“A Learning Curve”: Counselors’ Experiences Working With Sex Trafficking

Claudia G. Interiano-Shiverdecker, Devon E. Romero, Katherine E. McVay, Emily Satel, Kendra Smith

In this transcendental phenomenological study, we interviewed 10 counselors who have clinical experience working with sex trafficking survivors. Through in-depth individual interviews, participants discussed their lived experiences providing counseling to this population. Our analysis revealed four primary themes: (a) counselor knowledge: “learning curve,” (b) counselor skills: “creating a safe space to dive into work,” (c) counselor attitudes: “being able to listen to the client’s story,” and (d) counselor action: “more than just a counselor.” The findings indicated that counselors working with sex trafficking survivors needed to understand and address the different aspects of trauma. Our findings also demonstrate that working with sex trafficking survivors requires additional competencies such as recognizing the signs of sex trafficking, vulnerable populations, and the processes by which traffickers force people into sex trafficking. We discuss these findings in more detail and identify implications for counselor training and practice.

Keywords: sex trafficking survivors, counseling, phenomenological, trauma, competencies

Sex trafficking of any individual is a significant concern globally. In 2000, the United States government enacted the Victims of Trafficking and Violence Protection Act of 2000, which defined sex trafficking as “the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery” or “when the person induced to perform such act has not attained 18 years of age” (§ 103). Although the United States’s efforts fully meet the minimum standards established by the Victims of Trafficking and Violence Protection Act of 2000 to eliminate severe forms of trafficking, the Department of Justice initiated a total of 210 federal human trafficking prosecutions in 2020, of which 195 involved predominantly sex trafficking (U.S. Department of State, 2021). As stated in the Trafficking in Persons Report (U.S. Department of State, 2021), all 50 states, the District of Columbia, and U.S. territories have reported all forms of human trafficking over the past 5 years. With an estimated 4.8 million people victimized by sex trafficking (International Labour Organization, 2017), it is important to understand how counselors identify, provide services to, and advocate on behalf of sex trafficking survivors within the counseling setting. 

Sex Trafficking and Mental Health
     As a form of human trafficking, sex trafficking exposes individuals to torture; kidnapping; and severe psychological, physical, and sexual abuse. Physical health consequences of sex trafficking include general health complications (e.g., malnutrition), reproductive health consequences (e.g., sexually transmitted diseases, unwanted pregnancies), substance abuse, and physical injuries (Grosso et al., 2018; Lutnik, 2016; Muftić & Finn, 2013). Psychological abuses are numerous and can include intimidation, threats against loved ones, lies, deception, blackmail, isolation, and forced dependency (Thompson & Haley, 2018).

Constantly experiencing atrocious physical and psychological abuses creates mental health consequences such as depression, post-traumatic stress, dissociation, irritability, suicidal ideation, self-harm, and suicide (Cole et al., 2016; O’Brien et al., 2017). Survivors of sex trafficking may exhibit severe mental illness, including schizophrenia and psychotic disorders, increased risk of compulsory psychiatric admission, and longer duration of psychiatric hospitalizations (Oram et al., 2016). Moreover, social distancing and the global economic downturn due to the COVID-19 pandemic increased online sexual exploitation and the number of individuals vulnerable to sex trafficking (U.S. Department of State, 2021).

Because of the prevalence of sex trafficking, the health consequences that result from it, and the diverse areas in which counselors practice (e.g., community clinics, private practices, behavioral health departments, college/universities, K–12 schools), counselors must be prepared to work with sex trafficking survivors (Interiano-Shiverdecker et al., 2022, 2023; Litam, 2017, 2019; Romero et al., 2021; Thompson & Haley, 2018). Standards required by the Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2015) prepare counselors to demonstrate clinical competencies to address a variety of circumstances, including traumatic experiences, across various continuums of care (e.g., inpatient, outpatient). Clinical mental health counselors with specialization in substance abuse and marriage, couple, and family counseling can also address other comorbid issues typically encountered with sex trafficking clients such as substance abuse and relational difficulties (CACREP, 2015; Litam & Lam, 2020). Early incidence of sex trafficking (12–16 years for girls, 11–13 for boys and transgender youth; Franchino-Olsen, 2019) demands the attention of school counselors trained to promote the academic, career, and personal/social development of school-aged children (American School Counselor Association [ASCA], 2022; CACREP, 2015). Therefore, first-hand accounts of counselors providing services to this population can provide an overview of current needs, challenges, and recommendations for clinical practice and research.

Sex Trafficking Research in the Counseling Profession
     A recent review of the literature showed increased attention to sex trafficking coverage in top-tier counseling journals. Conceptual pieces reviewed relevant information on sex trafficking, counselor awareness, and counseling implications (Browne-James et al., 2021; Burt, 2019; Litam, 2017; Thompson & Haley, 2018). Empirical studies explored counselors’ attitudes toward sex trafficking (Litam, 2019; Litam & Lam, 2020), assessment for the screening of sex trafficking (Interiano-Shiverdecker et al., 2022, 2023; Romero et al., 2021), mental health treatment programs and modalities for sex trafficking (Johnson, 2020; Kenny et al., 2018; Schmidt et al., 2022; Woehler & Akers, 2022), and survivors’ recovery stories (Bruhns et al., 2018). Thompson and Haley (2018) reported a need for more training and education for counselors on sex trafficking. In a study done by Litam and Lam (2020), results indicated that counselor training in sex trafficking increased awareness. As a response, Interiano-Shiverdecker et al. (2023) developed an initial list of child sex trafficking competencies for counselors.

Although these studies provide relevant information for counselors’ work with sex trafficking, they do not focus on the experience of providing care for sex trafficking victims and survivors. Exploring counselors’ experiences provides a significant breakdown of current mental health care for this population. In other words, what does providing care for this population look and feel like in reality and what competencies work when serving sex trafficking victims and survivors? Only one phenomenological study focused on this inquiry, but this study examined therapists’ experiences working with foreign-national survivors of sex trafficking in the United States (Wang & Park-Taylor, 2021). Although this study presents important findings, it explored counselors’ work with only a certain group of sex trafficking individuals. Despite incomplete records, most data indicate that U.S. citizens are equally vulnerable to sex trafficking. For example, the National Human Trafficking Hotline (n.d.), which maintains one of the most extensive data sets on human trafficking in the United States, indicates that U.S. citizens comprised approximately 40% of their callers. The current study seeks to expand on the work of Wang and Park-Taylor (2021) by obtaining first-hand accounts of counselors providing services to sex trafficking clients in the United States and providing an overview of needs, challenges, and recommendations for clinical practice and research. The guiding research question for this study was: What are the lived experiences of counselors working with sex trafficking survivors in the United States?


Using transcendental phenomenological research, the researchers—Claudia G. Interiano-Shiverdecker, Devon E. Romero, Katherine E. McVay, Emily Satel, and Kendra Smith—sought to understand counselors’ experiences working with sex trafficking survivors. A transcendental phenomenological method was best suited for this study because it allowed us to provide thick descriptions of the phenomena while employing bracketing techniques to explore participants’ experiences outside of our perspectives (Hays & Singh, 2012). Utilizing Moustakas’s (1994) modification of Van Kaam’s method, we sought to explore the occurrences of counselors working with sex trafficking survivors and collectively met to address any biases that came up during data analysis.

Researchers as Instruments
     At the time of the study, Interiano-Shiverdecker and Romero were counselor educators at a university in the Southern United States with recent sex trafficking publications and experience working with youth vulnerable to sex trafficking in community and school settings. McVay was a doctoral candidate and a licensed professional counselor who was practicing as a social–emotional wellness counselor at a private school. Satel and Smith were master’s students in a clinical mental health program. Our desire to explore this topic stemmed from a limited discussion of sex trafficking in the literature and sought to include the voices of counselors. As the research team, we are all involved in a research lab dedicated to understanding sex trafficking and how counselors can better serve sex trafficking survivors. As such, we had varying levels of experience with research and engagement with sex trafficking. Satel and Smith were new to research, including topics surrounding sex trafficking. Therefore, Interiano-Shiverdecker and Romero’s broader understanding of the topic could have influenced newer members. For example, Interiano-Shiverdecker assumed that codes would resemble counseling competency categories (e.g., knowledge, skills, awareness). To reduce researcher bias, we engaged in weekly debriefing meetings for approximately 5 months for ongoing discussion of our perspectives and preconceived notions throughout data analysis. We documented our biases in journals, checked in on them during meetings, and referenced participants’ quotes to prevent imposing our assumptions of the data.

Participants and Sampling
     After receiving IRB approval from the university, we sought participants through purposeful sampling and snowball sampling. Purposeful sampling strategies included reaching out directly via email to counselors who fit the study criteria and sending two calls for participants on an email mailing list for counselors and counselor educators (i.e., CESNET). For direct emails, McVay created a list of individuals who fit the criteria from Interiano-Shiverdecker and Romero’s professional network and an internet search. We also engaged in snowball sampling methods through recruited participants involved in the study. Inclusion criteria included counselors over the age of 18, who had previously or were currently working with children or adults who had been sex trafficked. Participants confirmed meeting the inclusion criteria by responding to a demographic questionnaire before beginning the interview. Following the qualitative researcher’s recommendation of sample size, we sought a range between five and 25 participants for this study (Creswell, 2013; Moustakas, 1994). Counselors who agreed to participate completed the consent forms, a demographic form, and a one-time Zoom interview. Participants received a $25 gift card for their involvement in the study. We recruited for about 5 weeks after interviewing 10 counselors. After the tenth interview was completed and we concluded the first round of analysis for all interviews, we felt that data saturation was achieved when similar codes showed up throughout the data.

The resulting participant pool consisted of 10 counselors (nine female and one male) ranging in age from 27 to 61 years (M = 40.7, Mdn = 38.5, SD = 11.1). Seven participants identified as White, two participants identified as Hispanic, and one participant identified as Asian. The participants also identified their employment setting: university (n = 1), agency (n = 3), and private practice (n = 6). Participants disclosed providing services in one or several states such as Alabama (n = 1), Florida (n = 1), Missouri (n = 1), Nevada (n = 1), North Carolina (n = 1), and Texas (n = 7). One participant also reported providing services to sex trafficking survivors in the United Kingdom. Years working with survivors of sex trafficking ranged from 1 to 13+ years, with a range of three to 50+ clients who disclosed their sex trafficking experience. One participant (Alejandra) who had worked primarily with survivors of sexual abuse did not indicate their number “since a lot of clients I have worked with do not readily admit to being sex trafficked, I’m not sure.” Table 1 outlines participant demographics in more detail.

Table 1
Participant Demographics

Pseudonym Age Gender Race/Ethnicity Work Setting Years of Service # ST Clients CACREP
Kimberly 48 Female White Private Practice 11 30 Yes
John 38 Male White University 11 5 Yes
Stacy 33 Female White Private Practice 8 3+ Yes
Alejandra 54 Female Hispanic Agency Unsure Most of career No
Fen 39 Female Asian Private Practice 5 4 Yes
Cassandra 33 Female White Private Practice 5 50+ Yes
Tiffany 27 Female White Private Practice 1 25 Yes
Amanda 29 Female White Private Practice 4 5 Yes
Ana 61 Female Hispanic Agency 13+ 20 Yes
Cristina 45 Female White Agency 3 10+ No

Note. Years of Service = Years providing services to ST survivors; ST = Sex trafficking; CACREP = Program accredited by the Council for Accreditation of Counseling and Related Educational Programs. 

Data Collection Procedures
To follow phenomenological research methods, Interiano-Shiverdecker trained the doctoral student (McVay) in conducting semi-structured interviews. The researchers developed interview questions based on the purpose of the study and from a review of the literature. Interiano-Shiverdecker and McVay completed the interviews. Following Moustakas’s (1994) recommendations, the interview protocol consisted of 12 semi-structured, open-ended questions that invited an in-depth discussion of their experiences. To create our interview protocol, we reviewed current literature in counseling on sex trafficking, particularly qualitative studies (Browne-James et al., 2021; Bruhns et al., 2018; Johnson, 2020; Wang & Park-Taylor, 2021; Woehler & Akers, 2022). Based on this review and Interiano-Shiverdecker’s experience in qualitative research, we decided to focus not only on counselors’ experiences with working with this population but also on their perspectives on the identification, prevention, and impact of sex trafficking on their clients. The complete interview protocol can be found in the Appendix. Interviews lasted from 26 to 69 minutes in length and occurred via Zoom because data collection occurred in 2021 and it was the most appropriate medium to respect social distancing and obtain a national sample. According to our IRB approval, our data collection presented no more than minimal risks for the participants. All interview questions followed a respectful disposition using open-ended questions to engage participants. However, McVay explained before beginning the interviews that participants could stop, pause, or opt out of the interview if the questions brought too much emotional distress. No participant requested the interview to be stopped or paused. During the interviews, we used counseling skills to facilitate the conversation and to build upon the experiences discussed. We recorded and de-identified all interviews for verbatim transcription.

Participants also completed a demographic questionnaire before the interview to confirm their eligibility for the interview and obtain information on their age, gender, race/ethnicity, work setting, CACREP accreditation and degree, years working with sex trafficking survivors, and the number of clients they worked with who identified as trafficked.

Data Analysis
Utilizing Moustakas’s (1994) modification of Van Kaam’s data analysis, the research team engaged in the seven steps proposed by this approach. Data analysis and management relied on the use of NVivo software (Version 12). Interiano-Shiverdecker provided training in data analysis to McVay, Satel, and Smith. Interiano-Shiverdecker, McVay, Satel, and Smith engaged in the first step by individually analyzing transcripts and engaging in horizontalization of meaning units (Hays & Singh, 2012) to create in vivo codes for all nonrepetitive, nonoverlapping statements (meaning units). Second, we merged all files to determine the invariant constituents through a process of reduction and elimination. This first process of reduction allowed us to determine what was necessary and sufficient data to understand the phenomenon (Moustakas, 1994). The team then assigned themes or clusters of meaning to similar statements (third step). From the clusters of meaning, we created an initial codebook based on the discussions and findings from individual data analysis. We used the initial codebook to examine the themes against the dataset, ensuring that it was representative of participants’ experiences (fourth and fifth steps). As a team, we discussed any disagreements and worked on the data until we achieved a consensus. We worked out disagreements by discussing any opposing views and voting as a group on the best decision. We subsequently created textural descriptions through participants’ verbatim quotes, as well as created structural descriptions by examining the emotional, social, and cultural connections between what participants said (sixth step). Finally, we created composite textural-structural descriptions that outlined the reoccurring and prominent themes across all participants by organizing the themes into subthemes and ensuring that they represented all (if not most) participants’ experiences. After this analysis, we felt we achieved data saturation. After the completion of the initial analysis, Romero reviewed the data as a peer reviewer and offered suggestions. The entire research team reviewed the suggestions and came together to incorporate them until we reached a consensus and developed the final codebook.     

Strategies for Trustworthiness
     To limit the effects of researcher bias, we employed several strategies for trustworthiness. These included reflexive journals, triangulation of researchers, peer debriefers, an external auditor, member checking, and thick descriptions to ensure ethical validation, credibility, transferability, confirmability, sampling adequacy, and authenticity of our analysis (Hays & Singh, 2012). We engaged in reflexive journaling and weekly bracketing meetings during our individual and group data analysis to discuss codes, potential themes, and our assumptions shadowing the participants’ words. Researchers on the team brought varying levels of experience with research and the topic of sex trafficking, which we believe helped balance our subjective analysis of the data. We engaged in two rounds of member checking with the participants, one occurring after the transcription of the interviews and the second one after we wrote the themes. No participants changed the transcription of their interview or disagreed with the presentation of the themes. After the formulation of the themes from the original coding team, Romero served as a peer debriefer and reviewed the themes, key terms, and raw data, allowing participants to make recommendations on the content presented. This division in the research team allowed for another check outside of the original designated research team. An external auditor, a counselor educator with experience in conducting qualitative research, also reviewed the NVivo file and the write-up of the findings. The external auditor agreed with our data analysis procedures and presentation of the findings. He did provide suggestions to reduce the repetition of our first and second themes, which we implemented. Finally, we provide thick descriptions of our data collection and analysis procedures and present our results with direct quotes to ground our work.


We identified four prevalent themes about mental health counselors’ experiences with sex trafficking survivors: (a) counselor knowledge: “learning curve,” (b) counselor skills: “creating a safe space to dive into work,” (c) counselor attitudes: “being able to listen to the client’s story,” and (d) counselor action: “more than just a counselor.” We use pseudonyms to present our results.

Counselor Knowledge: “Learning Curve”
     All participants emphasized the importance not only of understanding trauma but also of gaining sex trafficking–specific knowledge throughout their work with survivors. Tiffany noted a “learning curve” when working with this population, despite working with trauma for most of her career. We categorized this theme into two subthemes: (a) understanding trauma work and (b) understanding sex trafficking and survivors.

Understanding Trauma Work
     To work with sex trafficking, all counselors spoke about the importance of having general knowledge of trauma work. The most prominent topics included multicultural, legal, and ethical considerations. Important multicultural considerations for counselors involve understanding group differences between their clients (e.g., gender, race, age) and working from a culturally sensitive framework. Kimberly emphasized that “we really need people to not only have cultural sensitivity but also encourage those who are of other races to counsel these girls,” adding that “they need someone that’s like them from the same culture . . . to relate culturally to somebody.”  Legal implications included understanding consent, informing clients of their limits of confidentiality when assessing for risk, and their role as mandated reporters. In reference to ethical practices, consultation and supervision arose as with any other trauma work. Stacy noted that it was “important for us to talk to one another if something’s going awry.”

Many participants conveyed how crucial it was for them to understand healing and its complexities. Cristina shared that clients are “going to have their ups and downs,” with Amanda echoing that there are “so many layers to the healing process.” Kimberly felt it important to remind herself that “you’re probably not going to see the seeds that you plant develop a lot of times.” Another important aspect of healing trauma, mentioned by half of the sample, was understanding clients’ stages of change. Stacy shared that one of her clients “went back to her hometown and relapsed immediately. And that’s also a hard thing to deal with—to know that I felt like we had some good sessions . . . and then it’s, ‘Wait a minute. You went back to the relapse [sex trafficking].’” Cristina noted that “especially [when they’re] first out and they’re not quite sure, that pre-contemplation if they want to leave or stay” was very important.

Another important aspect of their work included boundaries and self-care. All participants acknowledged that at some point in their careers, it was challenging to practice healthy boundaries. Cassandra acknowledged the following when working with individuals forced into sexual acts, “I wish I could take all the ladies I’ve ever worked [with], that have danced on stripper poles for money, unwillingly, and just like put clothes on them and wrap them up and hug them.” She added,

[It] can get really tricky when we start answering our phone because it’s an emergency all the time . . . and it’ll wear you out, your batteries will wear out, and you’ll end up having this dual relationship that will end up hurting her because . . . you’re not her friend.

It was helpful for Cassandra to remind herself that she was not the client’s parent. Rather, she shared, “when I hear things like that, I have to remind them that this is my job, this is what I do for a living.” Implementing healthy professional boundaries reduced burnout and facilitated self-care. Participants highlighted activities such as meditating, doing yoga, or taking the occasional day off. The counselors heeded that self-care also included managing their caseload to limit emotionally heavy clients or seeing a personal counselor themselves, as Cassandra and Amanda respectively noted. Amanda said, “you definitely have to secure your oxygen before you can secure other people’s.”

Understanding Sex Trafficking and Survivors
     All participants explained that working with this population required them “to understand what sex trafficking is and . . . the many different ways that it looks,” as stated by John. He elaborated that “it takes many different forms and shapes,” some of which may not be immediately recognized as trafficking. Participants agreed that sex trafficking can often be much more discreet than one might anticipate. Tiffany commented on media portrayals like the film Taken, stating that the real experience is often much less dramatic: “Listening to their stories, it’s very, very subtle . . . like, if you do this then I’ll pay for your college tuition . . . and then from there it gets bigger.” Similarly, Cassandra noted that sex trafficking “can be, like, a bunch of underaged females, thrown in the back of a truck and trafficked across the United States” or people that “have their own residences, that don’t actually live with the trafficker, or they live with a family member that’s trafficking them.”

Counselors learned that although anyone can be trafficked, some populations are more vulnerable. According to Fen, these populations include clients with cognitive disabilities, immigrants, emotional abuse survivors, clients with PTSD, and clients with addictions. Other populations mentioned included the LGBTQ+ population, people recently released from jail/juvenile detention centers, college students with debt, and people in financial need.

The participants’ work also required them to learn how clients were recruited and what kept them from leaving sex trafficking. John and Amanda noted that many survivors knew their traffickers or were introduced to them by family, friends, or a romantic partner. Ana explained that traffickers may kidnap people from big sporting events or from opposing gang(s) or may train survivors to recruit and groom for them. She also worked with women recruited online from abroad and trafficked once they arrived in the United States. Counselors also learned about the numerous tactics used by traffickers, including the trauma bond, coercion, and control. John noted that traffickers often use manipulation: “The common theme was ‘If you do this, you’d really be helping me out. You wanna see me be okay?’ or ‘You don’t want me to go to jail, do you?’” Cassandra reported working with a client whose parents used “an odd twist on Christianity” and the principle of “respect your elders” to traffic her. Other tactics mentioned were threats of violence against survivors and their families, branding or tattooing survivors, stalking, taking survivors’ IDs, gaslighting, and fear. Cassandra also observed that trafficking was “so alluring . . . there’s a lot of money in that . . . so much about leaving sex trafficking is starting from zero and creating something new.” Amanda recalled a client who “was very upscale and so they lived kind of a lavish lifestyle, and I could see and understand, really emphasize the struggle to like give that up,” particularly when they were worried about providing for their families. Factors that forced individuals into sex trafficking were multilayered. Amanda continued, “so many other facets and like layers to this. It’s like an onion.”

As a result, counselors learned about the overall impact of sex trafficking on survivors’ mindsets, behaviors, and presenting symptomology. As noted by Kimberly, sex trafficking impacted every aspect of survivors’ lives. Tiffany noticed that many of her clients were initially very fragile and mistrusting of everyone, while Cristina and Stacy shared that it was common for their clients to display guarded and closed-off body language. John’s work taught him that sex trafficking “affects [clients] in terms of intimacy and trust, and that trickles into their relationships, whether it’s with family, roommates, or romantic partners.” The counselors’ work with sex trafficking survivors included clients with an array of presenting concerns. Cassandra observed clients with complex PTSD, substance use issues, self-harm behaviors, suicidal ideation, self-hatred, self-blame, feelings of insecurity, an inability to trust, and eating disorders. Ana also noted that clients presented with anxiety, depression, paranoia, and physical concerns such as sexually transmitted diseases (STDs) and sleep problems.

Counselor Skills: “Creating a Safe Space to Dive Into Work”
     All participants recognized that because of the nature of their work and their clients, they needed to “create a safe space to dive into work,” as stated by Tiffany. To do so, they needed to build skills in two main categories: (a) assessment and ensuring safety and (b) processing trauma. Amanda explained, “I think all of that stuff [assessment and ensuring safety] really has to come first before we can do any really heavy work and therapy. . . They have to be stable before they can really dig into whatever they want to dig into.” Although this separation provides clarity, counselors’ experiences were also more fluid, at times requiring them to use skills particular to ensuring safety while processing trauma and vice versa.

Assessment and Ensuring Safety
     All counselors’ experiences of assessment and ensuring safety consisted of effectively engaging with their clients during the intake interview, assessing risk, applying crisis skills, and formulating personalized treatment plans. Based on her experiences, Cristina spoke about the importance of building rapport during that initial interview: “When I do our initial assessment with them . . . I have the assessment, but I’m having a conversation with them.” She also learned to discuss confidentiality and mandated reporting with her clients to explain her role as the counselor while also giving them a choice: “I tell them straight out, like, ‘Hey, you tell me this, I have to report it, I have to call law enforcement . . . so how do you want to do it?’” Cassandra found that obtaining a thorough history of the client was a critical part of the process:  

When addressing trauma, I don’t just go back to when the trafficking started. I go all the way back, make sure that I have that thorough history, because 99 times out of a 100, from my experience, that was not the first trauma that person experienced.

     Seven participants spoke about learning the signs of sex trafficking and knowing what questions to ask to obtain more information and determine a person’s exposure to sex trafficking. Amanda explained, “I don’t think I’ve ever had somebody start off within an intake session be, like, ‘Hiya, so I was trafficked.’” Participants learned to ask about phone use and the number of phones owned, the extent of drug use, sexually transmitted diseases, wanted and unwanted pregnancies, boyfriends and their ages, and sexual behaviors such as the use of a condom. When assessing, Alejandra learned to “ask questions that minimize you coming across as being shaming or judging.” At the same time, some counselors spoke about the lack of sex trafficking assessments that could facilitate this part of their work. Alejandra explained that she “did an assessment at work yesterday, and there, there are no questions about sex trafficking. . . . There are questions about abuse, but it is inferring more [about] sexual abuse, physical abuse, emotional abuse versus sex trafficking.” Fen echoed this sentiment by wishing there was a more rigorous psychosocial interview that assessed risks associated with sex trafficking because “at times people do hide and at times people don’t disclose.”

All counselors agreed that a significant aspect of ensuring safety for their clients was collaborating with clients on safety plans. Counselors took the time to develop a “well thought out” safety plan with their clients, as stated by Alejandra. Stacy explained how she helped the client brainstorm ways to feel safer, including leaving town for a while or taking steps to “create a new account, changing her look a little bit . . . getting [a] new phone number.” Collaboration was not only utilized to respect clients’ autonomy but also to instill hope—“Hope that you know that you have a future,” stated Cristina. Ana elaborated, “seeing what they want for themselves and their lives, like, where do you want to go with your life . . . if you didn’t have this going on, you know, what is it you would like to do for yourself?”

Processing Trauma
     To process trauma, all counselors listed skills, interventions, and therapies they found helpful with this population. Utilizing foundational skills (e.g., reflection, open-ended questions, appropriate self-disclosure) to build rapport was the most referenced code in this section, addressed by all participants. Cristina saw the benefit of learning how “to connect very quickly.” Stacy added, “I would definitely start relying a lot more on the rapport when I work with trauma.” Counselors also found it helpful to have a toolbox that included creative approaches and interventions that helped clients reclaim power, develop a support system, improve self-esteem, build and discover resiliency, and utilize the client’s strengths. Psychoeducation, mentioned by nine participants, included teaching their clients about sex trafficking because as John explained, “clients don’t always know that they are being trafficked.” Psychoeducation of sex trafficking requires explaining fraud, force, and manipulation. Kimberly explained how a client did not think she was trafficked because her partner did not have her “locked in a closet. I don’t got chains around me. I’m not his slave . . . I get up and get myself dressed. I go out there and meet these guys . . . I cooperate when he’s taking pictures of me.” To help her client reevaluate her situation, Kimberly utilized motivational interviewing–based questions such as “Would you let your sister do this?” or “What would be the benefits of leaving your situation?”

Although most counselors felt that an integrative approach to counseling worked best with sex trafficking clients, the therapies most mentioned included dialectical behavioral therapy, narrative therapy, and eye movement desensitization and reprocessing therapy. Counselors recommended individual treatment to process trauma, although four participants also mentioned family and group counseling. Fen found family therapy helpful “if the family wants to get involved in the practice” and “if there are family members who are ready to support them and come with them and who are aware of this.” Other participants mentioned the benefits of providing group counseling for sex trafficking survivors. Cassandra recalled how members of a support group she facilitated “connect with each other, they know that they’re not alone, they give each other honest feedback. . . . It has been super empowering.” Yet Alejandra, Fen, and Tiffany found that group counseling may not be well suited for all clients. “Group therapy doesn’t work really well because you know every survivor is different, and they don’t want to open up in front of others until they have worked through the process for a long time,” explained Fen.

Because of the nature of their work, counselors recognized that an essential skill to processing trauma was learning how to manage countertransference. Cristina spoke about how as “clinicians, we want to save all of them.” For this reason, Kimberly recognized that it was important for her to understand her attachment style. Cassandra recalled nights when she would go home and “worry about [if] I am going to see this client again.” Ana left sessions “shaking sometimes from those places . . . ’cause the stories I would hear.” Stacy highlighted that it was also difficult at times to manage the lies. She explained, “I was a little frustrated because I knew that she was hiding things . . . obviously it just wasn’t that time and that’s okay.” As a result, counselors found it essential to process their emotions. Kimberly explained that “if you haven’t emptied your cup of all the sad, mad, bad before you come into that office with them . . . you’re going to flip your lid whether it’s in front of them or behind closed doors.” 

Counselor Attitudes: “Being Able to Listen to the Client’s Story”
     All participant interviews illuminated thought patterns and beliefs they needed “to listen to the client’s story,” as stated by John. Counselors learned to personify certain attitudes by (a) valuing empathy and validation and (b) embodying a sense of safety.

Valuing Empathy and Validation
     All participants highlighted the importance of embracing a philosophy of empathy and validation in their work with clients by being warm, genuine, open-minded, patient, and nonjudgmental. Participant interviews described various mechanisms to embody these attitudes. For instance, a consistent approach they took was to respect and empower the clients’ choices and, ultimately, believe in and provide client autonomy through supportive and nonjudgmental means. Ana emphasized, “I think that’s huge for those whose choices were taken away. . . . It’s offering them a choice, and I think that’s very empowering for them.” Fen echoed this message stating, “You can’t push—you can definitely motivate—but you cannot just push.” Kimberly learned to be patient: “You’ll end up getting there eventually, just take your time. . . . You have to build that rapport and trust.” Cassandra stated, “Another thing I would say is don’t make any assumptions. . . . Everybody’s experiences, although there are similarities, every experience is so different.” Cristina described the shock value of hearing survivors’ stories and how essential it was for her to remain nonjudgmental and aware of her biases. Amanda embodied “those Rogerian qualities, like that open-mindedness, empathy, warmth, genuineness, authenticity—those things are all really important to utilize when meeting with that population, or any population.” Cristina provided an example of how she conveyed this to a client by saying, “I’m here if you need me. . . . There’s no judgment happening, I’m just glad you’re here.”

Counselors also shared a philosophy that validated clients’ experiences. Fen believed in “just making clients feel normal,” while Cassandra noted how helpful it was for her to approach clients’ behaviors as “normal reactions to abnormal situations.” An important attitude communicated by John was that “they are survivors.” Even though others and possibly even the client themselves might use the word victim, he found it helpful to have “the conversation about being a survivor versus a victim.” Tiffany further explained, “I’ve noticed just in working with sex trafficking survivors . . . it seems very hard for them to say the word ‘abuse’ or view themselves as anything other than a victim.” She found value in seeing the client as “a survivor” and teaching this perspective to the client.

Embodying a Sense of Safety
     All participants embraced attitudes that created and maintained a safe environment for their clients. Fen explained that as the counselor, “you’re the only safety net for that person” who provides safety and trust. Cristina reflected on a client who was still in “the life” and returned for help and services when needed. She stated, “she knows that I’m a safe person” and “this [shelter name] is her home, this is where she felt safe. But [she] knew she couldn’t get out of this life yet because she wasn’t ready to.” Fen explained that “there is shame, there is guilt, there is fear, and apprehension of being caught . . . so, one has to make them feel safe.” Some participants communicated and provided safety by creating a “homier and safer” office space or by buying a client’s favorite snacks and beverages, as described by Cassandra. Alejandra spoke of establishing “an environment where it’s safe to talk about taboo subjects” such as “having been a mule or whatever they did, you know, whatever sexual acts.”

Six of the participants also spoke of attitudes that promoted consistency and predictability. Kimberly stated, “That’s something they’ve never had in their life; you know, so while you’re doing all this other stuff, be consistent.” Several participants noted how difficult it was for their clients to have continuity with counselors. Kimberly shared:

Counseling someone who’s had this kind of trauma takes a long time . . . once you leave and can’t continue that counseling process, the likelihood of them going back to the counseling is very slim to none. . . . Even though they were resistant to building that rapport with you at the same time, deep down inside they’re connecting with you.

     Similarly, a few participants learned to be consistent in their messages shared with clients and accessibility to clients. For instance, Stacy spoke of the need for congruency between actions and words when working with these individuals: “Trust is such a fleeting word . . . it has to be action, sometimes, speaks louder than the words.”

Counselor Action: “More Than Just a Counselor”
     All participants realized that working with this population required them to reevaluate their role as the counselor. They learned that clients required “more than just a counselor,” as stated by Kimberly. Therefore, the fourth theme elucidated actions that counselors found necessary to help clients recover from their experiences. We categorized counselor action into two subthemes: (a) client advocacy and (b) engaging with social work/workers.

Client Advocacy
     Over half of our participants spoke about the importance of advocating for clients. Cristina talked about how some clients did not have a caseworker and needed someone “that’s in their corner.” Counselors spoke about specific needs they advocated on behalf of clients in the life or in recovery. Kimberly spoke about advocating for prison reform, particularly for minority women who went to prison for some of the things they got involved in while being trafficked. Cristina advocated for “easier access to get into drug treatment.” She explained that this was necessary because certain insurances did not pay for certain drug treatments, or it would take too long to get clients into treatment. Although clients would sometimes agree to treatment, it would take several days “to get everything going. . . . by then the kids change their minds, or they run. . . .The obstacles shouldn’t be that hard.” Other forms of advocacy focused on working with and educating police officers to best work with this population. Tiffany explained how many women didn’t trust law enforcement. She believed it was crucial to bridge these services because law enforcement could “get them out of that lifestyle, but then on the other hand, they’re very much like, ‘Don’t trust them.’” Stacy also spoke about advocating for shelters specific to sex trafficking. She remembered a client who visited a shelter once a month and loved it because “she felt safe there versus just, like, a domestic violence clinic . . . they had the awareness of sex trafficking versus just, like, you know, an overnight shelter type of place.”

Participants also taught clients how to advocate for themselves while also respecting their choices. Stacy explained, “It’s not my job to fix what they’re going through, but it is my job to be as supportive as I can.” She understood that she needed to “advocate for them but also having the respect that if they don’t want me to advocate for them, then that’s the place that they’re at too.” Stacy also clarified that at times she does not “really know exactly 100% how I would want to advocate” for clients who had been trafficked. Yet as she continued to reflect, she realized her desire to “seek out more education about it because I do think that it needs to be navigated in a specific way.”

Engaging With Social Work/Workers
     The call for advocacy led all counselors to speak about how their work required them to expand their roles to connect clients to resources and collaborate with social workers. Kimberly explained that this population requires “more than just a counselor while they’re in session . . . you’ve really got to start with building a community around them before you get into the deep trauma work.” Counselors provided resources to obtain transportation, financial assistance, government assistance, their GED or college degree, food, employment, stable housing, legal support, childcare, hygiene products, substance treatment, and medical care. Amanda explained that this population requires that their basic-level needs be met to help them feel like they “can function in society and be comfortable,” and Kimberly elaborated:

As a counselor, I used to have a huge list of resources that I could give them, but they also needed guidance from outside of the counseling office. . . . I have, like, eight people with one survivor, that’s how much it took us ’cause it’s so much work for one person. You’re talking about every aspect, everything that you learned as a child growing up. . . . If you want counseling to be successful, they have to have that outside component to help them . . . a counselor can’t do all of that.

     Ana partnered up with organizations already doing this work. She particularly spoke about an organization that not only focused on “educating people but also helping these women with resources.” She added that “the residential places they were able to stay in, they were able to finish their education and get an education there, and they also helped them with finding jobs, which was really important for them, too.” She explained that this was particularly important because many of the women she worked with had a violent criminal history. Many company insurances refused to hire women with criminal records, preventing their clients from a second chance at improving their lives. However, John learned to support clients with resources. “I don’t think it’s sufficient to just say ‘Here you go, here’s the resource guide. They have lots of options in there. Good luck.’ . . . Our job doesn’t end with giving the resources,” he explained.

An important point to make is that although some counselors spoke about collaborating with social workers, it seemed that most believe their work resembled “a little more of that, like, case management–type stuff to make sure that they have the resources if and when they want out,” added Cassandra. Kimberly elaborated, “You’re the one that’s helping to get them to [a] place where they can have a relatively stable life . . . but without the resources that come alongside that, they’re gonna go nowhere, [they’re] going to hit a wall every time.”


We sought to understand counselors’ experiences working with sex trafficking survivors through a phenomenological analysis. The participants in our study needed to understand and address the different aspects of trauma. Because of clients’ traumatic experiences that resulted in psychological injuries (Cole et al., 2016; Grosso et al., 2018; Lutnik, 2016; Muftić & Finn, 2013; O’Brien et al., 2017), counselors benefited from respecting the process of healing, addressing stages of change, and building a safe and trusting relationship. Counselors overall possessed knowledge of the development of post-trauma responses over time. They knew what to look for and how to best treat traumatic symptoms that permeated all aspects of their client’s lives, particularly sex trafficking survivors’ ability to trust others. Counselors believed that having a trauma-informed approach could reduce instances of re-victimization. Counselors also recognized the importance of self-awareness such as assessment of personal trauma, self-care, restorative practice, and biases regarding how youth are trafficked and by whom.

Yet, our findings demonstrate that working with sex trafficking survivors requires additional competencies as illustrated in previous research (Interiano-Shiverdecker et al., 2023). The participants discussed the need to become educated in recognizing the signs of sex trafficking, vulnerable populations, and the processes by which traffickers force people into sex trafficking to obtain a deeper understanding of the client’s worldview and provide appropriate support (Interiano-Shiverdecker et al., 2023). Participants addressed components—namely force, fraud, coercion, exploitation, power, grooming, and solicitation—commonly used in sex trafficking literature (Bruhns et al., 2018). When asked about the nature of their work, their focus naturally divided into sections that focused on assessing risk and safety planning, processing trauma, and helping the client re-establish their life and their identity. Our findings align with CACREP (2015) recommendations for clinical crisis skills and knowledge while also elucidating their application to sex trafficking survivors. Participants learned to assess for specific sex trafficking signs (e.g., phone usage, boyfriends and their ages, sexual behaviors) and to ask questions that differentiated sex trafficking from other forms of abuse.

Counselors must also understand the differences between sex work (i.e., the voluntary exchange of sexual services for compensation) and sex trafficking (i.e., subjection to the exchange of sexual services due to force, fraud, or coercion or from any person under the age of 18). As Ana shared, most counselors felt that the notion to detect was on their end “because I don’t always think it’s the responsibility of the client to be able to say ‘Hey, I’ve been trafficked.’” Thus, participants indicated that possessing these competencies could help increase the identification of sex trafficking. As such, some counselors may desire more guidance on specific sex trafficking assessments, which scholars have previously noted (Interiano-Shiverdecker et al., 2022; Romero et al., 2021). A content analysis on sex trafficking instruments (Interiano-Shiverdecker et al., 2022) illustrated the importance of asking specific questions to assess for control, confinement, threat, and isolation, as these are the main indicators of sex trafficking. Example items included: “Have you ever felt you could not leave the place where you worked [or did other activities]?” (confinement; Simich et al., 2014, p. 20); “Are you kept from contacting your friends and/or family whenever you would like?” (isolation; Mumma et al., 2017, p. 619); “Do you have to ask permission to eat, sleep, use the bathroom, or go to the doctor?” (control; Mumma et al., 2017, p. 619); and “Has anyone threatened your family?” (threat; Mumma et al., 2017, p. 619).

Moreover, for some sex trafficking victims, the relationship with their traffickers represented an affirming, reliable, and secure relationship in their lives, later used to coerce or force them into sexual, violent, or illegal behavior. Therefore, participants realized that processing trauma would require attitudes and skills that provided emotional safety, patience, and a nonjudgmental process. Survivors’ lack of choice throughout their sex trafficking experience fomented counselors’ abilities to empower clients over their bodies, boundaries, and choices, and help clients reintegrate into society (Interiano-Shiverdecker et al., 2023; Thompson & Haley, 2018). Participants seemed to emphasize that without all the elements mentioned, clients might not disclose their situation or trust the counselor enough to open up, and they might even terminate counseling abruptly.

This last point is connected to our fourth finding, counselor action. Aligned with the Multicultural and Social Justice Counseling Competencies (Ratts et al., 2016), the participants in our study recognized the need to engage in work that advocated for clients within and outside of the session. Despite their dedicated work with clients to process the emotional repercussions of sex trafficking and rebuild their lives, their efforts did not seem enough to support clients in their recovery. So much of what ailed their clients fell on systemic or external forces (e.g., poverty, employment, lack of resources). Although that existed outside of the counselor’s role and verged into another profession, our participants embraced these responsibilities or connected with other professionals. They believed that otherwise, clients would not succeed in their recovery. Our findings present an important reminder that sex trafficking, a modern form of human slavery, is an act of social injustice affecting individuals vulnerable to historical and systemic oppression.

     Our themes add to the existing research with implications for counseling practice, supervision, and education. Scholars (Romero et al., 2021; Thompson & Haley, 2018) have identified counselors as first-hand responders to the early detection and prevention of sex trafficking. Although each trafficking scenario is unique, counselors need to refer to sex trafficking indicators, recruitment and grooming tactics, and manipulative dynamics that prevent individuals from disclosing or leaving sex trafficking. It is important for counselors to dispel common myths of sex trafficking and understand that sex trafficking may appear differently than one may expect. Amanda alluded to clients who defined their experience as a “lavish lifestyle” and were lured by the financial benefits of sex trafficking. We caution counselors not to misinterpret sex trafficking as a “lifestyle,” as this implies choice. There may be a myriad of invisible factors contributing to their circumstances such as trauma bonding and financial instability.

Participants agreed that an integrative approach with interventions that addressed complex trauma (e.g., dialectical behavior therapy, eye movement desensitization and reprocessing therapy) worked best when working with sex trafficking. We encourage counselors to not only become familiar with such modalities but also to conceptualize any treatment modality through a trauma-focused lens that considers how sex trafficking impacts all aspects of a client’s life and how they will interact in session. Participant narratives indicated that clients could present with defiant behaviors, distrust, angry or irritable mood, and refusal to comply with treatment. These themes underscore the importance of a counselor’s ability to create safe, trusting, and empathic relationships that allow the client to disclose risk and eventually process trauma. Counselors should also integrate a strong rapport with sex trafficking clients by demonstrating unconditional positive regard, authenticity, and empathy with any treatment modality chosen. Although counselors establish a strong therapeutic relationship, they can integrate other counseling goals, including psychoeducation, assessing for risk, supporting clients through the stages of personal change, and helping the client rebuild and reintegrate into society. Based on the nature of their work, managing countertransference and self-care represents an essential instrument to maintain balance while engaging in emotionally draining clinical work. We encourage counselors to seek supervision, connect with colleagues, and practice regular self-care routines to avoid experiencing burnout, secondary trauma, and countertransference. Additionally, counselors should connect clients to services that provide basic needs (e.g., safe and stable housing, food). When clients lack basic physiological needs, they may struggle to focus on higher-order needs such as developing a safety plan or emotion regulation. Counselors can engage in legislative advocacy by writing letters to judges, sharing clinical experiences with senators, and providing training on sex trafficking victim identification and treatment. It is important for counselors to build constituency groups with education, governmental task forces, and legislators to lobby for bills that benefit clients, as sex trafficking exists in an ecosystem of community and social contexts (Farrell & Barrio Minton, 2019). Our findings also underscore the limitations of intake interviews when assessing for sex trafficking risk. Although identification and screening tools exist (Interiano-Shiverdecker et al., 2022; Romero et al., 2021), counselors are not always in a setting where a formal assessment is appropriate or accessible.

We encourage educators and supervisors to emphasize the value of informal assessment methods with counselors-in-training. Counselor knowledge of signs, symptoms, and questions to ask during an intake can improve identification efforts. Our findings also hold some implications for training beyond counselor education. Because of the complexities of working with trauma and sex trafficking, counselors intending to work with this population should seek out specialized training. For instance, they may review conference programs for trauma or sex trafficking–specific education sessions. At the same time, counseling programs should evaluate their preparation for counselors to work with sex trafficking. Requiring a trauma course, including content on sex trafficking and complex trauma throughout the curriculum (e.g., trauma, grief, addiction counseling courses), inviting guest speakers, and providing training opportunities and workshops for students and community counselors are all suggestions to ensure that counselors obtain the necessary knowledge and skills to work with this population. We believe that more training opportunities can minimize any possible misunderstanding of sex trafficking, expectations on clients to disclose, and re-victimization of clients that leads to early termination of counseling.

Limitations and Future Directions
     The nature of our sample holds some limitations for the interpretation and application of the themes from this study. We collected data from single data sources (i.e., individual interviews); additional interview sources (e.g., focus groups) may have contributed more information. Moreover, lack of racial and gender diversity was a limitation in this study because most participants identified as White and female. We noticed that participants did not discuss racial and gender differences in clients’ experiences of sex trafficking. This result could have originated from our interview protocol that sought to gain an overall understanding of sex trafficking experiences and therefore did not request this information. Participants’ demographic profiles may have also provided a limited perspective of the experiences of Black, Indigenous, and/or people of color. We also did not require CACREP accreditation or specific years of practice as part of our inclusion criteria. Although all our participants were licensed professional counselors, they had different degrees in mental health, a variety of clinical practice, and did not all graduate from CACREP-accredited programs. During our interviews, we did not define sex trafficking to the participants and engaged in open-ended questions that inquired about their experiences. Participants’ responses are based on their definition of sex trafficking, which can vary and might not be accurately distinguishable from sex work. As is the case with all qualitative research, counselors and scholars should consider the transferability of these findings to other client populations and with counselors. For example, the findings of this study can be applicable to professional school counselors, but the recruitment of school counselors as participants would have provided greater insight into the roles and responsibilities of counselors in schools. Furthermore, we did not include client perspectives in this study; therefore, even though our participants’ perspectives when working with sex trafficking survivors is very insightful, they may not have an accurate representation of clients’ experiences in session.

Based on these limitations, we recommend scholars explore individual and external factors that can impact counselors’ work with sex trafficking survivors. For example, we did not explore within-group differences (e.g., race, gender, sexual orientation, religion) between counselors and cross-cultural interactions between clients and counselors. These factors are important to consider and reflect on when building trust and a sense of safety for the client, particularly when considering current conversations around racial tension in the United States. A more in-depth analysis of these considerations could facilitate a better understanding of how multicultural traits play a role in counselors’ experiences when working with sex trafficking survivors. Participants’ emphasis on the need for specialized knowledge and skills to work with sex trafficking also warrants research on evidence-based interventions for sex trafficking survivors. Moreover, an examination of the client’s experiences is necessary to garner a holistic picture of the impact of sex trafficking on the client’s healing and counseling process. We also believe that researchers should consider external factors that might impact counselors’ experiences when working with sex trafficking. Considering participants’ discussion of advocacy and engaging with social work/workers, it seems necessary to consider sociopolitical and institutional elements that either hinder or support clients’ ability to leave sex trafficking and obtain access to services that allow them to heal and flourish. As such, counselors working with sex trafficking survivors must consider specific training that allows them to assess for risk, process the emotional ramifications of sex trafficking, and rebuild their lives.


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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Claudia G. Interiano-Shiverdecker, PhD, LPC-A, is an assistant professor at the University of Texas at San Antonio. Devon E. Romero, PhD, NCC, LPC, is an assistant professor at the University of Texas at San Antonio. Katherine E. McVay, PhD, LPC, is an assistant professor at Texas A&M University–Corpus Christi. Emily Satel is a graduate of the master’s program in clinical mental health counseling at the University of Texas at San Antonio. Kendra Smith is a graduate of the master’s program in clinical mental health counseling at the University of Texas at San Antonio. Correspondence may be addressed to Claudia G. Interiano-Shiverdecker, College of Education and Human Development, One UTSA Circle, San Antonio, TX 78249, claudia.interiano-shiverdecker@utsa.edu.  




  • Please tell me a little about yourself, your professional background, and clinical experience.


  • What is important for counselors to know when working with sex trafficking survivors?
  • How can counselors best detect when individuals are being sex trafficked or are vulnerable to sex trafficking?
  • How can counselors support individuals while they are being trafficked?
  • How can counselors help individuals leave their traffickers?
  • How can counselors support individuals from returning to their traffickers?
  • What do counselors have to know about supporting sex trafficking survivors after sex trafficking?

Personal Experiences and Mental Health

  • Please share, to the extent that you are comfortable, your experiences with working with sex trafficking survivors.
    • What is the age range in which most of your clients experienced sex trafficking?
  • How have these experiences impacted your clients?
    • Emotionally and mentally?
    • Physically?
    • Relationships with others?
    • Spiritual/religious beliefs?
  • What do you believe has helped them overcome the impact of sex trafficking?
  • What services or resources do you believe were most helpful to them?
  • What is important about your experience that I haven’t asked you and you haven’t had the chance to tell me?

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.

     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.

     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.


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.

Understanding Racial Trauma: Implications for Professional Counselors

Warren Wright, Jennifer Hatchett Stover, Kathleen Brown-Rice

Racial trauma has become a common topic of discussion in professional counseling. This concept is also known as race-based traumatic stress, and it addresses how racially motivated incidents impede  emotional and mental health for Black, Indigenous, and people of color (BIPOC). Research about this topic and strategies to reduce its impact are substantial in the field of psychology. However, little research about racial trauma has been published in the counseling literature. The intent of this paper is to provide an in-depth perspective of racial trauma and its impact on BIPOC to enhance professional counselors’ understanding. Strategies for professional counselors to integrate into their clinical practice are provided. In addition, implications for counselor supervisors and educators are also provided.

Keywords: racial trauma, BIPOC, counseling, professional counselors, clinical practice

     The impact of racism on the psychological, emotional, and physical well-being of those subjected to it is no secret. In fact, the Centers for Disease Control and Prevention (2021) has declared racism as a public health issue and threat to the health of minoritized individuals. Similarly, the Federal Bureau of Investigation (2019) reported that 5,155 people were targets of racially motivated hate crimes in 2018: 47.1% of the victims identified as Black/African American, 13% as Hispanic/Latino, 4.1% as American Indian/Alaskan Native, and 3.4% as Asian. Daily experiences of racism for Black, Indigenous, and people of color (BIPOC) can lead to an increase in health complications and mental health disparities (French et al., 2020; Williams et al., 2019). Hemmings and Evans (2018) noted that because of racism, BIPOC communities have limited access to resources, which impacts their quality of education and health care. Thus, racially marginalized communities are susceptible to chronic illnesses and mental health concerns such as diabetes, heart disease, depression, and suicide (Hemmings & Evans, 2018). Furthermore, researchers have found that exposure to racism and discrimination increases levels of stress in the body and can lead to chronic illnesses such as high blood pressure, diabetes, and gastrointestinal issues for people of color (Bernier et al., 2021; Chavez-Dueñas et al., 2019; Smith et al., 2011; Wagner et al., 2015), therefore adversely impacting the livelihood and overall well-being of BIPOC communities.

Racism-related stressors can lead to race-based traumatic stress, also known as racial trauma (Carter, 2007; Comas-Díaz et al., 2019). Racial trauma and race-based traumatic stress occur when there is an experience of direct or indirect racism that leads to psychological and emotional injury for BIPOC. Examples include experiencing microaggressions in the workplace (Sue et al., 2019), witnessing an unarmed Black person being killed by law enforcement (Williams et al., 2018), and being physically attacked because others believe a person’s racialized group is the cause of a global pandemic (e.g., Asian American and Pacific Islanders [AAPIs]; Litam, 2020). There is a substantial amount of literature in the field of psychology related to racism, race-based traumatic stress, and racial trauma (Adames et al., 2023; Bryant-Davis & Ocampo, 2006; Carter, 2007; Comas-Díaz et al., 2019; French et al., 2020; Helms et al., 2010; Mosley et al., 2021). However, there is little to no research in the counseling profession related to racial trauma. Therefore, this article provides an overview of racial trauma and implications for the counseling profession.

Race-Based Traumatic Stress and Racial Trauma

     Racial trauma is the collective stress experienced by BIPOC directly or indirectly due to continuous racially motivated incidents of microaggressions, exclusion, discrimination, and sociopolitical events that create psychological and emotional harm (Anderson & Stevenson, 2019; Comas-Díaz et al., 2019). Race-based traumatic stress is one of the most common interchangeable terms for racial trauma and refers to the stress response and emotional injury that occur after experiencing a racist encounter (Carter, 2007; Williams et al., 2018). Carter (2007), along with other researchers (Chavez-Dueñas et al., 2019; Helms et al., 2010; Smith et al., 2007, 2016), examined the experiences of BIPOC and the accompanying psychological stress when they experience racism-related incidents. Constant exposure to racially motivated incidents can create and lead to an overwhelming emotional stress response for BIPOC. Bryant-Davis and Ocampo (2005), Hemmings and Evans (2018), and Litam (2020) discussed how racist incidents of physical assaults, verbal attacks, and threats to one’s safety impact a person’s sense of self and can cause a person to present with symptoms of trauma.

It is imperative to note that experiencing racism and presentation of trauma symptoms are not all life threatening. Therefore, racial trauma differs from the traditional diagnosable PTSD criteria as stated in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association [APA], 2013). Although it is not explicitly stated in the DSM-5, racial trauma encompasses racism-related stressors associated with one’s membership in a racialized social group, historical trauma, and continuous exposure to racism-related violence. Consequently, conceptualizing and diagnosing a client that presents to counseling with trauma symptomology that does not fit the criteria for the PTSD diagnosis can be confusing for mental health professionals. Therefore, it is important for professional mental health counselors to be prepared to assess and treat clients who present to counseling with trauma symptomology related to racist incidents.

Impact of Racism and Racial Trauma

Racial trauma could impact a person’s sense of self, pride in culture, and identity (Brown-Rice, 2013; Skewes & Blume, 2019). Skewes and Blume (2019) found that assimilation, exploitation, and forced relocation led to the loss of spiritual and cultural practices for American Indian and Alaska Native (AI/AN) communities. Additionally, Brown-Rice (2013) stated that loss of cultural traditions and native practices creates a sense of confusion and hopelessness for Native American adults. Thus, racialized trauma can lead to a separation of cultural identity and practices. Similarly, Chavez-Dueñas and colleagues (2019) found that racial trauma has increased psychological distress for Latinx immigrant communities because of anti-immigration policies, opposition to assimilation into the American culture, and fear of deportation. Furthermore, racial trauma can lead to psychological concerns such as anxiety, depression, emotional dysregulation, and suicidal ideation (American Foundation for Suicide Prevention, 2020; Bryant-Davis & Ocampo, 2005; Comas-Díaz et al., 2019; French et al., 2020; Hemmings & Evans, 2018). Additionally, the American Foundation for Suicide Prevention (2020) found suicide rates for minoritized communities have increased. Moreover, racial discrimination has been positively correlated with suicidal ideation among African American young adults (American Foundation for Suicide Prevention, 2020).

Racism is consistently prevalent within American schools and continues to be an issue of concern experienced by BIPOC students (Kohli et al., 2017; Merlin, 2017). The experience of trauma coupled with racism and discriminatory practices in education has shown to impart racial disparities among BIPOC students in the areas of academic achievement, employment, and participation in the criminal justice system (Lebron et al., 2015). Black students are underrepresented in advanced courses, are less likely to be college ready, and spend less time in the classroom because of disciplinary practices (United Negro College Fund, 2020). According to a report on school discipline by the U.S. Department of Education Office for Civil Rights (2018), Black students only account for 18% of preschool enrollment, yet they make up 42% of total suspensions and 3 times more expulsions than their White peers. In addition, Black students are more than twice as likely to be referred to law enforcement and subject to arrest for school-based incidents when compared to their peers (United Negro College Fund, 2020). Furthermore, not only are Black students underrepresented in advanced courses, but they are overrepresented in special education programs and more likely to be identified with a disability (Harper, 2017). Therefore, it is imperative for professional mental health counselors to understand how racial trauma could impact the mental health and well-being of individuals at distinct phases of life span development (e.g., children, college students, etc.).

Currently, racial trauma has been exacerbated by the recent COVID-19 pandemic plaguing the United States and other parts of the world. Liu and Modir (2020) and Fortuna et al. (2020) highlighted the lived experiences within BIPOC communities regarding living in low-income neighborhoods, denial of access to care, and being disproportionately affected by the COVID-19 virus. Black Americans accounted for 34% of confirmed cases in the United States, followed by Latinos at 20%–25% of cases (Fortuna et al., 2020). This demonstrates that health disparities coupled with racism could impact the physical well-being of BIPOC. Racism-related stress impacts the emotional and physical health of BIPOC communities. This includes sense of self (Chavez-Dueñas et al., 2019), culture identity (Skewes & Blume, 2019), and overall wellness (Litam, 2020). Healing racial trauma requires professional mental health counselors working with BIPOC individuals to consider sociocultural factors such as systemic racism, oppression of marginalized communities, and cultural trauma.

Implications for Professional Counselors

The counseling profession highlights the importance of assessment competency as stated in the American Counseling Association (ACA) Code of Ethics (ACA, 2014; e.g., Standard E.5.c: Historical and Social Prejudices in the Diagnosis of Pathology) and the 2016 Council for Accreditation of Counseling and Related Educational Programs (CACREP, 2015) Standards (e.g., Assessment and Testing). In addition, the 2016 CACREP standards emphasized the importance of social and cultural diversity, highlighting strategies and techniques to identify and eliminate barriers of oppression and discrimination (CACREP, 2015). Because racial trauma is invasive and harmful for BIPOC individuals and communities, understanding its impact on psychological and emotional well-being is imperative for all mental health professionals in their respective roles. Thus, counselors must be prepared to provide culturally responsive care to BIPOC individuals who have experienced racism-related trauma.

Licensed Professional Mental Health Counselors
     Assessing for racial trauma is of utmost importance when conceptualizing and creating a treatment plan for BIPOC clients. It is imperative for counselors to become familiar with assessments and clinical interventions to inform their approach to treating racial trauma. Williams and colleagues (2018) proposed the UConn Racial/Ethnic Stress and Trauma Survey (UnRESTS) to assist mental health professionals in their case conceptualizations and treatment planning when racial trauma is present in BIPOC individuals. The UnRESTS is a clinician-administered semi-structured interview that is beneficial in case conceptualization to determine the multiple experiences of racism for the client. The interview comprises 6 sections: introduction of the interview, racial and ethnic identity development, experiences of direct overt racism, experiences of racism by loved ones, experiences of vicarious racism, and experiences of covert racism (Williams et al., 2018). Even though this survey is like the DSM-5 Cultural Formulations Interview (APA, 2013) and helps the counselor determine if the client’s symptomology fits criteria for PTSD, it should not be the only assessment tool used to determine a diagnosis of PTSD. Additionally, this interview tends to be lengthy in time; therefore, counselors should consider completing this interview within the first and second sessions. This assessment along with other clinical approaches could be beneficial to understanding the traumatic responses of clients impacted by racism.

Several BIPOC scholars have offered models, theories, and frameworks to heal racial trauma (Adames et al., 2023; Bryant-Davis & Ocampo, 2006; French et al., 2020; Mosley et al., 2021). Counselors must position themselves to consider approaches that go beyond Eurocentric theories and models when addressing and treating racial trauma. These include being critical of sociopolitical structures, awareness of one’s own racial identity, and comfort level when broaching the topic of racism and racial trauma (Adames et al., 2023; Thrower et al., 2020). For instance, Bryant-Davis and Ocampo (2006) provided a foundation for treating racial trauma in a safe environment. Their therapeutic approach included acknowledgment, grieving/mourning loss, analyzing internalized shame and racism, and centering coping and resistance strategies. Supporting clients to name oppressive systems, process their experiences of racist incidents, and deconstruct self-blame narratives because of racism fosters liberation and healing for BIPOC clients who have experienced racism-related stress and trauma (Adames et al., 2023). Thus, counselors must be empathetic and take initiative in helping BIPOC clients shift the focus on harm from self-blame to external oppressive factors. This promotes a strong sense of self and healthy living for BIPOC clients.

Similarly, models offered by Chavez-Dueñas et al. (2019), French et al. (2020), Mosley et al. (2021), and Adames et al. (2023) center the well-being and collective power of BIPOC communities. For example, critical consciousness, Black Psychology, Liberation Psychology, and trauma-informed care influenced these approaches to address racism-related stress and trauma. Subsequently, French and colleagues’ (2020) Radical Healing Framework centers justice and overall wellness for BIPOC communities. This is the intentional practice of going beyond just coping with racism to focus on healing wherein a client can thrive by connecting to community and engaging in resistance against racism-related stressors (French et al., 2020). Thus, helping clients to engage in activism and utilize microinterventions to disarm and address microaggressions can empower clients (Mosley et al., 2021; Sue et al., 2019). Microinterventions help equip clients with tools they can implement to assert boundaries and communicate disagreement with microaggressions (Litam, 2020; Sue et al., 2019). However, counselors must remember that safety is a priority when supporting clients in confronting perpetrators of racism-related trauma (Litam, 2020). Therefore, role-plays in counseling sessions could provide the space and time to strategize when it is and is not appropriate to confront perpetrators of microaggressions.

Utilizing these approaches with clients fosters validation and affirmation of their experiences. Failure to acknowledge and attend to the symptoms and experiences of racism-related stress and trauma can maintain psychological distress for BIPOC clients (Chavez-Dueñas et al., 2019). Furthermore, helping clients process the positive messages they received about their racial identity throughout their life can reinforce these approaches (Anderson & Stevenson, 2019). Thus, counselors should use a strength-based approach when supporting BIPOC clients in healing from racism-related stress and trauma. In addition, consultation with colleagues, supervisors, and counselor educators can provide support and a space to implement best practices to provide the most effective care for BIPOC individuals who have experienced racial trauma, rendering positive mental health outcomes.

Professional School Counselors
     Professional school counselors should demonstrate cultural competence and serve as essential stakeholders in identifying and supporting clients impacted by trauma (ACA, 2014; American School Counselor Association [ASCA], 2016; Parikh-Foxx et al., 2020). ASCA specifies these responsibilities and obligations in their ASCA Ethical Standards for School Counselors (ASCA, 2022). These principles serve as a framework in which professional values, norms, and behaviors are referenced. Further, school counselors can help to identify, respond to, and prevent incidents of racism and bias, as well as become resources to help promote systemic change and advocate for social justice within the educational setting (ASCA, 2020). However, ASCA (2021) recognizes the lack of racial literacy and the inherent gaps between racial equity and equality within education, petitioning for school counselors to continually pursue cultural competency and work toward mitigating the negative effects of racism and bias. Subsequently, ASCA guidelines encourage school counselors to examine their own biases and consult with community professionals to engage in immersive experiences and provide support to students and families who have experienced racial trauma or have been negatively impacted by racism (ASCA, 2021; Atkins & Oglesby, 2019; Levy & Adjapong, 2020).

As facilitators of change, school counselors can help to create environments that are safe and inclusive for both students and educators. One approach is to discuss issues of racial trauma using trauma-informed and restorative practices (National Child Traumatic Stress Network [NCTSN], 2018). Trauma-informed practices take on a phenomenological approach, seeking to identify, understand, and address the meaning behind student behaviors and experiences (Steane, 2019). Additionally, restorative practices not only provide an alternative to harsh disciplinary practices, but also create spaces for individuals to share their own perspectives without fear of judgement or ridicule, while being open to listening and validating the values, experiences, and perspectives of others (NCTSN, 2018; United Negro College Fund, 2020). Moreover, Anderson and Stevenson (2019) posited the concept of racial socialization, which is the intentional communication about the system of racism, racial identity, and experiences between parents and their children and others within the family system with similar racial and ethnic identities. Racial socialization aids in the development of a positive sense of self and cultural identity as mitigating forces to racial trauma. Further, the Racial Encounter Coping Appraisal and Socialization Theory (RECAST) helps families and youth prepare for, discuss, and respond to racially stressful experiences appropriately (Anderson & Stevenson, 2019). Thus, this can also prepare students to strategize how to respond to incidents of racism in the school environment.

It is evident that incidents of school-based racism are perpetuated by several factors and continue to negatively impact student performance and affect the health and well-being of BIPOC students (Kohli et al., 2017). The implementation of culturally responsive pedagogy can be used to mitigate this impact, increase academic success, and help students maintain cultural integrity (Ladson-Billings, 1995; Lebron et al., 2015). Counseling professionals can support this effort by engaging in training and professional development to understand racism and its impact on culturally diverse students and by facilitating necessary discussions that help to equip stakeholders with tools to adequately address discrimination, racism, and race-based trauma (NCTSN, 2018; Pietrantoni, 2017).

Counselor Supervisors
     The ACA Code of Ethics (2014; e.g., Section F: Supervision, Teaching, and Training) highlights the importance of counselor supervision for the development of counselors seeking licensure as independent mental health practitioners. Additionally, counselor supervision enhances a supervisee’s knowledge, skills, and ability to work with diverse clients (ACA, 2014). Therefore, counselor supervisors and their supervisees should be aware of racial trauma and the effects it could have on BIPOC clients. Pieterse (2018) posited guidelines and considerations for supervisors to follow when attending to racial trauma concerns in clinical supervision. Specifically, supervisors must be reflective of their own racial identity, understand how to assess for racial trauma, and implement effective clinical interventions for their supervisees’ clients impacted by racial trauma (Pieterse, 2018).

Additionally, understanding the concept of racial trauma in the larger context of historical trauma for BIPOC communities creates a learning environment for supervisees to deepen their knowledge of racial trauma (Comas-Díaz, 2000; French et al., 2020; Pieterse, 2018). For example, educating supervisees on historical depictions of racism-related stress and trauma for BIPOC communities, such as internment camps, chattel slavery, and colonization, provides the historical context of psychological wounds impacting BIPOC communities in present day by way of intergenerational trauma (Comas-Díaz et al., 2019; Nagata et al., 2019). Furthermore, clinical supervisors can role-play in supervision meetings with their supervisees to model helping clients process racist-related incidents, assessing for psychological distress, and empowering clients to practice effective coping and resistant strategies (Pieterse, 2018), thus ensuring supervisors’ awareness of multiculturalism and diversity in the supervisory relationship (ACA, 2014; e.g., Section F.2.b.: Multicultural Issues/Diversity in Supervision). It is critical for counselor supervisors to obtain the knowledge, skills, and abilities to best prepare counselor supervisees in addressing and treating racial trauma concerns.

Counselor Educators
     Moh and Sperandio (2022) urged the counseling profession to integrate trauma-informed curricula to best prepare counselors-in-training (CITs) to respond effectively to trauma concerns caused by systemic racism in the United States. However, there is hesitancy for counselor educators to teach CITs about racial trauma (VanAusdale & Swank, 2020). Specifically, counselor educators have reported a lack of knowledge and limited ability to teach CITs about racial trauma (VanAusdale & Swank, 2020), futher highlighting the need for trauma-informed curricula to be adopted in the counselor profession to best prepare counselors and educators to address the needs of those impacted by racial trauma. In addition, counselor educators’ lack of knowledge in trauma-informed care and racial trauma does not help prepare future CITs to address this concern once they have graduated from their respective counselor education programs, consequently leading to racial trauma concerns going unaddressed and deepening the wounds of racial trauma for BIPOC (Bryant-Davis & Ocampo, 2005; Comas-Díaz, 2000; Helms, et al., 2010).

However, counselor educators can find creative ways to implement racial trauma education into the classroom. For example, counselor educators can include required readings from BIPOC scholars in their classes that contribute to the racial trauma literature (e.g., Anderson & Stevenson, 2019; French et al., 2020; Mosley et al., 2021). Additionally, counselor educators can demonstrate how to implement the UnRESTS (Williams et al., 2018) for CITs in practicum and internship courses who are practicing conducting clinical interviews. Furthermore, counselor educators can introduce CITs to theories that go beyond the Eurocentric tradition. For example, the first author of this article, Warren Wright, was introduced to queer theory, critical theory, and critical race theory in his master’s-level multicultural counseling (formerly cross-cultural counseling) course. As a student, Wright was assigned to write a social justice and advocacy paper, in which he utilized critical race theory to discuss how adolescents’ responses to experiencing racism in K–12 education could present as behavioral and emotional dysregulation. To mitigate this concern, Wright created an after-school program that utilized dance movement therapy (i.e., stepping) to help Black adolescent males with emotional regulation, personal development, and academic excellence. This approach is an example of a trauma-informed and responsive practice that could reduce harsh disciplinary referrals and increase Black students’ socioemotional development (Stover et al., 2022). If counselor educators feel inadequate to teach trauma counseling or trauma-informed practices, they should seek additional training and consultation to increase their awareness, knowledge, and skills about trauma-informed curricula and approaches (Moh & Sperandio, 2022).


The aim of this article is to provide an understanding of racial trauma and its impact on the psychological and emotional well-being of BIPOC communities and provide recommendations for the counseling profession. Intentional practices, strategies, and approaches are needed to help reduce the impact of racial trauma experienced by BIPOC individuals and communities. Therefore, it is imperative for CITs, licensed professional mental health counselors, school counselors, counselor educators, and supervisors to be well-equipped to address racial trauma concerns. Failure of the counseling profession to address racial trauma concerns deepens the psychological and emotional injuries of racial trauma. Therefore, curricula for CITs should be adapted to best prepare the next generation of counselors to aid with and mitigate the lasting impacts of racially motivated trauma inflicted on BIPOC individuals and communities.


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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Warren Wright, MEd, NCC, LPC, CCTP, is a doctoral student at Sam Houston State University. Jennifer Hatchett Stover, MA, NCC, LPC, CCTP, CSC, is a doctoral student at Sam Houston State University. Kathleen Brown-Rice, PhD, NCC, ACS, LPC, LCMHC, LCAS, is a professor at Sam Houston State University. Correspondence may be addressed to Warren Wright 1932 Bobby K. Marks Drive, Huntsville, TX 77340, wbw007@shsu.edu.

Guidelines and Recommendations for Writing a Rigorous Quantitative Methods Section in Counseling and Related Fields

Michael T. Kalkbrenner

Conducting and publishing rigorous empirical research based on original data is essential for advancing and sustaining high-quality counseling practice. The purpose of this article is to provide a one-stop-shop for writing a rigorous quantitative Methods section in counseling and related fields. The importance of judiciously planning, implementing, and writing quantitative research methods cannot be understated, as methodological flaws can completely undermine the integrity of the results. This article includes an overview, considerations, guidelines, best practices, and recommendations for conducting and writing quantitative research designs. The author concludes with an exemplar Methods section to provide a sample of one way to apply the guidelines for writing or evaluating quantitative research methods that are detailed in this manuscript.

Keywords: empirical, quantitative, methods, counseling, writing

     The findings of rigorous empirical research based on original data is crucial for promoting and maintaining high-quality counseling practice (American Counseling Association [ACA], 2014; Giordano et al., 2021; Lutz & Hill, 2009; Wester et al., 2013). Peer-reviewed publication outlets play a crucial role in ensuring the rigor of counseling research and distributing the findings to counseling practitioners. The four major sections of an original empirical study usually include: (a) Introduction/Literature Review, (b) Methods, (c) Results, and (d) Discussion (American Psychological Association [APA], 2020; Heppner et al., 2016). Although every section of a research study must be carefully planned, executed, and reported (Giordano et al., 2021), scholars have engaged in commentary about the importance of a rigorous and clearly written Methods section for decades (Korn & Bram, 1988; Lutz & Hill, 2009). The Methods section is the “conceptual epicenter of a manuscript” (Smagorinsky, 2008, p. 390) and should include clear and specific details about how the study was conducted (Heppner et al., 2016). It is essential that producers and consumers of research are aware of key methodological standards, as the quality of quantitative methods in published research can vary notably, which has serious implications for the merit of research findings (Lutz & Hill, 2009; Wester et al., 2013).

Careful planning prior to launching data collection is especially important for conducting and writing a rigorous quantitative Methods section, as it is rarely appropriate to alter quantitative methods after data collection is complete for both practical and ethical reasons (ACA, 2014; Creswell & Creswell, 2018). A well-written Methods section is also crucial for publishing research in a peer-reviewed journal; any serious methodological flaws tend to automatically trigger a decision of rejection without revisions. Accordingly, the purpose of this article is to provide both producers and consumers of quantitative research with guidelines and recommendations for writing or evaluating the rigor of a Methods section in counseling and related fields. Specifically, this manuscript includes a general overview of major quantitative methodological subsections as well as an exemplar Methods section. The recommended subsections and guidelines for writing a rigorous Methods section in this manuscript (see Appendix) are based on a synthesis of (a) the extant literature (e.g., Creswell & Creswell, 2018; Flinn & Kalkbrenner, 2021; Giordano et al., 2021); (b) the Standards for Educational and Psychological Testing (American Educational Research Association [AERA] et al., 2014), (c) the ACA Code of Ethics (ACA, 2014), and (d) the Journal Article Reporting Standards (JARS) in the APA 7 (2020) manual.

Quantitative Methods: An Overview of the Major Sections

The Methods section is typically the second major section in a research manuscript and can begin with an overview of the theoretical framework and research paradigm that ground the study (Creswell & Creswell, 2018; Leedy & Ormrod, 2019). Research paradigms and theoretical frameworks are more commonly reported in qualitative, conceptual, and dissertation studies than in quantitative studies. However, research paradigms and theoretical frameworks can be very applicable to quantitative research designs (see the exemplar Methods section below). Readers are encouraged to consult Creswell and Creswell (2018) for a clear and concise overview about the utility of a theoretical framework and a research paradigm in quantitative research.

Research Design
     The research design should be clearly specified at the beginning of the Methods section. Commonly employed quantitative research designs in counseling include but are not limited to group comparisons (e.g., experimental, quasi-experimental, ex-post-facto), correlational/predictive, meta-analysis, descriptive, and single-subject designs (Creswell & Creswell, 2018; Flinn & Kalkbrenner, 2021; Leedy & Ormrod, 2019). A well-written literature review and strong research question(s) will dictate the most appropriate research design. Readers can refer to Flinn and Kalkbrenner (2021) for free (open access) commentary on and examples of conducting a literature review, formulating research questions, and selecting the most appropriate corresponding research design.

Researcher Bias and Reflexivity
     Counseling researchers have an ethical responsibility to minimize their personal biases throughout the research process (ACA, 2014). A researcher’s personal beliefs, values, expectations, and attitudes create a lens or framework for how data will be collected and interpreted. Researcher reflexivity or positionality statements are well-established methodological standards in qualitative research (Hays & Singh, 2012; Heppner et al., 2016; Rovai et al., 2013). Researcher bias is rarely reported in quantitative research; however, researcher bias can be just as inherently present in quantitative as it is in qualitative studies. Being reflexive and transparent about one’s biases strengthens the rigor of the research design (Creswell & Creswell, 2018; Onwuegbuzie & Leech, 2005). Accordingly, quantitative researchers should consider reflecting on their biases in similar ways as qualitative researchers (Onwuegbuzie & Leech, 2005). For example, a researcher’s topical and methodological choices are, at least in part, based on their personal interests and experiences. To this end, quantitative researchers are encouraged to reflect on and consider reporting their beliefs, assumptions, and expectations throughout the research process.

Participants and Procedures
     The major aim in the Participants and Procedures subsection of the Methods section is to provide a clear description of the study’s participants and procedures in enough detail for replication (ACA, 2014; APA, 2020; Giordano et al., 2021; Heppner et al., 2016). When working with human subjects, authors should briefly discuss research ethics including but not limited to receiving institutional review board (IRB) approval (Giordano et al., 2021; Korn & Bram, 1988). Additional considerations for the Participants and Procedures section include details about the authors’ sampling procedure, inclusion and/or exclusion criteria for participation, sample size, participant background information, location/site, and protocol for interventions (APA, 2020).

Sampling Procedure and Sample Size
     Sampling procedures should be clearly stated in the Methods section. At a minimum, the description of the sampling procedure should include researcher access to prospective participants, recruitment procedures, data collection modality (e.g., online survey), and sample size considerations. Quantitative sampling approaches tend to be clustered into either probability or non-probability techniques (Creswell & Creswell, 2018; Leedy & Ormrod, 2019). The key distinguishing feature of probability sampling is random selection, in which all prospective participants in the population have an equal chance of being randomly selected to participate in the study (Leedy & Ormrod, 2019). Examples of probability sampling techniques include simple random sampling, systematic random sampling, stratified random sampling, or cluster sampling (Leedy & Ormrod, 2019).

Non-probability sampling techniques lack random selection and there is no way of determining if every member of the population had a chance of being selected to participate in the study (Leedy & Ormrod, 2019). Examples of non-probability sampling procedures include volunteer sampling, convenience sampling, purposive sampling, quota sampling, snowball sampling, and matched sampling. In quantitative research, probability sampling procedures are more rigorous in terms of generalizability (i.e., the extent to which research findings based on sample data extend or generalize to the larger population from which the sample was drawn). However, probability sampling is not always possible and non-probability sampling procedures are rigorous in their own right. Readers are encouraged to review Leedy and Ormrod’s (2019) commentary on probability and non-probability sampling procedures. Ultimately, the selection of a sampling technique should be made based on the population parameters, available resources, and the purpose and goals of the study.

     A Priori Statistical Power Analysis. It is essential that quantitative researchers determine the minimum necessary sample size for computing statistical analyses before launching data collection (Balkin & Sheperis, 2011; Sink & Mvududu, 2010). An insufficient sample size substantially increases the probability of committing a Type II error, which occurs when the results of statistical testing reveal non–statistically significant findings when in reality (of which the researcher is unaware), significant findings do exist. Computing an a priori (computed before starting data collection) statistical power analysis reduces the chances of a Type II error by determining the smallest sample size that is necessary for finding statistical significance, if statistical significance exists (Balkin & Sheperis, 2011). Readers can consult Balkin and Sheperis (2011) as well as Sink and Mvududu (2010) for an overview of statistical significance, effect size, and statistical power. A number of statistical power analysis programs are available to researchers. For example, G*Power (Faul et al., 2009) is a free software program for computing a priori statistical power analyses.

Sampling Frame and Location
     Counselors should report their sampling frame (total number of potential participants), response rate, raw sample (total number of participants that engaged with the study at any level, including missing and incomplete data), and the size of the final useable sample. It is also important to report the breakdown of the sample by demographic and other important participant background characteristics, for example, “XX.X% (n = XXX) of participants were first-generation college students, XX.X% (n = XXX) were second-generation . . .” The selection of demographic variables as well as inclusion and exclusion criteria should be justified in the literature review. Readers are encouraged to consult Creswell and Creswell (2018) for commentary on writing a strong literature review.

The timeframe, setting, and location during which data were collected are important methodological considerations (APA, 2020). Specific names of institutions and agencies should be masked to protect their privacy and confidentiality; however, authors can give descriptions of the setting and location (e.g., “Data were collected between April 2021 to February 2022 from clients seeking treatment for addictive disorders at an outpatient, integrated behavioral health care clinic located in the Northeastern United States.”). Authors should also report details about any interventions, curriculum, qualifications and background information for research assistants, experimental design protocol(s), and any other procedural design issues that would be necessary for replication. In instances in which describing a treatment or conditions becomes exorbitant (e.g., step-by-step manualized therapy, programs, or interventions), researchers can include footnotes, appendices, and/or references to refer the reader to more information about the intervention protocol.

Missing Data
     Procedures for handling missing values (incomplete survey responses) are important considerations in quantitative data analysis. Perhaps the most straightforward option for handling missing data is to simply delete missing responses. However, depending on the percentage of data that are missing and how the data are missing (e.g., missing completely at random, missing at random, or not missing at random), data imputation techniques can be employed to recover missing values (Cook, 2021; Myers, 2011). Quantitative researchers should provide a clear rationale behind their decisions around the deletion of missing values or when using a data imputation method. Readers are encouraged to review Cook’s (2021) commentary on procedures for handling missing data in quantitative research.

     Counseling and other social science researchers oftentimes use instruments and screening tools to appraise latent traits, which can be defined as variables that are inferred rather than observed (AERA et al., 2014). The purpose of the Measures (aka Instrumentation) section is to operationalize the construct(s) of measurement (Heppner et al., 2016). Specifically, the Measures subsection of the Methods in a quantitative manuscript tends to include a presentation of (a) the instrument and construct(s) of measurement, (b) reliability and validity evidence of test scores, and (c) cross-cultural fairness and norming. The Measures section might also include a Materials subsection for studies that employed data-gathering techniques or equipment besides or in addition to instruments (Heppner et al., 2016); for instance, if a research study involved the use of a biofeedback device to collect data on changes in participants’ body functions.

Instrument and Construct of Measurement
     Begin the Measures section by introducing the questionnaire or screening tool, its construct(s) of measurement, number of test items, example test items, and scale points. If applicable, the Measures section can also include information on scoring procedures and cutoff criterion; for example, total score benchmarks for low, medium, and high levels of the trait. Authors might also include commentary about how test scores will be operationalized to constitute the variables in the upcoming Data Analysis section.

Reliability and Validity Evidence of Test Scores
     Reliability evidence involves the degree to which test scores are stable or consistent and validity evidence refers to the extent to which scores on a test succeed in measuring what the test was designed to measure (AERA et al., 2014; Bardhoshi & Erford, 2017). Researchers should report both reliability and validity evidence of scores for each instrument they use (Wester et al., 2013). A number of forms of reliability evidence exist (e.g., internal consistency, test-retest, interrater, and alternate/parallel/equivalent forms) and the AERA standards (2014) outline five forms of validity evidence. For the purposes of this article, I will focus on internal consistency reliability, as it is the most popular and most commonly misused reliability estimate in social sciences research (Kalkbrenner, 2021a; McNeish, 2018), as well as construct validity. The psychometric properties of a test (including reliability and validity evidence) are contingent upon the scores from which they were derived. As such, no test is inherently valid or reliable; test scores are only reliable and valid for a certain purpose, at a particular time, for use with a specific sample. Accordingly, authors should discuss reliability and validity evidence in terms of scores, for example, “Stamm (2010) found reliability and validity evidence of scores on the Professional Quality of Life (ProQOL 5) with a sample of . . . ”

Internal Consistency Reliability Evidence. Internal consistency estimates are derived from associations between the test items based on one administration (Kalkbrenner, 2021a). Cronbach’s coefficient alpha (α) is indisputably the most popular internal consistency reliability estimate in counseling and throughout social sciences research in general (Kalkbrenner, 2021a; McNeish, 2018). The appropriate use of coefficient alpha is reliant on the data meeting the following statistical assumptions: (a) essential tau equivalence, (b) continuous level scale of measurement, (c) normally distributed data, (d) uncorrelated error, (e) unidimensional scale, and (f) unit-weighted scaling (Kalkbrenner, 2021a). For decades, coefficient alpha has been passed down in the instructional practice of counselor training programs. Coefficient alpha has appeared as the dominant reliability index in national counseling and psychology journals without most authors computing and reporting the necessary statistical assumption checking (Kalkbrenner, 2021a; McNeish, 2018). The psychometrically daunting practice of using alpha without assumption checking poses a threat to the veracity of counseling research, as the accuracy of coefficient alpha is threatened if the data violate one or more of the required assumptions.

Internal Consistency Reliability Indices and Their Appropriate Use. Composite reliability (CR)
internal consistency estimates are derived in similar ways as coefficient alpha; however, the proper computation of CRs is not reliant on the data meeting many of alpha’s statistical assumptions (Kalkbrenner, 2021a; McNeish, 2018). For example, McDonald’s coefficient omega (ω or ωt) is a CR estimate that is not dependent on the data meeting most of alpha’s assumptions (Kalkbrenner, 2021a). In addition, omega hierarchical (ωh) and coefficient H are CR estimates that can be more advantageous than alpha. Despite the utility of CRs, their underuse in research practice is historically, in part, because of the complex nature of computation. However, recent versions of SPSS include a breakthrough point-and-click feature for computing coefficient omega as easily as coefficient alpha. Readers can refer to the SPSS user guide for steps to compute omega.

Guidelines for Reporting Internal Consistency Reliability. In the Measures subsection of the Methods section, researchers should report existing reliability evidence of scores for their instruments. This can be done briefly by reporting the results of multiple studies in the same sentence, as in: “A number of past investigators found internal consistency reliability evidence for scores on the [name of test] with a number of different samples, including college students (α =. XX, ω =. XX; Authors et al., 20XX), clients living with chronic back pain (α =. XX, ω =. XX; Authors et al., 20XX), and adults in the United States (α = . XX, ω =. XX; Authors et al., 20XX) . . .”

Researchers should also compute and report reliability estimates of test scores with their data set in the Measures section. If a researcher is using coefficient alpha, they have a duty to complete and report assumption checking to demonstrate that the properties of their sample data were suitable for alpha (Kalkbrenner, 2021a; McNeish, 2018). Another option is to compute a CR (e.g., ω or H) instead of alpha. However, Kalkbrenner (2021a) recommended that researchers report both coefficient alpha (because of its popularity) and coefficient omega (because of the robustness of the estimate). The proper interpretation of reliability estimates of test scores is done on a case-by-case basis, as the meaning of reliability coefficients is contingent upon the construct of measurement and the stakes or consequences of the results for test takers (Kalkbrenner, 2021a). The following tentative interpretative guidelines for adults’ scores on attitudinal measures were offered by Kalkbrenner (2021b) for coefficient alpha: α < .70 = poor, α > .70 to .84 = acceptable, α > .85 = strong; and for coefficient omega: ω < .65 = poor, ω > .65 to .80 = acceptable, ω > .80 = strong. It is important to note that these thresholds are for adults’ scores on attitudinal measures; acceptable internal consistency reliability estimates of scores should be much stronger for high-stakes testing.

     Construct Validity Evidence of Test Scores. Construct validity involves the test’s ability to accurately capture a theoretical or latent construct (AERA et al., 2014). Construct validity considerations are particularly important for counseling researchers who tend to investigate latent traits as outcome variables. At a minimum, counseling researchers should report construct validity evidence for both internal structure and relations with theoretically relevant constructs. Internal structure (aka factorial validity) is a source of construct validity that represents the degree to which “the relationships among test items and test components conform to the construct on which the proposed test score interpretations are based” (AERA et al., 2014, p. 16). Readers can refer to Kalkbrenner (2021b) for a free (open access publishing) overview of exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) that is written in layperson’s terms. Relations with theoretically relevant constructs (e.g., convergent and divergent validity) are another source of construct validity evidence that involves comparing scores on the test in question with scores on other reputable tests (AERA et al., 2014; Strauss & Smith, 2009).

     Guidelines for Reporting Validity Evidence. Counseling researchers should report existing evidence of at least internal structure and relations with theoretically relevant constructs (e.g., convergent or divergent validity) for each instrument they use. EFA results alone are inadequate for demonstrating internal structure validity evidence of scores, as EFA is a much less rigorous test of internal structure than CFA (Kalkbrenner, 2021b). In addition, EFA results can reveal multiple retainable factor solutions, which need to be tested/confirmed via CFA before even initial internal structure validity evidence of scores can be established. Thus, both EFA and CFA are necessary for reporting/demonstrating initial evidence of internal structure of test scores. In an extension of internal structure, counselors should also report existing convergent and/or divergent validity of scores. High correlations (r > .50) demonstrate evidence of convergent validity and moderate-to-low correlations (r < .30, preferably r < .10) support divergent validity evidence of scores (Sink & Stroh, 2006; Swank & Mullen, 2017).

In an ideal situation, a researcher will have the resources to test and report the internal structure (e.g., compute CFA firsthand) of scores on the instrumentation with their sample. However, CFA requires large sample sizes (Kalkbrenner, 2021b), which oftentimes is not feasible. It might be more practical for researchers to test and report relations with theoretically relevant constructs, though adding one or more questionnaire(s) to data collection efforts can come with the cost of increasing respondent fatigue. In these instances, researchers might consider reporting other forms of validity evidence (e.g., evidence based on test content, criterion validity, or response processes; AERA et al., 2014). In instances when computing firsthand validity evidence of scores is not logistically viable, researchers should be transparent about this limitation and pay especially careful attention to presenting evidence for cross-cultural fairness and norming.

Cross-Cultural Fairness and Norming
     In a psychometric context, fairness (sometimes referred to as cross-cultural fairness) is a fundamental validity issue and a complex construct to define (AERA et al., 2014; Kane, 2010; Neukrug & Fawcett, 2015). I offer the following composite definition of cross-cultural fairness for the purposes of a quantitative Measures section: the degree to which test construction, administration procedures, interpretations, and uses of results are equitable and represent an accurate depiction of a diverse group of test takers’ abilities, achievement, attitudes, perceptions, values, and/or experiences (AERA et al., 2014; Educational Testing Service [ETS], 2016; Kane, 2010; Kane & Bridgeman, 2017). Counseling researchers should consider the following central fairness issues when selecting or developing instrumentation: measurement bias, accessibility, universal design, equivalent meaning (invariance), test content, opportunity to learn, test adaptations, and comparability (AERA et al., 2014; Kane & Bridgeman, 2017). Providing a comprehensive overview of fairness is beyond the scope of this article; however, readers are encouraged to read Chapter 3 in the AERA standards (2014) on Fairness in Testing.

In the Measures section, counseling researchers should include commentary on how and in what ways cross-cultural fairness guided their selection, administration, and interpretation of procedures and test results (AERA et al., 2014; Kalkbrenner, 2021b). Cross-cultural fairness and construct validity are related constructs (AERA et al., 2014). Accordingly, citing construct validity of test scores (see the previous section) with normative samples similar to the researcher’s target population is one way to provide evidence of cross-cultural fairness. However, construct validity evidence alone might not be a sufficient indication of cross-cultural fairness, as the latent meaning of test scores are a function of test takers’ cultural context (Kalkbrenner, 2021b). To this end, when selecting instrumentation, researchers should review original psychometric studies and consider the normative sample(s) from which test scores were derived.

Commentary on the Danger of Using Self-Developed and Untested Scales
     Counseling researchers have an ethical duty to “carefully consider the validity, reliability, psychometric limitations, and appropriateness of instruments when selecting assessments” (ACA, 2014, p. 11). Quantitative researchers might encounter instances in which a scale is not available to measure their desired construct of measurement (latent/inferred variable). In these cases, the first step in the line of research is oftentimes to conduct an instrument development and score validation study (AERA et al., 2014; Kalkbrenner, 2021b). Detailing the protocol for conducting psychometric research is outside the scope of this article; however, readers can refer to the MEASURE Approach to Instrument Development (Kalkbrenner, 2021c) for a free (open access publishing) overview of the steps in an instrument development and score validation study. Adapting an existing scale can be option in lieu of instrument development; however, according to the AERA standards (2014), “an index that is constructed by manipulating and combining test scores should be subjected to the same validity, reliability, and fairness investigations that are expected for the test scores that underlie the index” (p. 210). Although it is not necessary that all quantitative researchers become psychometricians and conduct full-fledged psychometric studies to validate scores on instrumentation, researchers do have a responsibility to report evidence of the reliability, validity, and cross-cultural fairness of test scores for each instrument they used. Without at least initial construct validity testing of scores (calibration), researchers cannot determine what, if anything at all, an untested instrument actually measures.

Data Analysis
     Counseling researchers should report and explain the selection of their data analytic procedures (e.g., statistical analyses) in a Data Analysis (or Statistical Analysis) subsection of the Methods or Results section (Giordano et al., 2021; Leedy & Ormrod, 2019). The placement of the Data Analysis section in either the Methods or Results section can vary between publication outlets; however, this section tends to include commentary on variables, statistical models and analyses, and statistical assumption checking procedures.

Operationalizing Variables and Corresponding Statistical Analyses
     Clearly outlining each variable is an important first step in selecting the most appropriate statistical analysis for answering each research question (Creswell & Creswell, 2018). Researchers should specify the independent variable(s) and corresponding levels as well as the dependent variable(s); for example, “The first independent variable, time, was composed of the three following levels: pre, middle, and post. The dependent variables were participants’ scores on the burnout and compassion satisfaction subscales of the ProQOL 5.” After articulating the variables, counseling researchers are tasked with identifying each variable’s scale of measurement (Creswell & Creswell, 2018; Field, 2018; Flinn & Kalkbrenner, 2021). Researchers can select the most appropriate statistical test(s) for answering their research question(s) based on the scale of measurement for each variable and referring to Table 8.3 on page 159 in Creswell and Creswell (2018), Figure 1 in Flinn and Kalkbrenner (2021), or the chart on page 1072 in Field (2018).

Assumption Checking
     Statistical analyses used in quantitative research are derived based on a set of underlying assumptions (Field, 2018; Giordano et al., 2021). Accordingly, it is essential that quantitative researchers outline their protocol for testing their sample data for the appropriate statistical assumptions. Assumptions of common statistical tests in counseling research include normality, absence of outliers (multivariate and/or univariate), homogeneity of covariance, homogeneity of regression slopes, homoscedasticity, independence, linearity, and absence of multicollinearity (Flinn & Kalkbrenner, 2021; Giordano et al., 2021). Readers can refer to Figure 2 in Flinn and Kalkbrenner (2021) for an overview of statistical assumptions for the major statistical analyses in counseling research.

Exemplar Quantitative Methods Section

The following section includes an exemplar quantitative methods section based on a hypothetical example and a practice data set. Producers and consumers of quantitative research can refer to the following section as an example for writing their own Methods section or for evaluating the rigor of an existing Methods section. As stated previously, a well-written literature review and research question(s) are essential for grounding the study and Methods section (Flinn & Kalkbrenner, 2021). The final piece of a literature review section is typically the research question(s). Accordingly, the following research question guided the following exemplar Methods section: To what extent are there differences in anxiety severity between college students who participate in deep breathing exercises with progressive muscle relaxation, group exercise program, or both group exercise and deep breathing with progressive muscle relaxation?



A quantitative group comparison research design was employed based on a post-positivist philosophy of science (Creswell & Creswell, 2018). Specifically, I implemented a quasi-experimental, control group pretest/posttest design to answer the research question (Leedy & Ormrod, 2019). Consistent with a post-positivist philosophy of science, I reflected on pursuing a probabilistic objective answer that is situated within the context of imperfect and fallible evidence. The rationale for the present study was grounded in Dr. David Servan-Schreiber’s (2009) theory of lifestyle practices for integrated mental and physical health. According to Servan-Schreiber, simultaneously focusing on improving one’s mental and physical health is more effective than focusing on either physical health or mental wellness in isolation. Consistent with Servan-Schreiber’s theory, the aim of the present study was to compare the utility of three different approaches for anxiety reduction: a behavioral approach alone, a physiological approach alone, and a combined behavioral approach and physiological approach.

I am in my late 30s and identify as a White man. I have a PhD in counselor education as well as an MS in clinical mental health counseling. I have a deep belief in and an active line of research on the utility of total wellness (combined mental and physical health). My research and clinical experience have informed my passion and interest in studying the utility of integrated physical and psychological health services. More specifically, my personal beliefs, values, and interest in total wellness influenced my decision to conduct the present study. I carefully followed the procedures outlined below to reduce the chances that my personal values biased the research design.

Participants and Procedures
     Data collection began following approval from the IRB. Data were collected during the fall 2022 semester from undergraduate students who were at least 18 years or older and enrolled in at least one class at a land grant, research-intensive university located in the Southwestern United States. An a priori statistical power analysis was computed using G*Power (Faul et al., 2009). Results revealed that a sample size of at least 42 would provide an 80% power estimate, α = .05, with a moderate effect size, f = 0.25.

I obtained an email list from the registrar’s office of all students enrolled in a section of a Career Excellence course, which was selected to recruit students in a variety of academic majors because all undergraduate students in the College of Education are required to take this course. The focus of this study (mental and physical wellness) was also consistent with the purpose of the course (success in college). A non-probability, convenience sampling procedure was employed by sending a recruitment message to students’ email addresses via the Qualtrics online survey platform. The response rate was approximately 15%, with a total of 222 prospective participants indicating their interest in the study by clicking on the electronic recruitment link, which automatically sent them an invitation to attend an information session about the study. One hundred forty-four students showed up for the information session, 129 of which provided their voluntary informed consent to enroll in the study. Participants were given a confidential identification number to track their pretest/posttest responses, and then they completed the pretest (see the Measures section below). Respondents were randomly assigned in equal groups to either (a) deep breathing with progressive muscle relaxation condition, (b) group exercise condition, or (c) both exercise and deep breathing with progressive muscle relaxation condition.

A missing values analysis showed that less than 5% of data was missing for all cases. Expectation maximization was used to impute missing values, as Little’s Missing Completely at Random (MCAR) test revealed that the data could be treated as MCAR (p = .367). Data from five participants who did not return to complete the posttest at the end of the semester were removed, yielding a robust sample of N = 124. Participants (N = 124) ranged in age from 18 to 33 (M = 21.64, SD = 3.70). In terms of gender identity, 65.0% (n = 80) self-identified as female, 32.2% (n = 40) as male, 0.8% (n = 1) as transgender, and 2.4% (n = 3) did not specify their gender identity. For ethnic identity, 50.0% (n = 62) identified as White, 26.7% (n = 33) as Latinx, 12.1% (n = 15) as Asian, 9.6% (n = 12) as Black, 0.8% (n = 1) as Alaskan Native, and 0.8% (n = 1) did not specify their ethnic identity. In terms of generational status, 36.3% (n = 45) of participants were first-generation college students and 63.7% (n = 79) were second-generation or beyond.

Group Exercise and Deep Breathing Programs
     I was awarded a small grant to offer on-campus deep breathing with progressive muscle relaxation and group exercise programs. The structure of the group exercise program was based on Patterson et al. (2021), which consisted of more than 50 available exercise classes each week (e.g., cycling, yoga, swimming, dance). There was no limit to the number of classes that participants could attend; however, attending at least one class each week was required for participation in the study. Readers can refer to Patterson et al. for more information about the group exercise programming.

Neeru et al.’s (2015) deep breathing and progressive muscle relaxation programming was used in the present study. Participants completed daily deep breathing and Jacobson Progressive Muscle Relaxation (JPMR). JPMR was selected because of its documented success with treating anxiety disorders (Neeru et al., 2015). Specifically, the program consisted of four deep breathing steps completed five times and JPMR for approximately 25 minutes daily. Participants attended a weekly deep breathing and JPMR session facilitated by a licensed professional counselor. Participants also practiced deep breathing and JPMR on their own daily and kept a log to document their practice sessions. Readers can refer to Neeru et al. for more information about JPMR and the deep breathing exercises.

     Prospective participants read an informed consent statement and indicated their voluntary informed consent by clicking on a checkbox. Next, participants confirmed that they met the following inclusion criteria: (a) at least 18 years old and (b) currently enrolled in at least one undergraduate college class. The instrumentation began with demographic items regarding participants’ gender identity, ethnic identity, age, and confidential identification number to track their pretest and posttest scores. Lastly, participants completed a convergent validity measure (Mental Health Inventory – 5) and the Generalized Anxiety Disorder (GAD)-7 to measure the outcome variable (anxiety severity).

Reliability and Validity Evidence of Test Scores
     Tests of internal consistency were computed to test the reliability of scores on the screening tool for appraising anxiety severity with undergraduate students in the present sample. For internal consistency reliability of scores, coefficient alpha (α) and coefficient omega (ω) were computed with the following minimum thresholds for adults’ scores on attitudinal measures: α > .70 and ω > .65, based on the recommendations of Kalkbrenner (2021b).

The Mental Health Inventory–5. Participants completed the Mental Health Inventory (MHI)-5 to test the convergent validity of undergraduate students in the present samples’ scores on the GAD-7, which was used to measure the outcome variable in this study, anxiety severity. The MHI-5 is a 5-item measure for appraising overall mental health (Berwick et al., 1991). Higher MHI-5 scores reflect better mental health. Participants responded to test items (example: “How much of the time, during the past month, have you been a very nervous person?”) on the following Likert-type scale: 0 = none of the time, 1 = a little of the time, 2 = some of the time, 3 = a good bit of the time, 4 = most of the time, or 5 = all of the time. The MHI-5 has particular utility as a convergent validity measure because of its brief nature (5 items) coupled with the myriad of support for its psychometric properties (e.g., Berwick et al., 1991; Rivera-Riquelme et al., 2019; Thorsen et al., 2013). As just a few examples, Rivera-Riquelme et al. (2019) found acceptable internal consistency reliability evidence (α = .71, ω = .78) and internal structure validity evidence of MHI-5 scores. In addition, the findings of Thorsen et al. (2013) demonstrated convergent validity evidence of MHI-5 scores. Findings in the extant literature (e.g., Foster et al., 2016; Vijayan & Joseph, 2015) established an inverse relationship between anxiety and mental health. Thus, a strong negative correlation (r > −.50; Sink & Stroh, 2006) between the MHI-5 and GAD-7 would support convergent validity evidence of scores.

     The Generalized Anxiety Disorder–7. The GAD-7 is a 7-item screening tool for appraising anxiety severity (Spitzer et al., 2006). Participants respond to test items based on the following prompt: “Over the last 2 weeks, how often have you been bothered by the following problems?” and anchor definitions: 0 = not at all, 1 = several days, 2 = more than half the days, or 3 = nearly every day (Spitzer et al., 2006, p. 1739). Sample test items include “being so restless that it’s hard to sit still” and “feeling afraid as if something awful might happen.” The GAD-7 items can be summed into an interval-level composite score, with higher scores indicating greater levels of Anxiety Severity. GAD-7 scores can range from 0 to 21 and are classified as mild (0–5), moderate (6–10), moderately severe (11–15), or severe (16–21).

In the initial score validation study, Spitzer et al. (2006) found evidence for internal consistency (α = .92) and test-retest reliability (intraclass correlation = .83) of GAD-7 scores among adults in the United States who were receiving services in primary care clinics. In more recent years, a number of additional investigators found internal consistency reliability evidence for GAD-7 scores, including samples of undergraduate college students in the southern United States (α = .91; Sriken et al., 2022), Black and Latinx adults in the United States (α = .93, ω = .93; Kalkbrenner, 2022), and English-speaking college students living in Ethiopia (ω = .77; Manzar et al., 2021). Similarly, the data set in the present study displayed acceptable internal consistency reliability evidence for GAD-7 scores (α = .82, ω = .81).

Spitzer et al. (2006) used factor analysis to establish internal structure validity, correlations with established screening tools for convergent validity, and criterion validity evidence by demonstrating the capacity of GAD-7 scores for detecting likely cases of generalized anxiety disorder. A number of subsequent investigators found internal structure validity evidence of GAD-7 scores via CFA and multiple-group CFA (Kalkbrenner, 2022; Sriken et al., 2022). In addition, the findings of Sriken et al. (2022) supported both the convergent and divergent validity of GAD-7 scores with other established tests. The data set in the present study (N = 124) was not large enough for internal structure validity testing. However, a strong negative correlation (r = −.78) between the GAD-7 and MHI-5 revealed convergent validity evidence of GAD-7 scores with the present sample of undergraduate students.

In terms of norming and cross-cultural fairness, there were qualitative differences between the normative GAD-7 sample in the original score validation study (adults in the United States receiving services in primary care clinics) and the non-clinical sample of young adult college students in the present study. However, the demographic profile of the present sample is consistent with Sriken et al. (2022), who validated GAD-7 scores with a large sample (N = 414) of undergraduate college students. For example, the demographic profile of the sample in the current study for gender identity closely resembled the composition of Sriken et al.’s sample, which included 66.7% women, 33.1% men, and 0.2% transgender individuals. In terms of ethnic identity, the demographic profile of the present sample was consistent with Sriken et al. for White and Black participants, although the present sample reflected a somewhat smaller proportion of Asian students (19.6%) and a greater proportion of Latinx students (5.3%).

Data Analysis and Assumption Checking
     The present study included two categorical-level independent variables and one continuous-level dependent variable. The first independent variable, program, consisted of three levels: (a) deep breathing with progressive muscle relaxation, (b) group exercise, or (c) both exercise and deep breathing with progressive muscle relaxation. The second independent variable, time, consisted of two levels: the beginning of the semester and the end of the semester. The dependent variable was participants’ interval-level score on the GAD-7. Accordingly, a 3 (program) X 2 (time) mixed-design analysis of variance (ANOVA) was the most appropriate statistical test for answering the research question (Field, 2018).

The data were examined for the following statistical assumptions for a mixed-design ANOVA: absence of outliers, normality, homogeneity of variance, and sphericity of the covariance matrix based on the recommendations of Field (2018). Standardized z-scores revealed an absence of univariate outliers (z > 3.29). A review of skewness and kurtosis values were highly consistent with a normal distribution, with the majority of values less than ± 1.0. The results of a Levene’s test demonstrated that the data met the assumption of homogeneity of variance, F(2, 121) = 0.73, p = .486. Testing the data for sphericity was not applicable in this case, as the within-subjects IV (time) only comprised two levels.

——-End Exemplar——-


The current article is a primer on guidelines, best practices, and recommendations for writing or evaluating the rigor of the Methods section of quantitative studies. Although the major elements of the Methods section summarized in this manuscript tend to be similar across the national peer-reviewed counseling journals, differences can exist between journals based on the content of the article and the editorial board members’ preferences. Accordingly, it can be advantageous for prospective authors to review recently published manuscripts in their target journal(s) to look for any similarities in the structure of the Methods (and other sections). For instance, in one journal, participants and procedures might be reported in a single subsection, whereas in other journals they might be reported separately. In addition, most journals post a list of guidelines for prospective authors on their websites, which can include instructions for writing the Methods section. The Methods section might be the most important section in a quantitative study, as in all likelihood methodological flaws cannot be resolved once data collection is complete, and serious methodological flaws will compromise the integrity of the entire study, rendering it unpublishable. It is also essential that consumers of quantitative research can proficiently evaluate the quality of a Methods section, as poor methods can make the results meaningless. Accordingly, the significance of carefully planning, executing, and writing a quantitative research Methods section cannot be understated.

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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Outline and Brief Overview of a Quantitative Methods Section


  • Research design (e.g., group comparison [experimental, quasi-experimental, ex-post-facto], correlational/predictive) and conceptual framework
  • Researcher bias and reflexivity statement

Participants and Procedures

  • Recruitment procedures for data collection in enough detail for replication
  • Research ethics including but not limited to receiving institutional review board (IRB) approval
  • Sampling procedure: Researcher access to prospective participants, recruitment procedures, and data collection modality (e.g., online survey)
  • Sampling technique: Probability sampling (e.g., simple random sampling, systematic random sampling, stratified random sampling, cluster sampling) or non-probability sampling (e.g., volunteer sampling, convenience sampling, purposive sampling, quota sampling, snowball sampling, matched sampling)
  • A priori statistical power analysis
  • Sampling frame, response rate, raw sample, missing data, and the size of the final useable sample
  • Demographic breakdown for participants
  • Timeframe, setting, and location where data were collected


  • Introduction of the instrument and construct(s) of measurement (include sample test items)
  • Reliability and validity evidence of test scores (for each instrument):
    • Existing reliability (e.g., internal consistency [coefficient alpha, coefficient omega, or coefficient H], test/retest) and validity (e.g., internal structure, convergent/divergent, criterion) evidence of scores
      • *Note: At a minimum, internal structure validity evidence of scores should include both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).
    • Reliability and validity evidence of test scores with the data set in the present study
      • *Note: Only using coefficient alpha without completing statistical assumption checking is insufficient. Compute both coefficient omega and alpha or alpha with proper assumption checking.
    • Cross-cultural fairness and norming: Commentary on how and in what ways cross-cultural fairness guided the selection, administration, and interpretation of procedures and test results
      • Review and citations of original psychometric studies and normative samples

Data Analysis

  • Operationalized variables and scales of measurement
  • Procedures for matching variables with appropriate statistical analyses
  • Assumption checking procedures

Note. This appendix is a brief summary and not a substitute for the narrative in the text of this article.


Michael T. Kalkbrenner, PhD, NCC, is an associate professor at New Mexico State University. Correspondence may be addressed to Michael T. Kalkbrenner, 1780 E. University Ave., Las Cruces, NM 88003, mkalk001@nmsu.edu.


Lifetime Achievement in Counseling Series: An Interview With Mariaimeé Gonzalez

Joshua D. Smith, Neal D. Gray


Each year TPC presents an interview with a seminal figure in counseling as part of its Lifetime Achievement in Counseling series. This year I am honored to introduce Dr. Mariaimeé Gonzalez. She is a professor of counselor education, the chair of the Clinical Mental Health Counseling Program at Antioch University Seattle, and a transformational leader and advocate. Collectivism grounds and infuses her work and her practice of mentorship as community building and a key strategy for increasing diversity in the counseling profession. I am grateful to Dr. Joshua Smith and Dr. Neal Gray for bringing the contributions and vision of Dr. Gonzalez to TPC readers. —Amie A. Manis, Editor


     Mariaimeé “Maria” Gonzalez (she/her/ella), PhD, LPC, was born in Puerto Rico and raised in the United States. She earned both her master’s and doctoral degrees from the University of Missouri–St. Louis and moved to Seattle, Washington, in 2014 to become a faculty member at Antioch University Seattle (AUS), located on the traditional land of the first people of Seattle, the Duwamish People, past and present. Dr. Gonzalez is the chair of the Master of Arts in Clinical Mental Health Program and is the co-founder of the Antioch University Latinx Mental Health & Social Justice Institute, which brings together community-engaged research, service, training, and community partnerships to promote the mental health and well-being of Latinx/e people. She truly enjoys teaching in the master’s and doctoral programs at AUS and is passionate about her work with other accomplices in liberation. She is a licensed professional counselor in the state of Missouri and an approved supervisor in the state of Washington. Dr. Gonzalez currently serves as the president of the American Counseling Association (ACA) of Washington (2020–22), chair of ACA’s International Committee (2022), president elect-elect for the Western Association for Counselor Education and Supervision (WACES), and ACA parliamentarian for 2021–22. She served as coeditor of Experiential Activities for Teaching Social Justice and Advocacy Competence in Counseling and is a board member for the WACES Journal of Technology in Counselor Education and Supervision. Her research passions are global mental health, clinical supervision, Latinx/e human rights, counselor and counselor educator professional identity development, correctional counseling, liberation psychology, social justice and advocacy counseling, and anti–human trafficking advocacy. She has been involved with global mental health and advocacy for about 15 years and served as a United Nations delegate to advocate for global mental health, especially during the COVID pandemic. Dr. Gonzalez has spent over 20 years working through the paradigm of mental liberation, which includes global community and mentorship. She is currently a WACES mentor and enjoys spending time with her loved ones and community.

In this interview, Dr. Gonzalez discusses her work as a mentor, barriers facing the Latinx/e community, and advice for future counseling professionals.


  1. You have recently been recognized for your work in mentorship. What is the role of a successful mentor in counselor education?

The role of mentorship in counselor education is essential for creating community and supporting the future generation of mental health professionals. The Council for Accreditation of Counseling and Related Educational Programs (CACREP) mentions mentorship in the standard section 6.B.3.i, “the role of mentoring in counselor education.” Based on its importance, I believe mentorship should be promoted more often in the counseling profession and in programs.

A successful mentor in counselor education is someone who can provide a deeper perspective to a mentee on how to navigate counselor education and counseling environments through a lens of liberation. Mentorship can be conceptualized as a form of community building that allows for the mentor and mentee to learn from one another. The mentor can be a steward of the profession and provide support for the mentee to move forward with their professional and personal goals, values, and community building.

Research suggests that women and Black, Indigenous, and People of Color (BIPOC) folx are more likely than other groups to share that mentoring was an important component of their career. It is important that counseling professionals build their village of trusted colleagues to accompany them on their journey and foster the path of liberation as a counselor and/or counselor educator. Mentors can be part of this village and provide an environment that is supportive of mentees’ growth as individuals and as members of the counseling profession. By learning from one another, we can continue to be bound in our liberation and help the counseling profession evolve toward reducing oppression, creating space for all our gifts and stories, and lifting each other up.

  1. What are the benefits and challenges associated with mentorship that you have experienced? How did you navigate these challenges?

The primary benefit I have experienced with mentorship is community. As someone who leans into community for strength and support, I find mentorship to be an expansion of this concept. It can be healing to have someone there to listen to or consult with us about a variety of professional issues. I have noticed over the years more students and new professionals intentionally looking for mentors because they want someone with whom they can discuss professional goals and someone who will provide a brave place for conversations about how to navigate cultural spaces and tap into their own cultural capital. More BIPOC folx and women seek out mentors to help them learn how to fully utilize their own cultural knowledge, values, and gifts in the counseling profession. Another benefit of mentorship is being present for one’s story. As a mentor, it is an honor to walk beside someone on their journey. I feel I learn so much from my mentees and get excited about ways we can continue to encourage this profession to evolve and create community for future professionals.

Mentorship, like any relationship, takes time and nurturing. I have found that it is helpful to discuss with your mentee their goals, personal expectations of the relationship, personal learning styles, cultural values, time commitment, and their support system/village. At times, mentees have had a need for personal support that was more suited for their counselor or therapist. Understanding the boundaries of the role of the mentor–mentee relationship is part of understanding our roles and being ethical professionals.

  1. What do you consider to be your major contribution to the development of the counseling profession and why?

My voice is part of the collective consciousness of my loved ones and my community, including my ancestors. I think we all have power in our voices, and we each bring a unique perspective to this profession. My journey through mental health counseling, social justice, and higher education took roots early in my personal life as I overcame a series of challenging life events. Transitioning from Puerto Rico to the United States as a young child, overcoming poverty, and enduring the tragic loss of a loved one were mile markers along the path that has led me toward a career focused on social justice, mental health counseling, and counselor education. From my humble origins to chairing a clinical mental health counseling program at AUS, my professional and personal journey has prepared me to be deeply engaged in a profession that has provided purpose and an opportunity to create change in my world. As a lifelong social justice advocate, I have been passionate to live a life rooted in liberation and have used different paths to implement this. Over my career, I have had the honor to teach thousands of counselors-in-training and counselor educators-in-training, work with clients from all walks of life, publish research to foster social justice and advocacy, supervise and mentor, and be involved with leadership on many levels.

In my current state and national leadership roles, I work to promote a community in which we all strive to honor one another while creating a collective bond. Within this bond, we meet at the center of compassion while implementing our individual and communal gifts, strengths, commonalities, and differences. With this collective unity, we discover what connects us as professionals so we can expand our existing journeys, thus impacting how we interact with our counseling profession. The counseling profession reflects who we are and vice versa. This includes our voices, our stories, and our truths; therefore, if we evolve, we can continue to grow as a counseling profession. I have the honor to be the co-founder and co-director of a Latinx social justice mental health institute, ACA of Washington board chair, ACA parliamentarian 2021–22, president-elect-elect of WACES, chair of a counseling program, and chair of ACA’s International Committee 2021–22. In all these roles, the goal has been to create a community in which we can provide support, resources, and opportunity for voices to be heard and for change to occur. I believe my main contributions are part of a larger story, much greater than myself. This includes honoring those who have paved the way for me and many others to be part of this profession, and as a way to keep their legacy alive, I work to co-create communities rooted in social justice within our profession and in supporting the next generation of counselors as they focus on helping the professional landscape evolve to a place of more liberated thought.

  1. As the co-founder and director of the Latinx Mental Health & Social Justice Institute, what current barriers do you see this population facing and what does advocacy look like in your current role?

More than 19% of the U.S. population self-identify as Hispanic or Latine/x, making people of Latin origin the nation’s largest racial/ethnic minority (Lopez et al, 2021). Approximately 1 in 10 Latine/x individuals with a mental health issue uses mental health services from a general health care provider. Current barriers impacting the Latine/x population with regard to mental health are lack of accessible health services, lack of Spanish-speaking professionals, lack of culturally responsive treatment that aligns with Latine/x values, stigma in the community around mental health, and the need for better health care policies for all Latine/x individuals, including those who are undocumented (American Psychiatric Association & Lisotto, 2017). To tackle these barriers, we need to address systemic inequities on the macro, meso, and micro levels.

Currently, my advocacy is focused on growing our Latinx Mental Health & Social Justice Institute at AUS (https://latinxinstitute.antioch.edu). The Institute provides leadership for community-engaged research and service through capacity building and authentic partnerships with community stakeholders to promote impactful improvements in the health and well-being of Latine/x communities regionally, nationally, and internationally. We hope to help address barriers by creating a community of Latine/x professionals who will be accomplices in our liberation, working together to dismantle the oppressive systems that have impacted our communities, create opportunities for change rooted in liberation, and use our cultural stories, strengths, and values to guide our practices. We offer a master’s-level certificate in Latinx mental health and social justice, workshops to learn culturally responsive practices, partnerships with different nonprofit organizations, continuing education opportunities, an annual symposium during Hispanic Heritage Month, counseling services at our university’s clinic, community building, research, mentorship, training, global engagement, and cultural justice and advocacy. All efforts and roles I participate in are based on principles of social justice, human rights, and inclusion respective to intersections of one’s cultural Latinx narrative.

  1. What three challenges to the counseling profession as it exists today concern you most?

In the last 20 years, the average college tuition has increased by 30%. With the rising costs of higher education, more students are taking out student loans, and this debt is a burden that weighs more heavily on today’s college graduates than any generation that came before them. Due to the financial barriers, this impacts the demographic landscape of who enters the profession, quality of life, job satisfaction, and other factors. As a profession, we need to continue working on advancing and ensuring that licensed professional counselors can have seamless portability of their licenses when moving to other states, practicing across state lines, and engaging in telecounseling. This issue was illuminated during the COVID pandemic. We need to also work toward eliminating barriers that build a wall between our profession and the needs of our communities. Specifically, we need to work on decolonizing our profession. This includes recognizing that for many BIPOC individuals, the trauma from colonization and oppression impacts the mental health of individuals, families, and communities and the process of freeing ourselves from mental and systemic oppression. And last, we need to ensure adequate and equitable reimbursement for professional counselors in all settings. This means that all professional counselors need to be included as providers under all public and private insurance plans, especially Medicare.

  1. What needs to change in the counseling profession for these concerns to be successfully resolved?

We need to find a way to provide financial options for students pursing degrees in counseling and counselor education. This means intentionally creating a diverse pipeline of counselors and counselor educators through offering more scholarships, setting up state funding programs for counseling programs—more grants and university initiatives—and offering more easily accessible public service student loan forgiveness. In addition to eliminating financial barriers, we need to engage in practices to decolonize our profession. This includes decolonizing counseling theories, clinical practices, training programs, policies, research practices, leadership models, financial structures, and other systemic factors that create oppressive barriers. By dismantling systems of oppression, we can move toward a place of mental liberation and support liberatory practices in collaboration with the clients and communities in which we live and serve. When I think of liberation, I lean into the words of activist, Indigenous Australian (or Murri) artist, and academic, Lilla Watson, which she presented in a speech to the UN and attributed to her work with an Aboriginal Rights group in Queensland: “If you have come here to help me, you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together” (1985). As a profession, let’s continue to work toward a place in which we are bound in our liberation, freeing ourselves from oppression, and continue to heal collectively.

For the opportunity to heal, accessibility and inclusion are important for our profession to create community and connections. Currently, ACA has a strategic plan to address the challenges of licensure portability. They are working on a Counseling Compact, which “is an interstate compact, or a contract among states, allowing professional counselors licensed and residing in a compact member state to practice in other compact member states without a need for multiple licenses” (National Center for Interstate Compacts, 2022). The Counseling Compact is to help counselors have easier access to practice across state lines, which includes telehealth options, which will also allow clients more access to a diverse range of professional mental health counselors.

ACA and NBCC have been working for years on lobbying efforts to pass legislation that would allow for licensed professional mental health counselors to be reimbursed by Medicare. ACA’s and NBCC’s Government Affairs teams are working hard to get this legislation passed, but we should also get involved. We urge counselors to contact their state senators and ask for their support on this initiative. Medicare is the nation’s largest health insurance program. Opening its access to licensed professional counselors would increase access to services for BIPOC folx, people of lower socioeconomic status, and the older population. Medicare covers more than 43 million people age 65 or older and more than 10 million Americans with disabilities. Many of these folx are in communities with limited access to mental health services and/or the services lack diversity in professionals. As professional counselors in and around these communities, we should strive to create and then join the solution to accessible health care.

  1. If you were advising current counseling leaders, what advice would you give them about moving the counseling profession forward?

Listen. I would advise leaders to listen to the members and stakeholders. There are many ways in which we can work toward evolving our profession, but we need to listen to one another in order to do this together. I would encourage current leaders to support and mentor leaders from communities that have been silenced or not invited to the table. As leaders, we need to think of the next generation and be thoughtful about supporting all communities, especially BIPOC leaders. As BIPOC leaders, we have many gifts to offer and need to bring our villages with us. As stated earlier, we are all bound together in liberation, so let’s collectively lead into a more inclusive future of our profession.


This concludes the seventh interview for the annual Lifetime Achievement in Counseling Series. TPC is grateful to Joshua D. Smith, PhD, NCC, LCMHC, and Neal D. Gray, PhD, LCMHC-S, for providing this interview. Joshua D. Smith is an assistant professor at the University of Mount Olive. Neal D. Gray is a professor and Chair of the School of Counseling and Human Services at Lenoir-Rhyne University. Correspondence can be emailed to Joshua Smith at jsmith@umo.edu.



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