Rising From the Ashes: Voices of Rural Counselors During the Coronavirus (COVID-19) Pandemic

Brandi M. Sawyer, Edith Gonzalez

The global health and economic disaster caused by the coronavirus (COVID-19) pandemic has intensified mental health needs and subsequent demands on helping professionals. Counselors, in general, are at risk of experiencing both shared traumatic realities with clients and exacerbation of occupational stressors. For rural mental health counselors, who already face enhanced stressors related to rural service provision, the impact of COVID-19 is generally unknown. Through transcendental phenomenology, this study explores the experiences of 11 rural mental health counselors practicing in Texas during the COVID-19 pandemic. Two themes emerged, revealing experiences of systemic limitations as well as counselor growth and resilience. Findings provide implications for mental health counselor training, clinical practice, and advocacy.

Keywords: COVID-19 pandemic, rural, mental health counselors, transcendental phenomenology, resilience

With over a million deaths in the United States alone (Centers for Disease Control and Prevention [CDC], n.d.) the novel coronavirus (COVID-19) pandemic created a mental health crisis that includes long-term fear, trauma, grief, isolation, and negative social patterns (Czeisler et al., 2020; Eisma et al., 2021; Elbogen et al., 2021; Prati & Mancini, 2021). The influx of mental health needs meant that practitioners had to meet the demand of providing quality counseling services for those struggling with COVID-19 pandemic–related symptoms. Mental health counselors and related professionals experienced significant increases in caseloads and the clinical severity of presenting symptoms (Czeisler et al., 2020) that added increased pressure to workload, risk of burnout, and compassion fatigue, all of which are natural occupational hazards even under typical circumstances (Litam et al., 2021; Posluns & Gall, 2020; Sprang et al., 2007).

Increases in service demand were especially problematic when considering the vast preexisting shortage of mental health service availability worldwide (Wainberg et al., 2017). For rural mental health counselors, who ordinarily experience increased mental health service shortages (Breen & Drew, 2012; Slama, 2004), these demands and lack of resources were likely more intensely highlighted as lockdowns and shelter-in-place orders further reduced service access while simultaneously increasing the need for it (Panchal et al., 2023; Prati & Mancini, 2021). Mental health professionals were suddenly forced to transition to teletherapy services, a modality not frequently used prior to the COVID-19 pandemic (Burgoyne & Cohn, 2020; Pierce et al., 2021).

Teletherapy completely reshaped the provision of counseling services and required practitioners to consider and navigate various concerns, including accessibility and advocacy issues for vulnerable populations, quality of therapeutic engagement, ethical and legal matters, financial issues, treatment effectiveness, experience limitations, and training limitations (Maurya et al., 2020). This was likely a greater adjustment for rural practitioners, as they were less likely to use this modality than their urban counterparts prior to the COVID-19 pandemic (Pierce et al., 2020). Teletherapy has its disadvantages and advantages. The disadvantages include increased complexity of ethical issues such as privacy, information security, and maintaining a professional environment and professional relationships (Burgoyne & Cohn; Pierce et al., 2021). However, teletherapy provides client accessibility to services, overcoming the most notable barrier of local practitioner shortages experienced more often by rural residents (Tarlow et al., 2020). Through teletherapy, rural residents can connect to counselors in larger populated areas, but internet connectivity to do so has been a challenge historically (Handley et al., 2014).

Rural Mental Health

Practice and clinical topics related to rural populations are relatively sparse in empirical counseling literature, and this is especially true regarding rural mental health counselors during the COVID-19 pandemic. Existing research has established the enhanced hardships faced by rural populations, including more significant mental health presentations caused by mental health stigma (Slama, 2004) and a significant lack of mental health, medical, and transportation resources (Breen & Drew, 2012; Pullen & Oser, 2014; Slama, 2004). For rural counselors, this often means bulging caseloads, professional isolation, and more complicated cases than their urban counterparts.

Although not specific to COVID-19, Fruetel et al. (2022) documented the experiences of school and clinical mental health counselors responding to crises in rural areas. Findings indicated significant hardships such as isolation and lack of crisis stabilization resources. This highlights the fact that rural counselors continue to face significant mental health challenges in the community with limited institutional and professional support, placing further demands on existing providers and thereby increasing the risk of burnout and attrition (Litam et al., 2021; Sprang et al., 2007). To further complicate matters, the COVID-19 pandemic has exacerbated practitioner experiences of vicarious trauma, fatigue, and emotional disconnection as well as feelings of incompetence (Aafjes-van Doorn et al., 2020), which likely has a compounded effect for rural mental health counselors, who face additional geographic and cultural stressors (Breen & Drew, 2012; Pullen & Oser, 2014; Slama, 2004).

Trauma and Resilience
     For many counselors involved in trauma and crisis work, occupational hazards such as burnout, compassion fatigue, and vicarious trauma have been documented (Posluns & Gall, 2020; Sprang et al., 2007), but less is known about the complexities of sharing trauma and crisis simultaneously with clients. Bell and Robinson (2013) posited that such experiences evolve into a compounded experience for counselors, in which the interplay between both vicarious and direct traumaknown as shared traumatic realityenhances the post-traumatic exposure counselors experience. The shared traumatic reality of the COVID-19 pandemic has likely intensified existing occupational hazards of stress, burnout, and compassion fatigue (Litam et al., 2021; Posluns & Gall, 2020; Sprang et al., 2007).

Examining only the negative experiences associated with long-term trauma and crisis work would be unidimensional, inaccurate, and ignoring the potential value in such meaningful work. Additionally, this one-sided position ignores the presence and value of resilience among practicing counselors. Resilience has been represented as the ability to adapt and maintain well-being during unfavorable conditions (Clauss-Ehlers, 2008) and more specifically, taking deliberate actions to sustain health during hardship (Litam et al., 2021). Fostering resilience is imperative for mental health counselors who often face vicarious trauma. Without self-care and the ability to cope positively, these professionals risk burnout and impairment (Posluns & Gall, 2020), the latter of which has strong ethical implications because it poses an emotional risk to clients (Bell & Robinson, 2013).

Lambert and Lawson (2013), who studied counselors providing services during Hurricanes Katrina and Rita, found that counselors treating survivors of those disasters experienced compassion fatigue and burnout at no greater rates than counselors in general. Interestingly, those counselors who were both survivors and treatment providers experienced compassion satisfaction and post-traumatic growth, positive counterparts to compassion fatigue and post-traumatic stress, respectively. Similarly, Litam et al. (2021) found comparable results for counselors during the COVID-19 pandemic. Although occupational hazards such as compassion fatigue, vicarious trauma, and burnout were apparent for counselors in the sample, resiliency was a positive mitigating factor. It is important to note, however, that neither study examined multicultural issues as variables, and Litam et al. noted the absence of rural counselors as a significant limitation of their study.

Although not a study conducted with counselors, Wang et al. (2021) compared coping and adjustment in rural and urban individuals in North America. Despite adverse experiences among both groups, Wang et al. found several strengths in rural populations that were undetected in their urban counterparts, including enhanced coping and adjustment. These findings imply a cultural element to trauma and disaster response. In studies specific to counselors, Crumb et al. (2021) found strengths among rural school counselors providing disaster mental health services that included deepened empathy because of co-experience; Imig (2014) also found that despite difficulties, rural counselors found meaning in difficult work.

At the time of this study, we did not find additional research examining stress, resilience, or other quantitative or qualitative inquiries of rural mental health counselors’ experiences during the COVID-19 pandemic. This paucity of literature necessitates our study, which aims to fill a gap in understanding the interplay of rural mental health constraints and COVID-19 response. Learning how rural mental health counselors manage the complexities of limited mental health and medical resources, increased service demand, and vicarious trauma is imperative to better prepare for future mass disasters while maintaining the health and well-being of practitioners. Additionally, this study provides a much-needed voice for rural counselors and can further advocacy efforts for rural communities.

Method

The purpose of this study was to explore the experiences of rural mental health counselors during the COVID-19 pandemic and to develop a distinct picture of this population during long-term stress and disaster. We utilized a postpositivism paradigm, which allows for the acknowledgement of multiple perspectives while also striving for empirical rigor, to explore the universal experience of rural counselors during the COVID-19 pandemic (Guba & Lincoln, 1994; Hoshmand, 1996). To facilitate this exploration, we utilized a transcendental phenomenological methodology to capture the essence or true meaning of the phenomena of interest, the overall experiences, and the responses of the sample who share elements of an identity under similar conditions (Moustakas, 1994). Although postpositivism and transcendental phenomenology originate from different epistemological assumptions, one that emphasizes a reality that can be approximated through empirical observation and the other focusing on the essence of lived experience through subjective exploration, this study intentionally combined both to balance rigor and depth. Transcendental phenomenology and postpositivism have been found to complement each other through acknowledging multiple perspectives and having a top-down approach to research (Henderson, 2011; Hoshmand, 1996; Moustakas, 1994), and additional studies have utilized this paradigm and methodology (Eryaman et al., 2013; Hall et al., 2016). Nevertheless, to address potential incongruences, we utilized bracketing techniques to mitigate researcher bias and to ensure that the participants’ experiences remained central to the study. In alignment with transcendental phenomenology, we aimed to explore the lived experiences of rural mental health counselors during the COVID-19 pandemic, focusing on the perceived impacts and responses. The research questions guiding this exploration were:

  • RQ1:   What were the experiences of rural mental health counselors during the COVID-19 pandemic?
  • RQ2:   What impacts, if any, did COVID-19 have on the lives of rural mental health counselors?
  • RQ3:   How did rural mental health counselors respond, if at all, to the COVID-19 pandemic?

Site and Sample Selection
The sample criteria included Licensed Professional Counselors of all rankings—Licensed Professional Counselor-Associates (LPC-As), Licensed Professional Counselors (LPCs), and Licensed Professional Counselor-Supervisors (LPC-Ss)—who provided mental health counseling services in rural regions of Texas between March and December 2020. Texas was selected as a matter of convenience sampling (both Brandi M. Sawyer and Edith Gonzalez reside in Texas and are familiar with public license information) and because 76% of the state is considered fully rural. Additionally, Texas, like most other states, experienced government-mandated lockdowns, restricted social gatherings, and shuttered schools for most of 2020 (Friend, 2021; Limón, 2020), indicating that Texans experienced significant adversity from the pandemic. The criteria for rural regions were determined by the fiscal year 2022 definitions set forth by the Federal Office of Rural Health Policy (Health Resources and Services Administration, Federal Office of Rural Health Policy [FORHP], 2025).

Following approval for this study by the IRB, we obtained a list from the FORHP (2025) of counties in Texas with a completely rural status for fiscal year 2022 as an initial guide for sampling. Once the counties were identified, we used the Texas Behavioral Health Executive Council’s online search tool to obtain the names of eligible participants. This information was then used in a Google search to find addresses and emails for potential participants. In sum, we compiled a list of LPCs from 198 of 200 counties. Two counties were eliminated, as Sawyer had worked extensively in these rural counties and the likelihood that she knew potential participants was significantly increased. Email addresses, when available, were the first method of contact for recruiting participants. When not available, paper flyers were mailed to available addresses. Participants who completed the study and the final member-checking procedure received a $50 Amazon gift card. All participant recruitment and data collection took place in August and September of 2022.

Participants
     Following recruitment procedures, 12 individuals volunteered to participate in this study, 11 of whom completed individual interviews. Saturation of data, when no new themes emerged during interviews and analysis (Ando et al., 2014), was reached within the 11 participants; no additional participants were needed. Eight participants identified as female, two participants identified as male, and one participant identified as transgender male. Eight participants identified as White and three identified as Hispanic or Latino. Nine of the 11 participants had master’s degrees and two held doctoral-level degrees. Years in counseling practice ranged from 1.5–30. Years in rural counseling practice also ranged from 1.5–30. Working environments varied across the 11 participants and included seven in group and private practice, three in agency and nonprofit settings, and one in an educational setting fulfilling a mental health counseling role. The sample consisted of the following current license categories: nine LPCs, one LPC-A, and one LPC-S.

Data Collection
     Exploratory questions were designed to holistically capture the perceived impact of the COVID-19 pandemic, including the related thoughts, emotions, and behavioral responses as they align with the research questions exploring general experience, impact, and response. Participants chose personalized pseudonyms for anonymity and engaged in a 45–60-minute semi-structured, open-ended interview exploring their experiences working during the COVID-19 pandemic. The interview protocol included the following questions:

  1. What was it like to provide rural mental health counseling during the COVID-19 pandemic?
  2. How did you respond to the COVID-19 pandemic?
  3. What feelings do you experience about providing rural counseling during the COVID-19 pandemic?
  4. How did the COVID-19 pandemic impact your personal life?
  5. How did the COVID-19 pandemic impact your professional life?
  6. What was it like providing teletherapy during the COVID-19 pandemic?
  7. What is it currently like providing teletherapy?
  8. What is your perception of rural mental health counseling during the COVID-19 pandemic?
  9. How do you see your rural mental health work in the future following the COVID-19 pandemic?

Interviews were conducted and recorded via Zoom. Transcripts were first generated through a transcription application, Otter, and then verified for accuracy.

Data Analysis Procedures
     Following the procedures set forth by Moustakas (1994), we used thematic analysis to evaluate data using two cycles of inductive coding. Engaging in multiple levels of inductive coding allowed us to explore themes within participant experiences while minimizing preconceived biases, a process known as epoche. The steps of coding and analysis first included preliminary horizontalization, which involved reducing narrative data into smaller units but not yet grouping data based on shared meanings. Using a spreadsheet, we achieved this by taking participant transcripts line by line, summarizing them, and placing them into columns. The next step in analysis, phenomenological reduction, involved clustering data relevant to the research questions into categories of corresponding themes and considering these from a variety of perspectives. Clustering data was done first to efficiently manage the data in order to better recognize recurring themes. We evaluated the horizontal data in the spreadsheet and clustered data from textural descriptions in various statements until no new groupings emerged. Ancillary information irrelevant to the research questions was eliminated from further coding. The final coding procedure generated the broadest themes, which were grouped based on shared meaning derived from phenomenological reduction using imaginative variation. We evaluated and interpreted the context of all codes achieved in reduction until the final themes emerged.

Strategies for Establishing Trustworthiness
     We took steps to ensure trustworthiness of the findings according to Lincoln and Guba’s (1985) five tenets of trustworthiness: credibility, authenticity, transferability, dependability, and confirmability. Credibility and authenticity were achieved through in vivo and post-interview member checking to ensure accurate understanding or credibility of participant reports and by using two methods, providing ample opportunities for clarification. Another credibility validation tool, prolonged engagement, was achieved by having Sawyer interview, transcribe, check for accuracy, and conduct analysis, resulting in heightened awareness and understanding of the data. Triangulation with Gonzalez, who has different professional and personal identities, aided in furthering the inductive and methodological nature consistent with transcendental phenomenology (Moustakas, 1994).

Transferability was achieved through inductive procedures and obtaining rich details about study findings. Dependability was achieved through a rigorous methodology as outlined in Moustakas’s (1994) framework, which lends itself to examining multiple realities from an objective position. Multiple coding cycles additionally aided in dependability because they reduce abstract and biased findings. These same procedures also helped to achieve confirmability, enhancing objectivity in this qualitative research. We reduced researcher bias in interviewing and analysis through multiple coding cycles with rigorous methodology and triangulation (Lincoln & Guba, 1985).

Reflexivity
    Bracketing was used to achieve reflexivity as a means to isolate and understand participant experiences apart from existing presuppositions. Sawyer has a professional identification aligning with that of rural mental health counselors. For 14 years, she has practiced mental health counseling in rural Texas, and since the onset of the COVID-19 pandemic, has provided teletherapy. She is an LPC-S and National Certified Counselor (NCC) who lives in Texas and has roots in rural Texas. Sawyer led all aspects of the research study. Gonzalez served as an external auditor for data analysis and assisted with manuscript writing. She is a counselor educator, researcher, and LPC with extensive experience in qualitative research and previous teaching experience in a rural setting. Based on Sawyer’s positionality, there were some apparent internal assumptions existing prior to the study. We assumed, based on personal and professional experiences, that participants would likely identify some hardships with rural service provision. Based on Sawyer’s work with often resilient rural clients during the last 14 years, we assumed some strengths related to rural populations would likely be identified.

In addition to bracketing, Sawyer reviewed interview questions and reflected on their cognitive reactions to the questions prior to conducting the interviews in an attempt to be aware of and set aside suppositions about the topic. Following each interview, Sawyer again reflected on personal cognitive responses to the topics, making notes as needed, and regularly reflecting on potential biases and enhancing trustworthiness with Gonzalez to counter them. As a result of such reflection, during thematic analysis, we did line-by-line coding to minimize interpretive assumptions, yielding the most objective view of sample experiences possible.

Findings

Thematic analysis rendered two themes as distinctly capturing the rural mental health counselor experience: systemic limitations and counselor growth and resilience. The codes within these themes had a 100% endorsement from the sample.

Systemic Limitations
     The theme of systemic limitations was defined by participants as resource limitations within their rural communities, including significant shortages of mental health and medical services as well as services for basic needs such as food, housing, and financial assistance. Furthermore, a large majority of these clients characterized resource limitations as being both preexisting as well as exacerbated by the pandemic. For many participants, COVID-19 conditions greatly impacted their ability to provide face-to-face counseling in already resource-limited communities. Internet connectivity deficits in rural communities, which are already dealing with limited resources, were also included in this theme.

Mental health care prioritization and a lack of mental health care availability for rural clients were among the most prominent topics in participant reports. Participants shared the idea that because basic health care and other needs remained unmet in their communities, mental health care was a lower-ranking priority during the COVID-19 pandemic. One noted that “mental health had to take a second seat because their basic needs were not being met.” Another described that although mental health “maybe needed more,” other responsibilities took priority because the “importance of [mental health] was not there.” Additionally, one participant further addressed not just the need for mental health counseling services but the impact of the loss of services during the COVID-19 pandemic. She emphasized that these impacts were “more keenly” felt in rural areas due to baseline counseling resource limitations. Furthermore, one participant shared this perspective by noting the need for financial support for ongoing focus on parity in rural mental health care. Although this participant acknowledged the attention garnered by the COVID-19 pandemic for rural communities, she worried that the focus was waning too quickly.

In addition to mental health shortages, medical shortages were also prominent with rural clients. One participant, whose caseload was heavily comprised of transgender individuals, compared his experiences between metropolitan and rural areas, emphasizing the rural-specific difficulties for his clients. He went on to describe how the COVID-19 pandemic shutdowns led to a temporary loss of gender-affirming care in his community. He identified this experience as “particularly rough” for his clients who were “dealing with worrying about whether they would ever be able to access their gender-affirming health care or [have] it delayed a long time.” Limitations in resources for basic survival were also impacted during the COVID-19 pandemic, as one participant described the deepened scarcity of financial and housing assistance as well as food bank supplies. He went on to describe his community as “one of the poorest in Texas, where poverty is pronounced,” to emphasize the impact these resource shortages made in rural communities during this time.

In addition to health and other wellness services, internet connectivity deficits greatly impacted the ability for rural counselors to reach and provide services to rural clients. Nearly all participants identified geographical and/or financial barriers in rural communities obtaining internet connectivity necessary for everyday life during the COVID-19 pandemic. For those who could afford internet service, rural geography made consistent connectivity difficult. Some participants had to resort to primarily phone usage early in the COVID-19 pandemic. It was also noted that difficulties in connectivity impacted “already thin” mental health resources in rural communities and that “Wi-Fi is not as fast as it is in metro areas.” Even when some counselors attempted to have face-to-face services, they were met with difficulties in sustainability. In describing the changes to her private counseling practice, one participant described having to shutter her face-to-face business, which never rebounded after the period of shutdown between March and June 2020, and begin providing teletherapy only. This meant that there was one less in-person practice operating in a rural area where mental health resources were already limited.

Counselor Growth and Resilience
     The theme of counselor growth and resilience was defined as rural counselors’ abilities to overcome significant adversities related to COVID-19 pandemic conditions in the context of their rural identification. Specifically, growth was defined as the ability to not only manage difficult circumstances but also to experience a change in themselves as an outcome of that experience. Resilience was defined as an ability to rebound or cope quickly in the face of adversity and, in the case of the COVID-19 pandemic, traumatic circumstances. Among the 11 participants, over half detailed a clear alignment between rural-specific deficits, as noted in the theme of systemic limitations, and the need to respond in resilient ways. Two participants, for example, adjusted quickly to phone counseling without face-to-face contact when rural internet connectivity and Wi-Fi availability fell short. Relatedly, another provided face-to-face services throughout the COVID-19 pandemic as the only practitioner in her area who could meet this need.

All participants described significant adverse experiences, up to and including vicarious trauma, but also an ability to cope with or make meaning of the circumstance. Collectively, participants leaned into their challenges, and many described a sense of empowerment in meeting them. For example, one participant, like most other counselors in this study, struggled significantly with the idea of teletherapy service delivery. She had difficulty adjusting treatment for her caseload, which included children coping with trauma and their families. Despite the stress described, she grew to enjoy meeting these new demands. She not only described that she “likes a challenge” but also discussed a process of using cognitive flexibility in providing herself “grace” and coping with the sudden need to learn a new skill set.

Although the ability to pivot typical practice styles during desperate times was a notable element of rural counselor growth and resiliency during the COVID-19 pandemic, so was the ability to alter beliefs and personal philosophies in order to adapt to changing times. Participants described a shift in viewpoints and flexibility to teletherapy as a modality. Although initially and fundamentally opposed to the practice, one participant reflected on the ability of professionals to shift their views. In speaking on the revolution of teletherapy in counseling, she stated that an in-person counseling modality is “not the only practice . . . we have to be flexible . . . we can’t be as old school anymore.” Similarly, another participant, also speaking on behalf of himself and rural mental health counselors, described a positive component of the pandemic: trying new things and learning that they are beneficial. He illustrated this by describing his “work–life balance” since his employers retained remote working allowances initially issued during lockdown and stay-at-home orders.

Participants illustrated cognitive flexibility in response to changes within their working world, but cognitive flexibility only represented part of the growth and resiliency among this sample. As depicted in the theme of systemic limitations, most participants provided services to clients with intensely limited resources, which naturally impacted how they typically provide counseling. In efforts to be therapeutic for his often crisis-affected clients, a participant noted that most of his work in the early months of the COVID-19 pandemic was “just letting people know that however they’re feeling is okay,” and further described, “I am good at remaining calm when the person in front of me is not . . . and appear to have at least a reasonably soothing presence.” Another participant closely mirrored these concepts in her statement that “it was, for me, a lot of just providing this space for people to have whatever feelings they had about it. And for that to be okay.” Additionally, two more participants reflected the change in focusing on immediate needs versus long-term or abstract concepts in counseling. Both described staying abreast of current events to help clients process their concerns.

As mentioned earlier, a majority of the participants noted a direct connection between rural-specific resource deprivation and the need to respond with resilience. Consequently, many participants found themselves becoming an integral part of resource seeking and attainment, which was described as a notable deviation from their typical counseling role. One participant described responding by actively providing help to clients who needed food when there were shortages due to already limited resource closures. She described this process as case management and assumed an active role in ensuring resources were obtained, including “trying to find people that could go pick up groceries and drop off at their porches.” Another similarly reflected that she did “a lot more social work . . . more connecting people with resources and that sort of thing.” She went on to note that as she adjusted her typical role from mental health counseling, the clients felt “cared for” and subsequently experienced a renewed encouragement to keep moving forward with counseling. Another participant additionally noted that gender-affirming care was already “quite difficult to find” in his rural community but became even more difficult to access due to the COVID-19 pandemic. In response, he sought out “updates through newsletters and Facebook connections with professionals” to ensure clients that the medical community was working to resolve the deficit. Collectively, these participant reports indicated that this sample of rural mental health counselors possessed the ability to shift their work and adapt to rapidly changing circumstances during the COVID-19 pandemic.

Discussion

The study explored the experiences of rural mental health counselors during the COVID-19 pandemic, revealing that participants experienced both preexisting and exacerbated systematic limitations in addition to growth and resilience during the early and more impactful phases. Systemic limitations identified by participants spanned the spectrum of human needs from food, financial, medical, transportation, and housing resources to a near absence of mental health services in their respective rural communities. Unique to rural counseling, the mass implementation of teletherapy was met with limitations involving lack of connectivity and financial means to remain online. For many participants, connectivity concerns have persisted. Unfortunately, the dearth of services for basic needs also meant an increase in the need for mental health services to cope with those hardships.

The descriptions of rural resource and funding deprivation extend and support the findings of the rural counselor hardships from other qualitative studies (Breen & Drew, 2012; Imig, 2014). The findings from this study show that despite nearly a decade, systemic changes that would otherwise bolster the quality of life or resource availability in rural communities have not been actualized. Naturally, this has created enhanced stressors for this sample of rural mental health counselors who perceived these otherwise typical limitations in their work as being grossly exacerbated during the COVID-19 pandemic.

The findings related to growth and resiliency in this study align with previous findings on counselors’ work in mass disasters (Lambert & Lawson, 2013). Most recently, Litam et al. (2021) found that counselor resiliency was associated with post-traumatic growth and compassion satisfaction, states that are in contrast with post-traumatic stress and compassion fatigue, which cause burnout. We suggest that finding one’s purpose is critical for growth, which aligns with the descriptions provided by this sample of participants. Much like the rural counselors in this study, Posluns and Gall (2020) found that maintaining awareness, finding balance, and having a flexible coping style were key to overcoming hardship. Additionally, Pow and Cashwell (2017) found that emotion-focused coping skills such as mindfulness and emotional regulation techniques were effective at mitigating the traumagenic effects of disaster work among a sample of disaster mental health counselors. The findings, combined with those on resilience practices in the current study, strongly support counselors and clients emphasizing a greater role in resilience and positive coping during disasters.

Participants also described resilience in the form of strong personal and professional support from family, friends, and colleagues, which validated findings that both personal and professional support were important for coping with adverse conditions and experiences during the COVID-19 pandemic (Aafjes-van Doorn et al., 2020). This finding is interesting in light of prior research showing that rural counselors experience isolation (Breen & Drew, 2012; Imig, 2014). They are, however, consistent with the findings of Wang et al. (2021), which showed that social connections helped rural individuals cope better than their urban counterparts during COVID-19, and Crumb et al. (2021), which indicated that social connection and rural community collaboration are helpful in coping after disaster.

Though not a theme that is uniquely tied to the rurality of the mental health counselor sample, it was evident that participants experienced intense levels of negative affect vicariously with their clients, especially during the earlier and more impactful parts of the COVID-19 pandemic. Such experiences included anxiety, uncertainty, depression, trauma, and helplessness. Findings from this study included echoes of prior research related to broader populations (Czeisler et al., 2020; Eisma et al., 2021; Elbogen et al., 2021; Prati & Mancini, 2021). In our study, these vicarious experiences intensified the natural occupational hazards (Lambert & Lawson, 2013; Litam et al., 2021) associated with professional health counseling practice and created a shared traumatic reality caused by mass disaster (Bell & Robinson, 2013). Additionally, uniquely rural hardships such as immense systemic limitations no doubt exacerbated these pandemic-related stressors as described by nearly all participants. This in turn necessitated the growth and resilience demonstrated by most of this sample in their descriptions of responding in creative and resilient ways.

Implications
     Exploring the experiences of rural counselors during the COVID-19 pandemic reveals important training, clinical, and advocacy implications to consider. The findings emphasize the need for rural mental health counselors to adopt a more comprehensive approach that extends beyond traditional counseling roles. To effectively respond to sudden mass disasters or crises, like the COVID-19 pandemic, counselors must develop enhanced skills in case management, crisis intervention, referral coordination, and social service networking. Given the compounded challenges in rural settings, cultural competency training is vital for addressing the unique needs of these populations.

Mental health counselors should proactively familiarize themselves with available community resources and remain adaptable to extending services beyond conventional counseling modalities during crises. Counselors may consider expanding their training by attending workshops on advocacy and referral strategies and being more involved in networking with non-counseling resources within their clients’ communities. For those providing teletherapy services across their state or in several states, there are a few issues to consider. In addition to consulting and abiding by state laws related to interstate practice, mental health counselors should consider the location of their remote clients and at least generally link them to resources in their own communities.

Although teletherapy has proven beneficial, relying solely on virtual services is not a comprehensive solution for rural communities that lack consistent broadband access. Federal funding for increasing rural internet connectivity has been explored, as the National Telecommunication and Information Administration (n.d.) has allocated over a quarter of a million dollars to aid in increasing broadband accessibility in rural areas. However, until broadband for all is an established reality, continued advocacy is necessary to ensure rural connectivity remains a national priority.

Rural mental health counselors can further support rural clients by promoting culturally relevant resilience practices that emphasize mindfulness and emotional regulation (Pow & Cashwell, 2017) as well as self-awareness, balance, and cognitive flexibility (Posluns & Gall, 2020). For rural clients, aiding in establishing social support may better foster resilience development. Counselors can help rural clients explore, develop, and strengthen their involvement across multiple systems, including family, church, school, and the broader community to increase their capacity to cope with adversity. Further, counselors can help rural clients identify and leverage existing community strengths to mitigate the impact of resource limitations.

Advocacy and leadership are needed for promoting systemic change to drive policy and clinical practice shifts in the counseling profession (Lee & Rodgers, 2009). Advocacy efforts should prioritize systemic changes at local, state, and national levels that target funding allocations, service accessibility, and infrastructure development in rural areas. Addressing chronic resource limitations in rural areas involves advocating for increased mental health and medical funding, expanding access to basic needs, and sustaining broadband infrastructure initiatives. Prioritizing mental health care includes boosting resources, reducing stigma, and ensuring that mental health services are affordable and accessible. In these efforts, counselors can collaborate with community leaders, social service agencies, and advocacy organizations to elevate rural mental health priorities within broader policy discussions.

Finally, rural mental health counselors should recognize and enhance personal cultural strengths to overcome natural occupational hazards associated with counseling work as well as the enhanced challenges that coincide with rural practice. To maintain their own well-being amid ongoing crises, rural counselors should also engage in professional development that fosters their resilience. Implementing peer support programs, attending networking events, and participating in supervision groups can provide essential emotional support and guidance. Additionally, involvement in local, regional, and state counseling associations can further reinforce counselors’ sense of connection and reduce the isolation often associated with rural practice. This comprehensive approach will empower rural mental health counselors to better navigate the challenges they face and enhance their ability to support their clients.

Limitations and Future Research
     Despite providing rich phenomenological data to understand the experiences of this sample during the COVID-19 pandemic and contributing to a relative paucity of research on this population, this study was not without limitations. Defining rurality is complex with no single definition capturing the multifaceted nature of such a culturally intricate group (Imig, 2014), and our study is no exception. For the purpose of generating accurate findings, a categorical and geographically based definition was selected. While the FORHP’s (2025) fiscal year 2022 classifications were used and represented an enhanced and more accurate definition of rural areas compared to previous definitions, it neglected to consider the descriptive or cultural aspects of rurality. Defining COVID-19 and its parameters was also a limitation. Participants, much like society, have navigated the uncertain, mutating, and episodic nature of viral outbreaks; therefore, it is difficult to define as either a historical or current event 4 years later. At the time of the study, however, participants largely viewed the most impactful degree of the COVID-19 pandemic as having occurred in earlier phases, which is helpful in ameliorating this limitation. Conversely, the length of time between the identified impactful phases in 2020 and interview time in 2022 is an additional limitation. With the passing of nearly 2 years, retrospective reflections may impact the accuracy of participants’ accounts of their experiences.

This study brings about several recommendations for future research. Future studies should continue to explore counselor experiences during mass and prolonged disasters. Despite being several years removed from the devastation of the COVID-19 pandemic, lessons of preparation and adaptability linger. In the last year, the United States has experienced Hurricane Helene in North Carolina and the Los Angeles wildfires, among hundreds of other disaster declarations (Federal Emergency Management Agency, n.d.). It is important to understand how counselors can care for their clients and themselves while navigating shared traumatic realities. Learning ways to foster resilience and post-traumatic growth is necessary to prevent counselor burnout and, ultimately, improve client care. For rural research specifically, replications of this study and related inquiries should continue to seek the most robust definition of culture; developing mixed methods approaches to capturing rurality would most likely overcome some limitations present herein. Rural cultural resilience should be a continued exploration, as much research has highlighted primarily barriers and challenges with less emphasis on resilience (Fruetel et al., 2022; Imig, 2014; Pullen & Oser, 2014; Slama, 2004; Sprang et al., 2007). Lastly, comparative analyses should be done in the future to further determine the uniqueness of rural counselor growth and resilience, as identified as a theme in this study.

Conclusion

The COVID-19 pandemic intensified mental health challenges in the United States, further straining an already overburdened health care system. Rural communities, which already experience fundamental disparities in resources and mental health care, were no exception. This study revealed both the struggles and resilience of rural mental health counselors in navigating the impacts of the COVID-19 pandemic in their communities. Identifying both exacerbated resource limitations and the need to cope and adapt with creativity and strength provides lessons for all counselors in the face of inevitable mass disasters. The findings underscore the importance of self-care, resilience-building, and leveraging community support during crises. Counselors should be well-versed in local resources and adopt broader roles. Given persistent disparities in rural health care access, ongoing advocacy remains essential.

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

References

Aafjes-van Doorn, K., Békés, V., Prout, T. A., & Hoffman, L. (2020). Psychotherapists’ vicarious traumatization during the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S148–S150. https://doi.org/10.1037/tra0000868

Ando, H., Cousins, R., & Young, C. (2014). Achieving saturation in thematic analysis: Development and refinement of a codebook. Comprehensive Psychology, 3(4), 1–7. https://doi.org/10.2466/03.CP.3.4

Bell, C. H., & Robinson, E. H. (2013). Shared trauma in counseling: Information and implications for counselors. Journal of Mental Health Counseling, 35(4), 310–323. https://doi.org/10.17744/mehc.35.4.7v33258020948502

Breen, D. J., & Drew, D. L. (2012). Voices of rural counselors: Implications for counselor education and supervision. VISTAS Online, 1, 1–12. https://manifold.counseling.org/projects/vistas-online-2012/resource/voices-of-rural-counselors-implications-for-counselor-education-and-supervision

Burgoyne, N., & Cohn, A. S. (2020). Lessons from the transition to relational teletherapy during COVID-19. Family Process, 59(3), 974–988. https://doi.org/10.1111/famp.12589

Centers for Disease Control and Prevention. (n.d.). COVID-19 data tracker: Trends in United States COVID-19 deaths, emergency department (ED) visits, and test positivity by geographic area. https://covid.cdc.gov/covid-data-tracker/#trends_weeklydeaths_select_00

Clauss-Ehlers, C. S. (2008). Sociocultural factors, resilience, and coping: Support for a culturally sensitive measure of resilience. Journal of Applied Developmental Psychology, 29(3), 197–212. https://doi.org/10.1016/j.appdev.2008.02.004

Crumb, L., Appling, B., & Jones, S. (2021). Don’t wait, communicate: Rural school counselors and disaster mental health. Professional School Counseling, 25(1), 1–14. https://doi.org/10.1177/2156759X211023119

Czeisler, M. É., Lane, R. I., Petrosky, E., Wiley, J. F., Christensen, A., Njai, R., Weaver, M. D., Robbins, R., Facer-Childs, E. R., Barger, L. K., Czeisler, C. A., Howard, M. E., & Rajaratnam, S. M. W. (2020). Mental health, substance use, and suicidal ideation during the COVID-19 pandemic—United States, June 24–30, 2020. Centers for Disease Control Morbidity and Mortality Weekly Report, 69(32), 1049–1057.
https://doi.org/10.15585/mmwr.mm6932a1

Eisma, M. C., Tamminga, A., Smid, G. E., & Boelen, P. A. (2021). Acute grief after deaths due to COVID-19, natural causes and unnatural causes: An empirical comparison. Journal of Affective Disorders, 278, 54–56. https://doi.org/10.1016/j.jad.2020.09.049

Elbogen, E. B., Lanier, M., Blakey, S. M., Wagner, H. R., & Tsai, J. (2021). Suicidal ideation and thoughts of self-harm during the COVID-19 pandemic: The role of COVID-19-related stress, social isolation, and financial strain. Depression and Anxiety, 38(7), 739–748. https://doi.org/10.1002/da.23162

Eryaman, M. Y., Koçer, Ö., Kana, F., & Şahin, E. Y. (2013). A transcendental phenomenological study of teachers’ self-efficacy experiences. Cadmo: Giornale Italiano di Pedagogia Sperimentale, 2, 9–33. https://doi.org/10.3280/cad2013-002002

Federal Emergency Management Agency. (n.d.). Disasters and other declarations. https://www.fema.gov/disaster/declarations

Friend, D. (2021, March 31). A timeline of Texas’ COVID-19 policies one year after “15 days to slow the Spread.” The Texan. https://thetexan.news/a-timeline-of-texas-covid-19-policies-one-year-after-15-days-to-slow-the-spread

Fruetel, K. M., Duckworth, R. C., Scott, S. L., & Fenderson, E. N. (2022). Exploring the experiences of counselors responding to crisis in rural communities. Journal of Rural Mental Health, 46(1), 40–49. https://doi.org/10.1037/rmh0000148

Guba, E. G., & Lincoln, Y. S. (1994). Competing paradigms in qualitative research. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research (1st ed.; pp. 105–117). SAGE.

Hall, E., Chai, W., & Albrecht, J. A. (2016). A qualitative phenomenological exploration of teachers’ experience with nutrition education. American Journal of Health Education, 47(3), 136–148. https://doi.org/10.1080/19325037.2016.1157532

Handley, T. E., Kay-Lambkin, F. J., Inder, K. J., Attia, J. R., Lewin, T. J., & Kelly, B. J. (2014). Feasibility of internet-delivered mental health treatments for rural populations. Social Psychiatry and Psychiatric Epidemiology, 49, 275–282. https://doi.org/10.1007/s00127-013-0708-9

Health Resources and Services Administration, Federal Office of Rural Health Policy. (2025). How we define rural. https://www.hrsa.gov/rural-health/about-us/definition/index.html

Henderson, K. A. (2011). Post-positivism and the pragmatics of leisure research. Leisure Sciences, 33(4), 341–346. https://doi.org/10.1080/01490400.2011.583166

Hoshmand, L. T. (1996). Cultural psychology as metatheory. Journal of Theoretical and Philosophical Psychology, 16(1), 30–48. https://doi.org/10.1037/h0091151

Imig, A. (2014). Small but mighty: Perspectives of rural mental health counselors. The Professional Counselor, 4(4), 404–412. https://doi.org/10.15241/aii.4.4.404

Lambert, S. F., & Lawson, G. (2013). Resilience of professional counselors following Hurricanes Katrina and Rita. Journal of Counseling & Development, 91(3), 261–268. https://doi.org/10.1002/j.1556-6676.2013.00094.x

Lee, C. C., & Rodgers, R. A. (2009). Counselor advocacy: Affecting systemic change in the public arena. Journal of Counseling & Development, 87(3), 284–287. https://doi.org/10.1002/j.1556-6678.2009.tb00108.x

Limón, E. (2020, December 18). Here’s how the COVID-19 pandemic has unfolded in Texas since March. The Texas Tribune. https://www.texastribune.org/2020/07/31/coronavirus-timeline-texas

Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. SAGE.

Litam, S. D. A., Ausloos, C. D., & Harrichand, J. J. S. (2021). Stress and resilience among professional counselors during the COVID-19 pandemic. Journal of Counseling & Development, 99(4), 384–395. https://doi.org/10.1002/jcad.12391

Maurya, R. K., Bruce, M. A., & Therthani, S. (2020). Counselors’ perceptions of distance counseling: A national survey. Journal of Asia Pacific Counseling, 10(2), 1–22. https://doi.org/10.18401/2020.10.2.3

Moustakas, C. E. (1994). Phenomenological research methods. SAGE.

National Telecommunication and Information Administration. (n.d.). Broadband infrastructure program.
https://www.ntia.gov/funding-programs/internet-all/broadband-infrastructure-program

Panchal, U., Salazar de Pablo, G., Franco, M., Moreno, C., Parellada, M., Arango, C., & Fusar-Pol, P. (2023). The impact of COVID-19 lockdown on child and adolescent mental health: Systematic review. European Child & Adolescent Psychiatry, 32, 1151–1177. https://doi.org/10.1007/s00787-021-01856-w

Pierce, B. S., Perrin, P. B., & McDonald, S. D. (2020). Demographic, organizational, and clinical practice predictors of U.S. psychologists’ use of telepsychology. Professional Psychology: Research and Practice, 51(2), 184–193. https://doi.org/10.1037/pro0000267

Pierce, B. S., Perrin, P. B., Tyler, C. M., McKee, G. B., & Watson, J. D. (2021). The COVID-19 telepsychology revolution: A national study of pandemic-based changes in U.S. mental health care delivery. American Psychologist, 76(1), 14–25. https://doi.org/10.1037/amp0000722

Posluns, K., & Gall, T. L. (2020). Dear mental health practitioners, take care of yourselves: A literature review on self-care. International Journal for the Advancement of Counselling, 42, 1–20. https://doi.org/10.1007/s10447-019-09382-w

Pow, A. M., & Cashwell, C. S. (2017). Posttraumatic stress disorder and emotion-focused coping among disaster mental health counselors. Journal of Counseling & Development, 95(3), 322–331. https://doi.org/10.1002/jcad.12146

Prati, G., & Mancini, A. D. (2021). The psychological impact of COVID-19 pandemic lockdowns: A review and meta-analysis of longitudinal studies and natural experiments. Psychological Medicine, 51(2), 201–211. https://doi.org/10.1017/S0033291721000015

Pullen, E., & Oser, C. (2014). Barriers to substance abuse treatment in rural and urban communities: Counselor perspectives. Substance Use & Misuse, 49(7), 891–901. https://doi.org/10.3109/10826084.2014.891615

Slama, K. (2004). Rural culture is a diversity issue. Minnesota Psychologist, 9–13. https://www.apa.org/practice/programs/rural/rural-culture.pdf

Sprang, G., Clark, J. J., & Whitt-Woosley, A. (2007). Compassion fatigue, compassion satisfaction, and burnout: Factors impacting a professional’s quality of life. Journal of Loss and Trauma, 12(3), 259–280. https://doi.org/10.1080/15325020701238093

Tarlow, K. R., McCord, C. E., Yuxian, D., Hammett, J., & Wills, T. (2020). Rural mental health service utilization in a Texas telepsychology clinic. Journal of Clinical Psychology, 76(6), 1004–1014.

Wainberg, M. L., Scorza, P., Shultz, J. M., Helpman, L., Mootz, J. J., Johnson, K. A., Neria, Y., Bradford, J.-M. E., Oquendo, M. A., & Arbuckle, M. R. (2017). Challenges and opportunities in global mental health: A research-to-practice perspective. Current Psychiatry Reports, 19(28), 1–10.
https://doi.org/10.1007/s11920-017-0780-z

Wang, D., Chonody, J. M., Krase, K., & Luzuriaga, L. (2021). Coping with and adapting to COVID-19 in rural United States and Canada. Families in Society: The Journal of Contemporary Social Services, 102(1), 78–90. https://doi.org/10.1177/1044389420960985

Brandi M. Sawyer, PhD, NCC, LPC-S, is an assistant professor at Bellevue University. Edith Gonzalez, PhD, NCC, LPC, is an associate professor at the Hazelden Betty Ford Graduate School. Correspondence may be addressed to Brandi M. Sawyer, 1000 Galvin Rd. S., Bellevue, NE 68005, bsawyer@bellevue.edu.

Body Image Ideals and Risk for Disordered Eating in Black American Women: A Scoping Review

Andie Chilson, Melissa Mecadon-Mann, Rebecca Gwira, Loidaly G. Rosario-Singer

This scoping review examines 12 years of research on body image ideals and eating disorder (ED) pathology in Black American women. The authors synthesized the aims, methods, and results of 10 studies to outline the specific body image ideals within this population and the relationships between these ideals and ED risk. The findings from this review provide important insights to inform counseling and integrated care approaches for working with Black American women struggling with body image and disordered eating. This study highlights the existing evidence on body image and EDs in this understudied population and points to critical directions for future investigation.

Keywords: body image ideals, eating disorders, Black American, women, counseling

     Body image as it relates to disordered eating has been a widely researched topic within the medical and psychology fields (Blostein et al., 2017; Brandsma et al., 2019; Jung & Forbes, 2012; Malachowski & Myers, 2013; Mölbert et al., 2018; Reslan & Saules, 2013). Researchers have explored racial and cultural differences in disordered eating pathology and identified specific body image ideals among racial and ethnic communities (Aldalur & Schooler, 2019; Capodilupo & Kim, 2014; Goel et al., 2021). Disordered eating research has primarily focused on Western European, White body image ideals. Therefore, a scoping review was warranted to achieve a comprehensive view of this underexamined topic. According to Arksey and O’Malley (2005), there are four commonly cited reasons to warrant a scoping review: to examine the extent and nature of existing research on a topic; to discern whether a full systematic review is necessary; to summarize and disseminate key findings; and to identify gaps in the existing literature. We have observed a dearth of research on the intersection of body image ideals and eating disorders (EDs) in Black American women and, therefore, endeavored to summarize and disseminate key findings and identify gaps in the existing literature.

     Research is limited on the most effective modalities to treat disordered eating in minoritized populations. Cognitive behavioral and dialectical behavioral therapy are among the most popular counseling treatments for disordered eating in clients who are striving for a thin body ideal (Federici et al., 2012; Fursland et al., 2012). However, the body image ideals for Black and African American women differ from their White, Asian, Latine, and Native American peers (Smith et al., 2020; Talleyrand, 2012). Therefore, counseling modalities centered around the thin ideal are not the best fit for Black and African American clients who present with EDs. For example, Labarta and Bendit (2024) suggested a relational–cultural approach to ED treatment that provides space for the decolonization of traditional treatment models. As such, this scoping review was driven by the following research question: What are the most common body image ideals (as they relate to body weight/shape) for Black women living in the United States and how does this impact their risk for/presentation of disordered eating?

Body Image Ideals in Black Women Living in the United States
     Studies have shown that Black women may feel less pressure to be thin than their White peers (Awad et al., 2020). Historically, the Black community has seen larger bodies as resilient, healthy, and a symbol of wealth. Awad et al. (2015) identified a thick/toned/curvy body shape as optimal for Black women. Some Black women exercise not to lose weight but to achieve a large backside and a small waist. However, when in a majority White community, the pressure to conform to the thin ideal is still present (Awad et al., 2015). In these instances, diet (or not eating at all) and exercise are emphasized.

     The ideal body shape for Black American women also includes acceptance of a larger body size, or what some call the curvy ideal (Boutté et al., 2022; Cotter et al., 2015; Gitau et al., 2014; Hunter et al., 2017; Parker et al., 2022; Scott, 2019). The curvy ideal, sometimes described as a Coke-bottle figure (Hunter et al., 2017), consists of a large bust, a small waist, and a large backside. It has been stated that because Black women have wider acceptance of a larger body size or the curvy ideal, they experience body dissatisfaction less than their White peers (Boutté et al., 2022). It is important to note that the curvy ideal is not necessarily more attainable or healthy than the thin ideal (Scott, 2019). The curvy ideal is also related to body dissatisfaction and can be associated with body monitoring or body checking (Shafran et al., 2003). Body checking, or continual monitoring of weight, waist size, and body measurements, can be a risk factor for developing bulimia nervosa (BN) and anorexia nervosa (AN; Shafran et al., 2003).

Eating Disorder Prevalence and Risk/Protective Factors in Black American Women
     The scope of the existing research on ED pathology in Black and African American individuals is extremely limited. The most recent comprehensive study examining the prevalence of EDs in Black Americans was conducted in 2007. The study found that binge eating disorder (BED) was the most common ED among Black adults, comprising 2.24% of participants, and AN was the least common, with 0.17% of adults meeting diagnostic criteria (Taylor et al., 2007). Although this study is extremely useful in providing a point of reference for the prevalence of eating pathology in Black Americans, updated research on the topic is needed.

     According to Cotter et al. (2015) and Hunter et al. (2017), Black women have similar rates of disordered eating to their White peers. Many Black women feel an expectation to be thin and/or fit into a specific body ideal; however, there is a lack of research specific to Black women and ED pathology. Additionally, the research that does exist is highly focused on body mass index (BMI) and obesity rates, which have been proven to be poor indices of physical health (Rasmussen, 2019) and fail to address the underlying cause(s) and risk factors of disordered eating in Black communities (Hunter et al., 2017). Black women are often categorized as overweight and/or diagnosed as obese while EDs are likely undiagnosed or underdiagnosed in this demographic (Boutté et al., 2022).

     Racial identity development can act as a protective factor against disordered eating (Capodilupo & Kim, 2014; Rakhkovskaya & Warren, 2014). Capodilupo and Kim (2014) found that identification with the majority culture leads to higher levels of disordered eating, while Black women who identify with Black culture have lower levels of body dissatisfaction. As one works through racial identity development, they tend to identify more with cultural norms and push away from the body ideals of White culture and influence. The Black community emphasizes beauty ideals beyond size and shape (attitude, self-confidence, hair; Rakhokovskaya & Warren, 2014). Therefore, rejecting White beauty ideals through racial identity development may protect some women from disordered eating behaviors.

Present Investigation
     This scoping review was inspired by a review published by Harris (2015), which explored three different strata of research on EDs in Black American women from 1980–2015. The first stratum of research discusses the clinical implications of the exclusion of Black women from ED research in the 1980s. Harris demonstrated that as ED presentations in Black women became increasingly recognized, the rate of treatment for Black women with EDs similarly increased. However, ED research and treatment at this time still largely centered around economically advantaged White women and the Eurocentric beauty ideals with which they aligned (Harris, 2015).

     The second stratum of research highlighted by Harris (2015) emphasizes an expanded definition of body image to include affective, psychological, and behavioral facets, thus creating a more nuanced and inclusive dialogue around the implications of body image concerns for Black women. This expanded definition of body image also opened up the conversation for cultural variables related to body image that could be precursors to EDs in Black women (Harris, 2015).

     The third and final stratum of research examined by Harris (2015) saw an increase of within-group studies of Black American women compared to the between-group studies with White and Black women that dominated ED literature up to that point. This stratum of research also identified strong ethnic identity as a protective factor against EDs in Black women, and low ethnic identity as a risk factor for BED and BN symptomatology (Harris, 2015). In the conclusion of the paper, Harris called for further investigation into risk factors associated with eating pathology in Black American women.

     The goal of the present investigation, therefore, is to bridge the gap between the findings of the Harris (2015) study and the existing body of research. We endeavored to accomplish this in three ways: first, identify the most common body image ideals for Black women living in the United States; second, identify what relationship (if any) exists between body image and disordered eating in Black women living in the United States; and third, identify implications for counselors based on the research findings of the first two objectives. The language “Black” and “African American” was utilized to capture as many ethnic identities as possible, including those that did not originate in the United States. When articles specified ethnic identities in their demographics, we indicated as such.

Methods

Author Positionality
     There were four authors for the present investigation. It is critical to acknowledge that the first and second authors, Andie Chilson and Melissa Mecadon-Mann, are White women who have learned, only as outsiders, about the intersecting experiences of body image challenges and eating disorders in Black American women. Chilson has benefited both directly and indirectly from systemic racism, particularly as it pertains to adherence to Eurocentric beauty ideals and the inherent protection provided in identity. She has extensive experience working with eating disorders and body image challenges in women from diverse racial backgrounds. The second author, Mecadon-Mann, identifies as a cisgender White American woman in a large body. She has experience working with adolescents and emerging adults with diverse ethnic backgrounds and varied body image ideals and disordered eating behaviors. The third author, Rebecca Gwira, identifies as a first-generation, cisgender, Black woman in a mid-sized to large body. She also has experience working clinically with diverse eating disorder patients across demographic characteristics and levels of care. Her research centers marginalized voices, specifically Black women’s eating and body image concerns and intersectional stress. The fourth author, Loidaly G. Rosario-Singer, identifies as a cisgender Puerto Rican woman; she has benefited from some aspects of Eurocentric body ideals because she has had a small to mid-sized body the majority of her life. She has experience working with multilingual children and families with a focus on health equity and reproductive justice.

Methodology
     The following research questions guided this scoping review:

RQ1:   What specific body ideals are most commonly endorsed by Black American women, and how do these ideals differ from or align with the thin ideal traditionally emphasized in ED research?

RQ2:   What (if any) relationship does the existing literature identify between culturally specific body image ideals and the manifestation of different types of disordered eating behaviors in Black American women?

RQ3:   Identify implications for counselors based on the research findings of the first two objectives.

     Our systematic search was conducted based on the guidelines put forth by the PRISMA extension for scoping reviews (PRISMA-ScR), a 22-item checklist aimed at helping readers develop a better understanding of the terminology and key concepts reported in scoping reviews (Tricco et al., 2018). The checklist was created by a panel of 24 expert members and two research leads and was informed by the published guidelines of the EQUATOR (Enhancing the QUAlity and Transparency Of Health Research) Network (Tricco et al., 2018). A five-step scoping review process was undertaken, including 1) identifying the research question and objectives; 2) defining the scope of the review; 3) selecting the records; 4) charting the data; and 5) summarizing the results. Inclusion and exclusion criteria were identified a priori and documented in a protocol.

Eligibility Criteria
     The eligibility criteria for inclusion were based on population (P)—Black American women; exposure (E)—body image ideals; and outcome (O)—disordered eating. To attempt to capture all relevant literature published after or around the time of Harris (2015), articles published in English between 2013 and 2025 were eligible for inclusion in this review. Sources examining a pediatric population (under 18 years) or research conducted outside of the United States were excluded from the review.

Information Sources
     Inclusion and exclusion criteria were established a priori with the assistance of a public health librarian at Western Carolina University. These criteria were used to develop a standard checklist for study eligibility for screening titles/abstracts and subsequently full-text sources. All stages of the screening process were conducted using Covidence, an online software tool used to organize records in the systematic or scoping review process and to blind the results between the researchers. Study selection was conducted independently by Chilson and Mecadon-Mann based on the preestablished checklist. All decisions were automatically recorded via Covidence. Conflicts between the authors were resolved through discussion. Records were identified through searching the following electronic databases: Academic Search Premier, Biological & Agricultural Index Plus (H.W. Wilson), Business Source Premier, Child Development & Adolescent Studies, CINAHL Plus with Full Text, Communication & Mass Media Complete, eBook Collection (EBSCOhost), Education Source, ERIC, Gender Studies Database, Health Source: Nursing/Academic Edition, MasterFILE Premier, MEDLINE Complete, Mental Measurements Yearbook with Tests in Print, Military & Government Collection, Philosopher’s Index, APA PsycArticles, APA PsycInfo, APA PsycTests, SocINDEX with Full Text, SPORTDiscus with Full Text, and Ebony Magazine Archive.

Search
     To achieve an extensive review on the topic, literature from the past 12 years was included in the search. Because of limitations with access to sources outside of Western Carolina University, reference mining was not conducted as part of the present study. The search strategy was created by a public health librarian at Western Carolina University in collaboration with Chilson. The search strategy was checked for comprehensiveness and errors against the PRESS Peer Review of Electronic Search Strategies Guidelines. The specific search terms utilized were as follows: (Black OR Blacks OR African American*) AND (female* OR woman* OR women* OR lady OR ladies* OR gyn* OR girl*) AND (“eating disorder*” OR “disordered eating” OR anore* OR “binge eating” OR bulimi* OR purging OR purgeing OR “restrictive eating” OR orthore* OR overeat* OR pica) AND (body OR personal) AND (image OR perception OR satisfaction OR dissatisfaction OR psychosocial OR societ*).

Data Charting Process
     A data extraction template in Covidence was used to record key characteristics and relevant information from eligible records, including study design, research purpose, study participants, and research findings/results. Chilson and Mecadon-Mann independently charted the data, discussed the results, and regularly updated the data extraction form in Covidence.

Data Items
     Chilson and Mecadon-Mann abstracted data on article characteristics (i.e., country of origin, publication date, language), sample characteristics (i.e., race, gender, and age), and constructs/outcomes examined (i.e., body image ideals and EDs). Gwira subsequently vetted all the extracted articles based on the same criteria.

Critical Appraisal of Individual Sources of Evidence
     An in-depth examination of the unique body image ideals held by Black women and their influence on the risk for EDs is lacking in the current literature. Therefore, we endeavored to explore the link between specific body image ideals of Black women and their correlation with EDs. We also aimed to identify the most common body image ideals for Black women living in the United States as an independent construct. Individual articles were screened for eligibility using the systematic review management tool, Covidence. Chilson and Mecadon-Mann independently screened the articles against inclusion/exclusion criteria, which were established a priori. We then screened articles at the abstract level for general relevance and subsequently conducted full-text screenings. Articles included in the full-text screening were assessed to determine if sources examined Black American women, specifically; examined body image ideals, specifically, or body image ideals as an independent variable and ED as a dependent variable; and examined an adult sample (18 years or older) from the United States. After reviewing at the full-text level to determine that Black American women, specifically, were examined, Chilson and Mecadon-Mann looked for language such as Black American, African American, Caribbean American, and Haitian American to encompass the full spectrum of Black American women. Also at the full-text level, we screened for clearly identified body image ideals, which required reference to a preferred size/shape of a specific body part (e.g., Coke-bottle waist; Hunter et al., 2017) or preferred shape of the body, generally (e.g., curvy ideal; Scott, 2019). If the intersection of an ED was present, Chilson and Mecadon-Mann screened for either general reference to ED (e.g., “ED pathology”; Siegfried, 2021) or specific reference to an ED diagnosis (e.g., anorexia and bulimia; Hunter et al., 2017). Gwira screened each source separately against the established inclusion/exclusion criteria and charted assessments in an Excel spreadsheet. Gwira and Rosario-Singer reviewed the manuscript for accuracy and offered feedback for Chilson and Mecadon-Mann’s consideration.

Synthesis of Results
     The synthesis included quantitative analyses (e.g., means, standard deviation) to summarize the characteristics of included records, body image ideals in Black women, and any ED intersection noted. The results are presented in both a table and a descriptive format that aligns with the review’s objectives of identifying the most common body image ideals for Black women living in the United States and identifying the relationship between body image and disordered eating in Black women living in the United States.

Results

     The record identification process is outlined in Figure 1. A total of 501 records were identified through the initial search process. After removing all duplicates (n = 301), the authors were left with 200 records for screening. Next, 107 records were excluded based on criteria such as examination of a pediatric population (under age 18), women outside of the United States, and a lack of focus on Black women. There were 93 records then screened for eligibility, 83 of which were excluded because of patient population, type of publication, and lack of access. This process resulted in 10 records selected for inclusion.

Figure 1

PRISMA Flow Diagram for Scoping Reviews

Note. Adapted from Page et al., 2021.

 

Characteristics of the Sources of Evidence
     Included records examined Black women living in the United States. One study (Bruns & Carter, 2015) also examined White women, and another study (Siegfried, 2021) examined Hispanic/Latina/x women in addition to Black women. Participant ages ranged from 18–73 years and there was no discernible trend in the age selection of the included records. Only one study specifically examined a sample of women 25 years and older (Talleyrand et al., 2016). The majority of records included the age range with mean/standard deviation, except two papers, which only reported the age range and not the mean/standard deviation (Bruns & Carter, 2015; Siegfried, 2021).

     Included study designs were qualitative research (n = 4), randomized controlled trial (n = 2), cross-sectional (n = 2), mixed methods (n = 1), and exploratory factor analysis (n = 1). The 10 included records presented data from sample sizes ranging from 11 to 232. Two studies (Awad et al., 2015; Hollier, 2019) were conducted with women enrolled in universities across the United States. One study (Talleyrand et al., 2016) was conducted in the greater Washington metropolitan area. The other seven studies did not specify where they were conducted within the United States.

     Four studies utilized focus group questions aimed at identifying common themes pertaining to beauty ideals specific to Black women. Two studies used the Eating Disorders Inventory – 3 (Garner, 2004) to determine specific body image ideals and assess for the presence of ED pathology. Two studies employed the Eating Attitudes Test – 26 (Garner et al., 1982) to measure disordered eating behaviors. Other instruments utilized in the included studies were the Contour Drawing Rating Scale (n = 2; M. A. Thompson & Gray, 1995), The Skin Color Satisfaction Scale (n = 1; Falconer & Neville, 2000), The Reese Figure Rating Scale (n = 2; Patt et al., 2002), the Rosenberg Self-Esteem Scale (n = 2; Rosenberg, 1965), Family Experiences Related to Food Questionnaire (n = 1; Kluck, 2008), Family Food Experiences-Black Questionnaire (n = 1; Hunter et al., 2017), Body Image Disturbance Questionnaire (n = 1; Cash et al., 2004), Visual Analog Scale- Body Satisfaction (n = 1; Heinberg & Thompson, 1995), The Curvy Ideal Silhouette Scale (n = 1; Scott, 2019), Curvy Ideal Questionnaire (n = 1; Scott, 2019), The Sociocultural Attitudes Towards Appearance Questionnaire—3rd Edition (n = 1; J. K. Thompson et al., 2004), The Sociocultural Attitudes Towards Appearance Questionnaire—4th Edition (n = 1; Schaefer et al., 2015), Objectified Body Consciousness Scale (n = 1; McKinley & Hyde, 1996), Body Shape Questionnaire (n = 2; Cooper et al., 1987), Eating Disorder Examination-Questionnaire (n = 1; Fairburn, 2008), and Gormally Binge Eating Scale (n = 1; Gormally et al., 1982).

Table 1

Results of Individual Sources of Evidence

Author(s), Publication Date Aim of Study Study Participants Study Design Body Image Ideals Eating Disorder Intersection
Awad et al., 2015 Examine the issues that arise pertaining to AA women’s conception of beauty and body image, identify body image themes, and identify the sources of the body image messages received and internalized. Female AA students enrolled in a large Southwestern university in the United States between the ages of 19–25 Qualitative research Thick/toned/curvy as optimal
(n = 33)
Yes
Bruns & Carter, 2015 Examine how model ethnicity and body shape impact body dissatisfaction. Women self-identifying as African American or Caucasian between the ages of 18–45 Randomized controlled trial Thin ideal and plus-sized ideal No
Capodilupo
& Kim, 2014
Explore how race and gender interact and inform body image ideals. Women between the ages of 21–35; identified as African American (n = 10), Black American (n = 4), Caribbean American (n = 4), and Haitian American (n = 2); six women did not specify their ethnicity Qualitative research Large breasts, shapely hips, and full backside No
Hollier, 2019 Examine body dissatisfaction and self-esteem factors that contribute to BEDs among Black female students. Black college women currently enrolled in a private or public university in the United States between the ages of 18–54. All participants self-identified as “Black,” but 3.2% of the participants identified as “other” and “multi-racial” under this umbrella Cross-
sectional
Thighs, breasts, waist/hip ratio Yes
Hunter et al., 2017 Explore family food experiences (FFEs) of AA women and develop a measure of FFEs related to disordered eating. Studies 1 & 3: AA women from two National Pan-Hellenic Council sororities at a Southeastern university; Study 4: AA women from across the United States younger than 25 Mixed methods “Boobs and booties” (Study 1) and “Coke-bottle figure” (Study 3) Yes
Author(s), Publication Date Aim of Study Study Participants Study Design Body Image Ideals Eating Disorder Intersection
Javier, 2017 Increase understanding of body image and eating behaviors in AA and Asian American women. Study 1: AA women between the ages of 18–30 who reported body image problems Qualitative research Curvy and thin ideals Yes
Scott, 2019 Examine the effect of exposing Black women to rap lyrics that promote the curvy ideal on their level of body image dissatisfaction. Black women between the ages of 18–34 who had access to audio output (e.g., headphones, speaker); all participants identified as AA, 2.1% also identified as American Indian/Alaska Native, and 4.2% also identified as White Randomized controlled trial Curvy ideal No
Siegfried, 2021 Increase understanding of the ways cultural values and pressure impact the development of EDs in Black and Latinx women in the United States. Black, Hispanic/Latina/x, and Afro-Latina/x women between the ages of 18–25 living in the United States; 125 participants (49.2%) identified as Black, 107 (42.1%) identified as Hispanic or Latina/x, and 22 women (8.7%) identified as Afro-Latina/x Cross-sectional Thin ideal Yes
Talleyrand et al., 2016 Explore the phenomena that impact body image ideals, eating behaviors, and appearance in AA women over the age of 25 who report body/weight concerns. AA/Black women in the greater Washington metropolitan area; seven women identified as African American, two identified as Black, and two identified as African American/Black. Qualitative research Thin, sculpted “ripped” arms, and “sistah girl” hips No
Wilfred & Lundgren, 2021 Assessing the psychometric properties and validity of a body image assessment
for Black women.
Women between the ages of 18–73 who identified as African American (73.4%), African (8.5%), Afro-Latina (3.5%), Caribbean (1.5%), Caribbean American (1.5%), other Black descent (3.0%), and multiple racial identities (8.5%) Exploratory factor analysis “Slim-thick,” thin, and muscular Yes

 

Main Study Outcomes
     The most salient findings of the current study were twofold: first, the identification of specific body ideals held by Black women living in the United States; and second, the identification of a relationship between specific body image ideals and the presence of ED behaviors in Black women living in the United States. The first predominant body image ideal identified was a thick/slim-thick/curvy ideal. The majority of the included records indicated a striving for the curvy ideal (i.e., large breasts, shapely hips, and large backside) as opposed to the more commonly cited thin ideal. Four studies identified specific body parts that were highlighted as part of the curvy ideal. For example, Hunter et al. (2017) discussed “boobs and booties” (p. 29) as two specific body parts on which Black women focused their attention when striving for the curvy ideal.

     Although the curvy ideal was the predominant body shape ideal that was identified in the included records, the influence of the thin ideal was also present. Five studies highlighted the influence of the thin ideal on their sample populations, either on its own or in conjunction with the curvy ideal (e.g., Bruns & Carter, 2015). The final body image ideal noted in the included records was the muscular/toned ideal. Both Talleyrand et al. (2016) and Wilfred and Lundgren (2021) identified being visibly fit, toned, or muscular as desirable qualities for Black women. Talleyrand et al. described the desirability of Michelle Obama’s “ripped” arms, stating that she was the ideal combination of curvy and healthy. Wilfred and Lundgren identified a similar muscular internalization, specifically regarding having a toned abdomen as a desirable physical trait for Black women.

     The second major finding was that the majority of included records reported a relationship between specific body image ideals and the presence of an ED. More specifically, six out of the 10 included records noted this positive relationship (see Table 1 for specific studies). Hunter et al. (2017) identified an increased risk for AN and BN among Black women in a sorority who idealized being curvy, but only in certain places. Additionally, Awad et al. (2015) described the relationship between experiencing discrimination and the presence of disordered eating behaviors. Both Awad et al. and Javier (2017) found that a disconnect between one’s cultural heritage and the ideals of the White dominant group often led to disordered eating behaviors. If one perceives that they are divergent from the ideals of the dominant group (i.e., the thin ideal), they are likely to engage in potentially harmful disordered eating patterns. Finally, Wilfred and Lundgren (2021) found that the experience of a double consciousness (i.e., the pressure to adhere to two separate cultural ideals) increased ED pathology, specifically BED, among Black women.

     Several of the included articles correlated variation in skin tone with positive/negative body image and ED pathology. Wilfred and Lundgren (2021) and Hollier (2019) noted that pressure to meet White body image ideals, including a fair complexion, increase the risk for ED behaviors, BED in particular. Similarly, Awad et al. (2015) determined that women who experienced discrimination stress, dissonance between the dominant culture and their culture of origin, or identification as a devalued group by the majority culture were at an increased risk for ED pathology. Awad et al. (2015) used the example of having a darker complexion to illustrate this, noting that if a woman was darker complected than her peers, and felt devalued because of it, she was more likely to engage in ED behaviors. Capodilupo and Kim (2014) discussed the influence of skin tone in a similar manner, asserting that women who are lighter complected are more likely to be desired by Black men and are more frequently and positively portrayed in the media, decreasing their risk for poor body image and ED behaviors.

     The authors also examined moderating factors such as level of education, profession, and socioeconomic status, and found that only one study (Siegfried, 2021) examined the relationship between education and body image/ED pathology and determined that there was no substantial correlation with any of the measures. However, significantly, Siegfried (2021) determined that higher income was highly correlated with lower levels of acculturative stress as well as lower levels of internalization of the thin ideal but noted that there was no predictive factor between income and ED pathology.

Discussion

     This scoping review centered around four objectives: first, to identify the most common body image ideals for Black women living in the United States; second, to identify what relationship (if any) exists between body image and disordered eating in Black women living in the United States; third, to bridge the gap between the findings of the Harris (2015) study and the current body of research; and fourth, to identify implications for counselors based on the research findings.

Common Body Image Ideals
     Although some Black women in the United States are driven by the thin ideal, many describe a thick, toned, or curvy body shape as ideal. Most of the examined studies identified the thin ideal in combination with the curvy ideal as most desirable among the examined population. For example, Wilfred and Lundgren (2021) identified a “slim-thick” figure, high muscularity, and thinness as the predominant body ideals for Black women. Only one study, Siegfried (2021), identified thinness alone as the predominant body ideal. It is notable, however, that 50% of the included records highlighted thinness as a prominent body ideal for Black women. Although it has previously been assumed (Bruch, 1966) that Black women did not value thinness, the present findings indicate that this is not the case. Although Black women overwhelmingly value thinness in conjunction with the curvy ideal, thinness alone is still emphasized as a desirable quality.

Black American Body Image and Disordered Eating
     Black women have lower rates of body dissatisfaction than their White peers but comparable rates of disordered eating. However, Black women have also been associated with disordered eating behaviors that center around culturally specific ideals or factors. For example, Siegfried (2021) described the positive relationship between acculturative stress and the internalization of the thin ideal, which then positively predicts an increased risk for ED pathology. Siegfried further identified a relationship between the internalization of the thin ideal and the development of BN, specifically.

     One of the overarching messages regarding the relationship between specific body image ideals and disordered eating in Black American women was that being discrepant from one’s identified cultural ideals was a significant risk factor for disordered eating behaviors (Awad et al., 2015; Hollier, 2019; and Javier, 2017). For example, if an individual strongly identifies with a culture that emphasizes the curvy ideal and they naturally have a curvy figure, they are less likely to engage in disordered eating behaviors to alter their body shape. If an individual with the same curvy figure has a low degree of cultural identity, or identifies more strongly with another culture that emphasizes the thin ideal, they would be at increased risk to engage in disordered eating behaviors. Additionally, women who feel pressured to conform to the body ideals of two cultures are at an increased risk for eating pathology. This experience is referred to as double consciousness (Du Bois, 1903), which in this context means being made to feel like one needs to adhere to the beauty ideals of both mainstream (White European) culture and Black culture.

Gaps in Existing Literature
     Although the included records identified general body image ideals that are emphasized by Black American women, there was a dearth in the existing literature surrounding specific ED diagnoses that are linked with certain body image ideals. In the present investigation, only three of the included records identified a specific diagnosis that is linked with certain body image ideals in Black American women. Therefore, future research is warranted surrounding specific ED diagnoses and the associated prevalence rates in this demographic. We also identified that many Black women perceive beauty through a wider lens than simply body shape/size, including elements such as skin tone, hair (length, style, neatness), self-esteem, and attitude. Further investigation into these ideals will deepen the conceptualization of beauty and attractiveness ideals in Black women living in the United States today. Finally, the authors also identified a gap in recent literature examining moderating factors such as level of education and profession that may serve as risk/protective factors for ED behaviors. Further investigation into these factors is warranted to broaden the conceptualization of ED presentations in Black women.

     Additionally, there is a gap in the current research surrounding disordered eating and body image ideals in Black LGBTQ+ women, specifically. The studies included in the present investigation either excluded discussion of sexuality entirely or conceptualized it in relation to the male gaze. Therefore, further research into the relationship between sexuality and body image ideals/disordered eating in Black American women is warranted. Another identified gap in the existing literature centers around the influence of the Black/White male gaze on Black women’s self-identified body ideals. More specifically, research is warranted surrounding whether there are different body image ideals for Black women who identify more closely with the body shape/size preferences of Black men compared to White men, and any eating pathology associated with these ideals.

Implications for Counseling and Integrated Care
     Traditionally, there has been a limited focus on Black women and ED behaviors outside of the thin ideal. Counselors and care providers must be aware of the culturally embedded protective factors (e.g., racial identity development) that can support healthy eating patterns as well as potential risk factors. It is common for Black women to have higher body weight and BMI, but this does not mean they are immune from disordered eating. It is important to explore how stress and trauma may affect restriction and eating patterns (Small & Fuller, 2021). Boutté et al. (2022) suggested that care providers utilize strengths-based interventions that are holistic rather than interventions focused solely on diet and exercise. It is important, also, to assess for disordered eating before making recommendations to lose weight or form a weight loss plan. Counselors and other helping professionals should consider the implications of skin tone when supporting Black women. As previously noted, darker complected women who exist in a dominant White culture may be at a higher risk for poor body image and ED behaviors (Awad et al., 2015; Capodilupo and Kim, 2014; and Wilfred and Lundgren, 2021). The influence of White, Eurocentric beauty standards on Black women of varying skin tones should be accounted for when conceptualizing treatment plans.

     Labarta and Bendit (2024) suggested the use of an integrated relational–cultural approach to ED treatment. Relational–cultural theory (RCT) is rooted in feminist and multicultural theory with a central goal of connection, mutuality, and relationship (Jordan, 2017). RCT approaches to ED treatment allow the care provider and client to work in mutuality, break down power differentials, and repair relationships with food and the body. This framework provides space for discussion and healing focused on racial and social marginalization and how it affects body dissatisfaction, thus building self-image and resilience and empowering clients to live authentically. Further, Labarta and Bendit suggested a self-compassion approach to help clients build knowledge and skills about self-compassion, common humanity, and mindfulness. These factors are helpful in building resilience and can serve as protective factors for people from marginalized communities.

     Lastly, care practitioners should be trained in holistic approaches and cultural humility (Matthews et al., 2021). One way practitioners can do this is through expanding care services into the communities where marginalized people live and work. For example, community outreach partnerships can be made with organizations that promote Black female health and wellness. Additionally, practitioners should read literature and attend professional development presented by Black women. One suggested book is Treating Black Women with Eating Disorders (Small & Fuller, 2021).

Strengths and Limitations

     This review outlines research spanning a 12-year timeframe, providing a bridge to the anchor article written by Harris (2015). Because of reasons outside of our control, there were a handful of articles that were inaccessible. Furthermore, because of these constraints, we did not conduct reference mining as part of the search strategy. These articles may have added to the findings of the present study. We utilized Covidence software to review articles and lessen the chance of reviewer bias. After consensus was reached between Chilson and Mecadon-Mann, Gwira and Rosario-Singer provided insight into the articles and cultural implications of the research. However, bias is still a possibility in identifying terms and phrases that allude to body image satisfaction or dissatisfaction. An additional limitation is that this review only examined cisgender women. Research examining body image ideals and eating disorder prevalence in individuals outside of the gender binary is needed. The most substantial limitation is the dearth of research specifically focused on body image and EDs in Black women. Therefore, the authors identified a need for ED research and practice publications specifically focused on treating Black women in the United States.

 

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

References

Aldalur, A., & Schooler, D. (2019). Culture and deaf women’s body image. Journal of Deaf Studies and Deaf Education, 24(1), 11–24. https://doi.org/10.1093/deafed/eny028

Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616

Awad, G. H., Kashubeck-West, S., Bledman, R. A., Coker, A. D., Stinson, R. D., & Mintz, L. B. (2020). The role of enculturation, racial identity, and body mass index in the prediction of body dissatisfaction in African American women. Journal of Black Psychology, 46(1), 3–28. https://doi.org/10.1177/0095798420904273

Awad, G. H., Norwood, C., Taylor, D. S., Martinez, M., McClain, S., Jones, B., Holman, A., & Chapman-Hilliard, C. (2015). Beauty and body image concerns among African American college women. Journal of Black Psychology, 41(6), 540–564. https://doi.org/10.1177/0095798414550864

Blostein, F., Assari, S., & Caldwell, C. H. (2017). Gender and ethnic differences in the association between body image dissatisfaction and binge eating disorder among Blacks. Journal of Racial and Ethnic Health Disparities, 4(4), 529–538. https://doi.org/10.1007/s40615-016-0255-7

Boutté, R. L., Burnette, C. B., & Mazzeo, S. E. (2022). BMI and disordered eating in Black college women: The potential mediating role of body appreciation and moderating role of ethnic identity. Journal of Black Psychology, 48(5), 604–630. https://doi.org/10.1177/00957984211069064

Brandsma, L., Smith, G., Barney, J., Wolinsky, A., & Juarascio, A. S. (2019). Do I really look like that? Racial differences in the discrepancy between self and objective observer ratings of body size. Journal of Cultural Diversity, 26(2), 49–53. https://www.proquest.com/openview/4b765b7b92f487e823c686abd6560827/1?pq-origsite=gscholar&cbl=34124

Bruch, H. (1966). Anorexia nervosa and its differential diagnosis. Journal of Nervous and Mental Disease, 141(5), 555–566.

Bruns, G. L., & Carter, M. M. (2015). Ethnic differences in the effects of media on body image: The effects of priming with ethnically different or similar models. Eating Behaviors, 17, 33–36.
https://doi.org/10.1016/j.eatbeh.2014.12.006

Capodilupo, C. M., & Kim, S. (2014). Gender and race matter: The importance of considering intersections in Black women’s body image. Journal of Counseling Psychology, 61(1), 37–49. https://doi.org/10.1037/a0034597

Cash, T. F., Phillips, K. A., Santos, M. T., & Hrabosky, J. I. (2004). Body Image Disturbance Questionnaire (BIDQ) [Database record]. APA PsycTests.

Cooper, P. J., Taylor, M. J., Cooper, Z., & Fairburn, C. G. (1987). The development and validation of the Body Shape Questionnaire. International Journal of Eating Disorders, 6(4), 485–494.
https://doi.org/10.1002/1098-108X(198707)6:4<485::AID-EAT2260060405>3.0.CO;2-O

Cotter, E. W., Kelly, N. R., Mitchell, K. S., & Mazzeo, S. E. (2015). An investigation of body appreciation, ethnic identity, and eating disorder symptoms in Black women. Journal of Black Psychology, 41(1), 3–25.
https://doi.org/10.1177/0095798413502671

Du Bois, W. E. B. (1903). The souls of Black folk. A. C. McClurg & Co. https://www.gutenberg.org/files/408/408-h/408-h.htm

Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. Guilford.

Falconer, J. W., & Neville, H. A. (2000). Skin Color Satisfaction Scale. University of Missouri.

Federici, A., Wisniewski, L., & Ben-Porath, D. (2012). Description of an intensive dialectical behavior therapy program for multidiagnostic clients with eating disorders. Journal of Counseling & Development, 90(3), 330–338. https://doi.org/10.1002/j.1556-6676.2012.00041.x

Fursland, A., Byrne, S., Watson, H., La Puma, M., Allen, K., & Byrne, S. (2012). Enhanced cognitive behavior therapy: A single treatment for all eating disorders. Journal of Counseling & Development, 90(3), 319–329. https://doi.org/10.1002/j.1556-6676.2012.00040.x

Garner, D. M. (2004). Eating Disorder Inventory, Third Edition. Psychological Assessment Resources, Inc. https://www.parinc.com/products/EDI-3

Garner, D. M., Olmsted, M. P., Bohr, Y., & Garfinkel, P. E. (1982). The Eating Attitudes Test: Psychometric features and clinical correlates. Psychological Medicine, 12(4), 871–878. https://doi.org/10.1017/S0033291700049163

Gitau, T. M., Micklesfield, L. K., Pettifor, J. M., & Norris, S. A. (2014). Eating attitudes, body image satisfaction and self-esteem of South African Black and White male adolescents and their perception of female body silhouettes. Journal of Child & Adolescent Mental Health, 26(3), 193–205.
https://doi.org/10.2989/17280583.2014.901224

Goel, N. J., Thomas, B., Boutté, R. L., Kaur, B., & Mazzeo, S. E. (2021). Body image and eating disorders among South Asian American women: What are we missing? Qualitative Health Research, 31(13), 2512–2527. https://doi.org/10.1177/10497323211036896

Gormally, J., Black, S., Daston, S., & Rardin, D. (1982). The assessment of binge eating severity among obese persons. Addictive Behaviors, 7(1), 47–55. https://doi.org/10.1016/0306-4603(82)90024-7

Harris, S. M. (2015). Black American female eating dysfunctions and body image: A bioecological perspective. The Negro Educational Review, 66(1–4), 27–54. https://doi.org/10.13140/RG.2.1.4962.6640

Heinberg, L. J., & Thompson, J. K. (1995). Body image and televised images of thinness and attractiveness: A controlled laboratory investigation. Journal of Social and Clinical Psychology, 14(4), 325–338.
https://doi.org/10.1521/jscp.1995.14.4.325

Hollier, C. N. (2019). The influence of body dissatisfaction, colorism and self-esteem on disordered eating behaviors among female Black college students (Publication No. 10929891) [Doctoral dissertation, Howard University]. Proquest Dissertations Publishing.

Hunter, E. A., Kluck, A. S., Cobb-Sheehan, M. D., English, E. M., & Ray, E. (2017). Family food and shape messages: Capturing the experiences of African-American women. Appetite, 118, 26–40.
https://doi.org/10.1016/j.appet.2017.07.020

Javier, S. J. (2017). Sustainable adapted treatments for eating disorders: The role of cultural adaptation in prevention [Doctoral dissertation, Virginia Commonwealth University]. VCU Scholars Compass.
https://doi.org/10.25772/D792-4H68

Jordan, J. V. (2017). Relational–cultural theory: The power of connection to transform our lives. The Journal of Humanistic Counseling, 56(3), 228–243. https://doi.org/10.1002/johc.12055

Jung, J., & Forbes, G. B. (2012). Body dissatisfaction and characteristics of disordered eating among Black and White early adolescent girls and boys. The Journal of Early Adolescence, 33(6), 737–764.
https://doi.org/10.1177/0272431612468504

Kluck, A. S. (2008). Family factors in the development of disordered eating: Integrating dynamic and behavioral explanations. Eating Behaviors, 9(4), 471–483. https://doi.org/10.1016/j.eatbeh.2008.07.006

Labarta, A. C., & Bendit, A. (2024). Culturally responsive and compassionate eating disorder treatment: Serving marginalized communities with a relational-cultural and self-compassion approach. Journal of Creativity in Mental Health, 19(2), 251–261. https://doi.org/10.1080/15401383.2023.2174629

Malachowski, C. C., & Myers, S. A. (2013). Reconstructing the ideal body image in teen fashion magazines. Communication Teacher, 27(1), 33–37. https://doi.org/10.1080/17404622.2012.737926

Matthews, K., Morgan, I., Davis, K., Estriplet, T., Perez, S., & Crear-Perry, J. A. (2021). Pathways to equitable and antiracist maternal mental health care: Insights from Black women stakeholders. Health Affairs, 40(10), 1597–1604. https://doi.org/10.1377/hlthaff.2021.00808

McKinley, N. M., & Hyde, J. S. (1996). The Objectified Body Consciousness Scale: Development and validation. Psychology of Women Quarterly, 20(2), 181–215. https://doi.org/10.1111/j.1471-6402.1996.tb00467.x

Mölbert, S. C., Thaler, A., Mohler, B. J., Streuber, S., Romero, J., Black, M. J., Zipfel, S., Karnath, H.-O., & Giel, K. E. (2018). Assessing body image in anorexia nervosa using biometric self-avatars in virtual reality: Attitudinal components rather than visual body size estimation are distorted. Psychological Medicine, 48(4), 642–653. https://doi.org/10.1017/s0033291717002008

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., . . . Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71

Parker, J. E., Enders, C. K., Mujahid, M. S., Laraia, B. A., Epel, E. S., & Tomiyama, A. J. (2022). Prospective relationships between skin color satisfaction, body satisfaction, and binge eating in Black girls. Body Image, 41, 342–353. https://doi.org/10.1016/j.bodyim.2022.04.004

Patt, M. R., Lane, A. E., Finney, C. P., Yanek, L. R., & Becker, D. M. (2002). Body image assessment: Comparison of figure rating scales among urban Black women. Ethnicity & Disease, 12(1), 54–62.

Rakhkovskaya, L. M., & Warren, C. S. (2014). Ethnic identity, thin-ideal internalization, and eating pathology in ethnically diverse college women. Body Image, 11(4), 438–445. https://doi.org/10.1016/j.bodyim.2014.07.003

Rasmussen, N. (2019). Downsizing obesity: On Ancel Keys, the origins of BMI, and the neglect of excess weight as a health hazard in the United States from the 1950s to 1970s. Journal of the History of the Behavioral Sciences, 55(4), 299–318. https://doi.org/10.1002/jhbs.21991

Reslan, S., & Saules, K. K. (2013). Assessing the prevalence of and factors associated with overweight, obesity, and binge eating as a function of ethnicity. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 18(2), 209–219. https://doi.org/10.1007/s40519-013-0022-2

Rosenberg, M. (1965). Society and the adolescent self-image. Princeton University Press.

Schaefer, L. M., Burke, N. L., Thompson, J. K., Dedrick, R. F., Heinberg, L. J., Calogero, R. M., Bardone-Cone, A. M., Higgins, M. K., Frederick, D. A., Kelly, M., Anderson, D. A., Schaumberg, K., Nerini, A., Stefanile, C., Dittmar, H., Clark, E., Adams, Z., Macwana, S., Klump, K. L., . . . Swami, V. (2015). Development and validation of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4). Psychological Assessment, 27(1), 54–67. https://doi.org/10.1037/a0037917

Scott, A. (2019). 36-24-36: The effect of listening to rap lyrics that promote the curvy ideal on Black women’s body image dissatisfaction (Publication No. 2023-55661-281) [Doctoral dissertation, Purdue University]. https://etd.auburn.edu//handle/10415/7061

Shafran, R., Fairburn, C. G., Robinson, P., & Lask, B. (2003). Body checking and its avoidance in eating disorders. International Journal of Eating Disorders, 35(1), 93–101. https://doi.org/10.1002/eat.10228

Siegfried, R. J. (2021). Eating disorder pathology among discrete groups of Black and Latinx millennial women: Acculturative stress, the thin-ideal and disengagement (Publication No. 29213079) [Doctoral dissertation, Long Island University]. ProQuest Dissertations Publishing. https://www.proquest.com/docview/2675694034?pq-origsite=summon

Small, C., & Fuller, M. (Eds.). (2020). Treating Black women with eating disorders: A clinician’s guide (1st ed.). Routledge. https://doi.org/10.4324/9781003011743

Smith, J. M., Smith, J. E., McLaughlin, E. A., Belon, K. E., Serier, K. N., Simmons, J. D., Kelton, K., Arroyo, C., & Delaney, H. D. (2020). Body dissatisfaction and disordered eating in Native American, Hispanic, and White college women. Eating and Weight Disorders – Studies on Anorexia, Bulimia, and Obesity, 25, 347–355. https://doi.org/10.1007/s40519-018-0597-8

Talleyrand, R. M. (2012). Disordered eating in women of color: Some counseling considerations. Journal of Counseling & Development, 90(3), 271–280. https://doi.org/10.1002/j.1556-6676.2012.00035.x

Talleyrand, R. M., Gordon, A. D., Daquin, J. V., & Johnson, A. J. (2016). Expanding our understanding of eating practices, body image, and appearance in African American women: A qualitative study. Journal of Black Psychology, 43(5), 464–492. https://doi.org/10.1177/0095798416649086

Taylor, J. Y., Caldwell, C. H., Baser, R. E., Faison, N., & Jackson, J. S. (2007). Prevalence of eating disorders among Blacks in the National Survey of American Life. International Journal of Eating Disorders, 40(S3), S10–S14. https://doi.org/10.1002/eat.20451

Thompson, J. K., van den Berg, P., Roehrig, M., Guarda, A. S., & Heinberg, L. J. (2004). The Sociocultural Attitudes Towards Appearance Scale-3 (SATAQ-3): Development and validation. International Journal of Eating Disorders, 35(3), 293–304. https://doi.org/10.1002/eat.10257

Thompson, M. A., & Gray, J. J. (1995). Development and validation of a new body-image assessment scale. Journal of Personality Assessment, 64(2), 258–269. https://doi.org/10.1207/s15327752jpa6402_6

Tricco, A. C., Lillie, E., Zarin, W., O’Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., Hempel, S., Akl, E. A., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M. G., Garritty, C., . . . Straus, S. E. (2018). PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine, 169(7), 467–473. https://doi.org/10.7326/m18-0850

Wilfred, S. A., & Lundgren, J. D. (2021). The Double Consciousness Body Image Scale: A body image assessment centering the experiences of Black women. International Journal of Eating Disorders, 54(10), 1771–1781. https://doi.org/10.1002/eat.23581

Andie Chilson, MS, LGPC, is a psychotherapist at Greenhouse Psychotherapy. Melissa Mecadon-Mann, PhD, NCC, LPC, LSC, is an assistant professor at Western Carolina University. Rebecca Gwira, PhD, is a clinical postdoctoral fellow at the University of North Carolina at Chapel Hill School of Medicine. Loidaly G. Rosario-Singer, PhD, NCC, LCMHC-A, is Founder and Mental Health Consultant of De Colores Family Wellness. Correspondence may be addressed to Andie Chilson, 1519 Connecticut Ave NW, Washington, DC 20036, andie@greenhousepsych.com.

Experiences of Environmentally Aware Young Adults at the Transition From Late Adolescence to Early Adulthood

Kathleen L. Grant, Alyson Pompeo-Fargnoli, Melissa A. Alvaré

The climate crisis is having a significant impact on development and wellness. Young adults face challenges that no earlier generation has experienced, impacting their path toward wellness and thriving. This hermeneutic phenomenological study endeavored to illuminate the experiences of a group of environmentally aware young adults through semi-structured interviews. Thematic analysis, analyzed through Arnett’s theory of emerging adulthood, illustrated participants’ experiences of fear for the future, anxiety, and loss; limited coping strategies for dealing with climate-related emotions; and a perceived tension between their desire to make life choices aligned with their environmental values and a financially stable career. Recommendations for counselors to best serve this population included increasing counselors’ mental health literacy, developing specific strategies to support resilience, and exploring counselors’ ethical responsibilities as advocates.

Keywords: climate crisis, young adults, phenomenological, environmental values, resilience

The climate crisis is expected to have a profound impact on human life in the 21st century (Wuebbles et al., 2017). Evidence of the changing environment is evident everywhere, including historic storms, catastrophic wildfires, record-breaking heatwaves, and severe droughts (Intergovernmental Panel on Climate Change [IPCC], 2023). Americans increasingly believe that the climate crisis is impacting their mental health, with 57.9% of 16–25-year-olds very or extremely worried about climate change, and 38.3% indicating that feelings about climate change negatively impact their daily life (Lewandowski et al., 2024). The consequences of the climate crisis are predicted to continue profoundly impacting mental health (Clayton et al., 2021; Hickman et al., 2021; Sturm et al., 2020).

Definition of the Climate Crisis
     The climate crisis poses a significant threat to the future of human civilization. Each day, millions of tons of man-made greenhouse gases, including carbon dioxide (CO2) and methane, are released into the atmosphere (Wuebbles et al., 2017). Burning fossil fuels, such as oil and natural gas, to fuel modern lifestyles is one of the most significant sources of pollution that contributes to global warming (IPCC, 2023). As greenhouse gas emissions rise, global temperatures exhibit a corresponding increase, leading to sea level rise, heat waves, floods, droughts, and severe storms (IPCC, 2023). In 2014, the United States Department of Defense reported that climate change “will likely lead to food and water shortages, pandemic disease, disputes over refugees and resources, and destruction by natural disasters in regions across the globe” (Banusiewicz, 2014, para. 3). By 2050, anywhere from 200 million to 1 billion people will be displaced from their homes, communities, and possibly countries because of climate-related events such as extreme heat, flooding, and famine (IPCC, 2023). For over three decades, the scientific community has warned of the grave danger of global warming and climate change (Borenstein, 2022). Despite the dire warnings, global greenhouse gas emissions continue to increase (World Meteorological Organization, 2020). Young adults are inheriting a world full of unprecedented and complex challenges (Hickman et al., 2021).

Impact of the Climate Crisis on Young Adults
     A growing body of literature is documenting the impact of the climate crisis on mental health and wellness, particularly among young people and young adults (Clayton et al., 2021; Hart et al., 2014; Hickman et al., 2021; Sturm et al., 2020). Youth, as defined by the United Nations, encompasses individuals aged 15–24, although this definition may vary (United Nations, 2025). This age range also consists of those emerging adults in the unique developmental period of transitioning from adolescence to adulthood (Arnett, 2000). According to a large study (N = 10,000) published in The Lancet, 77% of young people (aged 16–25) surveyed reported that they think the future is frightening, and 45% indicated that their feelings about climate change had a negative impact on their daily lives (Hickman et al., 2021). Research illuminates how experiencing the direct impact of climate change, such as exposure to wildfires, floods, and displacement, can lead to acute anxiety-related responses and chronic and severe mental health disorders (Clayton et al., 2021; Watts et al., 2015).

Climate change and related disasters can cause direct anxiety-related responses and chronic and severe mental health disorders (Pihkala, 2020). A 2018 meta-analysis found an increased incidence of psychiatric disorders and psychological distress in populations exposed to environmental disaster (Beaglehole et al., 2018). Flooding and prolonged droughts have been associated with elevated anxiety levels, depression, and post-traumatic stress disorders (Hickman et al., 2021). Even among members of the population who have not been directly exposed to the impacts of climate change, such as environmental-related disasters, a simple awareness of the problem may evoke feelings of anger, powerlessness, fear, and exhaustion (Moser, 2007).

Emerging research has highlighted the mental health impact of the indirect effects of the climate crisis, such as climate anxiety (Clayton et al., 2021; Hickman et al., 2021; IPCC 2023). Climate anxiety is a response to the current and future threats of a warming planet (Clayton et al., 2021; Hickman et al., 2021). The associated feelings can include grief, fear, anger, worry, guilt, shame, and despair (Clayton et al., 2021; Doherty & Clayton, 2011). It is essential to acknowledge that scholars recognize anxiety as a natural condition of living and acknowledge its potential benefits, as it can motivate individuals to take action and effect change (Hickman et al., 2021). Climate anxiety, although it can be a complex and intense experience, can also be viewed as a congruent response to the dangers and challenges that global citizens will face now and in the future (Hickman et al., 2021).

Young people with marginalized identities will face the most devastating impacts of climate change (Watts et al., 2015). Low-income and Black, Indigenous, and other communities of color are often the most vulnerable to the worst impacts of climate change, such as flooding, drought, fire, and extreme heat (IPCC, 2023). Furthermore, because of intersectional marginalization, some individuals will be at even greater risk for severe impacts and negative mental health consequences (Hayes et al., 2018). Marginalized communities may lack access to mental health resources after traumatic weather-related events or to process the ongoing challenges associated with climate change (Hilert, 2021). The cultural stigma that reduces help-seeking behavior and lack of access to mental health services may also lead marginalized groups to suffer more from poor mental health outcomes (Priebe et al., 2012).

Research indicates that young people are particularly vulnerable to the adverse effects of climate change, largely because of their ongoing physical and mental development, their dependency on adults, and their likelihood of repeated exposure to climate-related events over time (Hart et al., 2014). However, there is a need for more research on the impact of climate change on mental health, especially as it impacts young people (Hickman et al., 2021). The counseling literature has a paucity of studies in this area (Hilert, 2021; Mongonia, 2022). As the impacts of the climate crisis continue to grow more severe, the profession must deepen its understanding of the climate crisis’s effects on young adults and explore paths toward resilience and wellness (Hickman et al., 2021).

Climate-Aware Counselors
     There is a growing need for counselors who are aware of and trained in the mental health impacts of the climate crisis, including climate anxiety (Hilert, 2021). This form of counselor competency includes identifying clients who are experiencing climate-based distress and anxiety (Mongonia, 2022). Although climate anxiety has yet to receive a formal classification in the Diagnostic and Statistical Manual of Mental Disorders (DSM), it is well accepted by counselors as a fear of impending environmental collapse that elicits strong and sometimes debilitating anxiety (Thomas & Benoit, 2022). Counselors must be able to assess and understand how to treat those who present with clinically significant levels of climate anxiety that interfere with functioning and developmental tasks (Pihkala, 2020). Treatment modalities often include teaching resilience and coping skills and increasing support systems (Baudon & Jachens, 2021). Counselors are called upon to support not only their clients through their environmental action but also to take action themselves (Thomas & Benoit, 2022).

Environmental Action
     One intervention that can promote positive mental health outcomes for young adults concerned about the climate crisis is climate activism or sustained efforts to effect positive change (Gislason et al., 2021). Young people have been at the forefront of creating new U.S. climate policy (see Sunrise Movement; Bauck, 2022) and driving action (Rashid, 2023). Climate action can positively bring about necessary social change and provide mental health benefits (Hart et al., 2014). Research suggests that young people engaged in climate action experience several benefits, including increased resilience, agency, a sense of purpose, and community, all of which support positive mental health outcomes (Gislason et al., 2021). However, focusing on the climate crisis can also expose individuals to difficult feelings, such as fear, sadness, loss, and hopelessness (Hickman et al., 2021). It is common for people to employ defense mechanisms, such as denial and minimization, to maintain more positive feelings and a more optimistic view of the future in response to the realities of a changing world (Doherty & Clayton, 2011).

Environmentally Aware Young People
     Environmental awareness can be broadly characterized as a level of consciousness concerning the importance of the natural environment and the impact of humans’ behavior on it (Ham et al., 2016). Environmental awareness often leads to a deeper understanding of the severity of climate change and the urgency to address it (Orunbode et al., 2019). Youth awareness of the climate crisis is associated with a range of emotional and mental health impacts, such as climate anxiety and feelings of grief, loss, anger, guilt, and existential dread (Hickman et al., 2021). However, environmental awareness can also lead to increased action, a sense of purpose, and resilience building (Clayton et al., 2021).

In the 2024 American Climate Perspectives Survey, Americans aged 18–24 reported the highest levels of environmental concern among all age groups (over 80%; Speiser & Ishaq, 2024). Concern over the environment drives some young adults to action, but not all. Scholars suggest that to prevent the most severe consequences of climate change, humans must take action and alter their ways of life (IPCC, 2023; Wuebbles et al., 2017). Environmental awareness and action will be increasingly important as the impact of the climate crisis grows more pervasive and severe (IPCC, 2023). Young adults, in particular, may need to take steps to adapt to the rapidly changing planet. This study involves young people who are aware of the climate crisis, are motivated to act, and have taken a step toward creating change.

Aims of Study
     This study focuses on the experiences of U.S.-based environmentally aware young adults who are moved to take action, aiming to understand their lived experiences as they transition from adolescence into adulthood. This is a significant period in life, as many young people are culminating their educational experiences and choosing who they want to be as adults, both personally and professionally (Arnett, 2014). The research questions guiding this study are: What are the lived experiences of environmentally aware young people as they transition to adulthood? How have their experiences impacted their mental health and understanding of themselves and their roles? How are their environmental experiences influencing their actions and aspirations for their futures (e.g., familial and career goals)?

Method

Hermeneutic phenomenology is a constructivist approach that scrutinizes individuals’ subjective experiences and their interpretations of those experiences, asking “what is the nature of this experience from the individual’s perspective?” (Moustakas, 1994; Ramsook, 2018). The study focused on interpreting the meaning of the lived experiences of the participants, which is crucial given that the experience of entering adulthood during the climate crisis is novel and new structures to understand the nature of this experience may be necessary. Climate engagement for emerging adults involves layered emotions, developmental stage influences, and societal pressures (Arnett, 2010; Clayton et al., 2021; Ogunbode et al., 2019). Hermeneutic phenomenology is well suited to context-rich experiences that cannot be separated from the social, political, and developmental realities in which they occur (Ramsook, 2018; van Manen, 1997). This method enabled us to explore not only what the participants said, but also how they understood themselves in this particular life stage.

Theoretical Framework
    Arnett’s developmental theory of emerging adulthood provided the framework for this study. According to this theory, between the ages of 18 and 29, young people consolidate their identity and explore career paths (Arnett, 2000, 2014). This is a time of possibility, in which multiple futures are open, and instability, as individuals transition from the structure provided by their family of origin and formal education and endeavor to make career and personal choices aligned with their values and aspirations (Arnett, 2000). Social and cultural factors also influence young people as they crystallize their identities and career paths (Arnett, 2010). This theory was selected because we were interested in the dynamic interactions among experiences, emotions, and actions within a critical developmental period and how these factors shape participants. Arnett’s theory and hermeneutic phenomenology both emphasize process, interpretation, and the evolving nature of identity within a specific context.

Participants
     Twelve interviewees, aged 20 to 25, participated in this research. All participants viewed climate change as an important issue and engaged in environmental action, although their methods for addressing it varied. There were seven female and five male interviewees. The majority identified as non-Hispanic White Americans, but two individuals described multiracial identities: one as South Asian and White, and the other as Asian Pacific Islander and White. All but one of the 12 participants were from a middle-class background; one described growing up in a working-class family. Eight participants were residents of New Jersey or Pennsylvania at the time of data collection, while the other four were residents of New Mexico, Colorado, Texas, and Washington, D.C.

Data Collection
     To be included in this study, participants had to be aged 18–25, view climate change as an important issue, have actively engaged in some form of environmental action for at least 6 months, reside in the United States, be able to communicate in English, and consent to participate in an audio-recorded interview lasting 60–90 minutes. Following IRB approval, we contacted key informants—academics in the climate movement who are recognized as leaders because of the reach of their speaking engagements and publications, and with whom we (Kathleen L. Grant and Melissa A. Alvaré) had a prior relationship—to recommend individuals who met the selection criteria. We also utilized social media platforms, including Facebook and Instagram, and posted an IRB-approved recruitment flyer on our personal and publicly accessible sites. Snowball sampling was used, as several respondents recommended their peers for interviews. Recruitment emails described the research study, detailed the interview procedures, and invited people to contact us if they were interested in participating. Once individuals responded to these emails, they were screened to see if they met the inclusion criteria. If so, they were asked to read and sign an informed consent document and complete a demographic questionnaire before scheduling the interview.

Interview questions were designed to elicit rich descriptions of participants’ lived experiences and perspectives. We utilized Arnett’s theory of emerging adulthood, specifically the five features of identity exploration, instability, self-focus, feeling in between, and possibilities/optimism, and considered how these factors would appear in climate awareness and action (Arnett, 2010, 2014). We drew from the existing literature to develop our initial interview guide, first drafting broad, open-ended domains. Then, we met to revise them with a critical eye, working to ensure that we were not asking leading questions or probes that were overly influenced by our own biases and expectations. Taking a phenomenological approach, we also ensured that our questions were crafted to go beyond eliciting descriptions to allow us to explore the meanings participants attached to phenomena of interest (e.g., climate change and career trajectories). We then sent a draft of our interview instrument to a renowned scholar in the field of climate justice, who made recommendations for further revisions.

All interviews were conducted and recorded over Zoom by one of the three authors. In line with the phenomenological tradition and our intentions to explore topics introduced by participants, we used semi-structured interviews. The semi-structured format promoted fluidity, allowing the informal dialogue to emerge and take unexpected directions, as respondents could discuss the topics most meaningful to them (Hesse-Biber & Leavy, 2010). The interview guide included questions such as: “How has learning about the environment impacted you personally, if at all?” “Has your environmental awareness had any impact on your life goals and/or career plans?” “When you think about the future, what feelings come up for you?” and “How, if at all, do you think you have changed as a result of your involvement in environmental action?”

We asked follow-up questions based on participants’ responses and probed—when appropriate—to gain clarity and delve deeper into their experiences and viewpoints. Interviews ranged from 55 to 75 minutes in length, and participants received $15 gift cards as compensation for their time and participation. The audio files from the recorded Zoom videos were sent to a professional transcription service.

Analysis
     Given our hermeneutic phenomenological design, the analysis followed van Manen’s (1997) approach, which involves a cyclical process of reading, reflecting, and writing to uncover thematic structures. Researchers (a) turn to the nature of lived experience, (b) investigate experiences as lived, (c) engage in hermeneutic phenomenological reflection, (d) engage in hermeneutic phenomenological writing, (e) maintain a robust and oriented relation, and (f) balance the research while exploring the parts and whole (van Manen, 1997, pp. 30–31). As Starks and Trinidad (2007) wrote, in coding data from phenomenological inquiries, “specific statements are analyzed and categorized into clusters of meaning” with close attention to “descriptions of what was experienced as well as how it was experienced” (pp. 1375–1376). Transcripts were divided among us for an initial pre-coding of each interview. We each engaged in preliminary note-taking, marking repeated phrases and themes, and memo writing on potential codes and sub-codes during this stage. We then met to discuss initial interpretations of interviews, emergent themes, and perceptions of the powerful and insightful stories shared by participants. At that time, we also devised an initial inductive code and created a codebook and color scheme for the next coding round. We then re-divided the transcripts and each coded four transcripts in shared Microsoft Word documents. Once all 12 interviews were coded, we met again to discuss our analyses and refine and collapse codes. We repeated this process with each reading, using four new transcripts to examine our coding processes and contribute to our analyses with the new code list and interpretations of the data.

Trustworthiness
     Our research team consisted of two counselor educators and one sociologist. We identify as White, middle and upper–middle-class women, aged 35–45, with shared concerns about the climate crisis. We engaged in ongoing discussions about how our social positions, interests, and privileges influenced all phases of the research process.

Trustworthiness was established primarily through prolonged engagement, critical reflexivity, and peer debriefing. We reviewed the audio recordings and transcripts for months. Both listening to the participants’ voices in the audio recordings of interviews and prolonged engagement with the transcripts is crucial for establishing trustworthiness, as it enables the researcher to see the world from each participant’s perspective and pick up on the richness and nuance of the narratives and ensures a thorough understanding of the participants’ statements, all of which are essential for phenomenological analyses (Moustakas, 1994). We were committed to maintaining an open stance and curiosity toward participants’ experiences. Each member of the team engaged in memo writing to document our emerging interpretations and consider how personal preconceptions and backgrounds might be influencing our interpretations. These memos were shared among the team and served as starting points for critical dialogue. We responded to each other’s memos, posing alternative perspectives and challenging probes to push one another to examine how personal biases might be shaping interpretations of the data. We also met regularly to engage in reflexive practice, unpacking the data collectively, scrutinizing our codes and emerging themes, seeking data that did not support the themes that were emerging, and interrogating how personal expectations and life experiences could be influencing our analyses. Whenever we found inconsistencies in our interpretations and/or data categorization schemes, we conducted thorough discussions to reach a consensus and ensure a uniform coding process.

Findings

This study aimed to gain a deeper understanding of the experiences of young adults engaged in environmental action during the transition from late adolescence to early adulthood. In particular, this study focused on the impact of environmental awareness and action on the participants’ development, personally and professionally, as they transition into adulthood. Through a hermeneutic phenomenological analysis of the 12 in-depth interviews, three key themes emerged from the participants’ narratives: 1) Fear for the Future, Anxiety, and Loss; 2) Limited Coping Strategies;
and 3) Tension Between Making a Difference and Making a Living.

Fear for the Future, Anxiety, and Loss
     The environmentally aware participants expressed fear for the future, anxiety, and loss throughout their narratives. Most discussed pervasive anxiety and fear for the future related to the climate crisis. In contrast, other participants were triggered by specific situations, such as a severe weather-related event (locally or globally) or a climate change–related news item (i.e., the release of a UN report on the climate crisis). One participant, Theodora, also reflected on the present-day harm that communities are experiencing: “And it’s here right now, and increased natural disasters are not a future thing; they’re happening. . . . It’s definitely impacted my mental health.” Mary discussed how the climate crisis is causing a “collective trauma” in her generation. She said, “I think it’s really impacting everybody because individual action feels so futile. I think we’re just feeling really lost.” Many of the participants discussed a fear for their future as adults.

The participants specifically shared their fears about the future in light of the climate crisis. They raised questions about where they will live, whether they should have children, and the state of the planet. Brianna stated that it is a “daunting and terrifying idea, if we don’t start to get it [global warming] worked out, just how much of an impact it can have on our future.” Amy stated, “I could say that the climate crisis has negatively impacted mental health . . . [I experience] anxiety and worry about the state of the planet, now and in the future.” Briana described:

It’s pretty hard to feel hopeful, especially since all of us live here in Colorado now, where fires are a big problem and stuff like that. We often have conversations where we’re like, “So the West is going to be on fire, and the Southwest won’t have water, and the coastlines are going to be flooded. Where can we live?”

Three participants (25%) discussed, without specific prompting, whether or not to have a child, as the climate crisis would profoundly impact their child’s life. Nancy stated, “I feel like my generation . . . is not the biggest about having kids. . . . There’s not going to be a good place for us to live.”

Several participants used the terms eco-anxiety and climate grief to discuss their emotional experiences related to climate change. Nancy indicated that reports of natural disasters trigger her eco-anxiety, and Carol stated that she started psychiatric medication partly because of her eco-anxiety. Evan discussed his feelings of climate grief, helplessness, and powerlessness.

Limited Coping Strategies
     The participants discussed various coping strategies for dealing with their intense climate-related emotions. The main strategies were adopting a positive mindset and ignoring or withdrawing from climate information/action. These two strategies are discussed below, after which the remaining strategies are briefly discussed.

The majority of the participants discussed choosing to stay optimistic about the future as a coping strategy. They discussed thinking about all the people, including themselves, who are engaged in climate action to make a difference. Alex discussed guarding against negative feelings by avoiding getting “too down on myself” or adopting “too negative of an outlook” and engaging in individual action as a coping strategy. Participants elaborated on the challenges they faced in maintaining a positive perspective, especially as they age and see an increasing number of negative climate-related events. Jackson stated that it is “more and more of a struggle” to maintain a positive attitude and be motivated to take climate action.

Participants also shared examples of ignoring or withdrawing from climate-related information or action as a means of coping with negative feelings or protecting themselves. Daniel stated, “I have taken an approach of doing the most that I can in my community while choosing to stay a little ignorant on what’s happening globally.” Sarina shared, “I felt pretty stressed and sort of want . . . to give up on trying to help environmental problems because a lot of them are so far gone that it can be pretty discouraging to read about.” Mary elaborated on her emotional experience:

And it almost teaches you, I’ve found, not to feel your feelings. So in a sense, I find myself becoming more apathetic because you’re desensitized to it. You’re seeing it all the time, but you can’t feel it all the time because no one wants to stare into the impending doom of environmental decay or whatever.

     Three of the participants discussed connecting with their community as a means to address their fears and concerns about the climate crisis. All three of these participants reported connecting with others who are environmentally minded or engaged in climate action. One participant discussed therapy as a strategy: “I do see a therapist occasionally. . . . She’s not trained on the eco-side of things. So she tries to understand and gets tools and whatnot, but definitely, it’s not her main area of concern. But she’s been helpful anyways.”

Two participants discussed being in nature, specifically hiking, as a coping mechanism. Mary stated, “Life outside and living a life that is environmentally based actually brings me a lot of joy, and that component of it doesn’t stress me out and give me anxiety.” Sarina shared that she does not have a clear coping strategy:

So even though me and my friends . . . are people who are trying to work towards improving things, I would say we all can feel pretty hopeless about the situation, especially [when] the current government-level response is not very strong. . . . I want to be hopeful, but I would say from a scientific perspective, it can also be pretty hard to feel hopeful for the future. Yeah, I don’t really have an answer. . . . it can be pretty overwhelming, and you just kind of have to try to think about something else. Because I guess I can remind myself I’m already working to try to increase knowledge, and that’s useful. So, I guess I’m playing some positive part, and so I can try to relieve myself with that information. But yeah, I guess I don’t really have a good way to feel better about it.

Tension Between Making a Difference and Making a Living
     The participants in this study were all in a transition period between adolescence and adulthood. In their narratives, many of the participants (n = 7) expressed the tensions between their environmentally based values and the need for a job that would provide economic security. These tensions emerged as the participants struggled to make choices congruent with their stated values and career choices that might have long-term impacts, both individually and for their communities.

The role of money and financial stability was not directly probed for in the interview protocol; however, participants often brought it up when asked what prevents them from engaging in environmental action. Jackson stated, “You can either pursue this as a passion and as an ideal and as a thing to do, or you can . . . make money and have a stable life.” He went on to state:

And so I grew up with a lot of that type of thinking, of like, eventually, you’re going to have to kind of settle your own goals and ideals in order to survive in the world on your own and provide safety nets to your family later on. And so I always kind of grew with that . . . in the back of my mind, and that became more present in college. . . . I think those have been the biggest kind of like detractors . . .  like “You have to choose one or the other.” Like, they [parents] weren’t necessarily discouraging my passion or any of that, they were just kind of like, “It’s one or the other.” Most people fall for the latter, and that’s kind of why we have the issues in the first place.

Evan discussed grappling with either getting paid with a traditional job or engaging in more meaningful environmental activism on a volunteer basis. He shared:

I guess, unfortunately, money is a factor. I found more ways to get paid for teaching than for volunteering my time. You have to think about, “What’s the balance of that going to be?” I need to be able to support myself, and so when I can, I will dedicate time to being active in my community and engaging with environmental issues. So, finding a balance.

Brianna, who was in law school studying environmental law, discussed the tension as she sees it:

Society . . . pins people against environmental work because it’s not lucrative, or they paint it not to be lucrative because I think people can make a decent living and know that they’re doing something beneficial. But I would say that there’s still a stigma in society just surrounding environmental work, and that if you want to make money and you want to live decently, that’s not the field to go into. I fully don’t believe in that anymore, but I think that that played a role in my choices.

Although most participants indicated that financially providing for themselves was a significant detractor from an environmentally focused career, several participants had alternative narratives. Amy, an environmental educator at a nonprofit land trust, discussed the importance of taking time in college to discover her identity and selecting a career aligned with her values, even if it was not financially lucrative. However, her financial realities were still infused into her thinking, reflected by her parents’ repeated refrain: “My parents, from day one, always said, ‘Pursue your passion, do what you love, and the money will come.’” Other participants were exploring careers in academia and research as methods to bring about change and did not mention finances as an impediment to an environmentally oriented career.

Discussion

This study aimed to gain insight into the lived experiences of environmentally aware individuals as they transition from adolescence into adulthood. Specifically, Arnett’s developmental theory of emerging adulthood was utilized to frame these experiences, as it considers the dynamic interactions among experiences, emotions, and actions within this critical developmental period between adolescence and adulthood (Arnett, 2000). In particular, Arnett’s theory provides insight into the tension and instability that young adults experience during this transition, particularly in terms of identity, career, and emotional development.

Three main themes emerged from the participants’ narratives, including feelings of fear for the future, anxiety, and loss; limited coping strategies; and tension between making a living and making a difference. Each participant described fear for the future, anxiety, and loss. These findings align with past research exploring mental health concerning the climate crisis (Gislason et al., 2021; Hickman et al., 2021; Ojala et al., 2021; Sanson et al., 2019). The depth and breadth of the participants’ descriptions of fear and anxiety suggest that thoughts, feelings, and experiences around the climate crisis impact their daily lives. Some participants reported powerful emotional responses to negative news about the climate. They were pondering significant life choices because of the climate crisis (e.g., questions about where to live and whether to have children). As previous researchers have suggested, these responses appear appropriate given the realities of the climate crisis and the expected impact it will have on their lives and those of future generations (Hickman et al., 2021). However, although participants expressed and communicated these fears and anxieties, few seemed to have comprehensive structures (psychological, behavioral, or relational) to act on their pervasive and legitimate concerns. Participants often managed complex feelings and plans independently in the absence of communities informed about their fears and realities for the future, which could help them navigate the challenges and possibilities of a life and a future heavily impacted by the climate crisis.

Although all participants experienced a range of emotional reactions to the climate crisis, they also employed various strategies to manage their feelings. The participants generally appeared to have limited strategies for dealing with challenging climate-related feelings. Most of the strategies were individualistic, and young people had to figure out how to manage their deep and complex emotions independently. Several participants discussed being optimistic as a coping strategy but also voiced that this strategy is ineffective and exhausting. Although keeping a positive attitude in the face of adversity can be beneficial, doing so without acknowledging or feeling the vast array of emotions associated with the climate crisis and their fear for their futures may be ineffective. This finding aligns with the conclusions of Hickman et al. (2021), which demonstrate that young people are facing unique stressors arising from the climate crisis that can impact their development.

Several participants discussed ignoring aspects of the climate crisis or the climate crisis itself to protect themselves. Denial is a common psychological defense to reduce climate-related distress (Doherty & Clayton, 2011). Participants noted that they disengaged from environmental action to avoid challenging feelings related to climate change. These individuals may benefit from positive strategies to manage their emotions, allowing them to take care of themselves and continue to be active citizens working toward change. Finally, participants shared coping strategies, including spending time in nature and engaging in therapy, as strategies to support their mental health. Participants also engaged with environmental communities as a coping strategy, which can be a significant influence during such a developmental period. Social and cultural factors have been shown to influence young people during the development of emerging adulthood as they crystallize their identities and career paths (Arnett, 2010). As the future will include increasingly complex and challenging climate crisis–related issues, individuals in this study may benefit from additional coping strategies, which will be further discussed in the Implications for Counseling section.

The final theme illuminated by the participants is the tension between making a difference and making a living.  Participants discussed the challenges inherent in creating environmental change, often in low-paying or volunteer capacities, and the desire to support themselves financially. Although the participants were interested in environmental action, both professionally and personally, they often struggled to create a life in adulthood where they could enact their values. Participants described examples of their engagement in environmental causes in high school and college but had a more challenging time maintaining action as they transitioned to adulthood. Although part of the challenge seemed to be the lack of clear, viable paths for the participants to engage in environmental action and careers as adults, financial realities also shaped their choices. Participants viewed jobs in the environmental sector as less lucrative than others, and they would not be able to support themselves or their future families on this salary, especially if they wished to maintain the same socioeconomic level as they were offered. Additionally, the participants saw this tension as a dichotomy; they could either have a well-paying career or engage in environmental action.

Implications for Counseling
     Young adults are increasingly experiencing mental health impacts of the climate crisis (Hickman et al., 2021). This study offers insight into the developmental and emotional experiences of young adult participants as they navigate the transition to adulthood, exploring how to make sense of their environmental concerns and act to create change. Counselors, including school counselors, college counselors, career counselors, and clinical mental health counselors, can play a crucial role in supporting mental health and wellness in the context of the climate crisis. Both the National Board for Certified Counselors (NBCC; 2025) and the American Counseling Association (ACA; Sturm et al., 2020) have issued statements emphasizing the need for counselors to advocate for climate action and educate themselves and others on the mental health implications of climate change.

The findings of the current study support the need for counseling services because of climate change impacts on mental health. Findings reveal that participants were experiencing challenging emotions related to the climate crisis and had limited strategies to cope with the changing world. Three implications for counseling are discussed below: increasing counselors’ climate change mental health literacy, supporting resilience, and the ethical responsibility of counselors as advocates.

Recommendation 1: Increase Counselors’ Climate Change Mental Health Literacy
     Counselors must practice “within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience” (ACA, 2014, Section C.2.a.). Many counselor education training programs do not cover the unique experiences and challenges individuals face because of the climate crisis, resulting in a void in counselor education training (Heiman, 2024; Hilert, 2021). Therefore, to ethically assist clients with this need, counselors must continue their education and, where necessary, seek additional supervision to treat this population. As a first step, counselors can consider learning more about the nature of the climate crisis, including the impacts on future generations (Doherty & Clayton, 2011). Publications such as the American Psychological Association’s 2021 report, Mental Health and Our Changing Climate: Impacts, Inequities, and Responses (Clayton et al., 2021), provide a comprehensive overview of the nature of the climate crisis and strategies for mental health practitioners. Counselors can also seek support, training, and consultation through membership in the Climate Psychology Alliance of North America, a community of mental health professionals who educate climate-aware practitioners (https://www.climatepsychology.us).

Participants in this study noted that their mental health practitioners were not adept at addressing their climate anxiety and trauma in sessions. Individuals may not directly broach the topics of climate anxiety, eco-grief, and weather-related PTSD; therefore, counselors must address these topics directly with clients. Climate-aware counselors must facilitate the expression of clients’ emotions about the climate crisis and help them further explore and articulate their experiences (Doherty & Clayton, 2011). Counselors can consider using interventions that facilitate emotional expression and create opportunities for adaptive behaviors (Doherty & Clayton, 2011). Interventions can also include existential therapy, particularly exploring how to find meaning, peace, joy, and hope in the face of ecological collapse and climate-related disasters (Barry, 2022; Frankl, 2006). Finally, eco-therapy is a promising modality for clients that centers healing through nurturing a stronger relationship with nature and the physical environment (Delaney, 2019). As such, it is recommended that counselors expand their knowledge of the climate crisis and its impact on mental health to serve their clients better as well as any supervisees.

Recommendation 2: Supporting Young Adult and Client Resilience
     This study found that participants lacked comprehensive structures to address their climate anxiety and fears about the future. Many participants felt overwhelmed by the climate crisis, which impacted their ability to take action in the climate movement. As a coping strategy to protect themselves from difficult feelings associated with climate change, some participants withdrew from climate information or action. As challenging weather-related events and the impact of the climate crisis are expected to increase in the coming years, young adults must develop both internal and external resources to survive and thrive in a changing world (Gislason et al., 2021).

Fostering resilience is an effective strategy for supporting the mental health and well-being of young adults, including those affected by the climate crisis (Clayton et al., 2021). Resilience can be fostered through the development of both internal and external resources, and counselors can play a crucial role in this process. Internal resources can include increasing self-efficacy or young adults’ belief in their ability to overcome the stress and trauma associated with climate change. Research suggests that those who believe in their ability to withstand the challenges associated with climate change have more positive psychological outcomes than those with lower self-efficacy (Clayton et al., 2021). Belief in one’s resilience is also correlated with fewer symptoms of depression and PTSD after natural disasters (Ogunbode et al., 2019).

Counselors can support young adults in developing external resources that enhance resilience, such as fostering social connections. Social connections to peers and those of different generations can be a vital source of emotional, informational, logistical, and spiritual support (Center for the Study of Social Policy, 2019). Individuals’ ability to withstand trauma and adversity increases when they are connected to strong social networks (Clayton et al., 2021).

Finally, this study found that participants did not have clear paths to enact their environmental values in their adult lives. They faced financial and cultural pressures to choose careers that would allow them to make a living. Although this study highlights that some participants may not have had the internal and external resources to cope with the emotional stressors of engaging in climate-related work, a viable career or civic path was elusive. All counselors who work with young adults, especially school and career counselors, have the opportunity to provide resources about the wide array of jobs available in the green economy, as well as methods to include civic involvement (i.e., participation on local environmental commissions, participation in activist groups, leadership in local government advocating for green policies) when planning one’s adult life. Models of adults who engage in environmental action, both personally and professionally, must be provided to young people as examples of possible paths in adulthood. As taking action is seen to have numerous mental health benefits, specifically as it builds agency, counselors must support clients in developing the attitudes, skills, and behaviors necessary to engage in activism and advocacy (Gislason et al., 2021; Sanson et al., 2019).

Recommendation 3: Ethical Responsibility of Counselors as Climate Advocates
     Counselors are ethically responsible for advocating for the well-being of their clients, as stated in the ACA Code of Ethics (2014): “When appropriate, counselors advocate at individual, group, institutional, and societal levels to address potential barriers and obstacles that inhibit access and/or the growth and development of clients” (Section A.7.a.). The climate crisis is and will continue to significantly negatively impact the growth and development of clients, with young clients and clients from historically marginalized populations such as people of color and people with low incomes among the most vulnerable (IPCC, 2023; Watts et al., 2015). Counselors’ ethical responsibility is to advocate for local, state, and national policies and practices to prevent the most dire climate outcomes and support a livable future for all. This includes the counseling profession’s call for counselors to be active in policy initiatives and advocacy related to climate change (NBCC, 2025).  Such policies may consist of those that support a just transition away from fossil fuels and to renewable sources of energy; agricultural strategies that reduce emissions, shift toward more sustainable diets, and reduce food waste (United Nations Environment Programme, 2020); and nature-based solutions such as stopping deforestation and ecological degradation and moving toward ecosystem regeneration (United Nations Environment Programme, 2020). As the impacts of the climate crisis are felt most significantly in communities of color (who are more likely to be situated in floodplains, heat islands, downwind from fossil fuel-burning plants, etc.), there is an added ethical responsibility to advocate for the well-being of the most vulnerable.

Limitations and Future Research
     This study had several limitations. First, the majority of participants identified as White and middle class. The study would have benefited from a greater diversity of participants to gain a broader perspective on cultural differences as they relate to the experiences of climate change, development, and mental health. Additional research is necessary to gain insight into the experiences of young adults across the intersections of identity, specifically focusing on those who will suffer the greatest impacts of the climate crisis, such as individuals from the global majority and low-income households. Secondly, all participants in this study were currently or had been previously engaged in some level of environmental action. The results of this study may not be applicable to those who are concerned about climate change but not actively engaged in taking action. Finally, although a sample size of 12 was suitable for the goals of this research and the standards of hermeneutic phenomenology (van Manen, 1997), the nature of qualitative research limits the ability to generalize these findings.

The participants in this study struggled with diverging from the status quo to make choices aligned with their values. In particular, values associated with individualism and capitalism frequently appeared as roadblocks, such as pressure to make a certain financial living and engaging with problems and solutions from an individualistic perspective. More research is needed to understand how young people challenge and resist dominant cultural values that prevent them from taking action to bring about environmental change and may contribute to poor mental health outcomes.

Conclusion

This study sheds light on the lived experiences of environmentally aware young people. Commensurate with previous findings, participants expressed fear for the future, anxiety, and loss (Hickman et al., 2021). This study highlighted the limited comprehensive strategies available to young people for addressing their climate-related emotions, which affected their ability to remain engaged in climate action. Additionally, participants felt significant cultural and financial pressure to make a living, which stood in contrast to their ability to engage in personal or professional environmental action. Counselors can support young adults by enhancing their climate-related mental health literacy, offering climate-specific interventions to increase their resilience, and engaging in social change through advocacy.

 

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

References

American Counseling Association. (2014). ACA code of ethics. https://bit.ly/acacodeofethics

Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55(5), 469–480. https://doi.org/10.1037/0003-066X.55.5.469

Arnett, J. J. (2010). Emerging adulthood(s): The cultural psychology of a new life stage. In L. A. Jensen (Ed.), Bridging cultural and developmental approaches to psychology: New syntheses in theory, research, and policy
(pp. 255–275). Oxford University Press. https://doi.org/10.1093/acprof:oso/9780195383430.003.0012

Arnett, J. J. (2014). Emerging adulthood: The winding road from the late teens through the twenties (2nd ed.). Oxford University Press. https://doi.org/10.1093/acprof:oso/9780199929382.001.0001

Banusiewicz, J. D. (2014). Hagel to address ‘threat multiplier of climate change.’ U.S. Department of Defense. https://www.defense.gov/News/News-Stories/Article/Article/603440/hagel-to-address-threat-multiplier-of-climate-change

Barry, E. (2022, February 6). Climate change enters the therapy room. The New York Times. https://www.nytimes.com/2022/02/06/health/climate-anxiety-therapy.html

Bauck, W. (2022, November 28). Where the Sunrise Movement goes from here. Slate. https://slate.com/news-and-politics/2022/11/sunrise-movement-biden-ira-2024.html

Baudon, P., & Jachens, L. (2021). A scoping review of interventions for the treatment of eco-anxiety. International Journal of Environmental Research and Public Health, 18(18), 9636. https://doi.org/10.3390/ijerph18189636

Beaglehole, B., Mulder, R. T., Frampton, C. M., Boden, J. M., Newton-Howes, G., & Bell, C. J. (2018). Psychological distress and psychiatric disorder after natural disasters: Systematic review and meta-analysis. The British Journal of Psychiatry, 213(6), 716–722. https://doi.org/10.1192/bjp.2018.210

Borenstein, S. (2022, February 28). UN climate report: ‘Atlas of human suffering’ worse, bigger. Associated Press. https://apnews.com/article/climate-science-europe-united-nations -weather-8d5e277660f7125ffdab7a833d9856a3

Center for the Study of Social Policy. (2019). Youth thrive: Protective & promotive factors for healthy development and well-being. https://cssp.org/wp-content/uploads/2025/04/core-meanings-youth-thrive-protective-promotive-factors.pdf

Clayton, S., Manning, C., Speiser, M., & Hill, A. N. (2021). Mental health and our changing climate: Impacts, inequities, responses. American Psychological Association. https://www.apa.org/news/press/releases/mental-health-climate-change.pdf

Delaney, M. E. (2019). Nature is nurture: Counseling and the natural world. Oxford University Press.

Doherty, T. J., & Clayton, S. (2011). The psychological impacts of global climate change. American Psychologist, 66(4), 265–276. https://doi.org/10.1037/a0023141

Frankl, V. E. (2006). Man’s search for meaning: An introduction to logotherapy (4th ed.). Beacon.

Gislason, M. K., Kennedy, A. M., & Witham, S. M. (2021). The interplay between social and ecological determinants of mental health for children and youth in the climate crisis. International Journal of Environmental Research and Public Health, 18(9), 4573. https://doi.org/10.3390/ijerph18094573

Ham, M., Mrčela, D., & Horvat, M. (2016). Insights for measuring environmental awareness. Ekonomski vjesnik: Review of Contemporary Entrepreneurship, Business, and Economic Issues, 29(1), 159–176.

Hart, R., Fisher, S., & Kimiagar, B. (2014). Beyond projects: Involving children in community governance as a fundamental strategy for facing climate change. In UNICEF Office of Research (Ed.), The challenges of climate change: Children on the front line (pp. 92–97).

Hayes, K., Blashki, G., Wiseman, J., Burke, S., & Reifels, L. (2018). Climate change and mental health: Risks, impacts and priority actions. International Journal of Mental Health Systems, 12(28). https://doi.org/10.1186/s13033-018-0210-6

Heiman, N. (2024). Climate change in and out of the therapy room. Nature Climate Change, 14, 412–413.
https://doi.org/10.1038/s41558-024-01979-3

Hesse-Biber, S. N., & Leavy, P. (2010). The practice of qualitative research (2nd ed.). SAGE.

Hickman, C., Marks, E., Pihkala, P., Clayton, S., Lewandowski, R. E., Mayall, E. E., Wray, B., Mellor, C., & van Susteren, L. (2021). Climate anxiety in children and young people and their beliefs about governmental responses to climate change: A global survey. The Lancet Planetary Health, 5(12), E863–E873. https://doi.org/10.1016/S2542-5196(21)00278-3

Hilert, A. J. (2021). Counseling in the Anthropocene: Addressing social justice amid climate change. Journal of Multicultural Counseling and Development, 49(3), 175–191. https://doi.org/10.1002/jmcd.12223

Intergovernmental Panel on Climate Change. (2023). Climate change 2022: Impacts, adaptation and vulnerability: Working group II contributions to the sixth assessment report of the intergovernmental panel on climate change. Cambridge University Press. https://doi.org/10.1017/9781009325844

Lewandowski, R. E., Clayton, S. D., Olbrich, L., Sakshaug, J. W., Wray, B., & Schwartz, S. E. O., Augustinavicius, J., Howe, P. D., Parnes, M., Wright, S., Carpenter, C., Wiśniowski, A., Ruiz, D. P., & van Susteren, L. (2024). Climate emotions, thoughts, and plans among US adolescents and young adults: A cross-sectional descriptive survey and analysis by political party identification and self-reported exposure to severe weather events. The Lancet Planetary Health, 8(11), E879–E893. https://doi.org/10.1016/S2542-5196(24)00229-8

Mongonia, L. (2022). Climate change and mental health: The counseling professional’s role. Journal of Counselor Leadership and Advocacy, 9(1), 57–70. https://doi.org/10.1080/2326716X.2022.2041505

Moser, S. C. (2007). More bad news: The risk of neglecting emotional responses to climate change information. In S. C. Moser & L. Dilling (Eds.), Creating a climate for change: Communicating climate change and facilitating social change (pp. 64–80). Cambridge University Press. https://doi.org/10.1017/CBO9780511535871.006

Moustakas, C. (1994). Phenomenological research methods. SAGE.

National Board for Certified Counselors. (2025). Policy recommendations to support professional counseling in the era of climate change. https://www.nbcc.org/resources/nccs/newsletter/climate-change-policy-recommendations

Ogunbode, C. A., Böhm, G., Capstick, S. B., Demski, C., Spence, A., & Tausch, N. (2019). The resilience paradox: Flooding experience, coping and climate change mitigation intentions. Climate Policy, 19(6), 703–715. https://doi.org/10.1080/14693062.2018.1560242

Ojala, M., Cunsolo, A., Ogunbode, C. A., & Middleton, J. (2021). Anxiety, worry, and grief in a time of environmental crisis: A narrative review. Annual Review of Environment and Resources, 46, 35–58.
https://doi.org/10.1146/annurev-environ-012220-022716

Pihkala, P. (2020). Anxiety and the ecological crisis: An analysis of eco-anxiety and climate anxiety. Sustainability, 12(19), 7836. https://doi.org/10.3390/su12197836

Priebe, S., Matanov, A., Schor, R., Straßmayr, C., Barros, H., Barry, M. M., Díaz-Olalla, J. M., Gabor, E., Greacen, T., Holcnerová, P., Kluge, U., Lorant, V., Moskalewicz, J., Schene, A. H., Macassa., G., & Gaddini, A. (2012). Good practice in mental health care for socially marginalized groups in Europe: A qualitative study of expert views in 14 countries. BMC Public Health, 12, 248–260. https://doi.org/10.1186/1471-2458-12-248

Ramsook, L. (2018). A methodological approach to hermeneutic phenomenology. International Journal of Humanities and Social Sciences, 10(1), 14–24. https://ijhss.net/index.php/ijhss/article/viewFile/408/124

Rashid, S. (2023, December 7). Rising up: How youth are leading the charge for climate justice. United Nations Development Programme. https://www.undp.org/blog/rising-how-youth-are-leading-charge-climate-justice

Sanson, A. V., Van Hoorn, J., & Burke, S. E. L. (2019). Responding to the impacts of the climate crisis on children and youth. Child Development Perspectives, 13(4), 201–207. https://doi.org/10.1111/cdep.12342

Speiser, M., & Ishaq, M. (2024). Americans expect U.S. EPA to ensure a safe and healthy environment and will support climate solutions that protect health and children. https://ecoamerica.org/wp-content/uploads/2023/01/ACPS-2024-Vol-I.pdf

Starks, H., & Trinidad, S. (2007). Choose your method: A comparison of phenomenology, discourse analysis, and grounded theory. Qualitative Health Research, 17(10), 1372–1380. https://doi.org/10.1177/1049732307307031

Sturm, D. C., Daniels, J., Metz, A. L., Stauffer, M., & Reese, R. (2020). Fact sheet. American Counseling Association. https://www.counseling.org/docs/default-source/center-resources/climate-change-fact-sheet.pdf?sfvrsn=83c7222c%5C_2

Thomas, I., & Benoit, L. (2022). A guide to eco-anxiety: How to protect the planet and your mental health; What we think about when we try not to think about global warming: Toward a new psychology of climate action. Journal of the American Academy of Child & Adolescent Psychiatry, 61(2), 342–345.
https://doi.org/10.1016/j.jaac.2021.11.025

United Nations. (2025). Youth. https://www.un.org/en/global-issues/youth

United Nations Environment Programme. (2020). Emissions gap report 2020. https://www.unep.org/emissions-gap-report-2020

van Manen, M. (1997). Researching lived experience: Human science for an action sensitive pedagogy (2nd ed.). Routledge. https://doi.org/10.4324/9781315421056

Watts, N., Adger, W. N., Agnolucci, P., Blackstock, J., Byass, P., Cai, W., Chaytor, S., Colbourn, T., Collins, M., Cooper, A., Cox, P. M., Depledge, J., Drummond, P., Ekins, P., Galaz, V., Grace, D., Graham, H., Grubb, M., Haines, A., . . . Costello, A. (2015). Health and climate change: Policy responses to protect public health. The Lancet, 386(10006), 1861–1914. https://doi.org/10.1016/S0140-6736(15)60854-6

World Meteorological Organization. (2020, March 9). State of global climate 2019. https://wmo.int/publication-series/state-of-global-climate-2019

Wuebbles, D., Easterling, D. R., Hayhoe, K., Knutson, T., Kopp, R. E., Kossin, J. P., Kunkel, K. E., LeGrande, A. N., Mears, C., Sweet, W. V., Taylor, P. C., Vose, R. S., & Wehner, M. F. (2017). Our globally changing climate. In D. J. Wuebbles, D. W. Fahey, K. A. Hibbard, D. J. Dokken, B. C. Stewart, and T. K. Maycock (Eds.), Climate science special report: Fourth national climate assessment, Volume 1 (pp. 35–72). U.S. Global Change Research Program. https://www.nrc.gov/docs/ML1900/ML19008A410.pdf

 

Kathleen L. Grant, PhD, NCC, is an associate professor at The College of New Jersey. Alyson Pompeo-Fargnoli, PhD, NCC, LPC, is an associate professor at Monmouth University. Melissa A. Alvaré, PhD, is a lecturer at Monmouth University. Correspondence may be addressed to Kathleen L. Grant, 2000 Pennington Rd, Ewing Township, NJ 08618, grant24@tcnj.edu.

Beyond Awareness: Actionable Recommendations for Counselor Educators to Combat Ableism

Julie C. Hill, Toni Saia, Marcus Weathers, Jr.

Ableism is often neglected in conversations about oppression and intersectionality within counselor education programs. It is vital to expand our understanding of disability as a social construct shaped by power and oppression, not a medical issue defined by diagnosis. This article is a call to action to combat ableism in counselor education. Actionable recommendations include: (a) encouraging professionals to define and discuss ableism; (b) including disability representation in course materials; (c) engaging in conversations about disability with students; (d) collaborating with, responding to, and supporting disabled people and communities; and (e) reflecting on personal biases to help dismantle ableism within counselor education. Implications for counselor educators highlight the ongoing need for more ableism content within the profession.

Keywords: ableism, disability, counselor education, representation, biases

Disability is rarely examined through intersectionality and critical consciousness, despite its deep connections to race, class, gender, and other social identities (Berne et al., 2018). As the United States becomes increasingly diverse, the need for counselors who can competently address the complex, intersecting needs of disabled people has never been more urgent (Dollarhide et al., 2020). Disabled people are the largest and fastest-growing minority group, with approximately 60 million people reporting some form of disability (Elflein, 2024). Despite this increasing prevalence, ableism, known as the systemic discrimination and exclusion of disabled people, remains persistent in our society. Slesaransky-Poe and García (2014) further discuss ableism as the belief that disability makes someone less deserving of many things, including respect, education, and access within the community.

Ableism and ableist beliefs have profoundly shaped how society perceives and interprets the disability experience. Historically, the medical model has framed disability as an inherent defect within the individual, requiring treatment, rehabilitation, or correction to restore “normal” functioning (Leonardi et al., 2006). This deficit-based perspective, reinforced by legal definitions, has shaped societal attitudes and policies, often prioritizing intervention over community integration. In contrast, the social model of disability shifts the focus from the individual to the broader societal structures, emphasizing how inaccessible environments, exclusionary policies, and ableist attitudes create disabling conditions (Bunbury, 2019; Friedman & Owen, 2017; Shakespeare, 2006). This model asserts that disability is not simply a medical issue, but a social justice concern requiring systemic change to remove barriers and promote full participation. Within counselor education programs, the biopsychosocial model is often taught as a more integrative framework that acknowledges disability as a complex interplay of biological, psychological, and social factors. Although medical interventions may be necessary for some individuals, this model emphasizes addressing environmental and attitudinal barriers contributing to marginalization. By adopting this holistic approach, counselors can better advocate for equity, inclusion, and meaningful accessibility for all.

This article provides an asset-based framework that views disability as a valuable aspect of diversity rather than a deficit or limitation. This approach recognizes the strengths, perspectives, and contributions that disabled people bring to communities and educational spaces (Olkin, 2002; Perrin, 2019). By embracing disability as an aspect of diversity, this framework challenges societal norms rooted in ableism, which often prioritize conformity and cure over anti-ableism (Bogart & Dunn, 2019). Through this lens of power and oppression, disability is celebrated as a source of innovation, creativity, and cultural richness, encouraging practices that empower disabled individuals to thrive both in the classroom and in the community. To reinforce this shift in thinking to disability as an asset, we use identity-first language, recognizing that many disabled people prefer it as a positive affirmation of their lived experiences and their connection to the disability community (Sharif et al., 2022; Taboas et al., 2023).

Intersectionality and Disability
     Scholars recognize intersectionality as an analytical tool to investigate how multiple systems of oppression interact with an individual’s social identities, creating complex social inequities and unique experiences of oppression and privilege for individuals with multiple marginalized identities (Collins & Bilge, 2020; Crenshaw, 1989; Grzanka, 2020; Moradi & Grzanka, 2017; Shin et al., 2017). The topic of disability is often absent in conversations regarding power, oppression, and privilege (Ben-Moshe & Magaña, 2014; Erevelles & Minear, 2010; Frederick & Shifrer, 2018; Mueller et al., 2019; Wolbring & Nasir, 2024) despite the potential for disability to intersect with other marginalized identities (e.g., racial/ethnic identity, gender identity, socioeconomic status, religious and spiritual beliefs, citizenship/immigration status) that lead to intersectionality-based challenges that conflict with the marginalization of being disabled (Wolbring & Nasir, 2024). For example, Lewis and Brown (2018) condemned the lack of accountability in reporting on disability, race, and police violence, which often irresponsibly neglects the coexistence of disability in conversations of experienced violence. Using the framework of intersectionality responsibly in disability discourse within counselor education holds significant potential for the professional development of counselors to work toward unmasking and dismantling ableism.

Challenges and Gaps in Anti-Ableism in Counselor Education and Training

How counselor educators teach about disability is crucial to dismantling ableism, yet history reveals a troubling lack of cultural humility in educational approaches. Cultural humility is a process-oriented approach that continuously emphasizes the counselor’s openness to learn about a client’s culture and invites counselors to consistently incorporate self-reflective activities to enhance their self-awareness (Mosher et al., 2017). Although cultural humility may be well intended, it may also have a harmful impact and fall flat if inherent biases go unrecognized. For example, counselor educators heavily relied on simulation exercises to address disability in the classroom (e.g., having students blindfold themselves for an activity to simulate blindness or having them sit in a wheelchair for a short period). Simulation exercises reinforce a deeply medicalized and reductive view of disability, one rooted in fear, pity, and misconception, ultimately erasing disability as both a culture and an identity (Öksüz & Brubaker, 2020; Shakespeare & Kleine, 2013). Beatrice Wright (1980, as cited in Herbert, 2000), cautioned that simulation experiences evoke fear, aversion, and guilt. These exercises rarely foster meaningful or constructive perspectives on disability. Instead of deepening understanding, these exercises risk reinforcing harmful stereotypes, further marginalizing disabled individuals rather than empowering them. Instead of disability simulations, honor the voices and experiences of disabled individuals through their narratives, such as Being Heumann by Judy Heumann, as well as documentaries and movies like Crip Camp, Patrice, or CODA. Contact with disabled individuals has been shown to reduce stigma against disabled people (Feldner et al., 2022; Smith et al., 2011). Additionally, incorporate analyzing ableism through case studies, readings, or media, followed by a structured discussion.

Topics of multiculturalism and diversity have increased over the years; the same cannot be said for disability (Rivas, 2020). Davis (2011) poignantly asked, “Is this simply neglect, or is there something inherent in the way diversity is considered that makes it impossible to recognize disability as a valid human identity?” (p. 4). More than a decade later, this question remains painfully relevant. Atkins et al. (2023) explored this issue through a study using the Counseling Clients with Disabilities Scale to evaluate professionals’ attitudes, competencies, and preparedness when working with disabled clients. The findings underscore the critical need for education and exposure to disability-related topics in counselor training, demonstrating that such efforts improve competency, reduce biases, and foster more inclusive, equitable, and empowering support. However, disability continues to receive significantly less attention than other cultural and identity groups in professional training and discourse (Deroche et al., 2020).

Furthermore, ableist microaggressions continue to be a concern for disabled individuals. Cook and colleagues (2024) conducted a study looking at microaggressions experienced by disabled individuals and found four categories of microaggressions: minimization, denial of personhood, otherization, and helplessness. They also found that experiencing ableist microaggressions affected participants’ mental health and wellness. Additionally, they found that those with visible disabilities were more likely to experience ableist microaggressions than those with invisible disabilities. Given these findings, counselor educators need to be aware that ableist microaggressions exist, what those microaggressions may sound like, and how they impact disabled clients.

Concerns exist about the extent to which counselor education programs cover disability content; there is also a need to examine instructors’ preparedness for covering such content. In a survey of counselor educators in programs accredited by the Council for the Accreditation of Counseling and Related Educational Programs (CACREP), 36% of the faculty surveyed believed their program was ineffective at addressing disability topics and that programs did not address disability and ableism to the extent necessary to produce competent professionals. Only 10.6% felt their program to be “very effective” in this content area, with the belief that their students were only somewhat prepared to work with disabled people (Feather & Carlson, 2019). Notably, these oversights in education translate into inadequacy in practice. A sample of mental health professionals who all reported working with disabled clients indicated the least amount of perceived disability competence in skills, the second least competence in knowledge, and the most competence in awareness (Strike et al., 2004). Faculty self-assessment of their ability to teach disability-related content was strongly linked to their prior work or personal experience with disability. This highlights the importance of integrating exposure to and training on disability-related concepts throughout core areas (Pierce, 2024). Although separated by a decade, these studies can be tied to a unifying, persistent issue: the lack of disability competence in counseling and counselor education spaces.

The 2024 CACREP standards call for an infusion of disability competencies into counseling curricula (CACREP, 2023), meaning that counselor educators and counselors-in-training must reimagine the available literature to provide adequate professional development and growth. Pierce (2024) advised that disability competence areas be focused on the following topics: accessibility, able privilege, disability culture, and disability justice. We must seek to dismantle ableism by infusing disability into curricula in an authentic manner that highlights the societal values and attitudes in which multiple forms of oppression work in tandem to create unique, intersectional experiences for disabled people.

Training Recommendations for Counselor Education Programs

The authors aim to ensure counselor educators have tangible strategies to dismantle ableism and teach their students to do the same. Counselor educators and counselors-in-training must look inward and rid themselves of negative attitudes and biases to eradicate ableism. Part of this process includes the critical skill of self-reflection and examining and understanding biased and ableist beliefs held by individuals and perpetuated by society. Until that happens, counselors will continue to do a disservice to disabled people (Friedman, 2023). For students who have never interacted with disabled people or thought about ableism, these conversations and strategies have the very real possibility of making them uncomfortable. Discomfort is okay. Disabled people often feel awkward or out of place every day because of ableism. It is not our job as counselor educators to make students comfortable; it is our job to make them competent, informed, and ethical professionals.

The following are five tangible strategies to thoughtfully and intentionally dismantle ableism. These strategies are purposefully broad and aim to expose counseling professionals and those in training to an intersectional perspective of disability that acknowledges disability as a valid aspect of diversity, identity, and culture. Rather than siloing these discussions to disability-related training, these strategies belong in all settings within counseling. Counseling professionals must include ableism in the conversations happening in places where they learn and work to shift the way they think, view, respond to, and construct disability. To begin, counselor education programs should consider hosting a workshop or seminar focused on ableism by disabled people to ensure that all students and faculty are on the same page and are using the same terminology. Once this has been established, ableism and disability content and knowledge should be incorporated into lectures, assignments, discussions, and exams across the counselor education curriculum. Further information on this integration is described in the first strategy below.

Define Ableism
     One of the factors that further perpetuates ableism is the lack of clarity on what ableism is and how it intersects with other forms of oppression. Counselor educators must share definitions of ableism that center on the perspective of the disabled community. Talia Lewis (2022) provided a working definition of ableism that disabled Black/negatively racialized communities developed:

A system of assigning value to people’s bodies and minds based on societally constructed ideas of normalcy, productivity, desirability, intelligence, excellence, and fitness. These constructed ideas are deeply rooted in eugenics, anti-Blackness, misogyny, colonialism, imperialism, and capitalism. This systemic oppression leads to people and society determining people’s value based on their culture, age, language, appearance, religion, birth or living place, “health/wellness,” and/or their ability to satisfactorily re/produce, “excel,” and “behave.” You do not have to be disabled to experience ableism. (para. 4–6)

This definition expands on the definition provided earlier of ableism as the systemic discrimination and exclusion of disabled people. It rejects the notion that ableism can be dismantled or separated from other forms of oppression (e.g., racism, sexism, and other systems of oppression). Within counseling curricula, we often use the term intersectionality, but it is impossible to address intersectionality with our students if we do not thoughtfully include ableism. We should challenge the idea that disability is a monolithic experience as we seek to build a more complex, interconnected, and whole understanding of disability (Mingus, 2011).

It is also essential to acknowledge internalized ableism, which is ableism directed inward when a disabled person consciously or unconsciously believes in the harmful messages they hear about disability. They project negative feelings onto themselves. They start to believe and internalize the message that society labels disability as inferior. They begin to accept the stereotypes. Internalized ableism occurs when individuals are so heavily influenced by stereotypes, misconceptions, and discrimination against disabled people that they start to think that their disabilities make them inferior (Presutti, 2021). For example, a disabled student may not participate in class because they believe their contributions are inferior compared to their nondisabled peers, or a disabled client may experience feeling undeserving, undesirable, and burdensome.

To effectively implement this awareness, ask students to define ableism in their own words. Coming up with their definition of ableism encourages critical thinking and allows the counselor educator to gauge students’ existing understanding. Then, introduce the Lewis (2022) definitions above to provide a more comprehensive framework. To reinforce these concepts, incorporate case studies illustrating real-world examples of ableism. Analyzing these cases in class discussions or group activities will help students identify ableist structures, challenge assumptions, and explore solutions for creating more welcoming environments. Counselors can examine ableism in societal contexts by viewing movies or television shows that feature disabled characters and analyzing how ableism is portrayed in media. Because of societal barriers to access and the taboos surrounding discussions of disability, the entertainment and news media serve as a key source for many people to form opinions about disability and disabled individuals. Unfortunately, these portrayals are limited and often spread misinformation and harmful stereotypes (Pierce, 2024). One way to help combat this could be by watching a movie or show together as a class and then having a discussion or having students watch on their own and write a short reflection followed by a class discussion. Some suggested movies include Crip Camp, Murderball, The Temple Grandin Story, Patrice, and Out of My Mind. Some suggested television shows include Speechless, Love on the Spectrum, Special, Raising Dion, Atypical, and The Healing Powers of Dude.

Include Disability Representation in Course Content
     The phrase “representation matters” also applies to disability. Counselor educators should include disability and discussions of the impact of systemic ableism throughout course content, not only in a single lecture or reading on the course syllabus. Decisions about course content send powerful messages about what the counselor educator, the program, and the broader counseling profession prioritize and value. Including or excluding specific topics reflects the educator’s perspective and shapes future counselors’ professional identity and competencies. When disability is overlooked or inadequately addressed, it signals to students that it is not a central concern in counseling practice, which reinforces systemic gaps in knowledge, awareness, and advocacy. To counter this erasure and to ensure meaningful representation, intentionally incorporate guest speakers, videos, readings, memoirs, and research that center on the perspectives of disabled people. This gives students an authentic and multifaceted understanding of disability beyond theoretical discussions. Consider integrating a book or memoir that centers a disabled perspective alongside the course textbook to bridge the gap between academic content and real-life experiences. This approach not only deepens students’ engagement but also challenges ableist assumptions by highlighting the lived realities, resilience, and contributions of disabled people.

Engage in Conversation About Disability With Students
     Disability is not a bad word. Counselor educators must instill this simple yet profound truth in students. Euphemisms like differently abled, handicapable, or special needs perpetuate ableism when used in place of the term disability, implying that disability is something shameful or in need of softening; they do more harm than good. Counselor educators must allow students the opportunity to engage in discussion about disability to challenge the idea that disability is taboo and move into a space where students can appreciate that disability is a natural part of life. Counselor educators must foster a safe and supportive learning community that allows students to engage in dialogue and discussion about their beliefs and experiences that have shaped their beliefs, and examine how those beliefs led to the development or perpetuation of ableist ideas and microaggressions. This allows students to learn, grow, and reshape their beliefs and understanding together. This quote sums it up best: “Disabled people are reclaiming our identities, our community, and our pride. We will no longer accept euphemisms that fracture our sense of unity as a culture: #SaytheWord” (Andrews et al., 2019, p. 6). To empower students to #SayTheWord in both classroom discussions and professional practice, dedicate time, especially during the first weeks of class, to explicitly affirm that disability is not a bad word. Normalize its use by providing historical context, sharing first-person perspectives, and emphasizing the importance of language in shaping attitudes. By reinforcing disability as an act of recognition rather than avoidance, you help students develop confidence in using identity-affirming language and challenging the stigma often associated with the term.

Collaborate, Respond, and Support Disabled People
     Counselor educators, counselors, and counselors-in-training should seek opportunities to listen to, respond to, support, and collaborate with disabled counselors and other disabled scholars. Thoughtful collaborations allow for authentic exposure and conversation that support the unlearning of ableist beliefs. This approach is consistent with the disability rights mantra “nothing about us without us” (Charlton, 1998, p. 3), which implies that no change can occur without the direct input of disabled individuals. One opportunity for collaboration includes professional conferences and attending presentations by disabled academics and professionals. Other opportunities for collaboration include working with and supporting local disabled business owners and seeking out organizations such as independent living centers to bring in disabled speakers to share their lived experience and interactions with ableism and microaggressions. Be sure to compensate these individuals for their time so that the work of collaboration is mutually beneficial to all parties.

Disabled people are the experts of their experiences, not professionals. This statement is not synonymous with implementing a client-centered or person-centered approach. Instead, the focus of this statement is to make sure counselors have the tools to trust, support, uplift, and dismantle ableism with disabled clients. If it starts in the classroom, counselors-in-training will be better prepared in practice and life outside of work. As professionals know, trust in the counselor-client relationship is essential for the disabled community. It often develops when individuals feel heard, trusted, and validated, rather than being second-guessed or minimized, especially as they share about the external and internal ableism they face daily. Lund (2022) recommended consulting with both disabled psychologists and trainees to bring a “critical insider-professional perspective” (p. 582) to the profession. By consulting and bringing these disabled professionals in for training or speaking about personal experiences, we can ensure that disabled voices are heard and recognized.

Another way to amplify disabled voices is through the teaching of disability justice. The Disability Justice framework affirms that every person’s body holds inherent value, power, and uniqueness. It recognizes that identity is shaped by the interconnected influences of ability, race, gender, sexuality, class, nationality, religion, and other factors. It stresses the importance of viewing these influences together rather than separately. From this perspective, the fight for a just society must be grounded in these intertwined identities while also acknowledging Berne et al.’s (2018) critical insight that the current global system is “incompatible with life” (para. 13). Central principles of disability justice, such as centering leadership by those most impacted, fostering interdependence, ensuring collective access, building cross-disability solidarity, and pursuing collective liberation, prioritize intersectionality and cross-movement collaboration to guarantee that no one is excluded or left behind. (Pierce, 2024).

Helping students understand and internalize these ideas and principles should lead to the development of more aware and anti-ableist counselors in several ways. Rather than viewing client struggles as isolated or purely personal issues, understand that many forms of suffering, especially those faced by disabled people and people with intersecting marginalized identities, are rooted in larger social, economic, and political systems that devalue certain lives. For example, ableism, racism, and capitalism often create conditions that threaten people’s survival, whether through limited access to health care, environmental injustice, or social exclusion.

Counselors-in-training should be attuned to how multiple aspects of identity (such as disability, race, gender, and class) interact to shape each client’s lived experience. This approach moves counseling away from a one-size-fits-all perspective and helps address the unique, layered barriers that clients face. Traditional counseling and counselor preparation often focus on assisting clients to adapt to oppressive systems. The Disability Justice perspective instead calls for counselors-in-training to see their role as also advocating for systemic change, working toward environments and policies that are actually supportive of all people’s well-being. Rather than idealizing independence, disability justice values interdependence and community care. Counselors and counselors-in-training can foster this by helping clients build supportive networks and by modeling collaborative, relational approaches in practice.

Regularly Reflect on Personal Biases and Be Open to Feedback
     Counselor educators often ask counselors-in-training to reflect on their own biases in terms of race, gender, and sexual orientation. However, ableism and disability are often forgotten or left out of those conversations. It is essential for these conversations about bias to include disability so that everyone has opportunities to explore and discuss their own potential biases. Embedding disability representation in the classroom allows everyone to see how they respond to disabled people, especially when that representation is in the form of case studies and client role-play. Then, everyone, including supervisors, can constructively receive feedback from a trusted figure and can change or improve their reactions and responses if necessary. Furthermore, counselor educators and counselors-in-training can keep reflective journals, seek supervision or peer discussions, and review case notes with an anti-ableist lens, which can help identify areas for growth. Additionally, counselor educators should actively solicit feedback from the disability community, welcoming their perspectives without defensiveness. When possible, attend training led by disabled professionals and the disabled community to reinforce a commitment to continuous learning and accountability.

Implications for Counselor Educators

Counselor educators are responsible for training counselors to work with all types of clients, including disabled clients. Counselors will encounter disabled clients, no matter the setting that they are working in. Disability can impact anyone and does not discriminate across gender, race, socioeconomic status, sexual orientation, or geographic location. Disability is the one minority group that anyone can become a part of at any time in their life. Most people will age into disability as they get older (Shapiro, 1994). Counselor educators need to be sure that counselors are confronting and dismantling their own ableism and ableist beliefs and that they understand that they may need to assist clients in processing their own experiences with ableism in society and interactions with others. One self-assessment for self-reflection and insight is the Systematic Ableism Scale (SAS; Friedman, 2023). The SAS has four underlying themes: individualism, recognition of continuing discrimination, empathy for disabled people, and excessive demands. The SAS is a tool that can be used to help understand how contradicting disability ideologies manifest in modern society to determine how best to counteract them. By using this assessment as a self-evaluation tool, both students and counselor educators can identify where their beliefs may be problematic or ableist and then set goals to address and improve in those areas.

We recommend that counselors intentionally occupy spaces where discussions on disability advocacy are occurring. Universities are often regarded as a primary source of knowledge production, but a common misconception is that the people themselves produce the knowledge. The reality is that not all disability content is produced by disabled individuals or organizations. Thus, we encourage counselor educators to expand access to knowledge about disability by seeking spaces outside the institution that share insider perspectives on the disability experience and organizations dedicated to empowering disabled communities. This may involve engaging with informal educational organizations such as Sins Invalid, AXIS Dance Company, and Krip Hop Nation or getting involved with formal professional organizations such as APA Division 22, the American Rehabilitation Counseling Association, or the National Rehabilitation Counseling Association. Some strategies that can be used to advocate for and in support of disabled clients include client-centered advocacy, understanding disability as a cultural identity, and building knowledge of the disability rights movement, ableism, and intersectionality, as well as integrating disability-inclusive language, avoiding ableist assumptions, and incorporating clients’ lived experiences into treatment (Chapin et al., 2018; Smart, 2015; Smith et al., 2011).

The foundation for a competent and qualified counselor begins with their training. This training can be formal education or ongoing professional development. For those responsible for educating counselors-in-training, laying the foundation for anti-ableism practices begins in the classroom. A universal design for learning (UDL) framework, developed by the Center for Applied Special Technology (CAST, 2018), aims to create accessible material and inclusive environments that are usable for all people by intentionally incorporating multiple representations of content to enhance student expression of learning and increase a variety of opportunities for engagement with the learning environment (Black et al., 2015; Dolmage, 2017; Fornauf & Erickson, 2020). UDL principles support anti-ableist practice by encouraging an ongoing partnership between students and instructors that facilitates consistent and practical feedback to promote student belongingness (Hennessey & Koch, 2007; Oswald et al., 2018). Promoting belonging and acceptance in counselor education programs requires intentional strategies that foster inclusivity, respect for diversity, and a strong sense of community. Effective techniques include: 1) Use inclusive curriculum design. Integrate diverse perspectives throughout the curriculum, with special attention paid to marginalized voices, such as disabled voices. 2) Use culturally responsive pedagogy. This includes employing a range of instructional methods to cater to diverse learning styles. Use trauma-informed practices by creating a learning environment that is sensitive to trauma, both past and present. 3) Implement community-building activities such as structuring programs around cohorts and encouraging the formation of affinity groups and peer support groups. 4) Encourage active dialogue and reflection around tough conversations such as diversity, ableism, inequality, and marginalization. This can be done both in person and online via discussion boards. Faculty can also encourage students to explore their thoughts, reflections, and experiences around issues of identity, belonging, and ableism in a reflective journal. 5) Collect feedback to guide continuous improvement. Faculty can assess students’ experiences with inclusion and ableism through climate surveys.

Additionally, the adoption of multiple methods for delivering information in alternate formats and continuous assessment of student progress reduces barriers to student engagement and expression in the learning environment, which in turn systematically challenges normative ableist practice that values a one-size-fits-all perspective that often neglects disabled thought and existence in pedagogical practices (Oswald et al., 2018). UDL strategies to disrupt ableist thought and practices may include using closed captioning on visual multimedia content (e.g., videos, PowerPoint presentations), incorporating movement breaks, creating interactive activities (e.g., role-play activities, gamification, debates on critical topics), and receiving feedback on instruction.

Hill and Delgado (2023) discussed the importance of including disability coursework and content across multiple domains to effectively address ableism in counselor education programs. Building upon their work, we suggest that the following key types of coursework and content be included. At a minimum, disability content should be integrated into the core CACREP curriculum areas: professional counseling orientation and ethical practice, social and cultural foundations, lifespan development, career development, counseling practice, group counseling, assessment and diagnosis, and research and program evaluation (CACREP, 2023).

Foundational Disability Studies
Students should explore and understand how ableism developed and its systemic nature, especially in the current political climate (Campbell, 2009; Dolmage, 2017). Additionally, students can learn about models of disability: medical, sociopolitical, functional, religious, moral, and biopsychosocial (Engel, 1977; Shakespeare, 2006; Smart, 2015). Students must also understand the concept of intersectionality, which examines how disability interacts with race, gender, sexuality, and socioeconomic status (Erevelles & Minear, 2010; Garland-Thompson, 2005).

Ethics and Multicultural Competence
    Students should understand the intersection of disability and ethics by being able to apply the ACA Code of Ethics to disability issues (Chapin et al., 2018; Feather & Carlson, 2019). In either an ethics class or a multicultural class, students must learn about crucial disability-related legislation, such as the Rehabilitation Act of 1973, the Americans with Disabilities Act, the Individuals with Disabilities Education Act, and the Workforce Innovation and Opportunity Act. In the multicultural class, students need to understand disability cultural competence and receive training on disability as a cultural identity and recognizing ableism as a form of oppression (Feldner et al., 2022; Smith et al., 2011). Additionally, in the multicultural class, students should be taught about biases and microaggressions, as well as how to identify and address ableist language and behavior.

Counseling Skills and Practice
     In a counseling skills class, students must learn accessible counseling techniques, such as modifying approaches for different abilities (e.g., sensory, cognitive, mobility). Students should also be presented with case studies involving disabled clients, with an emphasis on strengths-based and person-centered approaches. Additionally, students ought to receive supervision and advocacy training on how to support and advocate for clients with disabilities in clinical settings. Counselor educators can use the strategies listed here in the classroom and in practice.

Directions for Future Research

Two of the three authors of this article are disabled and bring lived experience to their teaching, writing, research, and engagement with the nondisabled world. This real-world experience informs the strategies presented and has been applied in both classroom and professional settings. However, these approaches have not yet been empirically tested through formal research. Future research could focus on empirically validating these strategies through qualitative or quantitative studies, particularly in evaluating confidence when working with disabled clients before and after implementing these strategies. Strategies include incorporating disability knowledge into the counselor education curriculum coursework (Hill & Delgado, 2023), using critical pedagogy and disability justice frameworks when teaching (Dolmage, 2017; Erevelles & Minear, 2010), providing experiential learning and opportunities for contact with disabled individuals (Smith et al., 2011), giving disability-related education and training for faculty and supervisors (Feldner et al., 2022), and encouraging the development of allyship and advocacy skills (Feldner et al., 2022; Goodman et al., 2004). Additional studies are also needed to examine ableism and confidence in teaching anti-ableist concepts and disability-related competencies by counselor educators. Finally, scales or measures to assess ableism, specifically in counselor education, could be created and validated.

Conclusion

These strategies do not aim to be an all-encompassing, definitive, or exhaustive checklist, as there are many ways to dismantle ableism. These strategies are a starting point, a reminder, a point of reflection, or an opportunity to affirm current strategies. Significantly, these strategies extend beyond counseling and are relevant across various educational and professional settings, from K–12 classrooms to higher education, social work, health care, and beyond. Wherever you land, we invite you to continue learning, growing, and committing to change with us. Alice Wong (2020) proclaimed, “There is so much that able-bodied people could learn from the wisdom that often comes with disability. However, space needs to be made. Hands need to reach out. People need to be lifted up” (p. 17). Together, we can extend our hands, challenge systemic barriers, and work to dismantle ableism in counseling settings and across all aspects of society.

 

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

 

References

Andrews, E. E., Forber-Pratt, A. J., Mona, L. R., Lund, E. M., Pilarski, C. R., & Balter, R. (2019). #SaytheWord: A disability culture commentary on the erasure of “disability.” Rehabilitation Psychology, 64(2), 111–118. https://doi.org/10.1037/rep0000258

Atkins, K. M., Bell, T., Roy-White, T., & Page, M. (2023). Recognizing ableism and practicing disability humility: Conceptualizing disability across the lifespan. Adultspan Journal, 22(1). https://doi.org/10.33470/2161-0029.1151

Ben-Moshe, L., & Magaña, S. (2014). An introduction to race, gender, and disability: Intersectionality, disability studies, and families of color. Women, Gender, and Families of Color, 2(2), 105–114. https://doi.org/10.5406/womgenfamcol.2.2.0105

Berne, P., Morales, A. L., Langstaff, D., & Invalid, S. (2018). Ten principles of disability justice. Women’s Studies Quarterly, 46(1–2), 227–230. https://doi.org/10.1353/wsq.2018.0003

Black, R. D., Weinberg, L. A., & Brodwin, M. G. (2015). Universal design for learning and instruction: Perspectives of students with disabilities in higher education. Exceptionality Education International, 25(2), 1–26.

Bogart, K. R., & Dunn, D. S. (2019). Ableism special issue introduction. Journal of Social Issues, 75(3), 650–664. https://doi.org/10.1111/josi.12354

Bunbury, S. (2019). Unconscious bias and the medical model: How the social model may hold the key to transformative thinking about disability discrimination. International Journal of Discrimination and the Law, 19(1), 26–47. https://doi.org/10.1177/1358229118820742

Campbell, F. K. (2009). Contours of ableism: The production of disability and abledness. Palgrave Macmillan.

CAST. (2018). Universal design for learning guidelines version 3.0. http://udlguidelines.cast.org

Chapin, M., McCarthy, H., Shaw, L., Bradham-Cousar, M., Chapman, R., Nosek, M., Peterson, S., Yilmaz, Z., & Ysasi, N. (2018). Disability-related counseling competencies. American Rehabilitation Counseling Association. https://www.counseling.org/docs/default-source/competencies/arca-disability-related-counseling-competencies-v51519.pdf?sfvrsn=984f4bd0_1

Charlton, J. I. (1998). Nothing about us without us: Disability oppression and empowerment. California University Press.

Collins, P. H., & Bilge, S. (2020). Intersectionality (2nd ed.). Wiley.

Cook, J. M., Deroche, M. D., & Ong, L. Z. (2024). A qualitative analysis of ableist microaggressions. The Professional Counselor, 14(1), 64–82. https://doi.org/10.15241/jmc.14.1.64

Council for the Accreditation of Counseling and Related Educational Programs. (2023). 2024 CACREP standards. https://www.cacrep.org/wp-content/uploads/2024/04/2024-Standards-Combined-Version-4.11.2024.pdf

Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, 1989(1), 139–167. https://chicagounbound.uchicago.edu/cgi/viewcontent.cgi?article=1052&context=uclf

Davis, L. J. (2011, September 25). Why is disability missing from the discourse on diversity? The Chronicle of Higher Education, 25, 38–40. https://www.chronicle.com/article/why-is-disability-missing-from-the-discourse-on-diversity

Deroche, M. D., Herlihy, B., & Lyons, M. L. (2020). Counselor trainee self-perceived disability competence: Implications for training. Counselor Education and Supervision, 59(3), 187–199. https://doi.org/10.1002/ceas.12183

Dollarhide, C. T., Rogols, J. T., Garcia, G. L., Ismail, B. I., Langenfeld, M., Walker, T. L., Wolfe, T., George, K., McCord, L., & Aras, Y. (2020). Professional development in social justice: Analysis of American Counseling Association conference programming. Journal of Counseling & Development, 98(1), 41–52. https://doi.org/10.1002/jcad.12298

Dolmage, J. T. (2017). Academic ableism: Disability and higher education. University of Michigan Press. https://doi.org/10.3998/mpub.9708722

Elflein, J. (2024, November 19). Topic: Disability in the U.S. – Statistics & facts. Statista. https://www.statista.com/topics/4380/disability-in-the-us

Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136. https://doi.org/10.1126/science.847460

Erevelles, N., & Minear, A. (2010). Unspeakable offenses: Untangling race and disability in discourses of intersectionality. Journal of Literary & Cultural Disability Studies, 4(2), 127–145. https://doi.org/10.3828/jlcds.2010.11

Feather, K. A., & Carlson, R. G. (2019). An initial investigation of individual instructors’ self-perceived competence and incorporation of disability content into CACREP-accredited programs: Rethinking training in counselor education. Journal of Multicultural Counseling and Development, 47(1), 19–36.
https://doi.org/10.1002/jmcd.12118

Feldner, H. A., Evans, H. D., Chamblin, K., Ellis, L. M., Harniss, M. K., Lee, D., & Woiak, J. (2022). Infusing disability equity within rehabilitation education and practice: A qualitative study of lived experiences of ableism, allyship, and healthcare partnership. Frontiers in Rehabilitation Sciences, 3, 947592.
https://doi.org/10.1080/09638288.2022.9397845

Fornauf, B. S., & Erickson, J. D. (2020). Toward an inclusive pedagogy through universal design for learning in higher education: A review of the literature. Journal of Postsecondary Education and Disability, 33(2), 183–199. https://files.eric.ed.gov/fulltext/EJ1273677.pdf

Frederick, A., & Shifrer, D. (2018). Race and disability: From analogy to intersectionality. Sociology of Race and Ethnicity, 5(2), 200–214. https://doi.org/10.1177/2332649218783480

Friedman, C. (2023). Explicit and implicit: Ableism of disability professionals. Disability and Health Journal, 16(4), 101482. https://doi.org/10.1016/j.dhjo.2023.101482

Friedman, C., & Owen, A. L. (2017). Defining disability: Understandings of and attitudes towards ableism and disability. Disability Studies Quarterly, 37(1).

Garland-Thomson, R. (2005). Feminist disability studies. Signs: Journal of Women in Culture and Society, 30(2), 1557–1587. https://doi.org/10.1086/423352

Goodman, L. A., Liang, B., Helms, J. E., Latta, R. E., Sparks, E., & Weintraub, S. R. (2004). Training counseling psychologists as social justice agents: Feminist and multicultural principles in action. The Counseling Psychologist, 32(6), 793–836. https://doi.org/10.1177/0011000004268802

Grzanka, P. R. (2020). From buzzword to critical psychology: An invitation to take intersectionality seriously. Women & Therapy, 43(3–4), 244–261. https://doi.org/10.1080/02703149.2020.1729473

Hennessey, M. L., & Koch, L. (2007). Universal design for instruction in rehabilitation counselor education. Rehabilitation Research, Policy, and Education, 21(3), 187–194. https://doi.org/10.1891/088970107805059689

Herbert, J. T. (2000). Simulation as a learning method to facilitate disability awareness. Journal of Experiential Education, 23(1), 5–11. https://doi.org/10.1177/105382590002300102

Hill, J. C., & Delgado, H. (2023). Incorporating disability knowledge and content into the counselor education curriculum. ACES Teaching Practice Briefs, 21(2), 18–31. https://www.researchgate.net/publication/388758290_Incorporating_Disability_Knowledge_and_Content_into_the_Counselor_Education_Curriculum

Leonardi, M., Bickenbach, J., Ustun, T. B., Kostanjsek, N., & Chatterji, S. (2006). The definition of disability: What is in a name? The Lancet, 368(9543), 1219–1221. https://doi.org/10.1016/S0140-6736(06)69498-1

Lewis, T. A. (2022, January 1). Working definition of ableism—January 2022 update. https://www.talilalewis.com/blog/working-definition-of-ableism-january-2022-update

Lewis, T. A., & Brown, L. X. Z. (2018). Accountable reporting on disability, race & police violence: A community response to the “Ruderman Foundation paper on the media coverage of use of force and disability.” https://www.talilalewis.com/blog/archives/06-2018

Lund, E. M. (2022). Valuing the insider-professional perspective of disability: A call for rehabilitation psychologists to support disabled psychologists and trainees across the profession. Rehabilitation Psychology, 67(4), 582–586. https://doi.org/10.1037/rep0000452

Mingus, M. (2010, February 12). Changing the framework: Disability justice. Leaving Evidence. https://leavingevidence.wordpress.com/2011/02/12/changing-the-framework-disability-justice

Moradi, B., & Grzanka, P. R. (2017). Using intersectionality responsibly: Toward critical epistemology, structural analysis, and social justice activism. Journal of Counseling Psychology, 64(5), 500–513. https://doi.org/10.1037/cou0000203

Mosher, D. K., Hook, J. N., Captari, L. E., Davis, D. E., DeBlaere, C., & Owen, J. (2017). Cultural humility: A therapeutic framework for engaging diverse clients. Practice Innovations, 2(4), 221–233. https://doi.org/10.1037/pri0000055

Mueller, C. O., Forber-Pratt, A. J., & Sriken, J. (2019). Disability: Missing from the conversation of violence. Journal of Social Issues, 75(3), 707–725. https://doi.org/10.1111/josi.12339

Öksüz, E., & Brubaker, M. D. (2020). Deconstructing disability training in counseling: A critical examination and call to the profession. Journal of Counselor Leadership and Advocacy, 7(2), 163–175. https://doi.org/10.1080/2326716X.2020.1820407

Olkin, R. (2002). Could you hold the door for me? Including disability in diversity. Cultural Diversity and Ethnic Minority Psychology, 8(2), 130–137. https://doi.org/10.1037/1099-9809.8.2.130

Oswald, G. R., Adams, R. D. N., & Hiles, J. A. (2018). Universal design for learning in rehabilitation education: Meeting the needs for equal access to electronic course resources and online learning. Journal of Applied Rehabilitation Counseling, 49(1), 19–22.

Perrin, P. B. (2019). Diversity and social justice in disability: The heart and soul of rehabilitation psychology. Rehabilitation Psychology, 64(2), 105–110. https://doi.org/10.1037/rep0000278

Pierce, K. L. (2024). Bridging the gap between intentions and impact: Understanding disability culture to support disability justice. The Professional Counselor, 13(4), 486–495. https://doi.org/10.15241/klp.13.4.486

Rivas, M. (2020). Disability in counselor education: Perspectives from the United States. International Journal for the Advancement of Counselling, 42, 366–381. https://doi.org/10.1007/s10447-020-09404-y

Shakespeare, T. (2006). The social model of disability. In L. J. Davis (Ed.), The Disability Studies Reader (2nd ed.; pp. 197–204). Routledge. https://disabilitystudies.nl/sites/default/files/beeld/onderwijs/lennard_davis_the_disability_studies_reader_secbookzz-org_0.pdf

Shakespeare, T., & Kleine, I. (2013). Educating health professionals about disability: A review of interventions. Health and Social Care Education, 2(2), 20–37. https://doi.org/10.11120/hsce.2013.00026

Shapiro, J. P. (1994). No pity: People with disabilities forging a new civil rights movement. Three Rivers Press.

Sharif, A., McCall, A. L., & Bolante, K. R. (2022). Should I say “disabled people” or “people with disabilities”? Language preferences of disabled people between identity- and person-first language. ASSETS ’22: Proceedings of the 24th International ACM SIGACCESS Conference on Computers and Accessibility, 1–18. https://doi.org/10.1145/3517428.3544813

Shin, R. Q., Welch, J. C., Kaya, A. E., Yeung, J. G., Obana, C., Sharma, R., Vernay, C. N., & Yee, S. (2017). The intersectionality framework and identity intersections in the Journal of Counseling Psychology and The Counseling Psychologist: A content analysis. Journal of Counseling Psychology, 64(5), 458–474. https://doi.org/10.1037/cou0000204

Slesaransky-Poe, G., & García, A. M. (2014). The social construction of difference. In D. Lawrence-Brown, M. Shapon-Shevin, & N. Erevelles (Eds.), Condition critical: Key principles for equitable and inclusive education (pp. 66–85). Teachers College, New York.

Smart, J. (2015). Disability, society, and the individual (3rd ed.). ProEd, Inc.

Smith, W. T., Roth, J. J., Okoro, O., Kimberlin, C., & Odedina, F. T. (2011). Disability in cultural competency pharmacy education. American Journal of Pharmaceutical Education, 75(2), 26. https://doi.org/10.5688/ajpe75226

Taboas, A., Doepke, K., & Zimmerman, C. (2023). Preferences for identity-first versus person-first language in a US sample of autism stakeholders. Autism, 27(2), 565–570. https://doi.org/10.1177/13623613221130845

Strike, D. L., Skovholt, T. M., & Hummel, T. J. (2004). Mental health professionals’ disability competence: Measuring self-awareness, perceived knowledge, and perceived skills. Rehabilitation Psychology, 49(4), 321–327. https://doi.org/10.1037/0090-5550.49.4.321

Wolbring, G., & Nasir, L. (2024). Intersectionality of disabled people through a disability studies, ability-based studies, and intersectional pedagogy lens: A survey and a scoping review. Societies, 14(9), 176. https://doi.org/10.3390/soc14090176

Wong, A. (Ed.). (2020). Disability visibility: First-person stories from the twenty-first century. Vintage.

 

Julie C. Hill, PhD, NCC, BC-TMH, LPC, CRC, is an assistant professor at the University of Arkansas. Toni Saia, PhD, CRC, is an associate professor at San Diego State University. Marcus Weathers, Jr., PhD, CRC, LPC-IT, is an assistant professor at Mississippi State University. Correspondence may be addressed to Julie C. Hill, 751 W. Maple St., Fayetteville, AR 72701, jch029@uark.edu.