2018; Tuazon et al., 2019). Similarly, professional counselors can raise the critical consciousness of Filipino clients by discussing the effects of race-based trauma and racial violence as a result of COVID-19 (Litam, 2020; Nadal, 2021). Including these topics during counseling can be instrumental for detecting the effects of race-based trauma, such as somatic symptoms, while grasping the manifestation of pandemic stress (Taylor et al., 2020). As health care providers focus predominantly on wellness, professional counselors play a significant part in deconstructing the connections and nuances among race-based traumatic stress and pandemic stress (Ratts & Greenleaf, 2018).

Additionally, professional counselors can raise the critical consciousness of Filipino clients by examining the intersection of underlying health disparities, Filipino core values, and overrepresentation of Filipinos working in health care positions during COVID-19 through a trauma-informed lens. Aligned with this perspective, professional counselors can identify and discuss how intergenerational trauma narratives may have persisted across generations of Filipino communities (David & Okazaki, 2006b; David et al., 2019; Nadal, 2021; Tuazon et al., 2019) in ways that have adverse effects on mental health. For example, professional counselors may support Filipino clients to critically reflect on how socialized messages from parents and elders with intergenerational trauma may have contributed to the internalization of colonial mentality. Professional counselors may also broach these cultural factors by promoting discussions within clients’ families and communities about the cultural preservation of Filipino identities (Choi et al., 2017, 2020; David et al., 2017).

Culturally Congruent Coping Responses Among Filipino Clients
Professional counselors can help Filipino clients who seek counseling during COVID-19 by empowering them to engage in coping responses that cultivate their cultural assets and strengthen their ethnic identity (David et al., 2017, 2019; Woo et al., 2020). Before implementing these culturally sensitive strategies, professional counselors must reflect on whether they hold individualistic notions and Western attitudes about which coping responses are deemed helpful or unhelpful to mitigate the effects of racial discrimination (Oh et al., in press; Sue et al., 2019). Following experiences of racial discrimination and stress, Filipinos tend to use disengagement coping responses (Centeno & Fernandez, 2020; Tuason et al., 2007). Following an assessment of coping responses, professional counselors can support Filipino clients by reinforcing culturally responsive disengagement coping strategies, such as tiyaga (Tagalog for “patience and endurance”) and lakas ng loob (Tagalog for “inner strength and hardiness”), to promote resilience and demonstrate flexibility.

Given these central cultural values, professional counselors must be cautioned from solely using emotion-centered counseling strategies that center experiences of stress, racial trauma, or COVID-19–related discrimination (Litam, 2020). Instead, Filipino clients may benefit from interventions that draw from their cultural values of endurance (tiyaga) and inner strength (lakas ng loob) to refocus energy toward cultivating meaningful relationships and roles (David & Nadal, 2013; David et al., 2017). For example, Filipino clients who are concerned about the wellness of their community may experience a heightened sense of purpose and inner strength by reflecting on how their actions have already benefitted their families rather than focusing on their fears. Indeed, when stressful experiences occur, Filipinos have a long history of demonstrating resilience. Empowering Filipino clients to reflect on the historical ways that the Filipino community has evidenced resilience and inner strength may cultivate a strong sense of Filipino pride and strengthen ethnic identity as protective factors to mental health distress (Choi et al., 2020; David et al., 2019; Tuazon et al., 2019).

Filipinos may also benefit from engagement coping strategies, such as prayer, employing religious and spiritual resources, and responding with humor, to promote health and wellness (Nadal, 2021; Sanchez & Gaw, 2007). Counselors can help Filipino clients leverage engagement coping strategies by reflecting on existing responses to stress. Counselors may ask, “How have you intentionally responded to stressful events in the past?” and “How did these ways of coping impact your levels of stress?” Counselors can also demonstrate culturally sensitive strategies and lines of questioning that move from general, shared Filipino values to specific client experiences. For example, counselors can state: “Many Filipinos find peace of mind through prayer, religious practices, and humor. I’m wondering if this is true for you?” Because of the community orientation and collectivism embedded within Filipino culture, it may be helpful for counselors to elaborate on cultural contexts and relationships that inform coping strategies: “I am wondering how you may have seen some of these coping strategies in your home, family, or community. How might you have experienced a coping strategy like humor within your own community?” This statement communicates a familiarity with Filipino cultural values and creates an invitation for clients to explore their coping resources.

Creating Outreach Initiatives and Partnerships
For counselors placed in school and community settings, challenging the systemic effects of COVID-19 among Filipino communities necessitates community partnerships and integrated care settings to achieve health equity (Adia et al., 2019). Health equity initiatives call for two types of overarching efforts to sustain long-term benefits and changes. One aspect of health equity relates to developing community partnerships as a method to intentionally increase health literacy within the community (Guo et al., 2018). Increasing mental health literacy, including education about counseling services and a comprehensive approach to wellness, operates as a direct intervention to cultural and linguistic barriers that precede negative health care experiences (Flynn et al., 2020). Increasing mental health literacy in Filipino communities may also normalize the process of professional mental health services, challenge the cultural notion that those who seek mental health care are crazy, and offer strength-based language related to counseling services (Ghimire et al., 2018; Maxwell et al., 2012; Nadal, 2021). Expanding on recommendations by Tuazon and colleagues (2019), professional counselors can challenge the systemic effects of COVID-19 in Filipino communities by helping community stakeholders understand culturally responsive practices for seeking professional mental health services. Professional counselors employed in community settings can leverage opportunities to liaise with Filipino community organizations and leaders to increase the utilization of counseling services as a preventive method (Graham et al., 2018; Maxwell et al., 2012), especially in response to the increased mental health issues in Filipinos following COVID-19. Professional counselors employed in community settings are therefore uniquely positioned to broach cultural factors of colonialism and systemic racism while addressing the urgency of mental health services for Filipino communities during COVID-19 (Day-Vines et al., 2018, 2020).

Increasing Visibility of Filipino Counselors
The second aspect of health equity initiatives focuses on increasing representation in the pipeline of providers. Although Flynn and colleagues (2020) documented the importance of culturally responsive practices to buffer negative health care experiences, public health scholars have generally identified that the representation of professional counselors is crucial for encouraging historically marginalized communities to seek services (Campbell, 2019; Graham et al., 2018; Griffith, 2018). According to Campbell (2019), historically marginalized clients are more likely to pursue services and demonstrate an openness to speak with professional counselors who are representative of their communities. In addition to increasing Filipino counselors and counselor educators in the pipeline (Tuazon et al., 2019), professional counselors can enact community-based initiatives that position Filipino leaders to support the larger Filipino community (Guo et al., 2018; Maxwell et al., 2012; Nadal, 2021). For example, professional counselors can train Filipino leaders and community members to share information about coping responses (e.g., mindfulness, yoga, and diaphragmatic breathing) that mitigate the deleterious effects of racism, colonialism, and COVID-19–related stress. Professional counselors can also work with community members to establish Filipino-led wellness groups that frame discussions about stress within the broader context of health and wellness. Assessing for previous assumptions about mental health literacy may be helpful to normalize group discussions about stress and mental health. As outreach initiatives and community partnerships are established within the context of COVID-19, professional counselors must consider how they develop marketing materials for counseling services that appropriately reflect the cultural and linguistic diversity of Filipinos and invite input from Filipino community leaders (Campbell, 2019; Graham et al., 2018).

Conclusion

The cumulative effects of colonialism and racism continue to influence the mental health and visibility of Filipino communities within the global crisis of COVID-19. Unlike other AAPI subgroups, experiences of pandemic-related distress in Filipinos are additionally compounded by their distinct history of colonization, cultural values, and low levels of help-seeking behaviors. Specific interventions for culturally responsive counseling and outreach for Filipino communities are critical (Choi et al., 2017; David & Nadal, 2013; David et al., 2017; Tuazon et al., 2019) and were outlined in this article. Professional counselors, especially those in community settings, have numerous opportunities to enact a systematic plan of action that integrates culture, health, and policy (Chan & Henesy, 2018; Nadal, 2021). These interventions illuminate a longstanding and never more urgent call to action for extending efforts and initiatives to increase the visibility of Filipino communities and support individuals of Filipino descent in counseling.

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

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Christian D. Chan, PhD, NCC, is an assistant professor at the University of North Carolina at Greensboro. Stacey Diane Arañez Litam, PhD, NCC, CCMHC, LPCC-S, is an assistant professor at Cleveland State University. Correspondence may be addressed to Christian D. Chan, Department of Counseling and Educational Development, The University of North Carolina at Greensboro, P.O. Box 26170, Greensboro, NC 27402, cdchan@uncg.edu.

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Recent Publications

Cureton, J. L., & Fink, M. (2019). SHORES: A practical mnemonic for suicide protective factors. Journal of Counseling &
Development, 97(3), 325–335.