Exploring Social Sexual Scripts Related to Oral Sex: A Profile of College Student Perceptions

Kylie P. Dotson-Blake, David Knox, Marty E. Zusman

Despite growing attention to the subject, a dearth of information exists regarding college students’ perceptions and process of meaning-making related to the act of oral sex. Such perspectives and allied social sexual scripts can have considerable consequences on the sexuality and sexual health of older teens and college-aged populations. The present research serves to elucidate such perspectives and presents a profile of college students’ degree of agreeing that oral sex is not sex. Over half (62.1%) of a sample of college students (N = 781) at a large southeastern university agreed that oral sex is not sex. Response rates across demographic groups are presented and factors that influence such perspectives are examined. Sexual script theory serves as the theoretical framework. Implications and limitations are explored.

Keywords: oral sex, social sexual scripts, college students, script theory, sexuality, sex counseling

Television talk show hosts, The Washington Post (Stepp, 2005) and Science Daily (University of California, San Francisco, 2005) have all had recent headlines related to oral sex in the older teen and college-aged populations. Because of these and other popular media sources, sex educators, parents and others have become more aware of oral sex engagement among college students and more concerned about the impacts of this engagement. Although society members are becoming concerned about this topic, limited information regarding college students’ perceptions and process of meaning-making related to the act of oral sex is available in the literature. To develop sexuality education curriculum and resources targeted at young people engaging in oral sex, professionals must first identify those most likely to engage in oral sex, their process of meaning-making around this engagement and risks young people are exposed to as a function of their engagement in oral sex.

In an effort to provide insight into this population’s process of meaning-making related to engagement in oral sex and initial information about characteristics of college students likely to engage in oral sex, this article presents the findings of a survey conducted at a large southeastern university. An initial profile of undergraduates who agreed with the statement “Oral Sex is Not Sex” is offered and findings are analyzed through the lens of social sexual script theory to explore the process of meaning-making related to the perceptions of participants regarding oral sex. We hope this information will assist sex educators, counselors, health professionals and parents in efforts to target individuals likely to engage in oral sex to minimize risks related to oral sex in the college student population. Thus, the purpose of this study was to provide a profile of undergraduates who agreed with the assertion that oral sex is not sex and to explore the links between participant responses and sexual scripts to illuminate fully how these participants perceived oral sex engagement. This profile is important because recent research suggests that young people perceive oral sex as safe, with few potential health risks (Halpern-Felsher, Cornell, Kropp, & Tschann, 2005). However, engaging in oral sex may expose individuals to the risk of viral and bacterial infections, including chlamydia, gonorrhea and herpes (Edwards & Carne, 1998a, 1998b). Consequently, it is critical that counselors fully understand the context and perceptions of college students in order to provide information to assist with healthy decision-making in developmentally-appropriate ways for these clients.

Theoretical Foundation

Sexual script theory situates perceptions of sexual interactions within the social context to explain how sexual identity and sexuality are shaped by social cultural messages (Frith & Kitzinger, 2001). Consequently, what is perceived to be “real” sex is defined by the society within which one exists, individual identity and socio-cultural normative sexual scripts. Sexual scripts vary across individuals, but often common elements exist within sexual scripts associated with particular cultural groups (Wiederman, 2005). As a social constructionist approach to exploring the development of sexuality, sexual script theory has been primarily used as a qualitative method of research (Simon & Gagnon, 2003). However, recent research has applied sexual script theory in quantitative research exploring the impact of exposure to sexually explicit material on young people (Stulhofer, Busko, & Landripet, 2010). For the study presented in this article, results were found using quantitative methods and then a qualitative exploration of themes that emerged from the quantitative data yielded links to sexual scripts postulated by sexual script theory.

Sexual Scripts and Heterocentric Standards

One sexual script prevalent in Western cultures, the traditional sexual script (Rostosky & Travis, 2000), serves to situate sexual intercourse between heterosexuals as real sex. This sexual script serves to disenfranchise sexual minorities by failing to recognize the full spectrum of sexual acts occurring between persons of any gender and the meanings attributed to these acts. Furthermore, not only is sex limited to heterosexual intercourse, but the concept fundamentally depends on male ejaculation since it is the male orgasm that denotes both the number of times a couple has sex and is the culmination (the climax) of sex (Frye, 1990). This phallocentric approach with regard to the concept of sex limits the power of women to be equal partners in a heterosexual relationship (Bhattacharyya, 2002). Consequently, these heterocentric standards for what qualifies as sex means that lesbians do not have real sex since lesbian sex does not involve penile penetration.

Within this sexual value system, vaginal-penile penetration/intercourse is at the apex of what constitutes sex, such that all other non-coital sexual practices/behaviors—such as oral sex—are considered foreplay and as a result have not been researched as fully and comprehensively as vaginal-penile penetration/intercourse. Much of sexual research has been situated within Western culture, resulting in the firm entrenchment of the traditional sexual script (Rostosky & Travis, 2000) within research methods and processes. This social entrenchment of heteronormative standards impacts the social sexual scripts college-aged individuals hold and apply in their sexual engagement (Bhattacharyya, 2002).

Peer groups have a strong influence on sexual behaviors, particularly among young adults. Peer group shifts in perceptions and values, when it comes to sex and sexual activity, will in turn impact sexual trends and patterns within peer groups. For college students, peer group perceptions powerfully impact individual perceptions and behaviors (Carter & McGoldrick, 1999). Prinstein, Meade, and Cohen (2003) discerned a positive relationship between young people’s reports of oral sex engagement and peer popularity. This suggests that peer culture for college students supports oral sex practice.

Peer group perceptions are formed within the context of the larger society and events, media and social issues within the society. One such societal event relevant to this discussion is the Clinton-Lewinsky scandal. At the heart of the scandal is Clinton’s famous utterance, “I did not have sexual relations with that woman, Miss Lewinsky” (Clinton, 1998). Whether his perception of oral sex as not real sex is due more to his personal perception based upon the traditional sexual script (Rostosky & Travis, 2000) or Clinton’s cunning sense of self-preservation will never be known. What is known, however, is that his statement and the subsequent maelstrom of controversy that ensued solidly asserted the question: “Is oral sex really sex?” into the public domain for debate.

Prevalence of Oral Sex Engagement in Young Adult and College-Age Population

In 2002, as part of the National Survey of Family Growth, 10,208 people ages 15–19 were included in the overall sample, and, of these respondents, more than half of males (55%) and females (54%) reported engaging in oral sex (Mosher, Chandra, & Jones, 2005). Richters, de Visser, Rissel, & Smith (2006) analyzed data from the Australian Study of Health and Relationships from a representative sample of 19,307 Australians aged 16 to 59 and found that almost a third (32%) of the respondents reported that oral sex was included in their last sexual encounter. Similarly, in a study of 212 participants ranging in age from 15 to 17, Prinstein, Meade, and Cohen (2003) reported that a third of the males and half of the females had engaged in oral sex in the past year. These studies reveal that many of the college-aged population are engaging in oral sex.

Oral Sex Scripts and Pop Culture

As dialogue about oral sex entered contemporary popular culture, it also became mainstreamed into the young adult vernacular and embedded into the tapestry of social mores and norms. Sexual script theory (Gagnon & Simon, 1973) emphasizes that social norms play a significant role in governing college students’ processes of meaning-making regarding health information and subsequent health and sexual behaviors. This theory holds at its foundation the understanding that sexuality is borne from cultural norms and messages that define what is deemed sex and socially-appropriate responses in sexual situations and encounters (Frith & Kitzinger, 2001).

In considering the impact of culturally-laden sexual norms and social sexual messages, one may infer that as oral sex has entered contemporary discourse, the social norms emerging from this discourse have impacted college students’ perceptions of and participation in oral sex. Understanding this process of social norm-belief-behavior interaction and possible consequences, including sexually transmitted infections (STIs), is critically important for sex educators, counselors and therapists working with the college-aged population, as these clients have intense levels of interactions with peers attuned to contemporary popular culture.

Young Adults and Sexually Transmitted Infections

Researchers also have found that young people are increasingly experiencing high rates of sexually transmitted infections (STIs) (Prinstein, Meade, & Cohen, 2003). According to the Centers for Disease Control and Prevention (2006), females who are 15–19 years of age reported the highest rates of all other demographic groups for chlamydia and gonorrhea. Of the 19 million STIs reported each year in the U.S., Weinstock, Berman, and Cates (2004) estimated that almost 50% occur in individuals who are 15–24 years of age. From these high rates of STIs in the young adult population, it can be inferred that more education around protection and safe sex engagement is necessary. Recent research has shown that young people also are concerned about the need for safety in sexual engagement and as such have turned to oral sex because they feel it presents fewer health risks (Halpern-Felsher, Cornell, Kropp, & Tschann, 2005). However, oral sex also presents risks of STIs. In a summary of research over more than 35 years regarding oral sex as a possible means of transmitting STIs, Edwards and Carne (1998a, 1998b) noted that oral sex may transmit viral and bacterial infections, including gonorrhea, chlamydia and herpes. Consequently, college students need to be educated about the risks of STI transmission through oral sex to minimize the harmful consequences.

The Need to Explore Perceptions of Oral Sex

In view of the various studies reporting the frequency and consequences of oral sex among young adults and college students, we emphasize the importance of educating this population about safe practices related to oral sex. A first step in this process is to assess the perceptions of this population in regard to oral sex. In short, though the research suggests that this population is engaging in oral sex (Prinstein, Meade, & Cohen, 2003), little is known about how they perceive the act and what meaning they attribute to the behavior in terms of their sense of self and sexual identity development. How do college students perceive oral sex? Do they perceive it to be real (i.e., intercourse) sex? How does it shape a young adult’s sense of self? Do college students feel that by engaging in oral sex and other non-coital behaviors that they are practicing a form of abstinence, that they are maintaining their virginity? Finding the answers to these questions may assist sex educators, counselors and therapists in developing comprehensive sexuality education programs incorporating resource awareness, prevention and health-focused knowledge for this population (Bay-Cheng, 2003).

In an effort to begin to address these questions and process, this article presents the findings of a study exploring the perceptions and behaviors of college students regarding oral sex. The purpose of the research was to identify a profile of undergraduates who agree with the assertion oral sex is not sex. This profile can be used to identify college students who may be more likely to engage in oral sex, allowing clinicians and educators to plan and implement developmentally-appropriate measures in contexts most likely to reach this population. An exploration of the intersection of social norms, utilizing sexual script theory, with characteristics prevalent in the profile that emerged will be discussed, as well as the implications and limitations of the study.

Sexual Script Theory and Perceptions of Oral Sex

By exploring research focused on oral sex engagement, the college-aged population and prevalent social sexual scripts, one may make significant inferences regarding this population’s perceptions of oral sex and process of meaning-making related to this sexual act. Again, it is important that the authors note that sexual scripts are based upon individual experience and social engagement and as such are impacted by the intersecting identity characteristics of individuals. Sexual scripts are reflective of culture and thus some elements will be common to members of the identified cultural group to which the script refers (Geer & Broussard, 1990). However, personal identity is multi-faceted and individuals belong to many different cultural groups by the nature of their race, ethnicity, religion, social class, sexual identity, education status, etc. Consequently, there may be wide variation in sexual scripts across individuals, even within a specific cultural group or sub-group (Wiederman, 2005).

Remaining cognizant of the diversity of sexual scripts across cultural groups, the authors will lead an exploration of selected dominant sexual scripts that may impact college-aged individual’s perceptions of and engagement in oral sex in the U.S. This exploration is not intended to be exhaustive; it is simply meant to serve as a foundation for understanding the potential of sexual scripts to impact these individuals’ processes of meaning-making related to oral sex. Finally, the authors recognize that sex extends far beyond penile penetration of a vagina. Unfortunately, the majority of research findings gleaned from a comprehensive review of the professional literature promote heteronormative standards by focusing solely on sex as the act of sexual intercourse between individuals of different genders. Consequently, the discussion of current professional research is limited in scope, indicating the need for additional research exploring the full range of sexual activities and sexual scripts impacting young adults and the college student population of any gender and sexuality.

Perception One: Oral Sex is Safe

The current professional literature suggests that young adults and college students articulate diverse reasons for engagement in oral sex. A reason that emerges dominantly from multiple studies is the perception that oral sex is safe with minimal risk and consequence (Halpern-Felsher et al., 2005; Remez, 2000). In a study of ninth-graders in California, participants were unlikely to use barrier protection when engaging in oral sex (Halpern-Felsher et al., 2005), indicating that they felt the practice of oral sex carried minimal risk for STIs. Possibly contributing to adolescent and teen perceptions of oral sex as safe are the sex education programs to which this population is exposed. Data suggest that abstinence-only and faith-based sex education programs do little to educate young adults on the very real and possible dangers associated with oral sex—i.e., the spread of STIs (Lindau, Tetteh, Kasza, & Gilliam, 2008). This lack of information may lead to the perception that because risks related to oral sex are not talked about, it must be safe. Surveys find that most young adults are misinformed, in that they are taught that STI risks are only associated with vaginal-penile intercourse. In sum, we surmise that these sex education programs, shifts in societal perceptions of and sexual scripts related to oral sex, and the use of oral sex as a substitute for intercourse may have a strong effect on the perceptions of the college age population reflecting that oral sex is safe sex.

Perception Two: Oral Sex Mitigates Religiosity and Sex Guilt Tension

Studies have shown strong correlations between degree of religiosity and patterns of sexual behavior. Kinsey, Pomeroy and Martin (1948, 1953) were some of the first to show empirically that religious identification limits sexual behaviors among the unmarried. Schulz, Bohrnstedt, Borgatta, and Evans (1977) also found that religiosity had a significant inhibiting effect on sexual behavior for both men and women. A study conducted by Wulf, Prentice, Hansum, Ferrar, and Spilka (1984) examined the sexual attitudes and behaviors among evangelical Christian singles, and found overall a more conservative outlook in sexual beliefs compared to the cultural norms. Of this group, those that were intrinsically faithful—that is, the more intensely religious who had a strong identification with traditional Christian values—and were not involved in a relationship, displayed the most conservative sexual attitudes. Among the more devout and single, the strongest correlations were found with respect to premarital intercourse and oral sex, in that these individuals were least likely to have engaged in these two activities.

Numerous studies have shown strong relationships between religiosity and sex guilt (Langston, 1973; Mosher & Cross, 1971). Those with conventional religious beliefs are more likely to have sex guilt, which in turn inhibits sexual behavior (Sack, Keller & Hinkle, 1984). Individuals with sex guilt are more absolutist in their orientations to sex and are less sexually active, since transgressing these strict sexual parameters might elicit intense displeasure and an antagonistic relationship with their religious community. By perceiving oral sex as not real sex, young adults and college students may be able to mitigate the tension between religious beliefs and sex guilt. For instance, a meta-analysis of studies looking at sexual attitudes and practices among young adults found that a majority believe oral sex to be less intimate compared to intercourse and that oral sex does not spoil virgin status (Remez, 2000). Many abstinence-only and faith based sex education programs now include a new push for virginity pledges, reinforcing the notion that vaginal intercourse is what is most at stake when it comes to preserving one’s virgin status.

Perception Three: Oral Sex Requires Less Commitment

Studies examining sexual attitudes and practices have found that sexual experience seems to be associated with a more liberal orientation to sex. This more liberal orientation to sex has been linked with “hooking up,” defined as having sex with someone one has just met (Richey, Knox, & Zusman, 2009). Paul, McManus, and Hayes (2000) examined the hookup culture within a college setting. They found that students high on impulsivity had a more noncommittal orientation with regard to relationships, displayed a high level of autonomy, and were much more likely to engage in both coital and non-coital hookups.

Social scripts are shared interpretations and have three functions: to define situations, name actors, and plot behaviors. For example, the social sexual script operative between two college students who are hooking up is to define the situation (a hookup, not a relationship where they will see each other tomorrow), name the actors (male and female college students out to meet someone for an evening of fun), and plot behaviors (go back to one’s dorm room or apartment, fool around, and not see each other again.). This hookup process leads to lessened intimacy and expectations for commitment in sexual encounters. Related to oral sex, findings (Halpern-Felsher et al., 2005) show that among teens and the college-aged population, oral sex is used as a substitute for vaginal-penile intercourse and as such may take the place of vaginal-penile intercourse in heterosexual hookup events. This perception of oral sex as less intimate by the college-aged population stands in contrast to perceptions of older adults, particularly older women, who view oral sex as equally intimate (or more so) to vaginal sex (Remez, 2000).

Perception Four: Oral Sex is Not Sex

The authors posit that each of the preceding sexual scripts is subsumed by an over-arching sexual script prevalent within the college-aged population: oral sex is not sex. By positioning oral sex as a less risky, less intimate sex practice that allows one to maintain his/her virginity with minimal religion-based sex guilt, the college-aged population may not identify oral sex as real sex. According to Remez (2000), peer culture socializes young adults to perceive oral sex as abstinence, allowing one to maintain and protect one’s virginity. Many factors related to contemporary social sexual scripts for oral sex support the assertion that the college-aged population does not identify oral sex as sex, including beliefs that oral sex does not impact their virgin status, is thought to be less dangerous, is less likely to lead to deterioration in the student’s reputation, and leads to less guilt than vaginal-penile penetration (Hollander, 2005).

All of the aforementioned sexual scripts contribute to the perceptions of college-aged individuals regarding oral sex. By raising awareness of the social sexual scripts, we hope to illuminate the process of meaning-making college-aged individuals attach to the act of oral sex. Further illumination of specific characteristics aligned with the over-arching social sexual script of oral sex is not sex will allow sex educators, counselors and others to target initiatives aimed at reducing risks related to oral sex in a more intentional, focused effort on individuals within the college-aged population who are most vulnerable to those risks.


The data for this study were taken from a larger nonrandom sample of 781 undergraduates at a large southeastern university who answered a 100-item questionnaire (approved by the Institutional Review Board of the university) on “Sexual Attitudes and Behaviors of College Students.” Respondents completed the questionnaire anonymously (the researcher was not in the room when the questionnaire was completed and no identifying information or codes allowed the researcher to know the identity of the respondents). Listwise deletion was used to address issues of missing data and two participants were excluded from statistical calculations due to missing data.

The measure used to collect data was a 100-item survey developed by Knox and Zussman (2007): Sexual Attitudes and Behaviors of College Students. The survey was developed based on a review of the professional literature related to sexuality among undergraduates. For the purpose of this research, demographic characteristics including gender, race, age and class level and the survey domains of sexual practices, religious identification and sexual values were included in the analysis. Within the domain of sexual practices were items asking participants to respond to whether they have given or received oral sex. Items surveying participants’ perceptions of themselves as religious and their beliefs about the importance of marrying someone of their same religion were included in the domain of religious identification. The domain of sexual values included items asking participants to choose the sexual value of absolutism, relativism, or hedonism, that best described their sexual values, and items asking participants to indicate their willingness to have sex without love.

Data Analysis
Data analysis was conducted using SPSS 17.0. Pearson product moment correlations and non-parametric statistics including cross-classification and Chi Squares were calculated to assess relationships among demographic characteristics and the selected domains. Following the quantitative analysis, themes within the results were explored through the lens of sexual script theory.


Analysis of the data revealed several relationships that may be related to the dominant social sexual scripts affecting teen and college-aged individual’s engagement in oral sex. The majority of participants (62%) indicated their agreement with the statement that oral sex is not sex. In comparing the characteristics of those who agreed and disagreed, five statistically significant relationships emerged. Through statistical analysis of the responses, a profile of participants who asserted that oral sex is not sex emerged. Of the respondents, 76.4% were females and 25.4% were males. Racial background included 79.5% European American, 15.7% Blacks (respondent self-identified as African-American Black, African Black, or Caribbean Black), 1.9% Biracial, 1.7% Asian, and 1.3% Hispanic. The majority, (95%) of the sample identified as heterosexual, 2.9% identified as bisexual and 2% identified as homosexual. The mean age of the sample was 19 years-old.

Underclassmen-Freshmen & Sophomores
Freshmen and sophomores were the most likely to agree that oral sex does not take away one’s virginity, with the majority of freshmen and sophomores indicating their agreement that engaging in oral sex does not constitute having sex (see Table 1). Juniors and seniors were less likely than underclassmen to agree that oral sex is not having sex. Hence, there was a general pattern that the lower the class rank of the student, the more likely the student to hold the belief that he or she could have oral sex and remain a virgin.

European American
Race was significantly related to perceptions of oral sex as not being sex (see Table 2). European American undergraduates were more likely than Blacks (respondent self-identified as African-American Black, African Black, or Caribbean Black) to agree that oral sex is not sex. In this study, the limited number of Asian and Latino participants renders the data of minimal use, however 61.5% of Asian participants (N=13) and 70% of Hispanic participants (N=10) indicated that they agreed that oral sex is not sex.

Self-Identified as Religious
Students who noted that they considered themselves to be religious by indicating that they agreed or strongly agreed with the statement, “I am a religious person,” were more likely to agree that oral sex is not sex than students who reported that they were not religious at all (61.3% vs. 14.3%). Participant responses revealed an inverse relationship between self-identification as “a religious person” and having never “given oral sex to a partner,” r(4) = -.121, p = .001, and having “never received oral sex,” r(4) = -.099, p = .006. An inverse relationship between perceptions of the importance of marrying someone with the same religious identification as oneself and giving and receiving oral sex respectively also was noted, r(4) = -.114, p = .001 and r(4) = -.129, p = .000. Participants who identified as religious were thus more likely to agree that oral sex is not sex and also indicated that they have engaged in oral sex.

Sexual Value
Given the alternative sexual values of relativism (“the appropriateness of intercourse depends on the nature of the relationship”), absolutism (“no intercourse before marriage”) and hedonism (“if it feels good, do it”), students who self-identified as hedonistic were more likely than those who viewed themselves as relativists and absolutists to agree that oral sex is not sex (65.8% vs. 62.9%, and 48.0%) (p < .05). Expressed another way, over 50% of absolutists compared to 34% of hedonists say the idea that one is still a virgin after having oral sex is not true. This 16% difference is striking. Participants who reported having engaged in sex without love also indicated they had engaged in both giving and receiving oral sex r(2) = -.229, p = .000, and r(2) = -.206, p =.000. These findings reflect that students who express more hedonistic perspectives are more likely to agree that oral sex is not sex and does not impact one’s status as a virgin.

Safe Sex Practices
A significant inverse relationship existed between participants who reported requiring the use of a condom before intercourse and never having given oral sex (r(4) = -.120, p = .001), and never having received oral sex (r(4) = -.092, p = .010). These findings indicate that the participants from this study who engaged in oral sex also used protective methods when engaging in intercourse outside of oral sex.

Gender was not significantly related to participant perceptions of oral sex as not being real sex and sex only referring to sexual intercourse. Gender was, however, significantly related to having never given oral sex χ2 (1, N = 781) = 3.843, ρ = .05) and having never received oral sex χ2 (1, N = 781) = 4.016, =.045), with males indicating in greater levels than females that they have received oral sex, and also that they have never given oral sex. These findings indicate that the gendered experiences of giving and/or receiving oral sex are important to explore, because it appears from the participant responses in this study that there may be gender differences in the likelihood of an individual giving or receiving oral sex.


This research sought to gain information about college-aged individuals most likely to agree that oral sex is not sex and to share information about individuals within this population’s perceptions about engagement in oral sex. The results allowed for the development of a demographic profile of participants who agreed that oral sex is not sex. In considering the results and demographic profile of participants who agreed that oral sex is not sex, relationships between sexual scripts and participant responses emerged.

The demographic profile which emerged indicated that participants most likely to agree that oral sex is not sex were underclassmen (freshmen and sophomores), European American and self-identified as religious. Inferences from the results were made through a parallel exploration of sexual scripts and the quantitative data from the studied domains and the demographic profile.

Oral Sex is Safe
The negative relationship that emerged between requiring the use of contraception before intercourse and engagement in oral sex may have many meanings. From the limited information provided through this analysis concerning safe sex practices and perceptions of oral sex, few inferences regarding the relationship between these issues can be made. Although the literature would suggest that college-aged students believe oral sex to be safe, this study did not provide enough information to definitively make this inference. However, the negative relationship between participants who required the use of contraception and previous experience with oral sex indicated that participants with previous experience giving and receiving oral sex were more likely to require the use of a condom before intercourse than were participants with no prior experience giving and receiving oral sex. From this finding, it could be inferred that participants who engage in oral sex are more likely to engage in safe sex practices, aligning congruently with the social sexual script posited in the professional literature of the perceptions that oral sex is safe. However, there could be many contributing factors to this relationship and further study is necessary to make clear inferences.

Oral Sex Potentially Mitigates Religiosity and Sex Guilt Tension
Supporting the sexual script that oral sex mitigates sex guilt because it is not real sex, the findings of this study discerned a strong relationship between religious identification and engagement in oral sex. Participants who reported strong self-identification as religious also reported having engaged in giving and receiving oral sex. Additionally, a significant relationship existed between participant responses to “I am a religious person” and “oral sex is not sex” χ2 (4, N = 781) = 10.310, p = .036). Other studies have shown that teens and young adults engage in oral sex because they view it as something that they do before they are ready to have sex (Remez, 2000). This of course implies that the only thing that counts as sex is vaginal-penile intercourse, and that this type of sexual activity breaks the threshold of virgin status.

These findings are not enough to conclude fully that oral sex is used to mitigate sex guilt-religiosity tension. However, the findings do suggest that college students who view themselves as religious also engage in oral sex, indicating that oral sex may be viewed as less likely to violate religious mores related to sexual engagement, since it is not viewed as real sex.

Oral Sex Requires Less Commitment
Perceptions of oral sex as less intimate and requiring less commitment may be better understood by exploring the class level, racial and sexual value components of the profile that emerged. Students at the beginning of their college careers, freshman and sophomores, were more likely to agree that oral sex is not sex. Developmentally, individuals at more advanced stages of one’s college career, such as juniors and seniors, may be more likely to be searching for a life-partner for a more committed, intimate relationship than students at the beginning of the college experience. By engaging in sexual acts perceived by this population as not real sex, these participants are able to avoid more deeply committed relationships.

In terms of racial background and the perception of oral sex as requiring less commitment, previous researchers have revealed that European Americans are more likely to engage in oral sex. In a national sample, 81% of European American men, 66% of African American men, and 65% of Latino men reported ever having received fellatio (Mahay, Laumann, & Michaels, 2001). Of European American, Latino and African Americans receiving fellatio, 82%, 68%, and 55%, respectively, reported the experience as “appealing” (Mahay et al., 2001). In the same study, 75% of European American women, 56% of Latina women, and 34% of African American women reported ever having provided fellatio for a male partner. Of European American, Latina and African American women providing fellatio, 55%, 46% and 25%, respectively, regarded the experience as “appealing” (Mahay et al., 2001). Mahay’s findings suggest that European Americans are more willing to engage in oral sex because they view it as less intimate, involved, or serious (Mahay et al., 2001). Like deep kissing or manual stimulation, they may perceive it as not sex. In contrast, African Americans may view oral sex as more “intimate, involved, and serious” and hence would be more likely to agree that oral sex is sex. The findings of this study support Mahay’s findings with European Americans being statistically more likely than African Americans to agree that oral sex is not sex.

Indicated sexual values also were related to the sexual script of oral sex as requiring less commitment. Participants who self-identified as hedonists (65.8%), with an if it feels good do it approach to sex, also agreed with the assertion that oral sex is not sex and will allow one to maintain virgin status. Since persons who “hookup” and had sex without love are more likely to be hedonists, it also is not surprising that students who reported that they had experienced having sex without love were more likely to report having engaged in giving and receiving oral sex. These findings support Young’s (1980) analysis of college students’ behaviors and attitudes relative to oral-genital sexuality, which revealed that college students who engaged in oral sex, had experienced sexual intercourse and were sexually active, possessed more favorable attitudes toward oral-genital sexual engagement.

In conclusion, Chambers (2007) studied college students and found agreement with oral sex is not sex, that oral sex is less intimate than sexual intercourse, and that the interpersonal context for being most comfortable about engaging in oral sex is a committed relationship, not a married relationship. Similarly, in the current study, we found that more than 60 percent of the respondents (62.1%) agreed that oral sex is not sex. Specifically, 62.1% responded “yes” to the statement “Having sex is having sexual intercourse, not having oral sex.” In contrast, 37.9% responded “no” to the statement.


Recognizing undergraduates who are more likely to agree with the assertion that oral sex is not sex will enable counselors and sex educators to provide targeted, specific education experiences to this population. This study revealed that undergraduates who were European American, religious, and underclassmen were more likely to agree that oral sex is not sex. However, although certain statistical differences existed among participants who believed that oral sex is not sex, over 60% of the total participant group in this study agreed that oral sex allows one to maintain one’s virgin status because it is not sex. This indicates that we do need specific targeted sex education opportunities for those most likely to agree that oral sex is not sex, but we also need broad, far-reaching education opportunities for the rest of the college-age population. Furthermore, this study explored the impact of dominant social sexual scripts on college-aged students’ perceptions of oral sex. By understanding the potential of social sexual scripts to ascribe meaning to an act of sexual engagement, sex educators and counselors will be better prepared to engage in discourse with young adults and college-aged individuals in a timely, developmentally-appropriate manner.


The data for this study should be interpreted with caution. The data used in this study were pulled from a convenience sample of 781 undergraduates at one southeastern university. This sample cannot be considered representative of the total college-aged population in the U.S. However, it may provide some information from which larger, more representative studies can be developed.

A major limitation of this study is the lack of diversity within the sample. With small numbers of gay, lesbian and bisexual participants, it was impossible to discern the perceptions and likelihood for engagement in oral sex by this demographic segment of the college-aged population. The literature would suggest that college students identifying as gay, lesbian or bisexual may have unique perceptions of oral sex and processes for making meaning of this experience (Feldmann & Middleman, 2002). Unfortunately, this study had limited participants identifying as gay, lesbian or bisexual and did not fully explore this population’s experiences and perceptions. This is a major limitation of this research and should be addressed by additional research specifically exploring the perceptions and engagement of college-aged individuals who identify as gay, lesbian or bisexual in giving and receiving oral sex. Additionally, there were few individuals of Latino or Asian descent included in the sample, limiting the utility of the findings with these individuals.

Another significant limitation of the study was the lack of in-depth exploration about the gendered experience of giving and receiving oral sex. From the initial results, it was determined that a significant relationship existed between gender and giving and/or receiving oral sex. This is an important consideration to explore, particularly when considering the impact of social sexual scripts on the sexual engagement of young people. It is quite possible that males and females in the young adult and college-aged population have very different experiences with and perceptions of the process of engaging in oral sex. This is an area that needs further research and not including a thorough investigation of the impact of gender on the responses of participants was a limitation of this study.


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Kylie P. Dotson-Blake, NCC, is an Assistant Professor and David Knox is a Professor at East Carolina University. Marty E. Zusman is Professor Emeritus at Indiana University Northwest. Correspondence can be addressed to Kylie P. Dotson-Blake, East Carolina University, 706 River Hill Drive, Greenville, NC 27858, blakek@ecu.edu.

Social Support and Career Thoughts in College Athletes and Non-Athletes

Stefanie Rodriguez

The career decision-making process can be a daunting task during the college years for both athletes and non-athletes alike. Understanding factors that influence this process and ways to best support students as they are making career decisions is integral to counselors working with college students. Social support and career thoughts were examined in 118 college student-athletes and 154 non-athletes from a large public university in the southeastern United States. Social support was found to have a significant relationship with career thoughts. In addition, several significant differences were found between the study’s subpopulations. Implications for practice and future directions for research are further explored.

Keywords: career decisions, college athletes, social support, career counseling, sociocultural context

Career planning is a process in a college student’s life that can cause a considerable amount of stress, and social support can have a positive effect on this stress. In the sport psychology research, social support has been found to be an important factor in reducing the effects of stress in athletes’ lives (Bianco & Eklund, 2001; Taylor & Ogilvie, 2001). Athletes not only experience stress related to academics and athletics, but also related to what they will do after college. Some are talented enough to play professionally, but many must face the reality of having a career outside of the realm of sports. As a result, career planning is an important process for college athletes because it prepares them for life after sports. Social support can be an important factor during this process by alleviating the stress associated with career planning.

In research examining the general college student population, career thoughts have been found to have an important effect on the career planning process (Peterson, Sampson, & Reardon, 1991; Peterson, Sampson, Reardon, & Lenz, 1996; Sampson, Peterson, Lenz, Reardon, & Saunders, 1996b; Sampson, Reardon, Peterson, & Lenz, 2009). If career thoughts are negative, the individual is unable to clearly evaluate self and occupational knowledge that is necessary to make a career decision. Decreasing negative thoughts is the first and most important step in the career decision-making process. In conclusion, it is important for those who are influential in college students’ lives to know what types of social support have the strongest relationship with the thoughts related to a career after college.

Social Support

Social support refers to the “social interaction aimed at inducing positive outcomes” (Bianco & Eklund, 2001, p.85). The terms “provider” and “recipient” are often used when discussing social support. A provider is an individual who gives the social support, and a recipient is an individual who receives the social support. A theory that targets social support and recipient satisfaction is the person-environment fit theory (Brown, 2002). This theory posits that the interaction between the person and environment is both active and reactive. The person-environment fit model of satisfaction is a part of person-environment theory. It defines satisfaction as “a pleasant affective state that is produced by the degree of fit between a person’s needs, personality characteristics, abilities, and the commensurate supplies provided by, and abilities requirements of, the environment” (Brown, Brady, Lent, Wolfert, & Hall, 1987, p. 338). Conversely, dissatisfaction is defined as “an unpleasant affective state resulting from a misfit between relevant person and environment characteristics” (Brown et al., 1987, p. 338).

In many cases, person-environment fit is considered subjective because it focuses on the perceptions of the person. Within the context of subjective person-environment fit, satisfaction with social support is defined as “a positive affective state resulting from one’s appraisal or his or her social environment in terms of its success in meeting his or her interpersonal needs” (Brown et al., 1987, p. 338). Conversely, dissatisfaction with social support is defined as “an unpleasant affective state resulting from a perception that the interpersonal environment is failing to satisfy important interpersonal needs” (Brown et al., 1987, p. 338).

Using person-environment fit as a theoretical basis, Brown, Alpert, Lent, Hunt, and Brady (1988) defined five broad factors of social support: (a) acceptance and belonging, (b) appraisal and coping assistance, (c) behavioral and cognitive guidance, (d) tangible assistance and material aid, and (e) modeling. The first factor, acceptance and belonging, measures the degree to which the individual’s needs for affiliation and esteem are met through the provision of love, acceptance, respect, belonging, and shared communication. The second factor, appraisal and coping assistance, relates to the degree to which the social environment provides the individual with emotional support, hope, and coping assistance through assurances that feelings are normal, positive reinterpretations of the situation and future, and information on coping skills during times of stress.

The third factor, behavioral and cognitive guidance, relates to the degree to which the social environment meets the individual’s needs for direct and modeled feedback about appropriate behaviors and thoughts. The fourth factor, tangible assistance and material aid, pertains to the degree to which instrumental needs for money, goods, and services are met by the social environment. The fifth and final factor, modeling, refers to the information on how others feel, handle situations and think (Brown et al., 1988). It also measures the satisfaction with a model or example to follow. In conclusion, the person-environment fit theory provides a basis for the description of five types of social support. In order to fully understand the role of social support on the career planning process, it also is essential to understand the role of career thoughts in the process.

Career Thoughts

Career thoughts are defined as “outcomes of one’s thinking about assumptions, attitudes, behaviors, beliefs, feelings, plans, and/or strategies related to career problem-solving and decision-making” (Sampson et al., 2009, p. 91). Cognitive therapy theoretical concepts specify that dysfunctional cognitions have a detrimental impact on behavior and emotions (Beck, 1976; Beck, Emery, & Greenberg, 1985; Beck, Rush, Shaw, & Emery, 1979). Cognitive information process (CIP) theory explains the role of cognitions in career decision-making. This theory is meant to enhance the link between theory and practice in the delivery of cost-effective career services for adolescents, college students and adults (Peterson et al., 1991; 1996; Sampson et al., 2009). Its goal is to help individuals make appropriate career choices and learn improved problem-solving and decision-making skills needed for future choices (Sampson et al., 2009).

There are a few definitions that need to be understood in order to fully comprehend and utilize CIP. Problem is synonymous with career problem and is defined as a “gap between an existing and a desired state of affairs” (Sampson et al., 2009, p. 4). The gap may be between an existing state (e.g., knowing I need to make a choice) and an ideal state (e.g., knowing I made a good choice). Problem-solving is a “series of thought processes in which information about a problem is used to arrive at a plan of action necessary to remove the gap between an existing and a desired state of affairs” (Sampson et al., 2009, p. 5). Decision-making includes “problem-solving, along with the cognitive and affective processes needed to develop a plan for implementing the solution and taking risks involved in following through to complete the plan” (Sampson et al., 2009, p. 6).

CIP theory assumes that effective career problem-solving and decision-making requires the effective processing of information in four domains: (1) self-knowledge, (2) occupational knowledge, (3) decision-making skills, and (4) executive processing (Sampson et al., 2009). Self-knowledge includes individuals’ perceptions of their values, interests, skills, and employment preferences. Occupational knowledge includes knowledge of individual occupations and having a schema for how the world of work is organized. Decision-making skills are the generic information processing skills that individuals use to solve problems and make decisions. Executive processing includes meta-cognitions, which control the selection and sequencing of cognitive strategies used to solve a career problem through self-talk, self-awareness, and control and monitoring.

Social Support and Career Planning

There is limited research examining social support and career planning. Career planning is related to career thoughts by the appraisal or cognitive processing that occurs during career decision-making. Based on limited scientific findings, social support has been found to have a positive and important effect on career planning. In a study on unemployed individuals, Blustein (1992) found that instrumental support in the form of constructive advice and resources help to better appraise career-related information and adapt to the novel circumstances. It also was found that social support can positively affect the recipient’s experience and is an important determinant of career activities such as researching career options or seeking assistance from a career advisor.

Similar findings indicate that along with instrumental support, emotional social support which is characterized by empathy, caring, love, and trust from families is especially important during stressful transitions such as job loss (DeFrank & Ivancevich, 1986). Regarding students and career planning, Quimby and O’Brien (2004) found that perceptions of robust social support resulted in feelings of confidence both in managing the responsibilities associated with being a student and pursuing tasks related to advancing vocational development. Though it is evident that social support is an important factor in the career planning process, additional research examining this construct and its place in career development is needed.

Given the reviewed literature and current gap, the purpose of this study was to examine the relationships among satisfaction with five types of social support and negative career thoughts in collegiate athletes and non-athletes.


Non-student-athletes and National Collegiate Athletic Association (NCAA) Division I student-athletes from the same university were recruited for this study. Complete data were obtained from 272 participants (154 non-athletes and 118 athletes). One hundred forty-six (53.7%) of the participants were male and 126 (46.3%) were female. The race/ethnicity breakdown was as follows: Caucasian (n = 162, 59.6%), African American (n = 74, 27.2%), Hispanic (n = 15, 5.5%), Asian American (n = 1, 0.4%), other (n = 12, 4.4%), and more than one apply (n = 8, 2.9%). Forty-three (15.8%) of the participants were freshman, 65 (23.9%) sophomores, 94 (34.6%) juniors and 70 (25.7%) seniors. Of the athletes, the varsity sport breakdown was as follows: baseball (n = 13, 11.0%), basketball (n = 14, 11.9%), football (n = 37, 31.4%), golf (n = 5, 4.2%), soccer (n = 7, 5.9%), softball (n = 8, 6.8%), swimming & diving (n = 8, 6.8%), tennis (n = 3, 2.5%), track & field (n = 18, 15.3%), and volleyball (n = 4, 3.4%). One (0.8%) athlete did not indicate involvement in a particular sport.

All participants were recruited from a single large university located in the southeastern region of the United States. They were above 18 years of age, and participants comprised of a volunteer, convenient sample obtained by contacting athletic administrators and professors.


Demographic Information Survey. The survey contained information about participants’ college major, age, gender, race/ethnicity, and academic year.

Social Support Inventory-Subjective Satisfaction (SSI-SS). The SSI-SS (Brown et al., 1987) consisted of 39 self-report items assessing one’s satisfaction with five types of social support: (a) acceptance and belonging, (b) appraisal and coping assistance, (c) behavioral and cognitive guidance, (d) tangible assistance and material aid, and (e) modeling. Participants responded to these items on a 7-point Likert-type scale ranging from 1 (not at all satisfied) to 7 (very satisfied) to indicate their satisfaction with the support they have received. A total score is obtained by summing all of the items. The overall score of the SSI-SS ranges from 39 to 273. The acceptance-belonging subscale score ranges from 9 to 63, and the appraisal-coping assistance subscale score ranges from 9 to 63. The behavioral-cognitive guidance subscale score ranges from 6 to 42. The tangible assistance-material aid subscale score ranges from 5 to 35, and the modeling subscale score ranges from 4 to 28. The total score and the scores of each of the five factors will be assessed in this study.

Alpha coefficients for the five factors are .93 for acceptance-belonging, .88 for appraisal-coping assistance, .81 for behavioral-cognitive guidance, .78 for tangible assistance-material aid, and .83 for modeling (Brown et al., 1987). The overall alpha coefficient is .96. The SSI-SS has been normed on college-age and adult populations.

Career Thoughts Inventory (CTI). The CTI (Sampson, Peterson, Lenz, Reardon, & Saunders, 1996a) is a 48-item self-administered, objectively scored measure of dysfunctional thinking in career problem-solving and decision-making. Participants respond to items on a 4-point Likert-type scale ranging from 0 (strongly disagree) to 3 (strongly agree) to indicate how much they agree with the negative career statement given. The CTI scores consist of one total score as well as scores on three subscales. The CTI is a CIP-based assessment and intervention resource intended to assess the quality of career decisions made by adults and college and high school students. It measures the eight content dimensions of CIP theory that include: (1) self-knowledge, (2) occupational knowledge, (3) communication, (4) analysis, (5) synthesis, (6) valuing, (7) execution, and (8) executive processing (Peterson et al., 1991; 1996).

The CTI has been normed on high school, college, and adult populations (Sampson et al., 1996b). Reliability evidence for the CTI total score includes internal consistency alpha coefficients ranging from .93 to .97 and a test-retest coefficient of .77. The readability of the CTI was calculated to be at a 6.4 grade level.

Decision-making confusion (DMC) is one subscale on the CTI and it refers to the inability to initiate or sustain the decision-making process as a result of disabling emotions and/or a lack of understanding about the decision-making process itself. Commitment anxiety (CA) is another subscale on the CTI and it reflects the inability to make a commitment to a specific career choice, accompanied by generalized anxiety about the outcome of the decision-making process. This anxiety perpetuates indecision. External conflict (EC) is the final subscale and it reflects the inability to balance the importance of one’s own self-perceptions with the importance of input from significant others, resulting in a reluctance to assume responsibility for decision-making.


Athletic academic advisers and professors at a large southeastern university were contacted via e-mail using a script. The principal investigator met with the participants whenever they were available to be administered the battery of tests, during their tutoring sessions in the athletic academic support office or in their classes. During the meeting, the participants were oriented to the purpose of the study. They were asked to sign an informed consent form, and told that their participation in the study was completely voluntary and that they may drop out at any time. The researcher administered the questionnaires beginning with the Demographic Information Survey, then the Social Support Inventory, and finally the Career Thoughts Inventory. Tests were then collected and a randomly assigned number identified each battery of tests.


Preliminary analyses were performed to obtain internal consistency coefficients of the measures and descriptive statistics. The alpha coefficients observed in this study for each Social Support Inventory-Subjective Satisfaction (SSI-SS) subscale and total score were: acceptance-belonging (α = .79), appraisal-coping assistance (α = .83), behavioral-cognitive guidance (α = .81), tangible assistance-material aid (α = .70), modeling (α = .74), and total score (α = .90). For the Career Thoughts Inventory (CTI) subscales and total score, the alpha coefficients observed were as follows: decision-making confusion (α = .86), commitment anxiety (α = .85), external conflict (α = .82), and total score (α = .89). The alpha coefficient values indicated adequate internal consistency.

Descriptive Statistics and Bivariate Correlations
Descriptive statistics for the SSI-SS subscales: acceptance-belonging, appraisal-coping assistance, behavioral-cognitive guidance, tangible assistance-material aid, and modeling; and CTI subscales: decision-making confusion, commitment anxiety, and external conflict are presented in Table 1. Overall, participants averaged a T-score within the average range for the majority of the subscales with the social support subscale of acceptance-belonging having the highest mean (M = 65.67, SD = 9.13).

The bivariate correlations among study variables are presented in Table 2. Without controlling for any variables, the social support types of acceptance-belonging and appraisal-coping assistance had the strongest relationships with decision-making confusion (r = -.37 and -.38, respectively). The bivariate correlations also indicated that all social support types had significant relationships with decision-making confusion, commitment anxiety, and external conflict. When all variables were controlled, there were no significant relationships between any of the five types of social support and career thoughts.


Three hierarchical regression analyses were performed with the five predictor variables and three criterion variables. All regression models were significant. It is suggested that the variance shared among the predictors is what accounts for the significant models. None of the social support types were found to have significant unique relationships with any of the career thoughts variables.

Structural Equation Modeling
Conceptual models of the posited relationship between social support and career thoughts, as seen in Figure 1, were tested using SEM procedures. The model shows that the five social support types were used as indicators for a social support latent factor and the three subscales of the CTI were used as indicators for a negative career thoughts latent factor.

The distributional properties of the study variables in the model were examined to select the appropriate model estimator. No substantial problems were evident in either univariate skewness (M = -.39; range from -.83 to .29) or kurtosis (M = .23; range from -.36 to .90) in the eight variables used in the SEM analysis. Mild multivariate kurtosis was indicated with a Mardia’s normalized estimate equating to 10.15. For the model, the model-reproduced and observed covariance matrices did not differ, χ² = 18.79, df = 19, p = .47. Desirable CFI and IFI indexes (1.00 for both) were observed. The satisfactory distribution of the residuals was substantiated by the observed standardized RMSR (.02). Figure 1 presents the standardized path coefficients and residuals for the SEM.

In the model, the social support latent variable accounted for 17% of the variance in the negative career thoughts latent variable. The social support latent variable accounted for the majority of the variance in the subscales of acceptance-belonging (R² = .70), appraisal-coping assistance (R² = .87), behavioral-cognitive guidance (R² = .79), tangible assistance-material aid (R² = .41), and modeling (R² = .52). The negative career thoughts latent variable accounted for the majority of the variance in the subscales of decision-making confusion (R² = .85), commitment anxiety (R² = .76), and external conflict (R² = .61). In summary, these analyses make it apparent that social support is associated with career thoughts as observed by the significant correlation between the latent variable of social support as measured by the SSI-SS and the latent variable of negative career thoughts as measured by the CTI.

Z-Score Analyses
Z-score analyses were performed to determine any significant differences between sample populations based on athletic status, gender, and academic class status in the relationship between social support and career thoughts. Regarding athletic status, a significant difference (p < .01) was found between athletes and non-athletes in the relationship between the social support type of appraisal-coping assistance and the career thoughts variable of commitment anxiety (z = 1.95), with that relationship being stronger in the non-athlete population. Also regarding athletic status, a significant difference (p < .01) was found between athletes and non-athletes in the relationship between the social support type of modeling and the career thoughts’ variable commitment anxiety (z = 2.02), with that relationship also being stronger in the non-athlete population.

No significant differences were found between the male and female genders in the relationship between social support and career thoughts. Regarding academic class status, upperclassmen had a significantly stronger relationship (p < .01) between total social support and the social support types of appraisal-coping assistance and behavioral-cognitive guidance and the career thoughts’ variable commitment anxiety (z = 2.08; 2.30; 2.15; respectively). In summary, several significant differences were found between sample populations.


Results revealed that social support accounts for about 17% of the variance in career thoughts. This suggests that social support has a moderate relationship with career thoughts. These results also support the literature on the positive effect of social support on the career planning process (Blustein, 1992; DeFrank & Ivancevich, 1986; Quimby & O’Brien, 2004).

The person environment fit model (Dawis, 2002) provided an important framework in the present study as satisfaction with social support was found to have a moderate relationship with career thoughts. However, the strong relationships between the five types of social support made it difficult to examine the unique relationship of each to career thoughts. The results infer that the five types of social support identified by Brown et al. (1988) may not be independent.

The bivariate correlations indicated that all social support types had significant relationships with the career thoughts variables. When all variables were controlled, there were no significant relationships between any of the five types of social support and career thoughts. Instrumental support, as defined by Blustein (1992) and DeFrank and Ivancevich (1986), relates to Brown et al.’s (1988) social support types of behavioral-cognitive guidance and tangible assistance-material aid. The results of the present study show that both social support types had moderate relationships with career thoughts. Emotional support, as defined by DeFrank and Ivancevich (1986), relates to Brown et al.’s (1988) social support type of acceptance-belonging. This type of social support also was found to have a negative, moderate relationship with career thoughts. These results reinforce those found in Blustein (1992) and DeFrank and Ivancevich (1986) in that social support is an important component in the career planning process.

It was found that the sociocultural context in which the social support is provided has an effect on the perception of the social support by the recipient. The significant difference between the athlete and non-athlete and upperclassmen and underclassmen populations in the present study may be due to their different sociocultural contexts. The results of this study suggest that the appraisal-coping assistance and modeling social support types may be better provided to the non-student-athlete population who are experiencing anxiety related to the career decision-making process. In addition, the appraisal-coping assistance and behavioral-cognitive guidance social support types may be more influential in reducing career decision-making anxiety if provided to upperclassmen.

The present study adds to the literature by studying the different types of social support that make up the social support construct. The study also adds to the literature by examining the relationship between social support and career thoughts, which has not been studied previously. In addition, the examination of the differences in the social support/career thoughts relationship between groups in the sample population (i.e., athlete/non-athlete, male/female, upperclassmen/underclassmen) adds an important dimension to the available literature.


The main limitation of this study is with the convenience sampling because the extent to which the students were representative of the overall population of college students is unknown. The participants were not obtained by random sampling, but rather obtained because of availability. Therefore, it is difficult to know the extent to which the results of this study are generalizable beyond this sample.


The present study investigated the relationship between the five types of social support and the three constructs that comprise career thoughts. Although none of the types of social support were found to have a uniquely significant relationship with career thoughts, there was in fact a moderate relationship between the overall construct of social support and career thoughts.

This study has important implications for practice. Coaches, athletic administrators, career counselors, mental health counselors, professors and other post-secondary administrators now have a better idea of what types of social support are deemed as having the greatest impact on how college students view their post-collegiate careers. Current literature only focuses on the overall social support construct and its positive effects, but the present study allows for the differentiation of the social support types, which provides additional information for practical purposes (Bianco & Eklund, 2001; Taylor & Ogilvie, 2001). Hopefully, this will increase the likelihood of college students actually receiving these types of social support based on their subgroup (i.e., athlete/non-athlete and upperclassmen/underclassmen). Also, college students now have the opportunity to be aware of what types of social support will lead to less negative career thinking.

Regarding implications for research, it is evident that additional research needs to be done to gain a better understanding of the relationship between social support and career thoughts in college students. This is the first study that has examined these two constructs and more research is necessary. More and better social support measures need to be introduced into the field that better examine social support and its different types. Also, this study supports the literature on the importance of career thoughts during the career planning process (Peterson et al., 1991, 1996; Sampson et al., 1996b, 2009). An improved foundation is now available for additional research on the cognitive aspects of career planning and how it relates to social entities.

Future Directions

The present study provides an important foundation for future research. Since it is the first study to examine social support and career thoughts directly, additional examinations of these constructs are necessary per the practical and research implications previously stated. Other variables such as career maturity, self-efficacy, motivation, and personality characteristics should be included in future research to try and account for the remaining variance in career thoughts. Also, the negative aspects of social support, such as peer or parental pressures, should be examined.

Since the present study only examines college students, other populations should be included in future research. In addition, it may be interesting to examine the differences between college students at private and public institutions. Other populations also can be researched, including adults on the verge of retirement or high school seniors trying to decide what to do after graduation.

It may be important to study the phases of the career development process and if different types of social support affect the various phases differently. For example, participating in volunteer activities to boost one’s resume is unlike job searching. In addition, performing qualitative research may add to the information provided from quantitative research.

It is important to note that the strong correlations between each type of social support may infer a poor measure of the different types of social support. A confirmatory factor analysis would be useful in determining if the Social Support Inventory is in fact an adequate measure of social support and its subtypes. There may be better inventories available that measure the different types of social support, and they should be used to determine any differences between social support measures. It is important to note the complexity of the social support construct and that other instruments should be identified that better measure the complex aspects of the construct. Overall, the current study provides an adequate foundation for future practice and research. The relationship between social support and career thoughts is important to understand in order to better help college students and possibly other populations prepare for whatever career transition they may face.


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Stefanie Rodriguez is an Adjunct Professor at the University of South Florida. Correspondence can be addressed to Stefanie Rodriguez, University of South Florida, 4202 E Fowler Ave, Tampa, FL 33620, stefanie.rodriguez@live.com.

The Ethical Frontier: Ethical Considerations for Frontier Counselors

Keith A. Cates, Christopher Gunderson, Michael A. Keim

Counselors working in frontier communities may encounter unique challenges and experiences not regularly found in larger contexts. This paper explores the aspects of counseling significant to rural and frontier settings. It discusses the traditional attitudes of rural and frontier populations, the counselor’s place in these communities, boundaries of competence, and ethical concerns that are significant to these areas of counseling, such as confidentiality. It also offers potential ways to address related ethical issues. The cultural milieu in small communities, subcultural self-identification, frontier attitudes and beliefs, and multiple relationships are explored.

Keywords: rural, ethics, frontier, multiple relationships, confidentiality, boundaries of competence

Working in small and rural communities presents counselors with challenges and experiences not necessarily or often encountered in larger population centers. The geographic constraints of the area itself, the culture and behavior of the client population, as well as the attitudes and skills of the counselor, can combine to create significant difficulties in providing ethically competent mental health care. Even the term rural is difficult to define when attempting to describe the 16% (Nusca, 2011) of the total U.S. population and the 20% (Trading Economics, 2011) of the Canadian population that live in “rural” settings. Rural in this usage is generally defined in regards to low population density, population size and distance from larger population centers. Although governmental agencies vary in their exact definition and identification of rural locations and populations in the United States, urban is generally defined as an area having more than 100 people per square mile, rural areas generally comprise open country and settlements with fewer than 2,500 residents and are defined as having between 99 and 6 people per square mile, and frontier is an area having less than 6 people per square mile (Bushy & Carty, 1994; Helbok, 2003). Much of Alaska, the central United States, and central Canada are primarily designated as frontier areas.

“Rural” and “frontier” become increasingly difficult to define when viewed through the perceptions of those living in these areas. Individual life experiences and interpretations blend with considerations of distance between families and communities, self-sufficiency, access to resources, and support to and from the community to create a style of living centered on individual capacity and self-reliance, as well as increased community interdependence (Brownlee, 1996; Erickson, 2001). Small and rural community living, however, does tend to have some similarities across geographic areas including scarce resources, higher poverty rates, lack of access to employment opportunities, lack of higher formal education, higher illiteracy rates, limited health services, limited insurance coverage, higher rates of disability, greater environmental hazards, increased overall age-adjusted mortality, and fewer mental health resources (Helbok, 2003; Murray & Keller, 1991; Roberts, Battaglia, & Epstein, 1999; Wagenfeld, 1988; Wilcoxon, 1989). In addition to the concerns associated with rural living, frontier areas have to contend with even fewer mental health care resources due to populations spread over a large geographic area, reduced numbers of mental health care providers, limited access to crisis services, mental health services and general medical care, inaccessibility to remote geographic areas, and the increased hardship of living in isolated locations (Bushy & Carty, 1994; Roberts et al., 1999).

Alaska is illustrative of the difficulties of providing for mental health care needs and access to experienced practitioners in rural and frontier communities. Alaska is the largest state (656,424 square miles) with the lowest population density in the United States with 1.2 persons per square mile. Much of that population is concentrated in two metropolitan statistical areas that account for approximately 66% of the state’s total estimated population (U.S. Census Bureau, 2012). In 2007, it had the highest suicide rate in the nation, with 21.8 suicides per 100,000 residents as compared to 11.5 suicides per 100,000 for the rest of the U.S. For Alaska Natives, the suicide rate jumps to 35.1 per 100,000 people (State of Alaska Bureau of Vital Statistics, n.d.).

In 2006, a report on the prevalence of mental health concerns estimated that 4.6 percent (21,754) of Alaskan adults in households had a serious mental illness and that 7.2% (12,725) of Alaskan youth had a serious emotional disturbance. The estimates for adults only include those with a diagnosable disorder that had persisted for over one year and was associated with a significant impairment (State of Alaska, Health & Social Services, n.d.). In 2007, approximately 11.3% of the population (about 53,000) of Alaskan adults (age 18 years or older) experienced serious psychological distress and 7.6% (about 36,000) had at least one major depressive episode (SAMHSA, 2009).

Community hospitals are important healthcare contact locations in rural and frontier areas. In 2011, Alaska community hospitals had only one community hospital bed for every 433 people. Outside the primary population areas of the state, this number increased to one bed for every 792 people. Only two psychiatric hospitals exist in Alaska and both of these are located in the municipality of Anchorage; outside of this area the state has no public psychiatric treatment options (U.S. Census Bureau, Health & Nutrition, 2012: U.S. Hospital Finder, 2011).

Small Communities

Small communities can be seen as each possessing their own cultural milieu with a shared context, set of perceptions and understandings and a view of “how we do things around here” (Alegria, Atkins, Farmer, Slaton, & Stelk, 2010, p. 50). When rural and frontier issues are part of a small community, the communities’ concerns magnify through the restrictions of geography and scarcity of resources and all of the previously noted ways that distinguish rural and frontier populations. Even so, rural and frontier communities have common threads with other small communities in their methods of subcultural self-identification. Each of them can be defined as much by external forces (such as geographic setting, population density, available natural and economic resources) as internal motivators (desire for small community interactions, dislike of big cities, desire for support from those with similar values and outlooks), but each also has a shared context that encourages successful adaptation in that setting, including an appreciation and support for the cultural norms and values endemic to each setting (Alegria et al., 2010). Therefore, the life context of the people who live in these communities, whether they are in a geographically isolated village in Alaska, a group of military families living in and around a military base, or an alternative lifestyle community living in a larger city, have much in common. Each of them is a part of a culture that shapes attitudes, behaviors and values as well as perceptions of what is accepted as “normal” in their community (Schank, Helbok, Haldeman, & Gallardo, 2010). This perception is frequently in contrast, or opposition, to the majority culture and is continually evolving through member interactions, reaction to the environment and perceived self-identity.

Rural and Frontier Attitudes and Behaviors

Self-reliance, which includes self-care behaviors, is a characteristic traditionally associated with rural residents. Historically, this reliance on self and kinship ties helped people to survive in remote, isolated, and difficult environments (Bushy & Carty, 1994) and created a hesitancy to seek services. Current potential mental health clients still tend to turn to familiar people, friends and family as a first level of support (Bushy & Carty, 1994; Helbok, 2003). These services are informal, heavily steeped in a shared history or culture, and frequently follow a tacit understanding of reciprocity among participants. This informal level of healthcare can be very beneficial in its promotion of healthy living and self-care behaviors, for example, in a family’s care of a mentally ill family member or a community’s support of a person with a disability or developmental issue. It also can be highly detrimental as it can hide that person’s issue within the family or community and enable a person to take on or maintain a sick role or prevent a person from seeking or receiving mental health care that may improve their overall functioning (Bushy & Carty, 1994).

The second level of assistance includes community groups, church and religious groups, school services, community educational and outreach programs, and civic organizations. Group members (usually extended community members) often combine and/or contribute resources to provide assistance to individuals and families in need, particularly in times of emergency or crisis. This generally takes the form of volunteering time and services, and donating food, clothing, other non-monetary items, and financial contributions. It also can include taking in an individual or family who is lacking housing or needs more comprehensive support (Bushy & Carty, 1994; Murray & Keller, 1991). The third level of support covers formal services such as community mental health and hospital/clinic services, medical doctors, governmental programs and services, and for-profit commercial service providers (Bushy & Carty, 1994). Financial remuneration is expected for the services provided and may potentially be based on a sliding scale or reduced fee schedule (Bushy & Carty, 1994; Murray & Keller, 1991).

That residents of rural and frontier areas tend to initially rely on the two informal levels of social support may in part be due to their self-reliant tendencies aggravated by geographic location and/or isolation, inability to access or qualify for services, inability to pay for services and lack of service providers. This also may be due to cultural traditions regarding the accepted traditional method of handling mental health issues (or if the concern is even acknowledged as a significant issue), a shared belief that outsiders are not to be trusted, resentment of outsiders coming to “rescue” them, and/or negative perceptions of the value of formal services in addressing the issue (Bushy & Carty, 1994; Erickson, 2001).

Acceptability of services by rural and frontier residents also is influenced by the behavior and approach of mental health professionals. A provider’s attitude and training in relation to rural and frontier practice can be fundamental in relating to a specific environment and the people living there. If a service is offered with an understanding of the particular characteristics and needs of a population, and the provider has been accepted into the community, then the services may be viewed as a treatment option in the community structure. If, however, the provider has not been accepted as a trustable member of the community or exhibits attitudes and behaviors that are incongruent with local values, then locals needing assistance may not seek services, or may not accept services that are readily available and accessible (Bushy & Carty, 1994).

Rural and Frontier Mental Health Services

The U.S. Department of Health and Human Services’ Health Professional Shortage Areas, which are determined by the availability of mental health service providers in relation to population numbers for a defined area (HRSA, 2011), illustrates the lack of qualified mental health services and providers for rural and frontier populations. This lack of qualified mental health professionals translates directly to reduced services for a given area as well as professional practice concerns for those that provide services.

In the face of such scarcity, frontier mental health providers frequently assume multiple roles in order to function in a variety of situations. Counselors may take on many duties past their primary role as clinician including case manager, crisis intervention specialist, advocate for client services, and community outreach worker, just to name a few. This multiplicity of duties provides better generalized coverage for client care, but can place the counselor in the ethically dangerous position of potentially breaching client confidentiality, operating outside professional training and competence, managing multiple dual relationships and conflicting professional roles, limited or no professional support, and increased potential for professional burnout (Roberts et al., 1999; Schank, 1998; Werth, Hastings, & Riding-Malon, 2010).

Ethical Issues in Rural and Frontier Mental Health Services

Counselors frequently face serious ethical dilemmas as service delivery in rural and frontier communities presents them with ethical challenges distinctive to those environments (McDermott, 2007). These ethical dilemmas and potential violations are no less common in rural and frontier areas than in urban locations but according to studies are more difficult to resolve (Bolin, Mechler, Holcomb, & Williams, 2008) due to geographic and social isolation, scarce resources, limited population numbers, and the cultural expectations that characterize those communities (Roberts et al., 1999; Scopelliti et al., 2004).

These ethical issues are not limited to populations that are primarily defined or identified by geographic restrictions or population density. They also are particularly relevant to small communities that are identified by demographic variables such as age, race, culture, sexual orientation, disability, or spiritual orientation. Although there are some needs that are specific to certain populations, the determination of appropriate ethical practice guidelines also should include the needs and cultural values of other small community groups (Schank et al., 2010; Schank & Skovholt, 1997).

The needs and considerations of rural and frontier communities frequently cause professional codes and guidelines to be in opposition to prevailing small community standards and expectations (Schank, 1998). To address these concerns, rural and frontier clinicians may find it necessary to adopt a view of professional boundaries and ethical guidelines that places more importance on community values and professional roles in the community than on rules of behavior as defined by professional organizations.

Urban ethical orientation in mental health services. This necessity on the part of mental health providers is intensified by the fact that mental health training and much of the ethics literature and professional ethics codes appear to favor urban-based mental health practices. This could potentially lead to erroneous assumptions when it comes to distinguishing between ethical and unethical practices in small community environments (Helbok, 2003; Roberts et al., 1999; Werth et al., 2010).

Most mental health clinicians are trained at universities and colleges located in urban and suburban areas. Their practical experience takes place in urban and suburban clinical training sites that have adequate resources and readily available personnel. Later in their practice, clinicians tend to work within areas that have relatively easy access to referral resources at multiple levels of intervention (hospitals, psychiatric treatment centers, partial treatment and day treatment centers), public transportation, various community support and centers, self-help groups, and peer support including ongoing supervision and professional mentoring (Helbok, 2003; Schank et al., 2010). This exposure to training in an urban/suburban environment may not adequately prepare those clinicians that go forward to work with small community and rural populations and creates the general consensus in the literature that an urban model of mental health training and service delivery is inadequate to meet the needs of rural and frontier communities. With this in mind, mental health service providers often feel that ethics codes and other literature are so urban-biased that they are not helpful in a rural or frontier context (Helbok, 2003; Murray & Keller, 1991; Roberts et al., 1999; Schank, 1998; Werth et al., 2010).

Current ethical codes do not adequately address ethical concerns in rural settings. It is important to understand that while there may be significant differences between the ethical considerations of urban, rural and frontier mental health practices, this does not mean that ethical codes have no applicability in rural and frontier clinical settings; to the contrary, potential ethical concerns should be closely monitored precisely because of the inherent ethical dangers that come with working as a clinician in such areas (Helbok, 2003). The fact that such situations will occur in rural and frontier clinical settings and will influence mental health services encourages the need to develop and expand the ethical codes and ethical decision-making processes (Schank et al., 2010) to include an understanding that rural and frontier mental healthcare decision-making is “colored and shaded by values, beliefs, emotions, competencies, and resources” (Cook & Hoas, 2008, p. 52). It is only by understanding and working with this coloring and shading that mental health providers can develop awareness and skills needed to work effectively in rural and frontier communities. To do this, rural and frontier clinicians must do more than simply adhere to standards or rote application of rules—they must understand why those rules exist, at what point those rules may be a detriment to the development of clinical relationships, and what may constitute a severe enough ethical issue in regards to both ethical codes and community values to warrant concern. Rural and frontier clinicians need to understand that “ethics should not be static but rather constantly examined and evolving in order to be the most beneficial to clients and counselors” (Schank, 1998, p. 272).


The limitations in both human and material resources in frontier areas can cause many seemingly obvious and standard professional practices to take on significant ethical aspects and primary among these is confidentiality. With fewer mental health professionals in a given area, fewer support mechanisms and services, and geographically large and sparsely populated areas, confidentiality can be more difficult to ensure in rural and frontier practice; while on the other hand a strict adherence to confidentiality can negatively impact important collaborative relationships in smaller communities (Scopelliti et al., 2004).

The close confines and small populations of many frontier areas and towns lend themselves to personal business being known by many people in the community and each person potentially being aware of many others’ behaviors (Helbok, 2003; Roberts et al., 1999). It is in this regard that confidentiality is difficult to control as the size of the community lends itself to many people knowing who is seeking and/or getting treatment at any time. The members of the community tend to collectively know those who are having difficulties with mental health, personal or addiction concerns. The stigma of receiving mental health services, particularly when the potential client knows that the community is aware of their actions, can cause many to avoid needed professional assistance. This is only compounded when the office or support staffs of a mental health service are longtime members of the community and are familiar with the client, or may even be related to the client. Potential clients may be reluctant to engage in services where they may personally know others, such as group counseling or outpatient addictions settings (Helbok, 2003; Solomon, Hiesbergr, & Winer, 1981). Office and support staffs, themselves not having to meet the ethical requirements of professional licensure, may be more apt to share confidential client information between themselves, friends and family members. This sharing of information between community members is a concern on a professional level as the lack of professional referral sources may mean involving people, groups and organizations that may not share a counselor’s view of confidentiality. These referral sources may include community, church, and volunteer organizations, and these organizations and their associated paraprofessionals may create confidentiality concerns for clients through the informal sharing of information which is common in small communities.

This sharing of confidential information across professional lines also is significant in the relations of the counselor to the broader array of professional services and agencies that may interact with their clientele. Law enforcement, medical, educational and social service professionals may expect the rural and frontier counselor to freely share information the counselor considers confidential to the client. Without an appropriate informed consent or release of information the counselor is obligated to not share any personal or treatment information, or to even tell if the client is receiving services. This ethical stance can be damaging to a counselor’s professional practice as it can distance them from the local professional community, reduce future client referrals and strain relations with other health and service professionals (Helbok, 2003; Solomon et al., 1981; Stockman, 1990). Hargrove (1986) maintained that confidentiality must be preserved unless there is consent to release information, or if there is a clear and present danger. At the same time, the counselor needs to be responsive to community standards and attempt to work in the best interests of their client even when most rural clients assume that information will be shared without their consent (Elkin & Boyer, 1987; Helbok, 2003). In frontier settings, it may be difficult to balance ethical obligations with community expectations, but the counselor can be the best agent of change in these situations by taking steps to educate referral sources and local professional organizations on the importance of confidentiality in counseling services and how confidentiality can reduce the client’s fear of being stigmatized. Counselors also should take steps beyond the development of a comprehensive informed consent to discuss with clients the professional requirements of confidentiality and promote clarity regarding what information will be shared and in what circumstances (Helbok, 2003).

Boundaries of Competence

A counselor’s boundaries of competence are defined as the “education, training, supervised experience, state and national professional credentials, and appropriate professional experience” (ACA Code of Ethics, C.2.a, 2005) that qualifies a counselor to work with a particular client, population, or mental health area. In rural or frontier areas the determination of professional boundaries of competence can be difficult to achieve (Helbok, 2003). As rural and frontier clinicians are called upon to serve a diverse range of client issues, they tend to work as generalists rather than specialists in order to provide the highest quality of service to the most clients within a given area (Werth et al., 2010). Within a small community they may be asked to address many issues including adjustment concerns, addictions, mental illness, trauma, crisis, marital issues, career development, developmental and learning issues, life-changing circumstances and/or end-of-life concerns. These concerns can surface in any of the situations that a frontier counselor may find themselves in including community outreach, educational training, professional consultation and individual or group counseling settings (Werth et al., 2010).

When such a situation arises it is the duty of the counselor to determine if the concerns of the potential client fall within or without their professional competence while also considering the availability of appropriate referrals and professional services that may be better suited to address this issue, the geographic availability of such referrals, if such exists, and the ability, resources and inclination of the client to access such services. The counselor may choose to deny a client services on the grounds of non-maleficence; namely, that by working outside their areas of experience they risk more potential harm to the client than they would by violating their boundaries of competence. On the other hand, the counselor may choose to uphold the principle of beneficence in regards to client care with the opinion that a potentially inappropriate treatment would be less harmful than no treatment, or when there are no reasonably available referral options (Remley & Herlihy, 2009). Both of these options can be untenable when judging the value of a person’s mental stability and ability to function against an ethical code that does not take into account the realities of small community life. In that regard, each of these options serves to highlight the position that determinations of boundaries of competence in frontier areas need to include an awareness of the needs of the community.

In areas where members of close-knit communities traditionally depend on each other in the face of adverse living conditions, and the problematic behavior of even a single person can disrupt a family and through that a community, it is imperative to be aware of the interdependence and needs of small communities. With this in mind, when a frontier counselor is faced with a client concern that they do not feel wholly qualified to treat, they may choose to work with the client knowing that referral services are too far removed or inaccessible and that professional action may be construed as a violation of competence on the part of the counselor, but also that working with the client may serve to maintain the client’s best functioning in the community, thus supporting the continued well-being of the community itself (Werth et al., 2010). In contrast, a counselor could deny services to a client based on the counselor’s perception of their own professional abilities in regards to a particular client concern. The counselor could then seek to augment the boundaries of competence through supervision, mentoring and continuing education, expanding understanding until more comfort working with a particular concern or population was achieved. This assumes, of course, that adequate supervision and continuing education opportunities are available and that the counselor is able to access these services. In this manner, the frontier counselor is in the same predicament as their clients with geographic location and distance determining availability of resources. While technologies (Internet, audio/visual conferencing, telephone) do create greater potential access to necessary resources, the reality of frontier life is that many areas do not have Internet or phone access, or have very limited access heavily dependent on weather conditions and other factors relating to location and available technical resources. While most licensing boards allow some continuing education units (CEU’s) to be obtained through distance means (Zur, 2006) and some allow distance supervision for licensure (McAdams & Wyatt, 2010), the actuality of frontier counseling frequently makes it difficult to readily obtain licensure CEU’s, timely mentoring, and collaborative resources when needed.

Multiple Relationships and Conflicting Professional Roles

“A dual relationship would be considered to exist when, in addition to the professional role and relationship, there exists a further meaningful relationship with clear role expectations and obligations, such as employer, friend, family member, or business partner” (Brownlee, 1996, p. 498). These dual and multiple relationships are the most pervasive ethical concern facing rural and frontier counselors and are the most complicated of all the ethical dilemmas encountered in daily professional practice (Helbok, 2003; McDermott, 2007; Scopelliti et al., 2004; Werth et al., 2010; Zur, 2006).

Perceived problems with multiple relationships in counseling. The relationships themselves are, of course, not the problem. The ethical concerns begin to arise when the boundaries of a therapeutic relationship become unclear through multiple relationships to the extent that the potential of client dependency, feelings of entitlement to special favors, and financial, emotional, or sexual exploitation can more readily occur (Nickel, 2004). That is why the traditional view of managing multiple relationships has been to avoid them (Ebert, 1997; Faulkner & Faulkner, 1997; Stockman, 1990) and in general, the ethical codes of mental health professional organizations have discouraged multiple relationships in an effort to avoid exploiting the trust and dependency of clients (Erickson, 2001).

In the American Counseling Association’s (ACA, 2005) ethics code, for example, counselors are encouraged to avoid all non-professional interactions or relationships with “clients, former clients, their romantic partners, or their family members…except when the interaction is potentially beneficial to the client” (A.5.c). If there is a potential benefit for a current or former client the counselor:
must document in case records, prior to the interaction (when feasible), the rationale for such an interaction, the potential benefit, and anticipated consequences for the client or former client and other individuals significantly involved with the client or former client. (A.5.d.)
This may be a reasonable course of action when the counselor has the justifiable belief that he or she can move around in an environment without the immediate concern of interacting with a current or former client (Schank & Skovholt, 1997). But when the constraints of geography, availability of mental health services, population density, and the distinct characteristics and expectations of frontier communities and their inhabitants are taken into account it is a much more sensible assumption on the part of the frontier counselor that non-professional contact with a client, former client, their romantic partners, or their family members is not only inevitable but imminent (Faulkner & Faulkner, 1997; Schank et al., 2010). It is this inevitable imminence that lies at the heart of the disparity between current ethical guidelines and practical mental health provision to rural and frontier populations.

While there are some clearly delineated ethical violations that apply across professions and work environments, such as sexual or romantic counselor-client relationships, the complexity of social values and human relationships makes it impossible to define clear directives for engaging in nonsexual multiple relationships, particularly for those who practice in rural and frontier communities (Faulkner & Faulkner, 1997; Nickel, 2004; Pope & Vetter, 1992). With these considerations in mind, the idea that all dual relationships are unethical “would seem to be unnecessarily restrictive and unrealistic in a rural context” (Brownlee, 1996, p. 500).

Place of multiple relationships in frontier counseling. Unfortunately for the frontier counselor, the very social structure of frontier life fosters multiple interdependent relationships between people as a way of adapting to the realities of living in remote and sometimes harsh and dangerous environments. The smaller and more remote a community is, the greater the interdependence between its members in regards to life necessities such as food, water and shelter, as well as other needs including health issues, education and companionship (Roberts et al., 1999). In frontier areas, the likelihood of multiple relationships between community members is even greater due to scant resources and professional services, reduced population density, and the fact that many of the community members will have family relations between them as well. As Roberts et al. (1999) stated, “in these naturally ‘enmeshed’ communities, there are few options for relationships other than overlapping ones” (p. 499). Multiple relationships between members are seen as normal and reflect expected and traditional cultural and social norms (Campbell & Gordon, 2003). They expect to interact with each other in significant social and personal endeavors so their social norms have more flexible and permeable boundaries (Nickel, 2004) than might be encountered in less interdependent and socially interwoven populations.

Utility of multiple relationships in frontier counseling. It is into this world of highly interconnected social and familial relationships that the frontier counselor strives to be accepted and trusted. Faced on the one side with the idea of the ethical slippery slope, where relatively minor ethical infractions tend to lead to more severe violations (Faulkner & Faulkner, 1997), and on the other with a populace that expects and in many cases demands social and interpersonal interactions, the frontier counselor must find ways to be embraced by the people that make up their communities (Schank & Skovholt, 2006). The most secure route to this acceptance is through involvement with the community as this promotes familiarity which may lessen suspicion and increase approachability (Campbell & Gordon, 2003), thereby fostering community approval and trust (Horst, 1989; Schank et al., 2010).

This approval may directly establish the counselor as a trusted resource regarding mental health concerns and allow the counselor to act as an advocate for the value of formal therapeutic services. It also may indirectly influence clinical effectiveness (Erickson, 2001; Scopelliti et al., 2004) as clients may mistrust a counselor who lives and operates outside of the community structure and isn’t available on social or personal levels. As Nickel (2004) stated, “No matter how warm and caring they may be during therapy, rural mental health care providers cannot be effective if they hold themselves distant and aloof in other situations” (p. 19). On a personal level, this aloofness may not be advisable as the frontier counselor, and potentially his or her family, is living in the community and as such, personal survival may depend on interactions and relationships with community members. This inherent dual relationship works against the potential of avoiding multiple relationships as it is acceptance into the community that helps ensure communal and personal survival in many frontier and remote areas. However, the deeper a counselor is accepted into a community the greater the probability of developing non-sexual multiple relationships with clients and their families (Werth et al., 2010). This, consequently, could lead to professional ethical concerns for all of the reasons mentioned previously and potentially lead to gross ethical violations and/or impairment on the part of the counselor (Faulkner & Faulkner, 1997; Stockman, 1990). It should be noted, however, that not all multiple relationships must lead to ethical violations. While some rural clinicians establish and maintain strict professional boundaries, discouraging multiple relationships due to a belief that clinicians who work in rural environments must make personal sacrifices (Faulkner & Faulkner, 1997), others believe that multiple relationships may enhance a clinician’s standing in the community (Schank et al., 2010) to the extent that chance meetings outside of therapy and routine social interactions are protected by the counselor’s investment in the community and the community’s trust in the counselor (Faulkner & Faulkner, 1997).

This emotional investment of the counselor in the community can become a positive ethical force as “dual relationships and familiarity with patients…tend to decrease the probability of exploitation—not increase it—as the power differential in a more egalitarian relationship is reduced” (Scopelliti et al., 2004, p. 955). Due to the counselor’s involvement in the community, the local clientele may choose the services of the frontier counselor because they may be seen as someone who would understand and have awareness of the client’s concerns (Schank et al., 2010). Thus the regard the counselor has for the community’s overall welfare can act as a monitor “warning that distancing through anonymity and neutrality is not only likely to be counter-therapeutic, but also to increase the likelihood of exploitation” (Scopelliti et al., 2004, p. 955). This of course assumes that the counselor is diligently aware of their relations with clients and community members because, as Reamer (2003) states, such relations “can be ethically appropriate and, in fact, therapeutically helpful as long as the clinical dynamics are handled skillfully” (p. 128). Conversely, lack of awareness can lead rural clinicians to consider that because multiple relationships can be expected they are free to engage in any type of relationship and excuse it as a natural result (Werth et al., 2010).

Considerations for Frontier Counselors

Certainly there are no easy answers to the ethical dilemmas that working in frontier areas presents. Limited by resources, bound by geography and distance, and confronted with issues that might seem tractable in more urbane environments, the awareness of a frontier counselor needs to be focused on many professional and ethical levels at any one time.

Define Clear Boundaries

Informed consent is paramount. Considering the potential for ethical violations in a frontier setting the counselor must clearly communicate to his or her clientele the parameters within which the counseling relationship can exist. This should include how the client wishes chance or social encounters with the counselor to be handled as well as how multiple relationships, to the extent that they can be pre-determined, should be addressed when they occur. In an environment where overlapping relationships are best viewed as a certainty the need for transparency in the client/counselor relationship is fundamental for a clinical relationship that can weather the ethical realities of frontier life.

The counselor also needs to consider his or her own professional boundaries and determine a level of comfort in regards to the potential ethical issues that shape frontier clinical practice. Clarifying one’s own understanding of where boundaries of competence are can help the counselor determine when he or she is entering an area of uncertainty regarding providing services in which the counselor may not be fully conversant. In this regard the counselor also needs to come to terms with his or her own acceptable level of multiple relationships with clients. Understanding one’s self-determined boundaries, be they ethical or personal, can help alert the counselor to behaviors that could lead to ethical violations.

Confidentiality. The counselor must communicate to the client the confidentiality issues that are common in frontier environments and establish an understanding of the counselor’s ethical and legal obligations. Even when the client expects the counselor to share information about the client with other services or professionals in the area, it is the responsibility of the counselor to foster an understanding on the part of the client as to the extent and obligation of counselor/client confidentiality. As with other aspects of counseling, the frontier counselor should also be prepared to define their professional boundary of confidentiality when dealing with other professional services or agencies in the area. To the extent that they are able, it is a counselor’s duty to protect their client’s confidentiality, even in the face of a cultural value that shares information as part of communal survival.

Professional Awareness

The journey from analyzing ethical case studies in training situations to personal involvement in potential ethical violations can be very short for the new frontier counselor (Schank & Skovholt, 2006). Counselors new to the frontier perspective need to find qualified supervision to help them establish their understanding of ethical decision-making in ethically challenging environments. This may include investigating state licensure regulations on distance supervision (via phone, Internet, etc.) to expand the supervision and mentorship possibilities. The counselor, new or experienced, should also strive to find supervision and peer-consultation that has experience in rural and frontier communities to better support an informed awareness of the necessities and realities of frontier life.

“Acts of everyday living are self-disclosures” (Schank et al., 2010, p. 503) and the frontier counselor needs to be aware of their behavior on professional, social, and personal levels. As so much of frontier counseling is inter-relational, this self-attention is significant as it can help foster an awareness of the ethical aspects of many facets of frontier counseling practices and alert the counselor to potential ethical concerns in the making. When concerns are identified it is then incumbent on the counselor to determine the nature and extent of the issue and take action when necessary. The nature of that action is dependent on the role the counselor has created for themselves in the community, the needs of the client and the community and the potential actions that can be taken within cultural and ethical guidelines.

Cultural Awareness

With their own traditions and attitudes, frontier communities are very much their own small community cultures with self-determined ways of behaving and interrelating. For the frontier counselor to be accepted into the community it is necessary for the counselor to understand the values the community is built upon and work to honor and foster those values through professional practices. While many of the cultural behaviors of a frontier community may seem at odds with professional counseling ethical practices, a merging of the two is possible with vigilance and understanding. It is not for the counselor to enter a frontier community and require that they follow a professional ethic designed on a divergent cultural model by a dissimilar people; rather, it is for the counselor to appreciate that an ethical code is based on accepted cultural and behavior ideals and that it is the counselor’s obligation to serve those ideals within the boundaries of accepted professional codes of ethics. Understanding the community needs and values in terms of desired ideals and expected behaviors will help the counselor to better become a part of and serve the community as an involved and invested member.

Future Investigation Directions for Frontier Ethics

As the work of rural and frontier counselors impacts a significant percentage of the U.S. population and that population experiences a higher lack of mental health provisions than urban clients, it is in our best interest to better understand the needs and practices of rural and frontier counselors so that we can then provide better services to rural and frontier communities. Primarily, research needs to explore the practices of small community, rural, and frontier counselors, which should include case studies of how clinicians approach and handle clinical issues. This investigation into counselor practices needs to focus on the ethical decision-making processes that counselors employ when managing the ethical concerns that are prevalent in these communities. It also needs to analyze the products of these processes in light of the professional counseling code of ethics to better determine at what level, if at all, rural and frontier counselors are experiencing ethical crossings or violations in their professional practices. Next, we need to gain an understanding of the extent to which counselor educators recognize and understand small community settings and their effect on counseling in such areas. This would include the training that may exist in counselor education regarding the preparation of counselors to work with small community, rural, and frontier populations and should include counseling program curriculum, professional development courses and continuing education opportunities. Understanding what counselors are being taught in relation to these populations will help to determine if their training is adequate and appropriate to the needs of these communities.


This paper seeks to illustrate the point that the ambiguity that makes a code of ethics a flexible set of guidelines of professional behavior also creates difficulties when the situations they caution against are an inherent part of the social fabric of the world that the counselor works within, particularly that of a rural or frontier community. It is clear that many ethical issues cannot be avoided when working with frontier communities and must be integrated into professional practice with due consideration. Counselors in these areas need to be conscientious in examining their relationships with clients and community members. This examination should lead to clear communication with clients on potential ethical issues and help define the roles and boundaries of the client and the counselor. It also requires the counselor to remain vigilant against potential boundary violations and to take action whenever an issue arises (Helbok, 2003; Kitchner, 1988; Remley & Herlihy, 2009).


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Keith A. Cates, NCC, is an Assistant Professor in the Department of Counseling and Special Education at the University of Alaska-Anchorage. Christopher Gunderson is the Director of Training and Development at Denali Family Services, Anchorage, Alaska. Michael A. Keim is an Assistant Professor in the College of Education at the University of West Georgia, Carrollton, GA, USA. Correspondence can be addressed to Keith A. Cates, University of Alaska–Anchorage, 3211 Providence Dr., UAA-COE-CASE, PSB 206K, Anchorage, AK 99508-4614, kcates@uaa.alaska.edu.

Sources by Which Students Perceive Professional Counselors’ Effectiveness

Michael W. Firmin, Richard A. Wantz, Ruth L. Firmin, Courtney B. Johnson

Using qualitative research methods, interviews were conducted with college students regarding the sources they
used in generating perceptions of professional counselors. Respondents believed that information sources such as word of mouth, media sources and personal experiences were responsible for their understandings of professional counselors. The findings have applications for leaders in professional counseling organizations. Common knowledge characteristics, public perceptions, counselor identity and advocacy are discussed.

Keywords: perceptions, professional counselors, information sources, counselor identity, advocacy

Perceptions do not equal reality. However, perceptions eventually can lead to what reality becomes in time. All professions possess public perception. When someone refers to doctors, lawyers, dentists, and other specialized occupational groups, images are created in our minds. These percepts possess varying degrees of reality, of course, but the effects of such images are cogent nonetheless. Of particular interest to the present study is the perception of human service personnel, including professional counselors.

As a whole, the human service profession has landed itself on the positive side of the public’s opinion spectrum (Nunnally & Kittross, 1958). McGuire and Borowy’s (1979) research showed a continuum of perceptions held by the lay public regarding a wide range of professionals who worked with mental illness. Those occupying the fields of nursing, physicians, counseling psychologists, social workers, psychiatric nurses, psychiatrists, and clinical psychologists received the highest rankings.

Undergraduate students’ opinions regarding effectiveness of various human service providers for helping mental health consumers were reported by Tse, Wantz, and Firmin (2010) and Wantz and Firmin (2011). Participants in these studies rated human service providers’ effectiveness more positive than negative. Professional counselors and psychologists were rated more effective with providing mental health services than other human service providers.

Richardson and Handal (1995) found the general public viewed psychotherapy as a reasonably effective means of treatment for between 25 and 50% of all cases. Most people also recognized that services of less traditional human service providers, such as marriage and family therapists, also could be used effectively in relation to particular disorders. Psychiatrists and psychologists, however, were perceived as having higher levels of competence when addressing mental health issues (Schindler, Berren, Hannah, Beigel, & Santiago, 1987). Educational attainment (Dotson-Blake, Know, & Holman, 2010), chronological maturity (Erikson, 1963; Oliver, Reed, & Smith, 1998), and psychosocial development (Tinsley, Hinson, Holt, & Tinsley, 1990) have been reported to be positively correlated with perceived benefits of counseling.

Murstein and Fontaine (1993) found familiarity of the general public to be greater concerning physicians, clergypersons, and psychiatrists than it was in their knowledge of psychotherapists and psychologists. Consequently, of the two, psychologists were the source the general public was most likely to use when recommending a human service provider. Also reported, the most common reasons for which clients sought mental health professionals were mild depression, marital problems, and child-rearing issues. A generation ago, Gelso, Brooks, and Karl (1975) reported mental health consumers’ overall preferences to be for counseling psychologists and psychiatrists.

Sharpley (1986) purported a tendency for mental health consumers to separate human service professionals into two categories, each entailing distinct perspectives. First, private practice and fee-for-service providers, psychologists and psychiatrists being the most prominent, were viewed as those who were most competent in treating mental illnesses. Second, public-utility and non-fee-demanding professionals, of which social workers and counselors prominently emerged, were perceived as being more practical and apt in providing service to the average person when addressing emotional problems.

Among the various human service professionals, counselors are of particular interest to the present study. Sharpley, Bond, and Agnew (2004) indicated that the public views counselors’ roles to be primarily listening, supporting, and helping to solve problems. While 79% said counselors were needed, and the same number indicated a willingness to pay for services provided, survey respondents personally were likely to consult a counselor concerning only 13–20% of the problems they faced. Participants also reported benefits of counseling to include having an impartial person to listen and help clarify, as well as having a facilitator for problem-solving, and meeting in a safe, confidential environment.

Fall, Levitov, Jennings, and Eberts (2000) described the public’s expressed general confidence in professional counselors’ abilities to treat “less serious” cases, but less confidence when treating cases which were perceived to be at higher levels of seriousness (e.g., psychopathology). These findings are congruent with those found by Fall, Levitov, Anderson, and Clay (2005) specifically studying the perceptions of the African-American population. In both studies, the participants expressed significantly greater levels of confidence in the abilities of psychiatrists when addressing severe issues, such as psychotic depression or post-traumatic stress disorder. Findings further showed that doctoral-level counselors were perceived similarly to clinical psychologists, while both studies showed that in every case professional counselors with doctorates were preferred over those with only master’s-level education. Wantz, Firmin, Johnson, and Firmin (2006) reported on university student perceptions of high school counselors. This qualitative study found college students reported high school counselors as having similar empathic and desire to help skills as licensed professional counselors.

Dixon, Vrochopoulos, and Burton (1997) reported the underrepresentation of counseling psychologists in introductory psychology textbooks, showing counseling to have significantly fewer references than clinical, school, and industrial psychologists. Likewise, Firmin, Johnson, and Winkler’s (2005) research showed almost no references to professional counselors in general psychology texts. Consequently, we conclude that while the public generally possesses positive perceptions of professional counselors, their presence is kept somewhat cryptic by the gatekeepers. College-educated students depend on introductory psychology texts to frame for them professional domains and functions among human service professionals.

As counselors have achieved professional status through licensure over the last two decades, identity confusion has been demonstrated by the practitioners within the field (King, 2006). Inevitably, this perplexity has trickled down to the minds of mental health practice consumers regarding distinctions and roles of professional counselors. Consequently, while the public generally likes the construct of who they think of as counselors, they also are unsure of these professionals’ roles (Butterfield, 1989).

Decades ago, Dahlem (1969) called for the vital need to research the general publics’ perception of counselors’ images and role perceptions, compared to counselors’ self-perceptions. He stressed the importance of clarifying consumers’ understandings and perceptions in relation to the success of the providers. Gelso and McKenzie (1973) followed up, studying ways in which students were informed of counselors’ available assistance. Students receiving only written information about hypothetical problems appropriate for counseling were less likely to experience changes of perceptions. This suggested that the most effective way to impact students’ impressions concerning counselors would be the presentation of written and oral information.

Narrowing the scope, the present study updates this important research inquiry. Specifically, our interests were to explore how college students, as potential consumers of mental health services, came to their understandings of counselors’ professional competence. That is, how effective do students perceive professional counselors to be? Obviously, since such perceptions are tied to students’ ultimate use of counselors’ services, the answers to the research question have significant implications for personnel working in college counseling settings.


In accomplishing the study’s aim of assessing how college students generate their perceptions of professional counselors, we considered a number of potential research designs. While quantitative methods such as surveys would provide us with a relative breadth of understanding in this area (Patten, 1998) and this would be valuable, we believed such an approach would not be as apt as a qualitative design. Generally, quantitative approaches answer “what” or “how many” types of questions (Sarafino, 2005). However, we were more interested in knowing answers to “how” and “why” types of questions. These, by and large, are best answered via qualitative designs (Atkinson, Coffey, & Delamont, 2003).

At the outset, we are explicit regarding our decision in using an atheoretical approach to the qualitative method. Significant and heated debate presently exists in qualitative circles regarding whether one should or should not use theory—and if so, what that role should be. Originally Glaser and Strauss (1967) advocated that atheoretic, inductive approaches were the only means of generating a grounded theory. Later, Strauss and Corbin (2008) purported that theory was legitimate and useable for some qualitative research designs. Glaser (1992), however, vehemently opposed this departure from the classical approach indicating that researchers must exercise disciplined restraint in holding back theory when generating or interpreting results.

Obviously, we are not going to abate the controversy in this article, but we do wish to be explicit in reporting our commitment to classical grounded theory. That is, philosophically we believe that phenomenological studies such as the present one should be conducted inductively—holding theory at bay. While we understand the implications and even potential limitations of this approach, we believe it to be most apt, nonetheless.

A sample of 26 students was drawn from a general psychology course (16 females and 10 males). The institution was a selective, private comprehensive university located in the Midwest. Departing from traditional criterion or purposeful sampling most often used with qualitative research (Seidman, 2006), we used random sampling for this study because we wished to enhance the external validity of our findings as much as feasible. That is, the trade-off of expanded generalizability was believed to be worth the expense of potentially less rich descriptions through specifically selected students. Since the general psychology course was part of the liberal arts core curriculum at the institution, our sample reflected a relatively wide cross-section of majors, included students who were freshmen through seniors, and participants’ ages ranged from 18 to 22 years of age. Interviews were tape recorded and later transcribed for analysis. In writing the present article, we used respondent pseudonyms for reading clarity.

We utilized a semi-structure method in conducting the in-depth interviews. We used staple constructs for generating questions, but also allowed students to deviate in their replies, enabling them to tell their own stories and share perceptions inductively. Following Firmin (2006a), two waves of interviews were conducted. That is, all participants were interviewed twice—with transcription and coding occurring in between the interviews. This allowed for constant comparison of the data and dialogue among the researchers for generating potential codes.

When analyzing the interviews, we used an open (Maxwell, 2005) coding, inductive process (Marshall, 1999). Since we located no studies published on this topic, axial coding was not practical and open coding was more consistent with the study’s exploratory aim. Frequent meetings among the article’s authors occurred and this process facilitated coding, providing verifications for consistency of analysis. When generating potential codes, we read through the transcripts, utilizing constant comparison methods (Bogdan & Biklen, 2007). This involved continuously comparing the transcripts to one another, looking for any repeating words, phrases, or constructs that were common among the participants. In order to keep the data manageable, some similar categories were collapsed into major categories. NVIVO qualitative research software also was used to help analyze data. This program helps to manage relatively large amounts of transcript documentation as well as aid in the generation of reliable themes across multiple participant data sets. This technology enhanced human capability, and it did not replace the role of subjective judgments required to conduct intuitive work (Lewins & Siver, 2007). Following Gay, Mills, and Airasian (2009), the process of transitioning from codes to themes involved asking key questions, conducting organizational review, visually displaying the findings, and concept mapping.

The research team’s dialogue regarding potential thematic outcomes enhanced the study’s internal validity. Naturally, one researcher can appropriately analyze data and provide apt findings. Nonetheless, the assurance of valid findings often is enhanced when multiple qualitative researchers participate in the analysis process (Ryan & Bernard, 2003). We included in this article only those themes on which the entire research team concurred. The study’s internal validity also was strengthened through generating a data trail (Daytner, 2006). This involved generating direct connections between each reported theme in our transcripts through identifying specific paragraphs within the interview conversations. Data trails can be useful to those who wish to check the validity of our reported findings or who hope to someday replicate or advance our present study (Firmin, 2006b).

Third, member checks (Merriam, 2002) were applied with various research participants. This is a qualitative research technique whereby we shared our findings with research subjects, garnering their feedback regarding how reported results aptly reflected their reported perceptions during the interview process. Each of the individuals with whom we checked commonly agreed with our reported results. Fourth, we strengthened the study’s internal validity by including participation from an independent researcher with renowned expertise in qualitative methodology (Flick, 2006). This expert appraised the steps at each stage of the study, the legitimacy of our process, assessed our data audit, and provided analysis regarding linking the transcripts data with the results. Fifth, saturation (Silverman, 2006) occurred when analyzing the transcript data. Specifically, after approximately 24 interviews, our participants generally shared similar sentiments, with few fresh insights added as subsequent interviews were added to the sample. In the qualitative tradition of experts such as Guest, Bunce, and Johnson (2006) and Neuman (2006), we believe our sample size was both ample and appropriate for the context of this specific study.

In summary, internal validity is a critical component in delineating appropriate qualitative research (Cope, 2004). Weightier confidence may be placed in the reported themes, that they adequately represent the general sentiments of the research participants when particular, deliberate steps are taken. Both in the study’s design and its implementation, we believe this project demonstrates rigor by established qualitative research standards (DeWet & Erasmus, 2005) and an apt grounded theory of the data collected (Lundberg & Young, 2005).


Upon examination of the interviews, several themes emerged from the coded transcripts. Primarily, respondents discussed their awareness of sources such as the media, word of mouth, and personal experience in the development of opinions regarding professional counselors. Further, respondents discussed characteristics of a “common knowledge” upon which consumers draw in their utilization or hesitancy of seeking counseling services. Finally, responses delineated the perceived effects of this common knowledge on the reputation of counseling.

Three Sources
Repeatedly, respondents spoke of three main sources on which they depended in generating their opinions of professional counselors’ effectiveness. Respondents particularly mentioned the contribution of media sources such as radio, newspapers, television, and movies, along with the more personal and implicative sources of word of mouth and personal experience. Considered holistically, this amalgamated into a nebulous resource of common knowledge. One respondent defined common knowledge as “general sources,” implying the prevalent accessibility of this information.

Consistent with the sample’s generational factors, responses repeatedly indicated the role of the media in their concept formation of who professional counselors are and what they do. Janet explained that “common knowledge would probably be just things they’ve heard on TV or seen on TV,” revealing the expectation of what a professional counseling session should theoretically cover and how a session should appear. Media also sharply influenced perceptions of what a counselor and client should look like (i.e., personal dress and hygiene) and even where these services are located (e.g., in a swanky hospital wing or in urban city slums). Pete specifically mentioned the impact Hollywood had on the formation of his own perceptions, indicating no coincidence in the congruity of college students’ expectations with media depictions.

Fortunately, respondents spoke with a voice of relative discernment, aware of the possible slants injected into information relayed by the media. Injecting a sense of humor, Jason admitted: “I know I was watching TV the other day, I think it was Growing Pains, or something like that, and they were talking about it [counseling] so that’s how I know.” Not credulous to the media portrayal, he continued: “Like they have no problems in life, everything’s going smooth for them . . . people that have no problems and are like happy all the time . . . that’s not true.” While not all respondents explicitly expressed this intuition, they generally did note the connotations associated with counseling by the media. For example, Coleen noticed the subliminal messages as she watched movies or television shows: “It’s usually like TV and movies just have different characters in them and it usually seems like a negative type thing. . . I think that they make it seem like it’s [counseling] a weird place to go and it’s not a fun thing.” Clearly, the media is not a bias-free information source, but requires active examination on the part of the viewer.

Numerous respondents mentioned the place that word of mouth had in the formation of their perceptions about counselors. Where personal experience waned and media fell short of credibility, respondents turned to testimonies of people they know who were counseled first-hand and held credence. When asked to describe sources of common knowledge regarding her perceptions of counselors, Barb offered: “I think a lot of people would be, maybe from people they know, who have been to one, who are one [professional counselor].” Respondents feel that no matter the strength of the connection, be it from a friend-of-a-friend or from the mouth of a professional counselor, hearing of others’ encounters considerably influences perception formation. Making judgments on topics with which respondents are personally unfamiliar (i.e., no personal experience in counseling) is alleviated when backed by the testimony of personal references.

Dan mentioned the input of “the whole movies and TV and media” in passing, but pointed to word of mouth as the primary information hub about how he developed his percepts regarding counselors. His assertion that word of mouth is the primary means rests on another assumption, “I’m sure probably the majority of the people don’t go to counseling,” highlighting that where personal experience lacks, the information network through word of mouth becomes prominent in concept formations. Dan concluded: “I think that in general it’s the word of mouth because you always know someone who’s been through something or doing something and has had to go to counseling.” Respondents believed that personal encounters with counselors by their friends were a rarity, and in a sense a commodity, taking what they heard at face value. As such, their collections of personal testimonies were typically sparse. Johanna considered word of mouth to be the prominent common knowledge source when thinking about counselors, as she stated: “I haven’t really read up on them or anything, but just based on what people have said, that’s where I’ve gotten my perspective from.” Even more, Johanna looked to her immediate context: “For me it would be more of adults, like parents, parents’ friends, stuff like that.” Speaking from the periphery, students gain perspective based on other’s comments.

When accessible, respondents relied on personal experience and interactions of acquaintances as their main contributors to their knowledge base about professional counselors. No matter how insignificant the interaction, respondents preferred personal encounters or those of close friends, more so than media or other sources, in their concept formations. For example, Emma drew on memories from elementary school: “Just like experiences in elementary school where counselors came around and talked like ‘don’t do drugs and things like that.” Respondents readily admitted their recollections may be somewhat “fuzzy,” but nonetheless preferred these to more broad sources.

The context of “home” was imperative for perception formation about counselors among respondents in our sample. Specifically, respondents heavily relied on past experiences to formulate opinions about new concepts or in discussing unfamiliar territory. Carla offered this insight: “I suppose it could be something that has come from their background or their family life.” Familial beliefs are known to possess cogent influences in multiple life domains such as politics, religion, prejudice, etc. In the present context, our students suggested that generational influences play a moderating role in perceptions of professional counseling.

As the majority of respondents could not draw from personal experience, the testimony of friends often was their closest connection to professional counselors. Stephanie mentioned that common knowledge was a salient influence in how she came to think of counselors. Later, she elaborated this could be from talking with “friends that went to go see a counselor” and who could fill in the gaps of her understanding. Randy affirmed the power generated when he will “hear other people’s experiences.” Obviously, respondents in our sample could not judge the relative quality of their friends’ experiences or the degree of truth represented by their friends’ accounts. But hearing what their friends told them left indelible impressions, nonetheless.

Common Knowledge Characteristics
Upon examination of their information sources, respondents reflected on the characteristics of their sources. Specifically, respondents mentioned that their knowledge about unfamiliar topics such as professional counselors may have little-to-no factual basis or may be unreliable. Mandy shared that respondents evaluate counselors by “just what they think they know. It might not necessarily come off of anything.” Respondents often were aware of this vulnerable reasoning, but when asked to offer their opinions, they drew on the ambiguous common knowledge anyhow. Linda stated her perception that this concept was “possibly general statistics or people’s assumptions about professional counselors, not necessarily what’s true.” In consideration of the often inaccurate portrayal of counselors through movies, magazines, and additional sources of media, these assumptions may differ widely from reality. Kevin offered this reasoning about how common knowledge affects perceptions about counselors: “People . . . think they know stuff about stuff, and really don’t. . . . So that’s why the majority of people don’t even know much about counselors and stuff like that. They hear one thing, and generalize it about everybody.” The tendency to generalize can be potently beneficial, depending on the accuracy of the source, of course. This principle has important ramifications for the development of counseling as a potential profession.

A second characteristic of common knowledge in our study is an inability of participants to recall the sources from which the information comes. Clearly, when making decisions such as choosing counseling services, knowing potential sources behind the motivation for utilizing them are important. Lori mentioned that students often rely on “things from a long time ago that they may not remember specifically” in order to evaluate the positive or negative effects of seeking professional counseling services. Similar to Rob’s tendency to generalize, our subjects’ distant recollections were said to be formative in their perceptions, however accurate they may or may not be. Steve elucidated that this source of common knowledge may be far removed from the true source: “Like second and third hand information about people who have gone to counselors, again television and movies, the joke from the Sunday newspaper, you know.” Perceptions for these students are formulated from a conglomeration of sources, credible or not, evidently even from the comics section of the Sunday newspaper.

While respondents relied heavily on word of mouth, Jordan did speak of the possible flaws in this resource: “I guess from other people talking to them about it. You can’t just know, obviously, but obviously they don’t remember where they’ve heard it from.” While acquaintances and peers may be eager to share their opinions, our subjects evidently often were unable to support their opinions with factual sources. Cathy concurred in stating that common knowledge of counselors is generated by “probably a little bit of what they fill in, what they assume.” Not only are their potential sources emitting their own assumptions, but the respondents fall prey to the same tendency in order to compensate for lack of information. Sandy further clarified, “it may just be, I assume they’re this way, but they really didn’t base that off of anything,” again revealing the flaws in their apt perception formation.

Effects of Common Knowledge
Without doubt, the lack of verifiable validity found in common knowledge about counselors creates powerful effects for the advancement of counseling as a profession. Namely, not only is the reputation of services potentially marred, but respondents also may be less likely to seek out counseling when needed due to their incorrect assumptions and faulty sources. Respondents reported feeling that the media, through movies, magazines or books, too often generates negative connotations with professional counseling images. Rachel noted: “I think that it [media] negatively affects their perception of professional counselors.” When prodded to share more, she continued: “A lot of times in TV and in movies they’re portrayed as odd people so I guess that’s the image that a lot of people have, because going back to their philosophy in the way they conduct their counseling.” Most definitely, “odd” is not a positive connotation to associate with professional counseling. In times of need, respondents likely will not seek out a source they consider to be odd. Larry offered a similar insight in his comment: “Probably that they’re just people who sit there and they try and make you talk to them even though you don’t want to and, I don’t know, probably the same thing that they would be with a psychologist.” This statement is loaded with several faulty assumptions, ubiquitous in other students’ comments. First, respondents tend to believe counselors force their clients to talk about issues when they do not wish to receive counsel, or that their sessions consist more of passive listening, where clients ramble as the counselor nods occasionally and interjects the expected empathetic reflection. Second, this respondent offhandedly equated counselors with psychologists, illuminating the lack of public awareness in deciphering services offered by counselors compared to psychologists.

Students indicated that the connotations afforded by common knowledge sources of professional counselors sometimes are positive and sometimes negative, depending on the source. Molly used media news as a concrete example: “Well, usually if they hear it in the news it will be negative, if the counselor screws up, they’ll hear that, and it might give them a bad image.” She continued that one negative news report could be potent enough to prevent her or others from ever seeking a professional counselor, regardless of the intensity of the personal need. Similarly, Kim thinks that movies could “go either way” and the audience “can either think of a positive image of counselors that they really do help someone, or they can portray them as people who are out of touch with reality and don’t really help the person necessarily.” This phenomenon follows the similar vein relative to the equivocal nature of these sources. Clearly, the common knowledge phenomenon affects the realm of professional counseling by impacting not only expectations of a session on the part of the counselor or the client, but also regarding the tendency to seek professional counseling services.


We believe that due deliberation of our findings are warranted on two levels: macro and micro. On the macro level, professional organizations must become more aggressive in advocating for the profession in media and other “common knowledge sources.” Specifically, we interpret our results as a clarion call to the American Counseling Association (ACA), the American Mental Health Counselors Association (AMHCA), and the National Board for Certified Counselors (NBCC).

In the past decade, how many times has a major motion picture made central references to a Licensed Professional Counselor (LPC)? A systematic assessment in answering this important question is warranted elsewhere. However, the authors of the present article are unaware of a single time when this has occurred. We do recall, of course, main characters visiting psychiatrists, psychologists, social workers, and even marriage & family therapists. But, it is completely unacceptable for Hollywood to ignore licensed professional counselors.

Our findings suggest that movies are powerful sources by which the public come to generate their perceptions of professional counselors. When movies ignore the profession, then it follows that counselors become vulnerable to unhealthy stereotypes, negative perceptions, or simply empty perceptions. The role of professional counseling organizations is to advance the profession—and our data suggests that much more needs to be done in this domain.

To be more specific, every time a major motion picture is released where main characters interact with human service professionals that are not counselors—advocacy must occur. That is, leaders of ACA, AMHCA, NBCC, state counseling organizations, and others need to issue united statements of protest. Media such as the Associated Press need to pick up on these protests, carrying complaints of professional counselors’ lack of Hollywood notice.

To proactively accomplish this, the professional organizations must make permanent connections with producers, directors, writers, and other influential individuals in Hollywood as scripts are generated. Hollywood needs to be aware that if they ignore professional counselors as potential sources of human service provision, then the professional counseling organizations will become active. It should be worth their while to ensure that an apt, positive representation of counselors occurs.

On the micro level, individual counselors must be more active when advertising their services to the public. Specifically, the local media should be utilized to portray positive messages about professional counselors and benefits of service utilization. Local news media frequently look for short stories or opinions from human service professionals on various topics. This particularly is true around holidays or other special occasions—or even traumatic events—when media generate special interest stories. Local television specials can be powerful mediums for perception formation among families and potential clients. Universities with communication arts programs can budget monies for student and/or professionally generated DVDs that highlight and promote professional counselors as quality options during times of personal need.

The same advocacy can occur with school newspapers, web sites, circulars, and other sources of “common knowledge.” Respondents from the present study indicated that media is a powerful source and influences their perceptions. Professional counselors, therefore, should seize this medium—using it to generate reoccurring positive messages.

Respondents also told us that parental opinions, former clients, information from friends, and other word of mouth sources were important in how they came to think of professional counselors. There is little that counselors can do to encourage positive word of mouth advertising for professional counselors. However, they can utilize the media to its fullest.

On both macro and micro levels, we are concerned about professional counselors’ general tendencies towards passivity. That is, counselors presently are at the mercy of how happenstance may occur in clients’ lives to formulate perceptions of counselors. Rather, counselors should architect how they want potential clients to think about them. Draft the message and then market it through public service announcements, movies, the media, and other sources that consumers say are important to their concept formations. In short, be proactive rather than laissez-faire on this important matter.

Limitations and Future Research

We believe the present research study provided an apt representation of the students interviewed. However, as with all qualitative research, external validity is a limitation. That is, while replication is important for quantitative research (Cumming, 2005), qualitative research is particularly context dependent, relying on replication ultimately to prove its generalizability (Firmin, 2006b). In this light, we are limited in our ability to apply the present findings to all students at all universities in the United States or the public in general. Further research should replicate this study, assessing students and potential clients in varying parts of the country. Further, national survey data should be collected—providing more breadth to our present findings—although, of course, breadth and depth acquisitions tend to be methodological tradeoffs.

No minority representation was included in the present sample. Of course they were not deliberately excluded; rather, the general psychology class from which the sample was drawn contained only a few minority students. By random sample chance they were not included. As previously indicated, we used random sampling of the students in the study in order to enhance external validity as much as possible. The university from which the sample was taken contains only a 6% total minority population. Consequently, further research should be conducted in this area, possessing greater numbers of minority students in those samples. Also, replicating the present qualitative study with all minority students would provide an interesting comparison to the present findings from a Caucasian sample.

In sum, we believe that the present study has powerful heuristic value. Researchers should take this concept and develop it much further than what we were able to do in the present design. Assuming that professional counseling is going to develop and flourish in the upcoming decades, then the call we make for proactive advocacy must be heard. Students and the public have perceptions of professional counselors. That simply is a fact of human nature. It behooves the professional counselor leaders as well as individual counselors to craft what they wish those perceptions to be.


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Michael W. Firmin is a Professor at Cedarville University. Richard A. Wantz is a Professor at Wright State University. Ruth L. Firmin and Courtney B. Johnson are doctoral students at Indiana University-Purdue University, Indianapolis. Correspondence can be addressed to Richard A. Wantz, Wright State University, Human Services, 3640 Colonel Glenn Highway, Dayton, OH 45435-0001, rick.wantz@right.edu.

Chaotic Environments and Adult Children of Alcoholics

Martha Nodar

The primary goal of this paper is two-fold: to challenge the belief that adult children of alcoholics tend to abuse alcohol as the result of genetic composition, and to show instead evidence that the unpredictable and chaotic home environment in which alcoholics grow up may be responsible. Adult children of alcoholics syndrome, mood alteration, and family history of alcoholism are explored. Addiction models and treatment plan implications are presented.

Keywords: abuse, addiction, chaos, home environments, alcoholics

According to the National Association for Children of Alcoholics (n.d.), out of the approximately 30 million children of alcoholics in the United States, 11 million are believed to be minors (younger than 18 years old) and the remainder (almost 20 million) are adult children. The term Adult Children of Alcoholics (ACoA) attempts to capture the shared characteristics typically found among those adults who grew up with either one or two alcoholic parents (Jones, Perera-Diltz, Sayers, Laux, & Cochrane, 2007). Alcoholic families are driven by a system of rigidity (arbitrary rules, lack of flexibility) where children develop a sense of chronic shock (Kritsberg, 1985). Kritsberg (1985) refers to chronic shock as an overwhelming fear that is never expressed or resolved, which commonly leads to shutting down. Prevented from expressing their emotions and from learning healthy coping skills in an alcoholic environment, coupled with poor family interaction patterns tend to place ACoAs at a higher risk for alcohol abuse (Woititz, 1984). In a move to augment Woititz’s (1984) findings, this essay reviews the risk for alcohol abuse among ACoAs from a complimentary paradigm: growing up in a chaotic family environment rather than having alcoholic parents may account for the tendency of alcohol abuse among ACoAs.

The ACoA Syndrome

A chaotic environment is fertile ground for the shared characteristics of ACoAs, known as the ACoA syndrome (Kritsberg, 1985). The ACoA syndrome is a developmental phenomenon shared by most if not all ACoAs, which describes “common symptoms and behaviors as the result of their common experience” (Kritsberg, 1985, p. 3). A kaleidoscope of characteristics engulf the syndrome, which is mostly grounded in fear: fear of abandonment, fear of intimacy, fear of change, chronic shock (a persistent state of apprehension), fear of making mistakes, feelings of inadequacy (fear of not being good enough) and poor coping skills (Kritsberg, 1985). Ratey and Johnson (1997) explain that syndromes are a constellation of traits that manifest themselves in a continuum depending on the individual’s psychological development. In other words, not all ACoAs may present all of the traits, but most ACoAs fall somewhere in the spectrum (Kritsberg, 1985; Woititz, 1984). Kritsberg (1985) insists the ACoA syndrome typically develops in response to a very rigid and chaotic family system that may be centered on the alcoholic.

Alcohol: A Mood-Altering Substance

An alcoholic is a person who abuses alcohol despite the consequences to self, finances, and interpersonal relationships. Alcohol is a depressant whose job is to suppress the central nervous system (CNS) while hijacking the brain’s mesolimbic reward system (Dodes, 2002). Encompassing a complex pleasure circuit, the mesolimbic reward system activates the limbic system (the seat of emotion), and at the same time deactivates the prefrontal cortex (the seat of reason) (Dodes, 2002). The dynamics involved in the nerve fibers of the reward pathway are believed to be responsible for the “sensation” or the feelings of euphoria sought by alcoholics (Heitzeg, Nigg, Yau, Zucker, & Zubieta, 2010, p. 287).

Although there may be different models to explain the etiology of substance abuse and addiction, there is a consensus among scholars that alcoholics attempt to alter their moods, such as depression, anxiety, anger, and feelings of inadequacy, through alcohol consumption (Dodes, 2002). Consequences of alcohol abuse are not only evident in the United States, but also are seen in families around the world. European studies focusing on adolescents from Austria, Germany, Czechoslovakia, Russia, Turkey, and Denmark show that “one family member’s substance abuse is often influenced by substance-using behaviors of others in the family” (Grüber, Celan, Golik-Grüber, Agius, & Murphy, 2007, p. 27). While ethnicity does not seem to play a significant role in the propensity toward alcohol abuse, other variables have been found to have an impact (Braitman et al., 2009). For instance, either having two alcoholic parents or having “an alcoholic father” increases the odds of alcohol abuse in both their male and female offspring (Braitman et al., 2009, p. 71).

Family History as a Variable

A longitudinal study that followed participants from 12 years of age to 31 by Warner, White, and Johnson (2007) showed that a combination of both early experimentation with alcohol and a family history of alcoholism are predictors of a “problem-drinking trajectory” (p. 56). Warner et al. reached their arguments based on a number of analyses including the application of Rutgers Alcohol Problem Index (RAPI). The RAPI is a psychometric instrument used to discern how problematic alcohol consumption may be perceived by a population and has received support among scholars. Neal, Fromme, and Corbin (2006) found RAPI to have acceptable validity and reliability and “test-retest correlations between 89 and 92” (p. 402). Warner et al. concluded that age at drinking onset alone is not sufficient to predict a problematic drinking trajectory. Instead, Warner et al. predict those who start drinking at an early age (adolescence) who also have a family history of alcoholism (ACoAs) are at higher risk to abuse alcohol as adults than those who do not have an alcoholic family history (non-ACoAs).

ACoAs vs. Non-ACoAs

Intrigued by the presence of alcohol in the family as a probable variable in the offspring’s alcohol abuse, Jones et al. (2007) led a research study to investigate the differences in alcohol consumption between ACoAs and non-ACoAs. With that in mind, the researchers divided the participants in two groups: those who identified themselves as having grown up with a substance-abuse parent and those who did not. Jones et al. applied the Self-Administered, Stand-Alone Screening Instrument (SASSI-3) to the participants. The SASSI-3 is a questionnaire unrelated to substance abuse. The rationale for asking substance-unrelated questions is an attempt to bypass the tendency of denial often found among those abusing a substance. After analyzing the results, Jones et al. noted no difference in the consumption of alcohol between the ACoA and non-ACoA groups. Jones et al. concluded that the culprit in an alcoholic home may not be so much the substance per se, but “the chaos associated with the substance use that may lead to the ACoA traits” (p. 24). In other words, the chaos and unpredictability experienced in alcoholic families may explain the ACoA syndrome, and the high risk of alcohol abuse among ACoAs (Kritsberg, 1985; Woititz, 1984).

Chaos and Unpredictability

In concert with Jones et al.’s (2007) theory of unpredictability, Ross and Hill (2001) conducted a study where participants from different ethnic and socioeconomic backgrounds were recruited from ongoing studies at the University of Michigan Alcohol Research Center. One group of adult children of alcoholics and one group of adults who had parents who drank moderately during social events were investigated. The researchers’ mission was to isolate unpredictability (lack of consistency) and chaos in the family as variables in developing alcohol abuse in adulthood. In agreement with Jones et al. (2007), Ross and Hill (2001) propose that “the chaotic nature” and the “unpredictability” in the home may be the precursors to alcohol abuse in adulthood (p. 610). Factors such as parental rejection or uninvolvement, abusive discipline and punishment, and systematic broken promises were the underpinnings measured in the unpredictability index (Ross & Hill, 2001).

Ross and Hill (2001) argued that their study revealed “parental unpredictability, rather than parental alcoholism per se, was associated with alcohol misuse . . . and [shows] why all children from alcoholic homes do not have problems with alcohol themselves” (p. 630). These researchers point out that the significance of unpredictability, which they found in homes of adult children of divorce, adult children of economic adversity, and among ACoAs is the factor linking these adult children, which cannot be over-emphasized (Ross & Hill, 2001).

Basing their premise on Bowlby’s (1969) theory of attachment and loss, Ross and McDuff (2008) contend that unpredictability is a derivative of insecure attachment between caregivers and their children. Attachment describes the bond children form with their caregivers. Attachments range in a continuum from secure to insecure (avoidant) depending on the caregiver’s availability and willingness to meet children’s needs (Bowlby, 1969). Insecure attachments are damaging to children because they tend to send implicit and explicit messages that they are not important enough to receive care (Bowlby, 1969). This mindset is unconsciously carried into adulthood, becoming the underpinning of the ACoA syndrome (Kritsberg, 1985).

In an effort to support their argument on unpredictability, Ross and McDuff (2008) administered both Ross and Hill’s (2001) Family Unpredictability Scale (FUS) and Ross and McDuff’s (2008) Retrospective Family Unpredictability Scale (Retro-FUS) to the participants in their study. Retro-FUS is specifically designed for ACoAs, and both FUS and Retro-FUS evaluate the degree of inconsistencies in discipline, nurturance, meals, and general family dysfunction. As a corollary, Hodgins, Maticka-Tyndale, El-Guebaly, and West’s (1993) Children of Alcoholics Screening Test (CAST) also was used to specifically distinguish ACoAs from non-ACoAs in the study. It is worth mentioning that the CAST has received support among the academic community for its accuracy in measuring specific family dynamics in the alcoholic home (Lease & Yanico, 1995). Ross and McDuff (2008) conclude that growing up in an unpredictable environment is an important factor placing the ACoAs at higher risk for abusing alcohol compared with non-ACoAs.

Addiction Models

Among some clinicians the genetic model has gained clamor because of the frequency of alcoholism observed in certain families (Wang et al., 2011). To identify the contributing gene or genes to alcohol dependence, Wang et al. (2011) conducted a study of a small sample of Australian twins and concluded there is no gene or group of genes responsible for the main effect of alcohol dependence, but rather the possibility that an individual with a certain genotype such as monamine oxidase A (MAOA) may have an increased risk for alcohol dependence. However, this increased risk would most likely only occur when those “subjects are exposed to environmental stressors” (Wang et al., 2011, p.1295). Examples of environmental factors may include the individual’s personality, coping strategies, or family system. These researchers conclude by stating that it is unclear how the genetic influence may or may not interfere in alcohol dependence and to what degree.

Also interested in exploring the genetic influence in alcohol abuse, Clarke et al. (2010) analyzed twin studies while conducting their own study. These researchers argue that stress activates certain responses in the brain, such as the locus coeruleus (LC), a structure located in one of the ventricles and sensitive to the activation (by a gene) to produce cortisol during times of stress. Clarke et al.’s argument is based on the notion that this dynamic between the stress and the production of cortisol may drive an individual to alcohol abuse to decrease the activity in LC, supposedly bringing a sense of calm during stressful situations. In other words, the gene activating the LC may be responsible for mediating the effect of alcohol which has been detected in twin studies.

As expected, the genetic model has its critics because they argue it has not yet established a definite or persuasive relationship between genes and alcoholism (Dodes, 2002). In his 1986 article, Peele unveils his concern for the popularity of the genetic model to explain the etiology of alcohol abuse. Peele (1986) argues the data obtained to form the basis of the genetic model for alcoholism do not take into account important variables. These variables may include the unique differences among alcoholics as well as within ACoAs; how the alcohol abuse may unfold in many individuals and how any of these variables may be affected by a family environment that may or may not include a history of alcoholism (Peele, 1986).

Peele (1986) insists there is no evidence that ACoAs inherit a “genetic liability for alcoholism” (p. 63). Peele explains the phenomenon observed in twins from biological alcoholic parents only shows a correlation between having alcoholic parents and abusing alcohol. Additional information about family dynamics where twins grew up, such as divorce, financial instability, or chaos in the family was not included in the research with twins (Clarke et al., 2010; Wang et al., 2011). Peele (1986) emphasized that the genetic model has “dangerous consequences” because it appears to deny the human complexity involved in substance abuse, and because it may prevent counselors from digging deep into the core issues of addiction with their clients (p. 63). Peele is supported by other scholars who believe ACoAs are modeling substance abuse behavior rather than having a genetic composition for alcoholism (Braitman, 2009).

Moreover, Dodes (2002) concedes that although some genes may “influence the susceptibility to developing alcoholism” (p. 81), it is not realistic to believe that one single gene or even a group of genes would have the power to produce one single specific behavior such as alcohol addiction or dependence. Dodes explains that genes are a sequence of DNA (molecules), but DNA not only contains additional information that is non-genetic, but DNA also controls whether genes are activated or not. The non-genetic factors in the DNA may include variables such as individual experiences, coping strategies, family environment and emotions. Even if a genetic predisposition is in place, that predisposition is not likely to materialize without the significant influence of the environment (Dodes, 2002).

In agreement with Peele (1986), Ross and Hill (2001, 2004) and Ross and McDuff (2008) divert from the genetic model, and instead lean toward the psychological models which focus on the learned maladaptive patterns of behavior. Other approaches include neurobiological models which attribute alcohol abuse as the result of the person’s brain functions (Heitzeg et al., 2010). Once the memory circuit makes an association between a substance and pleasure, addicts quickly learn to repeat the process to obtain a relief from their negative feelings such as loss, depression, anxiety and anger (Heitzeg et al., 2010). Some models overlap with each other, but all of them attempt to explain the substance abuse phenomenon.


The evidence presented herewith may carry some important implications for how addiction counselors may want to approach their treatment plan with those suffering from alcohol addiction or dependence. This paper argues that many addiction programs have failed to meet the needs of those suffering from substance abuse because the problem may not be the substance per se, but the consequences of growing up with maladaptive coping strategies that might have served to survive in a chaotic environment, but are no longer efficient. This paper claims that those suffering from addiction are able to continue their addiction likely because they have enablers in their household who are either consciously or unconsciously supporting the addiction. Addiction counselors may wish to consider involving those in the family who may be deriving a secondary gain from the addict’s addictive behavior. Both the person with addictions and the person supporting the addictions may be getting a payoff—a possible distraction to a traumatic childhood experience based on a chaotic environment.


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Martha Nodar is a graduate counseling student at Mercer University in Atlanta, Georgia. Correspondence can be addressed to Martha Nodar, Mercer University, 3056 Anderson Place, Decatur, GA 30033, martha.a.nodar@live.mercer.edu.

A Review of the Literature on Promoting Cultural Competence and Social Justice Agency Among Students and Counselor Trainees: Piecing the Evidence Together to Advance Pedagogy and Research

Amie A. Manis

There is a call for research on how to effectively foster cultural competence and a social justice advocacy orientation among counselor trainees. A multidisciplinary review of the literature reveals a body of anecdotal and empirical evidence in support of the use of pedagogical strategies grounded in critical theory to this end. Critical pedagogy regarding the development of a social justice origination is emphasized. Privilege, oppression, and experiential classroom activities are presented.

Keywords: critical theory, pedagogy, cultural competence, social justice, advocacy

The promotion of multicultural competence is an established professional training standard in industry and higher education (Musil, 1996). As a fourth force phenomenon within the counseling profession, multicultural education is intimately tied to advancing social justice (Arredondo & Perez, 2003) for trainees in the context of their studies (Ratts & Wood, 2011), and through populating our profession with culturally competent counselors. Its value in training has been empirically validated, yet much is left to discover about how to most effectively deliver multicultural education and ensure that counselors are able to engage in ethical and competent counseling and advocacy with diverse populations (Coleman, 2006; Manese, Wu, & Nepomuceno, 2001; Seto, Young, Becker, & Kiselica, 2006; Smith, Constantine, Dunn, Dinehart, & Montoya, 2006).

More recently advocacy competence has been recognized as a distinct professional standard for counselors with the American Counseling Association’s (ACA) endorsement of the Advocacy Competencies (Lewis, Arnold, House, & Toporek, 2002), the recognition of Counselors for Social Justice (CSJ) as a division of ACA, the 2005 ACA Code of Ethics, and the 2009 Council for Accreditation of Counseling and Related Educational Programs (CACREP) standards. As such, there is a growing body of literature with respect to the promotion of advocacy competence among counselor trainees grounded largely in critical theories (Bemak, Chi-Ying Chung, Talleyrand, Jones, & Daquin, 2011; Brubaker, Puig, Reese, & Young, 2010; Constantine, Hage, Kindaichi, & Bryant, 2007; Goodman, Liang, Helms, Latta, Sparks, & Weintraub, 2004; Green, McCollum, & Hays, 2008; Hof, Dinsmore, Barber, Suhr, & Scofield, 2009; Lewis, Arnold, House, & Toporek, 2002; Ratts & Wood, 2011; Steele, 2008; Toporek & Reza, 2001). Naturally, counseling research on the relationship between multicultural counseling competence and advocacy competence (Manis, 2008) and effective training methods for promoting advocacy competence (Hays, Dean, & Chang, 2007; Lewis, Davis, Lenski, Mukhopadhyay, & Taylor Cartwright, 2010; Murray, Pope, & Rowell, 2010; Odegard & Vereen, 2010) is early in its development.

Thus, while echoing the synergistic relationship between multicultural counseling competencies and social justice advocacy, Odegard and Vereen (2010) recently concluded “how counselor educators teach these constructs to students is a mystery” (p. 145). Their conclusion resonated with earlier expressions of this conundrum within and beyond the mental health professions. Palmer (2004) spoke to this challenge, indicating that the question of how to teach the constructs had been pondered and studied across disciplines.

In fact, a multidisciplinary review of the literature on multicultural education, social justice advocacy and critical pedagogy revealed not only a paucity of research on effective training practices in counselor education and supervision (Odegard & Vereen, 2010; Toporek, Lewis, & Crethar, 2009), but also a lack of attention and investment in training for social justice advocacy within counselor education programs (Hays et al., 2007; Nilsson & Schmidt, 2005; Ratts, 2006; Ratts & Wood, 2011). It further provided a pragmatic rationale for infusing attention to culture and social justice throughout program curricula (Brubaker, Puig, Reese, & Young, 2010; Dinsmore & England, 1996; Goodman et al., 2004: Green et al., 2008; Hays et al., 2007; Hill, 2003; Paylo, 2007; Ratts & Wood, 2011; Stadler, Suh, Cobia, Middleton, & Carney, 2006; Sue, Bingham, Porché-Burke, & Vasquez, 1999; Watts, 2004), and empirical evidence that suggested theoretically grounded pedagogies could be twice as effective as ungrounded approaches in delivering multicultural education (Smith et al., 2006). The literature also offered anecdotal and empirical evidence that critical pedagogical strategies are effective in raising the social consciousness of students and fostering social justice advocacy.

An analysis of the existing evidence, along with more recent findings specific to the field of counselor education and supervision offered a compelling case for further exploration of critical pedagogical strategies in training counselors and research on its efficacy. A brief overview of critical theory and pedagogy is presented, followed by a summary of key research findings. This is followed by a discussion of implications for counselor education and supervision practice, as well as future research.

Critical Pedagogy

Critical pedagogy is rooted in the work of Paolo Freire, who developed this approach with the explicit goal of empowering Brazilian peasants to advocate on their own behalf for social justice. Freire (1974) theorized that becoming aware of one’s sociopolitical reality and position through reflection and dialogue, or attaining critical consciousness, would serve as a catalyst for social justice advocacy.

The application of critical pedagogy in multicultural education has been described as “a deep examination, through dialogue with others, of the legitimacy of the social order in terms of access to socioeconomic resources and opportunities” (Sleeter, Torres, & Laughlin, 2004, p. 82), or in other words, social justice (Chang, Crethar, & Ratts, 2010; Fouad, Gerstein, &Toporek, 2006). Decoding is the term designated by Freire (1974) for this process whereby sociopolitical realities become transparent and a sense of empowerment as change agents is possible.

Freire (1974) used the term praxis to refer to social justice advocacy. He was deliberate in specifying that praxis is a manifestation, rather an outcome of critical consciousness. Thus, he emphasized the undeniably catalytic nature of developing critical consciousness, and the inherent charge which accompanies it regardless of one’s social positions of privilege or oppression. Freire also was explicit in observing the inherently value-laden nature of praxis, or social justice advocacy. He explained: “praxis (which can never be limited to mere activity of the consciousness) is never neutral; in the same way, education can never be neutral. Those who talk of neutrality are precisely those who are afraid of losing their right to use neutrality to their own advantage” (p. 132).

Sue, Bingham, Porché-Burke and Vasquez (1999) echoed Freire and elucidated the relationship between multiculturalism and social justice relative to mental health training and practice. They made it plain that multiculturalism, “…is not value neutral [and actually] … stands against beliefs and behaviors that oppress other groups and deny them equal access and opportunity” (p. 1064). Recognizing this valence is critical not only to advancing the practice standards of our profession (Ratts & Wood, 2011), but also to how we understand and frame our role as counselor educators and supervisors. “Our task as teachers is to clarify the complexity of the many overlapping economies of power and to work with our students to build the critical skills necessary to examine their own location in such a system and to find strategies of resistance to it” (Chan & Treacy, 1996, p. 214).

Enns and Forrest (2005) underscored the connection between the emergence of critical pedagogy from human rights movements and its regular use in multicultural education. They described the scope of multicultural education grounded in these theories as extending beyond the classroom and entailing: (a) a critical examination of the construction of knowledge, (b) an exploration of the relationships among diverse people, and (c) the recognition that cultural identities are dynamic and complex. The intuitive fit of critical pedagogy for raising the social consciousness of counselor trainees, as well as its regular employment in multicultural education lends the theory for investigation as an effective theoretical grounding for training culturally and advocacy competent counselors.

Cultivating Critical Consciousness: A Developmental Process

Critical pedagogical approaches reflect an appreciation of the socializing role of seasoned professionals and educators (Cornelius, 1998; Prilleltensky, 1989), the non-traditional and relational nature of the instructor–student relationship, and the developmental nature of the process of consciousness raising and becoming advocates (Ford & Dillard, 1996; Kathleen May, personal communications, 2006; Sleeter et al., 2004). Indeed, Ford and Dillard (1996) described multiculturalism in these terms: “… it is more than just a learning process, it is a socialization process that involves qualitative degrees of self-development” (p. 5). Sleeter et al. (2004) emphasized the importance of scaffolding students in this process of reflection on their own and others’ identities relative to social positions and experiences of privilege and oppression. The theoretical (Bemak et al., 2011; Green et al., 2008; Hof et al., 2009; Rasheed Ali, Ming Liu, Mahmood, & Arguello, 2008; Sleeter et al., 2004) and research literature (Hays et al., 2007; Murray et al., 2010; Nilsson & Schmidt, 2005; Paylo, 2007) has been consistent in the valuing of experiential learning as a means of cultivating social consciousness among students, and affording opportunities to practice and engage in advocacy.

Developing a Social Justice Orientation

Broido (2000) explored how college students from privileged positions actively engaged in advocacy for social justice understood their own development as advocates. Her findings initially suggested students’ willingness and ability to act as social justice allies developed through having increased information on social justice issues. She reported: “participants gained an overwhelming share of their knowledge of social justice issues from their experiences in the classroom” (p. 9).

The second critical factor in students’ willingness and ability to act as social justice allies was engagement in a dialectical meaning-making process. Broido (2000) concluded that it was “through reflection, discussion, and perspective taking, [that] the participants developed clarity regarding­­—and confidence in—their own position on social justice issues” (p. 10). The third finding pointed to the impact of self-confidence on the participants’ willingness to reflect on the role of privilege in their success.

These findings pointed to the potential importance of introducing material on social justice in counseling instruction. They also demonstrated the value of specific critical pedagogical practices, namely reflection, dialogue and decoding in the participants’ development of critical consciousness and change agency. Finally, they underscored self-confidence as a student quality that supported a critical examination of their own privileged positions.

Exploring Dynamics of Privilege and Oppression

Exploring dynamics of privilege and oppression is at the heart of critical pedagogy. A critical examination of one’s own social positions, as well as those of others, is considered integral to developing critical consciousness and social change agency. The findings of Chizhik and Chizhik (2002) highlighted the need for faculty to attend to student meaning with respect to dynamics of privilege and oppression.

Chizhik and Chizhik (2002) investigated middle class college students’ conceptions of privilege and oppression. They emphasized the importance for instructors of understanding students’ meaning-making with respect to those dynamics as a means of preparing to effectively guide them. They stated: “Knowing students’ preconceived notions about these terms should help instructors ‘scaffold students’ learning to a more multicultural and social justice orientation (if one does not already exist)” (p. 794).

Chizhik and Chizhik (2002) observed that both privileged and oppressed students as defined in terms of racial identity failed to understand these phenomena in systemic terms. They found that, “White students were more likely to blame oppression on internal factors [and believed that] the oppressed are and should be responsible for helping themselves” (p. 805). They also found that students of color were more likely to attribute privilege to factors external to the individual, but not to systemic factors. Furthermore, they found that students of color viewed “social change as a collective act rather than an individual act” (p. 805).

Chizhik and Chizhik (2002) identified the “lack of connection between privilege and oppression…[as] perhaps, the greatest challenge in multicultural discourse” (p. 806). They further suggested: “Understanding the compensatory relationship between privilege and oppression may be an important first step leading to an obligatory call for action through understanding one’s responsibility to act for social justice” (p. 806). Their findings underscored the need for exploration and collective meaning-making of the dynamics of privilege and oppression with students. They also suggested the relevance of this process for all students (Hays, 2008; Lark & Paul, 1998; Rooney, Flores, & Mercier, 1998). And finally, the findings have implications for helping students to resolve resistance to multicultural education and social justice advocacy.

Scaffolding the Development of Critical Consciousness

The challenging and potentially painful nature of decoding raises the importance of scaffolding students as they engage in reflection and dialogue. Broido’s (2000) findings pointed to the significance of confidence to the willingness and success of students of privileged social positions in decoding their experiences. The findings presented by Chizhik and Chizhik (2002) suggested the importance of attending to students’ preconceived ideas about privilege and oppression, and pointed to possible sources of resistance to engaging in open and active exploration of dynamics of privilege and oppression.

Clearly decoding requires unusual vulnerability within the classroom for both students and instructors (Garcia & Van Soest, 1997; Lark & Paul, 1998; Locke & Kiselica, 1999). Chan and Treacy (1996) captured the heart of the challenge more fully. They observed:
Any serious examination of a system of domination that usually cloaks its relationships of power makes many people uncomfortable; these are topics that are often skirted around. Moreover, this approach asks participants in the inquiry (students and teachers alike) to acknowledge [their] lack of knowledge, to examine what [they] do not know about [their] histories, [their] political and legal systems, [their] education, and the contexts in which [they] seek to understand [their] experiences. As we teach and learn about these power relationships, the world looks different and we take a different place in it; we are at least temporarily decentered from our usual normative self (p. 214).

Garcia and Van Soest (1997) conducted an exploratory study of master’s-level social work students engaged in a required course on diversity, particularly how their understanding of privilege and oppression changed over the course. Course objectives centered on familiarizing students with dynamics of social power, oppression, privilege and empowerment. A key pedagogical strategy was paying “considerable attention…to helping students assimilate information that challenged their world views, self-image, and professional self-concepts” (p. 122).

Their findings indicated that the majority of students’ in the course experienced increased social consciousness at the end of the course (Garcia & Van Soest, 1997). Changes reported by the White/non-Jewish students included increased awareness of privilege, increased understanding of the dynamics of oppression, increased hope and the identification of an action plan. Changes reported by the multiethnic students in the class also fell into the three areas of change reported by the White/non-Jewish students. Their changes were reported in terms of increased understanding “of their own oppression” (p. 125). One African-American student reflected: “This course has opened my eyes… It is easy for me to see how different rules can be racist, whereas in the past, I believed they were fair…I have become increasingly aware of how I am treated” (pp.125–126). In addition, among the reports of the students of color were increases in self-confidence, reflection and awareness of the oppression of other groups, as well as positive plans for change. These findings further supported the value and importance of scaffolding students in decoding dynamics of privilege and oppression for all students, and in this case for students in the mental health field.

The relevance of attending to dynamics of privilege and oppression in counselor education and supervision is further underscored by research within the field on social justice advocacy. Hays et al. (2007) conducted a qualitative study of counselors’ perceptions regarding how privilege and oppression were addressed in their training, and how these phenomena impacted counseling relationships. Their findings pointed to inadequate training in multicultural and advocacy competence, and a lack of attention to social justice advocacy specifically around the phenomena of privilege and oppression.

Experiential Activities: Moving Beyond the Classroom

Based on their findings Hays et al. (2007) proposed strategies to address the training deficits identified by counselors in practice. These resonated with critical pedagogy, and included: (a) addressing social justice advocacy in instruction, (b) attending to counselor self-efficacy as related to cultural and advocacy competence, (c) exploring the systemic nature of oppression in the context of case conceptualization, and (d) building from strategies used to enhance cultural competence such as guest speakers and experiential activities.

Nilsson and Schmidt (2005), among others (Ratts, 2006), also observed a deficiency in counselor training. They pointed out that while social justice advocacy has been emphasized in the literature, “this value appears not to have filtered through graduate training programs to its trainees” (p. 277). They further reported “little evidence that educators encourage students to act individually or in groups to produce social change” (p. 277).

Their findings pointed to a desire to advocate and political interest as two factors that may lead to advocacy and indicated a need for further research on differences in this regard between students of oppressed or privileged social statuses (Nilsson & Schmidt, 2005, p. 275). Nilsson and Schmidt (2005) arrived at conclusions with respect to counselor training that were similar to those of Hays et al. (2007). Specifically they noted: “counselors’ concern for others needs to be guided beyond the individual level and extended to societal and political levels” (p. 276). They also proposed incorporation of pedagogical strategies resonating with critical theory. These included engaging students in dialogue around political and social issues, exposing students to culturally diverse peers and individuals, providing opportunities for campus or community outreach, and teaching advocacy skills.

Paylo’s (2007) study of the characteristics of counselors who advocate also led to similar conclusions and recommendations. Paylo found that counselors who consider advocacy important are more likely to act as advocates. He stressed: “… it is imperative for counselor educators to infuse the importance of advocacy throughout the curriculum. They may not be able to directly affect counselors-in-training’s actual advocacy behaviors but by instilling the importance of advocacy, they may increase advocacy behaviors indirectly” (p. 134). He went on to suggest hands-on, relationally-oriented strategies such as bringing in guest speakers, infusing advocacy concepts within field and coursework, and service projects.

The literature provided both anecdotal and empirical support for service learning across disciplines as a strategy for promoting critical consciousness and social justice agency among students. McAllister and Irvine (2000) offered empirical support that “providing opportunities for students to interact with individuals from other ethnic backgrounds in authentic cultural settings” (p. 20) enhances the multicultural learning process. Beilke (2005) proposed community service as an effective intervention in facilitating the development of critical consciousness in pre-service teachers. She asserted that the “first task of developing a critical multicultural perspective is to see oneself more objectively by ‘unpacking’ power, privilege, and racial identity” (p. 3).

Research within counselor education also supported the practice of service learning as effective (Arthur & Achenbach, 2002), particularly immersion experiences or those involving direct contact with diverse individuals and communities (Burnett, Hamel, & Long, 2004; Coleman, 2006; Díaz-Lázaro & Cohen, 2001; Dickson & Jepsen, 2007).

Piecing the Evidence Together: Implications for Counselor Training and Research

Theory and research across the humanities addressing multicultural education, advocacy and social justice supported the developmental and process oriented nature of developing critical consciousness. It also provided compelling evidence to guide the use and further investigation of critical pedagogical strategies within the field of counselor education and supervision as a means of training counselors who are culturally competent and prepared to act as advocates for social justice. Key themes among the findings were the value of: (a) introducing social justice material in coursework, (b) incorporating examination, dialogue and reflection with respect to dynamics of privilege and oppression in society, (c) scaffolding all students in their meaning-making of the dynamics of privilege and oppression in their own experiences regardless of their identities and relative social positions, and (d) providing opportunities for experiential activities beyond the individual client level and classroom.


Consonant with the developmental nature of counselor training and the research findings discussed relative to critical pedagogy, the more recent literature in the fields of counseling and psychology promoted critical theoretical approaches (Brubaker et al., 2010), models (Green et al., 2008) and training strategies (Bemak et al., 2011; Hof et al., 2009; Rasheed Ali et al., 2008). These recommendations pointed to the value of pedagogies that: (a) incorporate a tone of equality, de-ideologize dominant paradigms and incorporate experiential training (Brubaker et al., 2010); (b) recognize the link between social justice advocacy and professional advocacy (Hof et al., 2009); and (c) address the domains of awareness, knowledge and skill in infusing social justice advocacy throughout curricula (Green et al., 2008). Green et al. (2008) proposed an advocacy counseling paradigm that builds from awareness of injustice, to knowledge to empowerment of self and others, up to skills to perform and teach to others. Their model is consistent with the guidance offered by Rasheed Ali, Ming Liu, Mahmood, and Arguello (2008), who advised: “Before the actual practical training of social justice begins, it is equally important for students to understand the meaning and implications of social justice as a theory as well as implementing theory to practice” (p. 3).

In their reflections on infusing social justice advocacy, Bemak et al. (2011) provided a number of suggestions. These included beginning with the faculty and engaging in collective meaning-making about social justice and how it applies across courses and content. They went on to address the relevance of personal experiences of students with respect to their worldview and their identities as counselors, and emphasized the need to explore the challenges of social justice work with students. They recommended utilizing real life situations and news in role plays and further suggested service learning as an important component of hands-on training.

Experiential learning, particularly in terms of service learning was a consistent recommendation in the most current literature. Murray et al. (2010) pointed out that experiential learning is already an essential component of counselor training through fieldwork. In addition to affording students the opportunity to apply gains in awareness, knowledge and skills, they asserted that service learning also encourages civic commitment. Rasheed Ali et al. (2008) described a homeless shelter practicum as an apt example of a practicum experience that reaches an underserved population and that could include attention to public policy initiatives. Ali emphasized the need for sensitivity and care in assessing community needs, placing students, and evaluating the impact of service learning projects when developing fieldwork opportunities for counselor trainees where they will have an opportunity to confront social injustices and engage in advocacy at the client, community and public policy levels.


Falender and Shafranske (2004) offered a clear description of diversity competent supervision as a process that not only promotes social justice, but also is in essence a social justice intervention. They asserted that diversity-competent supervision:
includes incorporation of self-awareness by both supervisor and supervisee and is an interactive process of the client or family, supervisee-therapist, and supervisor, using all of their diversity factors. It entails awareness, knowledge, and appreciation of the interaction among the client’s, supervisee-therapist’s, and supervisor’s assumptions, values, biases, expectations, and worldviews; integration and practice of appropriate, relevant, and sensitive assessment and intervention strategies and skills; and consideration of the larger milieu of history, society, and sociopolitical variables (p. 125).

Their conceptualization of the infusion of diversity and social justice within the supervisory relationship and the supervision process is in alignment with the critical pedagogical recommendations of Brubaker et al. (2010) for the infusion of advocacy in counselor training, as well as the recommendations of Glosoff and Durham (2010) for incorporating social justice advocacy in supervision. In short, their recommendations centered on calling supervisee attention to the continuum along which advocacy may occur, encouraging supervisee examination of their own place on the continuum, and scaffolding supervisee development of critical consciousness through reflective questioning, supervisor self-disclosure, and the incorporation of self-assessment and explicit examination of the counseling process in terms of dynamics of privilege and oppression.


Since research on social justice advocacy in counselor education and supervision is so young, the possibilities for investigation appear limitless. First, establishing a clear understanding of the state of social justice advocacy training in counselor education and supervision programs is needed. Surveying current practices would not only shed light on how the field has embraced the charge to train counselors who are competent advocates, but also would provide perspective on the range of practices currently in use. This would include investigation of (a) strategies for promoting advocacy competence currently employed in counselor education and supervision programs overall, (b) theoretical approaches to counselor training for social justice advocacy, (c) exploring the efficacy of standalone courses on cultural competence and/or advocacy as compared to infusion of training throughout a curriculum, and (d) the state and practice of social justice within counselor education and supervision programs.

Further qualitative inquiry into the training experiences of counselor trainees and counselors would lend an important perspective to the knowledge base. Immediate foci may include desires for training, reflections on the process of developing critical consciousness and committing to social justice advocacy, critical incidents in training, and social justice needs within counselor education. Similarly, qualitative investigation of the experiences of counselor educators and supervisors who are charged with implementing training initiatives would bring additional perspective to the challenges and opportunities inherent in this endeavor. In addition, qualitative investigations of the clients and communities with whom service-learning initiatives are planned or conducted could be useful in assessing not only needs but also the impact of such projects and advocacy initiatives (Murray et al., 2010; Rasheed Ali et al., 2008).

Examination of the relationship between multicultural counseling competence and advocacy competence also is indicated as an area in need of exploration. Understanding this relationship could lead to economies in programming and more effective facilitation of student development, as suggested by current practices and understanding of the synergistic relationship between the two competencies (Hays et al., 2007; Manis 2008). In addition, further investigation into how best to assess competence in both areas of practice would be useful (Smith et al., 2006).

Finally, experimental research that assesses the efficacy of critically grounded pedagogical strategies in short- and long-term approaches would be helpful in assessing its ongoing utility in counselor education and supervision curricula, and in considering the question of efficacy of stand alone versus infusion approaches (Manis, 2008). This could be limited to specific strategies such as examination of dynamics of privilege and oppression, or expanded to testing full models or approaches as presented in the literature. And while there is promising evidence of the efficacy of critically grounded approaches for counselor education and supervision, this does not rule out the potential utility of investigating the efficacy of approaches grounded in other theories (Smith et al., 2006).


A review of the literature pointed to an appreciation of critical theories in grounding training for competent social justice advocacy. These approaches call upon counselor educators to attend to social justice across the curriculum and remain alert to their role in socializing counselor trainees as advocates. They also emphasize the importance of attending to the individual meaning-making of counselor trainees with respect to culture and dynamics of privilege and oppression. Lastly, they underscore the developmental nature of developing critical consciousness and the need to incorporate strategies that both instruct counselor trainees, and allow them to apply concepts in the field.

Adopting a critical pedagogical approach demands a high degree of investment from faculty and trainees. Counselor education and supervision practices are inherently reflective and experiential, and thus consonant with critical pedagogies. Critical approaches offer tremendous potential for enhancing the process and content of existing counselor education and supervision curricula so as to better meet the training needs of diverse students and ultimately the clients and communities they will serve.

The time to delve more deeply into transformational practices in our field is now (Ratts & Wood, 2011). It has been five years since Smith et al. (2006) heralded the end of the debate on multicultural education, validated its value in training and called for research to examine the efficacy of theoretically grounded pedagogical interventions in multicultural education. A review of the literature points to the efficacy of critical theory in social justice pedagogy. This offers a sound basis for incorporating critical pedagogical strategies now, while collective efforts to fully investigate the effectiveness of critical pedagogy are undertaken to advance the most efficacious training within the field of counselor education and supervision.


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Amie A. Manis, NCC, is a Core Faculty member in Counselor Education and Supervision at Capella University. The author acknowledges the contributions of colleagues at the University of Virginia, including Dr. Kathleen May, Dr. Sandra Lopez-Baez and Dr. Matthew J. Paylo in the development of this paper. Correspondence can be addressed to Amie A. Manis, 255 Forge Road, Lexington, VA 24450, amie.manis@capella.edu.