Applying the Multicultural and Social Justice Counseling Competencies to Eating Disorder Treatment

Adriana C. Labarta, Danna Demezier, Alyssa A. Vazquez

Scholars, practitioners, and clients in the eating disorder (ED) treatment field emphasize the need for more culturally responsive approaches to improve care for marginalized communities. Treatment barriers, such as counselor biases, lack of access to care, and disempowering approaches, perpetuate these gaps across diverse groups with EDs. We propose that Ratts et al.’s (2016) Multicultural and Social Justice Counseling Competencies (MSJCC) can bridge these gaps by assisting counselors and other helping professionals working in ED treatment settings in deconstructing biases and implementing empowering treatment approaches for marginalized individuals with EDs. Using case vignettes, we illustrate how counselors can apply the MSJCC across counseling settings and engage in advocacy with the broader ED recovery community. We conclude by presenting implications for counselors, counselor educators, and supervisors, who all play a role in empowering clients and improving access to ED treatment for diverse populations.

Keywords: eating disorder, multicultural, social justice, marginalized, advocacy

     The SWAG myth has long persisted within the eating disorder (ED) treatment field, informing research and practice and centering the experiences of “skinny, White, affluent, girls” (Sonneville & Lipson, 2018). Abundant evidence highlighting the presence and impact of EDs across diverse cultural identities now discredits this stereotype (Halbeisen et al., 2022; Huryk et al., 2021; Schaumberg et al., 2017; Sonneville & Lipson, 2018). Nonetheless, scholars, practitioners, and clients alike point to prevailing gaps impacting minoritized populations with EDs and call for more inclusive, culturally informed practice (Burke et al., 2020; Hartman-Munick et al., 2021; Labarta et al., 2023). The American Counseling Association (ACA; 2014) Code of Ethics preamble highlights the importance of “honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts” (p. 3). Thus, multicultural competence is essential for the counseling profession to continue addressing the needs of culturally diverse clients, including social justice concerns that shape and contextualize mental health and wellness. The purpose of this article is to illuminate EDs as multicultural concerns that require counselors to challenge common, harmful stereotypes about EDs and to move toward more inclusive, culturally responsive treatment frameworks.

Multicultural Concerns Within Eating Disorders

Culturally responsive counseling requires counselors to understand clients’ diverse cultural and social identities as well as their mental health experiences (Ratts et al., 2016). Similarly, awareness of the intersection between EDs and multicultural concerns is imperative to culturally sensitive treatment. We begin with an overview of ED literature on underserved populations with particular attention to various aspects of cultural identity, including race and ethnicity, sexual orientation, gender identity, socioeconomic status and food insecurity, ability status, body size, and religion and spirituality. We conclude with a brief overview of intersectionality and ED literature.

Race and Ethnicity
     Although racial and ethnic minorities experience EDs at similar rates as non-Hispanic, White individuals (Marques et al., 2011), there is a lack of ED research using racial and ethnic minority samples (Burke et al., 2020; Egbert et al., 2022; Mikhail & Klump, 2021). For instance, Egbert et al. (2022) discovered that across 377 peer-reviewed manuscripts published between 2000 and 2020 in the International Journal for Eating Disorders, only 45.2% reported demographic information related to participants’ racial/ethnic identity. In studies that reported racial/ethnic demographic data, White participants comprised about 70% of the samples. Greater representation of racial and ethnic minorities in research is imperative in order to gain insight into the etiological and maintaining factors of EDs in diverse communities (Egbert et al., 2022), particularly because counselors may hold biases that contribute to significant disparities in ED diagnosis for people of color compared to White individuals (Sonneville & Lipson, 2018). Thus, researchers underscore the importance of exploring culturally and contextually relevant factors, such as sociocultural factors and acculturative stress (Kalantzis et al., 2023; Talleyrand, 2012; Warren & Akoury, 2020) and adopting therapeutic approaches that are collaborative and culturally sensitive (Acle et al., 2021).

Sexual Orientation
     Sexual minority populations experience increased risk for ED pathology and may present with higher ED pathology at admission to ED treatment compared to their cisgender, heterosexual peers (Mensinger et al., 2020). However, a recent systematic review examining ED literature from 2002 to 2022 revealed that ED risk varies across sexual minority groups (O’Flynn et al., 2023). Therefore, studies that combine sexual minority groups into one sample may provide an incomplete understanding of ED patterns across distinct identities (e.g., bisexual, gay, lesbian, pansexual). Counselors and researchers should assess sociocultural factors that influence ED risk (Engeln-Maddox et al., 2011) and minority stress experiences (Mason & Lewis, 2015; Meyer, 2003), as well as protective factors that serve as buffers against ED pathology, such as social support. It is important to move “away from heteronormative frameworks and toward more liberatory ones” (O’Flynn et al., 2023, p. 13). It is essential for counselors to recognize the expansiveness of sexuality and attraction, as well as how clients’ identities and experiences inform ED assessment and treatment approaches.

Gender Identity
     EDs impact people across diverse gender identities, including gender expansive and nonbinary individuals, transgender men and women, and cisgender men and women (Hartman-Munick et al., 2021; Nagata et al., 2020). However, because of assumptions surrounding EDs as female disorders, men may delay seeking treatment (Räisänen & Hunt, 2014) and feel like “the odd one out” (Kinnaird et al., 2019, p. 848). Nonbinary and transgender individuals with EDs also experience barriers to receiving inclusive care because of gender-based stereotypes (Hartman-Munick et al., 2021). Therefore, it is important for counselors to consider gender norms, ideals, and expressions (e.g., masculinity, femininity, androgyny) that may influence ED pathology and related body image concerns. For example, although EDs are typically associated with femininity and the thin ideal, research has shown that masculinity and muscularity ideals are also risk factors (Griffiths et al., 2015). Counselors should also avoid gender binary assumptions, as individuals who adhere to androgynous ideals are often overlooked in ED assessment and treatment (Cusack & Galupo, 2021). Gender-affirming ED treatment requires deconstructing traditional female-oriented approaches and considering the varied experiences of gender-diverse individuals.

Socioeconomic Status and Food Insecurity
     Another common harmful stereotype is that EDs primarily impact individuals of higher socioeconomic status (SES). A recent systematic review debunked this myth when it illustrated that EDs present across varied socioeconomic backgrounds (Huryk et al., 2021). Given that the cost of ED treatment is a significant barrier to care (Ali et al., 2017), individuals of lower SES may be less likely to seek treatment or may have limited access to specialized treatment (Huryk et al., 2021; Sonneville & Lipson, 2018). Relatedly, emerging research has drawn connections between food insecurity and EDs. Existing ED assessment tools often conceptualize food restriction as driven by weight or shape concerns (Hazzard et al., 2020; Middlemass et al., 2021). Individuals experiencing food insecurity, however, may engage in periodic dietary restriction because of fluctuations in food availability, which can lead to bingeing or overeating when food is more accessible (Rasmusson et al., 2019). Given the importance of addressing nutrition in ED treatment, counselors should broach the topic of food insecurity with clients in order to understand patterns of restriction and availability of food (Hazzard et al., 2020; Middlemass et al., 2021). Overall, scholars recommend that practitioners conceptualize SES as a multidimensional construct (e.g., income, occupation, wealth) during the assessment process to determine clients’ barriers and improve access to resources (Huryk et al., 2021).

Ability Status
      Individuals with disabilities are largely underrepresented in ED literature even though they are at increased risk of disordered eating behaviors (Cobbaert & Rose, 2023; Gesi et al., 2017; Nazar et al., 2016). Recent research has shown that autistic individuals experience more negative outcomes and barriers in ED treatment than neurotypical individuals (Babb et al., 2021). Cobbaert and Rose (2023) issued a call to action for ED health care professionals to engage in neurodiversity-affirming practices, specifically by rethinking the implementation and practice of ED treatment, which has historically centered the medical model and neurotypical experiences. Current recommendations include using strengths-based, trauma-informed approaches, challenging ableist expectations and treatments, and centering human rights and autonomy (Cobbaert & Rose, 2023). Research also suggests that individuals with physical disabilities have nuanced experiences with body image, which in turn can impact the development of EDs (Cicmil & Eli, 2014; Gross et al., 2000). For example, individuals may develop EDs as a means to cope with the psychological and social difficulties they experience related to living with a disability and navigating societal body image ideals and pressures (Cicmil & Eli, 2014). Ultimately, more research that examines the intersection of EDs and ability status is needed.

Body Size
     People of size, or larger-bodied individuals, often experience barriers to receiving quality care, including weight bias from clinicians and delays in being referred to ED treatment (Harrop et al., 2021; McEntee et al., 2023; Puhl et al., 2014). Because of fear of experiencing weight stigma in health care settings, people of size are less likely to seek treatment for health concerns, including EDs (Mensinger et al., 2018). Counselors may perpetuate weight loss–related treatment recommendations that can negatively impact clients’ long-term well-being (Chen & Gonzales, 2022; Puhl et al., 2014). Although larger-bodied individuals may experience significant psychosocial and medical consequences as a result of an ED, research demonstrates that fewer patients are referred to appropriate treatment because of assumptions of severity based on body size (Harrop et al., 2021). Scholars and advocates recognize the need for more research among this population (Ralph et al., 2022) and recommend increased training in the use of weight-inclusive and fat liberation frameworks when working with larger-bodied clients (Matacin & Simone, 2019; McEntee et al., 2023; Tylka et al., 2014).

Religion and Spirituality
     Religion and spirituality are critical sociocultural factors that can influence EDs and their treatment. Research has shown that religion and spirituality can serve positive, negative, or non-significant roles in ED recovery based on the individual’s lived experience (Akrawi et al., 2015; Buser et al., 2014; Richards et al., 2018). For example, Akrawi et al.’s (2015) systematic literature review revealed that a secure relationship with God was linked to decreased levels of disordered eating, while a doubtful or anxious relationship with God correlated with greater levels of disordered eating. Religious and spiritual coping strategies (e.g., prayer, meditation, meaning-making, and connecting with nature) can be protective in ED recovery (Buser et al., 2014; Richards et al., 2018). On the other hand, some individuals experience feelings of shame and guilt related to religious beliefs and bullying from members of their religious communities because of their ED (Richards et al., 2018). Because religion and spirituality are often personal and unique to the individual, Mintert et al. (2020) recommend that counselors explore their complex roles and potential relationship to clients’ presenting concerns and integrate evidence-based interventions affirming diverse religious and spiritual identities.

Intersecting Identities
     Intersectionality theory, which originates from Black feminist scholarship, describes how multiple marginalized social identities interact and impact mental health (Crenshaw, 1989). Because individuals with marginalized social identities experience inequities related to their ED presentation, counselors must consider the intersection of such identities in order to address specific concerns that impact underserved clients’ risk, treatment process, and outcomes (Burke et al., 2020; Burke et al., 2023). An intersectional approach considers the impact of one identity on another, including how several identities work to either place individuals at risk or support their resilience (Burke et al., 2023). Although more research is needed on EDs across diverse intersecting identities (Burke et al., 2020), scholars have started to explore intersectionality (Burke et al., 2023; Calzo et al., 2017; Diemer et al., 2015). Overall, the higher rates of EDs in marginalized individuals with intersecting identities imply a need for interventions that consider the inequities faced by these individuals and the impact on their risk for EDs (Burke et al., 2023).

Applying the MSJCC to Eating Disorder Treatment

Across ED literature, scholars have advocated for the development of culturally responsive models to address ongoing treatment disparities. We believe that the Multicultural and Social Justice Counseling Competencies (MSJCC; Ratts et al., 2016) can serve as a powerful framework for counselors and related helping professionals who work with clients with EDs. The MSJCC, centered on the values of multiculturalism and social justice, attend to essential constructs like intersectionality, including privileged and marginalized statuses within the counseling relationship. Four developmental domains outline essential areas for counselors to explore when working with clients with cultural sensitivity: Counselor Self-Awareness, Client Worldview, Counseling Relationship, and Advocacy Interventions. The first three domains are further organized into four aspirational competencies, namely attitudes and beliefs, knowledge, skills, and action. In the sections below, we review brief case vignettes illustrating various presentations of EDs across diverse intersecting identities, the application of the MSJCC across treatment settings, and relevant resources for counselors.

Counselor Self-Awareness
     Paul is a 13-year-old Hispanic, cisgender male with autism spectrum disorder (ASD). He is an only child and lives with his parents and paternal grandmother. Paul’s parents have described him as a picky eater throughout his life. He has an aversion to certain smells and/or textures in food and exhibits rigidity around mealtimes. For example, Paul rarely deviates from his comfort foods and often has the same daily meals, such as plain pasta that his mother prepares for lunch. One day at school, Paul realized that he had forgotten his lunchbox. When his teacher offered to assist him with getting food from the cafeteria, Paul became visibly distressed and began to panic. Paul’s teacher was concerned and contacted the school counselor to check in. Mrs. Walker, the school counselor, called Paul into her office and assessed his concerns, discovering his disordered eating behaviors.

Although Mrs. Walker had experience working with students with ASD, she found herself initially dismissing concerns related to his eating behaviors. After further reflection, Mrs. Walker recognized that her own cultural beliefs and biases related to gender were impacting her ability to fully assess his presenting ED symptoms. For example, she noticed that she held the erroneous belief that males don’t struggle with food. She consulted a colleague on next steps, as she did not want to violate any ethical codes or unintentionally harm Paul. Mrs. Walker began adjusting her attitudes and beliefs. She was surprised to find literature on EDs in males and learned about the unique experiences of those with ASD. Mrs. Walker reflected on internalized stereotypes of gender, disability, and mental health. She was challenged to consider Paul’s unique experience as a young Hispanic male with ASD and the cultural implications of ASD and EDs. To do so, she practiced cultural humility and reflected on her own cultural identities and biases and how they shaped her worldview.

Mrs. Walker sought to learn specific information about the intersection of ASD and EDs, such as their common comorbidity and clinical presentations like sensory sensitivities that may lead to food avoidance (Bourne et al., 2022). Mrs. Walker also used various resources to increase her knowledge of the risk factors of EDs in males, recognizing that risk factors often differ in females. She identified a need to take an individualized approach and developed skills to work with Paul through a culturally responsive lens. Specifically, Mrs. Walker implemented a tailored intervention to empower him and his family to connect with community referrals in order to support his recovery.

Mrs. Walker took action to support her work with Paul by sharing her newly attained knowledge about the intersection of disability and EDs. She initiated a campaign in her school to raise awareness of EDs and gender and disability biases, as well as the challenges that individuals with ASD face during their recovery process. These interventions allowed Mrs. Walker to work toward systemic change surrounding stigma on EDs, males, and people with ASD. She shared a list of local and national organizations that specialize in ASD or EDs (specifically, avoidant/restrictive food intake disorder, or ARFID) with Paul and his family to ensure that they had access to therapeutic support. Examples included Different Brains (https://differentbrains.org) for ASD and the National Alliance for Eating Disorders (https://www.allianceforeatingdisorders.com). Mrs. Walker remains in contact with Paul’s community mental health counselor to understand how she can support him within the school setting. After this experience, Mrs. Walker reflected on the importance of developing her own self-awareness as a counselor, which allowed her to challenge her biases and cultivate more meaningful relationships with diverse students.

Client Worldview
     Anita is a 19-year-old Black woman. Growing up in a low-income household, she and her family often struggled with food insecurity, leading to a scarcity mindset around food. Despite these challenges, Anita has always had a close, loving relationship with her family. About one year ago, she came out as pansexual to her parents and a few close friends. Although the experience was positive and empowering, Anita worries about her upcoming transition to college, being away from her family and friends, and connecting with other LGBTQ+ students on her campus. During her first semester, she would binge eat when feeling lonely or stressed. This was usually followed by intense feelings of guilt and shame which led to restriction of food. Anita decided to schedule an intake appointment at her college counseling center; she is scheduled to meet with Dalton, a new counselor who started his position this semester.

Dalton’s goal for the intake appointment is to gain a deeper understanding of Anita’s worldview. Although Dalton has experience working with clients with eating concerns in different settings, he has maintained an assumption that EDs primarily occur in affluent, White populations. Dalton recognizes the importance of challenging his attitudes and beliefs about EDs that could negatively interfere with the treatment process. As Anita shared her story, Dalton intentionally bracketed his biases and remained open to learning about her lived experience. After the session, he engaged in reflective practice by processing his reactions with a colleague at the center with expertise in EDs.

Pulling from his knowledge of culturally responsive theories, Dalton identified the role of intersectionality in Anita’s presenting concerns. As a pansexual woman of color raised in a low-income household, Anita’s experiences may be understood by considering her multiple minority identities. Anita faced significant challenges throughout her life (e.g., food insecurity, the coming out process, and recent transition to college), which may have led to an increased risk of developing an ED. Despite these risk factors, Dalton recognized that an intersectional approach also considers Anita’s strengths and protective factors (Chan et al., 2019), such as strong family support and willingness to seek counseling. Dalton used these insights to conceptualize Anita’s concerns and treatment plan from a strengths-based, culturally responsive lens.

Building on his understanding of theory, Dalton reflected on essential skills to help Anita in counseling. Dalton understood that it may take time for Anita to feel comfortable processing her experiences and sharing parts of her identity. Anita may fear rejection or misunderstanding from Dalton, particularly if he has a different upbringing or cultural background. Dalton understood that experiences of oppression can influence clients’ worldviews and experiences, potentially leading to feelings of disconnection. Given Anita’s complex relationship with food throughout her life, bingeing and restriction may have served as coping mechanisms to deal with uncertainty, loneliness, and fear of rejection. Thus, Dalton remained aware of the inherent power dynamic in the counseling relationship and intentionally shared power with Anita as she navigated her healing process (e.g., co-constructing the therapeutic focus and remaining open to feedback from Anita).

Dalton recognized the need for ongoing commitment, or action, to education and engagement with diverse communities. He sought opportunities to attend workshops or webinars on EDs in underserved populations in order to acquire more awareness, knowledge, and skills related to culturally sensitive approaches. Dalton learned about virtual LGBTQ+ support groups offered by Fighting Eating Disorders in Underrepresented Populations (FEDUP; https://fedupcollective.org) and shared this resource with Anita to expand her social support network. Dalton also reached out to organizations on campus, such as LGBTQ+ and Black, Indigenous, and people of color (BIPOC) student groups, to learn more about their experiences and needs as college students. He consulted with his new colleagues to familiarize himself with student resources, such as on-campus food pantries for food-insecure students. These action-based efforts allowed Dalton to deepen his understanding of Anita’s worldview, immerse himself in the campus community, and advocate for diverse students’ needs.

Counseling Relationship
     Jenna is a 40-year-old Jewish Orthodox, heterosexual, cisgender woman who identifies as having a larger body. She experienced significant trauma from her father as a teenager and is now estranged from her immediate family. This has impacted her body image and overall sense of self. Since being estranged, she has struggled with her religious and spiritual identity. Growing up, she learned to cope with difficult emotions with food. She experienced periods of bingeing to help soothe and numb her feelings, as well as periods of significant restriction stemming from attempts to control her body shape. She has reported significant shame regarding her body size and ED symptoms and has avoided seeking counseling because of perceived stigma. Jenna has decided to seek outpatient treatment to help manage ED behaviors after the urging of a friend. When beginning counseling, she realized that she may need to unpack some of her past trauma as well as how religious beliefs have shaped her relationship with food. Jenna began seeing Emily, an agnostic, gay, cisgender female counselor who identifies as “straight-sized,” or a person in a smaller body (Ashwell, 2020). Emily has been working in the field of ED for over 10 years.

While completing the intake assessment with Jenna, Emily asked questions to understand Jenna’s multicultural background. Emily reflected upon her own intersectional identities and how the differences in marginalized and privileged identities may impact the client–counselor relationship. Emily realized that Jenna holds more privilege as a heterosexual woman yet experiences more marginalization because of her Jewish Orthodox identity and larger body size. After the intake session, Emily reflected upon her own attitudes and beliefs about Jenna’s identities, critically evaluating her biases and assumptions, and considered how being in a straight-sized body may impact her client’s comfort or discomfort in the counseling relationship. Emily used curiosity and open communication to strengthen the counseling relationship.

After reflecting on her own attitudes and beliefs, Emily recognized that it was essential to increase her knowledge of her client’s experiences as a Jewish Orthodox woman. Emily learned about Jewish Orthodox beliefs and customs as well as the oppression and discrimination these communities may face. This knowledge was integral to establishing a connection with Jenna and preventing possible microaggressions (Mintert et al., 2020). Because of Jenna’s reported experience with her religious and ethnic background impacting her relationship with food, Emily also focused on exploring intersections between food, body image, and her cultural background.

Emily then explored skills for cultivating an open space for dialogue, particularly those related to addressing how different worldviews between the counselor and client could impact the counseling relationship. Emily demonstrated curiosity and avoided making assumptive statements regarding Jenna’s experiences, understanding the importance of broaching cultural differences in the client–counselor relationship (Day-Vines et al., 2007). Emily’s experience in the ED field prepared her to support clients in challenging diet culture in multiple ways, including discussing the impact of fat-oppressive culture on emotional health, being mindful of her language regarding body size, and creating an inclusive office space for clients in different bodies (Kinavey & Cool, 2019). When Jenna shared discomfort in working on body image issues with an individual in a “straight-sized” body, Emily utilized validation and reflecting skills to process these differences in lived body experiences, which helped Jenna feel safe to further process her body image experiences despite their differences.

Emily took action by holding more conversations with other professionals, joining online communities, and continuing her research to understand how to continue supporting clients of different religious and spiritual backgrounds and body sizes. Emily also supported Jenna in becoming more involved in advocacy, which Jenna found to be empowering and liberating and helped her to improve her relationship with her body. Emily provided resources for Jenna to learn about fat liberation through the Association for Size Diversity and Health (https://asdah.org) and the National Association to Advance Fat Acceptance (https://naafa.org). Emily also connected Jenna to an ED support group, the Larger Bodied Individuals Support Group offered by the National Alliance for Eating Disorders. Emily found that the counseling relationship was strengthened by advocating and taking action with and on behalf of her client.

Advocacy Interventions
     Ratts et al. (2016) indicated that counseling and advocacy interventions can occur at several levels (i.e., intrapersonal, interpersonal, institutional, community, public policy, international or global) on behalf of clients or counselors. Counselors are encouraged to consider contextual factors, such as client identities and counseling settings, and to determine the most appropriate and responsive advocacy interventions. The sections above covered several examples of intrapersonal and interpersonal advocacy efforts for counseling clients with diverse intersecting identities. Regarding counselor advocacy, another important intrapersonal consideration is the role of self-care in sustaining social justice and advocacy efforts (Mitchell & Binkley, 2021). The intensive nature of ED treatment (e.g., high mortality and relapse rates; Graham et al., 2020; Warren et al., 2013) emphasizes the need for self-care to maintain vitality and ensure ethical, culturally responsive care. Counselors can also reinforce the significance of wellness practices within their interdisciplinary collaborations that foster interpersonal advocacy within the ED treatment environment.

Counselors can critically evaluate the practices and policies within their institutions and counseling settings to foster inclusion beyond the counseling room. For example, Akoury et al.’s (2019) qualitative study discovered that some women of size experienced physical barriers in therapy waiting rooms, such as unaccommodating furniture. Ensuring that waiting areas and clinical settings accommodate clients of all sizes and abilities is essential to cultivating an affirming environment. It is also worth noting that there are institutional training gaps related to ED education, including within counseling programs (Labarta et al., 2023). Counselor educators and supervisors can address these gaps by adopting a culturally responsive approach to teaching about EDs, improving students’ awareness of EDs across populations, and advocating for the inclusion of ED education across curricula.

Counselors play an essential role in addressing their communities’ mental health needs. The majority of EDs go untreated, especially in minoritized populations (Bryant et al., 2022); thus, communitybased advocacy is crucial. One method to more deeply assess these needs is community-based participatory research (CBPR). Because of its strengths-based, collaborative approach, CBPR presents an opportunity for culturally responsive research to address health inequities and disparities impacting underserved groups (Rodriguez Espinosa & Verney, 2021). The core tenets of CBPR involve research with communities, implying shared power in the research process and giving marginalized communities a voice to express their perceptions on gaps and immediate needs (Hays, 2020). CBPR can be a powerful alternative to traditional methods in ED research, which have historically excluded the perspectives and experiences of marginalized groups. Action research methods allow researchers, practitioners, clients, and other stakeholders to collaborate and bridge research–practice gaps, which can improve access to ED and mental health treatment (Rodriguez Espinosa & Verney, 2021).

In addition to CBPR, counselors and other practitioners interested in community-based advocacy for EDs may partner with organizations to raise awareness regarding treatment barriers and challenges. Counselors can support underserved clients with accessing care through organizations like Project HEAL, with its mission to improve equitable treatment access (https://www.theprojectheal.org). Counselors may engage in targeted initiatives (e.g., mental health literacy) to reduce barriers that impact individuals who have an ED that is not yet diagnosed (Griffiths et al., 2018). Culturally responsive awareness campaigns can be initiated and situated within the community to reach individuals who may otherwise not have access to such information. In addition to settings like schools and community agencies, counselors may reflect on specific community venues to support marginalized individuals impacted by EDs, such as barbershops, hair salons, churches, and afterschool centers. Treatment recovery is sustained through early intervention, and increasing awareness may support treatment initiation (Griffiths et al., 2018).

On a larger scale, counselors can engage in public policy initiatives that advocate for improvements in health insurance coverage for ED treatment and research funding (Streatfeild et al., 2021), particularly because ED research remains underfunded compared to other mental health conditions (Austin et al., 2019). Further, remaining up to date on legislation impacting clients with advocacy organizations, such as the National Eating Disorders Coalition (https://www.eatingdisorderscoalition.org), can assist with advancing public policy efforts. Given that EDs are also global issues, international collaborations across disciplines may enhance ED prevention and intervention efforts, allowing for diverse cultural perspectives, deepening our understanding of sociocultural contexts, and extending the impact and reach of social justice and advocacy initiatives.

Implications for Counseling and Counselor Education

Counselors have an ethical responsibility to address the pervasive gaps impacting minoritized clients with EDs (ACA, 2014). The MSJCC are a comprehensive framework that assists counselors with exploring the client’s unique lived experience in addition to relational, systemic, and contextual factors influencing the treatment process (Ratts et al., 2016). The MSJCC can be easily integrated into a counselor’s theoretical approach, leading to a more robust, culturally responsive conceptualization and treatment plan. However, it is essential to note that nuances exist across ED treatment settings, particularly depending on the treatment approach used (e.g., manualized protocols versus individualized treatments). Thus, more extensive conversations within organizations may be necessary, including ways to make the treatment more accessible and inclusive to diverse clients. The MSJCC can serve as a resource to guide these discussions, allowing for a deeper understanding of issues at several levels of treatment (e.g., clients’ experiences, clinicians’ experiences, agency policies and procedures, community issues). For example, FEDUP (formerly Trans Folx Fighting Eating Disorders, 2020) presented a call to action in an open letter to ED organizations, providing essential recommendations, including, but not limited to, the following: hiring more diverse staff at treatment centers, moving away from gender-specific treatment, including inclusive language in handouts and resources (e.g., not defaulting to “she”), establishing scholarships for BIPOC and gender-diverse clients, and developing safe spaces for marginalized clients to connect.

Counselor educators and supervisors also play a role in bridging ED graduate training gaps by utilizing culturally responsive approaches when teaching and supervising ED concerns (Labarta et al., 2023). Suggested pedagogical strategies include applying deliberate practice, addressing countertransference issues, offering specialized coursework, infusing ED education across the curriculum, and collaborating with interdisciplinary professionals to serve as guest lecturers or speakers (Irvine & Labarta, 2024; Labarta et al., 2023; Levitt, 2006). Integrating the MSJCC into the counseling curriculum can assist educators and supervisors in enhancing ED training through a social justice lens. For example, a counselor educator teaching a psychopathology course can encourage counseling trainees to explore how diagnoses can perpetuate weight bias, such as with atypical anorexia nervosa (Harrop et al., 2021), a specified presentation of other specified feeding or eating disorder (OSFED). Counselor educators and supervisors can facilitate discussions on the historical and cultural context of idealized appearance norms, introduce weight-inclusive terminology, explore the limits of research related to weight and health, consider emerging research on fat scholarship, and help trainees remain accountable to their own weight bias and stigmas when working with clients of size (Muzacz et al., 2024; Rothblum & Gartell, 2019). In this way, educators and supervisors encourage trainees to remain critically reflexive of prevalent ED treatment practices and empower their diverse clients with EDs across the lifespan.

Future Research Directions
     Scholars have offered several recommendations to enhance culturally informed ED research by creating more inclusive demographic questionnaires and improving reporting in manuscripts (Burnette et al., 2022; Egbert et al., 2022), developing more inclusive assessment tools (Alexander et al., 2024), and designing outcomes-based studies with underrepresented samples (Emelianchik-Key et al., 2023). ED researchers can also use the MSJCC framework to ground their research. For example, counseling researchers have called for more research partnerships between academics and practitioners that can bridge existing research–practice gaps (Barrio Minton et al., 2021; Hays et al., 2019). Related research methods, such as CBPR, can meet this need and incorporate participant perspectives into the research process. Within ED research, this has important implications for marginalized populations who experience barriers to accessing treatment and are often underrepresented in treatment settings. Therefore, moving beyond clinical settings is critical to understanding the unmet needs of community members who may benefit from prevention-based interventions.

Conclusion

In this article, we presented the integration of the MSJCC (Ratts et al., 2016) into the treatment of EDs with marginalized clients. We believe that the MSJCC’s flexibility and social justice lens can assist counselors with bridging the existing gaps and empowering underserved clients across treatment settings. Furthermore, counselor educators and supervisors can utilize the MSJCC as a framework to reconceptualize ED training across counseling curricula, which will play a role in deconstructing dominant narratives on EDs and potentially improving the quality of care for marginalized communities.

 

Conflict of Interest, Funding Disclosure, and Author Note
The authors reported no conflict of interest or funding
contributions for the development of this manuscript.
The authors would like to thank Hayley Lovelace for
her insights and contributions during the initial
stages of this project.

 

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Adriana C. Labarta, PhD, NCC, ACS, LMHC, is an assistant professor at Florida Atlantic University. Danna Demezier, PhD, NCC, LMHC, is an assistant professor at Liberty University. Alyssa A. Vazquez, LMFT, is a doctoral student and adjunct faculty at Barry University. Correspondence may be addressed to Adriana C. Labarta, 777 Glades Rd., Bldg. 47, Rm. 274, Boca Raton, FL 33431, alabarta2018@fau.edu.

Shifting Paradigms: Exploring Multicultural Approaches to Psychedelic-Assisted Therapy in Counseling

Brittany L. Prioleau, Shama Panjwani

The integration of diverse and multicultural perspectives in psychedelic-assisted therapy represents an important element within this emerging field. As the therapeutic potential of psychedelics continues to capture the attention of mental health professionals, it is essential to underscore the critical significance of considering the diverse cultural backgrounds, belief systems, and systemic influences and barriers of individuals engaging in these therapies. This article explores the importance of embracing a multicultural and social justice lens within psychedelic-assisted therapy that examines the movement through a historical sociopolitical lens. It reviews the integration of social justice and advocacy into potential treatment, highlighting how psychedelic-assisted therapy has the potential to enhance effectiveness, accessibility, and ethical foundations within the counseling profession.

Keywords: psychedelic-assisted therapy, multicultural, social justice, advocacy, counseling

     Psychedelics are substances that alter states of consciousness (Nichols & Walter, 2021). This classification consists of substances derived from roots and plants, including cacti and fungi-like plants as well as synthetic substances that can affect perception. The association of psychedelics with the counterculture of the 60s and 70s created a stigma around usage and thwarted clinical research (Byock, 2018). However, in recent years, psychedelics have reemerged as a breakthrough therapeutic treatment modality for a variety of mental health disorders (Byock, 2018). The emergence of psychedelic-assisted therapy (PAT) and the results of clinical trials demonstrate significant improvements in treatment-resistant depression, increased psychological well-being, and overall long-lasting positive outcomes (Carhart-Harris et al., 2017; Davis et al., 2021; Mitchell et al., 2023; Ross et al., 2016). It is important to recognize the role that counselors and counselor educators will play in embracing diverse and multicultural aspects within the evolving and emerging field of PAT. Many communities of color face disproportionately high rates of mental health challenges because of a number of factors, including access to culturally competent treatment (Viña, 2024). PAT has the potential to address these disparities, but it can only do so effectively when treatment providers are cognizant of systemic barriers that may impact their clients. It is also important to recognize the influences of culture such as aspects of spirituality and the lived experiences from diverse and Indigenous perspectives within psychedelic therapeutic spaces. Psychedelic medicine use has a rich history in traditional cultures (Celidwen et al., 2023). However, the current psychedelic movement, including the research, predominantly represents Western perspectives, while leaders from Indigenous and diverse communities remain absent (Celidwen et al., 2023; George et al., 2020).

Within the current psychedelic science space, the voices and work of Indigenous communities, racial/ethnic minorities, and other historically marginalized populations often go unnoticed (George et al., 2020). Currently, much of psychedelic research excludes voices and perspectives of diverse populations, including those of women and ethnically diverse groups, in both research and practice. These groups must be acknowledged to ensure that they benefit from these novel approaches.

The diverse perspectives and cultural backgrounds of both counselors and their clients are important. In this article, we explore an array of multicultural considerations and address the importance of adopting a multicultural lens in the training and practice of counselors and counselor educators within the context of PAT. We aim to provide insights into and a comprehensive examination of the potential benefits, ethical considerations, and multicultural perspectives related to the potential integration of psychedelic training into counselor education and supervision. We also explore the urgent need for a culturally sensitive and inclusive approach within PAT, with a focus on areas such as cultural appropriation, legalization/criminalization, potential barriers to access, diversity in training, and research and future implications. Acknowledgment of multicultural perspectives in psychedelic therapy presents opportunities toward greater inclusivity and equity while expanding upon traditional healing approaches. Adopting this approach can enhance the efficacy and ethical foundation of these treatments within diverse communities.

Multicultural Considerations in Psychedelic-Assisted Therapy

Psychedelic substances have deep historical and cultural roots in many Indigenous and other traditional practices worldwide (K. Williams et al., 2022). Many Indigenous groups express concern over the cultural appropriation of psychedelics by Western medicine (Celidwen et al., 2023). Understanding the cultural meanings, rituals, and beliefs surrounding traditional plant medicine and psychedelic use can help counselors provide culturally competent care and avoid appropriating or misinterpreting these practices. Therefore, it is important that mental health professionals and educators approach PAT with sensitivity and awareness of diverse cultural perspectives. These considerations align with the American Counseling Association’s (ACA) Social Justice Competencies by encompassing and explaining the cultural contexts of psychedelic use, respecting traditional healing practices, and promoting inclusivity while ensuring equitable access to treatment (Ratts et al., 2016).

Disparities in Psychedelic Research
     Current research demonstrates that PAT is emerging as a promising therapeutic approach by offering potentially transformative treatments for a range of mental health–related issues. Early PAT researchers conducted controlled trials that demonstrated the safety and efficacy of psilocybin-assisted therapy in the context of end-of-life distress and cancer-related anxiety, depression, and addiction (Griffiths et al., 2006). The trial showed psilocybin-assisted therapy improved psychological well-being and reduced symptoms of anxiety and depression (Griffiths et al., 2016). In addition, controlled studies conducted in recent years have provided compelling evidence of the potential efficacy of psychedelics in treating mental health disorders, such as treatment-resistant depression, post-traumatic stress disorder, and substance use disorders (Bogenschutz et al., 2015; Mitchell et al., 2023).

The recent clinical trials pertaining to PAT offer great promise and beneficial impacts to mental health and well-being. However, these trials historically have limited the inclusion of Black, Indigenous, and people of color (BIPOC) and other marginalized populations (Michaels et al., 2018; K. Williams et al., 2022; M. T. Williams et al., 2020). For example, a study examining recent PAT clinical trials reported 85% of the participants identified as non-Hispanic White and 5% or less of the participants identified as people of color (Michaels et al., 2018). The lack of participation in the research may be due to factors such as historical mistrust (e.g., trauma linked to medical experimentation), lack of cultural sensitivity, accessibility, stigma and discrimination (e.g., legal ramifications), and non-inclusive recruitment strategies (George et al., 2020; Michaels et al., 2018; Thrul & Garcia-Romeu, 2021; K. Williams et al., 2022). Furthermore, in the most recent phase-2 MDMA trial, only 9.5% of the participants identified as being ethnically diverse (Mithoefer et al., 2011). Subsequently the sample from the phase-3 trial showed improvement toward diverse sampling (Mitchell et al., 2023). In a study examining ketamine-assisted therapy, researchers reported that all clinicians in the trial identified as White, while 89% of the participants also identified as White (Herzberg & Butler 2019). This data has important implications for current and future studies, as current results may not be as generalizable to the greater population (Michaels et al., 2018). Even with the increase and interest in psychedelic-related research, the recruitment and inclusion of diverse populations is lagging. Because researchers have primarily conducted empirical research in psychedelic medicine with a majority of White male participants, there is a lack of knowledge about the impact of PAT on minoritized populations (Viña, 2024). The absence of diverse ethnic and minority population representation may hinder the advancement of PAT. Inclusion of diverse groups may offer the opportunity to customize treatment approaches that may be better suited to people of color.

Cultural Impacts of Legalization
     The contexts of sociopolitical landscapes contribute to societal resistance and stigma around psychedelic therapy (Curtis et al., 2020; Hearn et al., 2022). The demonization of psychedelics in the media as well as government campaigns like the war on drugs not only contributed to the stigmatization of these substances and the perception that their use was inherently dangerous, but also fueled fears of a societal impact (Beckett et al., 2006; Sessa, 2016). This resistance can manifest both within counseling communities and the broader cultural context. Additionally, navigating the legal and regulatory challenges associated with multicultural psychedelic therapy adds layers of complexity to its integration into mainstream mental health practice (Marks & Cohen, 2021). The nature of the legalization and criminalization of psychedelic substances has led to hesitancy and resistance among both researchers and mental health professionals (Curtis et al., 2020; Hearn et al., 2022). Resistance to the integration of psychedelic therapy within counseling communities is often rooted in historical narratives, ethical concerns, and misconceptions associated with use (Smith et al., 2022). Many clinicians may fear the legal consequences, professional repercussions, and social stigma surrounding PAT. These impacts may discourage many educators and clinicians from exploring the therapeutic potential of these substances. This could perpetuate a lack of knowledge and formal training within counselor education, leaving educators and clinicians ill-equipped to integrate psychedelics into education and practice. Addressing this resistance requires comprehensive education initiatives within counseling programs. Educators and professional organizations must foster an open dialogue that provides accurate information about the therapeutic potential of psychedelics.

Some jurisdictions have begun to reconsider their approach through a growing recognition of the need for a more evidence-based and compassionate approach to drug policy. States like Oregon and cities like Denver, Colorado, have decriminalized the use of psychedelics (Siegel et al., 2023). The reevaluation of criminalization has opened doors for advancement in scientific research, leading to a resurgence of interest in therapeutic applications (Smith et al., 2022). Moreover, criminalization may limit access to PAT for individuals and communities that may benefit most from these treatments (Devenot et al., 2022). The illegal status of psychedelics presents challenges for patients to find qualified professionals who can provide these therapies legally and safely. Furthermore, the lack of access creates barriers for individuals to explore alternative and potentially transformative treatments for conditions that may be unresponsive to conventional approaches (Smith et al., 2022). Dismantling decades of stigma and overcoming criminalization will require continued advocacy from the counseling profession and mental health field.

Presently, ketamine stands as the only available legal substance that is often classified as psychedelic treatment in the United States. Ongoing research and evolving regulatory landscapes may pave the way for more legal options in the future (Dore et al., 2019). Although most psychedelics remain Schedule I controlled substances, making them illegal for recreational or therapeutic use, practitioners have legally used ketamine to treat treatment-resistant depression. Medical professionals have administered the drug under supervision in various clinical settings, offering hope to individuals who have not responded to conventional antidepressant therapies (Dore et al., 2019; Marks & Cohen, 2021). In the past, the legal classification of psychedelics as Schedule I substances, coupled with strict regulations, have made it challenging for researchers to obtain the necessary approvals and resources to conduct studies. However, researchers have put forth guidelines for testing psychedelics (Johnson et al., 2008). Although more federally funded clinical trials have emerged to highlight the benefits of PAT in recent years, underground use of the substances in community, therapeutic, and spiritual contexts has disproportionately impacted diverse and Indigenous communities (Williams et al., 2022). Furthermore, even with evidence of potential benefits of PAT, state and federal regulatory guidelines create barriers for the use of psychedelics in treatment (Byock, 2018).

Impacts of Criminalization
     The current sociopolitical climate and the overcriminalization of drug use continue to further stigmatize communities of color (Ching, 2019). Almost half of incarcerated individuals are in prison because of drug-related offenses (Buehler & Kluckow, 2024). Black men are imprisoned at a 5.7% higher rate than their White counterparts for similar convictions (Buehler & Kluckow, 2024). Racial disparities among drug arrests continue to persist. Because of these factors, people of color may feel less safe from a legal standpoint and may display more hesitancy to explore psychedelic-related therapeutics (George et al., 2020). People from historically marginalized communities may also be resistant to the use of psychedelics and PAT because of these implications (Ching, 2019). Additionally, psychedelic medicine has been underutilized to treat issues such as race-based trauma within communities of color. A study conducted by M. T. Williams et al. (2021) found a significant reduction in anxiety and depressive symptoms in participants who utilized psychedelics for the treatment of race-based trauma. However, if clinicians are not properly trained and do not understand the mechanics of racism, they can add to their clients’ trauma (Smith et al., 2022). In addition, researchers have argued that the current psychedelic-assisted model of therapy does not properly train counselors to treat BIPOC populations (Smith et al., 2022).

On a broader cultural level, because stigma surrounding psychedelic use persists, it often hinders individuals from diverse backgrounds from considering or openly discussing PAT (George et al., 2020). This stigma is rooted in societal misconceptions, fears, and historical prejudices; it may also include mistrust of the practitioners engaging in this mode of therapy (Smith et al., 2022). Addressing this stigma requires collaborative efforts between mental health professionals and community leaders. Public awareness campaigns that are culturally sensitive as well as education programs and community engagement initiatives can be utilized to challenge stereotypes and misinformation. These efforts should not only emphasize the potential benefits but also any associated risks of PAT. These efforts can assist in the destigmatization of PAT and validate its use as a legitimate therapeutic modality. Without legal access to psychedelic-assisted therapeutic modalities, historically marginalized populations remain vulnerable to criminalization. Advocacy efforts should focus on disseminating information geared toward acknowledging past drug policy harm and the potential for psychedelic healing. Addressing these barriers through advocacy and policy are essential to ensuring equitable access.

Ethical Considerations

The historical use of these substances for spiritual, cultural, and personal purposes challenges the notion of gatekeeping and medicalization. Therefore, ethical considerations extend beyond therapeutic settings to also encompass the possible recreational use of psychedelics (Pilecki et al., 2021). Gatekeepers who limit access to these substances raise questions about equity and personal autonomy. At the same time, there is a risk of overly medicalizing psychedelics, which may strip away the rich cultural and spiritual heritage that has been integral to their use.

Cultural Appropriation and the Commodification of Psychedelic Experiences
     Incorporating diverse and multicultural perspectives into the framework of PAT presents ethical challenges, particularly concerning the risk of cultural appropriation. Cultural appropriation refers to the adoption or use of elements from one culture by individuals or groups, often from a more dominant culture, without understanding, respect, or permission (Sue et al., 2022). Issues may arise in the context of PAT when people appropriate cultural practices or substances with deep historical or spiritual significance. One of the primary ethical considerations revolves around the respect for Indigenous knowledge and practices. Indigenous cultures have utilized psychedelic substances in their spiritual and healing rituals for centuries, and the current psychedelic movement faces challenges with the cultural and historical appropriation of these traditional healing methods (George et al., 2020). The appropriation of these practices without the involvement, permission, or benefit of Indigenous communities raises substantial questions about cultural exploitation and ethical responsibility. For example, the financial exploitation of plant medicines, without direct benefit to Indigenous peoples, could lead to unsustainable extraction of plant medicines, making them unavailable for communal use (Celidwen et al., 2023).

Indigenous and other cultures from around the world have long-standing traditions of working with psychedelic substances for spiritual and therapeutic purposes (Field, 2022). Many Indigenous cultures position the aspect of spirit as an integral component of healing and understanding (Field, 2022). The exploration and use of psychedelics in therapeutic contexts must confront the ethical challenges associated with cultural appropriation and the commodification of psychedelic experiences, which may exclude aspects of spiritual influences. Some may argue that in many Western-based PAT options, there is often an absence or underrepresentation of the integration of spiritual or transcendental aspects (K. Williams et al., 2022). Studies have shown that participants who undergo PAT, such as psilocybin-based therapy, highly correlate mystical or spiritual experiences with treatment (Reif et al., 2020). Although these treatments primarily focus on the clinical and therapeutic benefits of psychedelics, they may sometimes overlook the profound spiritual or mystical experiences that these substances can induce (Griffiths et al., 2006). The subjective nature of spirituality and the hesitance to incorporate it into scientific and clinical models that seek measurement of experiences as validation methods may be contributing factors (Sessa, 2016; K. Williams et al., 2022). However, for many individuals, the spiritual dimension of their psychedelic experiences is deeply meaningful and transformative (Griffiths et al., 2006). Recognizing the spiritual aspects and the potential for personal growth, healing, and enhanced well-being is important in order to offer a comprehensive and holistic approach to psychedelic therapy. This approach respects the diverse ways in which some individuals find meaning and make connections through these experiences.

Medicalization and Decolonization
     The historical exploitation of Indigenous practices, including the appropriation of sacred rituals, also encompasses commercialization of psychedelic substances (Devenot et al., 2022). Because of a number of promising studies, many companies and entities are positioned to profit from the therapeutic potential of psychedelic medicines by seeking to patent psychedelic substances (Marks & Cohen, 2021). Marks and Cohen (2021) argued that this may allow a small number of companies to act as gatekeepers, further restricting access to these emerging therapies. However, many marginalized groups, including Indigenous populations, do not receive these benefits (George et al., 2020; K. Williams et al., 2022). By not acknowledging the cultural roots of classic psychedelics, the colonization and appropriation of these practices may result in the erasure and exploitation of Indigenous knowledge and traditions (K. Williams et al., 2022). Mental health professionals engaging with psychedelic therapy must critically examine and address these concerns to ensure ethical and respectful practices.

As a profession, counselors must ensure that the voices of all cultures, including those who have stewarded plant medicines for millennia, are not lost and that advocacy becomes part of the PAT framework in order to create a more equitable future for all. Counselors should approach these practices with humility, respect, and a commitment to cultural preservation. PAT must acknowledge and address power dynamics, particularly in the context of historical and ongoing debate concerning the use of psychedelic substances. The Multicultural and Social Justice Counseling Competencies provide a guide for praxis to address these issues (Ratts et al., 2016). The current focus on medicalization and profit can overshadow the cultural, spiritual, and therapeutic significance of psychedelic experiences (Devenot et al., 2022; Schwarz-Plaschg, 2022). Furthermore, medicalization attempts to position Western approaches to Indigenous practices as the only legitimate way to utilize these substances may lead to restrictions and regulation of access (Schwarz-Plaschg, 2022). Mental health professionals need to recognize the impact of colonialism on Indigenous practices and the potential for appropriation of psychedelic plant medicines (Sessa, 2016). Educators and practitioners should actively work to dismantle power imbalances by engaging in ethical collaborations to promote the inclusion and empowerment of historically marginalized communities.

The Role of Counseling in Advocacy, Access, and Equity

PAT shows promise for addressing major facets of mental health disparities, particularly among vulnerable and underserved communities (Thrul & Garcia-Romeu, 2021). These communities often face higher rates of mental health–related issues, including trauma, depression, anxiety, and substance abuse, and they could potentially benefit significantly from these innovative therapies (Thrul & Garcia-Romeu, 2021). Counselors should prioritize access to these treatments in communities that are often disproportionately affected by mental health challenges (Herzberg & Butler, 2019; Michaels et al., 2018; Sevelius, 2017; Thrul & Garcia-Romeu, 2021; Williams & Labate, 2020). Psychedelic therapy should strive for equitable access, ensuring that individuals from all backgrounds can benefit from this modality. This requires addressing barriers such as costs and accessibility. Mental health professionals should work toward making PAT accessible and affordable (Herzberg & Butler, 2019; Michaels et al., 2018). This is particularly relevant for economically marginalized communities that have historically faced barriers to accessing quality mental health care. Many individuals from underserved and marginalized communities may face financial limitations that present as a barrier and could potentially limit access, preventing them from pursuing these investigative treatments (K. Williams et al., 2022). For PAT to be equitable, it is essential to consider financial accessibility. Being proactive and advocating for insurance coverage of PAT could significantly enhance access. This, in turn, can increase health and social disparities faced by these communities. As the field of PAT evolves, addressing these issues becomes increasingly important. Counselors must ensure future equitable access to PAT, as equity aligns with the broader goals of counseling and fundamentally links the idea that everyone, regardless of their cultural or socioeconomic background, should have access to innovative and effective mental health care.

Advocacy for policy changes is crucial for improving access to and equity in PAT. Counselors, counselor educators, and the broader mental health community can play a significant role in advocating for policy changes and greater access as these modalities become further legalized. Legal reforms can help decriminalize psychedelics and regulate access to PAT. The creation of standardized training and evidence-based guidelines is essential for those who wish to integrate PAT into their practice (Marks & Cohen, 2021).

Furthermore, counselors can embed PAT in a broader framework of multiculturalism and social justice advocacy by aligning it with the counselor social justice advocacy competencies. (Ratts et al., 2016). This involves addressing historical and ongoing injustices and actively working toward decolonizing practices and systems. Educators and clinicians engaging with PAT should recognize their role in advancing social justice and commit to principles of equity, inclusivity, and cultural empowerment. By approaching PAT with cultural humility and a commitment to ethical practice, professionals can contribute to a more inclusive, respectful, and responsible approach.

Moreover, multicultural perspectives bring depth to the therapeutic process itself. Different cultures have their unique healing practices, spiritual beliefs, and worldviews regarding altered states of consciousness. By embracing multicultural perspectives, counselors can expand their understanding of healing, embrace diverse approaches to well-being, and tailor PAT to meet the specific needs of individuals across cultural backgrounds (Sevelius, 2017). Promoting diversity and inclusivity within the field by training, providing educational opportunities to individuals from diverse backgrounds, and prioritizing the inclusion of diverse perspectives in research and practice can help promote equity. Development of inclusive policies that address historical injustices as well as ethical and cultural considerations aimed at reducing disparities in access related to psychedelics is crucial (M. T. Williams et al., 2020).

Multicultural Perspectives, Strategies, and Implications for Practice

Integrating multicultural perspectives into counseling practice is important for fostering inclusive and effective mental health care, particularly in emerging fields like PAT. Integrating diverse viewpoints and practices can help address systemic barriers, promote inclusivity, and enhance therapeutic outcomes for marginalized populations and other underrepresented groups. By addressing issues related to diversifying psychedelic research, diversifying the counseling workforce, and emphasizing culturally responsive approaches, counselors can create spaces that address diverse experiences. This section outlines actionable steps and strategies designed to incorporate multicultural frameworks into training, research, and practice.

Psychoeducation for Advocacy in Psychedelic-Assisted Therapy
     Counselors play a pivotal role in advocacy efforts for PAT by providing psychoeducation that empowers everyone—clients, marginalized communities, and the general public. Counselors can tailor psychoeducation to address the historical use of psychedelics and tackle issues related to marginalized populations, including common barriers to access. One strategic approach is to have counselors engage with clients and communities and educate them about the current changing legal landscape surrounding psychedelic substances, which includes regulatory changes and clinical trials that are shifting the conversation toward wider acceptance (Nichols & Walter, 2021). Providing accurate information about the safety, efficacy, and cultural history of psychedelics, specifically in non-Western and Indigenous contexts, can help reduce stigma and promote informed decision-making (George et al., 2020).

Additionally, professional counselors can offer a variety of workshops and community outreach programs that discuss the therapeutic potential of psychedelics and address concerns specific to underserved communities, such as fears of legal ramifications or historical trauma linked to medical experimentation (George et al., 2020; K. Williams et al., 2022). Legal reforms will help decriminalize psychedelics and regulate access to PAT. This approach should be culturally responsive to ensure that materials and discussions are tailored to the needs, values, and historical experiences of these populations.

Lastly, counselors can advocate for systemic change by collaborating with state and local organizations and policymakers to disseminate information about the potential benefits of PAT, specifically for treating trauma-related disorders in communities of color (Doblin et al., 2019; M. T. Williams et al., 2020). Counselors must also advocate for insurance coverage by lobbying through a call for action to reduce financial barriers for marginalized groups. Through a psychoeducational approach, counselors will advocate for more equitable access to PAT.

Diverse Representation in Psychedelic Research
     Discussing multicultural approaches in PAT helps researchers and counselors develop cultural competence, address biases, tailor treatment to individual needs, foster trust, empower clients, and promote social justice. By embracing a multicultural lens, researchers can create more effective and inclusive protocols for care that respect and acknowledge the diverse cultural backgrounds and identities of their clients (Scharff et al., 2010). Considering cultural factors in research of PAT is essential to ensure that therapy is relevant, respectful, safe, and inclusive (George et al., 2020). It promotes cultural sensitivity that acknowledges the diversity of human experiences, which aids counselors in providing effective and meaningful support to their clients so that PAT is accessible to individuals from diverse cultural backgrounds.

Diverse representation requires cultural sensitivity training to produce culturally competent research teams consisting of clinicians, researchers, and support staff. One strategy is to offer training that focuses on respecting and understanding diverse beliefs, values, cultural practices, and communication styles (Brennan & Belser, 2022). Diverse representation also entails having culturally different populations as participants in clinical trials. Engagement and collaboration must be addressed when tailoring recruitment strategies, dealing with barriers to access, enhancing language accessibility, and combating historical stigma through community education (Herzberg & Butler, 2019). Recruitment strategies using educational programs that specifically target underrepresented groups should involve culturally relevant communication channels to reduce stigma and increase awareness about psychedelic research within diverse communities.

Partnerships with community organizations and collaboration with community leaders will promote insight into specific cultural nuances and values and help build trust within diverse communities (Williams & Labate, 2020). Ethical considerations, including informed consent, privacy, and confidentiality, must be carefully addressed while also respecting and integrating the cultural contexts and values of participants (Smith et al., 2022). Along with increasing awareness, collaboration identifies barriers, such as financial constraints and transportation, that prevent marginalized individuals from participating. Adapting PAT protocols by incorporating traditional healing practices and spiritual elements that are meaningful to participants from diverse backgrounds creates additional cultural sensitivity around including culturally different populations (Celidwen et al., 2023). Diverse representation in psychedelic research is not only an ethical imperative, as outlined in the ACA Code of Ethics (ACA, 2014), but also is essential for producing results that impact diverse populations. It is vital to ensure that individuals from a broad spectrum of cultural and ethnic backgrounds understand the benefits and risks of PAT.

Diversifying Psychedelic Training and Workforce
     Specific guidelines for PAT vary and remain unclear (Schwarz-Plaschg, 2022). Moving forward, it is imperative that the counseling profession and governing bodies work together to create diverse training and treatment modalities. Furthermore, it is important that future PAT is reflective of people from diverse backgrounds to better fit the needs of people of color. Many current protocols and training programs are developed without input from diverse voices, which can result in a lack of cultural awareness regarding participants’ experiences (Buchanan, 2020). Incorporating a diverse array of clinicians from various backgrounds into psychedelic therapy training is a crucial step in ensuring the cultural relevance and effectiveness of these therapeutic approaches. Ensuring clinicians are culturally competent in training will help to build trust and rapport with clients from diverse backgrounds. Addressing mental health disparities within marginalized communities will also aid in culturally appropriate treatment approaches. Clinicians of color and clinicians from other diverse backgrounds bring valuable perspectives and cultural insights that enrich the field and promote a more inclusive, equitable, and effective approach to psychedelic therapy. Having a diverse workforce also aligns with and promotes the broader principles of social justice and health care equity. In the current landscape of psychedelic research and practice, people of color and women are often overlooked as leaders (Buchanan, 2020; George et al., 2020). Diversity in the workforce also reinforces the importance of making access to PAT equitable through representation. One strategy for diversifying the workforce is to encourage counseling programs to partner with other PAT training programs and offer scholarships and fellowships for training that create educational opportunities for marginalized students, thus promoting diversity and inclusivity. These scholarships and fellowships can specifically fund trainings for historically marginalized students.

As the counseling profession begins to explore ways to incorporate PAT into counselor training, embedding multicultural counseling competency as a foundational element of their PAT curriculum is recommended. One example could include introducing PAT in a counseling theories course as an emerging therapeutic framework to potentially treat treatment-resistant disorders. Exploration of PAT can also be included in a multicultural counseling course. This requires the inclusion of coursework that explores the history, cultural significance, and modern therapeutic applications of psychedelics across different cultures. Students should learn how various communities have actively integrated psychedelics into their healing practices for centuries, particularly in regions where plant medicines play a central role in traditional health and spiritual rituals.

Counseling programs may also include courses that provide specific training on addressing the cultural and historical trauma that may arise in clients from marginalized communities. For instance, the war on drugs disproportionately impacted Black and Indigenous communities in the United States, which may influence how they perceive psychedelics and PAT (Buchanan, 2020; Carhart-Harris et al., 2017). Counselors must receive training on acknowledging and addressing historical traumas when working with clients from these backgrounds, utilizing trauma-informed approaches that validate their experiences and build trust (Williams & Labate, 2020).

In addition, counselors must develop skills in culturally relevant communication to effectively engage with clients from various backgrounds. This includes being mindful of how different communities and clients may interpret the psychedelic experience. For example, some Indigenous groups may share experiences through a spiritual or shamanic lens, while others may relate their experience to their unique cultural background. Counselors should receive training from culturally competent PAT practitioners and established PAT programs to adapt their communication styles to respect cultural nuances and avoid the imposition of a singular Western therapeutic approach (George et al., 2020).

Community Collaboration
     Collaborating with diverse communities in the context of PAT is crucial for fostering culturally sensitive practices that honor traditional knowledge and ensure ethical integration into modern therapeutic frameworks. A potential strategy is for counselors to form community partnerships with individuals from the cultures whose practices are being integrated and ask these individuals to offer valuable insights and guidance on ethical considerations. An example from the literature describes panels from Indigenous communities creating a list outlining eight ethical considerations for engaging in psychedelic medicine. They include concepts pertaining to Indigenous knowledge, nature, and ways of being and knowing (Celidwen et al., 2023). These panels can help ensure that cultural perspectives are appropriately integrated into the therapy process. Moreover, collaboration with Indigenous and other cultural communities should involve mutually agreed-upon benefit-sharing arrangements. These arrangements can include providing financial support, resources, or other forms of reciprocity to recognize the value and utilization of the used cultural knowledge. Collaborating with Indigenous communities and leaders through engagement and partnerships can guide the creation of culturally sensitive and ethically appropriate practices and training while incorporating traditional healing and spiritual elements into research and training protocols. This collaboration can help create culturally competent research teams with diverse representation that can aid in recruiting underrepresented groups for clinical trials through education and trust building. This continual evaluation helps minimize cultural appropriation and preserves cultural sensitivity, which aligns with ethical principles that promote inclusivity, respect, and justice. These principles correspond with the multicultural and social justice advocacy competencies (Ratts et al., 2016).

Conclusion

Looking ahead to the future of counseling in psychedelic therapy, it is essential to acknowledge and honor the Indigenous and other cultural history and traditional use of these substances. Many cultures have maintained profound relationships with psychedelics as healing tools for generations by utilizing them in sacred rituals and healing practices (Fotiou, 2020). This cultural context offers valuable insights into the therapeutic potential of these substances and underscores the need for cultural humility and acknowledgment within the field of PAT. Recognizing Indigenous knowledge and practices not only informs our approach, but it also highlights the importance of collaborating with these communities and leaders (George et al., 2020). By doing so, counselors can foster a more inclusive and equitable future for PAT.

By acknowledging the diverse ways in which individuals experience healing, PAT has the potential to break down barriers and reduce mental health disparities. The future of PAT rests significantly in the hands of counselors and other mental health professionals. Additionally, culturally competent and inclusive psychedelic training can address disparities and promote equity in mental health services. As ambassadors of mental health and well-being, counselors can play a pivotal role in shaping the narrative around PAT. Educators bear the responsibility of imparting the knowledge, skills, and cultural competence required to navigate this evolving landscape. Incorporating psychedelic education into counseling programs equips future professionals with the skills to meet the diverse needs of their clients. Counselors can assist in these efforts by actively engaging in destigmatizing PAT, advocating for legal reforms, and promoting cultural humility that recognizes the significance of multicultural perspectives. Embracing multicultural perspectives in PAT is not merely an ethical imperative; it is a guide toward a more compassionate and holistic vision of mental health and well-being. Counselors, as educators, clinicians, and advocates, have the potential to shape a future that integrates the potential significance of PAT with cultural competence, offering profound respect of diverse experiences.

 

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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Brittany L. Prioleau, PhD, NCC, ACS, LPC, CIMHP, is an assistant professor at Mercer University. Shama Panjwani, PhD, NCC, LPC, is an assistant professor at Keiser University. Correspondence may be addressed to Brittany L. Prioleau, 3001 Mercer University Dr., Atlanta, GA 30341, prioleau_bl@mercer.edu.

Taking Action: Reflections on Forming and Facilitating a Peer-Led Social Justice Advocacy Group

Sunanda M. Sharma, Jennifer E. Bianchini, Zeynep L. Cakmak, MaryRose Kaplan, Muninder K. Ahluwalia

According to the American Counseling Association and the Council for Accreditation of Counseling and Related Educational Programs, social justice advocacy is an ethical imperative for counselors and a training standard for counseling students. As a group of socially conscious mental health counseling students and faculty, we developed and facilitated a social justice advocacy group to learn about tangible ways to engage in social justice action. Using the S-Quad model developed by Toporek and Ahluwalia, we formed and facilitated a social justice advocacy group for our peers. This paper will serve as a reflection of our experiences engaging in the process.

Keywords: social justice, advocacy, counseling students, S-Quad model, mental health

When describing the motivation for her political aspirations, Georgia gubernatorial hopeful Stacey Abrams (2019) stated, “We have to have people who understand that social justice belongs to us all.” This quote speaks to this group of authors who feel strongly about the importance of social justice in mental health counseling. This ethos served as the motivation to create a peer-led group to foster the development of our social justice advocacy skills. We used the S-Quad model (Toporek & Ahluwalia, 2020) to form and facilitate a social justice advocacy group for master’s and doctoral counseling students at our institution.

Historically, the counseling profession has been rooted in social justice advocacy (SJA) with Frank Parsons’s efforts to support White European immigrants in the United States to develop their vocational goals (Gummere, 1988; Toporek & Daniels, 2018). However, SJA has not been consistently operationalized across counselor training programs (Counselors for Social Justice [CSJ], 2020). Although ethical standards established by the American Counseling Association’s ACA Code of Ethics (ACA; 2014) encourage counselors to advocate for clients and communities when appropriate (A.7.a, A.7.b.), and training standards established by the Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2015) state that SJA should be a part of counseling curriculum (2.F.2.b.), counselors have reported receiving little guidance about how to implement advocacy in practice (Field et al., 2019; Ratts & Greenleaf, 2018). As counseling students, we experienced the same concern. To address this gap in our educational experience, we created and facilitated a group based on the S-Quad model (strengths, solidarity, strategies, and sustainability) of SJA (Toporek & Ahluwalia, 2020). As a group of socially conscious mental health counseling students, our aim was to grow in our roles as professionals by learning about, teaching, and engaging in SJA. In the process, we learned about ourselves as budding counselors and educators.

Literature Review

In their foundational article, Vera and Speight (2003) called on the counseling profession to expand its understanding of multicultural competence; they asserted that without SJA, counselors are perpetuating the systems of oppression from which their clients are attempting to heal. Utilizing intrapsychic approaches which neglect to account for contextual factors not only perpetuates oppressive counseling practices, but it also does a disservice to those with marginalized identities (Ratts, 2009; Vera & Speight, 2003). In order to properly serve clients, counselors must step beyond the classroom, expand the original conceptualization of our roles, and explore beyond the counseling office (Ratts, 2009; Ratts & Greenleaf, 2018; Vera & Speight, 2003). Despite the increase in available resources such as the ACA Advocacy Competencies (Toporek et al., 2009) and the Multicultural and Social Justice Counseling Competencies (MSJCC; Ratts et al., 2016), the number of sociocultural forces such as racial demographics of counseling programs and reliance on theories and interventions developed for White European clients prevents social justice from being a central force in the profession (CSJ, 2020).

As mental health professionals, we are positioned to understand the impact that oppression has on health (Nadal et al., 2021), which speaks to the need for operationalizing social justice counseling and SJA so counselors may support client wellness. Counseling students require more knowledge and practice to obtain appropriate resources and tools in order to intervene and resist systemic oppression (Vera & Speight, 2003). Ratts (2009) named social justice as the “fifth force” in counseling in an attempt to concretize the relevance and importance of challenging the status quo in counseling. However, the perceived attitude of the counseling profession toward social justice is reflected in the definition of counseling. The 20/20 initiative was a movement to unify the profession and solidify professional identity by arriving at the definition of counseling. Delegates from 31 counseling-related organizations (e.g., CACREP, Chi Sigma Iota) participated in a Delphi-method study to achieve consensus on a definition; however, only 29 organizations ultimately endorsed the definition (Kaplan et al., 2014). Although the definition for counseling includes the word “empower”; it does not include the words “social justice” or “advocacy.” Thus, CSJ was one organization that did not support the new definition (Kaplan et al., 2014). Despite these challenges, Ratts and Greenleaf (2018) assert that counselors must develop the advocate part of their identity, yet they note that there is more of a focus on traditional counseling skills rather than acknowledging the shifting sociopolitical climate and equipping counselors with the skills to address these concerns. The leadership and advocacy course (or the content in another course; CACREP, 2023) in CACREP-accredited counseling doctoral programs often only focuses on leadership and advocacy within and for the profession. Although CACREP (2023) standards do not dictate the courses a counseling program must offer, there continues to be limited discussion of SJA and social justice, nor are there solid instructional methods for counselor educators to use in the classroom (Chapman-Hilliard & Parker, 2022). This situation hinders students’ understanding of the role systemic issues have on minoritized communities, further deterring people in those communities from seeking help.

As counselors and counseling students, we understand our responsibility to advocate for clients, but we feel unprepared to fulfill our ethical (and for many of us, moral) duty. We did not learn enough about the concrete, tangible skills that a professional counselor can utilize to challenge oppression and inequity. We were unable to locate any studies regarding peer-led SJA groups for counseling students, thus we hope to contribute something novel to the counseling literature and encourage counseling students to better understand and grow into their roles as social justice advocates. Counselors-in-training (CITs) and practicing counselors within the profession sometimes question the relevance of SJA and report feeling confused about how to implement SJA in counseling (Field et al., 2019; Ratts & Greenleaf, 2018). hooks (1994) notes it is imperative that a student accepts responsibility for their education and becomes “an active participant, not a passive consumer” (p. 14). Thus, we engaged in this process to support our colleagues in the counseling student body and take accountability for our education.

Taking Action: Social Justice Advocacy Group

Leading organizations in the profession claim a two-pronged approach to advocacy: one prong advocating for the legitimacy of the counseling profession, and the other advocating on behalf of the clients and students whom counselors serve (Chang et al., 2012). In our educational experience, SJA on behalf of and in partnership with clients was emphasized, but tangible interventions were not discussed. Further, systemic issues and inequities were often left unaddressed. Thus, we developed this group to more concretely address the second “prong” of advocacy in counseling. First and fourth authors Sunanda M. Sharma and MaryRose Kaplan were part of the executive board of Chi Sigma Mu (Chi Sigma Iota chapter at Montclair State University) and co-founded the social justice committee. Second and third authors Jennifer E. Bianchini and Zeynep L. Cakmak were the first members of the committee who proposed ideas and facilitated events and activities related to social justice that they felt passionately about. Bianchini proposed a social justice book club ahead of a presentation that the CSI chapter organized (hosting the authors of the book Taking Action). The book club met three times with up to three students, from whom we received feedback to help us form the SJA group.

The following semester, fifth author Muninder K. Ahluwalia proposed restructuring the book club into an advocacy group by utilizing the Taking Action text as a framework to teach students about systemic SJA. CACREP (2015) standards state that multiculturalism and social justice must be discussed throughout counseling courses (2.F.2.b.); however, in our experiences, we found that social justice is addressed as an ethical and moral imperative, but curricula do not address concrete SJA skills and strategies to combat systemic oppression. The counseling program in which the first four authors are enrolled and the fifth author is a faculty member offers a social justice counseling class as an elective. However, the class is not consistently offered every semester and has only been taught by that one faculty member. Thus, our aim with this group was to provide a space for our colleagues in which we could collaboratively learn about how to enact social justice. This section will describe the S-Quad model, explain the group structure, outline the proposed learning objectives, and provide a table that outlines the curriculum of the group.

The S-Quad Framework
     As a profession, mental health counseling is positioned to “buffer” against challenges with oppression and changes to the status quo (Kivel, 2020). There is an emphasis on intrapsychic interventions to combat systemic issues, rather than attempt to uproot the oppression itself (Kivel, 2020; Ratts, 2009; Toporek, 2018). Toporek (2018) noted that upon reflection of the way the profession is positioned and her privileged identities, she developed a framework through which to take social justice action despite the challenges she continues to encounter. The S-Quad model includes four Ss for social justice advocates to formulate a way to address systemic injustices: strengths, solidarity, strategy, and sustainability (Toporek & Ahluwalia, 2020).

Strengths are described as a combination of one’s existing “skills, knowledge, and expertise” (Toporek & Ahluwalia, 2020, p. 27). Although strengths can be qualities one already has, both personal and professional, the authors also encourage budding advocates to reflect upon strengths that they would like to develop. Solidarity has multiple facets to its definition, as advocates are asked to support, honor, and respect communities they intend to engage with and to also seek support from their personal networks to remain grounded (Toporek & Ahluwalia, 2020). Solidarity is enacted through collaborative efforts and through the lens of cultural humility (Toporek & Ahluwalia, 2020). Strategy is the implementation of strengths and solidarity to construct a plan of action (Toporek & Ahluwalia, 2020). It is important to evaluate the efficacy, efficiency, and impact of different strategic plans to ensure they work toward the stated goal and—most importantly—benefit the community that the action is intended for (Toporek & Ahluwalia, 2020). Finally, a unique facet of the S-Quad model is the fourth “S,” sustainability. Sustainability addresses the wellness of advocates; without it, there is a higher likelihood they may abandon their efforts. SJA can be an enriching and healing practice, but it can also be an emotionally draining pursuit, and one can feel helpless when attempting to combat the gravity and breadth of oppression (Toporek & Ahluwalia, 2020). Thus, the authors encourage budding advocates to take an inventory of the practices that replenish and nourish them in order to remain engaged in their work.

Group Structure
     Sharma proposed structuring this SJA group as a biweekly, one-hour, peer-led, open (students were free to join at any point) psychoeducation group, whose grounding framework would be the S-Quad model (Toporek & Ahluwalia, 2020). Due to COVID-19 restrictions, we facilitated the group through Zoom. The objectives of the group were: to describe all components of the S-Quad model, to describe the ethical responsibility of being a social justice advocate, to create a solidarity network of fellow advocates, to increase awareness of how one’s positionality impacts their advocacy work, and to apply the S-Quad model (Toporek, 2018) through the creation of a social justice action plan (Sheely-Moore & Kooyman, 2011). Initially, the intention was to divide each group session into two parts. The first part of the session would be didactic, in which we would discuss the “S” of that week and ground it in a case study. The second half of the session would offer members the chance to process the content so they can apply what they are learning to their social justice plan. Upon reflection and discussion as co-facilitators, we recognized the challenges associated with attempting to address so much content in a 60-minute session and collectively agreed to shift the group and make it akin to a flipped classroom by including pre-recorded didactic videos. This afforded members the chance to view the videos at their own pace and come to the session prepared to engage in dialogue.

In our experiences, instructors who taught our counseling theories courses recommended for us to select one theory to learn about before declaring our theoretical orientation. Similarly, we asked members to narrow down their focus for the purposes of this group to a cause within a community that they feel passionately about. The other structural component we addressed with group members was that this curriculum is cumulative but not necessarily linear; so, an application of the previous “S” is necessary to study the following “S.” For example, once a group member identifies their strengths, we apply those strengths to inform what strategies they will use, but it does not necessarily mean that strengths are not revisited.

Given that this was a psychoeducation group rather than a traditional course, we did not want to use typical didactic methods to engage with this material. We intentionally paired each part of the S-Quad model with a story about an advocate from a minoritized community of whom others likely may not be aware. This demonstrated that SJA is not always done on a public stage. This narrative form of teaching (Hannam et al., 2015) allowed us to contextualize stories of advocates who are quietly resisting oppression in their respective communities. We spotlighted those stories so members could feel less intimidated by the prospect of SJA. In the interest of social justice and accessibility, the Chi Sigma Iota Counseling Honor Society’s Chi Sigma Mu chapter at Montclair State University funded books for interested members so they could follow along with the activities and didactic content. After the second session, we also introduced the idea of the social justice action plan. Table 1 shows the structure/syllabus of the group that we utilized for the semester and describes the ways in which we adapted to agreed-upon changes.

Table 1

Taking Action Group Structure

Week Topic & Activity Assigned Content/Activities
Week 1 Introducing

Taking Action

S-Quad Model

• Purpose, rationale, and structure of group

• Group agreements/norms

• Overview of S-Quad model (Toporek & Ahluwalia, 2020)

• ADDRESSING model (Hays, 2022), a framework that explores individual identity in context

• Difference between justice, charity, philanthropy

Week 2 1st S: Strengths

Activity 4.2, p. 29**

 

 

• Reviewing agreed-upon group norms

• Defining strengths

• Case study: Arunachalam Muruganantham (“The Pad Man”)

Processing case study as a group

• Introducing the social action plan

Week 3 Co-facilitators reflection meeting • This session was initially planned to address the 2nd S in the S-Quad, but no members attended the group this day. Instead, as co-facilitators, we met to discuss the progress of the group.

 

Week 4* 2nd S: Solidarity

Activity 5.1, p. 55

• Defining solidarity

• Case study: 4 young Black women, Black Lives Matter protests

Combining strengths and solidarity

Processing case study as a group

Week 5 3rd S:

Strategy

Activity 6.1, p. 66

• Defining strategy

• Case study: Cakmak

Strength, solidarity, and strategy

Processing case study as a group

Cakmak’s social action plan

Week 6 4th S:

Sustainability

Activity 7.6, p. 176

 

• Defining sustainability

• Case study: Alexandria Ocasio Cortez

Strength, solidarity, strategy, and sustainability

Processing the importance and guilt of self-care

Processing burnout

Week 7 Final Group

 

• Case study

Apply ADDRESSING, S-Quad model

• Feedback from members

*Marks shift to videos for the didactic portion
**All activities listed are from Ahluwalia & Toporek (2020).

 

Reflections

In this section, we offer our reflections on the group and extract salient collective themes that have come about through our processing. In our first session, we informed the group members that we intended to write a reflection paper, and they gave implicit consent to this writing; we did not collect data from group members for the purposes of this article. We begin by grounding the discussion of the group by acknowledging our positionality and social location and how that influenced how we approached our facilitation and planning of the group. Sharma, Bianchini, and Cakmak will provide their most salient takeaways from the forming and facilitation of the Taking Action group.

Positionality
      Sharma identifies as a cisgender, South Asian (Indian), middle-class, able-bodied woman who is a doctoral candidate in a CACREP-accredited counseling program and a full-time lecturer in a CACREP-accredited counseling program. I bring a bicultural perspective to my counseling practice and education, and I have attended primarily White institutions (PWIs) for most of my life. As a master’s and doctoral National Board for Certified Counselors Minority Fellowship Program fellow, I learned about the importance and practice of SJA. I am a practicing clinician in private practice (working mostly with White clients), and I engage in advocacy work with South Asian intimate partner violence survivors.

Bianchini identifies as a White, cisgender woman who grew up in a predominantly White community in the United States. My family has lived in the United States for several generations and the majority of my extended family identifies as part of the middle class. I do not have any disabilities and am a practicing Christian. I am a master’s-level graduate student and joined Chi Sigma Iota’s social justice committee in my first semester of coursework.

Cakmak identifies as a Muslim American, cisgender woman of Turkish origin. I do not have any physical disabilities, but I have been diagnosed with general anxiety disorder (GAD) and major depressive disorder (MDD). I identified as part of the upper middle class in Turkey as a child, and I am middle class as an immigrant in the United States. I have two graduate degrees, one in literature and one in counseling. I have done volunteer work with underrepresented religious and cultural communities since I was in high school.

Themes
     As cocreators and coauthors, we reflected on our collective and individual experiences of facilitating our Taking Action group. We each completed individual reflection sheets within 48 hours of each group session to capture our takeaways, and we processed our experiences together after each group session. We reviewed our reflection sheets individually and noted themes that arose for each of us. We then collectively reviewed the sheets to determine what themes arose across our reflection sheets. We reengaged in the reflection process as we wrote this manuscript. In this section, we highlight the major themes among our experiences.

Fear
     The most significant theme of our collective experience was fear. Throughout each session, fear came up under several different guises, which served as an umbrella for additional themes: judgment, self-efficacy, and humility. Fear was the main antagonist preventing us from doing social justice work before this program. Fear of not knowing the necessary information, fear of saying or doing the wrong thing, and fear of not helping enough or adequately were examples of how this feeling manifested. However, engaging in this group helped us alleviate that fear through resources, support, and a plan of action. In the first session, we felt tentative and timid, and optimistic yet stagnant. After providing members with more information and concrete steps to create real social justice action, our fear dissipated, our passion for working as a group was ignited, and the motivation to take action began.

Judgment
     In our first session, when we engaged members in a dialogue about group agreements, we noticed that there was more focus on the importance of the group serving as a judgment-free space than as a confidential one. We felt that members wanted to feel safe in the group because they feared being judged due to their self-perceived incompetence. We recognized they did not want to feel judged by others if their ideas were deemed unacceptable or incorrect. Establishing a nonjudgmental space permitted members to try, even if the outcomes were not as they hoped. We believe it allowed members to have a safe space to begin processing what they understand about SJA.

Judgment was a recurrent theme and shifted from self-judgment to judging others. Members reported feeling frustrated and upset when their peers in the program were not at the same level of advocacy awareness and action as they were. They reported feeling angry about others’ ignorance. Through a shared reflection on these feelings, the group acknowledged that the judgment of others reinforces the barriers to change that we are trying to knock down. Members recognized the importance of being humble regarding other people (another theme discussed below) and empathetic to help manage feelings of judgment.

When discussing sustainability and self-care, members and facilitators shared our hesitations to implement sustainability practices, despite it being an ethical responsibility. This hesitancy revealed itself to be motivated by self-judgment of our productivity levels. It appeared that the group members would not allow themselves the breaks they needed to provide self-care because of the importance they gave to SJA. We then discussed the need to be unapologetic in our self-care as advocates and counselors.

Self-Efficacy
     Related to judgment of self and others, we found self-efficacy was another significant and recurrent theme. Almost every group member expressed that they were struggling to feel like they could contribute enough to society to perform real social justice action rather than charity. Having members share similar insecurities resulted in an insightful and vulnerable conversation that helped us to feel connected and inspired. In the second session, members reported experiencing imposter syndrome, likely resulting from their low self-efficacy in social justice work. Our self-efficacy grew throughout the sessions as members received the information and tools they needed to take concrete steps in SJA. Once we clarified a reasonable idea of what was expected of them and had some direction, they felt more prepared to take action.

Humility
     Lastly, the theme of humility appeared in several different iterations. The humility through humor with which we, as facilitators, approached this process helped break the ice and create a comfortable atmosphere in our initial meeting. Humility emerged in our second session when discussing the first “S” of the S-Quad model, strengths. In our reflection process, we noted that both facilitators and members appeared to be uncomfortable when sharing what they are “good” at. We, as female-identifying co-facilitators, noted the societal pressure and shame that have historically come with feelings of discomfort for behavior commonly regarded as boastful.

In the fourth session, the group discussed the importance of humility within their community. Members discussed how it was easy to humble oneself when trying to assist a community from the outside, but that it was an important lesson that we must be humble within our own communities. Members seemed to realize that their experience of their community and identity would not be the same as the next person’s, highlighting the importance of intersectionality within the human experience.

Humility was next discussed in the fifth session in terms of failure. Members acknowledged the importance of possessing humility and patience regarding our work because we will generally fail more than we will succeed in our efforts to create change. If we never failed, we would never learn from our mistakes and there would be no more SJA to do. However, knowing this instills the hope to persevere, for you never know what your planted seeds of action will grow into.

Combining Themes
     As facilitators, we noticed a parallel between what we were experiencing and our members’ experiences. From the start of our group, we felt we needed to be more qualified to be teachers of SJA. This was our campus’s first peer-led advocacy group, which meant we did not have any models to reference, and we had to rely on our own ideas, skills, and judgment. With faculty support, we went outside the confines of our curriculum because we wanted to share and engage with this content in a meaningful way. This was a large undertaking, with little training and even less confidence. Similar to what we observed in our members, we were afraid of making mistakes in the content, direction, and discussion of this group because of the weight of the topic of social justice—especially as the first group any of us attempted to create or lead. We had to adapt to constantly developing circumstances, and this felt inappropriate for us as leaders. Something we recognized much later was that we could teach and learn simultaneously; we did not need to reach a point of expertise before developing this group. Although we do not consider ourselves experts in SJA, the work we did to prepare for each session, combined with the humility with which we presented ourselves and our work, effectively allowed us to lead the group to the best of our ability.

Another source of our fear was that there was an ulterior motivation for creating this group, which was not purely social justice–oriented. We sought a sense of community, particularly given the isolating COVID-19 pandemic we were living through, and running this group gave us that community, support, and friendship. This longing for connection played into our feelings of being unqualified to do social justice work because a few of us became involved in this project out of a desire to work with friends, and not solely because we wanted to devote ourselves to social justice. However, this search for connection and participation in this SJA group gave us a passion for this work if it was not present beforehand. That feeling of connection and belonging provided us with the inner power to attempt something bigger than ourselves. The bond we authors created while facilitating this group instilled the importance of collaboration, especially when doing something new, significant, and daunting. The “S” for solidarity was also particularly salient in this case; we recognize that we could not have created or run this group alone. We needed each other to not only complete all the work required but also to hold each other accountable, support each other in times of need, and encourage each other to keep going even when our hopes dimmed. In a sense, this group and the connection to each other provided the “S” for sustainability and wellness for ourselves and our work.

While reflecting on these two sources of our fear as facilitators, we discovered our desire to make this call to the counseling profession: to strengthen the bridge between academia and counseling in practice. Applying the knowledge gained from our courses to daily practice could be less intimidating and feel more like the natural progression of our nascent counseling careers. However, once the opportunity arose to test our skills, we felt hesitant and unprepared. Creating an advocacy group is not the only venue in which this fear of practice appears. As students, we authors felt a similar fear when stepping into our practicum and internship sites. It is natural to feel afraid when seeing clients for the first time as CITs, but this fear could be lessened by academic leaders guiding students into the field before their final year of studies. If more opportunities to work with real issues affecting communities were available to students and supported by faculty, the transition between the classroom and fieldwork would feel less daunting.

Discussion

Although this project was not an empirical study, our reflective process taught us about how it feels to learn about SJA and the labor required to teach about SJA. With this knowledge, we have identified potential implications for the counseling profession and counselor education training programs. We also acknowledge the limitations of the group we formed and facilitated.

Implications
     Per our experience, we believe social justice counseling—and advocacy skills more specifically—must have a more prominent place in counseling curricula. Potential solutions may include consistently operationalizing social justice counseling and SJA in counselor training programs (CSJ, 2020). Furthermore, it is imperative to have more guidance from our institutional standards such as CACREP (2023) and to have more ethical standards regarding SJA in the next iteration of the ACA Code of Ethics. CACREP (2023) requirements establish content that should be covered throughout all coursework, rather than specific classes; however, each program might have a different approach to operationalize these standards because they are vaguely defined (Austin & Austin, 2020).  For example, in the current CACREP (2023) standards, there is more frequent mention of social justice compared to the 2016 CACREP standards; however, there is still ambiguity about how this may present in a counseling course. Standard 3.B.1 (CACREP, 2023) says that counseling curricula must state how “theories and models of multicultural counseling, social justice, and advocacy” are addressed, but there is no mention of techniques, interventions, or skills for SJA. As a point of comparison, there are specific guidelines with respect to content like group counseling which delineate time that students must spend engaged in direct experience. However, it appears that social justice and SJA are still referred to in broader terms with fewer contingencies about how they must be addressed. We recognize that out-of-class work like advocacy might be left out of the curriculum because there are many required courses and training standards filling up students’ time in graduate school (Vera & Speight, 2003). However, we urge counseling leaders to consider the importance of SJA and the core role it plays in our healing work and our counseling identity.

Limitations and Future Directions
     This group was developed and facilitated to encourage counseling students to develop their social justice advocate identity, but it was not an empirical study, and our collective reflections can only offer so much insight to facilitating such groups in the future. As this was an extracurricular group for which attendees took time out of their personal schedules, we do not know what motivated our peers to attend sessions that we offered. This would be important knowledge to address in future offerings of this group and to understand students’ attitudes toward social justice in counseling. Another limitation of our group was our inability to reach students who are unsure of what social justice is and might not recognize it as an inherent and imperative part of mental health counseling. Practicum and other service-learning opportunities for SJA within the profession have been explored in the literature (Farrell et al., 2020; Field et al., 2019; Langellier et al., 2020), but perhaps peer encouragement can help CITs to feel more confident as advocates. Although we intentionally kept the group open for accessibility, new introductions and catching up took time away from the group plan and content. We do not have data to explicate a group like this, but we hope our master’s and doctoral peers feel encouraged to start similar groups within their own programs. Finally, we wrote this article more than a year after our group ended; although we relied on our reflection sheets and notes from our experience, we are aware that there may be gaps in our recollections.

For future groups, we would be interested to complete an empirical study through an IRB in order to collect data regarding peer-led SJA groups. Screening or surveys before and after the group could not only provide valuable data, but also offer guidance for attendees even before the group starts and an opportunity for reflection after the group ends. Our decision to keep our group open led to attrition of members; thus, empirical studies might also investigate factors that contribute to student engagement. Collecting quantitative and qualitative data may provide further insight into effective strategies for describing and encouraging students to engage in concrete SJA skill development.

Conclusion

The experience of facilitating an SJA group was new, challenging, transformative, and important to our growth as CITs and budding counselor educators. As counselors, we understand our ethical duty to engage in SJA; however, we have not had adequate training in tangible strategies to utilize when advocating on behalf of our clients. The S-Quad model is an important guide that helped facilitate our understanding of how to implement SJA as mental health professionals. As co-facilitators and coauthors, we learned a great deal about ourselves as developing social justice advocates, CEs, and CITs and confronted fears parallel to those of the group members. Although SJA is a growing focus in the counseling literature, there is a great deal of research and training that must continue to occur so current and future counselors can develop their social justice advocate identities.

 

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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Sunanda M. Sharma, MS, NCC, LPC (NJ), LPCC (OH), is a lecturer at Wright State University. Jennifer E. Bianchini, BFA, is a master’s student at Montclair State University. Zeynep L. Cakmak, MA, LAC (NJ), is a mental health counselor at Montclair State University. MaryRose Kaplan, PhD, NCC, LPC, is a school counselor and adjunct professor at Montclair State University. Muninder K. Ahluwalia, PhD, is a professor at Montclair State University. Correspondence may be addressed to Sunanda M. Sharma, 3640 Colonel Glenn Hwy., Millett Hall 370, Dayton, OH 45435, sharmas1@montclair.edu.

Bridging the Gap Between Intentions and Impact: Understanding Disability Culture to Support Disability Justice

K. Lynn Pierce

Persistent ableism in higher education, counseling practice, and society necessitates disability justice advocacy. In this article, the author explores the historical context of disability and the importance of disability knowledge for counselors and counselor educators. In addition to discrimination and inaccessibility, able privilege and lack of representation present significant barriers to equity and empowerment of disabled people. Better awareness of disability culture and community-oriented frameworks for the collective liberation of disabled people, such as disability justice, can improve disability equity and allyship within counseling and counselor education.

Keywords: ableism, disability justice, advocacy, allyship, counseling

The disability rights motto, “Nothing about us without us,” highlights the importance of including disabled people in decisions that affect them. However, in a society dominated by able privilege, this motto has at times translated into “Nothing at all.” The absence of disabled representation and empowerment leads to a lack of understanding, empathy, and action toward improving the lived experiences of the disability community.

Over 60 million Americans live with a disability, making them the largest minority group in the United States (Centers for Disease Control and Prevention, 2023). The Americans with Disabilities Act (ADA) defines a person with a disability as “a person who has a physical or mental impairment that substantially limits one or more major life activity” (ADA National Network, 2024, para. 1). These activities include daily tasks like breathing, walking, talking, hearing, seeing, sleeping, taking care of oneself, doing manual tasks, and working. The year 2020 marked the 30th anniversary of the ADA, the major law granting protections to disabled individuals. Yet institutional ableism continues to persist in higher education, counseling practice, and public life. Disabled people face various obstacles, including unresolved barriers to physical access (including of health care and mental health services), social stigma, and insufficient funding for rehabilitation programs. Able privilege (also referred to as ability privilege or able-bodied privilege) is a viewpoint in which non-disabled bodies are considered normative (Lewis, 2022). Able privilege is pervasive in society and continues to contribute to societal stigmatization of and discrimination against disabled bodies, minds, and lives.

Positionality
     The positionality of authors engaged in disability justice work is crucial for acknowledging biases and perspectives that influence the writing process. This practice also allows for transparency for readers to better understand the context this article is situated in. This is particularly important given the diversity of cultural norms within and between disability subcommunities and the differences of perception of ableism, access, and disability equity shaped by individuals’ unique experiences of disability.

I identify as a White, queer, disabled academic who aligns with crip culture. The term “crip” is a reclamation of the derogatory slang “cripple,” much as “queer” has been reclaimed by the LGBTQ+ community. I integrate the principles of disability justice and bring lived experience into advocacy, clinical, and research work pertaining to the disability community. I have navigated ableism personally and professionally and am invested in critical examination of ableist systems and advancement of cross-disability liberation. I use an anti-ableist and identity-affirming ideological lens to approach disability advocacy. The use of identity-first language throughout this paper reflects this positionality and is an acknowledgement of many disability subcommunities’ preference for this language.

A Brief History of Disability in the United States

Attitudes and policies surrounding the disability experience in the United States have historically imposed harsh restrictions and exclusions grounded in ableism. In the late 19th and early 20th centuries, the eugenics movement promoted the view that disability was undesirable and needed to be purged from society (Rutherford, 2022). Many proponents of eugenics were scientists, doctors, and policymakers. This contributed to forced sterilization and institutionalization of disabled people, restrictive immigration policies, and segregation in education. These policies, along with social stigma, led to disabled people being socially and economically disadvantaged and pushed to the fringes of society (RespectAbility, 2021).

In the 1970s, The Independent Living Movement and Centers for Independent Living (CILs) emerged as a civil rights campaign spearheaded by and for the disability community (Hayman, 2019). This movement pushed back against the discriminatory environments and paternalistic professionals of the time and focused on providing peer support, dignity, civil rights, and autonomy through direct service and advocacy. At this same time, the 504 protests (referring to section 504 of the Rehabilitation Act) paved the way for the civil rights work that eventually culminated in the passage of the ADA in 1990, which finally extended similar federally protected rights to disability as those that cover race and gender (Cone, n.d.).

Since 2000, disability-related activism has been most prominent online. Within this environment, community-based efforts such as the #SayTheWord movement and disability-related hashtags began to trend on social media. Many within the disability community have embraced X, formerly known as Twitter, specifically because it is free, has accessibility features, and allows for global connection and unprecedented reach to businesses and public figures, as well as other individuals and organizations within the disability community (Wilson-Beattie, 2018). Facebook and other social media groups have been important gathering places for disabled individuals to connect, obtain information about their conditions and available treatments, and find others who can relate to their experiences.

Exclusion of Disability in Education and Practice

The Rehabilitation Act of 1973 and the ADA both extended disability protections into higher education settings. However, because of the lack of protections in these settings prior to these laws, colleges and universities were already built on inaccessible foundations both physically and socially (Dolmage, 2017). This has led to a continued lack of equity for disabled people within higher education.

The National Center for Education Statistics (2018) reported that 19.4% of the undergraduate student body report having a disability, but only 11.9% at the graduate level. The Center for College Students with Disabilities reported that less than 4% of faculty members have disabilities (Grigely, 2017).
This suggests barriers to recruitment and retention and/or biases that prevent disclosure of disability identity. Despite the requirements under the Rehabilitation Act and ADA to provide equitable access, providing disability-related supports is often in conflict with ableist systems within higher education. For example, very few universities and colleges embrace a holistic and affirming model to support disability inclusion on their campuses and instead use an accommodation-only–focused approach. Most colleges and universities do not have a disability cultural center or student organizations focused on disability, despite the benefits for students and the community that such a center can provide (Elmore et al., 2018).

Disability and Counselor Education

Unfortunately, there is very little research available on disability within counseling and counselor education. Disability is often absent from captured demographics in our research, including when studies focus on the experiences of diverse counselors, counselor educators, and students. There is no information currently available regarding disability representation among counselor educators or counseling leadership, and very little about the experiences of disabled individuals within the profession or even the experiences of disabled clients with professional counselors.

Counselor education programs, apart from rehabilitation-specific classes, seldom focus on disability topics. According to Feather and Carlson (2019), 36% of faculty surveyed believed their program was ineffective at addressing disability topics, while only 10.6% believed their program to be “very effective” in this content area. Faculty self-assessment of competence to teach disability-related content correlated significantly with previous work or personal experience with disability, underscoring the importance of exposure to and training about disability-related concepts being infused across core areas. Key elements related to disability competence such as accessibility, able privilege, disability culture, and disability justice are explored in the following sections.

Considering Accessibility

Accessibility is a word that is often co-opted in diversity, equity, and inclusion (DEI) spaces to mean attainability, affordability, inclusion, etc. However, accessibility is a concept that is legally related to the ability of disabled people to equitably interact with built environments and services. The Office for Civil Rights (OCR) defines accessibility as:

When a person with a disability is afforded the opportunity to acquire the same information, engage in the same interactions, and enjoy the same services as a person without a disability in an equally integrated and equally effective manner, with substantially equivalent ease of use. (U.S. Department of Education, 2013, p. 3)

Physical accessibility includes factors such as ample accessible parking, pathways without stairs, clear curb cuts, even paving, wide doors and pathways, clear signage, clear spaces for wheelchairs and mobility devices, and accessible bathrooms. Accessibility of websites and other digital services is also covered under the ADA. The accessibility of learning management systems, captioning and transcripts for videos, and accessible file types are all important factors in classroom accessibility. Despite the ADA requirements, many spaces fall short, emphasizing the need for continual self-evaluation and consultation (ADA National Network, 2016).

Accessibility is often viewed only as what must be done at a minimum legally, and sometimes it is unclear within a given structure who exactly is responsible for ensuring accessibility. This often results in a reactive approach that places the burden on disabled people to experience barriers and report them. Another common approach is an accommodation mindset, in which disability is seen as so unlikely within a setting that those who need disability supports are seen as burdensome and must request them in advance. This can be contrasted with a barrier reduction or universally designed approach, in which disability would be proactively considered and planned for within a system or space. The resistance to these more equitable approaches is largely the result of lack of awareness of disability prevalence and needs, rooted in ableism and able privilege (Dolmage, 2017).

Able Privilege
     Able privilege (also referred to as ability privilege or able-bodied privilege) is a viewpoint in which non-disabled bodies are considered normative. This condition lends itself to the continuation of inaccessible environments and attitudes, which, in turn, further entrenches able privilege within society. To illustrate the implications of able privilege, one may consider the day-to-day experiences of non-disabled individuals and the stark contrast with the experiences of disabled people. The simple act of opening a door without strategizing your approach or having the liberty to choose any seat at a movie theater or concert are further indicators of able privilege. If you have always been able to access materials showcasing individuals of your ability as role models or had access to mentors who mirror your ability, you have experienced able privilege. The ability to move around with the assurance that housing options will generally be accessible to you is a distinct advantage, one that disabled people, particularly those who use mobility devices or who have physical limitations often cannot take for granted. The invisibility of these privileges to those who benefit from them is precisely what fuels the cycle of able privilege, leading to a lack of representation and empowerment for disabled individuals (Dolmage, 2017).

Able privilege is a major but often neglected aspect of social inequality, mostly because disabled individuals are systematically underrepresented. This exclusion is deeply ingrained in our society, impacting policies, cultural norms, and current structures, which further magnify able privilege. “Ugly laws,” a discriminatory legislation active in certain parts of the United States through the ’70s and ’80s, literally pushed disabled people out of public view, further contributing to their erasure (Schweik, 2011). The discomfort with the disabled body being seen and acknowledged in public continues, with organizations like the Ford Foundation finding a lack of disability representation in popular media (Heumann et al., 2019). Despite increasing emphasis on diversity, equity, inclusion, and accessibility (DEIA) in counseling, the reality is that the disability community often finds itself on the outskirts of these crucial conversations because of historical inequalities that are unchallenged or a continued lack of equitable access (Dolmage, 2017).

This cycle of exclusion parallels a common physical accessibility challenge: The lack of disabled people present in a space is often used to justify a lack of priority given to accessibility. However, the inaccessibility itself is the barrier preventing disabled people from entering and remaining in these spaces in the first place. Inaccessibility precludes disabled presence and advocacy, and barriers often then stand unchallenged.

Our educational systems and programs are no exception to the impacts of the exclusion of disabled bodies and minds. Ableist ideologies are often left unchallenged and unknowingly promoted, shaping the understanding of disability at crucial developmental stages. The exposure that most people have to disabilities is also skewed, leading to the formation of harmful stereotypes and stigmas discussed further below.

Disability Culture

Disability culture encompasses a group identity with shared experiences, a history of oppression, literature, art, language, and expression. This is highlighted through various forms of art and literature and through movements advocating for disability rights and inclusion (Brown, 2015). However, the disability community boasts a rich and diverse culture that’s often absent from mainstream media and popular culture.

Representation
     As with other minoritized and marginalized populations, the representation of disability in mainstream media, film, and literature can have significant impacts on the societal view of disability and bias and stigma experienced by disabled individuals. Because of the various challenges in access presented by society and the taboos regarding discussions of disability, media is a primary way many people may form opinions about disability and disabled people. Unfortunately, these depictions are few and often convey misinformation and harmful tropes. In a review of 100 top movies in 2016, fewer than 3% of characters had a disability (Smith et al., 2017). Heumann and colleagues (2019) found in their examination of disability in media that most disabled characters in film fell into four stereotypes: the Super Crips who triumph over disability and provide the message that disability is merely a negative thing to be overcome; Villains who are often portrayed with disfigurement of some kind and play on fear and discomfort of disability and difference; Victims who are defined only by their disability and often are shown as better off dead than disabled; or Innocent Fools who embody negative stereotypes of those with intellectual disabilities or neurological differences. These issues with one-dimensional and negative representation in the small number of examples of disability shown on the screen are compounded by a lack of input from disabled writers, actors, or directors. Most disabled characters are played by non-disabled actors, and disability is the most underrepresented minority in the Hollywood film industry (Woodburn & Kopić, 2016).

Within the disability community, a starkly different narrative emerges, often directly hitting back at the misrepresentation and villainization of disability that is commonplace in mainstream media. For example, Disfigured: On Fairy Tales, Disability, and Making Space by Amanda Leduc (2020) critically analyzes the narratives ingrained in our culture around disability. Leduc particularly explores the impact of fairy tales and their modern retellings on identity development and belonging for disabled people, centering her own story and other disabled people’s narratives. Crip Camp, a Netflix documentary, discusses the disability rights movement through the personal stories of advocates such as the late Judy Heumann (Hale & LeBrecht, 2020). Heumann’s autobiography, Being Heumann: An Unrepentant Memoir of a Disability Rights Activist (2020), is a powerful work in the disability space along with early commentaries on empowered language and identity choice such as Nancy Mairs’s essay, On Being a Cripple (1986).

“Crip culture” is one notable aspect of disability culture. In the anthology Criptiques, compiled by Caitlin Wood (2014), crip, slang for cripple, is embraced as a powerful self-descriptor, representing audacity, noncompliance, and a direct challenge to disability being pushed into the shadows. It is an example of the arts and expression of “crip culture,” which draws on shared experiences of ableism, creating a community that affirms and reflects its members’ originality and beauty. Criptiques presents a diverse set of essays embodying this revolutionary spirit and fostering discussions about disability experiences (Wood, 2014).

Social media platforms, particularly X/Twitter, have catalyzed the formation of a global disability community. Hashtags like #DisabledandCute and #AbledsAreWeird have trended, fostering discussions and highlighting the shared experiences within the disability community. “The disability revolution will be tweeted” because of the critical role social media plays in fostering community in accessible formats (Wilson-Beattie, 2018).

Emerging trends in disability spaces include the #SayTheWord movement, which seeks to reclaim the term disability and challenges forced person-first, euphemistic language often pressed on the disability community by able-bodied individuals, discussed further below. Spoonie communities are also prevalent in chronic illness and even some mental health circles. These spaces use the spoon theory by Christine Miserandino (2003), which describes how there is a set amount of energy for daily tasks that can be lowered by disability-related factors such as pain or fatigue. Spoon theory seeks to help disabled people and those close to them understand the fluctuating nature of chronic illness and better communicate about it.

Language and Empowered Expression
     It is essential to understand how to talk about disabilities and disabled people in an empowering and inclusive way. Person-first language (e.g., “person with a disability” and “person with [condition]”) emphasizes the person before the disability. While this language is used primarily in academic spaces and was mandatory until the seventh edition of the American Psychological Association style manual (APA; 2020), it is often criticized for being avoidant and contributing to perpetuating rather than confronting stigma (Collier, 2012).

Alternatively, identity-first language proposes that the identity of an individual should lead the conversation. This mode of language is used more commonly within disability spaces, such as “disabled individuals” or “autistic people.” Some subgroups, like the Deaf and autistic communities, strongly identify with their disability factors, promoting a sense of disability pride.

     Disabling language, such as “handicapped,” “wheelchair-bound,” or “crippled,” are terms that are outdated, inaccurate, and offensive. These terms can be stigmatizing based on social and historical contexts, like referring to someone diagnosed with schizophrenia as “schizophrenic.” The exception to this is in usages such as those outlined above in which some subcommunities have reclaimed words like “crippled” or find them accurate and therefore identity affirming. This highlights a trend that language and slang within the disability community often focuses on relevant factors of assistive technology or the disabilities themselves (e.g., “wheelies” for wheelchair users, “spoonies” for those who endorse spoon theory, or “potsies” for those with postural orthostatic tachycardic syndrome [POTS]), whereas out-of-group language typically rejected by disabled people is often designed to avoid using the word disability (e.g., “differently abled,” “diverse-ability,” or “special needs”).

While person-first language is valid and should be used when it is the preference of the individual with a disability, there are many compelling arguments for normalizing and empowering identity-based language. Person-first language can be incongruent with people’s self-concept and with their experience of the perception others have of them. Person-first language can perpetuate stigmatization of disability, leading to perceived hypocrisy (Collier, 2012). The language choices made by able-bodied allies often disregard the preferences of the disabled community, echoing a history of erasure and opposing the principle of “nothing about us without us.” This has sometimes extended to able-bodied academics imposing their preference for person-first language on disabled people through academic standards and publishing norms. It can be argued that these restrictions historically have inhibited self-identification, language preference, and the ability to produce scholarship that accurately represents disabled people and community values. This impedes collaborative research with the disability community and reinforces a division and lack of understanding between the disability community and counselors or other medical and mental health providers.

Allyship and Disability Justice
     Allyship is not an identity but a practice. Allies for the disability community must operate in solidarity with and advocate for the rights of those oppressed by systems in ways that do not reinforce the system’s oppression (Brown, 2015). This involves actively listening, observing dynamics of power, focusing on impact rather than intent, leaning into discomfort, modeling inclusive language, and offering kind and constructive feedback. In this context, it’s vital to understand ableism, defined as, “a system of assigning value to people’s bodies and minds based on societally constructed ideas of normalcy, productivity, desirability, intelligence, excellence, and fitness” (Lewis, 2022, para. 4). Ableism devalues and discriminates against disabled people and gives preference and normative status to able-bodied people.

The Disability Justice framework (Sins Invalid, 2015) offers a comprehensive and inclusive perspective on human bodies and experiences. The Disability Justice framework was originally developed by the activist Patty Berne, a co-founder of the organization Sins Invalid, to reflect the collaborative work occurring in community spaces. Sins Invalid is a performance project that deconstructs the dehumanizing practices disabled people face and centers intersectionality and diversity of identities.

The Disability Justice framework emphasizes that every body is unique, important, and powerful. This framework understands that people are shaped by complex intersections of factors like ability, race, gender, sexuality, social class, nationality, religion, and more. Instead of isolating these factors, it insists on viewing them collectively. This viewpoint stresses that our pursuit of a fair society is rooted in these intertwined identities and points out a critical observation: Our current global system is essentially “incompatible with life” (Berne, 2015, para. 13). Disability Justice principles include “leadership of the most impacted,” “interdependence,” “collective access,” “cross-disability solidarity,” and “collective liberation” and focus strongly on intersectionality and cross-movement organizing to ensure no one is left behind or excluded (Sins Invalid, 2015, p. 1).

Although there are voices advocating for disability rights, these are predominantly from within the disability community itself, a testament to the lack of understanding and allyship from broader society. Historically, those who could have been allies—abled caregivers, academics, medical professionals, and others—have often worked against the community, whether consciously or not (Dolmage, 2017). This can be combated first by ensuring access to spaces so that disabled voices are present. Then, allies can elevate these voices while implementing a framework like disability justice to ensure that those impacted are leading and that cross-disability approaches are being implemented around equity and liberation work, in line with community priorities.

Implications for the Counseling Profession 

Counselor Education and Preparation
     Instructors have a critical role in supporting disabled counselors-in-training. Not only is this support mandated by law, but it also increases visibility, representation, and lived experiences of disability in the profession, thereby improving services for clients. Implementing Universal Design for Learning (UDL) can minimize the need for accommodations and provide access, engagement, and learning motivation to the widest possible audience of learners (CAST, 2018). UDL is grounded in Universal Design principles, which are architectural strategies to make physical spaces usable by the widest number of people possible. The UDL principles include strategies such as multiple means of representing information to capture various learning types and multiple means of expression to allow learners to demonstrate learning in various ways (CAST, 2018). Adopting these principles can significantly contribute to making materials and learning environments more accessible. Instructors should consider how they can better focus on curriculum, activities, and assessments that increase exposure of counseling students to disability as a common multicultural factor and client identity. In addition, it is highly advisable to approach accessibility proactively in assignments and course materials and to become comfortable with the process required to swiftly provide equitable accommodations for students when a request is made.

Where a need for access or accommodations is established for a student, an opportunity also exists to proactively advocate for and support students in ensuring accessibility and equity in their practicum and internship placements, graduate assistantships, and other duties required for or connected to their program of study. Sometimes a student’s disability and related accommodation needs are new. Even for those who have established what they need to succeed in a classroom, counseling programs with their clinical requirements are a new setting and students may not always know what they need in advance. It is therefore the responsibility of counselor educators to take a barrier reduction approach, take on the labor of researching the accessibility of approved sites and processes of accommodations specific to graduate students within their universities, and work collaboratively with the student at all stages of a program.

Counseling Practice
     It is an ethical mandate that counselors become competent in working with disabled clients as addressed in the ACA Code of Ethics pertaining to nondiscrimination and multicultural issues (American Counseling Association, 2014). It is also important for counselors to work in ways that are respectful and promote client autonomy. This can begin with ensuring that proper etiquette is understood. Examples include speaking directly to a person, not their interpreter or attendant; not drawing attention to, commenting on, or interfering with assistive technology (including service animals); and asking questions rather than making assumptions. Working from a disability-affirming perspective is important, as well as being engaged in self-reflective work around disability bias and seeking appropriate supervision. Supervision might be with a peer to check for bias and process reactions to disability topics, or with someone with disability identity or rehabilitation training to consult on best practices around accessibility and disability-affirming approaches.

The physical counseling environment needs to be accessible according to ADA guidelines, and this should be determined based on the checklist for existing facilities and/or a professional consultant (ADA National Network, 2016). Continuing to offer telehealth as an option while still ensuring spaces are accessible helps to meet a long-standing need expressed by disabled people in ensuring access to mental health care. Websites need to meet web accessibility guidelines, and it is advisable to ensure accessible formats are available for documentation (e.g., large font and digital options). Within spaces, common triggers for various conditions should be considered. For example, fluorescent lights may trigger migraines or neurological conditions, while chemical sensitivities could be triggered by anything from bleach and other cleaning supplies to perfume, room fresheners, or lavender and other essential oils.

In working with clients, it should not be assumed a client is not disabled merely because they are not visibly disabled or have not disclosed a disability. If a client is visibly disabled or has disclosed but not elaborated, signaling openness to further discussion while respecting boundaries and client priorities is warranted. Intrusive questioning is never appropriate, and client autonomy and treatment goals should always be respected. In my own work, I think of this similarly to when I may diffuse a question regarding trauma on an intake by acknowledging the client may not yet trust me; we can come back to discuss it further at any time in our work together, and I invite them to share to their level of comfort. An example of broaching a visible or previously disclosed disability might be simply asking if there is anything that can be done to increase accessibility or comfort in the space. Another approach might be to reflect the client’s own language to describe the disability, chronic illness, assistive technology, etc. and to simply ask if there is anything specific that the client would like for you to know up front that would support your work together, or whether they would like to address things as they come up.

Conclusion

Disability culture is rich and complex, asserting its place in sharp contrast to mainstream narratives with defiance. It is a culture that celebrates wholeness and intersectionality and challenges ableist norms without apology for occupying space.

By understanding how ableism in counseling and counselor education fits into the broader history of disability oppression and increasing awareness of disability culture and disability justice, the counseling profession can better serve the disability community. Normalizing conversation about disability allows us to prepare ourselves, our students, and our supervisees to work with this large and diverse population. When we act intentionally to proactively make spaces accessible, we are providing disabled people with the same rights we provide to other clients. This allows them to share their stories gradually and comfortably, without having to disclose too early or fight for their basic rights.

 

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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K. Lynn Pierce, PhD, NCC, ACS, LPC, CRC, is an assistant professor and Counselor Education and Supervision PhD Program Coordinator at Mercer University. Correspondence may be addressed to K. Lynn Pierce, Mercer University College of Professional Advancement, 2930 Flowers Rd. S., Chamblee, GA 30341, pierce_k03@mercer.edu.

Perceptions and Experiences of School Counselor Trainees on Self-Care Grounded in Mindfulness and Social–Emotional Learning

Kyoung Mi Choi, Jung H. Hyun

This study, using a transcendental phenomenological approach, explored the perceptions and experiences of school counselor trainees participating in a self-care course grounded in mindfulness and social–emotional learning. Seven students who enrolled in a master’s-level school counseling program and completed a summer self-care course shared their experiences, leading to the identification of five key themes: (a) recognizing the importance and need for self-care, (b) cultivating a nonjudgmental mindset toward challenging emotions, (c) integrating self-care into both personal and professional settings, (d) an increase in compassion and empowerment, and (e) a commitment to ongoing learning and advocacy. The school counselor trainees’ narratives highlight the importance of self-care as a way to reclaim power within themselves and become change agents in their school communities.

Keywords: school counselor trainees, self-care, mindfulness, social–emotional learning, advocacy

The COVID-19 pandemic has dramatically changed the way we live, work, learn, and interact on a daily basis, making self-care a crucial topic of discussion in both schools and workplaces (Harrichand et al., 2021; Norcross & Phillips, 2020). Many K–12 students are facing increased emotional distress and mental health issues, such as high levels of anxiety, depression, and post-traumatic symptoms (Chen et al., 2020; Marques de Miranda et al., 2020; Prime et al., 2020). At the same time, school counselors are also struggling with issues such as fatigue, burnout, and even vicarious trauma (Parker & Henfield, 2012), along with other challenges like high workloads, uncertainty about their role, and a lack of perceived support and professional development opportunities (Savitz-Romer et al., 2021). This makes self-care for school counselors and trainees more critical now than ever before (Harrichand et al., 2021).

Self-care refers to engaging in activities or behaviors that promote one’s overall wellness and prevent burnout (Christopher et al., 2016). This concept can also be expanded to include a larger sense of self-care that encompasses embracing one’s humanity; increasing awareness of internalized negative cultural messages; and fostering a positive cultural identity that embraces one’s heritage and community strengths, assets, traditions, and legacy (Duncan-Andrade & Morrell, 2008). Some scholars view self-care as the start of personal power (hooks, 1994) and a process of humanization in education that is reciprocal, anti-oppressive, and supportive of collective well-being (Paris & Winn, 2013). Additionally, many educators and scholars believe that dismantling oppressive ideologies and power structures is an important objective in the transformative process of self-care, which involves critical self-reflection, recognition of dehumanization, and reclaiming agency (Berila, 2016; Freire, 1970/2000; hooks, 1994; Litam & Hipolito-Delgado, 2021).

The significance of self-care has led to it being viewed not just as an individual responsibility, but also a professional one. Leading counseling organizations, such as the American Counseling Association (ACA) and the Council for the Accreditation of Counseling and Related Educational Programs (CACREP), consider self-care to be a crucial aspect of a mental health professional’s duties. The ACA Code of Ethics (2014) states that “counselors engage in self-care activities to maintain and promote their own emotional, physical, mental, and spiritual well-being to best meet their professional responsibilities” (p. 8). The CACREP (2015) standards, under the Professional Counseling Identity section, include standards for counselor education programs that emphasize self-care strategies appropriate to the counselor role (Section 2.F.1.i). The American School Counselor Association (ASCA; 2019) promotes the monitoring of “emotional and physical health and practice wellness to ensure optimal professional effectiveness” for school counselors (p. 7).

However, despite the recognition of self-care as an ethical responsibility, most counseling training programs do not incorporate it as part of their curriculum (Chen et al., 2020; Christopher & Maris, 2010; Shapiro et al., 2007). Lack of time, academic pressure, and the absence of guidance and faculty role models are cited as barriers (Campbell & Christopher, 2012; Christopher & Maris, 2010; Nelson et al., 2018). Nevertheless, there is a pressing need for self-care strategies to be included in counselor training and curriculum (Mitchell & Binkley, 2021). This study utilized transcendental phenomenology to investigate the essence of self-care experiences among school counseling trainees who participated in a 10-session seminar course that focused on mindfulness and social–emotional learning (SEL).

Literature Review

Mindfulness as Humanizing Process in Self-Care
     The integration of mindfulness as a self-care practice into counseling training and programs has been widely adopted over the past three decades (Bohecker & Horn, 2016; Bohecker et al., 2016; Campbell & Christopher, 2012; Christopher & Maris, 2010; Shapiro et al., 2007). Research has shown that mindfulness can lead to numerous benefits, including reduced levels of anxiety and depression, enhanced life satisfaction, increased social connection, optimism, tolerance, empathy, and self-efficacy (Bohecker & Horn, 2016; Bohecker et al., 2016; Brown & Ryan, 2003). Christopher and Maris (2010) asserted that incorporating mindfulness practices into counselor training programs could help reduce burnout, compassion fatigue, and other stress-related physical and psychological symptoms by providing education in self-care and stress management. Furthermore, Shapiro and his team (2007) found that Mindfulness-Based Stress Reduction training had a significant impact, decreasing stress levels, negative affect, rumination, and anxiety, and boosting positive affect and self-compassion.

Moreover, mindfulness is more than just a form of relaxation, but a transformative and proactive approach to self-care. It involves increased awareness of internalized negative cultural messages and the cultivation of a positive cultural identity (Duncan-Andrade & Morrell, 2008). The practice of mindfulness can lead to critical self-reflection and bring to the surface issues of power and privilege, and through deep reflection and honest dialogue, can support the process of humanization and the dismantling of oppressive ideologies (Berila, 2016; del Carmen Salazar, 2013).

Given the high levels of stress and burnout that school counselors commonly experience, prioritizing self-care practices is crucial for maintaining their personal and professional well-being. Mindfulness-based self-care has emerged as a promising approach for addressing these challenges and provides a unique opportunity for school counselors to reflect on their identities within societal and cultural contexts. Additionally, the SEL framework can be helpful in self-care training by outlining specific skills essential for managing stress, fostering well-being, and developing advocacy in both personal and professional contexts.

Social–Emotional Learning
     SEL is defined as “the process in which children enhance their ability to integrate thinking, feelings, and behaving to achieve important life tasks” (Zins et al., 2007, p. 194). The Collaborative for Academic, Social, and Emotional Learning (CASEL) outlines five core competencies of SEL: self-awareness, self-management, social awareness, relationship skills, and responsible decision-making (CASEL, 2023a). CASEL’s mission is to make SEL a fundamental aspect of every child’s education through offering training and educational opportunities to advance scientific research, assessment, and implementation of effective SEL practices in schools (CASEL, 2023b). Numerous studies have demonstrated the positive impact of SEL programs on students’ growth (Carrell & Carrell, 2006; Durlak & DuPre, 2008; Lapan & Harrington, 2009).

Despite the positive effects of SEL in education, its traditional definition has faced numerous criticisms for its inadequacy in addressing equity and justice issues in classrooms and the educational system in light of recent racial and gender awareness. Higheagle Strong and McMain (2020) argued that the traditional SEL approach reinforces oppressive ideologies by valuing White, middle-class knowledge systems above others, portraying marginalized students as troubled and incompetent, and perpetuating injustice. With a growing emphasis on cultural responsiveness in the SEL definition (Higheagle Strong & McMain, 2020; Jagers et al., 2019), a critical question arises: “Are we teaching individual students to manage their emotions and behaviors simply for the sake of upward mobility or recognize and reclaim their emotions and relationships as fuel for social and cultural healing and transformation?” (Camangian & Cariaga, 2021, p. 16).

CASEL subsequently revised their definition of SEL and introduced a new concept of transformative SEL, defined as “a process whereby students and teachers build strong, respectful relationships founded on an appreciation of similarities and differences; learn to critically examine root causes of inequity; and develop collaborative solutions to community and social problems” (Jagers et al., 2018, p. 2). This updated definition acknowledges existing educational disparities and places an emphasis on authentic partnerships between schools, families, and communities. It also calls for a re-examination of the curriculum, instructional methods, and evaluation systems. Educators are encouraged to adopt an equity-focused lens when assessing the five core SEL competencies, asking questions such as “What are the social dynamics among students from different backgrounds in your class? Do you view these differences as a liability or an asset?”, “How do you create an inclusive and safe learning environment for all your students?”, and “Are there policies or practices in your school that prevent your students from receiving the quality education they deserve?”

Overall, the principles of SEL are closely aligned with the goals of school counseling, particularly in developing the skills necessary for promoting the social, emotional, and cognitive development of their students and promoting equity, social justice, and cultural competence necessary for supporting diverse student populations. School counselors can leverage SEL strategies to create a welcoming and inclusive environment that fosters learning, resilience, and well-being among students. Van Velsor (2009) emphasized the role of school counselors as SEL consultants, empowering students to achieve their personal goals and promoting prosocial behaviors, with the ultimate aim of improving the well-being of both the school and society.

Self-care has been integrated into the ethical standards of school counselor preparation programs (Christopher et al., 2016; Nelson et al., 2018), and mindfulness is often taught and studied in these programs (Campbell & Christopher, 2012; Christopher & Maris, 2010). However, there has been a lack of research investigating the experiences of school counselor trainees when learning and practicing self-care alongside mindfulness and SEL competencies in counselor education. In this study, we created and implemented a self-care curriculum for school counseling trainees and examined how this curriculum impacted their personal and professional lives through the use of transcendental phenomenology. The goal was to delve into the experiences of master’s students who took part in a summer course on self-care that was grounded in both mindfulness and SEL.

Methodology

The transcendental phenomenological investigation is often used in research to explore individuals’ subjective experiences and perceptions of a particular phenomenon (Giorgi, 2009; Moustakas, 1994). Using this approach, we aimed to explore the school counseling trainees’ thoughts, feelings, and behaviors of the personal and professional changes in the areas of self-awareness, self-management, social awareness, relationship skills, and responsible decision-making. The umbrella research question that guided this study was “What is the essence of the lived experiences of self-care of school counseling trainees who took 10 seminar sessions grounded in mindfulness and SEL in a master’s-level counseling program over a 5-week period?” Semi-structured interview questions were used to explore the participants’ experiences in their own words, which are detailed in Appendix A. After the approval from the IRB, we invited counseling trainees to participate in the study and followed the three steps of Moustakas’s (1994) transcendental approach: (a) the epoche, (b) the eidetic reduction, and (c) the transcendental reduction in data analysis.

Participants
     The purposive sampling method outlined by Glesne (2011) was utilized to select participants for the study. Invitations were extended to all 15 students who had completed the EDCO 298 Seminar in Professional Counseling during the summer course. Based on the guidelines set by Polkinghorne (1989), a sample size of 5–25 individuals is recommended for a phenomenological study. Seven participants, who were female graduate students in the counselor education program, agreed to take part in the study through in-depth interviews. The participants were between the ages of 21 and 45 and attended a single, midsized, public university designated as a Hispanic-Serving Institution in Northern California, United States. Five of the participants identified as Hispanic, Mexican, or Latinx, while two identified as White.

Data Collection
     The data for this study was collected through qualitative interviews with individuals who had completed a summer course, EDCO 298 Seminar in Professional Counseling, taught by Kyoung Mi Choi. To ensure impartiality and minimize the impact of the professor’s influence, three precautions were taken: (a) participants were contacted at least 14 days after the course had ended and their grades were posted, (b) they were informed that participation in the study was voluntary, and (c) all interviews were conducted by Jung Hee Hyun, who had no association with the program and held no power over the students’ grades.

Description of the Course
     In summer 2020, Choi created an online 5-week course called EDCO 298 Seminar in Professional Counseling, which is detailed in Appendix B. The focus of the course was on self-care, combining six mindfulness core values (such as presence, gratitude, and compassion) and the five SEL competencies framework (self-awareness, self-management, social awareness, relationship skills, and responsible decision-making). The course was attended by 15 master’s-level school counseling students. The aim of the class was to encourage and inspire the students to make a deeper connection with their thoughts, emotions, and physical well-being.

The objectives of the course were to (a) explore the five SEL competencies, (b) explore the mindfulness-based self-care and SEL interventions for counseling and personal growth, (c) understand the effectiveness of the SEL tools and practice mindfulness in daily life, and (d) create a workshop that serves the community the student hopes to serve. The instructor’s role was to create a supportive and safe environment in which students could share their personal narratives and experiences, including their strengths, cultural assets, resilience, privilege, discrimination, and oppression. Throughout the course, various mindfulness practices were utilized, such as collective breathing, body scan, mindful walking, mindful eating, mindful speaking, journaling, storytelling, visualization, and meditation.

Individual Interviews
     After the summer session was over, Choi’s counselor education department gave permission to announce the research project via email. Those who showed interest in participating were given a research packet containing details of the study, informed consent, and a demographic sheet, as well as contact information for further inquiries. At every stage of the recruitment and research process, it was emphasized that participation or non-participation in the study would not affect the participants’ course credit or final grade. To be eligible for the study, participants had to meet the following criteria: (a) enrolled in the counselor education program, (b) completed the summer seminar, (c) successfully finished the entire course, and (d) willing to participate in a voluntary lengthy interview.

Once students agreed to participate in the study and submitted their informed consent, contact information, and demographic questionnaire (including a pseudonym, gender, age, self-identified ethnicity, and specialization), they were individually interviewed by Hyun through Zoom. The interviews lasted for approximately an hour and followed a semi-structured format consisting of 16 open-ended questions asked in a consistent order (see Appendix A). The interviews were recorded in their entirety and then transcribed by a graduate student who was not affiliated with the study. After being reviewed by the participants and analyzed by the researchers, the audio recordings were deleted. To maintain the confidentiality of the participants, only pseudonyms were used in all written materials.

Data Analysis
     The research methodology employed by the team was transcendental phenomenology (Moustakas, 1994), aimed at uncovering the fundamental nature of human experience (Moerer-Urdahl & Creswell, 2004). NVivo12, a qualitative data analysis software by QSR International (2018), was utilized for data storage, coding, and retrieval. To analyze the data, we followed Moustakas’s (1994) steps for data analysis, which involved the following process: (a) the researchers reflected on and recorded their own experiences of self-care, mindfulness, and critical consciousness before, during, and after data collection; (b) the transcripts were imported into NVivo12, and key statements that provided insight into the participants’ experiences of self-care were highlighted (horizontalization); (c) themes were formed by summarizing these significant statements (cluster of meanings); (d) the significant statements and themes were used to describe the participants’ experiences as a collective whole (textural description); (e) the context that influenced the participants’ experiences of self-care was described using the significant statements and themes (imaginative variation/structural description); and (f) a synthesis of the meanings and essence of the experience was provided by integrating all of the textual and structural descriptions into a universal description.

Reflexivity Statement
     Choi is a professor and holds a master’s degree in school counseling and international relations, as well as a doctorate in counselor education and supervision. She has been teaching at the master’s level for over a decade and has received extensive training in mindfulness, yoga, and SEL. Hyun is an associate professor specializing in school counseling and holds a master’s degree in school counseling and a doctorate in counselor education. She provides counseling and consultation to children and parents using play therapy and multicultural counseling interventions. Choi taught the course that the study is based on, while Hyun conducted the participant interviews. Both Choi and Hyun have prior experience in qualitative research and are dedicated to promoting multiculturalism and social justice in counselor education.

In our research, we utilized the epoche technique, which involves temporarily setting aside our preconceived beliefs and assumptions about self-care to approach the research with an open mindset. Throughout the research process, we made a conscious effort to examine and clarify our assumptions to avoid potential biases. We also practiced reflexivity by reflecting on our own positionality and how it could affect our assumptions and interpretations of the data. This approach helped us to ensure that our findings were based on the actual experiences and perspectives of the participants, rather than on our own assumptions. Our assumptions about self-care included the following: (a) the importance for counselors to be responsible about self-care; (b) the impact of self-care practice on both personal and professional life; (c) the necessity for counseling programs to provide specific tools and strategies to support students in developing the knowledge and skills for self-care; (d) the holistic approach of self-care, encompassing cognitive, emotional, physical, interpersonal, and spiritual well-being; (e) the gradual development and continual practice required for self-care ability; (f) the possibility of self-care looking different based on individual and cultural backgrounds; and (g) the transformation process of self-care, facilitating the humanization process, increasing awareness of internalized oppressive messages and cultural identities and leading to individual and collective liberation.

Establishing Trustworthiness
     In order to enhance the reliability and validity of the study, we employed the use of an external auditor and member checking (Glesne, 2011; Hays & Wood, 2011; Lincoln & Guba, 1985). The external auditor, a research assistant with previous experience in phenomenological approaches but no prior knowledge of self-care or mindfulness research, was appointed to assist in increasing the credibility of the study. The external auditor reviewed the research process, examined the interview process for potential biases, and verified the interpretations of the data. Additionally, we utilized member checking, in which we presented emergent themes and interview content to the participants to ensure their agreement with the written comments and to check for any additional information or edits.

Findings

We identified five themes that reflect the perceptions and experiences of school counseling trainees regarding self-care grounded on mindfulness and SEL: (a) recognizing the importance and need for self-care, (b) cultivating a nonjudgmental mindset toward challenging emotions, (c) integrating self-care into both personal and professional settings, (d) an increase in compassion and empowerment, and (e) a commitment to ongoing learning and advocacy. These themes, which capture the essence of the participants’ experiences, are contextualized as follows.

Theme One: Recognizing the Importance and Need for Self-Care
     Participants in a summer course focused on self-care were aware of their motivations and inspiration for registering for the course. They reported their experiences of struggle and challenges in their lives, particularly during the COVID-19 pandemic. Elizabeth stated, “I was facing personal challenges. This course arrived just when I needed it the most.” Sophia added, “I was struggling with intense emotions during the lockdown period and had doubts about myself. But after taking the first class, I felt that it was meant for me.”

     Despite the eagerness of all participants to gain knowledge on self-care, they lacked a clear understanding of the concept. The term “self-care” had been mentioned in other classes within the counseling program, but the application of self-care through mindfulness and SEL was unfamiliar to most of them. Daisy expressed:

I never truly comprehended the meaning of connecting with oneself, which requires dedicating time for personal reflection within daily activities and establishing a connection with one’s body and emotions. This was a new idea for me, as I had not previously implemented or even recognized its significance before participating in the course.

     The participants were amazed to discover the relationship between their body, mind, emotions, and nature when they made time for self-reflection and self-care. Stacy expressed, “I never considered the idea of self-care before. This class has shown me that some of the things I already do actually fall under the category of self-care.” Sophia also said, “Self-compassion, I did hear about it or read about it, but I never truly dedicated myself to practicing it.” Furthermore, Stacy added, “I never realized the importance of having a complete connection between the body and nature.”

Theme Two: Cultivating a Nonjudgmental Mindset Toward Challenging Emotions
     The participants shared their difficulties in managing emotions such as anxiety, depression, anger, disappointment, uncertainty, and shame. They found learning practical mindfulness strategies to recognize and process these emotions without judgment to be helpful. Elizabeth shared how she connected with her body and was able to understand the physical and emotional cues signaling her needs through increased self-awareness:

I have always been constantly on the move and never took the time to acknowledge my physical and emotional well-being. This class taught me the importance of paying attention to my body’s signals, both physical and mental, signaling the need to slow down. I learned to recognize signs, such as backaches, sore muscles, and headaches, and to listen to what they are trying to tell me about my overall well-being.

Sara echoed, saying, “Self-awareness is about embracing and loving myself.” Veronica, who identified as an immigrant, shared her insight on the impact of self-compassion and a shift in perspective:

As an English learner, I often get nervous during public speaking or classroom presentations because I self-doubt. That’s where self-compassion has played a crucial role for me. Instead of viewing myself as someone who doesn’t speak perfect English, I see myself as someone who has accomplished much despite being an immigrant. I used to struggle with low self-confidence, but after being introduced to self-compassion, it has opened my eyes to see everything as a growth opportunity rather than a potential failure. It’s about focusing on what you have, rather than what you lack, and viewing yourself as a human being like any other. This shift in perspective has been healing.

     Carol explained how the class aided her in processing challenging emotions, saying “I learned to create space between myself and my emotions, have more control over impulsive emotions, and take breaks to have fun or engage in self-care.” Daisy summarized her approach to dealing with challenging emotions by saying, “The course taught me that it’s okay to accept my feelings, allowing myself to experience them without judgment. I understand that they are temporary and by processing them, I am able to let them go.”

Theme Three: Integrating Self-Care Into Both Personal and Professional Settings
     A strong connection between understanding the importance of self-care and its practical application in daily life was evident in the narratives of all participants. They explored, experimented with, and reinforced a variety of self-care strategies both in and outside of class. Sophia stated, “The class helped me to become more patient, and I now practice those techniques daily.” Elizabeth also spoke of the impact of the class and her daily self-care practices:

I realized the enormous benefits of taking time for myself, both in the morning to start my day and in the evening to relax. Practicing mindfulness and self-care, such as staying aware of my body’s signals through yoga, stretching, and breathing, has been incredibly helpful. My physical healing has become a path to emotional healing. I’m making a conscious effort to care for myself. The class was the perfect introduction to this.

Veronica echoed similar experiences in implementing what she learned from the course.

I feel like I gained a lot from this course because we were able to put what we learned into practice. This class provided a deeper understanding of the subject through reading and trying different practices such as meditation and deep breathing. I’ve made a conscious effort to practice mindfulness daily, instead of only when I felt the need. Currently, I’ve been more consistent and practice it at least five times a week.

     Positive and affirmative perspectives toward oneself transformed the participants’ relationship with themselves. Sophia described this transformation by saying, “Since taking the class, I have become a different person. By different, I mean that I approach things differently and I don’t feel stressed out as much. I am able to identify and process my emotions, and accept them.” She explained how her 5-minute mindfulness practice changed her challenging relationship:

Mindfulness allows me to connect with myself, to disconnect from external distractions. I only need 5 minutes of silent meditation to feel that inner connection. If I have an issue or conflict with someone in my family, I take those 5 minutes to disconnect from the story, reflect, and become more relaxed.

Theme Four: An Increase in Compassion and Empowerment
     The participants, who exuded confidence and a newfound sense of self-care, expressed their eagerness to assist others in their own self-care journeys. They saw their role as school counselors as being further strengthened, and they showed a keen interest in exploring effective mindfulness and self-care techniques. Veronica stated, “I am confident that offering emotional support online will be just as impactful as in person. I now have a wider range of tools and activities to support my students.” Sophia also shared how her newfound sense of empowerment has made her more compassionate toward her students, saying:

I have changed. Our learning has taught me that my students are the most important individuals sitting in front of me in my counseling offices . . . my goal in supporting them is to acknowledge their opinions, feelings, and emotions. I care about all that they are experiencing, not just their issues but also their emotions. I have gained more empathy for them and strive to provide them with the best support I can.

     Elizabeth stated, “As a future school counselor, I am confident that incorporating mindfulness practices into my work will have a positive impact on my interactions with students, staff, and teachers. I have learned these techniques in class and am eager to put them into practice.” Daisy shared her engagement with her students, saying:

At times, I can feel overwhelmed by the volume of students I see in a day and the diverse range of topics discussed. However, by taking the time to connect with myself and acknowledge my emotions, I find that I am more grounded after a workday. This has also helped me form stronger connections with my students.

Carol also expressed that mindfulness can rejuvenate one’s energy and foster positive relationships with oneself and others:

When you have a student who requires a lot of your energy, and you find yourself feeling depleted afterwards, it can be challenging to give your best to the next student. I think it’s important to learn how to recharge quickly so that each student receives the best version of you. With the pandemic, it’s even more crucial to meet the students’ needs academically, emotionally, and for career and college planning. What I have found is that students especially need emotional support because of the stress caused by COVID-19.

Theme Five: A Commitment to Ongoing Learning and Advocacy
     The participants recognized the significance of self-care and appreciated their capacity to support others with openness, curiosity, and empathy without any judgments. They viewed self-care and mindfulness as a never-ending journey of learning and personal growth. They expressed their determination to continue their mindfulness-based self-care journey. Elizabeth described the process of healing as like a domino effect, in which one positive change can lead to a chain of similar changes in other areas of life: “Healing one aspect of my life has a positive impact on other parts as well. I’m excited to attend workshops and read more to further my mindfulness journey.” Daisy spoke of her strengthened connection with her students, saying “I feel like I am able to better communicate with my students. I strive to offer them a warm and caring presence, and I am being transparent and accepting of their diverse cultural backgrounds.”

Sara explained her practice with her family, saying, “I have been continuing to study and practice throughout the summer and have been sharing and discussing with my family members. This has been a really healing experience for our family.” Sophia also emphasized the importance of continuing her practice, stating:

Healing is a process, and it doesn’t happen overnight. However, it does help us become better people, improve our connections with others, become better listeners, judge less, and listen more to ourselves. This class has had a truly positive impact on me, and I plan to continue my mindfulness practices.

     Advocacy is seen as a natural progression. Stacy also expressed her commitment to practicing alongside her students, saying, “It’s important to understand the importance of congruence in both teaching and life. If I just tell my students what to do, they won’t listen. But if I practice alongside them, it’s more effective.” Sophia spoke about the power of sharing mindfulness practices and their impacts with others, stating,

As a counselor and advocate for these techniques, I want to bring them into the K–12 education system at an early age. I hope to introduce these practices wherever I go and to our students, as I believe everyone can benefit from them.

Discussion 

The five themes embody the significance and definition of self-care grounded in mindfulness and SEL for graduate students in counseling who took a summer self-care course. Participants reported a new experience in self-discovery through the practice. Despite the difficulties brought by the COVID-19 pandemic and the shift to online education, learning about self-care helped them cope with daily stress. By participating in a group, they discovered their personal and professional understanding of self-care. They learned how to connect with their emotions, physical sensations, thoughts, and others in their relationships. Particularly, they emphasized the importance of embracing difficult emotions. The self-care grounded in mindfulness and SEL taught in the course enabled them to face emotions such as anger, disappointment, anxiety, uncertainty, and shame with nonjudgment and acceptance. The students connected their understanding of self-care with their daily practices both in and outside of the class. The consistent and dedicated practice demonstrated a true embodiment of self-care among the participants.

Along with displaying great confidence in themselves and their self-care practices, the participants strongly expressed their desire to help others in their communities. Their professional identity as school counselors was enhanced, and the participants developed agency to empower underserved students and communities by introducing self-care strategies and mindfulness practices. After completing the course, the participants expressed their intention to continue the practice and viewed self-care and mindfulness as a lifelong journey.

These findings align with previous qualitative studies (Baker, 2016; Bohecker & Horn, 2016; Campbell & Christopher, 2012; Christopher et al., 2011, 2016; Christopher & Maris, 2010) on the experiences of master’s-level students in mindfulness self-care courses. Across these studies, a common theme is that students reported substantial changes in both their personal and professional lives. This included increased confidence in their professional and interpersonal relationships, a greater appreciation for their physical well-being, healthier lifestyle choices, and the ability to handle challenging situations more effectively.

Furthermore, the significance of the current study is to confirm that self-care is imperative for counselor training. As the participants expressed their sense of empowerment and desire to engage in creating and providing workshops for their families, schools, and communities, they demonstrated self-care as part of social and cultural advocacy. There was a clear shift from a deficit- to a strengths-based self-identity regarding linguistic ability, emotional availability, and a healing-focused process. This is consistent with the role of school counselors, as system change agents need to critically examine dominant culture and its impact on their own racial identity development, power, privilege, and oppression in educational settings (Mitchell & Binkley, 2021). Before disrupting and dismantling the oppression and power in the system, school counselors will need to embrace themselves wholly and consider using themselves as a tool in advocating for those in need. When serving diverse students and communities, self-care goes beyond relaxation and self-awareness of one’s own thoughts and emotions. It also involves reclaiming power within oneself—physically, emotionally, spiritually, and culturally.

Implications

The study’s results have significant implications for counselor educators. First, student readiness is crucial for the maximum impact of self-care courses. What is noticeable in the findings is that the students were ready to change as they chose the course and had a strong desire to learn more about self-care. When students are prepared, the impact can be powerful. Additionally, students who accepted themselves, both strengths and weaknesses, and experienced the mind–body–spirit connection had a greater awareness of themselves and felt more prepared to serve others. The study suggests that self-reflection is essential to maintaining an ethical practice when working with people of different identities, values, and cultures. The participants in this study emphasized their humanity by accepting their identities, processing challenging feelings, practicing self-compassion, and sharing their experiences and knowledge to empower others.

Second, the study recommends that counselor education programs incorporate a self-care course or workshop into their curriculum, as it has been shown to have a positive impact on pre-service counselors (Harrichand et al., 2021). Students’ strong desire to learn more about mindfulness and self-care is consistent with the literature (Baker, 2016) and shows the urgency of incorporating mindfulness practice, SEL, and self-care practice in the school counseling curriculum. The participants recommended offering the course every year and an advanced level later in the program. Because of logistical difficulties, it may be more practical to integrate self-care knowledge and practice into existing coursework and programs rather than adding an extra course.

Lastly, many studies on mindfulness, SEL, or self-care do not give enough importance to humanization, agency, inclusion, and equity in the individual and collective self-care process (Mitchell & Binkley, 2021). This study suggests that it is essential to include mindfulness in personal as well as social and cultural transformative processes. Participants expressed increased agency and advocacy during and after learning and practicing self-care. The self-care course can cultivate and strengthen the capacity to imagine a world beyond the current social conditions with confidence in the ability to bring change through individual and collective efforts (Pyles, 2020).

Limitations and Future Research
     The authors of the study acknowledge that self-selection may have contributed to biases in the findings, as participants who enrolled voluntarily in the summer elective course showed strong interest in the research topic (Lavrakas, 2008). They also volunteered to share their experiences, which could have resulted in them focusing on positive and socially desirable narratives. The authors of the study also acknowledge that factors such as the class format, selected activities, and instructor’s teaching styles may have contributed to the participants’ experiences, which may not be generalizable to other school counseling trainees and programs. For future research, a study exploring how master’s students with different placements (i.e., pre/post-practicum, internship) or cultural identities (ethnicity, sexual and gender identity, religion, generation) experience and practice self-care could provide valuable insights to counselor educators. Additionally, a quantitative study using pre- and post-surveys to assess progress in the five SEL competencies can provide useful data for counselor educators and researchers to understand students’ social–emotional development.

Conclusion

This study examined the experiences of school counselor trainees in a self-care course based on mindfulness and SEL, consisting of 10 seminar sessions over 5 weeks. The findings revealed information about the transformation process, the importance of self-care in counseling preparation programs, and the empowering effects on graduate students becoming agents of change. Participants experienced a transformation leading to a change in their relationship with their mind, body, and emotions, and this transformation extended to their relationships with family, friends, students, and colleagues, empowering them to be more engaged with their communities and society. They embodied Carl Rogers’s (1980) core conditions for change, including unconditional positive regard, genuineness, and empathy (Campbell & Christopher, 2012), both personally and professionally, describing the experience as encountering a new self through fresh eyes.

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

 

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Appendix A
Semi-Structured Interview Protocol

Title of the Study: School Counselor Trainees’ Perceptions and Experiences on Self-Care Grounded in Mindfulness and Social–Emotional Learning (SEL)

To be consistent with the goal of qualitative research, all participants will be described through their own viewpoints and in their own words. All questions are open-ended, and these semi-structured interview protocols will guide the researcher throughout the interviews. However, it is not expected that the remaining questions will be asked sequentially, that all questions will be asked of all participants, or that the list of provided questions is exhaustive. Rather, we offer the questions below as representing possible directions in which we anticipate the interviews may proceed.

Introduction

We want to thank you for your willingness to participate in this study. Recently, you completed the course EDCO 298-01 Seminar in Professional Counseling. Today, we would like to take some time to collect information on your perceptions, thoughts, reactions, and follow-up response to your mindfulness-based self-care and SEL practice. If at any time you feel uncomfortable or do not desire to answer a question, please let me know.

Semi-Structured Interview Questions

  1. What are the most important things you learned regarding mindfulness-based self-care and SEL?
  2. How have your knowledge and practice of SEL affected your personal and professional life in the area of self-awareness, self-management, responsible decision-making, relationship skills, and social awareness?
    • Do you attribute these changes to the class?
    • Have these changes stayed with you since you took the class? What has changed?
  1. Describe the history of your self-care practices.
    • What self-care practices do you currently practice? How often for each?
    • How did the class influence these practices?
  2. Describe how your mindfulness-based self-care affects your personal and professional life.
    • In what ways do your own practice of mindfulness and self-care change how you think about students’ or clients’ issues or problems? How have your ideas about what is therapeutic, or healing, changed since taking the class? Do you see mindfulness techniques as healing? How?
    • Have the mindfulness practices influenced who you are as a counselor, advisor, educator, or therapist or what it’s like for you to be in the role of the counselor, advisor, educator, or therapist? How?
    • Have you tried to introduce mindfulness concepts/techniques with a client/student? Which techniques? What was your level of comfort with introducing the mindfulness techniques?
  3. What are consequences/outcomes from mindfulness-based self-care practices? (elaborate)

General Questions & Feedback

Is there anything you would like to say about your experiences in relation to the course that we have overlooked? What suggestions do you have to make this course a better experience?

Ending

We want to thank you for your participation in this project.

Appendix B
Course Content and Activities

Week Module Mindful Theme SEL Competencies Class Activities
One 1 Presence Self-Awareness Course Overview: Review syllabus, expectations, course
requirements, and online resourcesWhat’s Social and Emotional Learning (SEL)?

Three Collective Breaths

Why Aren’t We Teaching Mindfulness: TED Video

Pre-Training Survey

Small Group with Accountability and Support

2 Self-Connection Practice

Mindful Listening and Speaking

Brave Zone

Trauma-Informed Practice: Grounding, Orienting, and Centering

“Seven Up” Film

My Seven Up Writing

Body Scan

Weekly Journal Entry

Two 3 Gratitude Self-Management Setting Intentions

Mind–Body Connection

Non-Violent Communication

Empathy Practice

Appreciation Circle

4 Non-Violent Communication Tools: Mourn/Celebrate/Learn (MCL)

Exploring Identities: “I Am”

Thankful Thoughts

Negative Bias

Weekly Journal Entry

Three 5 Creativity Relationship Skills Play Therapy: Foundations and Techniques (1)

Creative Arts

Additional Readings

6 Play Therapy: Foundations and Techniques (2)

My Relationships

Community Circle: Appreciation Practice

Weekly Journal Entry

Four 7 Compassion Social Awareness Check-In: Daily Practice

Compassionate Self-Talk

Neuroplasticity

“Into Light” Video

My Life and Vision: Milestones

8 Courageous Conversations

Mindful Eating

Sound Healing

Capstone Preparation

Weekly Journal Entry

Five 9 Equity & Inclusion Responsible Decision-Making Giving and Receiving Loving-Kindness

Transformative SEL: Advocacy

Gender Identities and Pronouns

Mindful Breathing

Silent Mindfulness Practice

Yoga and Mindfulness

10 Capstone Presentations

Celebration: A Closing Ceremony

Post-Training Survey

Final Journal Entry

 

Kyoung Mi Choi, PhD, NCC, is a professor at San José State University. Jung H. Hyun, PhD, NCC, is an associate professor at Nova Southeastern University. Correspondence may be addressed to Kyoung Mi Choi, One Washington Square, San José, CA 95192, kyoungmi.choi@sjsu.edu.