Racial Trauma in Academia: Experiences of Black Women Counselor Educators

April D. Brown, LaShauna M. Dean, Matthew Lyons

This transcendental phenomenological study explored the lived experiences of Black women counselor educators mitigating experiences of racial trauma in the workplace. Bell’s critical race theory and Crenshaw’s intersectionality served as the frameworks for this study. Six participants were selected based on specific criteria: They held a PhD or EdD in counselor education and supervision, worked full-time in a CACREP-accredited program, were employed for at least 2 years, and self-reported that they experienced racial trauma in the workplace. Data collection involved semi-structured interviews, which were transcribed and analyzed for themes. Findings revealed the following textural themes: disrespect from colleagues and students, diminished well-being, lack of trust in competency, expressing concerns for safety/hypervigilance, a heightened awareness of intersectionality, awareness of social conditioning/exposure to sexualization, and the cognitive process. The final theme, surviving the environment, contributed to the structural description. Finally, the results provide implications for counselor educators, mental health professionals, and counselor education program administrators.

Keywords: racial trauma, Black women, counselor educators, workplace, transcendental phenomenological

 

The intersection of race and gender has long been a critical focal point in understanding the lived experiences of Black women, particularly in professional settings (Crenshaw, 1989). Black women occupy a unique space within the workforce, often navigating the compounded challenges of racism and sexism. These dual oppressions are pervasive and deeply ingrained in the structures of many workplaces, including counselor education. This study focuses on a central research question: What are the lived experiences of Black women counselor educators mitigating instances of racial trauma in the workplace? This article contributes to the body of literature that explores how Black women counselor educators experience oppression and racial trauma in the workplace.

Black women are disproportionately affected by workplace discrimination, and their experiences are often dismissed or minimized by colleagues and supervisors (Comas-Díaz et al., 2019; Williams, Printz, & DeLapp, 2018). Almost 92% of Black women reported racial discrimination in the workplace (Carter & Forsyth, 2010), which is compounded by a lack of representation of Black faculty within postsecondary institutions (National Center for Education Statistics [NCES], 2022). NCES (2022) found that among the 1.6 million faculty in degree-granting postsecondary institutions, Black women comprised 4% of full-time faculty. The 2024 Vital Statistics Survey of the Council for Accreditation of Counseling and Related Educational Programs (CACREP) revealed that 18.27% of full-time faculty in CACREP-accredited programs identified as Black, whereas 61.16% identified as White (CACREP, 2025). However, there is a lack of research explaining how Black women faculty in counselor education perceive racial trauma in the workplace.

Mental Health and Racial Trauma
     Racism has detrimental effects on mental health and can cause psychological distress (Clark et al., 1999; Pieterse & Carter, 2007; Pieterse & Powell, 2016). Carter and Forsyth (2010) found that encounters with racism resulted in several harmful emotions, such as guilt, shame, anxiety, and hypervigilance. Other effects of racism include identity issues, internalization, isolation, aggression, substance abuse, domestic violence, race-related stressors, sexual promiscuity, and suicidal ideation, all of which can look different individually, institutionally/structurally, and culturally (Hemmings & Evans, 2018; Pieterse & Powell, 2016).

There is a pressing need to address the effects of racism in all settings, as Black women experience more mental health problems than other racial groups (Allen et al., 2019; Catabay et al., 2019). Black women experience not only individual racism, but also institutional or structural racism, which can lead to health disparities (Holder et al., 2015; Jones, 1997; Knighton et al., 2022; Pieterse & Powell, 2016; Sotero, 2006). Workplace hostility can cause severe traumatic stress, including increased anxiety, depression, hypervigilance, avoidant reactions, and other poor mental health outcomes (Carter & Forsyth, 2010; Dickens & Chavez, 2018; Loo, 2003; Shih et al., 2013; Triana et al., 2015; Williams, Printz, & DeLapp, 2018).

Racial trauma is “a form of race-based stress referring to people of color and Indigenous individuals’ reactions to real or perceived experiences of racial discrimination” (Comas-Díaz et al., 2019, p. 1). Racial trauma results from overt acts of racial hostility and subtle, insidious forms of racism, such as microaggressions or the pressure of having to conform to predominantly White workplaces. For Black women counselor educators, instances of racism include racialized marginalization, pressure to prove their competence, and invalidation of their experiences (Haskins et al., 2016; Pérez & Carney, 2018). The cumulative effect of these experiences can lead to chronic stress, anxiety, depression, and other mental health challenges, which are exacerbated by the intersectional nature of Black women’s identities (Arday, 2022; Bernard et al., 2017; Crenshaw, 1989; Pieterse & Powell, 2016; Pizarro & Kohli, 2020).

Due to racialized and gendered microaggressions, Black women faculty might feel racial battle fatigue (Behar-Horenstein et al., 2012; Chancellor, 2019), which is often made worse by the Strong Black Woman schema, a cultural expectation for Black women to exhibit resilience in the face of adversity (Castelin & White, 2022; Liao et al., 2019). Similar to the effects of racial trauma, the Strong Black Woman schema can cause adverse psychological effects (Castelin & White, 2022; Liao et al., 2019). While this stereotype may serve as a coping mechanism, it can also discourage Black women from seeking mental health support, leading to a reluctance to acknowledge or address the psychological harm they endure.

Racial Trauma in the Workplace
     Because Black women are more susceptible to mental health concerns, exploring their lived racial trauma experiences in counselor education programs could provide insight into the associated mental health outcomes (Carter & Forsyth, 2010). Research supports that many Black women experience ongoing workplace discrimination (Dickens & Chavez, 2018; Holder et al., 2015; Shih et al., 2013; Velez et al., 2018). For Black faculty, racial trauma negatively impacts job satisfaction (DeCuir-Gunby & Gunby, 2016). Black women frequently feel the need to identity-shift or alter their cultural behavior, often through code-switching, causing psychological distress (Dickens & Chavez, 2018; Fields & Cunningham-Williams, 2021; Shih et al., 2013). Unfortunately, these changes do not always prevent adverse outcomes (O’Brien et al., 2016).

There is an unfulfilled need to discuss and address racial trauma in the workplace. While there are promising clinical approaches, such as race-based therapy (Bryant-Davis & Ocampo, 2006), racial trauma recovery (Comas-Díaz, 2016), feminist therapy (Brown, 2008), and trauma-focused cognitive behavioral therapy (TF-CBT; Phipps & Thorne, 2019), there are no empirically supported treatments for racial trauma (Comas-Díaz, 2016; Williams et al., 2018a). This research seeks to investigate how Black women faculty conceptualize and interpret the impact of racial trauma in academia, aiming to elucidate the nuanced meanings and implications.

Methods

The central research question guiding this study was: What are the lived experiences of Black women counselor educators mitigating instances of racial trauma in the workplace? This question was explored using Moustakas’s (1994) transcendental phenomenological design. Transcendental phenomenology allows the researcher to understand the natural essence of the phenomenon through intentionality and intuition (Descartes, 1977; Husserl, 1999). The researchers captured the essence of each participant’s experience by constructing textural descriptions of what the participants experienced and how they experienced it (Moustakas, 1994), which were constructed into composite textural and structural descriptions.

Research Positionality
     Three authors are involved in this study, and before discussing our results, we want to acknowledge our positionality in relation to this research. The first author, April D. Brown, originally developed this study for her doctoral dissertation. She is an African American cisgender woman and a practicing counselor who acknowledges experiencing racial trauma. As a licensed professional counselor, Brown has worked closely with clients who experienced racism and discrimination in the workplace. She also encountered her own internalized racism and experienced vicarious trauma as she listened to participant stories. She attended therapy, engaged in reflective meditation repeatedly, and consulted a peer reviewer to ensure objectivity in this study.

The second author, LaShauna M. Dean, is an African American cisgender woman who has been a faculty member in counselor education for 12 years. She recognizes that her social position may influence her interpretation of participant narratives, given her experiences as a Black faculty member. Dean has a strong commitment to accurately conveying participants’ stories, as she recognizes the potential benefits of addressing racial trauma in counselor education and has reflected on her own biases through the research process by engaging in critical self-reflection.

The third author, Matthew Lyons, is a White cisgender male counselor educator and academic administrator. Diversity is a significant part of his personal and professional priorities. Lyons acknowledges the ever-present reality of racism and the importance of sharing stories of racial trauma. He was the chair of the dissertation committee for Brown and, therefore, involved in this research from the early stages.

Recruitment and Participants
     All participants in this study were Black women counselor educators employed as full-time faculty in CACREP-accredited programs. Researchers recruited participants by first utilizing the CACREP directory to send emails to faculty, secondly by posting the recruitment flyer in the Facebook group for the Association for Multicultural Counseling and Development, and lastly by posting study details on the CESNET-L listserv. Each recruitment attempt included a description of the study, the interest and inclusion survey to verify eligibility and the contact information of the primary researcher. Eligible participants self-identified as a Black woman, held a terminal degree in counselor education and supervision, had at least 2 years of faculty experience, and self-reported experiencing racial trauma. Participants were provided with the Comas-Díaz et al. (2019) definition of racial trauma and responded “yes” or “no” to whether their experiences met the definition. Six participants met all recruitment criteria, including availability for the interview. One participant did not disclose gender pronouns and is referred to using gender-neutral pronouns (they/them) in this manuscript. Participants’ demographics and pseudonyms are presented in Table 1.

Table 1

Participants’ Demographic Characteristics

Participants Amber August Hazel June May Summer
Age 25–40 41–56 25–40 25–40 41–56 25–40
Gender pronouns She/her/

hers

She/her/ hers Prefer not

to say

She/her/ hers She/her/ hers She/her/ hers
ACES region NCACES SACES SACES NCACES SACES SACES
State of residence MN AL MD WI LA TN
Years of experience 6–10 11–14 2–5 2–5 2–5 6–10

Note. ACES = Association for Counselor Education and Supervision; NCACES = North Central Association for Counselor Education and Supervision; SACES = Southern Association for Counselor Education and Supervision. Regional classifications are based on the five ACES regions (ACES, 2021).

Data Collection
     Semi-structured interviews, lasting approximately 60 minutes, served as the primary source of data. The interview protocol included questions about experiences of racial trauma as well as supports that mitigated those experiences (see Appendix). The interview protocol was developed to address identified gaps in the literature around workplace trauma explicitly experienced by Black women in counselor education and was aligned with the principles of transcendental phenomenology.

Data Analysis
     Data analysis followed the eight-step process outlined by Moustakas (1994), which involves a systematic and reflective approach to understanding lived experiences. Our research team began by transcribing interviews and engaging in horizontalization, identifying all relevant statements with equal value. Through reduction and elimination, nonessential or overlapping data were removed, and significant expressions were distilled into invariant constituents, which were then clustered into core themes. We then verified the relevance of these themes in the final identification phase to ensure they authentically reflect participants’ experiences. Using these themes, we constructed individual textural descriptions (what was experienced) and structural descriptions (how it was experienced). These were then synthesized into textural–structural descriptions to capture the full essence of each participant’s experience. Finally, these insights were integrated into a composite description that represents the collective meaning and essence of the phenomenon across all participants, ensuring both depth and rigor in capturing the lived experience.

Interviews were conducted via Microsoft Teams video calls and transcribed using Rev, a transcription service. Following transcription via Rev (n.d.), the interview data were analyzed using Delve (n.d.), a cloud-based qualitative data analysis platform designed to support rigorous thematic analysis. Delve assisted the researchers in systematically coding, clustering, color-coding, and visually mapping qualitative data to identify patterns and themes across transcripts. This process facilitated an iterative and structured approach to data analysis consistent with phenomenological methodology. Delve and Rev comply with General Data Protection Regulation standards, ensuring participant confidentiality and the secure handling of sensitive data throughout transcription and analysis (Delve, 2022; Rev, n.d.). Upon completing the data analysis process, each participant received copies of the constructed descriptions from their interviews to provide feedback in alignment with member checking procedures.

Trustworthiness
     Several methods were employed to ensure trustworthiness during the study’s interview and data analysis portions. First, Brown used a detailed field log and reflexive journal to record decisions and processes throughout the research, which facilitated self-reflection and enhanced self-awareness throughout the research process. The journal documented thought processes and supported data interpretation (Silver & Lewins, 2014; Tobin & Begley, 2004).

Member checking was also used to ensure trustworthiness by sending participants their textural–structural descriptions after the interview. Participants could confirm or modify their descriptions in writing to ensure that they accurately reflected their experiences (Humphrey, 1991; Moustakas, 1994), and this feedback was used to make adjustments. For unresponsive participants, Humphrey (1991) suggested that their descriptions should reflect the researchers’ interpretation of the data.

Finally, an independent peer reviewer participated in the data analysis to confirm the findings and served as a sounding board to ensure objectivity throughout the research. The peer reviewer had experience conducting phenomenological research. Brown met with the peer reviewer three times to discuss the data analysis process, during which they reviewed the initial list of themes, reviewed the reduction and elimination process, identified core themes, and incorporated the relevant information into the study. All participants were aware of the peer reviewer’s role from the informed consent form.

Results

This transcendental phenomenological study explored the lived experiences of Black women counselor educators and their experiences of racial trauma in the workplace to highlight ways in which they navigated those experiences. Our results indicated that the experiences of Black women counselor educators were unique to their individual contexts and settings. The following themes emerged from our data: 1) disrespect from colleagues and students, 2) diminished well-being, 3) lack of trust in competency, 4) expressing concerns for safety/hypervigilance, 5) heightened awareness of intersectionality, 6) awareness of social conditioning/exposure to sexualization, 7) the cognitive process (i.e., how racial trauma experiences impacted their thought process), and 8) surviving the environment.

Theme 1: Disrespect From Colleagues and Students
     While discussing their experiences of racial trauma in the workplace, the participants described navigating disrespect from colleagues and students, such as name-calling, retaliation, microaggressions, and professional demotions (e.g., not being addressed by their professional titles or credentials). For Hazel, experiencing disrespect in predominantly White institutions was a “reality check.” They stated, “[In the] field of counseling and psychology . . . as a counselor educator, you will be called by your first name. You’ll be demoted by students, by faculty, by colleagues, by everyone.” They recalled, “I’ve gotten emails from students, ‘Hey, can you change [something]?’” August stated, “One student . . . didn’t get the A she thought she [would], and she stopped speaking to me.” She recalled another incident, stating, “I had another student [who] was like, ‘All you talk about is race.’” She also recalls being told, “I am the worst teacher.”

Theme 2: Diminished Well-being
     Participants expressed diminished well-being while navigating racial trauma at work. May described experiencing significant physical and psychological distress as well as social–emotional concerns, noting an unintentional 77-pound weight loss, disrupted sleep, diminished appetite, and medical issues such as elevated blood pressure, along with cognitive distortions and heightened perfectionistic tendencies. She explained:

My presentation changed, and [there were] rumors. I’ve gained the weight back, but I had lost a lot of weight rapidly, and I had started to become more isolated and closed-off and cryptic. So, some folks were like, “Your personality went from bubbly to more withdrawn.”

August also expressed how racial trauma affected her well-being. She noted that she was diagnosed with pneumonia, an autoimmune disorder, and shingles while navigating racial trauma at work. She stated, “Long story, it’s not really short, but health. Health was the main thing that [racial trauma] really impacted. And mental health as well.”

Theme 3: Lack of Trust in Competency
     Lack of trust in competency was a key theme that emerged from the participants’ experiences. While most participants described experiencing a lack of trust in competency in previous workplaces, one participant, June, was actively facing it in her current workplace. Her experience provides a critical perspective on how racial trauma manifests in real time. She recalled:

[The students would] ask me a question, and I’d respond. Then they’d look it up and be like, “Well, actually, dah, dah, dah.” Or I’d give them a response; they’d run to someone else and be just doing all this stuff. Or one group, they do an exit survey and stuff. They just ripped into every class that was specific to what I taught. No grace of, “Oh, it’s your first time teaching.”

June perceived a lack of trust in her competency as an ongoing issue in the workplace. She explained, “It was a reminder of, no matter what, it doesn’t matter if I’m super competent or know what I’m talking about, there’s always going to be people questioning every last thing I tell them.”

Theme 4: Expressing Concerns for Safety/Hypervigilance
     June expressed concerns for safety while actively navigating experiences of racial trauma. Unlike other participants, who had processed their experiences after leaving harmful workplaces, June was currently navigating a series of traumatic incidents. She was “fearful of things,” displayed hypervigilance, and frequently assessed potential threats at work. The first incident occurred when a magazine published content criticizing her work. She stated, “That moment was just like, whoa. There’s a lot of fear with that.”

After the incident, June expressed concerns for her safety by not wanting to put her location on her institution’s website. She stated, “I don’t want to make it easier for people to find me. I know they can find me if they really want to.” Her fears extended to food delivery. She explained, “Oh, my gosh. You never know who’s going to deliver [the food]. What if they recognize my name and want to harm me in some way, or what if I come on campus and something happens?” June worried about her safety returning to work in person during the COVID-19 pandemic. She described attending the “first all-college meeting” at her predominantly White institution and how she felt being the only Black person in the room. She stated, “Actually, it was kind of overwhelming because I was like, ‘We’re all in this room. I don’t like it.’” June recalled walking to class when she saw a van approaching her slowly. She stated, “The windows rolled down, and they yelled, ‘“Trump 2020’ or something.” She explained:

It was jarring because I wasn’t expecting that to happen. Then they drove off. I remember feeling so disoriented that I’ve been walking to class this whole time, that I started to, in a way, get lost, not remember where my classroom was, just because I was still in disbelief. I’m like, “It’s broad daylight.”

After these incidents, June took measures to protect herself. She stated, “I ended up buying a key chain. I forgot what it’s called, but it’s a little metal thing that I guess, worst-case scenario, you just jab someone with it, right, but it’s not sharp or anything.”

Theme 5: Heightened Awareness of Intersectionality
     Participants experienced a heightened awareness of intersectionality, recognizing that their intersections of race and gender impacted their workplace experiences. For participants, navigating these intersections in the workplace was the norm, something to be expected. August explained that in counselor education, “You’re the unicorn—you’re just unusual.” For Summer, navigating race and gender required a constant attunement to self-awareness. She stated, “It’s a constant knowing. It’s a constant double consciousness. I have to think about how other people are experiencing me [and] how I’m experiencing the situation. Also, [I’m] thinking about how I’m showing up in these particular environments.” Similarly, Amber shared, “I am very cognizant that I have a worldview and a perspective unique to being a Black woman.” She also said that navigating race and gender “takes a little bit of work,” including “learning how to do some compartmentalizing with my identity.”

Theme 6: Awareness of Social Conditioning/Exposure to Sexualization
     Awareness of social conditioning/exposure to sexualization described participants’ awareness of society’s assumptions of Black women and of being sexualized at work. Our participants believed that preconceived notions such as societal assumptions, stereotypes, and expectations for Black women exacerbated their racial trauma experiences. Summer reflected on how societal stereotypes prevent Black women from being seen as whole individuals. She noted that Black women are often perceived as strong, emotionless, or lacking intellectual credibility, leaving little room for their full humanity to be acknowledged. Consequently, she believed that her identity contributed to colleagues dismissing her experiences of racial trauma in the workplace.

June said, “I think it’s interesting because, on one hand, I feel like Black women are always kind of seen as strong, right, and scary, and angry, and whatever.” August’s awareness of social conditioning meant managing work and caregiving responsibilities. She mentioned, “Sometimes, it gets very stressful being a woman and being that nurturing person because that’s what is expected of me.” August believed that Black women are socialized to do it all. She explained:

I have to, in a sense, be a liaison for adjunct professors and everything. I’m doing all of this, I’m teaching, and I was trying to publish so I wouldn’t perish, going to conferences, and taking care of my mom. I was juggling [everything].

Participants were sexualized at work by colleagues and students. Summer perceived being sexualized by her colleagues as a form of name-calling. She stated, “I’d gotten an award for something, and someone said [I received the award] because my boss had jungle fever, [not] because of my expertise or my knowledge. They thought it was a joke.” Summer found the joke inappropriate, stating it “sexualized” her. She also felt “ostracized” and “traumatized.” In contrast, May experienced sexual harassment from a student. She recalled feeling stunned and in disbelief, noting that she never expected a student to address her in such a sexualized manner or to encounter this kind of harassment in a professional setting.

May attributed her experience to her identity. She noted that Black women are oversexualized in the media. As a result of her experience, she adjusted her appearance and behavior to reclaim her sense of agency and reduce unwanted attention. She stated:

At one point, I thought I was becoming the asexual mammy archetype because I was becoming more coddling, more docile, and more, whatever you say, let’s go with the flow. I remember how my dress had changed. I started wearing [what] I call the deaconess buns, like the braided buns, after the situation. I wouldn’t put on nothing but chapstick, and I would dress down. But the outfits I was picking were like those floral-pattern, shapeless [dresses] so you couldn’t see a single curve.

Theme 7: The Cognitive Process
     The participants described how their racial trauma experiences impacted their thought processes. May initially felt unsupported at her institution. She explained, “Being a Black woman in academia, in the beginning, it was very lonely, isolating, and tokenized for me for [the] years 2018, 2019, [and] 2020.” May’s perspective shifted when her department hired another Black woman. She stated, “I immediately felt the love; it was the missing component.”

June believed that her racial identity made her more susceptible to racial discrimination. She stated, “I know that it’s always going to be a thing because there’s always going to be students coming in who have never encountered a Black woman in a role like this.” She also viewed racial trauma as inevitable at a predominantly White institution. She explained:

I think, in some ways, I kind of expected to run into some stuff. In some ways, I maybe thought it might have been a little bit [worse], actually. I think that’s just having an awareness of, “Yeah, I’m entering a predominantly White environment.”

June perceived the incidents she experienced on campus as intense, which left her feeling threatened and intimidated.

Hazel expressed a mistrust of the institution. They refused to teach a course again after the administration withheld pertinent information about a student in their class. They stated, “I don’t trust the admin to be protective or to keep me safe. Yeah, the mistrust is definitely there.” Hazel became suspicious and questioned joining professional organizations and the integrity of the profession as a whole. They explained, “[Racial trauma] made me question my field, question my counterparts, and wonder, ‘How are we really helping?’”

Theme 8: Surviving the Environment
     Participants employed various strategies to reduce the impact of racial trauma in the workplace and maintain well-being. Many relied on spiritual and therapeutic practices. Summer shared that her “church family” provided support, and her spirituality increased as she navigated racial trauma. May echoed, “My church, my God, [and] my higher power [helped me cope].” Participants also used therapeutic resources. Summer stated, “For my mental health and well-being, I went to counseling.” May found individual therapy and coaching helpful, August benefited from group therapy, and June engaged in the sandplay process. August and Summer also found journaling beneficial. Similarly, Amber relied on self-awareness and shared, “The more I understand about myself . . . the better I’m able to navigate.” August found that “using [her] senses to ground [her]” was highly beneficial.

Community support was another key strategy. Amber noted, “I think it’s really important to have support, to not try to address it alone.” Summer emphasized “a positive support group, an affinity group . . . committed to actionable steps to help you navigate a racist academy.” May similarly highlighted the importance of forming “a united front” with colleagues. June’s relationships with marginalized colleagues created spaces to process, “support each other,” and have “all kinds of conversations.” She also found connecting with students “exciting” and meaningful.

Some participants coped by giving back to the community. June felt responsible for Black students, drawing on the concept of “other mothering” and expressing a desire to nurture and look out for students facing racism. Hazel continued working at an institution where they experienced racial trauma because they were committed to supporting a Black student. They stated, “I’m on a student’s dissertation. . . . She’s an African American student, and I really want to support her. I’m trying to hang in there.”

Participants also found relief through intentional diversity, equity, and inclusion (DEI) efforts. June routinely incorporated multiculturalism, equity, and social justice into her courses. She shared, “I tell students about [racial battle fatigue]. I find any reason to bring it up at least once.” She noted, “It gives you hope so that it’s healing in that way.” Summer similarly infused Ratts et al.’s Multicultural and Social Justice Counseling Competencies (MSJCC; 2015) across her program, explaining that diversity was present “not [in] just one day of the schedule but [in] every conversation we’re having.” Amber, as program chair, remained committed to promoting DEI and relied on a “social justice lens” to review policies and ensure equity.

Several participants turned to counseling literature as a coping strategy. Hazel described using exercises from The Racial Healing Handbook by Anneliese Singh and referencing Jennifer Fraser’s work on workplace bullying. May accessed the MSJCC and the work of scholars such as Derald Wing Sue, David Sue, Cirecie West-Olatunji, Kent Butler, and writers like Gwendolyn Brooks, bell hooks, and Patricia Collins.

Overall, participants’ coping strategies reflected key relational dimensions: self, others, space, and time. August’s and Amber’s focus on self-advocacy, self-awareness, and self-care fostered resilience. June and Summer emphasized relationality through peer and student connections. Spatial awareness informed decisions to leave unsafe environments, as seen in Hazel’s and Summer’s stories. May’s experience highlighted time as a resource that required boundaries and intentional management. Together, these strategies demonstrate the multidimensional ways Black women in counselor education coped with and made meaning of their racial trauma experiences.

Discussion

This transcendental phenomenological study explored Black women counselor educators’ lived experiences of racial trauma in the workplace, and our results indicate that those experiences of racial trauma were unique to the participants’ contexts and settings. The participants perceived their experiences of racial trauma in the workplace as a larger systemic issue that was beyond their control, supporting the idea that racial inequality results from institutional and structural factors rather than individual prejudice (Reece, 2018). Previous research has explored racial microaggressions in the workplace, racism on college campuses, racial battle fatigue among educators, and microaggressions among female faculty (Avent Harris et al., 2019; Blackshear & Hollis, 2021; Pérez & Carney, 2018; Rollock, 2021). Past research also indicated that Black women faculty in predominantly White institutions frequently experience microaggressions from students, colleagues, and staff (Blackshear
& Hollis, 2021).

Our study provided new insight into Black women counselor educators’ perspectives on their racial trauma experiences in the workplace. Participants described disrespect from colleagues and students, including microaggressions, name-calling, retaliation, and professional demotions that indicated being devalued in their professional roles. Participants also described feeling several negative emotions, such as hurt, frustration, and outrage, while navigating racial trauma in the workplace (Carter & Forsyth, 2010). As outlined in previous research (Anderson, 2012; Bernard et al., 2017; Carter & Forsyth, 2010; Pieterse & Powell, 2016), our participants confirmed that race-related stress resulted in physical and mental health challenges, which aligns with previous studies that link the prevalence of racism to ailments among people of color (Allen et al., 2019; Alvarez et al., 2016; Catabay et al., 2019; Loo, 2003; Williams et al., 2018) and the detrimental impact of workplace discrimination on overall well-being (Dickens & Chavez, 2018; Knighton et al., 2022; Shih et al., 2013; Triana et al., 2015). Black women often feel compelled to prove their competence and credibility to colleagues and students, particularly White colleagues (Haskins et al., 2016; Kelly et al., 2017; Pérez & Carney, 2018). Our study revealed that a lack of trust in competency was an ongoing issue for a participant working in a predominantly White setting. Results suggest that students primarily questioned and challenged this participant’s competence.

Participants expressed concerns about their physical and psychological safety, with a participant describing the need to protect herself after experiencing a series of traumatic incidents on campus. Two participants left the institutions where they experienced racial trauma to find safer work environments. This finding suggests that emphasizing the “E” stage (enhancing safety) within the TF-CBT PRACTICE framework may help reduce the impact of racial trauma (Metzger et al., 2020). Therefore, counselor education program administrators might focus on prioritizing psychological safety in the workplace to reduce racial trauma experiences among Black women counselor educators.

Participants knew their social locations, societal stereotypes, and assumptions negatively impacted their roles in the workplace and believed preconceived notions influenced their experiences of racial trauma. They were aware of the intersectionality of racism and sexism (Crenshaw, 1989), which they believed increased their susceptibility to workplace racism (Avent Harris et al., 2019; Behar-Horenstein et al., 2012; Chancellor, 2019; Rollock, 2021).

Past research showed that Black women encounter racism and sexism in higher education (Behar-Horenstein et al., 2012). Our participants described experiences of sexual harassment by colleagues and students, indicating that their intersecting identities exacerbated their racial trauma experiences. Participants’ heightened awareness of intersectionality developed as they navigated the complexities of race and gender in their workplace (Bell, 1995; Delgado & Stefancic, 2017). Their deep understanding of intersectionality, shaped by lived experiences of oppression at the intersection of race and gender, underscores the need for deeper exploration of the unique perspectives and worldviews that emerge from navigating these systemic barriers.

In alignment with previous research finding that Black faculty experience daily microaggressions in the workplace and feelings of victimization (Arday, 2022), our participants described feeling excluded and isolated within their institutions as they navigated the workplace alone. These experiences are consistent with previous research  highlighting the challenges that marginalized faculty face in counselor education (Haskins et al., 2016; Pérez & Carney, 2018). Another participant perceived her experiences of racial discrimination as inevitable, supporting past research that Black tenured faculty reported and expected racism in institutions (Blackshear & Hollis, 2021), while mistrusting the institution involved, feeling suspicious, and lacking confidence in the work environment. This finding supports previous literature that documents suspiciousness as a psychological effect of racial trauma (Bryant-Davis & Ocampo, 2006; Comas-Díaz et al., 2019). Our study’s results indicate that cognitively processing racial trauma experiences was an emotional release for participants.

Amidst their challenges, our participants navigated and processed racial trauma in distinct and deeply personal ways, reflecting varied coping strategies and resilience. Participants discussed how they employed several internal and external coping strategies to reduce the impact of racial trauma. The coping strategies described by participants parallel previous recommendations for addressing racial trauma, including Black women’s reliance on internal resources for coping (Stevens-Watkins et al., 2014), community support (Chioneso et al., 2020; Liu & Modir, 2020), and integrating relaxation techniques (Metzger et al., 2020).

Past research found that Black women and people of color are less likely to seek mental health services (Stevens-Watkins et al., 2014) and support for stress and racism (Carter & Forsyth, 2010); however, our study participants sought counseling to cope with their experiences. Two participants left their institutions when they felt unsafe, confirming that racism negatively impacts job retention and well-being (Pizarro & Kohli, 2020). Participants focused on DEI work as a strategy for coping, explicitly advocating for faculty diversity to reduce racial trauma experiences. Our study revealed that participants used counseling literature to cope and unknowingly applied Ratts et al.’s (2015) MSJCC advocacy domains. Despite this, study participants did not consciously consider using the MSJCC to address workplace issues such as racial trauma. This finding supports the recommendations of previous scholars to fully operationalize the MSJCC (Hays, 2020; Singh et al., 2020).

Implications for the Profession
     This study has implications for Black women counselor educators experiencing racial trauma in the workplace, mental health professionals supporting clients facing racial trauma, and counselor education program administrators who supervise Black women faculty and implement policies affecting their work. Black women counselor educators must consider how systemic issues contribute to their workplace experiences and overall well-being. Mental health professionals working with clients who may be experiencing racial trauma should identify and screen for racial trauma, use culturally relevant interventions and racial models of recovery to treat racial trauma, utilize cognitive and behavioral strategies that promote relaxation, and help clients identify internal and external resources for coping.

Mental health professionals also have a responsibility to address issues related to oppression, privilege, and social inequities (Lee, 2007). When working with Black women counselor educators, mental health professionals should be aware of anti-DEI policies and legislation while empowering clients to engage in social justice and advocacy to reduce racial trauma at work. As DEI programs are no longer permitted within federal government agencies (The White House, 2025), implications for counselor education program administrators include recognizing the impact of anti-DEI mandates, policies, programs, and activities on counselor education programs. Administrators should inform counselor educators, staff, and students about how these changes impact employment, hiring practices, workplace policies and procedures, and curriculum. Although recent executive orders emphasize advancing a policy of equal dignity and respect (The White House, 2025), counselor education administrators should consider strategies to foster a workplace culture that upholds federal civil rights protections for all employees. They should also familiarize themselves with anti-discrimination laws and focus on enhancing psychological safety and support to reduce the impact of racial trauma in counselor education programs.

Limitations
     Our recruitment strategy limited our sample size due to the criteria we set and the sensitive nature of the research topic, which consequently restricts the transferability of our findings. Our sample size also lacks racial and gender diversity, with all participants identifying as Black women. Black people experience racial trauma more than any other racial group (Comas-Díaz et al., 2019; Williams, Printz, & DeLapp, 2018). However, the exclusion of male participants is a limitation, and understanding Black men’s experiences as counselor educators is also worth exploring in depth.

Finally, bracketing personal experiences in phenomenological research is difficult because researchers always bring their own assumptions to the study (Moustakas, 1994; van Manen, 1990, 2014). Hence, our interpretation of the data could reflect our biases, beliefs, and values. Because all of us have counselor educator experience, our professional experiences may have shaped our interpretation of participants’ experiences. Therefore, we took intentional steps to minimize our biases and bracket our experiences, including journaling, member checking, and peer review throughout the research process.

Conclusion

This study aimed to explore Black women counselor educators’ lived experiences of racial trauma in the workplace. The findings showed that the participants had experiences unique to their contexts and settings. Participants experienced significant challenges, including disrespect from colleagues and students, diminished well-being, a lack of trust in their competency, expressing concerns for safety/hypervigilance, a heightened awareness of intersectionality, an awareness of social conditioning/exposure to sexualization, and the cognitive process. Despite these hardships, they employed various coping strategies to survive the environment, thus mitigating racial trauma in the workplace. This study contributes essential knowledge to counselor education by highlighting the systemic conditions that shape the experiences of Black women counselor educators and revealing a critical need for structural and institutional change to ensure safe, equitable, and culturally responsive environments that support the well-being and professional longevity of Black women faculty.

 

Conflict of Interest and Funding Disclosure
Data collected and content shared in this article

were part of a dissertation study, which was
awarded the 2024 Dissertation Excellence Award
in Qualitative Research by The Professional Counselor
and the National Board for Certified Counselors.

 

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April D. Brown, PhD, NCC, CPCS, LPC, is a licensed professional counselor at The Wellness Room LLC. LaShauna M. Dean, PhD, NCC, ACS, LPC, is an associate professor at University of the Cumberlands. Matthew Lyons, PhD, is a professor and dean at University of the Cumberlands. Correspondence may be addressed to April D. Brown, 2870 Peachtree Rd NW Suite 915-8596, Atlanta, GA 30305,  info@trythewellnessroom.com.

 

Appendix

Interview Protocol

  1. What does it mean to be a Black woman counselor educator?
  2. Tell me about your experiences working as a Black woman counselor educator.
  3. Tell me about the racial trauma you have experienced in the workplace.
    1. What was it like for you? How did these experiences impact you?
  4. Tell me what areas in your life were most impacted due to these experiences.
  5. How would you describe the role that race and gender played in these experiences?
  6. Let’s talk about what you have done to mitigate experiences of racial trauma in the workplace.
    1. How would you describe the intentional choices you made to deal with these experiences?
    2. What specific actions did you take?
    3. What specific interventions helped you overcome these experiences?
  7. Tell me, was there anything from the counseling literature that helped you?
    1. What about the Multicultural Social Justice Counseling Competencies?
  8. Tell me who was a part of your work experience and helped you overcome racial trauma in the workplace.
  9. What external factors helped you overcome these experiences?
  10. As you reflect on your experiences, is there anything else you want me to know about your experiences mitigating racial trauma in the workplace?

Counseling With a Child Holding Afghan Parolee Status in the United States

Shadin Atiyeh, Tahani Dari

Currently, 200,000 Afghans live in the United States, including the 76,000 Afghan nationals who arrived in 2021 under Operation Allies Welcome. Afghan refugees have often lived their entire lives under strife and occupation, presenting specific concerns unique to this population. To demonstrate how mental health and social and economic factors can manifest traumatic responses in children from migrant backgrounds, the article presents a case study involving a school-aged child and recommendations for how a counselor would work with this client in the school setting. The article also presents practical applications and interventions that could be beneficial in these cases while also considering the limitations that exist in the current case study regarding relevant issues for immigrants in counseling.  

Keywords: counseling, Afghan refugees, case study, children, migrant

     Afghan migration to the United States started to increase significantly in the late 20th century, growing from 4,000 in 1980 to 45,000 by 2000 (Saydee & Saydee, 2025). Currently, about 200,000 Afghans are living in the United States (Saydee & Saydee, 2025). The Afghan immigrant population in the United States has a lower median age than other immigrant and native-born groups in the United States, and 30% of Afghan immigrants are under 18 years old (Montalvo & Batalova, 2024). We present historical and contextual information related to the experiences of Afghan parolees in the United States and how counselors may work with a school-aged Afghan parolee and their family through a case study. Parole in this context refers to a temporary, discretionary immigration status allowing admission to the United States for humanitarian concerns or significant public benefit (Immigration and Nationality Act, 2025, 8 U.S.C 212(d)(5)).We demonstrate counseling using an integrative ecological approach with an Afghan child who arrived in the United States with humanitarian parole status through the case study. For this case study, we define children as school-aged (6–18). The case study is hypothetical, incorporating elements based on our experiences working with Afghan parolees in community and school settings in the United States post-evacuation in 2021. We illustrate through the case study of a school-aged child an integrative approach relevant for both school and mental health counselors.

Operation Allies Welcome
In August 2021, 76,000 Afghan nationals arrived in the United States under Operation Allies Welcome, an emergency evacuation effort after the American withdrawal from Afghanistan and subsequent takeover by the Taliban (U.S. Department of Homeland Security, 2022). Before arrival, these Afghans completed a rigorous health and security screening process and were granted humanitarian parole to enter the United States (U.S. Department of Homeland Security, 2022). This parole status allows individuals to enter the country without a visa in cases of humanitarian concern or benefit to the United States (National Immigration Forum [NIF], 2021), such as requiring protection from harm, seeking critical medical treatment within the United States, caring for a sick relative living in the United States, attending a funeral, or participating in a legal proceeding. Under this status, Afghan evacuees were allowed to remain in the country and to work legally for a period of 2 years. Similar past evacuation efforts occurred after the Hungarian Revolution in 1957, the withdrawal from Vietnam in 1975, the withdrawal from Iraq in 1996, and the evacuation of interpreters from Iraq in 2007 (NIF, 2021).

     The recent exodus of displaced persons from Afghanistan after the U.S. withdrawal joined refugees fleeing the country in response to decades of conflict and hardship, including the Soviet invasion in the 1980s, civil war in the 1990s, the Taliban takeover in 1996, and the American invasion in 2001 (Montalvo & Batalova, 2024). Once in the United States, Afghan parolees were initially housed at Army base camps across the country (which closed by February 19, 2022), until referred to a refugee resettlement agency for permanent resettlement. Parolees had 2 years to apply for an immigration status that allows for a pathway to citizenship, such as asylum or a special immigrant visa (SIV; Bruno, 2023). This process differs from the typical refugee resettlement process, in which refugees must have fled their country because of persecution, been granted refugee status, and been referred to the U.S. resettlement screening process, which can take 5 to 8 years. Refugees who arrive under this process are eligible to work from the day of arrival in the United States and have a pathway toward citizenship.

     Although Afghan parolees were deemed eligible for public benefits, resettlement, and other integration services benefits upon arrival to the United States, and were spared the long waiting process for refugee resettlement (Bruno, 2023), they were required to apply for work authorization as well as an immigration status that would allow them to stay in the country permanently (Bruno, 2023). The influx of Afghan migrants also overwhelmed resettlement agencies, many of whom were already operating under limited capacity because of COVID-19 and years of low arrivals (Office of the Inspector General, 2023). Because of the urgency of the evacuation, many of these migrants had little time to prepare or consider the implications of the decision to leave Afghanistan. Some had to leave behind family members, even spouses and children, with no pathway toward family reunification (until the family reunification initiative launched almost 2 years later; Rush, 2023).

Contextual Considerations for Counseling
It is important for counselors not to regard any country as a monolith and to assess the individual ethnic and cultural background of their clients. Afghanistan is diverse, made up of more than 19 different ethnic groups with distinct languages and cultures (Saydee & Saydee, 2025). The two primary languages are Dari and Pashto, and the primary ethnic groups include Pashtuns, Tajiks, Hazaras, and Uzbeks (Saydee & Saydee, 2025). Three-fourths of children in Afghanistan report experiencing violence at home, and children are at risk for child labor, early marriages, sexual violence, military recruitment, and honor killings (Saydee & Saydee, 2025). Although exposure to violence may be prevalent, counselors should never assume that a client is abusive or being abused solely because of ethnicity nor label the culture as inherently violent. Symptoms of trauma, such as hypervigilance and avoidance symptoms, can be exacerbated by honor values in Afghan culture (Missmahl, 2018). For example, an Afghan woman may lean heavily on cultural expectations that she serves as homemaker and caretaker to avoid uncomfortable experiences in a new country. A counselor may not question her behavior out of respect for her cultural beliefs, further enabling her isolation. Alternatively, a counselor may perceive culturally appropriate behavior, such as refusing to be in a room alone with a man, as indicative of paranoia, social phobia, or another pathological symptom.

     Socioeconomic circumstances can contribute to psychological distress in children (Golberstein et al., 2019). Counselors may expect that a person who has experienced trauma such as war and sudden flight from their country must be traumatized. They might attribute symptoms of distress to traumatic experiences from overseas, and therefore miss that possible present unemployment, social isolation, homelessness, and/or food insecurity might be responsible for these symptoms (Im et al., 2021). In these cases, counselors should be prepared to investigate and address the socioeconomic circumstances that contribute to psychological distress (Missmahl, 2018).

     Uncertain legal status complicates the daily life and integration of Afghan parolees resettled in 2021 and can contribute to symptoms of traumatic distress (Drožđek et al., 2013). The traditional refugee resettlement process includes coordination between several federal agencies, nonprofit organizations, and local communities that includes security and health screenings and clearance overseas, placement and travel, and reception and connection to services (Office of Refugee Resettlement, 2015). Although the initial parole status granted them legal presence for 2 years, they had to apply for employment authorization cards and wait for approval before starting work. Their only pathway toward permanent residency in the United States was to apply for asylum, which can also be an expensive and lengthy legal process, or to apply for an SIV, if they were eligible, by being able to prove that they worked with Americans in Afghanistan for at least 1 year. Asylum involves demonstrating evidence of persecution in the country of origin based on race, religion, nationality, membership in a particular social group, or political opinion (Bruno, 2023). Receiving an SIV involves demonstrating evidence that the Afghan individual assisted the U.S. government in the fight against the Taliban or eligible employment by or on behalf of the U.S government in Afghanistan (Bruno, 2023). Those who left behind immediate family members in Afghanistan had no pathway toward applying for them to join them in the United States.

     Grief over separation from family and fear for their safety can be a major source of distress (Bryant et al., 2021), as can fear of discrimination in the United States (Yang et al., 2025). A young person coming to the United States from Afghanistan in 2021 is likely to have lived their whole life under American foreign occupation. Additionally, this person may feel a sense of betrayal for abandoning their country, and that sense of betrayal may color each decision, either to acculturate to American life or to cling to traditional Afghan ways. Afghan evacuees left behind their hometowns and the social structures inherent in them. Hence, practicing their cultural or religious beliefs may be difficult in a new country when these practices involve community, because this new community needs to be rebuilt.

     In addressing the psychosocial needs of Afghan children resettled from the evacuation effort, counselors need to provide a comprehensive approach that considers the legal, physical, emotional, and social needs to begin the reconstruction of a new community structure for these children. Miller et al. (2006) conducted a study exploring Afghan conceptualizations of mental health and distress and found that well-being was made up of three areas: community (honor), family (respect, harmony), and the individual (hope, faith, calm). Young refugees, in general, benefit from a multidisciplinary approach (Stammel et al., 2017). Family can be a source of protection, belonging, and strength for immigrant children (Burgos et al., 2017). In Afghanistan, families are often tight-knit, and each contributes to the extended family unit. Although it can be a source of stress, children of immigrants often become involved in caring for parents as adults struggle to navigate new systems (Burgos et al., 2017). At the same time, contributing to the family can increase self-esteem for youth (Burgos et al., 2017). For Afghans, this can be a way of honoring culture, building social support, and promoting self-esteem.

     Maintaining ethnic identity, religious practices, and family cohesion can lead to well-being among immigrant children (Burgos et al., 2017). Reimagining ethnic identity in the process of immigration can be a crucial step in integration and identity development. For example, an Afghan child can identify with other refugees from different countries who have experienced a similar process of flight from war and resettlement in a new country. This can be balanced against maintaining other important aspects, such as religious identity. Using religious practices and tenets to resolve family and internal distress can be useful, such as increasing tolerance and patience, practicing listening and respect, and using various relaxation techniques like prayer or aromatherapy (Faqiri, 2018). Children arriving from Afghanistan with humanitarian status are unique from other refugee groups because of the nature of their evacuation directly to the United States and the differences in their immigration status and its implications for long-term integration (Saydee & Saydee, 2025). We highlight these dynamics in the following case study.

Case Study: Aaisha

     Ten-year-old Aaisha recalls the dangers of her home country, Afghanistan, and the limitations she experienced growing up in a war-torn country. These dangers forced her family to seek asylum in the United States. During her escape, her immediate family—her mother, father, and younger sister—were unable to stay with other close family members with whom she had grown up, such as her grandparents, aunts, uncles, and cousins. The separation from extended family and subsequent immigration to a new country disrupted her life and continues to affect the life her family is trying to build in the United States, where she now lives and attends elementary school.

     While Aashia was still living in Afghanistan, the parents tell the school counselor, she was unable to play outside or attend school because of the danger of sniper and missile attacks. She reports that she even learned to identify what type of weapon was being used based only on the sound it made. Her mother tells the school counselor that they were able to get on a plane out of Afghanistan, during which her younger sister almost died because of the heat and crowded conditions. The family lived on an Army base in Texas for 2 months until they were assigned to a resettlement agency in another state. They have been staying at a local hotel for 2 months since then and are waiting for employment authorization and permanent housing.

     Aaisha is struggling to adjust. She fears she is too far behind the other students in her grade at school, and the language barrier prevents her from connecting to classmates or fully expressing herself. She remembers the violence of her home country and, despite the new environment, thinks often about her past, in which she needed to hide. She still misses her extended family and her home in Afghanistan deeply. Leaving her family each day to go to school makes her feel nervous, and when at home, she suffers from restless sleep, further adding to her stress at school. She struggles to pay attention, and her teacher complains that she is distracted and often excuses herself to the restroom, which prevents her from engaging fully in the lessons. She does not want to complain and worry her parents, but the teacher assigned her to sit with two Afghan male students in class who have been in the country longer. They do not speak her language and ignore her when she tries to ask them for help. The girls in the class also seem to laugh at her and make fun of her clothes. At home after school, she procrastinates doing homework, often complaining that she has a headache. She also changes the subject when asked about her school day, frequently reporting that she does not feel well. The school counselor is concerned about Aaisha’s psychological well-being and has approached her and her parents about possible therapy options. The school counselor has suggested that her parents explore art therapy as a constructive way for their daughter to creatively express and process her emotions and trauma. Her parents like this idea but cannot afford therapy or even art classes. The school counselor refers the student to an on-site school-based clinic staffed by clinical mental health interns. The school counselor meets with the intern to discuss her concerns before the clinical mental health intern meets with the client. School-based mental health clinics can be effective and bridge gaps in accessibility for counseling services (Solomon et al., 2020).

     An ecological approach can help school counselors promote equity for students like Aaisha (Savitz-Romer & Nicola, 2022). Children develop within and are influenced by multiple levels of society, including the immediate family, school environment, community, and wider sociological forces (Bronfenbrenner, 1979). The ecological approach can be useful in understanding the dynamic factors involved in refugee children’s development and potential areas of intervention (Yoon et al., 2023). Below, we show how an ecological approach can help us understand the case and provide a productive starting point for intervening to help Aaisha.

Ecological Approach
Case conceptualization and treatment planning with refugees should take an ecological approach that considers all relevant factors, highlighting areas of challenge and strength (Yoon et al., 2023). The ecological model attends to different spheres of the child’s life pre- and post-migration. The model includes any education, trauma, information, coping skills, and medical support the child would have received before immigration to a new country (Minhas et al., 2017). Assessing a child’s needs using an ecological approach can provide useful information to important individuals in the child’s life (Minhas et al., 2017), including caregivers, medical teams, pediatricians, physicians, and school staff who can help support successful acculturation. Minhas et al. (2017) developed an ecological approach to assessing risk factors among refugee children. This approach is represented by the acronym EMPOWER: Education, Migration, Parents and family, Outlook, Words, Experiences of trauma, and Resources (Minhas et al., 2017). Using this model, the school counselor and clinical mental health intern meet and discuss the possible ecological factors relevant to Aaisha’s case, applying the EMPOWER model, to coordinate her care. For her educational background, they know that she’s currently in an English as a Second Language (ESL) class and is perceived by her instructor as struggling with attention and focus. She is proficient in both spoken and written Dari and has some proficiency with English. She also experienced an interruption in her formal education because of her migration experience. Her migration experience included a forced migration from her home country to the United States, one that she did not have time to plan or prepare for. Her family was evacuated from Afghanistan and held in a temporary shelter in Texas at a military base for 2 months until they were referred to the local nonprofit agency for 3 months of resettlement services. Her family is now living on a temporary parole status and has to pay a lawyer to help with processing an application for asylum, leading to a more permanent pathway to staying in the United States. For her family, she lives with her mother, father, and sister who serve as a resource and source of strength for her. She is experiencing grief over the loss of her family and social network in Afghanistan. For her outlook, she is motivated to do well in school and to feel a sense of belonging and safety in a community. She worries about her extended family overseas and is troubled by loneliness. Related to words, she speaks Dari and some English. For resources, she can seek support from the local nonprofit that resettled the family and that offers additional social services such as a food pantry, after-school tutoring, and assistance navigating public benefits. She has limited support from the local Afghan community because they were also resettled recently and many of them came from a different ethnic group.

Evidence-Based Treatments
Counselors can help in a variety of ways by addressing grief related to the loss of friends and family, the effects of being a minority, perceived discrimination and acculturation, exposure to trauma and harassment, and the effects of social issues (Beehler et al., 2011; Beiser et al., 2015; Goh et al., 2007; Kopala et al., 1994). To meet the unique needs of children and families, practitioners must use evidence-based interventions, such as cognitive behavioral therapy (Sullivan & Simonson, 2016), while making appropriate adaptations to render them logistically and culturally accessible. Counselors using an integrative approach can utilize evidence-based interventions to address various aspects of the mental health challenges a child is facing. Counselors can focus on grieving the loss of family and friends (Goh et al., 2007), the effect of being a minority (Kopala et al., 1994), perceived discrimination (Beiser et al., 2015) and acculturation (Beehler et al., 2011; Beiser et al., 2015), exposure to trauma (Beehler et al., 2011), harassment, and social issues (Goh et al., 2007). With Aashia, these elements are all involved. She is experiencing migratory grief, which is often unnamed and unrecognized (Yoon et al., 2023), as well as the loss of family, friends, and the comfort of living in a familiar climate, environment, and surrounded by a familiar language. The experience of being perceived as a religious and racial minority in a different social system in the United States is also distressing. Aaisha was exposed to trauma overseas before migration, and the experience of migration and resettlement was further traumatizing. Evidence-based interventions are needed to assist with the processing of trauma associated with these experiences.

     School-based mental health professionals can play an important role in offering mental health services for migrant children. Two-thirds of students surveyed said they preferred to seek counseling at school (Fazel et al., 2016; Sullivan & Simonson, 2016). Because of their ability to identify distress, address psychosocial functioning, and implement creative expression (Goh et al., 2007; McNeely et al., 2020), schools are well-situated to support student wellness, offering an opportunity to provide mental health services for migrant children in an acceptable and accessible manner (Sullivan & Simonson, 2016). For Aaisha, the school could be an accessible place to receive these services. The school counselors would not be able to provide the individual treatment themselves, but they can support the on-site clinics and coordinate with the individual practitioners. The school counselors would also be able to organize and offer group sessions to build peer psychosocial support. By providing referrals to individualized services, offering group sessions, and facilitating advocacy to build a welcoming and supportive school environment, the school counselor is meeting ethical responsibilities through a holistic approach (Harrichand et al., 2022).

Art Therapy
     Creative expression through evidence-based art therapy provides an outlet for children, such as refugees struggling with traumatic past experiences, and can be an effective way for them to begin to process their complex emotions and trauma (Rowe et al., 2017; Sullivan & Simonson, 2016). In the absence of a shared common language, art provides a mechanism for communication and expression among peers (St. Thomas & Johnson, 2001). Rowe and colleagues (2017) reported that the use of assessment tools like the Diagnostic Drawing Series can be helpful as a baseline because art therapy can initially cause depressive symptoms as the trauma surfaces but ultimately leads to decreased anxiety and depression. If working with Aaisha, the school-based clinical mental health counselor could use art therapy to help reduce her anxiety and depression through either structured drawing or the Diagnostic Drawing Series. Art therapy could also offer Aashia a way to communicate her emotions in a safe environment.

Peer Support and Groups
     It is up to counselors to develop an encouraging environment for students to address and process their present and past feelings (St. Thomas & Johnson, 2001). St. Thomas and Johnson (2001) investigated a 12-week program to help children process their feelings through puppetry in a supportive peer group setting. Panter-Brick et al. (2018) found that high levels of traumatic distress can be managed using psychosocial groups. They found that small peer groups help adolescents develop trusting relationships with individuals from different cultures. Groups also have the benefit of supporting acculturation for refugees and immigrants through rebuilding communities and offering opportunities to practice interpersonal skills (Atiyeh et al., 2020). As Aaisha is navigating life in a new country and rebuilding community, the school counselor can provide a group intervention that could assist her in learning new skills and reducing isolation. The school counselor would lead a peer support group for Aaisha and other new students to offer support in acclimating to the school environment, address social skills, and develop peer support. A group intervention can offer an opportunity for the school counselor to address Aaisha’s social needs, facilitating her connection with peers in a supportive environment. The school counselor would also be able to identify shared barriers or concerns new students face in the school and advocate more effectively for a welcoming environment among school faculty, staff, students, and families.

Cognitive Behavioral Therapy (CBT) and Trauma-Focused CBT
     Interventions that focus on helping refugees and immigrants through trauma can be very therapeutic (Im et al., 2021). Cognitive behavioral therapy (CBT) interventions like narrative exposure therapy, creative exercises, cognitive restructuring, trauma-focused therapy, and psychoeducation are effective for children with post-traumatic stress disorder (PTSD), anxiety, and depression (Kangaslampi et al., 2015). The clinical mental health counselor working with Aaisha could implement these techniques to treat symptoms of trauma and facilitate adaptive coping techniques for acculturative stress. Trauma-focused cognitive behavioral therapy (TF-CBT) can be used to process and understand trauma (de Arellano et al., 2014). TF-CBT focuses on helping children with processing trauma and working through PTSD, depression, anxiety, and behavioral issues. TF-CBT has also helped counselors work with children who have struggled with depression, PTSD (de Arellano et al., 2014; Scheeringa et al., 2011), and behavioral issues (de Arellano et al., 2014). Scheeringa et al. (2011) completed a 12-session model for reducing PTSD and depression in children. TF-CBT could be productive with a client like Aaisha, who witnessed the danger of sniper and missile attacks. Addressing and focusing on her trauma could help reduce PTSD symptoms over time. The counseling intern working in the school-based clinic would offer TF-CBT to support with art therapy techniques to help Aaisha process grief and past trauma, and to strengthen coping skills to manage worries and anxiety. The counseling intern starts with a thorough informed consent process with both Aaisha and her parents, with an interpreter present to discuss the counseling process, the time limitation of her internship, and the plan for ongoing services after the end of the TF-CBT protocol. The intern develops a treatment plan that identifies manageable goals important to Aaisha for the timeframe they have to work together.

Integrative Approach
Using an integrative, school-based approach that addresses the logistical and cultural needs of the client in treating trauma and adjustment-based concerns, the school counselor working with Aaisha would need to hire a trained contractual interpreter to assist with co-facilitating an integrative group intervention. The school counselor could work with her teachers to identify other girls within her age bracket who might share similar concerns. The group sessions could follow the general protocol of TF-CBT, including psychoeducation, relaxation, affect regulation skills, integration of the trauma narrative, communication skills, and parenting skills. Art therapy techniques at each stage will make activities more accessible and meaningful. These techniques might include creating group murals or collages with coping techniques. While the clinical mental health counselor is working with the students, the school counselor could lead parenting skills and psychoeducation sessions with the parents so that they can be brought into the group sessions to support their children effectively.

Limitations/Considerations
While we offer an integrative approach in this case study, school counselors must account for their school contexts and resource limitations. Within those limitations, we advocate for an approach that honors the client’s cultural background, family and community involvement, and holistic needs for well-being. School and clinical mental health counselors must work in partnership with each other, students, interpreters, families, and wider school communities to meet these needs ethically. The ASCA National Model (2025a) and the ASCA School Counselor Professional Standards & Competencies (2025b) outline school counselors’ responsibility to build partnerships among schools, families, and communities. Seeking supervision and consultation can support creative advocacy efforts to address migration-related trauma and acculturation concerns within resource constraints.

Conclusion

     Equipped with background knowledge of migration issues, cultural norms, and relevant social systems as well as skills in evidence-based interventions, advocacy, and cultural brokering, counselors can successfully support refugee and immigrant children in their pursuit of wellness. An ecological approach that includes consideration for poverty, trauma, and culture is best suited to facilitate understanding of both the pressing challenges and areas of strength and resilience among refugee and immigrant children. Counselors are well-positioned in the community and school settings to help facilitate psychosocial adjustment in collaboration with schools, service providers, health care providers, and families.

 

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

 

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Shadin Atiyeh, PhD, NCC, ACS, LPC, CCC, CRC, is an assistant professor at Wayne State University. Tahani Dari, PhD, NCC, LPC, is an associate professor at the University of Detroit Mercy. Correspondence may be addressed to Shadin Atiyeh, 5424 Gullen Mall, Detroit, MI 48202, shadin.atiyeh@wayne.edu.

Providing Wellness Counseling in Older Adult Living Communities: Challenges and Opportunities

Matthew C. Fullen, Jonathan D. Wiley, Paul M. Delaughter, Connie C. Tomlin, Jordan B. Westcott, Nick Gowen

Older adult living communities (OALCs; i.e., continuing care retirement communities, assisted living facilities, and long-term care settings) are growing in number and complexity, and industry leaders are recognizing that promoting wellness among their residents is a top priority. Although OALCs offer services to keep their residents engaged and active, residents’ emotional needs often go unmet. Adults who reside in OALCs are likely to benefit from counseling services, especially when delivered within a wellness framework; however, there is inconsistent availability of wellness counseling within OALCs. Our article describes how wellness approaches can be utilized, addresses the unique counseling needs of OALC residents, and considers the importance of multicultural competence when serving older adults. The included case study highlights the promise of wellness counseling in OALCs.

Keywords: older adults, counseling, wellness, living communities, assisted living

 

Older adult living communities (OALCs) play an essential role in promoting multidimensional wellness among older adults (Hettler, 1976). OALCs are growing in number and complexity, and industry leaders suggest that promoting wellness among residents is a top priority (Johnson, 2025). Although OALCs offer services that engage residents’ multidimensional wellness, their mental health needs often go unmet (Fullen, Wiley, et al., 2020). Adults who reside in these communities are likely to benefit from counseling services; however, counseling is not consistently available within OALCs (Fullen, Wiley, et al., 2020).

Concurrent with the population increases of older adults, the number of OALCs, such as continuing care retirement communities, assisted living facilities, and long-term care settings, is increasing across the United States (Christman, 2025). According to the U.S. Census Bureau, by 2060 almost a quarter of all U.S. residents will be over age 65 and life expectancy will reach 85 years (Medina et al., 2020). It is estimated that OALCs will need to hire 1.2 million new employees across professional domains in order to meet residents’ needs and account for this growth in the older adult population (Argentum, 2016).

Demographic and industry trends point to counselors being well-positioned to meet the mental health and emotional wellness needs within OALCs. This is a timely development in the counseling profession, as licensed counselors recently became eligible to enroll as Medicare-eligible providers (Consolidated Appropriations Act, 2023). However, counselors face the challenges of understanding the counseling needs of older adults, practicing culturally competent care, and overcoming the obstacles related to providing professional counseling services within OALCs (Fullen, Wiley, et al., 2020). Therefore, we describe the unique counseling needs of residents of OALCs, as well as specific challenges to providing counseling services within OALCs related to mental health services integration, payment and reimbursement, and counselor education, training, and supervision. Because OALCs are increasingly using a wellness framework in their approaches to older adult health care, we will also describe how wellness can be used to introduce counseling within these settings.

Older Adult Wellness Counseling
     To better conceptualize older adult wellness, it is helpful to summarize the eight dimensions of older adult wellness that have been described in our previous work (Fullen, 2019). These dimensions include physical, relational, emotional, developmental, spiritual, cognitive, contextual, and vocational domains. These dimensions are briefly defined in Table 1, with a corresponding assessment question included for reference.

Table 1

Eight Dimensions of Wellness in Older Adulthood

Wellness Dimension Brief Definition (derived from Fullen, 2019) Sample Assessment Question
Physical Taking care of one’s body, as well as attending to needs associated with disability, chronic illness, or pain In what ways do you continue to care for your body?
Relational Maintaining meaningful relationships with friends, family, and others in your community Do you feel supported by those around you, and how do you support others?
Emotional Maintaining hope and resilience in spite of challenges one faces Are you content, and do you think you will be in the future?
Developmental The need to develop healthy, realistic attitudes about growing older What does growing older mean to you?
Spiritual Exploring your meaning and purpose Where do you find meaning in your daily life?
Cognitive Fostering control, self-efficacy, and commitment to brain health and lifelong learning How do you exercise your brain?
Contextual Inhabiting a community where you belong and thrive Do you feel secure and supported where you live?
Vocational Pursuing your life’s calling, regardless of whether the calling is associated with paid work What is your calling?

 

Wellness Counseling
     Multidimensional wellness is based on the assumption that older adults have holistic needs that may reflect intersections between physical, emotional, social, or spiritual domains (Fullen, 2019). Wellness counseling occurs when counselors incorporate multidimensional assessment and treatment planning, a focus on client strengths, and a paradigm shift from addressing illness to promoting growth and self-discovery (Fullen, 2016). Frameworks for wellness counseling across client ages have been described (Ohrt et al., 2019), and specific modifications for using wellness counseling with older adults exist (Fullen, 2019). Wellness counseling has been identified as a strategy to counteract ageism (Fullen, 2019), particularly because of the medicalization of aging and the shift away from illness and client deficits that is emphasized within the wellness paradigm. Because older adult wellness is multidimensional, counselors using a wellness framework may identify several wellness dimensions that correspond with particular presenting problems. Therefore, the practice of wellness counseling begins with a multidimensional assessment of a client’s wellness, followed by a review of the client’s strengths, and ongoing discussion about how to apply these strengths to meet specific, multidimensional wellness goals and challenges that older adult clients may bring to counseling. Consistent with its focus on holism, counselors using a wellness counseling approach emphasize how client strengths can be leveraged to address areas of vulnerability (Fullen, 2016). Areas of strength may be targeted for additional growth, whereas areas of present vulnerability may be highlighted for intervention. As interventions are applied, ongoing assessment of wellness dimensions occurs to advance the pursuit of holistic wellness.

Wellness Challenges Facing Older Adults in OALCs
     Older adults residing in OALCs face many of the same challenges as their peers living outside of these settings. Living in a residential setting can provide older adults with security and comfort, enabling them to age in place. Many OALCs offer a range of care options, including independent living, assisted living, skilled nursing, long-term care, and memory care (Shippee, 2012). Although these communities are designed to promote aging well in multiple dimensions (e.g., physical wellness, social wellness, intellectual wellness; Johnson, 2025), some residents will experience wellness challenges that necessitate counseling intervention (Fullen, 2016). Counselors working in these settings need to be prepared to meet residents’ counseling needs and to be aware of the unique challenges that older adults living in OALCs routinely face. When considering how to apply a wellness framework to counseling older adults in OALCs, counselors can respond by engaging clients in dialogue about how common challenges impact their wellness, identifying clients’ wellness strengths, and developing strategies to leverage strengths to address specific challenges.

Grief and Loss
     Grief and loss issues are common among older adults. In addition to grief associated with the loss of family members and friends, there are other substantial losses that older adults face, including the loss of independence, home, health and mobility, vision and hearing, career and purpose, finances, preferred living arrangements, and cognitive abilities (Gitterman & Knight, 2019). Sometimes the decision to move into an OALC is made after losing a spouse, which could include a long-term grieving process (Sopcheck, 2020). In some cases, people decide to move into OALCs shortly after retirement, anticipating a comfortable life with fewer responsibilities, appealing amenities, and the comfort provided by being surrounded by others in their same age cohort (Brecht et al., 2009). Considerations of both contextual and developmental wellness can be valuable when responding to grief and loss. For example, asking an OALC client to define what it would look like to feel secure and supported (i.e., contextual wellness) during a period of bereavement may promote their sense of belonging within the OALC, which could contribute to the belief that the next phase of life is still worthwhile (i.e., developmental wellness). Moreover, helping clients identify wellness strengths during a period of grief and loss can be beneficial. For example, an OALC client may experience encouragement at the thought that a deceased loved one would be proud of them for meeting new friends in their OALC community, which reflects a form of relational wellness.

For those moving into these communities shortly after retiring, the loss of career and vocation may result in tremendous challenges (LaBauve & Robinson, 2011). This life stage transition can result in feelings associated with a lack of purpose and belonging, and the loss of a social network that may have been in place for many years (Myers & Degges-White, 2007). Another challenging adjustment for older adults occurs when they are no longer able to drive. This decision is often prompted by other family members who encourage them to stop driving, making many older adults feel as if they have lost a key element of their independence (Bell & Menec, 2015). Supporting clients in reappraising their vocational wellness, which may involve broaching how they continue to pursue a sense of meaning and purpose in their lives, can be beneficial.

Adjustment
     In contrast, other older adults are forced to move into these settings because of failing health, mobility issues, or cognitive decline (Krout et al., 2002). Adjustment issues related to failing health can be difficult for older adults, and many live with chronic pain, limited mobility, and full reliance on others for care. Older adults who relocate to an OALC may have left behind a home of many years, familiar surroundings and routines, as well as friends and neighbors. Many older adults are surprised by the intense feelings that arise shortly after moving into a facility (Ayalon & Green, 2012), including an extended period of grief. For older adults who have lived most of their lives in single family dwellings, sharing common areas such as dining halls and activity spaces may be difficult (Chaudhury et al., 2013). These adjustments are particularly pronounced for older adults who transition to higher levels of care in OALCs. Nighttime sleep disturbances are common and may result in a variety of physical and mental health issues (Martin & Ancoli-Israel, 2008). For individuals facing physical health challenges, the dimension of physical wellness may be most relevant. Specifically, encouraging clients to consider ways in which they continue to care for their bodies, despite bodily changes they may be experiencing, can shift the emphasis from a focus on client deficits to one of resilience and strength.

Moving into an OALC is a significant life adjustment that can lead to emotional distress. In the early stages of adjustment, residents may find it difficult to refer to their OALC as their home; instead, they may hold on to emotional connections to their prior residence. They may feel ambivalent and uncertain as they struggle to place themselves within the existing categories of residents, which may reflect the disenfranchisement of their grief and grieving process (Ayalon & Green, 2012). For some, this may be the first time they have been in a setting where most people around them use assistive devices such as canes, walkers, and wheelchairs (Ayalon, 2015). Mental health concerns may rise to a level of depression and/or anxiety. Depression may result from various factors, including the adjustment to living in an OALC, profound grief and loss, failing health, and lack of purpose and belonging (Ayalon & Green, 2012). Anxiety can also be a concern for adults in these settings as they face their mortality, financial worries, fear of decline and death, and loss of independence, which would require them to rely on others for care (Creighton et al., 2016). Understanding the impact of these adjustments on emotional wellness may be an important first step in these cases.

Relationships
     One of the most challenging life transitions older adults face is the shift in family dynamics that occurs when children begin to take care of their parents (Branson et al., 2019). As older adults move into advanced levels of care in OALCs, their adult children may experience guilt for having placed their parents in a “home.” This guilt may lead to overinvolvement and overprotection by their children, which can be a source of frustration for the older adults (Davis et al., 2019). For spouses moving into OALCs together, the strain of living in a smaller environment may create tension (Ayalon & Greed, 2016). Oftentimes, one spouse may be the primary caregiver for the other, which can also create relational challenges (Polenick & DePasquale, 2019). Approaching these cases from a relational wellness perspective allows both the counselor and the client to assess changes in their relationship and how clients continue to receive and provide emotional support. The therapeutic relationship can also function as a source of relational wellness, which may provide clients with the foundation they need to pursue other relationships with OALC community members, friends outside the OALC, or family members.

Alzheimer’s Disease and Other Related Dementias
     As the size and proportion of the U.S. population aged 65 and older continue to increase, the number of Americans with Alzheimer’s and other related dementias will continue to rise. There are currently an estimated 7.4 million Americans living with Alzheimer’s dementia (Alzheimer’s Association, 2026). Those in the earlier stages of the disease are often undiagnosed and still capable of living independently (Savva & Arthur, 2015). Older adults residing in OALCs during this phase of the disease may withdraw from social activities because of feelings of inadequacy associated with their cognitive impairment (Nelis et al., 2011). Others may not recognize the changes they are experiencing, which can lead to confusion, frustration, and embarrassment in social situations (Robinson et al., 2012). Maximizing the length of independence for those with early-stage dementia is critical because it is likely their last phase of life for living independently. Quality of life is likely to be significantly reduced as the disease progresses. Counselors can play a vital role for these individuals by maximizing the length of time they can live independently. Although counseling can be instrumental for people in all stages of dementia, OALC residents with early-stage dementia may find counseling services particularly beneficial.

Given the complexity of Alzheimer’s Disease and other related dementias, a multifaceted approach to older adult wellness could be useful (Fullen, 2019). By using the eight dimensions of wellness, a counselor may find specific strengths or shortcomings in areas such as relational wellness, cognitive wellness, emotional wellness, or contextual wellness. Clients who are caregivers may have needs in the same dimensions, as well as in areas such as vocational wellness, developmental wellness, and spiritual wellness. Identifying wellness dimensions in which clients and caregivers maintain strengths may be a helpful strategy in maintaining quality of life and bolstering a sense of resolve during what can be an overwhelming and discouraging experience.

Substance Misuse
     As the Boomer generation (i.e., adults born between 1946 and 1964) continues to enter older adulthood, a growing number of older adults are at risk for alcohol and substance abuse (Barry & Blow, 2016). Misuse of alcohol and prescription drugs among older adults is currently higher than in previous generations, partially attributed to the 25% of older adults who are prescribed potentially addictive psychoactive medications, which are the most prevalent medications prescribed to this age group (Ogbonna & Lembke, 2019). Older adults residing in OALCs typically have convenient and frequent access to alcohol at planned social gatherings. Researchers assert that alcohol may be used as a coping mechanism for those living in these settings (Sacco et al., 2015). There may be less concern about limiting social drinking, as driving is less common. However, there are numerous negative consequences for older adults, including increased fall risks and harmful drug interactions (Barry & Blow, 2016). Many older adults are unaware of substance abuse ramifications, particularly related to the physiological changes related to aging that make them more vulnerable to these adverse effects (Williams et al., 2005).

Counselors can play a supportive role for these older adults through both psychoeducation and professional treatment. Problematic substance use has a multifaceted connection to wellness, requiring counselors to consider an array of relevant wellness dimensions, such as physical wellness, emotional wellness, and relational wellness. Once one or more areas of wellness are identified for greater emphasis during treatment, it is also important to discuss which areas of wellness continue to be sources of strength. For example, an OALC resident whose alcohol use has negatively impacted their relationships may describe how taking care of their body through walking or lifting weights (physical wellness) continues to provide a healthy sense of control and self-efficacy (cognitive wellness).

Ageism
     Counseling professionals in OALCs should be knowledgeable about experiences associated with aging, including societal stigma against older adults. Ageism, or prejudice, stereotyping, and discrimination against older adults based on age (Butler, 1969), negatively influences older adults’ mental health (Gendron et al., 2016). Like other forms of prejudice, ageism is systemic (Fullen, 2018).
For example, stereotypes about older adults permeate American culture and can lead to poor mental health outcomes for older adults (Fullen, 2018). Systemic ageism is reinforced by individual, interpersonal expressions of ageism, which older adults may experience from medical professionals, family members, and even OALC staff.

Furthermore, older adults may assimilate negative stereotypes about aging and late life into their self-concept, leading to internalized ageism, through which they may believe negative stereotypes about themselves or discriminate against other older adults (Gendron et al., 2016). Counselors working in these settings should be aware of the impact that ageism can have on older adults and remain vigilant in identifying ways in which ageism is organizationally embedded in OALCs. Attitudes toward aging contribute to a person’s developmental wellness, which can be more broadly assessed through therapeutic dialogue (Fullen, 2019). When clients describe internalized aging attitudes, it is important to identify the origin of these messages. Gently challenging these ageist assumptions can enhance the therapeutic relationship (relational wellness) and result in a greater sense of resilience (emotional wellness) and self-efficacy (cognitive wellness).

Culturally Responsive Care With Older Adults in OALCs
     In addition to being prepared to work with a wide variety of clinical concerns using a wellness framework, counselors working in OALCs should be prepared to work with clients from many different backgrounds with diverse lived experiences. It is important to ask clients how their sociocultural experiences, as well as gender, socioeconomic status, and religious affiliations, influence how they define the eight dimensions of wellness for themselves. Counselors can best meet their clients’ needs when they understand clients contextually, considering the unique experiences that have informed clients’ lives based on their sociocultural identities (Ratts et al., 2016). Although all clients have specific cultural considerations counselors should attend to, counselors who desire to work in OALCs must be aware of specific issues in later life and how sociocultural factors can influence development across the lifespan (Fullen, 2020b).

Use an Intersectional Lens
     Counselors who practice in OALCs will undoubtedly work with clients who have been impacted by ageism. However, many clients will hold additional marginalized identities that influence their experiences of aging and ageism. The intersection of age with other marginalized identities significantly alters the experiences of aging for older adults (Wang et al., 2025). Crenshaw (1989) introduced the construct of intersectionality to explain how occupying two or more marginalized positionalities creates a gestalt experience of discrimination. Intersectionality is a framework that enables people to understand how interlocking systems of oppression can exacerbate one another, creating a unique experience for individuals who hold multiple minoritized identities (Crenshaw, 1989). In essence, understanding clients in OALCs through an intersectional lens is crucial for developing a nuanced understanding of their experiences and clinical concerns. Therefore, in addition to the necessity of understanding systemic ageism (Fullen, 2018), counselors who provide services in the context of OALCs should be aware of the unique intersections other sociocultural factors can have with age in such settings.

Social determinants of health, such as race/ethnicity, gender/gender identity, sexual orientation, and socioeconomic status, influence clients’ mental health across the lifespan, with some effects emerging in later life (Allen et al., 2014). Additionally, there is evidence that inequity across the lifespan leads to poorer mental health outcomes in older adulthood for marginalized groups, such as racial/ethnic minority older adults (Ferraro et al., 2017); lesbian, gay, bisexual, and transgender (LGBTQ+) older adults (Fredriksen-Goldsen et al., 2017); and older adults with disabilities (Kattari et al., 2017). These findings suggest that the older adults who are most likely to need counseling are also more likely to have experienced unique intersectional challenges. Therefore, understanding clients’ contexts and backgrounds, selecting appropriate interventions and assessments that account for clients’ unique cultural considerations, and providing opportunities for clients to process experiences of discrimination and stigma are all critical components of culturally competent care for all clients.

Broach Culture
     Counselors should endeavor to learn about their clients’ cultures, broach cultural differences, select culturally appropriate interventions and assessments, and engage in advocacy within OALCs to ensure equitable access to resources and programming (Day-Vines et al., 2007; Ratts et al., 2016). To understand the salience of client identities and how these identities have influenced the client’s life, it is crucial to directly discuss both the client’s culture and the cultural differences between the counselor and the client early in the counseling process (Day-Vines et al., 2007). Broaching the client’s culture provides them with the opportunity to share their most salient identities, how those identities have shaped their lives, and how those identities influence their experience in their OALC. This strategy also provides an opportunity for the counselor to demonstrate cultural humility and indicate that they will not perpetuate the same harm that clients may experience from staff or other residents in the community.

Similarly, counselors must commit to learning about their clients’ cultures, including the influence of age and generational cohort (Ratts et al., 2016). For example, counselors who work in OALCs should familiarize themselves with adult development and aging rather than educating themselves on the basics related to that process. By developing a knowledge base around the aging process, counselors create space for their clients to share their unique experiences of aging. In order to conceptualize their clients through an intersectional framework, counselors should also research how aging is perceived in the various cultures their clients belong to (Ratts et al., 2016). This approach may require the counselor to develop self-awareness concerning implicit biases they may possess regarding their clients’ cultural identities to ensure that they do not contribute to their clients’ experience of marginalization. Particularly salient is ageism, which counselors may invoke in counseling if they do not develop awareness around their biases related to the aging process (Fullen, 2018). In learning about their clients’ cultures, counselors have the opportunity to select interventions and assessments that are culturally appropriate based on age and other sociocultural factors that impact the client.

Address Systemic Barriers
     Finally, inequitable access to resources impacts older adults who reside in OALCs. Counselors should advocate within their workplace to address systemic barriers to access within the community (Ratts et al., 2016), help specific clients access necessary resources (Ratts et al., 2016), and develop programming that meets the unique needs of residents who are disproportionately impacted. Ultimately, counselors must attend to their clients’ holistic cultural experiences and maintain an awareness of the risks posed to older adults by a lifetime of marginalization. An essential consideration for culturally responsive work with older adults is selecting appropriate theory and empirically sound interventions.

Case Study
     Michelle, a licensed counselor, begins a new staff position at a local continuing care retirement community, where she will provide talk therapy services to residents. This is the retirement community’s first counselor, and Michelle understands that this may be some of the residents’ first experience with a mental health professional. To broach the topic of mental health at a services fair hosted by the community, Michelle creates a booth and designs a flyer outlining the eight dimensions of wellness and describing how they relate to older adult mental health. Residents stop by Michelle’s booth at the services fair, and she uses the tool as a conversation starter about mental health and also a preview of what working with her in individual therapy sessions may entail.

One community resident, Roy, tells Michelle that he is struck by her description of vocational wellness, particularly the question, “What is your calling?” Roy admits that he has only thought about “vocation” in terms of his career, from which he retired over a decade ago. He tells Michelle that he has been struggling with the concepts of purpose and meaning since moving to the community, and Michelle invites Roy to schedule an individual session with her to discuss these ideas in depth.

During their intake session, Michelle reminds Roy of the eight dimensions of wellness and asks him to point out any dimensions that are going particularly well in his life. She also broaches culture with Roy and invites him to share how aging is viewed among people who share his cultural background. Roy remarks that he had previously seen aging as “only going downhill” and admits that he has not thought about his wellness so much as his illness. Michelle uses this as an opportunity to take a strengths-based approach with Roy, explaining that enhancing certain aspects of wellness can help offset any inevitable or sudden deterioration in other aspects of wellness. Hearing this, Roy describes his robust social life in the retirement community—a sign of high relational wellness—and how his relationships increased his well-being, in spite of a worsening eye condition that has left him unable to see far distances (an example of decreasing physical wellness). Michelle notes how Roy’s increased relational wellness may be positively offsetting his declining physical wellness; she uses this as an example of the importance of a holistic approach to wellness in Roy’s life. Michelle and Roy decide to include vocational, physical, and relational wellness in Roy’s treatment plan. Together, they decide on three counseling treatment goals: 1) Determine what gives Roy meaning and purpose, and identify concrete actions to incorporate meaning and purpose into each day (vocational wellness); 2) Care for his eyesight as best he can while also maintaining a healthy diet and routine exercise in consultation with his primary care provider (physical wellness); and 3) Invest in existing and new friendships within his OALC with a goal of thriving in the area of relational wellness.

After the initial session, Michelle reflects on her session with Roy. She is pleased that the eight dimensions of wellness provide her with a helpful, strengths-based lens through which to view aging and older adulthood. She reflects that previously in her career, she overly focused on older adults’ physical wellness, often medicalizing the aging process and “othering” aging bodies. By exposing herself to a holistic approach to older adult mental health, Michelle challenges her own ageist beliefs and behaviors and notes that wellness can exist at any age.

Challenges Facing Counselors Working in OALCs
     Despite the numerous benefits of integrating wellness-based counseling services within OALCs (Fullen, 2020b), there are several challenges to consider. Historically, OALCs have been slower to integrate mental health services compared to medical services. Payment barriers for counseling have historically interfered with creating opportunities to work within this context. Finally, there are barriers associated with how counselor education programs prepare students, which have limited the growth of counseling within OALCs. The following section will describe each of these barriers.

Mental Health Services Integration Challenges
     Although older adults’ mental health needs are well documented (Moye et al., 2019), the number of OALCs that employ or contract with a mental health professional is unclear. In a large survey of counseling professionals, only 1.6% described 65 years of age and older as a primary area of clinical emphasis (Fullen, Lawson, & Sharma, 2020). Additionally, in a study of psychologists, scholars found that only 1.2% described geropsychology as a specialty area (Moye et al., 2019). Moye and colleagues found that psychologists who specialize in working with older adults were more likely to work in independent practice, including over half of private practice practitioners. However, it is not clear how often their services were integrated into OALCs.

The presence of counseling services within long-term care settings is slightly more apparent. A survey of Florida nursing homes indicated that approximately 50% had a psychiatrist and a psychologist present at their site on a weekly basis. However, 90% of these providers were independent practitioners who were not formally affiliated with the long-term care facility (Molinari et al., 2009). Meanwhile, wellness programming, which aims to address the holistic needs of OALC members, is increasingly being implemented within OALCs, particularly in communities that provide ongoing care to older adults as their needs evolve. Those wellness initiatives are often focused on enhancing physical and social wellness (Edelman et al., 2010), frequently excluding other dimensions, including psychological or emotional well-being (Fullen, Wiley, et al., 2020).

Counselors who aim to work within OALCs should consider that some residents prioritize finding resources available on the community’s campus over seeking counseling services outside the community (Plys & Kluge, 2016). This suggests that until counseling services are offered in the OALC setting’s immediate vicinity, residents may continue to experience a barrier to access. Therefore, efforts are needed to integrate counseling services into the range of other on-site services offered directly to OALC residents (Fullen, Wiley, et al., 2020). Two other barriers are payment challenges and a dearth of training opportunities for working with older adults in counselor preparation programs.

Counselor Education, Training, and Supervision Challenges
     Developing counselor training opportunities to provide services for older adults, including those who reside in OALCs, is an additional barrier that must be addressed. Historically, the counseling profession has not adequately prioritized the counseling needs of older adults. For example, the 2016 Standards of the Council for the Accreditation of Counseling and Related Educational Programs (CACREP) failed to include any reference to terms like old, older, older adults, or ageism, and only one reference each to the words age and aging (CACREP, 2015; Fullen, 2018). A content analysis of 26 years of research in the counseling profession indicated that only 1.6% of all publications focused on issues associated with aging (Fullen et al., 2019). However, following revisions to the Medicare mental health law, there have been recent indications that efforts to equip counseling students and counseling professionals to work with older adults are underway. The 2024 CACREP Standards include subtle improvements, such as including age and generational status in glossary definitions of diversity, cultural identity, and marginalized populations (CACREP, 2023). This reflects the viewpoint that older adults should not be overlooked in discussions of how social and cultural identities impact the needs of clients. There is evidence that exposure to working with older adults and greater self-efficacy around this work are associated with increased interest in working with older adults (Schmidt et al., 2024; Wagner et al., 2019). Likewise, Moye et al. (2019) found that psychologists expressed a strong interest in further gerontology education on depression, dementia, anxiety, bereavement, caregiver stress, and adjustment to medical illness or disability. These findings suggest that there is recognition of the need for greater emphasis on aging-related topics during training programs and beyond.

To address this shortage of training opportunities, developing partnerships between university-based mental health training programs and local OALCs is essential (Silva-Smith et al., 2011). Fortunately, OALCs near universities are common and university-based OALCs are popular among older adults (Gresham, 2024). Expanding counseling services in OALCs by embedding a mental health trainee represents an innovative approach to service delivery that is mutually advantageous for students, training programs, community residents, and the OALC (Fullen, Wiley, et al., 2020). Anecdotally, we have curated a counselor training program within a local OALC. Recognizing the need for emotional well-being supports, the counselor training program at Fullen’s university (Virginia Tech) partnered with a local OALC in 2018 to launch an innovative program in which graduate students in counseling provide pro bono counseling services to older adults. Individual, couples, and group counseling services are provided to residents in independent living, assisted living, skilled nursing, and long-term care, resulting in a diverse array of opportunities to address unmet mental health needs and promote emotional well-being.

This partnership alleviates cost barriers by enlisting graduate students who are completing their clinical internships. Accessibility concerns are mitigated by integrating the counseling services directly on the OALC campus. By making counseling available and visible within the community, stigma about working with older adult clients appears to be shrinking. Students are exposed to older adults’ mental health needs within their counselor training program using a strengths-based wellness model. This approach introduces students to the effectiveness of counseling services for older people while addressing myths about aging. Counseling services are advertised at the site’s health and wellness fair, at meet and greets, and in the OALC newsletter. Referrals from site staff or other residents are customary. Overall, the services have been well-received by residents of the community. The OALC, counselor training program, and counseling interns all report a high degree of program satisfaction.

Future Research
     There is considerable opportunity for future research to illuminate the impact of wellness counseling within OALCs. For example, outcome research on the use of a multidimensional wellness framework within OALCs, such as the eight-dimensional model previously described, is needed to demonstrate the utility and effectiveness of this approach to counseling. Similarly, research demonstrating whether certain wellness dimensions are prioritized more or less by OALC clients would be useful. If more counselor training programs are developed within OALCs, future research on the supervision of counselor trainees using wellness counseling within OALCs would be beneficial.

In addition to a focus on wellness counseling outcomes, more research on multicultural competence when working with OALC clients is necessary. For example, research is needed to improve the practice of broaching in the areas of age and ability, given the fact that most counselors and counselor trainees will hold chronological ages, and in some cases ability levels, that differ from their OALC clients. Studies are needed to better understand how counselors proactively engage their older adult clients in dialogue around age identity, age differences, ageism and ableism, and the potential for misunderstanding within the therapeutic relationship based on these differences.

Conclusion
     In conclusion, OALCs are an emergent setting for the delivery of wellness counseling services. The interest in wellness among industry leaders, combined with a growing awareness of the mental health needs of older adults, suggests that OALCs have a great deal of potential for counselors. By incorporating multidimensional wellness approaches that are responsive to the unique needs of older adults, counselors have an opportunity to expand their footprint and promote mental health and well-being across the lifespan.

 

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

 

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Matthew C. Fullen, PhD, LPCC (OH), is an associate professor at Virginia Tech. Jonathan D. Wiley, PhD, LPC (VA), is an assistant professor at Tennessee Tech. Paul M. Delaughter, PhD, LPC (VA), is an assistant professor at Appalachian State University. Connie C. Tomlin, MA, LPC (TN), is the owner of Tomlin Counseling & Consulting. Jordan B. Westcott, PhD, NCC, is an assistant professor at the University of Tennessee-Knoxville. Nick Gowen, LPC (CO), is a counselor at Verve Therapy. Correspondence may be addressed to Matthew C. Fullen, Virginia Tech, School of Education, 1750 Kraft Drive, Blacksburg, VA 24061, mfullen@vt.edu.