Online Counselor Education: A Student–Faculty Collaboration
Donna S. Sheperis, J. Kelly Coker, Elizabeth Haag, Fatma Salem-Pease
Online counselor education has been studied extensively since its inception, but the experiences of students within these programs have received limited attention. This collaborative view from faculty and students of online counselor education was developed to share the stories of students who have engaged in both synchronous and asynchronous distance counselor education programs at the master’s and doctoral level. Students talked about finding online programs to be viable options to work flexibly within their adult lives. In addition, they shared that they were more satisfied when there were efforts to foster connection through synchronous or other means found in a community of inquiry. Finally, their reports illuminate potential directions for research in exploring the experience of students in online counselor education programs.
Keywords: online programs, counselor education, synchronous, community of inquiry, students
Online counselor education has been a reality since the late 1990s, yet little is known about the training experiences of students in these programs. At the time of this writing, there are approximately 79 master’s and doctoral online counseling programs accredited by the Council for the Accreditation of Counseling and Related Educational Programs (CACREP; n.d.) and several other distance counseling programs without CACREP accreditation. Potential students have many options to consider in the online counselor education environment, and distance programs continue to strive to differentiate themselves from an ever-growing landscape of educational offerings. What is it that students and recent graduates of different online programs reported were the experiences that fostered their growth as professional counselors and counselor educators? Who supported them and their growth (e.g., peers, faculty, supervisors)? How did they stay engaged, motivated, and focused on their goals in a distance environment?
The aim of this article was to explore these questions with students and graduates of distance counseling and counselor education programs. Current students and recent graduates of distance counseling and counselor education programs were invited to bring voice to their experiences through informal interviews and this collaborative account. Program faculty contacted the students and graduates who volunteered to share their perspectives about the programs and agreed to have their responses used in this article. Two of the students who provided their opinion also served as coauthors. This effort was not designed to create generalizable or transferable knowledge; thus, there was no formal sampling strategy in place. It should also be noted that because the goal was not to generate generalizable or transferable knowledge, these interviews did not fall under the purview of IRB review. Thus, student responses are not anonymized and are cited as personal communications, with the students’ permission.
To gather a broad range of information, we reached out to students from programs with a variety of characteristics, including both CACREP- and non–CACREP-accredited counselor education programs; private for-profit and private nonprofit programs; faith-based and secular programs; and programs employing a continuum of distance delivery methods ranging from asynchronous, to hybrid, to synchronous. However, the information provided is not exhaustive in terms of the types of programs available. Instead, we were interested in the views of students across diverse online counselor education programs. Throughout the article, we include direct quotes from students as well as references from the literature that relate to those experiences.
For our small group of students and graduates who shared their perspectives for this article, the average age was 41.4, with all contributors in their 40s except one. Given that distance education learners tend to fall into the category of “adult learner,” an exploration of motivators for choosing online education among this group was germane. In a survey of adult learners, the Education Activities Board (2019) indicated that today’s adult learners are “savvy, digital consumers who approach their education with a consumer-like mindset” (p. 2).
As indicated by Snow and Coker (2020), one might expect there would be a plethora of literature to assist in understanding experiences of students in distance education programs. Studies examining student perceptions of social presence, engagement, outcomes, and teaching strategies in online distance education have been conducted, but specific inclusion of student perceptions of distance counselor education is lacking (Bolliger & Halupa, 2018; Gering et al., 2018; Lowenthal & Dunlap, 2018; Murdock & Williams, 2011). This glimpse into the experiences of students and graduates from distance counselor education programs informs our understanding of how direct consumers view their counseling training and preparation experiences.
Choosing Online Counselor Education
It is a major decision to become a professional counselor or counselor educator. Another important decision is deciding where to train and by what learning method to receive training. To understand why a prospective student might choose a distance education program, we must first understand the characteristics of the online learner. Distance education students tend to skew older than their on-campus counterparts, and the average age of an online learner is 34 (Education and Careers, 2019).
With this fact in mind, we asked our five students to respond to the following prompt: “Provide us with a brief statement as to why you chose counseling and then online education.” Among our small group, reasons for choosing online counselor education clustered around family, work, and lifestyle. Two of our five students shared that being a single parent of one or more children with special needs was a driving factor. Another, also the parent of a child with special needs, needed the flexibility afforded by distance learning to be able to live overseas to accommodate her husband’s job. Keeping a particular job and work schedule were reasons for other students.
According to an Education Activities Board survey (2019), the number of graduate students taking online courses rose 47% between 2012 and 2017, suggesting that the appeal of flexible options for adult learners is a salient factor in their decision to pursue an online education. Amy Campos, a graduate of a large for-profit university with a CACREP-accredited program, summed it up well:
I was in my late 30s when I decided it was time to level up and begin the journey to a graduate degree. I was raising two neurodiverse children and had just entered the unfamiliar territory of single parenting! I knew I would need to find a program that not only supported my career and educational goals but blended with my personal and family needs as well. (personal communication, May 3, 2019)
Overall, students indicated that an online program offered the flexibility they needed to successfully navigate graduate training at the current stage of their lives.
Structure and Process of Online Counselor Education Programs
When we started training in online counselor education programs, there were limited options in terms of program structure and student experiences. In the early 2000s, the delivery of curriculum in counseling programs was an either–or proposition: students either enrolled in a traditional face-to-face (F2F) program or in an online program that was solely asynchronous except for an on-campus skills training component (i.e., residency). Asynchronous learning simply means that students do not attend required meetings of the class during a given week, although they likely have assignments with required dates. The early adopters of online counselor education were able to meet and achieve CACREP accreditation through a blend of asynchronous learning experiences in learning management systems such as Blackboard with asynchronous assignments, readings, and discussion posts, and F2F, on-campus training residencies to practice and demonstrate clinical skills.
Given that most early online counselor education training programs followed this same format, much of the early literature regarding the efficacy of online learning focused on the comparisons between two instructional modalities: F2F or on-campus vs. online, asynchronous instruction. In a comparison of levels of learning and perceived learning efficiency of on-campus and online learning environments, Smith et al. (2015) found that levels of learning (i.e., student participants’ perceptions of learning) between online and on-campus students were essentially the same, while the efficiency of learning outcome (i.e., student participants’ perceptions of time devoted to learning activities and achieving learning outcomes) favored the online modality.
Other studies have shown little difference in academic outcomes between on-campus and online delivery methods in psychology programs (Hickey et al., 2015) and counseling programs in Australia (Furlonger & Gencic, 2014). Examinations of blended learning models similarly have shown that students can benefit from both on-campus and distance modalities (Karam et al., 2014). More and more, teasing out the different kinds of learning opportunities across the ever-widening spectrum of distance education is becoming the focus. The use of videoconferencing, interactive media, and a blend of synchronous and asynchronous deliveries is increasingly common in counselor education (Snow et al., 2018).
Our students discussed a variety of delivery methods and structures from their online learning experiences. According to Fatma Salem-Pease, a coauthor who was also interviewed as a student at a private nonprofit university with a non–CACREP-accredited program,
some courses are lighter than others, with more focus on practicing counseling skills, and will therefore have more synchronous activities. Other courses focus on psychology and counseling fundamentals and therefore require more reading, research, and involve writing more papers. A big majority of the learning is done individually. (personal communication, April 25, 2019)
Two of the students’ programs were structured with required weekly, synchronous class meetings, and the students indicated that these components positively impacted their sense of engagement and learning. According to Michelle Fowler, a graduate of a private nonprofit university with a CACREP-accredited program, “group projects and small group breakouts through Zoom were a good way to get to know people. The best way to really get to know people was through assigned weekly meeting groups” (personal communication, April 10, 2019). Similarly, Libby Haag, a student at a private nonprofit religious university with a CACREP-accredited program, shared that the synchronous nature of her program was her favorite part (personal communication, April 16, 2019). She felt that being connected in that fashion to faculty and peers allowed her to practice the relational elements essential to becoming a competent counselor. There was a definite enthusiasm for these relationships from students whose programs offered the synchronous environment online.
Two other students interviewed for this article were in programs that followed the more traditional online format of asynchronous classes with F2F residency experiences. Interestingly, comments from one of our students who attended a program with an asynchronous learning model identified a potential need to include other modes of training and delivery in addition to asynchronous learning. Shawn Clark, a graduate of a public university with a large CACREP-accredited program, wrote:
We have to meet once a week at night as a class during the internship processes but not during any other classes. I enjoyed the interaction during these meetings because we were able to critique each other’s skills, which helped me develop professionally. If we could have met as a class online during all my classes, I believe I would be more prepared as a counselor. (personal communication, April 22, 2019)
From all of our students’ observations, a blend of formats, deliveries, and experiences seemed to benefit them most. These observations support the emerging literature concerning different deliveries of distance education. According to Harris (2018), a combination of modalities, including F2F, online, asynchronous, and synchronous, tap into a variety of learning styles and together can create a learning experience that positions students for success.
Community of Inquiry
Allen et al. (2016) suggested that about 77% of institutions with distance offerings find them critical to their long-term strategy and the future growth of their institutions. An important element in online education is the community of inquiry, which is a framework for teaching and learning that is built on aspects of constructivist pedagogy. Specifically, the community of inquiry is comprised of social presence, cognitive presence, and teaching presence (Richardson & Ice, 2010). Akyol and Garrison (2008) defined these types of presence as follows: social presence is the experience of connection in online learning, cognitive presence is the exchange of information and ideas, and teaching presence is the facilitation and shaping of the discourse. For the purpose of this article, we asked students to talk with us about how they experienced these in their interactions with peers and faculty.
Interactions With Peers
Researchers who have studied the community of inquiry model have found that a lack of interaction between online students results in an experience of loneliness and an increase in students dropping courses (Ozaydın Ozkara & Cakir, 2018). All of the students we spoke with talked about developing deeper connections during the residency component of their curriculum and how meaningful those relationships were. But there were other areas for connection provided as well. Students who were in programs with a synchronous online component commented on the use of breakout rooms in virtual platforms such as Zoom and how helpful they were to developing community. Additionally, the use of virtual groups during the group counseling course increased opportunities to interact with peers. None of the students participating in our discussion cited online discussion boards as a way to increase or improve interactions with peers, but some did share that simply seeing the same students’ names in multiple classes was helpful.
Interactions With Faculty
Within the community of inquiry, teaching presence is comprised of both the way the faculty member sets the stage for learning and the way they generate a focus for the online discourse (Walsh, 2019). Unfortunately, faculty tend to view their teaching presence more favorably than students (Blaine, 2019). As such, it was important to get the student perspective on interactions with faculty.
Students’ interaction ranged from being in the classroom to taking advantage of opportunities to connect out of class. Within the class, students found instructor videos to be helpful, sharing that in some fully asynchronous programs, students may never see their faculty members’ faces or hear their voices as lectures are developed at the institutional level and prepopulated in each course shell. Faculty members who took the use of video even further, such as using the video feedback options in the learning management system, were appreciated even more. But it was the interactions outside of the classroom that seemed to be the most impactful to students.
Students discussed having email, phone, and video chat communication with faculty and how important that was to their experience. These interactions felt personal and “helped me rebuild my self-esteem and acknowledge my self-worth” as well as student self-efficacy while serving as a professional model (F. Salem-Pease, personal communication, April 25, 2019). Students who did not have more personal interactions outside of class reported less satisfaction in this area. A clear takeaway is that the more students can interact with each other and with their faculty both in and out of the classroom, the more fulfilling their experience is with online education.
Practicum and Internship
Having taught in counselor education programs for a combined 40 years, we recognize that whether on-campus or online, the experience of practicum and internship is one of the most anxiety-provoking elements of counselor training. Whether the anxiety is about finding an appropriate site, securing sufficient direct client hours, or struggling with insecurity around skills and abilities, students entering field experience need additional support (Nease, 2013). The experience of online students is no different. Those who live in towns with a large, campus-based program reported some challenges helping sites understand their status. One student talked about needing to make a case for her program when the site was primarily accustomed to dealing with the hometown university. However, students who had lived in their hometown for a while and had good connections, or who lived in areas that are highly populated and have multiple agency opportunities, reported less stress.
Faculty connections were also found to be helpful. Just as students may come from all areas of the country or the world, so may faculty. Having faculty familiar with state requirements and who have peers in the towns where students are trying to gain a site can be helpful. All students reported a willingness to be persistent, make the necessary calls, know their program and training, and take on the hurdles of a human resource department as necessary qualities for success in finding practicum and internship sites.
Counselor Licensure
Counselor educators are well aware that state licensure requirements are not uniform, can be tricky, and are challenging to even the most seasoned licensure candidate. But students often enter counseling programs assuming that licensure is similar across states and territories (Buckley & Henning, 2016). To this end, most of the students we spoke to talked about having discussions about state licensure requirements early in their training. Students were advised to look for any challenges or deficiencies posed by their program of study:
The only concern I had with my license was from not having a human sexuality course from my university. The state of Florida requires this class. However, when I reached out to my university and told them of my dilemma, they found the course in another program and offered it to me. I will be taking it this summer. (S. Clark, personal communication, April 22, 2019)
In addition, many students reported having early assignments that required them to review their state board requirements.
We are required to research the state requirements and write several papers about them during the very first term. After that, we are constantly reminded of our state requirements, especially as we head into practicum and internship, and also when selecting elective courses. (F. Salem-Pease, personal communication, April 25, 2019).
Students seemed to benefit from programs that began the licensure discussion during admissions and kept it at the forefront throughout their training.
Motivation in Online Training
We started this paper with a premise that many learners in distance education programs need to be self-motivated to be successful. Even programs that have synchronous and on-campus portions still generally require students to engage in some amount of self-paced and self-guided learning. As early as 1986, Moore was writing about the importance of self-directed learning in distance education environments. He suggested that the self-directed or autonomous learner is motivated to “set their goals and define criteria for achievement” (Moore, 1986, p. 13).
Our students were asked to consider any strategies that have helped them remain motivated through their training program. All of the students mentioned some combination of the need to stay organized, make and keep a schedule, and set realistic goals for success. Fatma Salem-Pease offered that it is a combination of having an organized weekly schedule and self-care routines that helps to maintain motivation: “One significant aspect of my self-care has become planning ahead and giving myself the appropriate amount of time to complete an assignment well before the deadline.” She went on to say, “Self-care is an important component of any journey and is absolutely necessary to maintain stamina until the end” (personal communication, April 25, 2019). Two students discussed the roles their professors played in their ability to stay motivated. Michelle Fowler shared that “[a] big challenge was dealing with the different formats teachers used” (personal communication, April 10, 2019). Libby Haag discussed how being an independent thinker and problem solver goes hand-in-hand with being mindful and respectful of professors’ time: “I make sure my email communications are respectful, clear, and concise. I believe these relationship-focused skills have helped me to have better connections with my professors and peers in an environment that often feels isolating” (personal communication, April 16, 2019).
Other ways our students described their ability to be self-motivated in a distance learning environment included being disciplined, intrinsically driven, resourceful, dedicated, and having a sense of self-efficacy. As one student stated, “self-efficacy is an important factor that determines the student’s perception of her ability to achieve certain tasks” (F. Salem-Pease, personal communication, April 25, 2019). This observation is supported by inquiries that have examined the relationships between self-efficacy, confidence, and attainment in online formats. Watson (2012) found that students in online learning environments have higher self-efficacy beliefs than students in traditional, on-campus programs and that online learning environments may in fact increase personal motivation and self-efficacy.
A framework for understanding motivation in educational environments is self-determination theory, which makes a distinction between autonomous (self-determined) motivation and controlled (externally pressured) motivation (Ryan & Deci, 2008). Ryan and Deci (2008) posited that individuals are more likely to engage in positive change, whether in therapeutic, educational, or family settings, when there are external supports in place that promote autonomy. Autonomous motivation is achieved when the needs for autonomy, competence, and relatedness are met (Baeten et al., 2012). Learning environments that strive to create conditions where students can feel they have some level of autonomy balanced with a clearly formulated structure, as well as opportunities for involvement and engagement with faculty and peers, have a combination of factors that are conducive to student motivation (Baeten et al., 2012).
Watson (2012) explained that “one of the common concerns often voiced has been whether or not ‘skills-based’ or ‘techniques’ courses could be offered sufficiently online” (p. 143). This aspect is often addressed in CACREP-accredited programs through the F2F residency experience and synchronous video activities that allow students to practice counseling skills and get helpful feedback and guidance from professors (Snow et al., 2018). Online students report that course materials generally make use of a variety of videos, including full counseling session videos and those incorporating certain techniques, which fosters vicarious learning. Fatma Salem-Pease indicated that the level of attention she received while pursuing her online degree was higher and more personalized than when she was pursuing an on-campus degree. She attributed this distinction to the fact that group sizes were small and her belief that there may be a benefit to professors reviewing video recordings in the comfort of their own office or home space where they are not pressured to assess the skills of multiple individuals in one sitting.
“What I Wish I Had Known Before Starting an Online Program”
The students who shared their perspectives were asked to talk about what they wish they had known coming into an online program. Many wished they had truly understood the importance of developing relationships with faculty and fellow students. Generating groups using Facebook or other social media was suggested as a way to facilitate this. In addition, some wished they had known that developing teams to practice skills would have been helpful to the online counselor-in-training.
A primary area of consideration on this topic was the financial cost of online education. Because many online programs are housed in private institutions, it was suggested that students
look long and hard at the expense associated with the program and the entry-level jobs they will get with their degree. The amount of debt in relation to that salary can be overwhelming, and while it may prove to work out in the long run, [online private institutions] may not be the wisest choice. (S. Clark, personal communication, April 22, 2019)
Whether in private or public universities, students were pleased that the online programs allowed them to pursue the education they wanted and needed while still maintaining a full-time job.
Student Perspectives of the Literature
We offered our two student coauthors and graduate interviewees the opportunity to each identify a relevant article from the literature that resonated, in some way, with their experiences as online learners and to contribute to this article by outlining the impact of that article on their learning experience. The student authors of this manuscript found that building relationships was reflected in the literature as an essential element, just as it was in their own experiences.
Building Relationships in Online Counselor Education Programs—Libby Haag
At the essence of counseling is relationships (Hall et al., 2010). Online education can often remove the humanistic quality by an absence of F2F instruction, resulting in a lost opportunity to connect with peers, professors, and future counselors and thus lacking an essential component in personal growth. Relationship-building skills are imperative for developing effective counselors, maintaining professional integrity, and implementing gatekeeping, and online learners often can feel detached from their professors and peers. Although on-site schooling offers the humanistic relationship-building aspect, online formats have the ability to educate underserved and diverse individuals to give them the opportunity to become professional counselors (Hall et al., 2010). Online counselor education combines the best aspects of technology with traditional campus education, which may create a more accessible, relational, and humanistic approach to the development and training of counselors.
Humanistic Framework
According to Hall et al. (2010), a more effective online education for counselors is a humanistic framework that includes both technology and consistent F2F video interaction while maintaining a student-centered focus. This interactive model can effectively solve the problem of how to reach many underserved students to promote diversity in growing our profession while still teaching effective counseling skills to nurture the important humanistic, personal relationship aspect that is paramount to our profession. This humanistic framework to create a more effective and personal online experience has four principles: “the importance of viewing and valuing students holistically, the importance of maintaining meaningful relationships, an emphasis on valuing intentionality, and the recognition that people are goal oriented and creative beings” (Hall et al., 2010, p. 47).
Viewing and Valuing Students Holistically. Online educators need to view each student holistically as a distinctive individual and not use a reductionist approach (Hall et al., 2010). It is essential that the student feel important and valued while being viewed phenomenologically. A suggestion for viewing and valuing students in a more holistic manner would be to do video interviews as part of the application process. This would help establish a relationship with a professor before school even begins to create a meaningful, intentional, and relationship-driven curriculum.
Maintaining Meaningful Relationships. According to Hall et al., “a good relationship is the basis of counseling and education” (2010, p. 48). Therefore, personal relationships need to be developed in an online program for both teachers and peers. Some suggestions to foster a positive relationship begin with sending emails before class starts and encouraging an open-door policy for communication. In addition, professors can approach an online class with group counseling techniques. For example, when beginning class, the professor could have all the students introduce themselves in the video forum using an icebreaker. At the next class, they can have the students reintroduce one another. Small group projects are also encouraged with some group counseling techniques (Hall et al., 2010).
Valuing Intentionality. Intentionality, as defined by Hall et al., is “a sense of purpose in guiding and choosing one’s behavior” and “our capacity to reach out, take care of, and tend to others in purposeful ways” (2010, p. 48). Online professors could begin to guide students into becoming intentional learners, with an emphasis on self-awareness and deliberate reflection of their considerate interactions with others. This will help foster and model the connection online counseling students need for effective relationship skills in the future.
People Are Goal-Directed and Creative Beings. Personal growth is a primary characteristic of a holistic, humanistic online education. Professors need to be willing to nurture creativity, drive, and resourcefulness within the classroom. Having a personal growth-based curriculum will only increase the student’s online experience. Hall et al. (2010) asserted that opportunities for growth and intrinsic motivation exist in creating an environment that promotes self-actualization, self-realization, and self-enhancement. It is suggested that teachers use a variety of techniques to match unique learning styles of a diverse student body for fostering creativity in online counselor education.
From a Personal Perspective
In examining and analyzing Hall et al. (2010) above, Libby Haag shared that her personal experience with a humanistic online framework has helped her to become a more rounded counselor. She feels as if she thrived in this environment, which was rooted in a very CACREP-driven curriculum with an emphasis on personal and professional growth. The relationships she created with teachers, peers, and supervisors were invaluable, and the F2F interaction helped to develop better social skills and a sense of community. She indicated that she made sure to reach out and let peers and professors get to know her personally. These actions helped her to feel connected and valued in a system that can sometimes lack a human element. She found that her most influential professors were those who were very personable and patient and who used humor and modeled authenticity with a focus on fostering relationships. They were available for personal consultation and they always offered a good deal of feedback. Overall, concurrent with the literature, Libby Haag’s experience was that a relationship-focused online program was essential in creating competent counselors.
Self-Efficacy and the Online Learner—Fatma Salem-Pease
Fatma Salem-Pease discovered that the 2012 article by Watson, “Online Learning and the Development of Counseling Self-Efficacy Beliefs,” supports a lot of the viewpoints she had previously shared in her personal communications. First, the article discussed the importance of practicing learned skills in real-life F2F situations and expressed the concerns voiced by many counselor educators about the efficacy of an online program that does not incorporate F2F learning components. As discussed earlier in this article, Watson (2012) explained that “One of the common concerns often voiced has been whether or not ‘skills-based’ or ‘techniques’ courses could be offered sufficiently online” (p. 143). This aspect is often addressed through residency experiences and through synchronous video activities that allow students to practice counseling skills and receive helpful feedback and guidance from professors. Course materials also have a variety of videos, including counseling sessions and how certain techniques are used, which foster vicarious learning.
Watson (2012) noted that “academic coursework, assigned readings, classroom discussions, self-reflection, modeling, supervision and hands on experiences associated with practica and internships” are required elements to enhancing competency and perception of self-efficacy (p. 145). The study hypothesized that F2F students have higher levels of perceived counseling self-efficacy than online students. The researcher administered the Counseling Self Estimate Inventory to 373 graduate students, 207 of which were F2F students, while 166 reported having taken the core skill development courses online. The results of the study disproved the hypothesis and showed that online counseling students have stronger counseling self-efficacy than F2F students.
These results support Fatma Salem-Pease’s and other students’ thoughts that online students have the opportunity to individualize their learning to their specific needs, helping them feel more confident in what they know and more aware of what they need to work on further. Structured F2F educational programs, she believes, burden students with an extensive and specific schedule to follow daily, which leaves minimal time for students to reflect on what is being learned and how to maximize the learning experience. Online students can be more actively engaged in their learning and have more freedom to choose what to accomplish and learn with their time.
Conclusion
Although much has been written about the online learning experience in counselor education, it is rare to hear faculty and students work together to share their experiences in online education and training settings. What we have captured here first and foremost is that online counselor education provides a positive option for many students and faculty. Online counselor education allows students to blend academic pursuits into their current family and career lives in a way that is more accessible than traditional on-campus programs. When embarking on this journey, students value the connections they are able to foster with faculty and with peers, many of which occur through the synchronous parts of a program. Given that many programs are fully asynchronous, further research into the use of synchronous components would benefit the field of online counselor education.
Additionally, students strongly supported the fact that the path to success is smoother when programs attend to the various field experience and licensure requirements of their students across states. It is clear that an online counselor education program requires skills in both self-motivation and self-care to provide the maximum benefit to the student. Although this paper addressed the student experience in a non-empirical manner, a more research-driven approach to understanding student experience in distance counselor education programs is needed. Overall, online counselor education is functional, effective, and preferred by many students who are now pursuing their own careers in the profession of counseling.
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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Donna S. Sheperis, PhD, NCC, ACS, CCMHC, LPC, is an associate professor at Palo Alto University. J. Kelly Coker, PhD, NCC, LPC, is an associate professor at Palo Alto University. Elizabeth Haag was a graduate student at the University of the Cumberlands. Fatma Salem-Pease was a graduate student at Southern New Hampshire University. Correspondence can be addressed to Donna Sheperis, 5150 El Camino Real, Los Altos, CA 94022, dsheperis@paloaltou.edu.
