Research on International Counseling Students in Selected Counseling Journals: A 16-Year Content Analysis

Byeolbee Um, Lindsay Woodbridge, Susannah M. Wood

This content analysis examined articles on international counseling students published in selected counseling journals between 2006 and 2021. Results of this study provide an overview of 18 articles, including publication trends, methodological designs, and content areas. We identified three major themes from multiple categories, including professional practices and development, diverse challenges, and personal and social resources. Implications for counseling researchers and counselor education programs to increase understanding and support for international counseling students are provided.

Keywords: international counseling students, counseling journals, content analysis, publication trends, counseling researchers

International counseling students (ICSs) can be defined as individuals from outside the United States who seek professional training by enrolling in counselor education programs in the United States. After graduation, they often keep contributing to the counseling field as professional counselors or counselor educators, either in the United States or their home countries (Behl et al., 2017). In 2021, non-resident international students accounted for 1.02% of master’s students and 3.81% of doctoral students in counseling programs accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2022). However, because these percentages do not include international students who have resident alien status in the United States (Karaman et al., 2018), the actual numbers of international students in counseling programs may be higher. Despite the underestimated number of ICSs in CACREP-accredited programs, Ng (2006) found that at least one international student was enrolled in 41% of CACREP-accredited programs, which suggested that many counselor education programs already had some degree of global cultural diversity. Considering that the number of ICSs in the United States has risen within a few decades (CACREP, 2022; Ng, 2006), additional research is needed on this population and how best to prepare them for professional practice.

 Research on International Students in Counseling Programs
     While in training, ICSs, like domestic students, experience pressure to perform across academic, practical, and personal contexts (Thompson et al., 2011). However, ICSs face the additional challenges of adapting to a new culture and practicing counseling in that culture (Ju et al., 2020; Kuo et al., 2021; Ng & Smith, 2009). These challenges stem from having varying levels of experience using English in an academic context, adapting to new sociocultural and interpersonal patterns, and navigating key clinical factors of counselor education such as supervision and therapeutic relationships (Jang et al., 2014; C. Li et al., 2018; Y. Mori et al., 2009). Researchers have found that ICSs perceive more barriers and concerns regarding their training, such as academic problems and role ambiguity in supervision (Akkurt et al., 2018; Ng & Smith, 2009).

Regarding the experiences of ICSs, researchers have paid scholarly attention to the concept of acculturation, which is the assimilation process an individual experiences in response to the psychological, social, and cultural forces they are exposed to in a new dominant culture (C. Li et al., 2018; Ng & Smith, 2012). According to counseling studies, ICSs’ levels of acculturation and acculturative stress were associated with several variables related to their professional development, including counseling self-efficacy, language anxiety, and diverse academic and life needs (Behl et al., 2017; Interiano-Shiverdecker et al., 2019; C. Li et al., 2018). For example, Interiano-Shiverdecker et al. (2019) found that two domains of acculturation—ethnic identity and individualistic values—were positively associated with counseling self-efficacy for international counseling master’s students. Researchers have also uncovered the potential issues ICSs can experience related to a lack of acculturation: Behl et al. (2017) found that students’ acculturative stress was positively associated with their academic, social, cultural, and language needs.

With goals of uncovering effective coping strategies and identifying characteristics of high-quality training environments, researchers have investigated the personal and academic experiences of ICSs (Lau & Ng, 2012; Nilsson & Wang, 2008; Park et al., 2017; Woo et al., 2015). Woo and colleagues (2015) identified several coping tools of ICSs. These tools included self-directed strategies such as engaging in reflection and keeping up with the latest literature, support from mentors, and networking among international students and graduates (Woo et al., 2015). Researchers have attended to strategies that support ICSs’ development of cultural competence and commitment to social justice (Delgado-Romero & Wu, 2010; Karaman et al., 2018; Ng & Smith, 2012). For example, Delgado-Romero and Wu (2010) piloted a social justice group intervention with six Asian ICS participants and found the intervention to be a useful way to empower students and enhance their critical consciousness about inequity.

Supervision has been another area of focus in ICS research. Through interviews and surveys of ICSs, researchers have identified supervision strategies that support ICSs’ developing cultural competence, professional development, and self-efficacy (Mori et al., 2009; Ng & Smith, 2012; Park et al., 2017). A shared theme across these studies is the importance of clear communication. Findings of two studies (Mori et al., 2009; Ng & Smith, 2012) support supervisors engaging ICS supervisees in communication about critical topics such as cultural differences and the purpose and expectations of supervision. Based on a consensual qualitative analysis of interviews with 10 ICS participants, Park et al. (2017) recommended that programs and supervisors make sure to share basic information about systems of counseling, health care, and social welfare in the United States.

Necessity of ICS Research
     Across academic units, there has been a growing attention to international graduate students (Anandavalli et al., 2021; Vakkai et al., 2020). Given the increasing representation of international students in counseling programs, researchers have called for academic and practical strategies to support ICSs’ success in training (Lertora & Croffie, 2020; Woo et al., 2015). These calls are aligned with the values of professional counseling organizations. Specifically, the American Counseling Association (ACA; 2014) endorsed respect for diversity and multiculturalism as elements of counselor competence. This value is reflected in the ACA Code of Ethics, including Standard F.11.b, which urges counselor educators to value a diverse student body in counseling programs. Similarly, the CACREP standards have identified counseling programs as responsible for working to include “a diverse group of students and to create and support an inclusive learning community” (CACREP, 2015, p. 6). Because counselors must have a profound comprehension of and commitment to diversity, experiences with multiculturalism during professional training programs are essential (O’Hara et al., 2021; Ratts et al., 2016). In this vein, the presence of international students in counseling programs can be beneficial for both domestic and international students by enhancing trainees’ understanding of diversity and multicultural counseling competencies (Behl et al., 2017; Luo & Jamieson-Drake, 2013). Given that there is a substantially increasing need for addressing multiculturalism, diversity, and social justice in the counseling profession, counseling programs’ efforts to recruit various minority student groups, including ICSs, will contribute to not only counselor training but also client outcomes in the long term.

However, despite the importance of the topic, researchers have consistently indicated that research on ICSs has been quite limited (Behl et al., 2017; Lau et al., 2019). In counseling research, there is a history of researchers using content analysis to provide a comprehensive overview of topics that are underrepresented but have growing importance. For example, Singh and Shelton (2011) published a content analysis of qualitative research related to counseling lesbian, gay, bisexual, transgender, and queer clients. Involving the summarization of findings from a body of literature into a few key categories or content areas (Stemler, 2001), content analysis is a useful methodology for expanding the field’s knowledge and understanding of the topic. Considering ICSs’ unique challenges and their potential contributions to enriching diversity in counseling programs and in the profession (Park et al., 2017), a comprehensive understanding of the current ICS literature is needed. This content analysis can identify how the research on ICSs has progressed and what remains unexplored or underexplored, which can provide meaningful implications for researchers interested in conducting ICS research in the future.

Purpose of the Study
     The purpose of this study is to identify major findings in literature recently published on ICSs in the United States and to draw useful implications for counseling researchers and counseling programs seeking to better understand and support international students in counseling programs. Our content analysis, which focused on ICS research published between 2006 and 2021 in selected counseling journals, was driven by the following research questions: 1) What are the publication trends in ICS research, such as prevalence, publication outlets, authorship, methodological design, and sample size and characteristics?; and 2) What is the content of the ICS research published in counseling journals? Based on the findings, this study aimed to suggest recommendations for counseling researchers to fill the scholarly gap in ICS research and for counselor education programs to provide more effective training experiences to their international trainees.

Method

     Content analysis is a useful methodology to expand our knowledge and understanding of the field through an overview of the current literature (Stemler, 2001). This approach makes it possible to effectively summarize a large amount of data using a few categories or content areas. In counseling research, content analysis has been used to provide an overview of a profession that is underrepresented but with growing importance (e.g., LGBTQ; Singh & Shelton, 2011), which is aligned with the aim of this study. This study employed both quantitative and qualitative content analysis to provide an overview of ICS research. Quantitative content analysis refers to analyzing the data in mathematical ways and applying predetermined categories that do not derive from the data (Forman & Damschroder, 2007). After reviewing existing content analysis articles in the counseling field, Byeolbee Um and Susannah M. Wood determined the scope of our quantitative analysis as: (a) journal and authorship, (b) research design, (c) participant characteristics, and (d) data collection methods.

Research Team
     The research team consisted of two doctoral candidates and one full professor, all of whom were affiliated with the same CACREP-accredited counselor education and supervision program at a Midwestern university. Um and Lindsay Woodbridge were doctoral candidates in counselor education and supervision when conducting this research project and are currently counselor educators. Um is an international scholar from an East Asian country. She has drawn on her experiences in quantitative and qualitative courses and research projects to engage in research of marginalized counseling students, including ICSs. Woodbridge is a domestic scholar who has taken classes and collaborated with international student peers and worked with international students in instructional and clinical capacities. She has taken quantitative and qualitative research courses and completed several research projects. The first and second authors met regularly to establish the scope of the investigation, collect data, and form a consensus on coding emerging categories and sorting them into themes. Wood, an experienced researcher and instructor, has worked as a counselor educator for more than 15 years. She has worked with international students in teaching, supervision, advising, and mentoring capacities. She audited the research process, reviewed emergent categories and themes, and provided constructive feedback at each phase of the study.

Data Collection
     To identify a full list of ICS studies that satisfy the scope of this study, Um and Woodbridge independently performed electronic searches using research databases including EBSCO, PsycINFO, and ERIC. Because ICSs have attracted scholarly attention relatively recently and because Ng’s (2006) study that estimated the number of ICSs in CACREP-accredited programs was the first published research on ICSs in counselor education programs, we set 2006 as the initial year of our search. We used the following search criteria to identify candidate articles: (a) published between 2006 and 2021 in ACA division, branch, and state journals and major journals under the auspices of professional counseling organizations; (b) containing one or more of the following keywords: international students, international counseling students, international counseling trainees, international counseling programs, counselor education; and (c) involving original empirical findings from ICSs in the United States.

We conducted an extensive search of ICS research across various journals in the counselor education field and identified ICS articles from several ACA-related journals, including Counselor Education and Supervision (CES), Journal of Multicultural Counseling and Development (JMCD), The Journal of Counselor Preparation and Supervision (JCPS), The Journal for Specialists in Group Work (JSGW), and the Journal of Professional Counseling: Practice, Theory & Research (JPC). Additionally, we found ICS articles from the International Journal for the Advancement of Counselling (IJAC) and the Journal of Counselor Leadership and Advocacy (JCLA), which are associated with the International Association for Counselling and Chi Sigma Iota, respectively. Although they are not under the broader umbrella of ACA, these journals have contributed to enriching scholarship in the counseling field.

After the initial searches, Um and Woodbridge made a preliminary list of the articles identified based on the search results. Subsequently, they re-screened the articles independently. Among the 27 identified articles, we excluded five conceptual papers, three articles that examined counselors’ or counselor educators’ experiences after graduation, and one article about ICSs in Turkey. Consequently, the final data consisted of 18 articles published by seven selected counseling journals.

Data Analysis
     The research team analyzed content areas of the ICS research as an extension of qualitative content analysis, which requires performing the systematical coding and identifying categories/themes (Cho & Lee, 2014). We followed a series of steps suggested by Downe-Wamboldt (1992), which included selecting the unit of analysis, developing and modifying categories, and coding data. Several methods were used to ensure the trustworthiness of this content analysis study (Kyngäs et al., 2020). For credibility, Um and Woodbridge conducted multiple rounds of review on determining an adequate unit of analysis and tracked all discussions and modifications in great detail. For dependability, we calculated interrater reliability coefficients and Wood provided feedback about the results. Um also secured confirmability by utilizing audit trails, which described the specific steps and reflections of the project. Finally, to support transferability, we carefully examined other content analysis articles, reflected core aspects in the current study, and depicted the research process transparently.

Coding Protocol
     After completing the quantitative content analysis, we conducted the qualitative content analysis as Downe-Wamboldt (1992) suggested. In so doing, we applied the inductive category development process suggested by Mayring (2000), which features a systematic categorization process of identifying tentative categories, coding units, and extracting themes from established categories. Specifically, after discussing the research question and levels of abstraction for categories, Um and Woodbridge determined the preliminary categories based on the text of the 18 ICS articles. We practiced coding the data using two articles and then performed independent coding of the remaining articles. Using a constructivist approach, we agreed to add additional categories as needed. Subsequently, the categories were revised until we reached a consensus. In the final step, established categories were sorted into three themes to identify the latent meaning of qualitative materials (Cho & Lee, 2014; Forman & Damschroder, 2007). Regarding validity, the congruence between existing conceptual themes and results of data coding secures external validity, which is regarded as the purpose of content analysis (Downe-Wamboldt, 1992).

Interrater Reliability
     We used various indices of interrater reliability to assess the overall congruence between the researchers who performed the qualitative analysis and ensure trustworthiness. In this study, we used the kappa statistic (κ) suggested by Cohen (1960), which shows the extent of consensus among raters for selecting an article or coding texts (Stemler, 2001). Cohen’s kappa has been used extensively across various academic fields to measure the degree of agreement between raters. More specifically, the kappa statistic was calculated in two phases: 1) after screening articles and 2) after coding the texts according to the categories. The kappa results between Um and Woodbridge were .68 for screening articles and .71 for coding the text, both of which are considered substantial (.61–.80; Stemler, 2004).

Results

Results of Quantitative Content Analysis
     Based on our electronic search, we identified a total of 18 ICS articles published between 2006 and 2021 in seven selected counseling journals, including three ACA division journals, one ACA state-branch journal, one ACES regional journal, and two journals from professional counseling associations (see Table 1). Specifically, two articles were published in CES, three in JMCD, one in JCPS, one in JSGW, three in JPC, seven in IJAC, and one in JCLA. Across the 18 ICS articles, a total of 35 researchers were identified as authors or co-authors with six authoring more than one article. According to researchers’ positionality statements in qualitative articles, eight researchers reported that they were previous or current ICSs in the United States. The institutional affiliations of researchers include 22 U.S. universities and two international universities, with three institutional affiliations appearing more than once across the studies.

Table 1
Summary of International Counseling Student Research in Selected Counseling Journals Between 2006 and 2021

Journal and Author	Research Design	Participants	Data Collection	Topic
Counselor Education and Supervision (CES)
Behl et al. (2017)	Quantitative (Pearson product-moment correlations)	38 counseling master’s and doctoral students	Online survey	Stress related to acculturation and students’ language, academic, social, and cultural needs
D. Li & Liu (2020)	Qualitative (Phenomenology)	11 doctoral students	Semi-structured interview	ICSs’ experiences with teaching preparation
Journal of Multicultural Counseling and Development (JMCD)
Kuo et al. (2021)	Qualitative (Consensual qualitative research)	13 doctoral students	Semi-structured interview	ICSs’ professional identity development influenced by their multicultural identity and experience
Nilsson & Dodds (2006)	Quantitative (Exploratory factor analysis, ANOVA, and hierarchical multiple regression analysis)	115 master’s and doctoral students in counseling and psychology	Online survey	Development of a scale to measure issues in supervision
Woo et al. (2015)	Qualitative (Consensual qualitative research)	8 counselor education doctoral students	Semi-structured interview	Coping strategies used during training in supervision
The Journal of Counselor Preparation and Supervision (JCPS)
Park et al. (2017)	Qualitative (Consensual qualitative research)	10 counseling master’s and doctoral students	Semi-structured interview	Practicum and internship experiences of ICSs
The Journal for Specialists in Group Work (JSGW)
Delgado-Romero & Wu (2010)	Qualitative (Not identified)	6 Asian counseling graduate students	Counseling practice	Social justice–focused group intervention
Journal of Professional Counseling: Practice, Theory & Research (JPC)
Interiano- Shiverdecker et al. (2019)	Quantitative (Hierarchical multiple regression analysis)	94 counseling master’s and doctoral students	Online survey	Relationship between acculturation and self-efficacy
Ng (2006)	Quantitative (Descriptive analysis)	96 CACREP-accredited counseling programs	Responses via email/telephone	Enrollment in CACREP-accredited programs
Sangganjanavanich & Black (2009)	Qualitative (Phenomenology)	4 master’s students and 1 doctoral student in counseling	Semi-structured interview	Perceptions of supervision
International Journal for the Advancement of Counselling (IJAC)
Akkurt et al. (2018)	Quantitative (Moderation analysis)	71 counseling master’s and doctoral students	Online survey	Relationships between acculturation, counselor self-efficacy, supervisory working alliance, and role ambiguity moderated by frequency of multicultural discussion
Interiano & Lim (2018)	Qualitative (Interpretive phenomenology)	8 foreign-born doctoral students	Semi-structured interview	Influence of acculturation on ICSs’ professional development
Lertora & Croffie (2020)	Qualitative (Phenomenology)	6 counseling master’s students	Demographics survey, focus group, and semi-structured interview	Lived experiences of master’s-level ICSs in counseling program, including challenges and support, cultural differences, and future career paths
C. Li et al. (2018)	Quantitative (Linear regression analysis)	72 counseling master’s and doctoral students	Online survey	Influence of acculturation and foreign language anxiety on ICSs’ counseling self-efficacy
Ng & Smith (2009)	Quantitative (F-tests)	56 international counseling students 82 domestic counseling students	Survey	Perceived barriers and concerns of ICSs in their training compared to domestic counseling students
Ng & Smith (2012)	Quantitative (Hierarchical regression analysis)	71 counseling master’s and doctoral students	Online survey	Relationships among ICSs’ training level, acculturation, counselor self-efficacy, supervisory working alliance, role ambiguity, and multicultural discussion
Smith & Ng (2009)	Mixed methods (Descriptive analysis, constant comparative method of analysis, and phenomenology)	11 master’s students and 10 doctoral students (including 7 recent graduates)	Online survey	ICSs’ experiences, resources, hindrances, and recommendations regarding multicultural counseling training
Journal of Counselor Leadership and Advocacy (JCLA)
Kuo et al. (2018)	Qualitative (Consensual qualitative research)	13 doctoral students	Semi-structured interview	ICSs’ professional identity development influenced by their multicultural identity and experience

Note. ICS = international counseling student.

In terms of research design, eight articles employed quantitative research designs with diverse statistical methods including hierarchical multiple regression analysis, ANOVA, exploratory factor analysis, descriptive analysis, linear regression analysis, and moderation analysis. Another nine articles used qualitative approaches including phenomenology and consensual qualitative research, while one article (Smith & Ng, 2009) applied mixed methods design including both quantitative and qualitative analyses. Regarding participants, eight quantitative studies reported having between 38 to 115 ICS participants, including Ng’s (2006) study in which the author collected information on ICSs from 96 CACREP-accredited counseling programs. The numbers of participants in the eight qualitative ICS articles were relatively smaller, ranging from 5 to 13, which is natural given the characteristics of quantitative and qualitative research designs. Finally, the mixed methods study included 21 ICS participants. Quantitative researchers most frequently used online surveys to collect data, although one researcher (Ng, 2006) gathered information via email or telephone. Researchers using qualitative methodologies primarily used semi-structured interviews to collect data, while Delgado-Romero and Wu (2010) performed a group counseling intervention and interpreted the results, including the feedback of group members.

Results of Qualitative Content Analysis
     The content areas of the ICS research included personal and professional aspects of ICSs’ adjustment and development. These aspects were influenced by ICSs’ unique circumstances along with their needs, potential stressors, and accessible resources and strategies. During qualitative content analysis, we generated and established preliminary categories. We then developed the preliminary categories into three main themes encompassing ICS research: (a) professional practices and professional development, (b) academic, social, and cultural challenges, and (c) personal and social resources. Each theme consisted of several identified categories.

Professional Practices and Professional Development
     Many studies examined ICSs’ perceptions, concerns, needs, and suggestions of professional training experiences, including practicum and internship (e.g., Lertora & Croffie, 2020; Park et al., 2017), supervision (e.g., Ng & Smith, 2012; Nilsson & Dodds, 2006), multicultural training (e.g., Akkurt et al., 2018; Smith & Ng, 2009), social justice group intervention (Delgado-Romero & Wu, 2010), and teaching preparation (D. Li & Liu, 2020) from the unique perspective of ICSs. Furthermore, in relation to the professional practices, several categories of ICSs’ professional development were identified, such as counseling self-efficacy (e.g., Interiano-Shiverdecker et al., 2019; C. Li et al., 2018), professional identity development (e.g., Kuo et al., 2018, 2021), role ambiguity (Akkurt et al., 2018; Ng & Smith, 2012), and multicultural competencies (Smith & Ng, 2009).

Academic, Social, and Cultural Challenges
     The second theme included unique challenges that ICSs encountered across academic, social, and cultural domains. The most commonly identified category from 12 studies was acculturation (e.g., Behl et al., 2017; Interiano & Lim, 2018; Lertora & Croffie, 2020). In addition, ICSs faced other cultural barriers involving cultural differences (e.g., Behl et al., 2017; Woo et al., 2015), difficulties in performing teaching and supervision practices (e.g., Li & Liu, 2020; Woo et al., 2015), and struggles in understanding cultural values and U.S. culture (e.g., Kuo et al., 2021; Sangganjanavanich & Black, 2009). ICSs reported that their academic and social concerns included English proficiency (e.g., Kuo et al., 2021; Nilsson & Dodds, 2006) and experiences of language anxiety (C. Li et al., 2018); stigma, biases, and discrimination (e.g., Ng & Smith, 2009; Sangganjanavanich & Black, 2009); and interpersonal isolation (e.g., Behl et al., 2017).

Personal and Social Resources
     The third theme emerged from multiple categories of personal and social resources that supported ICSs. In terms of personal resources, researchers identified several characteristics such as self-reflection, self-regulation, and self-efficacy, which contributed to ICSs’ professional development (e.g., Delgado-Romero & Wu, 2010; Interiano-Shiverdecker et al., 2019; Woo et al., 2015). Additionally, the sources of social support for ICSs included their peers and other ICSs (e.g., D. Li & Liu, 2020; Woo et al., 2015), faculty and mentors (e.g., Smith & Ng, 2009; Woo et al., 2015), department and college (e.g., Delgado-Romero & Wu, 2010; D. Li & Liu, 2020), and family (Kuo et al., 2018).

Discussion

The purpose of this content analysis was to provide an organized overview of counseling studies conducted for ICSs over the past 16 years both from quantitative and qualitative perspectives. The aggregated findings, including publication trends and content areas of ICS research, are expected to present the missing pieces in research to better understand and support ICSs and provide meaningful recommendations to better support their professional development. Specifically, we identified 18 articles published in selected counseling journals during the 16-year period from 2006 to 2021. Our findings included the journals, authorship and affiliation, research orientation, participant characteristics, data collection method, and content areas. In general, researchers from many educational institutions have conducted collaborative research focusing on ICSs, with a balance of quantitative and qualitative methodologies. Research participants were ICSs at master’s and doctoral levels, with larger participant groups for quantitative studies and smaller groups for qualitative studies. The most frequently employed methods for data collection were online surveys and semi-structured interviews. Among the 18 identified ICS articles, three main content themes emerged, with each theme consisting of several categories.

In terms of the content, counseling researchers have consistently examined the professional practices of ICSs in their programs. Our findings indicate that many researchers were interested in supervision as an essential aspect of counselor education. Supervision involves intricate dynamics between the supervisor, supervisee, and client, and it can have a substantial influence on counselor competency development (Falender & Shafranske, 2007; Nilsson & Dodds, 2006). For this reason, ICS research has focused not only on investigating the supervisory concerns, needs, and satisfaction of ICSs, but on providing an integrative supervision model for this population (Nilsson & Dodds, 2006; Park et al., 2017; Sangganjanavanich & Black, 2009). Beyond supervision, researchers have also explored other topics, including teaching preparation and social justice counseling (Delgado-Romero & Wu, 2010;
D. Li & Liu, 2020). We found that researchers have attended to ICSs’ professional competencies as well as their training processes, including counseling self-efficacy, professional identity, and multicultural and social justice competencies (Kuo et al., 2021; C. Li et al., 2018; Smith & Ng, 2009). These professional competencies and training processes are regarded as important indices of successful and effective counselor training (Center for Substance Abuse Treatment, 2014; Woo et al., 2015). As a whole, ICS research has addressed diverse student training experiences and resultant developmental outcomes, although the absolute number of studies remains limited.

Our results highlight cultural and language differences as a primary barrier for many ICSs when they initiated their study in a foreign country. This finding is consistent with previous studies, including Mori’s (2000) seminal work. Most studies we examined identified acculturation as a key construct of ICSs’ adjustment and growth in a foreign country (Interiano & Lim, 2018; Ng & Smith, 2012). Many ICS participants sought to maintain a balance between engaging in U.S. language and culture and sustaining their own cultural identity (Interiano-Shiverdecker et al., 2019; D. Li & Liu, 2020; Sangganjanavanich & Black, 2009). Specifically, ICSs reported cultural challenges in several areas, including the educational system, teaching styles, personal interactions, social justice issues, and cultural values and practices (Behl et al., 2017; Delgado-Romero & Wu, 2010; D. Li & Liu, 2020). One study found that doctoral-level ICSs experienced greater cultural adjustment problems and conflicts compared to master’s-level ICSs (Ng & Smith, 2009), which implies that differentiated understanding and approaches may be required according to ICSs’ developmental stages. Also, our findings echoed the existing literature that one of the main obstacles for international students is language proficiency (Kuo et al., 2021; C. Li et al., 2018), as ICSs who had difficulty using English reported greater academic needs and concerns than their peers (Behl et al., 2017).

A notable finding is that the cultural barriers ICSs experienced were intertwined with their social concerns. ICSs are exposed to social dangers involving stigma, discrimination, and interpersonal isolation (Behl et al., 2017; Delgado-Romero & Wu, 2010). Although several researchers explored the potential relationship between ICSs’ length of time in the United States and their stress and cultural development (Behl et al., 2017; Nilsson & Dodds, 2006), their findings did not indicate any significant relationship. This lack of an effect may imply that other risks and protective factors have more influence on the successful adjustment and achievement of ICSs regardless of the amount of time they have spent in the United States. As such, our findings have shown that ICSs face unique challenges across their professional and personal lives in acculturating to two or more cultures and satisfying counseling training requirements.

Corresponding to these challenges, various personal and social resources have been regarded as protective factors of ICS development. Specifically, in terms of social support, researchers identified the importance of support from mentors, supervisors, peers, and other international graduate students (e.g., Woo et al., 2015). Given that ICSs often experience a lack of social support, it is noteworthy that the current ICS literature highlights the need for counselor training programs to promote students’ personal strengths and social connections.

Overall, we identified patterns and trends in research on international students in counseling programs based on studies published in selected counseling journals. Despite our efforts to reflect on diverse ICS experiences, the paucity of ICS research across selected counseling journals, particularly ACA journals, is notable. Given the increasing representation of ICSs in the wider counseling student body (Ng, 2006), further studies addressing the resources and barriers of this student population are needed. Furthermore, international students were exposed to unprecedented difficulties and mental health threats during the COVID-19 pandemic (Chen et al., 2020). These challenges necessitate more scholarly attention toward supporting and advocating for ICSs, including their adjustment, professional development, and transition from training to practice.

Implications
     Because members of the counseling profession have expressly emphasized the importance of enriching multiculturalism and diversity (D. Li & Liu, 2020), we expect our findings to provide meaningful implications for counselor education programs. First, counseling researchers are encouraged to conduct more ICS research given the limited available studies and the increasing representation of international students in counseling programs. Even though they attempted to examine diverse training experiences and competency development of ICSs, many areas are understudied, such as their teaching and social justice practices. The existing ICS research mostly concentrated on identifying factors that influence ICSs’ academic and social lives. However, given the continuous increase of ICSs in the counseling field, research about strengths and support strategies of counselor education programs having many ICSs is worth studying. Also, in future studies, researchers can try to reflect the actual voices of ICSs about what they want from their training programs, whether they feel their program is affordable, and whether their program is effective in supporting their professional development. In addition, counseling researchers can develop projects considering cultural differences of ICSs in order to better understand them not as a single group but as multiple individuals having unique cultural backgrounds. Overall, this content analysis study underscores the need for more research on this student population.

Regarding counselor education programs, programs can provide specific resources to support the professional development of ICSs. To help ICSs overcome language barriers, for instance, institutions can provide professional assistance in the use of English, such as writing centers and speaking centers. Departments can provide language support specifically relevant to counseling, including workshops and seminars about practical language tips for counseling practice and research writing. For example, Jang and colleagues (2014) recommended instituting mock supervision sessions before practicum and/or internship to further prepare international counseling trainees for their duties. Counselor education programs are expected to address the unique language and academic needs of ICSs.

Counselor education programs should also facilitate ICSs’ cultural understanding and adjustment. Counselor education programs can design and provide opportunities for ICSs to socially interact with colleagues and faculty members in the program. Existing studies that highlight the importance of mentoring (e.g., Delgado-Romero & Wu, 2010; Ng, 2006; Woo et al., 2015) are further proof that faculty members in counselor education programs can play a significant role in the personal and professional development of ICSs. Because ICSs share unique challenges and learning experiences (D. Li & Liu, 2020; Sangganjanavanich & Black, 2009), faculty members who were ICSs or have experience advising or collaborating with ICSs can serve as essential mentors for this population.

Counselor education programs might benefit from developing and employing curriculum and courses that apply the empirical findings of ICS research, including the results of this study. These studies serve as a reference for designing more effective counselor training. Programs that design their training to support the needs of ICSs may also find that they are more effective in recruiting and retaining international students. For example, faculty members can respond to ICSs’ anxiety and concerns before they enter clinical practice (Ellis et al., 2015; Nilsson & Wang, 2008). Also, ICSs are expected to benefit from synthesized results about ICS research, promoting a deeper understanding of themselves and enabling them to develop their own coping strategies and access potential resources. Furthermore, counselor education programs need to prepare different training trajectories for master’s students and doctoral students. Compared to ICSs in doctoral programs, ICSs are relatively rare at the master’s level, comprising only 1% of master’s-level counseling trainees (CACREP, 2015). Because master’s-level ICSs may feel like they belong to the minority, helping them feel connected is an essential task for counselor education programs. Therefore, programs are required to prioritize the effective delivery of knowledge and adequate practical opportunities for supervisees at the master’s level.

Finally, counselor education programs should work toward a program culture that supports diversity. Although fostering multiculturalism has emerged as a priority for counselor education programs, more work is needed to support internationally diverse perspectives. For example, Taephant and colleagues (2015) examined the experiences of U.S.-educated international counselors practicing in non-Western counseling environments. Drawing upon these findings and other relevant references, counselor educators may design a class discussing the limitations of Western-style training. As is evidenced by existing literature, open discussions about cultural differences can be effective for the psychosocial adjustment and professional development of ICSs.

Limitations and Future Research
     This study includes some limitations to note. The first and most important limitation is the concerning lack of research focusing on international students in the counseling profession (D. Li & Liu, 2020; Nilsson & Dodds, 2006; Woo et al., 2015). Even though ICSs have recently begun to attract scholarly attention (Lau et al., 2019), the number of articles published recently may not be sufficient to discuss the diverse purposes and areas of focus for ICS research. Although our study specifically highlighted the need for more research on ICSs, an extensive range of discussion was not possible due to the limited number of articles. Thus, we encourage more professional counseling organizations and counseling researchers to consider ICSs’ professional development as a research topic. Also, because this study was limited to articles published in journals related to ACA and selected other professional organizations, future research with a more comprehensive search may elicit rich and diverse discussion. Finally, content analysis has a few methodological limitations, such as no existence of unified rules and a precise analytical process, and potential biases in coding, which necessitates further research on ICSs using other methodologies for more in-depth investigations.

Conclusion

     ICSs can contribute to increasing program diversity and cultivating students’ multicultural counseling competency but have been understudied despite their growing representation. This study provided a comprehensive overview of ICS research across 18 articles within a 16-year period, using both quantitative and qualitative content analysis. Counseling researchers can pay more scholarly attention to the academic and social lives of ICSs from a strength-based approach. Counseling programs and counselor educators can support ICSs by providing resources for adjustment, developing curricular and extracurricular activities involving ICSs, and working toward a more multicultural and inclusive program environment.

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

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Byeolbee Um, PhD, is an assistant professor at the University of Oklahoma. Lindsay Woodbridge, PhD, LMHC, LPC, is an assistant professor at the University of Wisconsin-Stout. Susannah M. Wood, PhD, NCC, is a professor at the University of Iowa. Correspondence may be addressed to Byeolbee Um, 820 Van Vleet Oval, Rm 303, Norman, OK 73019, byeolbee.um-1@ou.edu.