Sep 13, 2024 | Volume 14 - Issue 2
Sapna B. Chopra, Rebekah Smart, Yuying Tsong, Olga L. MejĂa, Eric W. Price
This mixed methods program evaluation study was designed to assist faculty in better understanding studentsâ multicultural and social justice training experiences, with the goal of improving program curriculum and instruction. It also offers a model for counselor educators to assess student experiences and to make changes that center social justice. A total of 139 first-semester students and advanced practicum students responded to an online survey. The Consensual Qualitative Research-Modified (CQR-M) method was used to analyze brief written narratives. The Multicultural Counseling Competence and Training Survey (MCCTS) and the Advocacy Competencies Self-Assessment Survey (ACSA) were used to triangulate the qualitative data. Qualitative findings revealed student growth in awareness, knowledge, skills, and action, particularly for advanced students, with many students reporting a desire for more social justice instruction. Some students of color reported microaggressions and concerns that training centers White students. Quantitative analyses generally supported the qualitative findings and showed advanced students reporting higher multicultural and advocacy competencies compared to beginning students. Implications for counselor education are discussed.
Keywords: social justice, program evaluation, training, multicultural counseling, counselor education
In the midst of the COVID-19 pandemic and the long-standing inequities it brought to light, many universities began examining the ways that injustice unfolds within their institutions (Mull, 2020). Arredondo et al. (2020) noted that counseling and counselor education continue to uphold white supremacy and center the experiences of White people within theories, training, and research. White supremacy culture promotes Whiteness as the norm and standard, intersects with and reinforces other forms of oppression, and shows up in institutions in both overt and covert ways, such as emphasis on individualism, avoidance of conflict, and prioritizing White comfort (Okun, 2021). Arredondo et al. (2020) called for counselor educators to engage in social justice advocacy and to unpack covert White supremacy in training programs. The present study investigated the multicultural and social justice training experiences of students in a Western United States counseling program so that counseling faculty can be empowered to uncover biases and better integrate social justice in the curriculum.
Counselor education programs are products of the larger sociopolitical environment and dominant patriarchal, cis-heteronormative, Eurocentric culture that often fails to âchallenge the hegemonic views that marginalize groups of peopleâ which âperpetuate deficit-based ideologiesâ (Goodman et al., 2015, p. 148). For example, the focus on the individual in traditional counseling theories can reinforce oppression by failing to address the role of systemic oppression in a clientâs distress (Singh et al., 2020). Counseling theory textbooks usually provide an ancillary section at the end of each chapter focusing on multicultural issues (Cross & Reinhardt, 2017). White supremacy culture is so ubiquitous that it is typically invisible to those immersed within it (DiAngelo, 2018). It is not surprising then that counseling is often viewed as a White, middle-class endeavor, and BIPOC (Black, Indigenous, and People of Color) clients frequently perceive that they should leave their cultural identities and experiences outside the counseling session (Turner, 2018). Counselor educators have been encouraged to reflect on how Eurocentric curricula and pedagogy may marginalize students and seek liberatory teaching practices that promote critical consciousness (Sharma & Hipolito-Delgado, 2021).
Studentsâ Perceptions of Their Growth, Learning Process, and Critiques of Their Training
    Studies of mostly White graduate students show gains in expanding awareness of their own biases and privilege, knowledge about other cultures and experiences of oppression, as well as the importance of empowering and advocating for clients (Beer et al., 2012; Collins et al., 2015; Sanabria & DeLorenzi, 2019; Singh et al., 2010). Others indicated the benefits of integrating feminist principles in treatment (Hoover & Morrow, 2016; Singh et al., 2010). Consciousness-raising and self-reflection were key parts of multicultural and social justice learning (Collins et al., 2015; Hoover & Morrow, 2016), and could be emotionally challenging. Indeed, Goodman et al. (2018) identified a theme of internal grappling reflecting studentsâ experiences of intellectual and emotional struggle; others noted studentsâ experiences of overwhelm and isolation (Singh et al., 2010), as well as resistance, such as withdrawing or dismissing information that challenged their existing belief system (Seward, 2019). Researchers have also documented student complaints about their social justice training; for example, that social justice is not well integrated or that there was inadequate coverage of skills and action (Collins et al., 2015). Kozan and Blustein (2018) found that even among programs that espouse social justice, there was a lack of training in macro level advocacy skills. Barriers to engaging in advocacy included: lack of time (Field et al., 2019; Singh et al., 2010), emotional exhaustion stemming from observations of the harms caused by systemic inequities (Sanabria & DeLorenzi, 2019), and ill-informed supervisors (Sanabria & DeLorenzi, 2019).
The studies reviewed thus relied on samples of mainly White, cisgender, heterosexual women. Some noted that education on social justice is often centered on helping White students expand their awareness (Haskins & Singh, 2015). In one study focused on challenges faced by students of color, participants expressed frustration with the lack of diversity among their professors, classmates, and curriculum (Seward, 2019). Participants also experienced marginalization and disconnection when professors and students made offensive or culturally uninformed comments and when course content focused on teaching students with privileged identities. Students from marginalized communities also face isolation in academic settings and sometimes question the multicultural competence of their professors (Haskins & Singh, 2015), which in turn contributes to the underrepresentation of students of color in counseling and psychology (Arney et al., 2019).
The Present Study
Counselor educators must critically examine their curriculum, course materials, and overall learning climate for students (Haskins & Singh, 2015). Listening to studentsâ experiences and perceptions of their training offers faculty an opportunity to model cultural humility, gain useful feedback, and make necessary changes. Given the increased recognition of racial trauma and societal inequities, it is critical that counseling programs engage with students of diverse backgrounds as they seek to shift their pedagogy. Historically, academic institutions have responded to student demands with performative action rather than meaningful change (Zetzer, 2021). This mixed methods study is part of a larger process of counseling faculty working to invite student feedback and question internalized assumptions and biases in order to implement real change. The goal of program evaluation is to investigate strengths and weaknesses in order to improve the program (Royse et al., 2010). According to the 2024 Council for Accreditation of Counseling and Related Educational Programs (CACREP) standards, program evaluation is essential to assess and improve the program (CACREP, 2023). Thus, the purpose of this program evaluation study was to understand studentsâ self-assessment and experiences with the counseling programâs curriculum in the area of multicultural and social justice advocacy, with the overarching goal of program curriculum and instruction improvement. This article offers counselor educators a model of how to assess program effectiveness in multicultural and social justice teaching and practical suggestions based on the findings. The research questions were: What are beginning and advanced studentsâ self-perceptions regarding their multicultural and social justice advocacy competencies? What are beginning and advanced studentsâ perceptions of the multicultural and social justice advocacy competencies training they are receiving in their program?
Method
We employed a mixed method, embedded design in which the quantitative data offered a supportive and secondary role to the qualitative results (Creswell et al., 2003). Qualitative and mixed methods research designs are particularly useful in program evaluation (Royse et al., 2010). Mixed method approaches also offer value in research that centers social justice advocacy, as the integration of diverse methodological techniques within a single study fosters the understanding of multiple perspectives and facilitates a deeper comprehension of intricate issues (Ponterotto et al., 2013). We used an online survey to collect written narratives (qualitative) and survey data (quantitative) from two counseling courses: a beginning counseling course in the first semester (beginning students), and an advanced practicum course, taken by those who had completed at least part of their year-long practicum (advanced students).
Participants
    Participants were counseling students enrolled in a CACREP-accredited program at a large West Coast public university in the United States that is both a federally designated Hispanic-serving institution and an Asian American and Native American Pacific Islanderâserving institution. Responses were collected from two courses, which included 94 beginning students (84% response rate) and 62 advanced students (71% response rate). Twelve percent of the advanced practicum students also completed the survey when they were first-semester (beginning) students. The mean age of the 139 participants was 27.7 (SD = 7.11), ranging from 20 to 58 years. Racial identifications were 40.3% White, 33.1% Latinx, 14.4% Asian, 7.2% Biracial or Multiracial, 2.9% Black, 0.7% Middle Eastern, 0.7% American Indian/Alaska Native, and 0.7% Native Hawaiian/Pacific Islander. The majority identified as women (82.0%), followed by 14.4% as men, and 2.9% as nonbinary/queer. Students self-identified as heterosexual (71.2%), bisexual (11.5%), lesbian/gay (6.5%), queer (4.3%), pansexual (1.4%), and about 1% each as asexual, heteroflexible, and unsure. About 19.4% of students were enrolled in a bilingual/bicultural (Spanish/Latinx) emphasis within the program.
Procedure
    After receiving university IRB approval, graduate students enrolled in the first-semester beginning counseling course (fall 2018 and 2019) or the advanced practicum course (summer 2019 and 2020) were asked to complete an online survey through Qualtrics with both quantitative measures and open-ended questions as part of their preparation for class discussion. Students were informed that this homework would not be graded and was not intended to âtestâ their knowledge but rather would serve as an opportunity to reflect on their experience of the programâs multicultural and social justice training. Students were also given the option to participate in the current study by giving permission for their answers to be used. Those who consented were asked to continue to complete the demographic questionnaire. In accordance with the American Counseling Association Code of Ethics (2014), students were informed that there would be no repercussions for not participating. A faculty member outside the counseling program managed the collection of and access to the raw data in order to protect the identities of the students and ensure that their participation or lack of participation in the study could not affect their grade for the course or standing in the program. All students, regardless of participation status, were given the option to enter an opportunity drawing for a small cash prize ($20 for data collection in 2018 and 2019, $25 for 2020) through a separate link not connected to their survey responses.
Data Collection
    We collected brief written qualitative data and responses to two quantitative measures from both beginning and advanced students.
Qualitative Data
    The faculty developed open-ended questions that would elicit student feedback on their multicultural and social justice training. Prior to beginning the counseling program, first-semester students were asked two questions about their experiences and impressions: How would you describe your knowledge about and interest in multiculturalism/diversity and social justice from a personal and/or academic perspective? and How would you describe your initial impressions or experience of the focus on multicultural and social justice in the program so far? They were also asked, if it was relevant, to include their experience in the Latinx counseling emphasis program component. Advanced students, who were seeing clients, were asked the same questions and also asked to: Consider/describe how this experience of multiculturalism and social justice in the program may impact you personally and professionally (particularly in work with clients) in the future.
Quantitative Data
    Two instruments were selected to quantitatively assess studentsâ perceptions of their own multicultural and advocacy competencies. The Multicultural Counseling Competence and Training Survey (MCCTS; Holcomb-McCoy & Myers, 1999) is designed to assess counselorsâ perceptions of their multicultural competence and the effectiveness of their training. The survey contains 32 statements for which participants answer on a 4-point Likert scale (not competent, somewhat competent, competent, extremely competent). Sample items include: âI can discuss family therapy from a cultural/ethnic perspectiveâ and âI am able to discuss how my culture has influenced the way I think.â The reliability coefficients for each of the five components of the MCCTS ranged from .66 to .92: Multicultural Knowledge (.92), Multicultural Awareness (.92), Definitions of Terms (.79), Knowledge of Racial Identity Development Theories (.66), and Multicultural Skills (.91; Holcomb-McCoy & Myers, 1999). In this study, the Cronbachâs alpha coefficients ranged from .75 to .96.
The Advocacy Competencies Self-Assessment Survey (ACSA; Ratts & Ford, 2010) assesses for competency and effectiveness across six domains: (a) client/student empowerment, (b) community collaboration, (c) public information, (d) client/student advocacy, (e) systems advocacy, and (f) social/political advocacy. It contains 30 statements that ask participants to respond with âalmost always,â âsometimes,â or âalmost never.â Sample questions include âI help clients identify external barriers that affect their developmentâ and âI lobby legislators and policy makers to create social change.â Although Ratts and Ford (2010) did not provide psychometrics of the original ACSA, it was validated with mental health counselors (Bvunzawabaya, 2012), suggesting an adequate internal consistency for the overall measure, but not the specific domains. In this study, the Cronbachâs alpha coefficients ranged from .69 to.79 for the six domains, and .94 for the overall scale. For the purposes of this study, we were not interested in specific domains and used the overall scale to assess studentsâ overall social justice/advocacy competencies.
Data Analysis
Qualitative Data Analysis
    To analyze the qualitative data, we used Consensual Qualitative Research-Modified (CQR-M; Spangler et al., 2012), which was based on Hill et al.âs (2005) CQR but modified for larger numbers of participants with briefer responses. In contrast to the in-depth analysis of a small number of interviews, CQR-M was ideal for our data, which consisted of brief written responses from 139 participants. CQR-M involves a consensus process rather than interrater reliability among judges, who discuss and code the narratives, and relies on a bottom-up approach, in which categories
(i.e., themes) are derived directly from the data rather than using a pre-existing thematic structure. Frequencies (i.e., how many participants were represented in each category) are then calculated. We analyzed the beginning and advanced studentsâ responses separately, as the questions were adjusted for their time spent in the program.
After immersing themselves in the data, the first two authors, Sapna B. Chopra and Rebekah Smart, met to outline a preliminary coding structure, then met repeatedly to revise the coding into more abstract categories and subcategories. The computer program NVivo was used to organize the coding process and determine frequencies. After all data were coded, the fifth author, Eric W. Price, served as auditor and provided feedback on the overall coding structure. Both the consensus process and use of an auditor are helpful in countering biases and preconceptions. Brief quantitative data, as used in this study, can be used effectively as a means of triangulation (Spangler et al., 2012).
Quantitative Data Analysis
    To examine for significant differences in the self-perceptions of multicultural competencies and advocacy competencies between White and BIPOC students as well as between beginning and advanced students, a two-way (2×2) ANOVA was conducted with the overall MCCT as the criterion variable and student levels (beginning, advanced) and race (White, BIPOC) as the two independent variables. In addition, two (5×2) multivariate analyses of variances (MANOVAs) were conducted with the five factors of multicultural competencies (knowledge, awareness, definition of terms, racial identity, and skills) as criterion variables and with student levels (beginning, advanced) and student races (White, BIPOC) as independent variables in each analysis. Data for beginning and advanced students were analyzed separately to assess whether time in the counseling program helped to expand their interest and commitment to social justice.
Research Team
     We were intentional in examining our own social identities and potential biases throughout the research process. Chopra is a second-generation South Asian American, heterosexual, cisgender woman. Smart is a White European American, heterosexual, cisgender woman. Yuying Tsong identifies as a genderqueer first-generation Taiwanese and Chinese American immigrant. Olga L. MejĂa is an Indigenous-identified Mexican immigrant, bisexual, cisgender woman. Price is a White, gay, cisgender male. All have experience as counselor educators and in qualitative research methods, and all have been actively engaged in decolonizing their syllabi and incorporating multicultural and social justice into their pedagogy.
Results
The research process was guided by the overarching question: What are beginning and advanced counseling studentsâ perceptions of their multicultural and social justice competencies and training and how can their feedback be used to improve their counselor education program? We explore the qualitative findings first, as the primary data for the study, followed by the quantitative data.
Qualitative Findings for Beginning Counseling Students
    Two higher-order categories emerged from the beginning studentsâ narratives: developing competencies and learning process so far.
Developing Competencies
    Studentsâ descriptions of the competencies they were developing included themes of awareness, knowledge, and skills and action. Some students entered the program with an already heightened awareness, while others were making new discoveries. Awareness included subthemes of humility (24.5%), awareness of own privilege (6.4%), and awareness of bias (3.2%). âThereâs a lot to learnâ was a typical sentiment, particularly from White students. One White female student wrote: âI definitely need more and I believe that open discussions, even hard ones would be some of the best ways to go about this.â A large group expressed knowledge of oppression and systemic inequities (33%); a smaller group referenced intersectionality (3.2%). Within skills and action, some students expressed specific intentions in allyship (11.7%); a number of students expressed commitment to social action but felt unsure how to engage in social justice (11.7%).
Learning Process So Far
    Central themes in this category were support for growth, concerns in training, and internal challenges. Some students felt excited and supported, while some were cautiously optimistic or concerned. Support for growth was a strong theme that reflected excited and enthusiastic to learn (22.3%); appreciation for the Latinx emphasis (18.1%); and receiving support from professors and program (17.0%). For example, one Mexican student in the Latinx emphasis who noted that mental health was rarely discussed in her family shared: âFor me to see that there is a program that teaches students how to communicate to individuals who are unsure of what counseling is about, gave me a sense of happiness and relief.â
A few students were adopting a wait-and-see attitude and expressed some concerns about their training. Although the percentage for these subthemes is low, they provide an important experience that we want to amplify. This theme had multiple subthemes. The subtheme concerns from students of color included centering White students (3.2%), microaggressions (3.2%), and lack of representation (1.1%). A student who identified as a Mexican immigrant shared experiences of microaggressions, including classmates using a hurtful derogatory phrase referring to immigrants with no comment from the professor until the student raised the issue. Concerns in training also included the subtheme concerns with how material is presented in classes (7.0%). For some, the concern related to the potential for harm in classes in which White and BIPOC students were encouraged to process issues of privilege and oppression. For example, one Asian Pacific Islander student wrote that although they appreciated the emphasis on social justice, âTime always runs out and I believe itâs careless and dangerous to cut off these types of conversations in a rushed manner.â A small minority seemed to suggest a backlash to the emphasis on social justice, stating that the content was presented in ways that were too âpolitically correct,â âbiased,â or ârepetitive.â
     Multiple subthemes emerged from the theme of internal challenges. Both BIPOC and White students shared feeling afraid to speak up (5.3%). BIPOC students expressed struggling with confidence or wanting to avoid conflict, while White studentsâ fear of speaking up was also connected to discomfort and uncertainty as a White person (2.1%). A small minority of White students did not express explicit discomfort but seemed to engage in a color-blind strategy, as indicated in the theme of people are people (2.1%): âI find people are people, regardless of any differences, and love hearing the good and bad about everybodyâs experiences.â Some students of color expressed limited knowledge about cultures other than oneâs own (4.3%). For example, an Asian American student stated that they had gravitated to âthose who were most similar to meâ growing up. Lastly, a few students shared feeling overwhelmed and exhausted (3.2%).
Qualitative Findings for Advanced Counseling Students
    Four higher-order themes emerged: competencies in process, multiculturalism and diversity in the program, social justice in the program, and the learning process.
Competencies in Process
    Similar to beginning students, advanced students described growing self-awareness, knowledge and awareness of others, skills, and action. Their disclosures often related to clinical work, now that they had been seeing clients. Self-awareness included strong subthemes of: humility and desire to keep learning (25.8%); increased open-mindedness, acceptance of others, and compassion (22.6%); awareness of personal privilege and oppression (17.7%); awareness of personal bias and value systems (17.7%); and awareness of personal cultural identity (14.5%). One Mexican American student wrote: âI have also gained an increased awareness of how my prejudices can impact my work with clients and learned about how to check-in with myself.â
    Knowledge and awareness of others had subthemes of privilege and oppression (19.4%) and increased knowledge of culture (14.5%), with awareness of the potential impact on clients. The advanced students also had more to say about skills, which included subthemes of diversity considerations in conceptualization (29%), and in treatment (12.9%), and cultural conversations in the therapy room (21%). One White student wrote: âI have been able to have difficult conversations that once were unheard of. I have also been able to bring culture, ethnicity, and oppression into the room so that my clients can feel understood and safe.â Within the theme of action, 52% wrote about their commitment to social justice and intention to advocate. Although this strongest subtheme suggested action was still more aspirational than currently enacted, a smaller group also wrote about the experiences that they have already had with client advocacy (12.9%), community and/or political action (12.9%), and unspecified action (11.3%).
Multiculturalism and Diversity in the Program
    Many students (44%) indicated that they appreciated that multicultural issues were integrated or addressed well within the program. However, with more time spent in the program, 26% felt that there was more nuance, depth, or scope needed. Some wanted more attention to specific issues, such as disability, gender identity, and religion/spirituality. One Asian American student wrote that the focus had been âbasic and surface-level,â adding âI feel like it has also generally catered to the protection of White feelings and voices, which is inherently complicit in the system of White supremacy, especially in higher ed.â Others (9.7%) said more training in clinical application was needed.
Social Justice in the Program
    Students expressed a variety of opinions. The largest number (29%) were satisfied that social justice issues were well integrated into the program. Although more students were satisfied than not, many (24%) noted that social justice is addressed but not demonstrated. Similarly, 24% noted minimal attention, specifically that social justice was not addressed much beyond the one course focused on culture, and 24% noted a desire for more opportunities within the program to engage in advocacy. Some suggested requiring social justice work rather than leaving it as an optional activity. Others (13%), mostly from 2020, noted the relevance of current events and sociopolitical climate. One White student shared about a presentation on Black Lives Matter: âThis project opened my eyes to my limited knowledge of systemic oppression in the U.S. and impacted me in ways that I will NEVER be the same.â A small number of students (3%) reported that there was no need or room for more training in social justice. One White student wrote that they felt âfrustratedâ and that the social justice âagenda is so in my face all the time,â adding âsometimes I feel like I am being trained to be an advocate and an activist, which is/are a different job.â
The Learning Process
    Three central themes emerged: enrichment experienced, challenges, and suggestions for change. Many students were appreciative of their experience. A strong subtheme within enrichment experienced was professorsâ encouragement and modeling (24%). Others commented on how much came from learning from peers (21%). Some shared feeling personally empowered (14.5%). For example, a student who identified as coming from an Asian culture wrote about the hesitancy to be an activist, stating, âThere is an underlying belief that our voices will not really ever be heard which is strongly tied to systemic oppression and racism throughout history. Consequently, I appreciate this challenge to grow more in social justice issues.â Others shared ways that the program prompted them to engage in social justice outside the classroom (11.3%). For example, one student wrote: âThis program gave me the knowledge and education I needed to make sure that when I did speak out I wasnât just talking to talk. I would actually have facts, stats, evidence-based research to back up my argument.â A number of students noted the unique benefits of the Latinx program (9.7%). One Mexican American student reflected that they had learned about diversity within Latinx cultures, and that, âAs a result, I feel more confident in being able to serve clients from various Latinx cultures or at least know where to obtain relevant information when needed.â Many students expressed a sense of belonging (8.1%).
    Challenges. Nearly 10% wrote about struggling to make time [for social justice] and 6.5% noted the emotional impact. For example, one White student wrote: âIt was a rude and brutal awakening, to say the least. It was riddled with emotion and heartache but was worth the process.â A few had conflicted or mixed feelings (8.1%)âthey felt appreciative but wanted more. A few noted possible harm to marginalized students (6.5%). One Asian American student wrote that faculty should be âcalling out microaggressions . . . otherwise, their stance on social justice feels more performative and about protecting their own liability rather than caring for their students of color.â A smaller number (4.8%) struggled with peers and colleagues who seemed uninformed.
    Suggestions for Change. Students offered suggestions for improvement, with a strong theme to develop more diverse representation (16.1%), including more representation in faculty, students, case examples, and class discussions. Some comments were specifically about needed attention to Black experiences; one concerned teaching about resiliencies and strengths in the face of oppression. Almost 15% suggested making changes to courses or curriculum. One White student wrote: âIf it were me running the program (lol) I would . . . remove the culture class and have all those topics embedded into the fabric of each class because culture and diversity are in all those topics.â A few suggested that faculty require social justice assignments (8.1%), adding that many students will not act unless required. A few also suggested that the program provide more education of White students (8.1%).
Quantitative Findings
Quantitative analyses were conducted to provide triangulation for the qualitative findings and a different view of the data, including possible differences between BIPOC and White students and beginning and advanced students. Table 1 includes descriptive statistics providing an overview of beginning and advanced studentsâ self-perception of their multicultural and social justice competencies.
Table 1
Descriptive Statistics of Competencies
|
|
|
Multicultural |
Social Justice/Advocacy |
|
|
N |
Mean |
SD |
Mean |
SD |
| White |
Beginning |
35 |
2.58 |
.50 |
62.97 |
24.23 |
| Advanced |
27 |
3.09 |
.38 |
76.07 |
19.11 |
| Total |
62 |
2.80 |
.52 |
68.68 |
22.93 |
| BIPOC |
Beginning |
59 |
2.66 |
.56 |
63.05 |
29.30 |
| Advanced |
35 |
3.01 |
.30 |
77.14 |
20.71 |
| Total |
94 |
2.79 |
.51 |
68.30 |
27.19 |
| Total |
Beginning |
94 |
2.63 |
.54 |
63.02 |
27.39 |
| Advanced |
62 |
3.05 |
.34 |
76.68 |
19.87 |
| Total |
156 |
2.80 |
.51 |
68.45 |
25.51 |
To examine if there were discernable differences between the beginning and advanced studentsâ perceptions of their competencies, and if there were differences between White and BIPOC students, a two-way (2×2) ANOVA was conducted with the overall MCCT as the criterion variable and student levels (beginning, advanced) and race (White, BIPOC) as the two independent variables. Results indicated that although there were no interaction effects between race and student levels, there were significant differences in overall multicultural competencies between beginning and advanced students, F(1, 152) = 30.54, p < .001, indicating that advanced practicum students reported significantly higher overall multicultural competencies than beginning students. There were no statistically significant differences between White and BIPOC students in their overall multicultural competencies. Two (5×2) MANOVAs were conducted with the five factors of multicultural competencies as criterion variables (knowledge, awareness, definition of terms, racial identity, and skills). Student levels (beginning, advanced) and student race (White, BIPOC) were independent variables. Results indicated that there were significant differences between beginning and advanced students in at least one of the multicultural competencies components, Wilksâ Lambda = .72, F(5, 150) = 11.97, p < .001. More specifically, follow-up univariate ANOVAs indicated that advanced students reported significantly higher multicultural competencies in their knowledge, F(1, 154) = 43.74, p < .001, Âľ2 = .22; awareness, F(1, 154) = 6.20, p = .014, Âľ2 = .04; and racial identity, F(1, 154) = 43.17, p < .001, Âľ2 = .21. However, there were no significant differences in definitions of terms or skills. Even though there were no significant differences between White and BIPOC students in their overall multicultural competencies, the results of the 5×2 MANOVA indicated that there were significant differences in at least one of the components, Wilksâ Lambda = .87, F(5, 150) = 4.49, p = .001. Follow-up univariate ANOVAs indicated that White students reported higher multicultural competencies in racial identity than BIPOC students in this study, F(1, 154) = 4.51, p = .035, Âľ2 = .03. There were no differences in the other areas.
A two-way (2×2) ANOVA was conducted with the overall ACSA as the criterion variable and student levels (beginning, advanced) and race (White, BIPOC) as the two independent variables. Results indicated that while there were no interaction effects between race and student levels, there were significant differences in overall advocacy competencies between beginning and advanced students, F(1, 152) = 10.78, p = .001, indicating that advanced students reported significantly higher overall advocacy competencies (M = 76.68) than beginning students (M = 63.02). There were no statistically significant differences between White and BIPOC students in their overall advocacy competencies.
Discussion
This study was designed to examine studentsâ experiences of their multicultural and social justice training as an aspect of program evaluation, specifically to assist faculty in improving curriculum and instruction with regard to multicultural and advocacy competencies; the study also offers a unique contribution to existing literature by including a more racially diverse (60% BIPOC) sample. Students reported growth in the core areas of multicultural and social justice competency as outlined by Ratts et al. (2016): awareness, knowledge, skills, and action. Consistent with Field et al.âs (2019) findings, students reported more growth in awareness and knowledge than in social justice action, with some differences as students moved through the program. Although beginning students identified personal biases, the theme of self-awareness was more complex for them later in the program. This suggests that a longer time spent in the program contributed to personal growth; although this seems expected, these outcomes have not necessarily been examined before and confirm that the programsâ increasing effort on multiculturalism and social justice are showing gains. The advanced students wrote about clinical application as well and made overt statements of their commitment to social justice. The quantitative results supported these qualitative findings, with advanced students reporting higher multicultural competencies in knowledge, awareness, and racial identity and higher overall advocacy competencies compared to beginning students. With one exception, there were no significant differences between White and BIPOC students in their self-assessment of multicultural or advocacy competencies. Across racial groups, students expressed humility and desire to learn more.
Although students expressed mixed opinions about their experience of the multicultural and social justice training, a greater number of advanced students reported that they thought multicultural (44%) and social justice issues (30%) were well integrated into the program compared to the number of students with critiques. Students reported that support from faculty and peers facilitated their growth and learning, consistent with previous research (e.g., Beer et al., 2012; Keum & Miller, 2020). Some students noted a sense of belonging, particularly those in the Latinx emphasis.
Similar to other researchers, we found that many students wanted social justice issues to be integrated across the curriculum rather than into one course (Beer et al., 2012; Collins et al., 2015); they also wanted more focus on skills and action (Collins et al., 2015; Kozan & Blustein, 2018). Studentsâ scores on the ACSA advocacy competencies scale reflect this gap in training as well. Though fewer students offered critiques of their training, these responses are important to amplify because some of these concerns are rarely solicited or acknowledged. For example, BIPOC students echoed the challenges faced by students in Sewardâs (2019) study, including lack of representation in their faculty, classmates, and curriculum as well as feelings of marginalization when microaggressions in the classroom went unchecked and when instruction centered the needs of White students. Additionally, a few advanced students from 2020, during a time of significant racial-sociopolitical uprising in the United States, expressed concern that class discussions potentially caused harm to students from marginalized communities. Though more students expressed a desire for greater in-depth training, a small minority of mostly White students indicated that they did not want more social justice training and would rather focus solely on traditional counseling skills. These different student perspectives point to the challenges of teaching social justice amidst diverse political and ideological backgrounds and the need to increase community and collaboration.
Listening to Student Feedback and Implications for Decolonizing Program Curriculum
    This studyâs findings support the benefits of listening to studentsâ voices related to multicultural and social justice to inform counselor educators on program strengths and areas for growth. Although student feedback was not the sole impetus for making program changes, accessing this more detailed response was helpful in refining our purpose and direction, as well as highlighting weaknesses. Perhaps more important was the facultyâs willingness to engage in this self-reflective process and to take necessary actions. Rather than waiting for exit interview feedback from graduating students, counselor educators can conduct ongoing program evaluations through anonymous online surveys as well as town hall meetings that invite students to share their process of learning, perceptions of the cultural climate, and experiences of microaggressions. We have a growing understanding that during such evaluations great care needs to be taken for building safety, so as not to retraumatize students from marginalized communities. Based on the results and a series of Zoom town hall meetings, we have implemented changes, such as more consistent integration of social justice across the curriculum; training and day-long retreats focused on increasing faculty competence; faculty participation in Academics for Black Survival and Wellness, an intensive training led by Dr. Della Mosely and Pearis Bellamy; accountability support groups in social justice work; and decolonizing syllabi and class content (e.g., including BIPOC voices and nonâAPA-style writing assignments). Faculty have also made significant modifications to course materials. For example, beginning students complete weekly modules that include readings and exercises from The Racial Healing Handbook (Singh, 2019), and students study Liberation Psychology during the first week of theories class so they can consider ways to decolonize more traditional models throughout the semester. These strategies have been helpful in preparing students for more difficult conversations surrounding anti-racism in more advanced courses throughout the program. Forming faculty accountability partners or small groups is helpful so that faculty can support each other as a part of their ongoing development in addressing internalized White supremacy and avoiding harm to students.
Student feedback also called attention to the need for self-care, which our program continues to explore. Consistent with previous research (Collins et al., 2015; L. A. Goodman et al., 2018; Hoover & Morrow, 2016; Singh et al., 2010), students reported that their multicultural and social justice learning was often accompanied by moments of overwhelm, hopelessness, and despair. Without tools to manage these emotions, some students may retreat into defensiveness and withdrawal (Seward, 2019), and some may experience activist burnout (Gorski, 2019). Sustainability is necessary for effective social change efforts (Toporek & Ahluwalia, 2021). Counseling programs can offer resources and guidance for students to practice self-care with counselor educators modeling self-care behavior. For example, the Psychology of Radical Healing Collective (Chen et al., 2019) offered strategies to practice radical self-care, including making space for oneâs own healing, finding joy and a sense of belonging, and engaging in advocacy at the local community level. Mindfulness practices can be integrated into social justice education to help students and counselor educators manage difficult emotions, increase their ability to be present, and strengthen compassion and curiosity (Berila, 2016). In addition to individual self-care practices, counselor educators can advocate for community care by tending to the communityâs needs and drawing on collective experience and wisdom (Gorski, 2019).
The findings point to the need for counselor educators to better address Whiteness and White supremacy, as well as to center the experiences of students from marginalized communities. Counselor educators may be able to mobilize and direct White studentsâ feelings of guilt into racial consciousness and action by helping them explore Whiteness, White privilege, and what it means to them while allowing and confronting feelings that arise (Grzanka et al., 2019). It may be helpful for educators to read and assign books on White fragility and ways to address it (DiAngelo, 2018; Helms, 2020; Saad, 2020), so that they can assist White students in managing these emotions. It is important that educators explicitly name and recognize White supremacy as it shows up in counseling theory and practice, and to include a shift from the primary focus on the individual to understanding and dismantling oppressive systems. Counselor educators must also attend to the ways in which they center the comfort of White students over the needs of BIPOC students, so that they do not perpetuate harm and trauma (GalĂĄn et al., 2021). Although students with privileged identities may learn powerful lessons about oppression from their classmates, it is important that such learning does not occur at the expense of students with marginalized identities. Offering spaces for White students, especially those who are new to conversations about race and racism, to process their feelings may be helpful to avoid harm to BIPOC students who have experienced racial trauma. Similarly, BIPOC students may benefit from spaces in which they can talk freely and support each other as they unpack their own experiences of microaggressions and trauma (GalĂĄn et al., 2021).
Based on the finding that support from faculty was important in facilitating student growth and learning, counselor educators may benefit from implementing strategies informed by relational pedagogy and relationalâcultural theory (Dorn-Medeiros et al., 2020). Relational pedagogy centers the relationship between teachers and students and posits that all learning takes place in relationships. Relationalâcultural theory emphasizes mutual empathy and empowerment and is rooted in feminist multicultural principles. Practices grounded in these approaches include professorsâ use of self-disclosure to model openness, vulnerability, and self-reflection; and their work to reduce power imbalances and invite student feedback at multiple points in time through anonymous surveys and one-on-one meetings. Counselor educators can uplift students as the experts of their experience (Sharma & Hipolito-Delgado, 2021).
Limitations and Future Research
    The results of this study must be considered in light of a number of limitations. The use of the online survey meant that we were not able to follow up with students for further discussion or clarification of their responses. Adding focus groups or interviews to this methodology would likely provide a more thorough picture. In spite of assurances to the contrary, some students may have been hesitant to be honest out of concern that their own professors would be reading their feedback. It is possible that different themes would have emerged if all students had participated. In addition, 12% of the advanced students had participated as beginning students and therefore were previously exposed to the survey materials. Although this could have impacted their later responses, we suspect that given the nearly 2-year time lapse this may not have been meaningful. Nevertheless, future research and program evaluation would be strengthened with longitudinal analyses. Lastly, the reliability for the ACSA was relatively low, so conclusions are tentative; however, the results support the qualitative data. Despite these limitations, this study offers a model for assessing studentsâ learning and experiences with the goal of program improvement. The process of counselor educators humbling themselves and inviting and integrating student feedback is an important step in decolonizing counselor education and better serving students and the clients and communities that they will serve.
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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Sapna B. Chopra, PhD, is an associate professor at California State University, Fullerton. Rebekah Smart, PhD, is a professor at California State University, Fullerton. Yuying Tsong, PhD, is a professor and Associate Vice President for Student Academic Support at California State University, Fullerton. Olga L. MejĂa, PhD, is a licensed psychologist and an associate professor at California State University, Fullerton. Eric W. Price, PhD, is an associate professor at California State University, Fullerton. Correspondence may be addressed to Sapna B. Chopra, Department of Human Services, California State University, Fullerton, P.O. Box 6868, Fullerton, CA 92834-6868, sapnachopra@fullerton.edu.
Sep 13, 2024 | Volume 14 - Issue 2
Taylor J. Irvine, Adriana C. Labarta
Eating disorders (EDs) are increasingly prevalent and pose significant public health challenges. Yet, deficits exist in counselor education programs regarding ED assessment, conceptualization, and treatment. Consequently, counselors report feeling incompetent and distressed when working with ED clients. We propose a conceptual framework, the 3 Cs of ED Education and Training, to enhance trainee development. The 3 Cs are: (a) cultivating trainee self-awareness through reflexivity and deliberate skill practice, (b) capturing contextual and sociocultural factors with culturally responsive approaches, and (c) collaborating with interdisciplinary ED professionals while strengthening counselor professional identity. Implications for counselor educators include incorporating activities aligned with this framework into curriculum and experiential training in order to facilitate trainee competence in ED assessment and treatment.
Keywords: eating disorders, 3 Cs of ED Education and Training, framework, counselor education, trainee development
Eating disorders (EDs) remain one of the most lethal mental health illnesses, contributing to roughly 3 million deaths globally each year (van Hoeken & Hoek, 2020) and impacting 29 million or 9% of Americans over their lifetime (Deloitte Consumer Report, 2020). In the United States alone, EDs directly result in 10,200 deaths annually, averaging one death every hour (Deloitte Access Economics, 2020). The steady rise of EDs across genders and countries is of increasing concern, with scholars noting in their systematic literature review that rates have doubled from 3.5% in 2000â2006 to 7.8% in 2013â2018 (Galmiche et al., 2019). EDs also exact a significant economic toll in the United States. In the 2018â2019 fiscal year, Streatfeild et al. (2021) found that EDs generated financial costs of nearly $65 billion, averaging about $11,000 per affected individual. Moreover, their study estimated an additional $326.5 billion in non-financial costs due to reduced well-being among those with EDs. Given their associated comorbidities with other mental health illnesses (Ulfvebrand et al., 2015), enduring somatic issues (Galmiche et al., 2019), and facilitation of psychological distress (Kärkkäinen et al., 2018), EDs pose significant public health and economic threats that necessitate further consideration. However, the literature lacks meaningful attention to ED prevention and treatment (van Hoeken & Hoek, 2020), an oversight that needs to be redressed within counselor education (CE) graduate training programs. A failure to examine this clinical issue threatens the maintenance of quality assurance and ethical standards within the profession, enabling short- and long-term client harm.
Challenges and Gaps in ED Education and Training
    Given the steady rise in the prevalence of EDs and their associated consequences, counseling trainees must be equipped with comprehensive training in order to effectively conceptualize and treat these complex conditions. However, across the decades, research has illuminated ED education and training deficits, particularly in graduate programs (Biang et al., 2024; Labarta et al., 2023; Levitt, 2006; Thompson-Brenner et al., 2012). For instance, Labarta et al.âs (2023) recent study examined clinician attitudes toward treating EDs, revealing challenges related to the lack of specialized graduate training. Among surveyed respondents, only 25.7% reported that their programs offered a specialized course on EDs, while approximately half of the sample (41.3%) divulged that their program dedicated only 1â5 hours of ED-related instruction throughout the curricula. Furthermore, one participant indicated that ED education is ârarely more than one lecture at the masterâs levelâ (Labarta et al., 2023, p. 21). This is particularly concerning as research shows that trainees are not only very likely to encounter a client battling an ED at some point in their professional career (Levitt, 2006) but are also going to be less prepared and effective in treating such clients without specialized ED training in graduate programs (Biang et al., 2024; Labarta et al., 2023).
As a result of this lack of ED education, scholars have noted negative implications for helping professions, contributing to clinician incompetence, increased burnout, and diminished self-efficacy when working with ED clients (Labarta et al., 2023; Levitt, 2006; Thompson-Brenner et al., 2012). Clinician competence is a necessary vehicle to not only promote individual accountability but to also ensure the integrity of the broader counseling profession. However, holistic competency development is threatened without adequate, targeted ED training, increasing the likelihood that counselors-in-training (CITs) will encounter recurring treatment failures when working with clients struggling with an ED (Williams & Haverkamp, 2010). Williams and Haverkamp (2010) echoed this sentiment, stating that the field risks the occurrence of âiatrogenesis . . . particularly when the practitioner has a poor understanding of EDs, the negative reactions that eating disordered clients can evoke in the clinician are not managed, and/or there are specific types of process and relationship errors made in therapyâ (p. 92). For example, although a school counselor may not serve as the primary treatment provider for an adolescent with bulimia nervosa, their understanding of warning signs and symptoms, supportive collaboration with students and families, and knowledge of specialized community referrals are invaluable to the counseling process (Carney & Scott, 2012). As such, counselor educators must assist CITs with developing essential competencies for treating EDs during graduate training programs, ultimately working toward bridging this gap and improving the quality of care.
Addressing the deficit of multicultural research in the field of EDs is of paramount importance, as it directly impacts the practice and education of counselors. Accrediting and professional bodies expect counselor educators to impart multicultural knowledge and skills to CITs, including a focus on diverse cultural and social identities (American Counseling Association [ACA], 2014; Council for the Accreditation of Counseling and Related Educational Programs [CACREP], 2023). Furthermore, Levitt (2006) emphasized that the significant consequences and growing prevalence of EDs across diverse cultural groups necessitate that clinicians âgain exposure to the etiology, manifestation, and treatment of eating disorders within multiple contextsâ (p. 95). This assertion underscores the critical need for a more inclusive and culturally competent approach to assessing, treating, and educating about EDs, emphasizing the urgency of addressing the existing gaps in research. Ultimately, the absence of targeted ED research and training, notably conceptualization and assessment strategies, poses ethical concerns for safeguarding clientsâ welfare, rendering trainees ill-equipped to address milder presentations of these disorders, let alone complex cases with more severe symptoms, such as heightened suicidality, enduring medical complications, and acute psychological distress (Kärkkäinen et al., 2018).
Research concerning client experiences is also imperative when assessing education and training needs for effective ED treatment. Babb et al. (2022) conducted a meta-synthesis of qualitative research on ED clientsâ experiences in ED treatment, illuminating important themes on cliniciansâ roles in supporting clients. Several clients reported that some staff perpetuated stereotypes about EDs (e.g., viewing the client as an illness versus a person) and tried to fit clients into specific theoretical frameworks. Clients attributed this lack of awareness and sensitivity to the providersâ lack of specialized training in EDs. Conversely, clients in this study felt empowered when providers were empathic and provided individualized approaches to treatment. These participants noted that âbeing seen as an individualâ facilitated motivation for treatment, with the therapeutic alliance as an essential factor in this process (Babb et al., 2022, p. 1289). These client perspectives provide valuable insights that should inform the development of CE training programs to better prepare CITs for working with individuals with EDs.
Training Recommendations for Counselor Education Programs
Collectively, the findings cited above underscore the importance of comprehensive ED training for counselors to be able to effectively and compassionately serve diverse clients with EDs. However, accessibility to such education and training remains a challenge to both the graduate students and practitioners (Biang et al., 2024; Labarta et al., 2023). Furthermore, despite the efficiency of manualized approaches, Babb et al.âs (2022) study emphasized the need for both flexibility and avoiding a one-size-fits-all approach to ED treatment, particularly given the diversity of clients with EDs, including those from traditionally underrepresented backgrounds (Schaumberg et al., 2017). Clientsâ lived experiences corroborate these gaps, reporting instances of stereotyping, rigid adherence to theoretical frameworks, and a lack of empathy stemming from inadequate specialized training (Babb et al., 2022). These findings highlight the pressing need for training strategies that ensure competence and uphold ethical standards within the treatment of EDs, including ongoing education for new practitioners entering the field.
The following section offers competency-based recommendations for CE programs to incorporate into their curricula and experiential training. We propose a conceptual model that we call the 3 Cs of ED Education and Training. The 3 Cs are: (a) cultivating trainee self-awareness, (b) capturing contextual and sociocultural factors, and (c) collaborating with interdisciplinary professionals (see Figure 1). We also provide an overview of recommended activities and associated reflective prompts that can be used in a special topics course on EDs (see Appendix A), as well as suggested adaptations for integration across counseling curricula. By integrating these teaching strategies, CE programs can enhance competency-based education for EDs (Williams & Haverkamp, 2010), which may empower CITs to provide compassionate, empirically supported services to this vulnerable population.
Figure 1
The 3 Cs of ED Education and Training
Â
Cultivating Trainee Self-Awareness
    Cultivating trainee self-awareness is essential to ethical and multiculturally competent ED treatment. As espoused in our ethical codes (ACA, 2014), counselors are expected to examine their own beliefs, attitudes, and emotional responses when working with clients. Without such conscious examination, clinicians risk projecting their personal biases onto their clients or responding in ways that might inadvertently cause harm. For instance, the pervasive weight stigma embedded in our society can unconsciously influence counselors and may result in microaggressions, victim blaming, or the dismissal of symptoms, particularly when working with clients in larger bodies (Veillette et al., 2018). Counselors may also experience countertransference reactions triggered by ED behaviors or other challenging treatment components, such as high relapse rates, resistance to treatment, or insurance coverage issues (Labarta et al., 2023; Warren et al., 2013), negatively influencing the therapeutic relationship (Graham et al., 2020). Reflexive exercises, paired with targeted deliberate skill practice, are valuable mechanisms for facilitating conscious self-examination and building relevant knowledge and skills for effective ED treatment.Â
Encouraging Reflexivity and Deliberate Practice
    Reflexivity, defined as âa practice of observing and locating oneâs self as a knower within certain cultural and socio-historical contexts,â allows CITs to engage with courses on cognitive, affective, and experiential levels (Sinacore et al., 1999, p. 267). The integration of reflexive exercises and critical discussions into ED curricula is essential for cultivating self-awareness and, in effect, mitigating potential client harm. Such practices create opportunities for trainees to identify and address any unconscious biases or beliefs, which, if unaddressed, can undermine the quality of care provided. By establishing a habit of mindful self-inquiry, educators can take the first critical step in preparing ethically conscientious counselors attuned to ED clientsâ diverse needs (Labarta et al., 2023).
This intentional practice of reflexivity should be paired with deliberate practice strategies focused specifically on promoting skill development for treating EDs. Deliberate practice is a systematic and intentional training method that targets skill development in order to attain expert performance in a given area or domain (Ericsson, 2006; Irvine et al., 2021). Research shows that integrating deliberate practice strategies early in CE training promotes competency development (Chow et al., 2015). Ericsson (2006) developed five crucial tasks of deliberate practice: self-assessment, skill repetition, formative feedback, stretch goals, and progress monitoring. The first task is a necessary step in increasing trainee self-awareness, which is particularly crucial when working with vulnerable populations, such as those struggling with EDs. Deliberate practice empowers trainees to refine their skills and continuously evolve as competent, empathic, and effective counselors. Thus, deliberate self-reflection on personal assumptions is key, as examining oneâs relationship with food and body is imperative to prevent issues like value imposition and orient the focus of treatment to the clientâs healing process.
Integrating reflexivity and deliberate skill practice early in CE training is vital to promoting lasting competency. CITs often overestimate their competence at the end of their training, necessitating that CE programs systematically monitor the congruence between CITsâ self-assessments and counselor educatorsâ assessments of CITsâ competency and skill development (Gonsalvez et al., 2023). Routine reflexive exercises can illuminate areas for growth, while deliberate practice strategies provide structured mechanisms for targeted skill refinement. As trainees embark on their professional journeys, ongoing and intentional efforts to self-reflect and evolve through skill refinement will empower them to provide safe, ethical, and effective ED treatment.
Capturing Contextual and Sociocultural Factors
    It has been well-documented that EDs impact individuals across social and cultural identities despite the misconception that only thin, White, affluent, cisgender women are affected (Schaumberg et al., 2017). Indeed, scholars have pointed to the need for intersectional, social justiceâinformed research that addresses the unique ways that context and culture influence EDs and body image concerns (Burke et al., 2020; Halbeisen et al., 2022). The prevalence of EDs and pervasive body image issues is alarming in todayâs sociocultural landscape. For instance, the recent increase in gender-affirming care bans and anti-LGBTQ+ legislation poses profound and detrimental effects on individuals battling an ED (Arcelus et al., 2017), as these restrictive policies exacerbate the mental and emotional distress already experienced by LGBTQ+ individuals, further isolating them and undermining their access to critical health care services (Canady, 2023). As a result, members of this community are more apt to experience intensified body dysphoria, heightening the risk of developing or worsening an ED in an attempt to conform to societal norms (Arcelus et al., 2017).
In the wake of the COVID-19 pandemic, the world has experienced a collective trauma that triggered a series of physical and mental health consequences that will linger for years to come, including rising rates of disordered eating and body-related concerns. Termorshuizen et al. (2020) surveyed 1,021 individuals across the United States and the Netherlands, revealing that ED diagnoses increased at a rate of roughly 60%, with respondents noting increased binge episodes (30%) and restriction behaviors (62%) during this time. Scholars have also shown the deleterious effects of the pandemic on body image perception. For instance, in one study of 7,878 respondents, 61% of surveyed adults and 66% of surveyed children (17 and under) disclosed frequent negative feelings regarding their body image, with 53% of adults and 58% of children reporting that the pandemic has significantly exacerbated these feelings (House of Commons, 2021). Unfortunately, weight stigma was also pervasive in the media, with concerns regarding quarantine weight gain (e.g., âQuarantine-15â) contributing to eating and body image challenges (Schneider et al., 2023). Amidst the multifaceted challenges presented by recent sociopolitical events and the intersecting struggles faced by diverse individuals with EDs, it is essential that counselors implement culturally responsive approaches to treatment and advocacy efforts.
Centering Culturally Responsive Approaches
    Given the diversity of clients who struggle with eating and body image concerns (Schaumberg et al., 2017), CE programs must integrate culturally sensitive theories into the curriculum to ensure that CITs possess the necessary competencies to explore relevant cultural factors and effectively treat diverse clients with EDs (Williams & Haverkamp, 2010). Two theories that fostered the development of the Multicultural and Social Justice Counseling Competencies (MSJCC; Ratts et al., 2016) are intersectionality theory and relationalâcultural theory (Singh et al., 2020). Intersectionality is a framework for comprehensively understanding the interaction of systemic inequalities and oppression that significantly affect marginalized community members (Burke et al., 2020; Crenshaw, 1991). This theoretical paradigm deepens our understanding of factors such as age, race, ethnicity, sexual orientation, ability status, body size, and gender identity and how these factors influence an individualâs lived experience. Intersectionality is vital for promoting social justice and culturally responsive treatment while also serving as a tool to dismantle oppression and colonizing practices within the profession (Chan et al., 2018; Singh et al., 2020). Intersectionality-informed practice may assist researchers and counselors with considering risk and protective factors for EDs; however, the lack of attention to the intersecting roles and identities of ED clients (e.g., a Catholic, bisexual, Latina) remains a concern, which is crucial for informing culturally competent counseling and training practices (Burke et al., 2020).
Relationalâcultural therapy (RCT; Jordan, 2009) is another promising theory that may decolonize dominant counseling approaches (Singh et al., 2020). Due to its emphasis on relational connection, social justice, and empowerment, RCT has been applied to the treatment of EDs (Labarta & Bendit, 2024; Trepal et al., 2015). Infusing RCT into practice may help counselors understand sociocultural influences that maintain ED (e.g., diet culture, weight stigma, acculturation) and perpetuate feelings of disconnection for individuals who do not conform to prevailing body or appearance standards. RCT also aligns well with counselingâs wellness orientation due to its relational and strengths-based focus, emphasizing resilience over pathology in the treatment of ED (Labarta & Bendit, 2024). Counselor educators can expand beyond traditional ED treatment approaches by integrating culturally responsive theories like intersectionality and RCT into course curricula, thus highlighting the intrapersonal, interpersonal, and systemic components that impact clients with EDs.
Collaborating With Interdisciplinary Professionals
    The counseling profession has recognized the importance of interdisciplinary practice, encouraging counselors to participate in âdecisions that affect the well-being of clients by drawing on the perspectives, values, and experiences of the counseling profession and those of colleagues from other disciplinesâ (ACA, 2014, Code D.1.c, p. 10). The CACREP Standards (2023) also emphasize the need for counseling students to learn about collaboration, consultation, and community outreach as part of interprofessional teams (Section 3.A.3). Indeed, interdisciplinary collaboration provides an opportunity for individual and systems-level advocacy (Myers et al., 2002). The challenge remains in how counselors can balance establishing a distinct professional identity while simultaneously fostering a sense of community among various helping professions (Klein & Beeson, 2022). Researchers have underscored common experiences of counselors within interdisciplinary teams, including challenges with building legitimacy and credibility, especially among more well-established helping professions such as psychiatry or psychology (Klein & Beeson, 2022; Ng et al., 2023). Given that multidisciplinary collaboration is also crucial to ED treatment (Crone et al., 2023; Williams & Haverkamp, 2010), counselor educators must prepare CITs to effectively work within interdisciplinary treatment teams while utilizing their counseling values and training to best serve their clients and advocate for the inclusion of counselors across ED treatment settings (Labarta et al., 2023).
Strengthening Counselor Professional Identity
    Given that EDs are biopsychosocial in nature, effective treatment commonly involves collaboration among various health professions (e.g., medicine, psychiatry, counseling, psychology, dietetics) to ensure holistic, comprehensive client care (Crone et al., 2023). Counselorsâ developmental, preventive, and wellness-based perspectives can help provide a strengths-based approach to interdisciplinary collaborations (Labarta et al., 2023). For example, a psychiatrist at a residential facility may focus on assessing a clientâs pathology, comorbidity, and changes in symptoms throughout treatment. Although counselors can also focus on assessing client symptoms, their training allows them to provide insight into protective factors that foster client resilience in their recovery process (e.g., social support and cognitive flexibility). Both professionals bring unique expertise, knowledge, and skill sets that provide a distinct conceptualization of the clientâs concerns with food or with their body. However, the ultimate goal of the treatment team is to ensure ethical and competent care for the client.
Outside of intensive ED treatment, counselors in school settings and community agencies can offer prevention-based approaches to mitigate risk factors leading to the development of EDs. Prevention-based efforts, such as community programs and workshops, are essential to the field of ED, given the alarmingly low rates of help-seeking in adults with lifetime EDs (34.5% for anorexia nervosa, 62.6% for bulimia nervosa, and 49.0% for binge eating disorder), which are even more pronounced among marginalized communities (Coffino et al., 2019). As such, counselors and other helping professionals can collaborate on ways to increase accessibility to mental health services for underserved groups with increased risk of eating or body image concerns (e.g., LGBTQ+; Nagata et al., 2020). Regardless of the settings within which CITs will work, students can benefit from developing teamwork, leadership, and advocacy skills, as well as a systemic conceptualization of client care (Ng et al., 2023). Ultimately, counselor educators can encourage the exploration of shared goals across helping professions and the utilization of counseling values and training to enhance interdisciplinary work for diverse clients and communities recovering from EDs (Klein & Beeson, 2022; Labarta et al., 2023; Ng et al., 2023).
Implications for Counselor Educators
The 3 Cs for ED Education and Training pose several implications for counselor educators and counseling programs. Although intended for ED treatment, this framework captures essential competencies across counseling specialties, such as counselor self-awareness, cultural and diversity issues, and interdisciplinary practice (CACREP, 2023). As such, integrating these foci into the counseling curriculum can help reinforce competencies regardless of the settings within which students will work. Counselor educators teaching about EDs should also consider ways to incorporate other ED counseling competencies, such as relevant ethical issues, assessment and screening, and evidence-based treatments into coursework (Williams & Haverkamp, 2010). These topics can be integrated into the 3 Cs for ED Education and Training in several ways. For instance, ethical issues and scenarios, such as determining when a client may need a higher level of care, can be presented to students as a standard component of collaborating with interdisciplinary professionals. Counselor educators can also review common ED assessments and encourage students to critically evaluate gaps in the diagnostic process that impact underrepresented populations (e.g., men with EDs), capturing contextual and sociocultural factors and enhancing culturally responsive care (see Appendix B for more examples.)
We also recognize the potential challenges of implementing the 3 Cs of ED Education and Training, as a stand-alone, special topics course on EDs may not be possible for all counseling programs. However, counselor educators can adapt and incorporate the suggested activities in Appendix A into various CACREP core courses to enhance ED education across the curriculum. CE programs can also utilize their Chi Sigma Iota chapters to host events on EDs, such as an interdisciplinary panel discussion followed by a group discussion on professional counseling identity and advocacy (Labarta et al., 2023). Opening these events to the local community could encourage continuing education, collaboration, and advocacy.
Directions for Future Research
    Given that the 3 Cs of ED Education and Training is a conceptual framework, there are several directions for future research. Counselor educators and researchers may consider developing a stand-alone course to test the effects of this framework on CITsâ competence in treating EDs. To our knowledge, limited ED competency measures exist, especially for counselors. As such, researchers could explore developing an instrument that measures ED competency areas that include the 3 Cs of ED Education and Training. Such a tool would be helpful for research, clinical, and teaching purposes. An ED competency tool may also enhance CITsâ and counselorsâ deliberate practice efforts, promoting quality care for clients across ED treatment settings. Additionally, one theoretical framework educators can modify to help enhance traineesâ clinical competencies in treating EDs is Irvine and colleaguesâ (2021) Deliberate Practice Coaching Framework (DPCF), given its structured guidance for skill refinement through individualized coaching and feedback. The development and future testing of an adapted DPCF for EDs may further enhance reflexive and deliberate practice efforts for CITs and counselors working with this population.
Conclusion
In this article, we have proposed our 3 Cs of ED Education and Training to address current gaps in ED education and enhance trainee preparedness across CE programs. Informed by existing literature, this framework incorporates essential elements of comprehensive ED treatment, including counselor self-awareness, cultural and contextual factors, and interdisciplinary practice. The flexibility of this framework allows educators to adapt current curricula to strengthen ED training in CE programs and to meet the needs of their students. Further research that tests a stand-alone course incorporating this framework is needed. The 3 Cs of ED Education and Training offer a path forward in remedying the salient gaps in ED education, ultimately advocating for more compassionate, ethical, and inclusive care across counseling settings.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
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Appendix A
The 3 Cs of ED Education and Training: Suggested Activities and Reflective Prompts
Â
| 3 Cs of ED Education & Training |
Suggested
Activities |
Activity Sample
Reflective Prompts |
Adaptations for Integration Across Counseling Curricula |
| Â
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Cultivating Trainee
Self-Awareness |
Reflexive Journaling:
Have CITs maintain a journal, reflecting on their experiences (e.g., biases, assumptions, insights, challenges) throughout the course.
Instructors can provide suggested weekly prompts based on the content or topic area discussed.
Deliberate Practice:
During the first week, CITs will read Williams and Haverkampâs (2010) article on ED counseling competencies.
CITs then write a reflection paper identifying 2â3 targeted, actionable areas for development and growth.
Revisit these competencies at the end of the course to assess CIT growth and ongoing development areas. |
Reflexive Journaling Prompts:
Reflect on your beliefs, values, and attitudes about counseling ED clients. What would you like to learn? What challenges do you anticipate?
How might cultural factors impact how counselors work with ED clients? Consider how your cultural and social identities shape your relationship with food and body image.
Complete the Anti-fat Attitudes Questionnaire (Crandall, 1994) and interpret your score. What insights did you gain? Why might self-assessment in this domain be an important tool for counselors? (Kerl-McClain et al., 2022)
Deliberate Practice Prompts:
Using a Likert scale of 1 (not confident) to 5 (very confident), how confident do you feel to treat clients with EDs?
Using a Likert scale of 1 (not prepared) to 5 (very prepared), how prepared do you feel to treat clients with EDs?
Identify 2â3 areas of personal or professional development and growth.
Identify 2â3 actionable steps for this semester and beyond.
|
Psychopathology and Diagnosis Courses:
Before teaching ED diagnoses, facilitate a brief activity to promote reflexive practice (see suggested prompts).
Follow up with a class discussion on CITsâ reflections, reactions, insights, and the possible impact of biases or assumptions on the diagnosis and treatment process for ED clients.
Practicum and Internship Courses:
CITs working in ED treatment settings can use the deliberate practice prompts to continually assess strengths and growth areas.
Encourage CITs to complete the self-assessment on ED knowledge and skills. Based on the identified gaps, campus instructors can invite guest lecturers to discuss topics of interest. |
| 3 Cs of ED Education & Training |
Suggested
Activities |
Activity Sample
Reflective Prompts |
Adaptations for Integration Across Counseling Curricula |
| Â
Â
Â
Â
Â
Â
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Capturing Contextual
and
Sociocultural Factors |
Media Critique:
Have CITs select and analyze a form of media (e.g., movies, TV series, social media).
CITs can then consider the messages conveyed about EDs and body image.
Class Discussion:
Engage in a class discussion on CITsâ observations, noted themes, and implications for counseling practice.
Educators may also initiate a discussion on media literacy and how to broach similar discussions with clients and colleagues.
|
Individual Reflection Prompts:
How were EDs and/or body image concerns portrayed explicitly and implicitly?
How do sociocultural factors (e.g., race, ethnicity, gender, etc.) influence media portrayals and messages about EDs/body image?
How might these portrayals or messages influence oneâs beliefs about EDs?
Class Discussion Prompts:
What were the overarching themes or messages across the various media?
How can culturally responsive theories (e.g., RCT, intersectionality) inform how we conceptualize the impact of media on EDs and body image concerns?
How can counselors work with clients impacted by harmful media ideals?
How can counselors advocate for more culturally inclusive and responsible ED portrayals in media? |
Social and Cultural Diversity Course:
Facilitate a discussion on CITsâ observations of ED media portrayals, considering the impact of limited representation on mental health access.
Provide a case study of a client with intersecting minoritized identities and encourage CITs to identify culturally responsive treatment approaches and theories that can benefit the clientâs recovery. |
| 3 Cs of ED Education & Training |
Suggested
Activities |
Activity Sample
Reflective Prompts |
Adaptations for Integration Across Counseling Curricula |
| Â
Â
Â
Â
Â
Â
Â
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Collaborating with Interdisciplinary Professionals |
ED Expert Panel:
Invite professionals across disciplines specializing in treating EDs (e.g., M.D., psychiatrist, psychologist, dietician).
Engage the panelists in a discussion on their respective training, roles, responsibilities, and experiences working in interdisciplinary treatment teams.
Reserve Q&A time for CITs to share any thoughts, questions, and insights (Labarta et al., 2023).
Professional Identity Reflection Paper:
After the ED expert panel discussion, have CITs write a reflection paper on what they learned from the panelists.
CITs can reflect on how counselors contribute to interdisciplinary teams using their developmental, prevention-focused, and wellness-based training.
Facilitate a broader discussion with CITs during the subsequent class meeting. |
Expert Panel Discussion Prompts:
Briefly discuss your ED treatment experiences and describe your main roles and responsibilities.
Discuss the benefits and challenges of working in interdisciplinary treatment teams.
What would you say are the most prevalent issues faced by ED professionals today?
What words of wisdom can you share with CITs considering working with ED clients?
Professional Identity
Paper Prompts:
¡     What challenges and opportunities do you foresee as a counselor working in an interdisciplinary treatment team?
¡     How can counseling values inform an interdisciplinary perspective on ED treatment?
¡     What personal strengths could you contribute as an interdisciplinary treatment team member?
¡     Reflect on the MJSCC (Ratts et al., 2016), discussing how they can inform a counselorâs work with diverse clients struggling with eating and/or body image concerns. |
Introduction to Mental Health Counseling Course:
If coordinating an ED expert panel is not feasible, consider inviting other professionals across specialty areas (e.g., EDs, addictions, integrated behavioral health) to share their experiences
CITs can complete a reflection paper on their insights and reactions to the guest panelists using the professional identity paper prompts as a guide.
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Appendix B
Educator Checklist for Integrating the 3 Cs of Eating Disorder (ED) Education and Training Into Counselor Education Curricula
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| Cultivating Trainee Self-Awareness |
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Increase trainee awareness by incorporating ED warning signs, risk factors, and conceptualization strategies into assessment and treatment approaches. |
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Routinely assess student competency on ED-related knowledge and skills, evaluating for any incongruence between the studentsâ and educatorsâ scores. Additionally, assess multicultural counseling competencies related to EDs during student evaluations. Provide feedback for growth. |
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Encourage student attendance at ED-focused workshops, webinars, and conferences to enhance deliberate practice efforts, promoting professional growth and development. |
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Promote student exploration of their own cultural identities, values, and biases related to appearance, health, and eating behaviors. |
| Capturing Contextual and Sociocultural Factors |
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Incorporate diverse ED case examples and vignettes that reflect a range of intersecting cultural identities and experiences. |
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Provide training on culturally responsive ED treatment approaches like RCT and intersectionality. Be sure to cover strategies for adapting evidence-based ED treatment approaches to be culturally relevant for diverse clients. |
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Emphasize the importance of cultivating cultural humility and client empowerment, particularly when working with ED clients from diverse or marginalized backgrounds. |
| Collaborating With Interdisciplinary Professionals |
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Critically examine course syllabi to identify where ED content and scholarship could be incorporated or expanded (e.g., textbooks, media, articles). Include resources from interdisciplinary helping professionals. |
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Compile a list of interdisciplinary community referrals and resources to support students working with ED clients. |
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Provide opportunities (e.g., guest lecture, course assignment) for students to learn from ED experts in various helping disciplines. Encourage students to reflect on ways to utilize their counseling values and training within interdisciplinary treatment collaborations. |
Note. This checklist is a framework for integrating ED education into CE graduate training. Consider modifying components to align with your specific curriculum, resources, and student population. The goal is to integrate ED education in a way that provides students with foundational knowledge, skills, and practical experience to effectively support clients struggling with EDs and body image issues in their future counseling practice.
Taylor J. Irvine, PhD, NCC, ACS, LMHC, is an assistant professor at Nova Southeastern University. Adriana C. Labarta, PhD, NCC, ACS, LMHC, is an assistant professor at Florida Atlantic University. Correspondence may be addressed to Taylor J. Irvine, Department of Counseling, Nova Southeastern University, 3300 S. University Dr., Maltz Bldg., Rm. 2041, Fort Lauderdale, FL 33328-2004, ti48@nova.edu.
May 22, 2024 | Volume 14 - Issue 1
William B. Lane, Jr., Timothy J. Hakenewerth, Camille D. Frank, Tessa B. Davis-Price, David M. Kleist, Steven J. Moody
Interpretative phenomenological analysis was used to explore the simultaneous supervision experiences of counselors-in-training. Simultaneous supervision is when a supervisee receives clinical supervision from multiple supervisors. Sometimes this supervision includes a university supervisor and a site supervisor. Other times this supervision occurs when a student has multiple sites in one semester and receives supervision at each site. Counselors-in-training described their experiences with simultaneous supervision during the course of their education. Four superordinate themes emerged: making sense of multiple perspectives, orchestrating the process, supervisory relationship dynamics, and personal dispositions and characteristics. Results indicated that counselors-in-training experienced compounded benefits and challenges. Implications for supervisors, supervisees, and counselor education programs are provided.
Keywords: clinical supervision, simultaneous supervision, counselors-in-training, interpretative phenomenological analysis, counselor education
    Supervision is a key component of counselor education in programs accredited by the Council for the Accreditation of Counseling and Related Educational Programs (CACREP; 2015) and an ethical requirement in the ACA Code of Ethics (American Counseling Association, 2014). Supervision of counselors-in-training (CITs) serves the purpose of guiding counselor development, gatekeeping, and, ultimately, ensuring competent client care (Borders et al., 2014). For the present study, we defined simultaneous supervision as a pre-licensure CIT receiving weekly individual or triadic supervision from more than one supervisor over the same time period. At the time of the study, the 2016 CACREP standards required that internship and practicum students receive individual and/or triadic supervision averaging 1 hour per week throughout their clinical experience (Standards 3.L. & 3.H.). Some CITs may gain field experience at multiple clinical sites requiring individual site supervision at each site. Many programs require students to engage in faculty advising meetings (Choate & Granello, 2006), which may take a form analogous to formal supervision. Additionally, supervisees may have clinical supervision, focused on supervisee development and client welfare, as well as administrative supervision, focused on functionality and logistics within an agency; these roles may be fulfilled by the same person or at times by two separate supervisors (Kreider, 2014; Tromski-Klingshirn & Davis, 2007). Consequently, although simultaneous supervision is not required in and of itself, it often occurs in counselor education practice.
Supervision Foundations
    Counseling supervision research has increased significantly in the last few decades (Borders et al., 2014). Borders and colleagues (2014) developed best practices for effective supervision, including emphasis on the supervision contract, social justice considerations, ethical guidelines, documentation management, and relational dynamics. Previous research has overwhelmingly demonstrated that a strong supervisory alliance is the bedrock of effective supervision (Bernard & Goodyear, 2019). Sterner (2009) further studied the supervisory relationship as a mediator for supervisee work satisfaction and stress. Lambie and colleagues (2018) developed a CIT clinical evaluation to be used in supervision, with strength in assessing personal dispositions in addition to clinical skills. A review of the supervision literature revealed that a strong supervisory relationship based in goal congruence, empathic rapport, and transparent feedback processes (Bernard & Goodyear, 2019; Borders et al., 2014; Sterner, 2009) generate mutual growth between supervisor and supervisee, enhancing clinical work. Additionally, CACREP mandates that faculty and site supervisors foster CIT professional counselor identity through the supervisory process (Borders, 2006; CACREP, 2015).
Counselor development is also a crucial factor in clinical supervision. An entire category of supervision models centralizes the professional development of supervisees in their approach (Bernard & Goodyear, 2019). One of the most widely known models, the Integrative Developmental Model, plots learning, emotion, and cognitive factors across multiple stages of therapist development (Stoltenberg & McNeill, 2010). By focusing on overarching themes of selfâother awareness, autonomy, and motivation, the Integrative Developmental Model (Stoltenberg & McNeill, 2010) illuminates how supervisees fluctuate and grow in their anxiety, self-efficacy, reliance on structure, and independence. All these factors may have substantial impact when considering the complexity that simultaneous supervision brings. Furthermore, professional dispositions of openness to feedback and flexibility and adaptability (Lambie et al., 2018) may have additional developmental implications when considering the complexity of simultaneous supervision.
Ethics similarly serve as a foundation of supervisory experiences. Multiple standards and principles of the ACA Code of Ethics (2014) may be complicated by simultaneous supervision and require special attention. Veracity may be of particular interest given the commonality of supervisee nondisclosure (Kreider, 2014), multiplied by the added number of supervisors in one time period. Furthermore, specific standards in Section D: Relationships With Other Professionals may be implicated by obligations in working with multiple professionals; multiple standards in Section F: Supervision, Training, and Teaching may be indicated because of the convergence of both teaching and clinical supervision in counselor training programs; and, finally, reconciling the additional complexities of simultaneous supervision not explicitly identified elsewhere in the 2014 Code of Ethics may elicit a need to carefully consider Section I: Resolving Ethical Issues. With more parties involved, greater nuance would be expected in ethical decision-making.
Much of the foundational research and reviewed contextual factors have either focused specifically on sole supervision or do not differentiate between sole and simultaneous supervision. When considering best supervision practices, the phenomenon of simultaneous supervision presents distinct practical concerns. Exploration is needed to better understand how supervisees might navigate different but related supervisory relationships, how goals and tasks can be congruent across separate supervisory experiences, and how supervisees would make meaning of multiple sources of feedback. Despite the apparent use of simultaneous supervision in counselor education programs, few researchers have explored these dynamic concerns.
Multiple Supervisors and Multiple Roles
    Early researchers began to conceptualize the challenges and strengths inherent in simultaneous supervision in both counseling (Davis & Arvey, 1978) and clinical psychology (Dodds, 1986; Duryee et al., 1996; Nestler, 1990), with mixed results overall. Nestler (1990) identified the difficulties in receiving contradictory feedback from multiple supervisors, reflective of fundamental differences in the supervisorsâ approaches. Dodds (1986) similarly identified multiple potential stressors in having concurrent supervisors at agency and training settings. Dodds argued that although the general goals to teach and serve clients overlapped, each had inherent differences in their primary institutional goals and structures. Duryee and colleagues (1996) described a beneficial view of simultaneous supervision, in which supervisees overcome conflicts with site supervisors via support and empowerment from academic program coordinators. Davis and Arvey (1978) presented a case study in which supervisees, in a raw comparison, more highly favored the dual supervision overall. These findings highlight the dynamics that occur in the context of simultaneous supervision and connect with recent findings.
Recent researchers have focused on dual-role supervision, defined as one individual supervisor serving as both a clinical and administrative supervisor to one or more supervisees (Kreider, 2014). Kreider (2014) investigated supervisee self-disclosure as related to three factors: supervisor role (dual role or single role), supervisor training level, and supervisor disclosure. Level of supervisor disclosure was found to be significant in explaining differences in supervisee self-disclosure and was hypothesized as a mitigating factor in supervisor role differences (Kreider, 2014). Tromski-Klingshirn and Davis (2007) surveyed the challenges and benefits unique to dual-role supervision for post-degree supervisees. Most supervisees reported neutral to positive outcomes from a dual-role supervisor, but a minority of supervisees noted power dynamics and fear of disclosure as primarily problematic (Tromski-Klingshirn & Davis, 2007), similar to the earlier hypotheses of Nestler (1990) and Dodds (1986). The small amount of existing research solidifies the prevalence of simultaneous supervision and the challenges and benefits for the supervisees. A missing link emerges in understanding how CITs come to understand their experience in simultaneous supervision from a qualitative perspective.
The distinct focused phenomenon of simultaneous supervision is limited in counseling literature. The few conceptual examinations of simultaneous supervision in the mental health literature have indicated confusion and role ambiguity (Nestler, 1990), while at other times simultaneous supervision has been noted to improve comprehensive learning (Duryee et al., 1996). Our study addresses the gap in the literature regarding current simultaneous supervision in counselor education utilizing qualitative analysis.
Method
Given the limited research on simultaneous supervision and its prevalence within the profession, we decided to explore this phenomenon qualitatively. Our research question was âWhat is the experience of CITs receiving simultaneous supervision from multiple supervisors?â We used interpretative phenomenological analysis (IPA) to explore this question because of its utility with counseling research, grounded methods of analysis, and emphasis on both contextual individual experiences with the phenomenon and general themes (Miller et al., 2018).
Research Team
    At the time of the study, the research team consisted of four doctoral studentsâWilliam B. Lane, Jr., Timothy J. Hakenewerth, Camille D. Frank, and Tessa B. Davis-Priceâwho each had previous experience with simultaneous supervision as supervisees and supervisors. The teamâs perspective of this phenomenon from both roles informed their interest in and analysis of the phenomenon. The fifth member of the team, David M. Kleist, was our doctoral faculty research advisor. The sixth author, Steven J. Moody, provided support in the writing process.
Participants and Procedure
    Our participants were four CITs from CACREP-accredited graduate programs accruing internship hours. Smith et al. (2009) suggested seeking three to six participants for IPA, as this allows researchers to explore the phenomenon with individual participants at a deeper level. All four participants specialized in either addiction, school, or clinical mental health counseling, and identified as White, female CITs ranging from 23 to 37 years old. Additionally, each participant reported receiving supervision from at least two supervisors to include university-affiliated supervisors and site supervisors. Each participant came from a different university representing the Rocky Mountain and North Central regions of the Association for Counselor Education and Supervision. To protect confidentiality, each participant selected a pseudonym for the study.           Â
After securing approval from our universityâs review board, we recruited participants through purposive convenience sampling. We posted a recruitment email to the CESNET listserv, an informational listserv for counselor educators and supervisors. This listserv was selected as an initial step of convenience sampling to increase the potential to reach a broad range of counseling programs. Nine individuals responded to the call to participate in the research by taking a participant screening survey that helped us determine suitability for the study. After removing individuals from research consideration because of potential dual relationships, nonresponse, or not meeting inclusion criteria, four individuals were selected as participants. We further planned to engage in serial interviewing to gain richer details of the phenomenon and achieve greater depth with the four participants (Murray et al., 2009; Read, 2018). Prior to data collection, the researchers completed a brief phone screening with each participant to review the interview protocol and explain the phenomenological approach guiding the questions. A $40 gift card was provided as a research incentive to participants. Our selection criteria included (a) being a masterâs student within a CACREP counseling program, (b) currently accruing internship hours, and (c) receiving simultaneous supervision. We selected participants in internship only because homogenous sampling helps produce applicable results for a given demographical experience (Smith et al., 2009).
Data Collection
    Consistent with the recommendations of Smith et al. (2009), we conducted two semi-structured interviews with each participant lasting between 45â90 minutes. We utilized the online videoconferencing platform Zoom to conduct and record the interviews. First-round interviews consisted of four open-ended questions (see Appendix) that allowed participants to explore the experience of simultaneous supervision in detail (Pietkiewicz & Smith, 2014). These questions were open-ended to allow participants to explore the how of the phenomenon (Miller et al., 2018). The final interview questions were developed through initial generation based off research and personal experiences with the phenomenon, refinement in consultation with the research advisor, and interview piloting with volunteer students who did not participate in the study. Research participants were asked about their overall experience with having multiple supervisors, benefits and detriments of simultaneous supervision, and the meaning they made as a result of experiencing simultaneous supervision. Second-round interview questions were developed based on participant responses to first-round interview questions. After two rounds of interviews and analysis, we conducted a final member check to confirm themes. All participants expressed that the developed themes were illustrative of their lived experiences with simultaneous supervision.
Data Analysis
    We followed IPAâs 6-step analysis process as outlined by Smith et al. (2009) and added a seventh step with the use of the U-heuristic analysis for group research teams (Koltz et al., 2010). Our process consisted of first coding and contextualizing the data individually, followed by group analysis, triangulated with the fifth author, Kleist, as research advisor. We completed this process for each participant and then analyzed themes across participants as suggested by Smith et al. We reached consensus that four superordinate themes emerged with 11 subthemes across the two rounds of interviews. All participants endorsed agreement with the themes from their experiences in simultaneous supervision during the member check process.
Trustworthiness
    We integrated Lincoln and Gubaâs (1985) framework in conducting multiple procedures for establishing trustworthiness and credibility. We demonstrated prolonged engagement and persistent observation through consistent coding meetings over the span of 1 year. Additionally, we adapted the U-heuristic analysis process during data analysis to analyze data individually and collectively to strengthen the credibility of our findings (Koltz et al., 2010). Finally, after we developed the themes, we triangulated the results with participants via a member check, ensuring the individual and group themes matched their idiographic experiences.
We bridled our personal experiences with simultaneous supervision throughout the research process. Bridling recognizes that researchers have had close personal experiences with the phenomenon and that bias is best managed by recognition rather than elimination (Stutey et al., 2020). The four principal investigators, Lane, Hakenewerth, Frank, and Davis-Price, individually engaged in memo writing, discussed personal reactions to the data, and participated in group discussions regarding meaning-making of the phenomenon with Kleist serving as research advisor.
Results
Our data analysis produced four superordinate themes identified across all cases. These themes were (a) making sense of multiple perspectives, (b) orchestrating the process, (c) supervisory relationship dynamics, and (d) personal dispositions and characteristics. In the sections that follow, each theme is described in further detail and exemplar quotes are given to support their development.
Making Sense of Multiple Perspectives
    Making sense of multiple perspectives was defined as the receipt and conceptualization of supervisory feedback from multiple supervisors during the same academic semester. Supervisees identified their supervisors as having differing professional orientations. At times, these differing backgrounds led to supervisors providing differing opinions for the same client.
Participants used metaphors to make meaning of the distinct offerings of their supervisorsâ feedback. An example of capturing multiple perspectives was one participant, Emma, utilizing the ancient Indian parable of âThe Blind Men and the Elephantâ (Saxe, 1868): âThe point of the story is all the world religions might have a piece of the picture of God, you know. And so between all of us [clinicians and supervisors] together, maybe we have a perspective of truth.â Through retelling of the Indian fable, this participant was able to vividly capture her personal perspective of differing viewpoints through an integrative lens as opposed to a conflict of ideas. Within this superordinate theme, the two subthemes of supervisee framing and safety net vs. minefield emerged.
Supervisee Framing
    Supervisee framing focused on the participantâs personal view of hearing multiple perspectives from supervisors within simultaneous supervision. Some participants described hearing varying perspectives as being helpful and valuable, providing support, and increasing confidence. They typically framed the idea of receiving various feedback as a way to gain ideas and then make their own informed decisions. Molly shared this positive perspective when she stated, âI like coming to [my differing supervisors] with different issues I have with different clients because I feel like they both have valuable experience, but in different ways.â In contrast, Hailey identified multiple perspectives as being âreally difficult,â and Diana noted they were âmore frustrating than beneficialâ and confusing. Similarly, Hailey stated, âMy supervisors are all very different, so they give me different feedback, and a lot of times it conflicts with what the other one has said.â The superviseeâs framing of discrepant feedback impacted their overall perceptions with simultaneous supervision. Supervisees either valued or were confused by the feedback. Generally, participants spoke of times when multiple perspectives were beneficial and difficult, but it appeared all participants were left with the task of making sense of multiple perspectives while receiving simultaneous supervision.
Safety Net vs. Minefield
    Making sense of multiple perspectives was described as creating a safety net of support, while others found the experience to be a minefield that increased confusion, ambiguity, and isolation. Emma and Molly characterized their experience as providing support in an often overwhelming profession. Molly articulated, âI feel like if I didnât have that good support, that good foundation, I donât think I could do it because itâs just so much.â She later added, âI feel like getting those different perspectives, getting that support, getting those encouragers is beneficial because I donât feel as overwhelmed, even though itâs overwhelming.â
Participants also perceived their simultaneous supervision as a minefield wherein they believed they were in double binds. Hailey reflected on an experience when her supervisors contradicted each other and expressed, âIt just sucked because I was doing what my supervisor told me to do and suggested I do, and then I was told everything I did was wrong.â Diana echoed that discrepant feedback felt like a constant dilemma needing to be managed âcarefully.â In reflecting on contradicting supervision, Diana said, âItâs hard because everybody has their own thing. . . . You just kind of have to appease everyone.â In the face of conflict, it was easier to placate than resolve. Participantsâ cognitive framing was a major element of the phenomenon. Whereas making sense of multiple perspectives focused on the cognitive elements of receiving feedback from different supervisors, the next theme focused on the behavioral elements.
Orchestrating the Process
    Another theme that emerged in our data analysis was that of supervisees orchestrating the process of simultaneous supervision. This theme revolved around action-oriented steps in supervision. The essence of this theme was captured when Hailey acknowledged the need for âchecking her motivesâ on what she shared with different supervisors. She asked herself, âAm I sharing this with this [supervisor] because I feel like theyâre going to answer in the way that I feel like . . . they should answer, because itâs easier for me?â Hailey acknowledged the difficulty in this, countering with, âOr am I just going to them because itâs that person that Iâm supposed to see?â Hailey recognized that having options when it came to approaching supervisors meant that disclosure needed to be intentional rather than straightforward as it is when CITs only have one choice. Participants were aware of their process as they picked and chose what to share with whom, through seeking out a preferred supervisor and through managing the practical aspects of having multiple supervisors. The subthemes of picking and choosing, seeking a preferred perspective, and managing practical considerations were a part of orchestrating the process.
Picking and Choosing
    The subtheme of picking and choosing emerged in how our participants described what they would share in supervision and the course of action taken in their counseling practice. This subtheme was labeled as an in vivo code, derived from Haileyâs quote: âSo I definitely pick and choose what I talk to about each one. Becauseâthis sounds terribleâbut I respect the one [supervisor] more.â Hailey also described feelings of vulnerability and self-efficacy from week to week, related to her reactions from feedback: âI knew after having such a hard supervision last week showing tape, I was like, âI cannot be super vulnerable right now. I need to choose something thatâs more surface level.ââ Molly experienced picking and choosing as a means of proactively managing the repetitive nature of supervision: âI think just bringing different things to different supervisors is really helpful, and not constantly talking about the same client or the same situation, because that gets obnoxious and repetitive, and youâre gonna get a hundred different opinions.â
After receiving feedback, participants had varying perspectives on how to integrate and transfer constructs into action. Some participants viewed discrepant feedback as mutually exclusive, whereas others had a more integrative perspective. Molly expressed frustration in choosing between differing feedback from multiple supervisors: âSometimes I donât really know which I should go with, which I should choose, and which would be best for the client. . . . Itâs like a double-edged sword, like itâs good at some points, but then bad at others.â Diana, who expressed similar frustration in choosing between perspectives, relieved this tension by resolving that, âI have to live with myself at the end of the day, so as long as itâs not unethical, I donât worry about it too much. And as far as the stuff that Iâm told that needs to be done, I do what I can.â Other participants espoused a much more integrative perspective. Emma stated, âI think the thing I like the best about it is actually when [my supervisors] have different advice . . . because then I feel like between the two, I can kind of find what I really like.â All participants spoke about selecting what to share with supervisors and choosing how to integrate feedback into action.
Seeking a Preferred Perspective
    Coinciding with picking and choosing, participants also sought a preferred perspective in the process of receiving simultaneous supervision and orchestrating the process. Some reported the decision to go to one supervisor over another was situationally based and determined by clinical skill or specialty of the supervisor. Diana captured this as follows, âWell, I can have a conversation with either. I just get very different answers. If itâs the technical stuff of what has to be doneâher. If itâs âhow would you approach the situation?â I do tend to talk to him.â Diana also likened seeking a preferred perspective to a child searching for a desired answer: âItâs like, who do I want to talk to? Itâs almost like, talk to the person you want for the answer you want. Itâs like, âWell, if Mom doesnât have the right answer, go talk to Dad.ââ
Managing Practical Considerations
    All participants spoke to the practicality of meeting with multiple supervisors. Even though some participants strongly valued having multiple supervisors, all participants spoke to the larger time commitment needed in having simultaneous supervision. Molly captured how simultaneous supervision felt overwhelming, adding to the many other sources of feedback she received: âI already have two group supervisions. Iâve heard opinions about this, and Iâm hearing other perspectives of my classmates, of my coworkers. Now I have to have triadic and hear their opinions and have individual. . . . Itâs just a lot.â Emma framed this time commitment as detracting from her other obligations: âIt just starts adding up. Like, my whole Tuesday evenings are gone, and thatâs time I could be seeing clients.â Hailey expressed frustration about the obligatory nature and placating to the programâs requirement to see multiple supervisors: âHonestly, I just give the other supervisor little things because I know I have to talk to him . . . and itâs more, like, checking a box.â Finally, Emma captured how this time commitment was epitomized in documentation: âAnd the paperwork got exhausting, too, because I had to do everything in triplicate sometimes.â She further talked about the additional mental labor: âAnd now what are we gonna talk about since I just talked about all of this with [a different supervisor] and feel like I found good solutions, you know?â Supervisees had to manage their time and fit more supervision into their schedules. Simultaneous supervision added complexity, and participants needed to orchestrate this process to manage it efficiently and effectively.
Supervisory Relationship Dynamics
    Supervisory relationship dynamics was determined to be a superordinate theme as it reflected on the connecting and disconnecting elements of the supervisory relationship. This theme was broken into three subthemes. The subthemes of vulnerability, power dynamics, and systems of supervision illustrated the relational dynamics within simultaneous supervision.
Vulnerability
    In supervisory relationships, feelings of safety and vulnerability influenced interactions with different supervisors. To illustrate, Hailey noted:
There are certain supervisors I feel more safe with. And so those are the ones that I share more with . . . versus some of them I feel less safe with . . . I donât share as much with them that is vulnerable, or that makes me vulnerable.
Participant experiences highlighted how vulnerability dictated what and how elements were shared in simultaneous supervision.Â
Power Dynamics
    The determination of safety occurred within power dynamics. Diana commented that multiple supervisors serving as evaluators and gatekeepers can create âthis weird relationship where you donât want to be too vulnerable because this person is also your boss and can decide if you are going to stay in that position or not.â Diana and Hailey noted feeling disempowered and disengaged from supervision, referring to supervisors as âbossesâ throughout their interviews. When participants perceived their supervision as a firmly directive process, discrepant directives were especially distressing. Diana rephrased this sentiment: âI guess the best thing to compare it to would be if you have more than one boss, but they all give you a different, âI want this, I want this, I want this.ââ Emmaâs experience was more accordant, and she specifically expressed at one time, âNone of [my supervisors] are really super bossy either.â Participants identified power dynamics as salient aspects of how they experienced supervision and with whom they connected. Working with more than one supervisor sometimes resulted in characterization of âgoodâ and âbadâ supervisors, making individual supervisory relationship dynamics crucial.
Systems of Supervision
    Participants conceptualized the phenomenon as broader systems of supervision in which individual supervisors were interacting with each other. Emma noted, âThe two faculty supervisors work very closely together and I assume talk all the time.â Emma and Molly provided multiple examples of supervisors working together to best serve clients, thus bolstering supervision through their combined expertise. Molly stated, âIt was nice because [my two supervisors] were in agreement and I felt comfortable going into session with [my client].â Even negative experiences contributed to systems of supervision. Hailey reported seeking out additional support when her assigned supervisory relationships did not meet her needs, widening the reach of simultaneous supervision even more: âBy not being a good supervisor, he helps me seek out other resources and figure it out for myself.â Finally, Molly noted that supervisor coordination was primarily for evaluation at the end of the semester and only if problems arose. However, she imagined what it would be like if they were more collaborative:
They would have had a better understanding of the way I work in a counseling room. . . . Because my site supervisor really understood how I approached things and the way I would interact with my clients, but I feel like my university supervisor didnât really, like, she had little snippets of what I was like in a counseling room.
Power, vulnerability, and systems in the supervisory relationship impacted supervisees from multiple levels in their clinical journey.
Personal Dispositions and Characteristics
    Personal dispositions and characteristics resulted from participants speaking about the phenomenon as well as what they said about their supervisors. Three dispositions that emerged as relevant were tolerance for ambiguity, curiosity, and availability. The first two subthemes were identified as they spoke about the phenomenon and the third subtheme was a characteristic present because of the nature of simultaneous supervision.
Tolerance for Ambiguity
    Tolerance for ambiguity was found to be a critical disposition. This disposition allowed participants to see differences in opinion as helpful. Emma shared that she âvery rarelyâ saw people as giving her âconflicting information.â She said that she saw it as everybody having their own perspective. This connected to her ability to view multiple perspectives as âpieces of the puzzle,â as she expressed earlier in her retelling of the Indian fable. Although participants sometimes expressed concern about direction, Diana shared, âYou can ask questions and you can not know and itâs okay.â This disposition directly related to how they reconciled and then reacted to multiple perspectives of simultaneous supervisors.
Curiosity
    Curiosity also manifested more implicitly with supervisees. Participants showed curiosity by taking interest in what supervisors had to say, seeking more information, or staying open to difficult feedback. Hailey shared that simultaneous supervision âdefinitely requires a lot of continuing to look inward and examining your motives and yourself and what the supervisors have said.â In speaking more broadly, Emma shared, âSo I donât think Iâll ever give [simultaneous supervision] up now that Iâve kind of experienced how valuable it is to get another professional opinion.â Curiosity manifested itself as a transient characteristic for other participants. Diana experienced transference with one of her supervisors, which was a barrier to her ability to exhibit this helpful disposition. One of her supervisors suggested that she try and work things out with another supervisor she was having difficulty with, to which Diana said, âNo. Who is gonna walk into their supervisor and be like, âOkay, so my problem with you is youâre a bitch. You remind me of my abusive ex.â . . . But at the same time, I have to work with her.â This was an example of Diana demonstrating a closing off to feedback. Both tolerance for ambiguity and curiosity manifested and impacted their experience of multiple perspectives.
Availability
    An important disposition was emotional and physical availability. Emma expressed that âthereâs always somebody I can get a hold of.â Hailey expressed that she had âmore coverage just in general,â but also questioned her supervisorsâ true availability: âDo I even need to bring this to supervision or can I work on this on my own? Because sometimes I feel like I annoy them.â All participants expressed that availability was important to their experience, although physical availability did not always translate to being available to discuss what the supervisee wanted. Those participants who identified supervisors within simultaneous supervision as being more available had more positive thoughts regarding simultaneous supervision.
Discussion
All four participants identified the complex position of CITs receiving supervision from more than one supervisor. The results align with the growing body of literature affirming the importance of a positive working relationship between CITs and supervisors (Bernard & Goodyear, 2019; Borders et al., 2014; Sterner, 2009) as well as significant differences between faculty and site supervision (Borders, 2006; Dodds, 1986). The results parallel supervision literature detailing the multiple roles of supervisees (Bernard & Goodyear, 2019) who, unlike supervisors, are not required to have specific education in supervision. The theme of personal dispositions has been studied extensively in counselor education, resulting in prominent placement in clinical assessment instruments (Lambie et al., 2018). The presented themes diverge from the current research base in their construction of a clear model of simultaneous supervision. The subthemes of picking and choosing, seeking a preferred perspective, and systems of supervision illustrate the interpersonal dynamics of simultaneous supervision that is distinct from sole supervision, an underrepresented phenomenon in the supervision literature. Participants in this study reported mixed feelings with simultaneous supervision. Four primary themes emerged from this study: making sense of multiple perspectives, orchestrating the process, supervisory relationship dynamics, and personal dispositions and characteristics. These four themes encompass many areas of the supervisory experience while illuminating guidelines for supervisors engaging in simultaneous supervision.
Implications
    Results from this study reinforce the complex levels of integration CITs experience when receiving supervision from multiple supervisors. This process of integration can lead to confusion, ambiguity, and also deeper understanding. The results indicate that the perceived benefit of simultaneous supervision was often based on the relationship between the supervisor and CIT, ability and support to organize the process, and the personal dispositions of the CIT. The implications for this research target three populations.
Supervisors
    The findings of this study indicate several implications for supervisors working with clinicians receiving simultaneous supervision. First and foremost, the critical importance of the supervisory relationship to supervision in general (Bernard & Goodyear, 2019) was further substantiated as a foundation for effective simultaneous supervision. Questionable supervisee behaviors such as intentional nondisclosure via seeking a preferred perspective or picking and choosing can be avoided through purposefully fostering trust in the relationship. Similarly, supervisors may support the perspective of simultaneous supervision as a safety net if support for vulnerability is established and the relationship is actively attended to. Supervisors should be mindful of their availability to CITs and periodically check in to see if they are meeting the needs of the supervisee.
Supervisors who are aware of the themes developed from this research may be better equipped to capitalize on benefits and mitigate challenges. One benefit was that simultaneous supervision allowed participants to receive multiple synergistic perspectives regarding their work with clients. Depending on the developmental level of the supervisee and the demeanor of the supervisor, however, these multiple perspectives may present challenges. Supervisors can apply their knowledge of developmental models to tailor their interventions. Supervisors might anticipate that CITs earlier in development (e.g., in practicum) may require structured support in simultaneous supervision to avoid performance anxiety and frustration from rigid applications of multiple perspectives consistent with this stage (Stoltenberg & McNeill, 2010). Supervisors may also wish to focus supervision on interventions that actively facilitate development of these dispositions, such as employing constructivism to elicit greater cognitive flexibility (Bernard & Goodyear, 2019).
Some early-stage supervisees may experience challenges when navigating varying perspectives and feedback provided to them by multiple supervisors. Challenges can be mitigated when supervisors broach the topic of simultaneous supervision with supervisees early. Additionally, when supervisors ensure they respect other supervisors and create collaborative relationships, supervisee difficulty with simultaneous supervision may decrease. When a supervisor learns of a differing opinion of another supervisor, it is important that it is broached as a variance in approach rather than an incorrect practice. Supervisees experiencing difficulties with simultaneous supervision may also benefit from supervisors checking in with them regarding the variable feedback they are receiving. A collaborative supervisory system may strengthen supervisee development and integration of counseling constructs. Counseling programs can play a key role in setting systemic expectations for supervisors and supervisees.
Counselor Education Programs
    Accredited counselor education programs have autonomy in how they meet various CACREP (2015) supervision and clinical requirements. Programs may choose to require simultaneous supervision, may require multiple clinical sites, and may utilize faculty advising as supplementary clinical supervision. In unique situations such as students completing two tracks or receiving additional supervision for gatekeeping reasons, how programs manage simultaneous supervision can become complex. Best practice guidelines, policies, and procedures regarding simultaneous supervision can be made clear in clinical handbooks, with clinical coordinators, and in material for site supervisors. This would help to address the supervisee confusion from the programmatic side. Another important implication with simultaneous supervision is to consider the supervisory process through a systemic lens. When simultaneous supervision is utilized, there will be many interactions occurring outside of the dyad or triad apparent to one individual supervisor. When supervisors collaborate and communicate, supervisees may be more likely to receive congruent feedback, understand gatekeeping action, and receive consistent expectations. In particular, communication between academic and clinical supervisors can bridge the gap between idealism and practicality (Bernard & Goodyear, 2019; Choate & Granello, 2006). Programmatically mandated, semesterly site visits and opportunities for regular check-ins could fulfill this purpose.
Supervisees
    Participants often spoke to the challenge of organizing simultaneous supervision effectively in relation to feedback, documentation, and case presentation material. Although a certain level of organizational skill is expected of graduate students, the coordination required in simultaneous supervision often seemed unanticipated and unwieldy for students. Preparing for the supervision experience in another course and/or an orientation in lab supervision may aid in this. All participants discussed, at varying distress levels, how having supervision scheduled too close together (e.g., same day or two days in a row) increased repetitiveness and thus made simultaneous supervision feel less efficacious. Supervisees may want to intentionally schedule supervision sessions spaciously to avoid potential repetition or redundancy. With the steady increase in virtual supervision, scheduling supervision in ideal time frames may be easier with increased access and absent travel time. Programmatic preparation, intentional scheduling, and collaborative supervision notes may aid the simultaneous supervision process.
In the areas of core dispositions, CITs who embraced ambiguity and fostered reflexivity, curiosity, and flexibility tended to navigate simultaneous supervision with more ease. Reflexivity, curiosity, and tolerance for ambiguity seemed to strengthen the ability to receive feedback from multiple sources, integrate feedback appropriately, and maintain strong supervisory relationships. A typical guiding question from participants was, âHow can I apply this combined feedback to my particular site and client while still maintaining my own clinical identity?â Necessarily, students will enter a program with differing levels of core strengths, yet any student can be encouraged to strengthen their core dispositions. Supervisees are encouraged to think about simultaneous supervision with the same organization and openness required for other courses such as pre-practicum and multicultural counseling. Correspondingly, supervisors have complex responsibilities maintaining ethical competent care, organizing supervision, and fostering these core dispositions.
Ethical Implications of Simultaneous Supervision
    In addition to recommendations for the three populations above, findings from this study highlight ethical considerations. Worthington et al. (2002) identified âintentional nondisclosure of important informationâ (p. 326) and âinappropriate methods of managing conflict with supervisorsâ (p. 329) as two major ethical issues that are unique to supervisees and correlate with some of the participant superviseesâ experiences of triangulating supervisors, seeking outside consultation to circumvent supervisors, or intentionally withholding information. To ensure client welfare, supervisors and supervisees may benefit from explicitly discussing ethical implications and considerations unique to this phenomenon at the outset of supervision and again when conflicts arise. Future research that addresses limitations of this study will further clarify the role of supervisors, supervisees, and programs in simultaneous supervision as well as specific ethical guidelines.
Limitations and Future Directions
    Limited information was gathered about the specific counselor education programs in which our participants were enrolled, restricting the inferences able to be made about simultaneous supervision in context. We also chose a convenience sampling method using CESNET and selected four participants. The choice of indirect sampling, primarily through counselor educators redirecting calls to their students, may have limited participants. Further, all participants of this study identified as the same gender and race, which limits the diversity of experience shared. Future researchers may consider sampling more participants to get a broader exploration of the phenomenon. In doing so, researchers may be able to obtain greater representation in gender and race to increase the transferability of this study.
This study focused on the phenomenon of simultaneous supervision as experienced within individual and triadic supervision. Simultaneous supervision is embedded within the broader experience of supervision, and isolating the phenomenon required vigilance by the researchers. Future researchers would benefit from intentional follow-up questions that better focus participants on simultaneous supervision rather than individual experiences with supervisors. As our study did not explicitly ask participants to distinguish between university-affiliated and site supervisors, future researchers may pursue a qualitative study that highlights the difference. Other research may utilize grounded theory to develop a model of simultaneous supervision for supervisors and supervisees to follow or focus explicitly on supervisorsâ perspectives of simultaneous supervision. Quantitative research may illuminate the frequency and use of simultaneous supervision in counselor education programs overall or identify correlations between counselor dispositions such as tolerance for ambiguity and supervision outcomes in simultaneous supervision. Because of the lack of information regarding the phenomenon of simultaneous supervision, many opportunities for research regarding the phenomenon persist.
Conclusion
Overall, the findings from this research indicate CITs valued greater support and thrived when integrating âboth/and thinkingâ in navigating feedback from multiple supervisors. This perspective reinforces the need for systemic communication among counselor educators and supervisors. Additionally, results suggest CITs would benefit from supervisors broaching the topic of simultaneous supervision early in their clinical experience.
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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William B. Lane, Jr., PhD, NCC, BC-TMH, LPCC, is an assistant professor at Western New Mexico University. Timothy J. Hakenewerth, PhD, NCC, LPC, is an assistant professor at the University of Illinois Springfield. Camille D. Frank, PhD, NCC, LMHC, LPC, is an assistant professor at Eastern Washington University. Tessa B. Davis-Price, PhD, LMHC, LCPC, is an assistant professor at Saint Martinâs University. David M. Kleist, PhD, LCPC, is a professor and department chair at Idaho State University. Steven J. Moody, PhD, is a clinical professor at Adams State University. Correspondence may be addressed to William B. Lane, Jr., 1000 W College Ave, Silver City, NM 88061, william.lanejr@wnmu.edu.
Appendix
Interview Protocol
| Interview Questions |
| Round 1 |
| What has been your experience with having multiple simultaneous supervisors?
In your own experience, how has simultaneous supervision been a strength?
In your own experience, how has simultaneous supervision been challenging?
What have you learned about yourself and the counseling profession as youâve experienced simultaneous supervision? |
| Round 2 |
| How has having simultaneous supervision been different from times when you have only had one supervisor?
What has it been like to have your supervisors interact with each other in regard to the supervision that you have received from them?
What personal dispositions (characteristics/qualities) do you think you have that influenced your experience of simultaneous supervision?
How has simultaneous supervision impacted your experience of safety or vulnerability in supervision?
What practical considerations have you needed to consider for having multiple simultaneous supervisors? |
Nov 9, 2022 | Volume 12 - Issue 3
Melissa J. Fickling, Matthew Graden, Jodi L. Tangen
The purpose of this phenomenological study was to explore how feminist-identified counselor educators understand and experience power in counselor education. Thirteen feminist women were interviewed. We utilized a loosely structured interview protocol to elicit participant experiences with the phenomenon of power in the context of counselor education. From these data, we identified an essential theme of analysis of power. Within this theme, we identified five categories: (a) definitions and descriptions of power, (b) higher education context and culture, (c) uses and misuses of power, (d) personal development around power, and (e) considerations of potential backlash. These categories and their subcategories are illustrated through narrative synthesis and participant quotations. Findings point to a pressing need for more rigorous self-reflection among counselor educators and counseling leadership, as well as greater accountability for using power ethically.
Keywords: counselor education, power, phenomenological, feminist, women
    The American Counseling Association (ACA; 2014) defined counseling, in part, as âa professional relationship that empowersâ (p. 20). Empowerment is a process that begins with awareness of power dynamics (McWhirter, 1994). Power is widely recognized in counselingâs professional standards, competencies, and best practices (ACA, 2014; Association for Counselor Education and Supervision [ACES], 2011; Council for the Accreditation of Counseling and Related Educational Programs [CACREP], 2015) as something about which counselors, supervisors, counselor educators, and researchers should be aware (Bernard & Goodyear, 2014). However, little is known about how power is perceived by counselor educators who, by necessity, operate in many different professional roles with their students
(e.g., teacher, supervisor, mentor).
In public discourse, power may carry different meaning when associated with men or women. According to a Pew Research Center poll (K. Walker et al., 2018) of 4,573 Americans, people are much more likely to use the word âpowerfulâ in a positive way to describe men (67% positive) than women (8% positive). It is possible that these associations are also present among counselors-in-training, professional counselors, and counselor educators.
Dickens and colleagues (2016) found that doctoral students in counselor education are aware of power dynamics and the role of power in their relationships with faculty. Marginalized counselor educators, too, experienced a lack of power in certain academic contexts and noted the salience of their intersecting identities as relevant to the experience of power (Thacker et al., 2021). Thus, faculty members in counselor education may have a large role to play in socializing new professional counselors in awareness of power and positive uses of power, and thus could benefit from openly exploring uses of power in their academic lives.
Feminist Theory and Power in Counseling and Counselor Education
    The concept of power is explored most consistently in feminist literature (Brown, 1994; Miller, 2008). Although power is understood differently in different feminist spaces and disciplinary contexts (Lloyd, 2013), it is prominent, particularly in intersectional feminist work (Davis, 2008). In addition to examining and challenging hegemonic power structures, feminist theory also centers egalitarianism in relationships, attends to privilege and oppression along multiple axes of identity and culture, and promotes engagement in activism for social justice (Evans et al., 2005).
Most research about power in the helping professions to date has been focused on its use in clinical supervision. Green and Dekkers (2010) found discrepancies between supervisorsâ and superviseesâ perceptions of power and the degree to which supervisors attend to power in supervision. Similarly, Mangione and colleagues (2011) found another discrepancy in that power was discussed by all the supervisees they interviewed, but it was mentioned by only half of the supervisors. They noted that supervisors tended to minimize the significance of power or express discomfort with the existence of power in supervision.
Whereas most researchers of power and supervision have acknowledged the supervisorâs power, Murphy and Wright (2005) found that both supervisors and supervisees have power in supervision and that when it is used appropriately and positively, power contributed to clinical growth and enhanced the supervisory relationship. Later, in an examination of self-identified feminist multicultural supervisors, Arczynski and Morrow (2017) found that anticipating and managing power was the core organizing category of their participantsâ practice. All other emergent categories in their study were different strategies by which supervisors anticipated and managed power, revealing the centrality of power in feminist supervision practice. Given the utility of these findings, it seems important to extend this line of research from clinical supervision to counselor education more broadly because counselor educators can serve as models to students regarding clinical and professional behavior. Thus, understanding the nuances of power could have implications for both pedagogy and clinical practice.
Purpose of the Present Study
    Given the gendered nature of perceptions of power (Rudman & Glick, 2021; K. Walker et al., 2018), and the centrality of power in feminist scholarship (Brown, 1994; Lloyd, 2013; Miller, 2008), we decided to utilize a feminist framework in the design and execution of the present study. Because power appears to be a construct that is widely acknowledged in the helping professions but rarely discussed, we hope to shed light on the meaning and experience of power for counselor educators who identify as feminist. We utilized feminist self-identification as an eligibility criterion with the intention of producing a somewhat homogenous sample of counselor educators who were likely to have thought critically about the construct of power because it figures prominently in feminist theories and models of counseling and pedagogy (Brown, 1994; Lloyd, 2013; Miller, 2008).
Method
We used a descriptive phenomenological methodology to help generate an understanding of feminist faculty membersâ lived experiences of power in the context of counselor education (Moustakas, 1994; Padilla-DĂaz, 2015). Phenomenological analysis examines the individual experiences of participants and derives from them, via phenomenological reduction, the most meaningful shared elements to paint a portrait of the phenomenon for a group of people (Moustakas, 1994; Starks & Trinidad, 2007). Thus, we share our findings by telling a cohesive narrative derived from the data via themes and subthemes identified by the researchers.
Sample
    After receiving IRB approval, we recruited counselor educators via the CESNET listserv who were full-time faculty members (e.g., visiting, clinical, instructor, tenure-track, tenured) in a graduate-level counseling program. We asked for participants of any gender who self-reported that they integrated a feminist framework into their roles as counselor educators. Thirteen full-time counselor educators who self-identified as feminist agreed to be interviewed on the topic of power. All participants were women. Two feminist-identified men expressed initial interest in participating but did not respond to multiple requests to schedule an interview. The researchers did not systematically collect demographic data, relying instead on voluntary participant self-disclosure of relevant demographics during the interviews. All participants were tenured or tenure-track faculty members. Most were at the assistant professor rank (n = 9), a few were associate professors (n = 3), and one was a full professor who also held various administrative roles during her academic career (e.g., department chair, dean). During the interviews, several participants expressed concern over the high potential for their identification by readers due to their unique identities, locations, and experiences. Thus, participants will be described only in aggregate and only with the demographic identifiers volunteered by them during the interviews. The participants who disclosed their race all shared they were White. Nearly all participants disclosed holding at least one marginalized identity along the axes of age, disability, religion, sexual orientation, or geography.
Procedure
    Once participants gave informed consent, phone interviews were scheduled. After consent to record was obtained, interviewers began the interviews, which lasted between 45â75 minutes. We utilized an unstructured interview format to avoid biasing the data collection to specific domains of counselor education while also aiming to generate the most personal and nuanced understandings of power directly from the participantsâ lived experiences (Englander, 2012). As experienced interviewers, we were confident in our ability to actively and meaningfully engage in discourse with participants via the following prompt: âWe are interested in understanding power in counselor education. Specifically, please speak to your personal and/or professional development regarding how you think about and use power, and how you see power being used in counselor education.â After the interviews, we all shared the task of transcribing the recordings verbatim, each transcribing several interviews. All potentially identifying information (e.g., names, institutional affiliations) was excluded from the interview transcripts.
Data Analysis
    Data analysis began via horizontalization of two interview transcripts by each author (Moustakas, 1994; Starks & Trinidad, 2007). Next, we began clustering meaning units into potential categories (Moustakas, 1994). This initially revealed 21 potential categories, which we discussed in the first research team meeting. We kept research notes of our meetings, in which we summarized our ongoing data analysis processes (e.g., observations, wonderings, emerging themes). These notes helped us to revisit earlier thinking around thematic clustering and how categories interrelated. The notes did not themselves become raw data from which findings emerged. Through weekly discussions over the course of one year, the primary coders (Melissa Fickling and Matthew Graden) were able to refine the categories through dialoguing until consensus was reached, evidenced by verbal expression of mutual agreement. That is, the primary coders shared power in data analysis and sometimes tabled discussions when consensus was not reached so that each could reflect and rejoin the conversation later. As concepts were refined, early transcripts needed to be re-coded. Our attention was not on the quantification of participants or categories, but on understanding the essence of the experience of power (Englander, 2012; Moustakas, 1994). The themes and subthemes in the findings section below were a fit for all transcripts by the end of data analysis.
Researchers and Trustworthiness
    Fickling and Jodi Tangen are White, cis-hetero women, and at the time of data analysis were pre-tenured counselor educators in their thirties who claimed a feminist approach in their work. Graden was a masterâs student and research assistant with scholarly interests in student experiences related to gender in counseling and education. We each possess privileged and marginalized identities, which facilitate certain perspectives and blind spots when it comes to recognizing power. Thus, regular meetings before, during, and after data collection and analysis were crucial to the epoche and phenomenological reduction processes (Moustakas, 1994) in which we shared our assumptions and potential biases. Fickling and Graden met weekly throughout data collection, transcription, and analysis. After the initial research design and data collection, Tangen served primarily as auditor to the coding process by comparing raw data to emergent themes at multiple time points, reviewing the research notes written by Fickling and Graden and contributing to consensus-building dialogues when needed.
Besides remaining cognizant of the strengths and limitations of our individual positionalities with the topic and data, we shared questions and concerns with each other as they arose during data analysis. Relevant to the topic of this study, Fickling served as an administrative supervisor to Graden. This required acknowledgement of power dynamics inherent in that relationship. Graden had been a doctoral student in another discipline prior to this study and thus had firsthand context for much of what was learned about power and its presence in academia. Fickling and Gradenâs relationship had not extended into the classroom or clinical supervision, providing a sort of boundary around potential complexities related to any dual relationships. To add additional trustworthiness to the findings below, we utilized thick descriptions to describe the phenomenon of interest while staying close to the data via quotations from participants. Finally, we discuss the impact and importance of the findings by highlighting implications for counselor educators.
Findings
Through the analysis process, we concluded that the essence (Moustakas, 1994)âor core themeâof the experience of power for the participants in this study is engagement in a near constant analysis of powerâthat of their colleagues, peers, students, as well as of their own power. Participants analyzed interactions of power within and between various contexts and roles. They shared many examples of uses of powerâboth observed and personally enactedâwhich influenced their development, as well as their teaching and supervision styles. Through the interviews, participants shared the following:
(a) definitions and descriptions of power, (b) higher education context and culture, (c) uses and misuses of power, (d) personal development around power, and (e) considerations of potential backlash. These five categories comprised the overarching theme of analysis of power and are described below with corresponding subcategories where applicable, identified in italics.
Definitions and Descriptions of Power
    Participants spent much of their time defining and describing just what they meant when they discussed power. For the feminist counselor educators in this study, power is about helping. One participant, when describing power, captured this sentiment well when she said, âI think of the ability to affect change and the ability to have a meaningful impact.â Several participants shared this same idea by talking about power as the ability to have influence. Participants expressed a desire to use power to do good for others rather than to advance their personal aspirations or improve their positions. Use of power for self-promotion was referenced to a far lesser extent than using power to promote justice and equity, and any self-promotional use was generally in response to perceived personal injustice or exploitation. At times, participants described power by what it is not. One participant said, âI donât see power as a negative. I think it can be used negatively.â Several others shared this sentiment and described power as a responsibility.
In describing power, participants identified feelings of empowerment/disempowerment (Table 1). Disempowerment was described with feeling words that captured a sense of separation and helplessness. Empowerment, on the other hand, was described as feeling energetic and connected. Not only was the language markedly different, but the shifts in vocal expression were also notable (nonverbals were not visible) when participants discussed empowerment versus disempowerment. Disempowerment sounded like defeat (e.g., breathy, monotone, low energy) whereas empowerment sounded like liveliness (e.g., resonant, full intonation, energetic).
Table 1
Empowered and Disempowered Descriptors
| Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Descriptors |
| Empowered |
Disempowered |
| Authentic
Free
Good
Heard
Congruent
Genuine
Selfless
Hopeful
Confident
Serene
Connected
Grounded
Energized |
Isolated
Disenfranchised
Anxious
Separated Identity
Not Accepted
Disheartened
Helpless
Small
Weak
Invisible
Wasting Energy
Tired
Powered Down |
Participants identified various types of power, including personal, positional, and institutional power. Personal power was seen as the source of the aspirational kinds of power these participants desired for themselves and others. It can exist regardless of positional or institutional power. Positional power provides the ability to influence decisions, and it is earned over time. The last type of power, institutional, is explored more through the next theme labeled higher education context and culture.
Higher Education Context and Culture
    Because the focus of the study was power within counselor educatorsâ roles, it was impossible for participants not to discuss the context of their work environments. Thus, higher education context and culture became a salient subtheme in our findings. Higher education culture was described as âthe way things are done in institutions of higher learning.â Participants referred to written/spoken and unwritten/silent rules, traditions, expectations, norms, and practices of the academic context as barriers to empowerment, though not insurmountable ones. Power was seen as intimately intertwined with difficult departmental relationships as well as the roles of rank and seniority for nearly all participants. Most also acknowledged the influence of broader sociocultural norms (i.e., local, state, national) on higher education in general, noting that institutions themselves are impacted by power dynamics.
One participant who said that untenured professors have much more power than they realize also said that âpower in academia comes with rank.â This contradiction highlights the tension inherent in power, at least among those who wish to use it for the âgreater goodâ (as stated by multiple participants) rather than for personal gain, as these participants expressed.
More than one participant described power as a form of currency in higher education. This shared experience of power as currency, either through having it or not having it, demonstrated that to gain power to do good, as described above, one must be willing or able to be seen as acceptable within the system that assigns power. Boldness was seen by participants as something that can happen once power is gained. Among non-tenured participants, this quote captures the common sentiment: âNow, once I get tenure, that can be a different conversation. I think I would feel more emboldened, more safe, if you will, to confront a colleague in that way.â The discussion of context and boldness led to the emergence of a third theme, which we titled uses and misuses of power.
Uses and Misuses of Power
    Participants provided many examples of their perceptions of uses and misuses of power and linked these behaviors to their sense of ethics. Because many of the examples of uses of power were personal, unique, and potentially identifiable, participants asked that they not be shared individually in this manuscript. Ethical uses of power were described as specific ways in which participants remembered power being used for good such as intervention in unfair policies on behalf of students. Ethical uses of power shared the characteristics of being collaborative and aligned with the descriptors of âfeeling empoweredâ (Table 1).
In contrast, misuses of power were described in terms of being unethical. These behaviors existed on a spectrum that ranged from a simple lack of awareness to a full-blown abuse of power on the most harmful end of the continuum. Lack of awareness of power, for these participants, was observed quite frequently among their counselor education colleagues and they noted that people can negatively affect others without realizing it. In some cases, they reported seeing colleagues lack cultural awareness, competence, or an awareness of privilege. Although many colleagues cognitively know about privilege and speak about it, the lack of awareness referred to here is in terms of the behavioral use of privilege to the detriment of those with less privilege. One example would be to call oneself an LGBTQ+ ally without actively demonstrating ally behavior like confronting homophobic or cis-sexist language in class. Moving along the spectrum, misuses of power were described as unfairly advantaging oneself, possibly at the expense or disadvantage of another. Misuses of power may or may not be directly or immediately harmful but still function to concentrate power rather than share it. An example shared was when faculty members insist that students behave in ways that are culturally inconsistent for that student. At the other end of the spectrum, abuses of power are those behaviors that directly cause harm. Even though abuses of power can be unintentional, participants emphasized that intentions matter less than effects. One participant described abuses of power she had observed as âpeople using power to make others feel small.â For example, a professor or instructor minimizing studentsâ knowledge or experiences serves to silence students and leads to a decreased likelihood the student shares, causing classmates to lose out on that connection and knowledge.
One participant shared a culture of ongoing misuses of power by a colleague: âAnd then theyâre [students] all coming to me crying, you know, surreptitiously coming to me in my office, like, âCan I talk to you?â Iâm like, âYeah, shut the door. Whatâd he do now?â Iâm happy to be a safe person for them, itâs an honor, but this is ridiculous.â The irony of feeling powerless to stop anotherâs misuses of power was not lost on the participants. One participant expressed that she wished to see more colleagues ask questions about their use of power:
We have to ask the question, âWhat is the impact? What is happening, what are the patterns?â We have to ask questions about access and participation and equity. . . .
And from my perspective, we have to assume that things are jacked up because we know that any system is a microcosm of the outer world, and the outer world is jacked up. So, we have to ask these questions and understand if thereâs an adverse impact. And a lot of time there is on marginalized or minoritized populations. So, what are we going to do about it? Itâs all well and good to see it, but what are we doing about it, you know? . . . How are you using your power for good?
Personal Development Around Power
    Participants reflected deeply on their own development of their thinking about and use of power. All participants spoke early in the interviews about their training as counselors and counselor educators. Their early training was often where they first fully realized their feminist orientation and recognized a need for greater feminist multicultural dialogue and action in counseling. Participants were all cognizant of their inherent personal power but still not immune to real and perceived attempts to limit their expression of it. In general, participants felt that over time they became more able and willing to use their power in ethical ways. One participant shared the following about her change in understanding power over time:
Iâve never really been a power-focused person, and so I just donât know that I saw it around me much before that. Which now I realize is a total construct of my privilegeâthat Iâve never had to see it. Then I started realizing that âOh, thereâs power all around me.â And people obsessed with power all around me. And then once I saw it, I kind of couldnât un-see it. I think for a long time I went through a process of disillusionment, and I think I still lapse back into that sometimes where Iâll realize like, a lot of the people in positions of power around me are power-hungry or power-obsessed, and theyâre using power in all the wrong ways. And maybe they donât even have an awareness of it. You know, I donât think everybody whoâs obsessed with power knows that about themselves. It almost seems like a compulsion more than anything. And I think thatâs super dangerous.
    Nearly all participants reflected on their experiences of powerlessness as students and how they now attempt to empower students as a result of their experiences. Working to build a sense of safety in the classroom was a major behavior that they endorsed, often because of their own feelings of a lack of safety in learning contexts at both masterâs and doctoral levels. Vulnerability and risk-taking on the part of the counselor educator were seen as evidence that efforts to create safety in the classroom were successful. Speaking about this, one participant said:
I think itâs actually very unethical and irresponsible as a counselor educator to throw students in a situation where you expect them to take all these risks and not have worked to create community and environments that are conducive to that.
    Participant feelings toward power varied considerably. One said, âI think overall I feel fairly powerful. But I donât want a lot of power. I donât like it.â One participant shared, âI am not shy, I am not afraid to speak and so sometimes maybe I do take up too much space, and there are probably times for whatever reason I donât take up as much space as I should,â showing both humility and a comfort with her own power. These quotes show the care with which the participants came to think about their own power as they gained it through education, position, and rank. No participants claimed to feel total ease in their relationship with their own power, though most acknowledged that with time, they had become more comfortable with acknowledging and using their power when necessary.
One participant said of her ideal expression of power: âPart of feeling powerful is being able to do what I do reasonably well, not perfect, just reasonably well. But also helping to foster the empowerment of other people is just excellent. Thatâs where itâs at.â This developmental place with her own power aligns with the aspirational definitions and descriptions of power shared above.
Along with their personal development around power, participants shared how their awareness of privileged and marginalized statuses raised their understanding of power. Gender and age were cited by nearly all participants as being relevant to their personal experiences with power. Namely, participants identified the intersection of their gender and young age as being used as grounds for having their contributions or critiques dismissed by their male colleagues. Older age seemed to afford some participants the confidence and power needed to speak up. One participant said:
 We are talking about a profession that is three-quarters women, and we are not socialized to grab power, to take power. And so, I think all of that sometimes is something we need to be mindful of and kind of keep stretching ourselves to address.
Yet when younger participants recalled finding the courage to address power imbalances with their colleagues, the outcome was almost always denial and continued disempowerment. To this point, one participant asked, âHow do we get power to matter to people who are already in the positions where they hold power and arenât interested in doing any self-examination or critical thinking about the subject?â
Finally, power was described as permeating every part of being an educator. To practice her use of power responsibly, one participant said, âI mean every decision I make has to, at some point, consider what my power is with them [the students].â Related to the educator role, in general, participants shared their personal development with gatekeeping, such as:
I think one of the areas that I often feel in my power is around gatekeeping. And I think that is also an area where power can be grossly abused. But I think itâs just such an important part of what we do. And I think one of the ways that I feel in my power around gatekeeping is because itâs something I donât do alone. I make a point to consult a lot because I donât want to misuse power, and I think gatekeepingâand, really, like any use of power I thinkâis stronger when itâs done with others.
    Again, this quote reflects the definition of power that emerged in this study as ideally being âdone with others.â Gatekeeping is where participants seemed to be most aware of power and to initially have had the most anxiety around power, but also the area in which they held the most conviction about the intentional use of power. The potential cost of not responsibly using their power in gatekeeping was to future clients, so participants pushed through their discomfort to ensure competent and ethical client care. However, in many cases, participants had to seriously weigh the pros and cons of asserting their personal or positional power, as described in the next and final category.
Considerations of Potential Backlash
    Participants shared about the energy they spent in weighing the potential backlash to their expressions of power, or their calling out of unethical uses of power. Anticipated backlash often resulted in participants not doing or saying something for fear of âmaking wavesâ or being labeled a âtroublemaker.â Participants described feeling a need to balance confrontations of perceived misuses of power with their desire not to be seen as combative. Those participants who felt most comfortable confronting problematic behaviors cited an open and respectful workplace and self-efficacy in their ability to influence change effectively. For those who did not describe their workplaces as safe and respectful, fear was a common emotion cited when considering whether to take action to challenge a student or colleague. Many described a lack of support from colleagues when they did speak up. Some described support behind the scenes but an unwillingness of peers to be more vocal and public in their opposition to a perceived wrong. Of this, one participant said, âAnd so getting those voices . . . to the table seems like an uphill battle. I feel like Iâm stuck in middle management, in a way.â
Discussion
For the participants in this study, analysis of power is a process of productive tension and fluidity. Participants acknowledged that power exists and a power differential in studentâteacher and superviseeâsupervisor relationships will almost certainly always be present. Power seemed to be described as an organizing principle in nearly all contextsâprofessionally, institutionally, departmentally, in the classroom, in supervision, and in personal relationships. Participants found power to be ever present but rarely named (Miller, 2008). Engaging with these data from these participants, it seems that noticing and naming power and its effects is key to facilitating personal and professional development in ways that are truly grounded in equity, multiculturalism, and social justice. Participants affirmed what is stated in guiding frameworks of counseling (ACA, 2014) and counselor education (ACES, 2011; CACREP, 2015) and went beyond a surface acknowledgement of power to a deeper and ongoing process of analysis, like Bernard and Goodyearâs (2014) treatment of power in the supervisory context.
Contemplating, reflecting on, and working with power are worthwhile efforts according to the participants in this study, which is supported by scholarly literature on the topic (Bernard & Goodyear, 2014). Participantsâ personal and professional growth seemed to be catalyzed by their awareness of gender and power dynamics. Participants expressed a desire for a greater recognition of the role of power and the ways in which it is distributed in our professional contexts. For example, although mentioned by only two participants, dissatisfaction in professional associationsânational, regional, and stateâwas shared. Specifically, there was a desire to see counselor educators with positional power make deliberate and visible efforts to bring greater diversity into professional-level decisions and discussions in permanent, rather than tokenizing, ways.
The ongoing process of self-analysis that counselors and educators purport to practice seemed not to be enough to ensure that faculty will not misuse power. Though gender and age were highly salient aspects of perceptions of power for these women, neither were clear predictors of their colleaguesâ ethical or unethical use of power. Women and/or self-identified feminist counselor educators can and do use power in problematic ways at times. In fact, most participants expressed disappointment in women colleagues and leaders who were unwilling to question power or critically examine their role in status quo power relations. This is consistent with research that indicates that as individual power and status are gained, awareness of power can diminish (Keltner, 2016).
These feminist counselor educators described feelings of empowerment as those that enhance connection and collaboration rather than positionality. In fact, participantsâ reports of frustration with some uses of power seemed to be linked to people in leadership positions engaging in power-over moves (Miller, 2008). Participants reported spending a significant amount of energy in deciding whether and when to challenge perceived misuses of power. Confronting leaders seemed to be the riskiest possibility, but confronting peers was also a challenge for many participants. The acknowledgement of context emerged in these data, including a recognition that power works within and between multiple socioecological levels (e.g., microsystems, mesosystems, macrosystems; Bronfenbrenner, 1979). The culture of academia and higher education also contributed to unique considerations of power in the present study, which aligns with the findings of Thacker and colleagues (2021), who noted counselor educator experiences of entrenched power norms are resistant to change.
Contextualizing these findings in current literature is difficult given the lack of work on this topic in counselor education. However, our themes are similar to those found in the supervision literature (Arczynski & Morrow, 2017; Bernard & Goodyear, 2014). The participants in our study were acutely aware of power in their relationships; however, they appeared to feel it even more when in a power-down position. This finding is similar to research in the supervision context in which supervisees felt as though power was not being addressed by their supervisors (Green & Dekkers, 2010). Further, just as the supervisors researched in Mangione et al.âs (2011) study attended to power analysis, our participants strived to examine their power with students. The distinction between positive and negative uses of power was consistent with Murphy and Wright (2005). Participants conceptualized power on a continuum, attended to the power inherent in gatekeeping decisions, managed the tension between collaboration and direction, engaged in reflection around use and misuse of power, and sought transparency in discussions around power. More than anything, though, our participants seemed to continually wrestle with the inherent complexity of power, similarly to what Arczynski and Morrow (2017) found, and how to address, manage, and work with it in a respectful, ethical manner. As opposed to these studies, though, our research addresses a gap between the professionâs acknowledgement of power as a phenomenon and actual lived experiences of power by counselor educators who claim a feminist lens in their work.
Implications
    The implications of our findings are relevant across multiple roles (e.g., faculty, administration, supervision) and levels (e.g., institution, department, program) in counselor education. Power analysis at each level and each role in which counselor educators find themselves could help to uncover issues of power and its uses, both ethical and problematic. The considerable effort that participants described in weighing whether to challenge perceived misuses of power indicates the level of work needed to make power something emotionally and professionally safe to address. Thus, those who find themselves in positions of power or having earned power through tenure and seniority are potentially better situated to invite discussions of power in relatively safe settings such as program meetings or in one-on-one conversations with colleagues. Further, at each hierarchical level, individuals can engage in critical self-reflection while groups can elicit external, independent feedback from people trained to observe and name unjust power structures. Counselor educators should not assume that because they identify as feminist, social justiceâoriented, or egalitarian that their professional behavior is always reflective of their aspirations. It is not enough to claim an identity; one must work to let oneâs actions and words demonstrate oneâs commitment to inclusion through sensitivity to and awareness of power.
Additionally, we encourage counselor educators to ask for feedback from people who will challenge them because self-identification of uses or misuses of power is likely not sufficient to create systemic or even individual change. It is important to acknowledge that power is differentially assigned but can be used well in a culture of collaboration and support. Just as we ask our students to be honest and compassionately critical of their own development, as individuals and as a profession, it seems we could be doing more to foster empowerment through support, collaboration, and honest feedback.
Limitations and Future Directions
    Although not all participants disclosed all their demographic identifiers, one limitation to the current study is the relative homogeneity of the sample across racial and gender lines. The predominance of White women in the present study is of concern, and there are a few possible reasons for this. One is that White women are generally overrepresented in the counseling profession. Baggerly and colleagues (2017) found that women comprised 85% of the student body in CACREP-accredited programs but only 60% of the faculty. These numbers indicate both the high representation of women seeking counseling degrees, but also the degree to which men approach, but do not reach, parity with women in holding faculty positions. Further, in Baggerly et al.âs study, about 88% of faculty members in CACREP-accredited programs were White.
Another potential reason for the apparent racial homogeneity in the present sample is that people of color may not identify with a feminist orientation because of the racist history of feminist movements and so would not have volunteered to participate. Thus, findings must be considered in this context. Future researchers should be vocally inclusive of Black feminist thought (Collins, 1990) and Womanism (A. Walker, 1983) in their research design and recruitment processes to communicate to potential participants an awareness of the intersections of race and gender. Further, future research should explicitly invite those underrepresented hereânamely, women of color and men faculty membersâto share their experiences with and conceptualizations of power. This will be extremely important as counselor educators work to continue to diversify the profession of counseling in ways that are affirming and supportive for all.
Another limitation is that participants may have utilized socially desirable responses when discussing power and their own behavior. Indeed, the participants identified a lack of self-awareness as common among those who misused power. At the same time, however, the participants in this study readily shared their own missteps, lending credibility to their self-assessments. Future research that asks participants to track their interactions with power in real time via journals or repeated quantitative measures could be useful in eliciting more embodied experiences of power as they arise in vivo. Likewise, studentsâ experiences of power in their interactions with counselor educators would be useful, particularly as they relate to teaching or gatekeeping, because some research already exists examining power in the context of clinical supervision (Arczynski & Morrow, 2017; Green & Dekkers, 2010; Mangione et al., 2011; Murphy & Wright, 2005).
We initially embarked upon this study with a simple inquiry, wondering about othersâ invisible experiences around what felt like a formidable topic. More than anything, our discussions with our participants seemed to indicate a critical need for further exploration of power across hierarchical levels and institutions. We are grateful for our participantsâ willingness to share their stories, and we hope that this is just the beginning of a greater dialogue.
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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Melissa J. Fickling, PhD, ACS, BC-TMH, LCPC, is an associate professor at Northern Illinois University. Matthew Graden, MSEd, is a professional school counselor. Jodi L. Tangen is an associate professor at North Dakota State University. Correspondence may be addressed to Melissa J. Fickling, 1425 W. Lincoln Hwy, Gabel 200, DeKalb, IL 60115, mfickling@niu.edu.
Nov 9, 2022 | Volume 12 - Issue 3
Krystle Himmelberger, James Ikonomopoulos, Javier Cavazos Vela
We implemented a single-case research design (SCRD) with a small sample (N = 2) to assess the effectiveness of solution-focused brief therapy (SFBT) for Latine clients experiencing mental health concerns. Analysis of participantsâ scores on the Dispositional Hope Scale (DHS) and Outcome Questionnaire (OQ-45.2) using split-middle line of progress visual trend analysis, statistical process control charting, percentage of non-overlapping data points procedure, percent improvement, and Tau-U yielded treatment effects indicating that SFBT may be effective for improving hope and mental health symptoms for Latine clients. Based on these findings, we discuss implications for counselor educators, counselors-in-training, and practitioners, which include integrating SFBT principles into the counselor education curriculum, teaching counselors-in-training how to use SCRDs to evaluate counseling effectiveness, and using the DHS and OQ-45.2 to measure hope and clinical symptoms.
Keywords: solution-focused brief therapy, single-case research design, hope, counselor education, clinical symptoms
Solution-focused brief therapy (SFBT) is a strength-based and evidence-based intervention that helps clients focus on personal strengths, identify exceptions to problems, and highlight small successes (Berg, 1994; Gonzalez Suitt et al., 2016; Schmit et al., 2016). Schmit et al. (2016) conducted a meta-analysis of SFBT for treating symptoms of internalizing disorders and identified that SFBT might be effective in creating short-term changes in clientsâ functioning. Other researchers (e.g., Gonzalez Suitt et al., 2016; Novella et al., 2020) also found that SFBT can be helpful with clients from various cultural backgrounds and with different presenting symptoms such as anxiety. Yet, there is scant research evaluating the efficacy of SFBT on subjective well-being with Latine (a gender-neutral term that is more consistent with Spanish language and grammar than Latinx) populations. Additionally, there is not a lot of research that investigates the effectiveness of counseling practices among counselors-in-training (CITs) at community counseling clinics with culturally diverse clients. Although the costs are relatively low, the type of supervision, training, and feedback given to CITs provides community clients with the potential for effective counseling services. However, only a few researchers (e.g., Schuermann et al., 2018) have explored the efficacy of counseling services within a community counseling training clinic. Therefore, empirical research is needed regarding the efficacy of SFBT with Latine populations in a counseling training clinic at a Hispanic Serving Institution.
The Latine population is a fast-growing group in the United States and makes up approximately 19% of the U.S. population (U.S. Census Bureau, 2020). Despite this growth, members of this culturally diverse population continue to face individual, interpersonal, and institutional challenges (Ponciano et al., 2020; Vela, Lu, et al., 2014). Because Latine individuals experience discrimination and negative environments (Cheng & Mallinckrodt, 2015; Ponciano et al., 2020; Ramos et al., 2021), perceive lack of support from counselors and teachers in Kâ12 school environments (A. G. Cavazos, 2009; Vela-Gude et al., 2009), and experience microaggressions (Sanchez, 2019), they are likely to experience greater mental health challenges. Researchers have identified numerous internalizing and externalizing symptoms that represent Latine individualsâ mental health experiences, likely putting them at greater risk for mental health impairment and poor psychological functioning (Cheng et al., 2016). Researchers also detected that Latine youth had similar or higher prevalence rates of internalizing disorders (e.g., anxiety and depression) when compared with their White counterparts (Merikangas et al., 2010; Ramos et al., 2021). Given that Latine individuals might be at greater risk for psychopathology and their mental health needs are often unaddressed because they do not seek mental health services (Mendoza et al., 2015; SĂĄenz et al., 2013), further evaluation of the effectiveness of counseling practices for this population is necessary.
Fundamental Principles of Solution-Focused Brief Therapy
    Developed from the clinical practice of Steven de Shazer and Insoo Kim Berg, SFBT is a future-focused and goal-directed approach that focuses on searching for solutions and is created on the belief that clients have knowledge and resources to resolve their problems (Kim, 2008). Counselorsâ therapeutic task is to help clients imagine how they would like things to be different and what it will take to facilitate small changes. Counselors take active roles by asking questions to help clients look at the situation from different perspectives and use techniques to identify where the solution occurs (de Shazer, 1991; Proudlock & Wellman, 2011).
In SFBT, counselors amplify positive constructs and solutions by using specific strategies and techniques to build on positive factors (Tambling, 2012). Common techniques include the miracle question, scaling questions, exceptions, experiments, and compliments, which are designed to help clients identify personal strengths and cultivate what works (de Shazer, 1991; Proudlock & Wellman, 2011). We agree with Vela, Lerma, et al. (2014) that counselors can use postmodern and strength-based theories (e.g., SFBT) to develop positive psychology constructs such as hope, positive emotions, and subjective well-being. SFBT might be useful to help Latine clients identify strengths, build on what works, and reconstruct a positive future outcome.
Several researchers have indicated the efficacy of SFBT for treating various issues with different populations (Bavelas et al., 2013; Kim, 2008). Schmit et al. (2016) conducted a meta-analysis with 26 studies examining the effectiveness of SFBT for treating symptoms of depression and anxiety. They found that SFBT resulted in moderately successful treatment; however, adultsâ treatment effects were 5 times larger when compared to those of youth and adolescents. One possible explanation was that SFBT may require clientsâ maturity to integrate and understand SFBT concepts and techniques. Researchers also concluded that the impact of SFBT may be effective in producing short-term changes that will lead to further gains in symptom relief as well as psychological functioning (Schmit et al., 2016).
Brogan et al. (2020) commented that âthere are limited studies that demonstrate the effectiveness of this method with the Latine . . . populationâ (p. 3). However, we postulate that SFBT principles are compatible with Latine cultural and family characteristics (Lerma et al., 2015; Oliver et al., 2011). There are several reasons that make SFBT an appropriate fit for working with the Latine population. For instance, researchers suggest that understanding family dynamics or familismo when evaluating mental health and overall well-being with the Latine population is important (AyĂłn et al., 2010). Familismo is strong family ties to immediate and extended families in the Latine culture.
In a study investigating Latine families, Priest and Denton (2012) found that family cohesion and family discord were associated with anxiety. Calzada et al. (2013) also highlighted that although family support can positively impact mental health, family can also become a source of conflict and stress, which might result in poor mental health. By using SFBT principles, counselors can help Latine clients identify how familismo is a source of strength through sense of loyalty and cooperation among family members (Oliver et al., 2011).
Another emphasis with SFBT that aligns with the Latine culture is the focus on personal and family resiliency. Because Latine individuals must navigate individual, interpersonal, and institutional challenges (Vela et al., 2015), they have natural resilience and coping skills that align with an SFBT approach. Counselors can use exceptions, scaling questions, and compliments to help Latine individuals discover their inherent resilience and continue to persevere through personal adversity.
Constructs: Hope and Clinical Symptoms
    Consistent with a dual-factor model of mental health (Suldo & Shaffer, 2008), we focused on two outcomes: hope and clinical symptoms. First, hope, which has been associated with subjective well-being among Latine populations (Vela, Lu, et al., 2014), refers to a pattern of thinking regarding goals (Snyder et al., 2002). Snyder et al. (1991) proposed Hope Theory with pathways thinking and agency thinking. Pathways thinking refers to individualsâ plans to pursue desired objectives (Feldman & Dreher, 2012), while agency thinking refers to perceptions of ability to make progress toward goals (Snyder et al., 1999). Researchers found that hope was positively related to meaning in life, grit, and subjective happiness among Latine populations (e.g., Vela, Lerma, et al., 2014; Vela et al., 2015). Other researchers (e.g., Vela, Ikonomopoulos, et al., 2016) have explored the impact of counseling interventions on hope among Latine adolescents and survivors of intimate partner violence. Given the association between hope and other positive developmental outcomes among Latine populations, examining this construct as an outcome in clinical mental health counseling services is important.
In addition to hope as an indicator of subjective well-being, we used the Outcome Questionnaire (OQ-45.2; Lambert et al., 1996) to measure clinical symptoms in the current study for several reasons, including its strong psychometric properties, its use in the counseling training clinic where this study took place, and its use in other studies that evaluate the efficacy of counseling or psychotherapy and show evidence based on relation to other variables such as depression and clinical symptoms (Ekroll & Rønnestad, 2017; Ikonomopoulos et al., 2017; Soares et al., 2018). The OQ-45.2 measures three areas that are central to individual psychological functioning: Symptom Distress, Interpersonal Relations, and Social Role Performance.
Purpose of Study and Rationale
    The purpose of this study was to evaluate the efficacy of SFBT for increasing hope and decreasing clinical symptoms among Latine clients. We implemented an SCRD (Lenz et al., 2012) to identify and explore changes in hope and clinical symptoms as a result of participation in SFBT. We evaluated the following research question: To what extent is SFBT effective for increasing hope and decreasing clinical symptoms among Latine clients who receive services at a community counseling clinic?
Methodology
We implemented a small-series (N = 2) AB SCRD with Latine clients admitted into treatment at an outpatient community counseling clinic to evaluate the treatment effect associated with SFBT for increasing hope and reducing clinical symptoms. The rationale for using an SCRD was to explore the impact of an intervention that might help Latine clients at a community counseling training clinic. We used criterion sampling to recruit participants who (a) sought counseling services at a community counseling clinic, (b) had internalizing symptoms related to anxiety and depression, and (c) worked with a CIT who was supervised by faculty in a clinical mental health counseling program.
Participants
    Participants in this study were two adults admitted into treatment at an outpatient community counseling clinic in the Southern region of the United States. Both participants identified as Hispanic; one identified as a female and the other identified as a male. During informed consent, we explained to participants that they would be assigned pseudonyms to protect their identity. The participants consented to both treatment and inclusion in the research study.
The two participants for this study were selected to participate in this study because of their presenting internalizing symptoms (e.g., depression, anxiety) and fit for SFBT principles. Because we wanted to increase hope among these Latine clients, we felt that SFBT was an appropriate approach. The fundamental principles of SFBT align with attempting to facilitate hope among clients with various symptoms because it helps clients view mental health challenges as opportunities to cultivate strengths, explore solutions, and identify new skills (Bannik, 2008; Joubert & Guse, 2021). SFBT practitioners also posit that clients can recreate their future, cultivate resilience, and construct solutions, which aligns well with tenets of the Latine culture (J. Cavazos et al., 2010). In the first session prior to treatment, both clients indicated that they believed they were in control of their future mental health and that they could construct solutions. We also informed them that SFBT focuses on future solutions as opposed to focusing on problems and the past. Because these clients indicated a willingness to explore their future through co-constructing solutions, they were a good fit for SFBT principles in counseling.
Participant 1
    âMaryâ was a 31-year-old Latine female with a history of receiving student mental health services at a university counseling clinic. Mary sought individual counseling services because of a recent separation with the father of her three children who was emotionally abusive. Anxiety associated with this separation was compounded by traumatic experiences from 5 years prior. Mary stated that her Latine culture generated greater symptoms of anxiety while recognizing her new role as a single mother. Maryâs therapeutic goals and focus of treatment were to reduce clinical symptoms of anxiety as well as improve self-identity and self-esteem.
Participant 2
    âJoelâ was a 20-year-old Latine male with a history of receiving mental health services for symptoms of depression. Joelâs therapeutic goals and focus of treatment were to reduce clinical symptoms of anxiety and associated anger as well as improve self-esteem. Joel reported being a victim of domestic violence and child abuse. Additionally, Joel expressed distress with revealing his sexual identity because of patriarchal roles in the Latine culture that may result in rejection.
Measurements
Outcome Questionnaire (OQ-45.2)
    The OQ-45.2 is a 45-item self-report outcome questionnaire (Lambert et al., 1996) for adults 18 years of age and older. Each item is associated with a 5-point Likert scale with responses ranging from never (1) to almost always (5). We used the total score for the OQ-45, which was calculated by summing the three subscale scores with a possible total score ranging from 0â180. Higher scores are reflective of more severe distress and impairment. Sample response items include âI feel worthlessâ and âI have trouble getting along with friends and close acquaintances.â This assessment was designed to include items relevant to three domains central to mental health: Symptom Distress, Interpersonal Relations, and Social Role Performance (Lambert et al., 1996).
Researchers have examined structural validity and reliability. Coco et al. (2008) used a confirmatory factor analysis to test various models of the factorial structure. They found support for the four-factor, bi-level model, which means that each survey item relates to a subscale as well as an overall maladjustment score. Amble et al. (2014) also examined psychometric properties using confirmatory factor analysis, concluding that âthe total score of the OQ-45 is a reliable and valid measure for assessing therapy progressâ (p. 511). Their findings are like Boswell et al.âs (2013) findings that found support for the validity of the total OQ-45 score. There is also evidence based on relation to other clinical outcomes measured by the General Severity Index from the Symptom Checklist 90-Revised, the Beck Depression Inventory, and Social Adjustment Scale (Lambert et al., 1996). Additionally, previous psychometric evaluations have revealed evidence of reliability through reliability indices such as Cronbachâs alpha (Ikonomopoulos et al., 2017; Kadera et al., 1996; Umphress et al., 1997). Internal consistency estimates through Cronbachâs alpha range from .71 to .92 (Ikonomopoulos et al., 2017; Lambert et al., 1996).
Hope
    The Dispositional Hope Scale (DHS; Snyder et al., 1991) is a self-report inventory to measure participantsâ attitudes toward goals and objectives. Participants responded to eight statements evaluated on an 8-point Likert scale ranging from definitely false (1) to definitely true (8). We used the total Hope score, which was obtained by summing scores for both Agency and Pathways subscales. Total scores range from 8â64, with higher scores indicating greater levels of hope. Sample response items include âI can think of many ways to get the things in life that are important to meâ and âI can think of many ways to get out of a jam.â
Researchers have examined structural validity and reliability. Galiana et al. (2015) used confirmatory factor analysis to identify that a one-factor structure was the best fit. There is also evidence of validity with other theoretically relevant constructs such as meaning in life (Vela et al., 2017) as well as evidence of concurrent and discriminant validity with other measures related to self-esteem, state hope, and state positive and negative affect (Snyder et al., 1996). There is also evidence of factorial invariance (Nel & Boshoff, 2014), suggesting that factor structure is similar across gender and racial ethnic groups. Additionally, there is evidence of reliability (e.g., internal consistency) as indicated through Cronbachâs alpha coefficients ranging from .85 to .86 (Snyder et al., 2002; Vela et al., 2015).
Study Setting
    During the present study, each participant was involved in individual counseling at a community counseling clinic. The facility, located in the Southern region of the United States, provides free counseling services to community members. Individual and group sessions are free and last approximately 45 to 50 minutes. The community counseling clinic offers preventive and early treatment for developmental, emotional, and interpersonal difficulties for community members. CITs at the community counseling clinic are graduate counseling students enrolled in practicum or internship.
Interventionists
    Krystle Himmelberger, who was the CIT in the current study, adapted strength-based interventions designed to facilitate positive feelings by helping clients set goals, focus on the future, and find solutions rather than problems. She was a CIT in a clinical mental health counseling program. Prior to the study, she selected and designed interventions and activities according to specific guidelines from SFBT manuals and sources (Buchholz Holland, 2013; de Shazer et al., 2007; Trepper et al., 2010).
James Ikonomopoulos and Javier Cavazos Vela were faculty counseling supervisors who monitored sessions and provided weekly supervision to maintain fidelity of SFBT interventions. Bavelas et al. (2013) suggested that live supervision may provide a second set of clinical eyes to help CITs. Himmelberger received weekly supervision to ensure procedural and treatment adherence (Liu et al., 2020). Furthermore, videotaped supervision and transcriptions provided her with the ability to communicate between sessions. These measures were used to enhance treatment fidelity by focusing on quality and competency.
SFBT Principles and Intervention
    Participants received six to nine sessions of individual SFBT using the description of techniques and activities in the following resources: More Than Miracles: The State of the Art of Solution-Focused Brief Therapy (de Shazer et al., 2007), Solution-Focused Therapy Treatment Manual for Working With Individuals (Trepper et al., 2010), and âThe Lifeline Activity With a âSolution-Focused Twistââ (Buchholz Holland, 2013). We used the following SFBT principles to guide the intervention: focus on specific topics, a positive and co-constructed therapeutic relationship, and questioning techniques (Trepper et al., 2010). First, Himmelberger focused on specific topics such as preferred future, strengths, confidence in finding solutions, and exceptions. She used future-specific and solution-focused language in each session to help clients focus on their preferred futures. Second, she developed a positive therapeutic relationship with clients through shared trust and co-construction of counseling experiences. She was positive and helpful, and she helped instill optimism and hope in her clients. A positive therapeutic relationship was evidenced based on her report as well as live supervision and reviews of session recordings. Finally, Himmelberger used questioning techniques that focused on clientsâ strengths, exceptions, and coping skills. She used questioning techniques that helped clients focus on progress toward their preferred future and future-oriented solutions.
The techniques she used included looking for previous solutions, exceptions, the miracle question, scaling questions, compliments, future-oriented questions, and âso what is betterâ questions. Himmelberger used looking for previous solutions to help clients identify their previous coping strategies to cope with the problem. Based on Himmelbergerâs report in supervision sessions, both clients commented that they were surprised that they had been successful in the past when the problem did not exist. She also used exceptions to help clients identify what was different when the problem did not exist. Additionally, she used present- and future-oriented questions to help clients focus on future solutions. This was an important technique as clients were not used to ignoring the problem. When clients provided updates on their progress toward their goals, Himmelberger used compliments to validate what clients were doing well. Using compliments helped cultivate a positive therapeutic relationship with these clients.
Finally, with the miracle question, she asked clients to provide details about their preferred future and what that would look like. She followed up with a question about constructing solutions regarding what work it would take to make that preferred future happen. Then in each session, she conducted progress checks toward that preferred future by asking scaling questions (On a scale from 1â10, where are you now with progress toward your preferred future?) and questions about âwhat is betterâ (What is better now when compared to last week?). She complimented clientsâ progress toward that preferred future.
Procedures
    We used AB SCRD to determine the effectiveness of an SFBT treatment program (Lundervold & Belwood, 2000; Sharpley, 2007) using scores on the DHS and OQ-45.2 total scale as outcome measures (Lambert et al., 1996). The two participants who were assigned to Himmelberger did not begin counseling until they consented to treatment and the research study. In other words, they did not receive counseling services prior to participation in this study. After 4 weeks of data collection, the baseline phase of data collection was completed. Participants did not receive counseling services during the baseline period.
The treatment phase began after the fourth baseline measure. At the conclusion of each individual session, participants completed the DHS and OQ-45.2. Himmelberger collected and stored the measures in each participantâs folder in a locked cabinet in the clinic. After the 12th week of data collection, the treatment phase of data collection was completed, at which point the SFBT intervention was withdrawn.
A percentage of non-overlapping data (PND) procedure was used to analyze quantitative data (Scruggs et al., 1987). A visual representation of change over time is graphically represented with a split-middle line of progress visual trend analysis showing data points from each phase (Lenz, 2015). Statistical process control charting was used to determine whether the characteristics of treatment phase data were beyond the realm of random occurrence with 99% confidence (Lenz, 2015). An interpretation of effect size was estimated using Tau-U to complement PND analysis (Lenz, 2015; Sharpley, 2007).
Data Collection and Analysis
    We implemented the PND (Scruggs et al., 1987) to analyze scores on the Hope and OQ-45.2 scales across phases of treatment. The PND procedure yields a proportion of data in the treatment phase that overlaps with the most conservative data point in the baseline phase. PND calculations are expressed in a decimal format that ranges between 0 and 1, with higher scores representing greater treatment effects (Lenz, 2013).
Upon considering the percentage of data exceeding the median procedure (Ma, 2006), we selected the PND because it is considered a robust method of calculating treatment effectiveness (Lenz, 2013). This metric is conceptualized as the percentage of treatment phase data that exceeds a single noteworthy point within the baseline phase. Because we aimed for an increase in DHS scores, the highest data point in the baseline phase was used. Finally, given that we aimed for a decrease in OQ-45.2 total scale scores, the lowest data point in the baseline was used (Lenz, 2013). To calculate the PND statistic, data points in the treatment phase on the therapeutic side of the baseline are counted and then divided by the total number of points in the treatment phase (Ikonomopoulos et al., 2016).
Estimates of Effect Size and Clinical Significance
    PND values are typically interpreted using the estimation of treatment effect provided by Scruggs and Mastropieri (1998) wherein values of .90 and greater are indicative of very effective treatments, those ranging from .70 to .89 represent moderate effectiveness, those between .50 to .69 are debatably effective, and scores less than .50 are regarded as not effective (Ikonomopoulos et al., 2015, 2016). Tau-U values are typically interpreted using the estimation of treatment effect provided by Vannest and Ninci (2015) wherein Tau-U magnitudes can be interpreted as small (⤠.20), moderate (.20â.60), large (.60â.80), and very large (⼠.80). These procedures were completed for each participantâs scores on the Hope and OQ-45.2 scales.
Clinical significance was determined in accordance with Lenzâs (2020a, 2020b) calculations of percent improvement (PI) values. Percent improvement values greater than 50% were interpreted as representing clinically significant improvement with large effect sizes, 25% to 49% were interpreted as slightly improved without clinical significance, and less than 25% represented no clinical significance. Lenz (2021) also recommended for researchers to provide sufficient context and visual representation when interpreting and reporting clinical significance. As one example, without context and visual representation, researchers could interpret a PI value of 49% as not having clinical significance.
Results
A detailed description of participantsâ experiences is provided below. Figure 1 depicts estimates of treatment effect on the DHS; Figure 2 depicts estimates of treatment effect on the OQ-45.2 total scale.
Figure 1
Ratings for Hope by Participants With Split-Middle Line of Progress
Note. PND = Percentage of Non-overlapping Data.
Figure 2
Ratings for Mental Health Symptoms on OQ-45.2 by Participants with Statistical Process Control Charting
Note. PND = Percentage of Non-overlapping Data.
Participant 1
    Data for Mary is represented in Figures 1 and 2 as well as Tables 1 and 2. A comparison of level of Hope across baseline (M = 56.00) and intervention phases (M = 63.50) indicated notable changes in participant scores evidenced by an increase in mean DHS scores over time. Variation between scores in baseline (SD = 3.50) and intervention (SD = 0.83) indicated differential range in scores before and after the intervention. Data in the baseline phase trended downward toward a contra-therapeutic effect over time. Dissimilarly, data in the intervention phase trended upward toward a therapeutic effect over time. Comparison of baseline level and trend data with the first three observations in the intervention phase did suggest immediacy of treatment response for the participant. Data in the intervention phase moved into the desired range of effect for scores representing Hope. Overall, visual inspection of Maryâs ratings on the DHS (see Figure 1) indicates that most of her scores in the treatment phase were higher than her scores in the baseline phase.
Maryâs ratings on the DHS illustrate that the treatment effect of SFBT was moderately effective for improving her DHS score. Evaluation of the PND statistic for the DHS score measure (0.83) indicated that five out of six scores were on the therapeutic side above the baseline (DHS score of 63). Mary successfully improved Hope during treatment as evidenced by improved scores on items such as âI can think of many ways to get out of a jam,â âI can think of ways to get the things in life that are important to me,â and âI meet the goals that I set for myself.â Scores above the PND line were within a 1-point range. Trend analysis depicted a consistent level of improvement following the first treatment measure. This finding is corroborated by the associated Tau-U value (ĎU = 0.92), which suggested a very large degree of change in which the null hypothesis about intervention efficacy for Mary could be rejected (p = .02). Also, interpretation of the clinical significance estimate of PI is that 13.39% improvement is not clinically significant (Lenz, 2020a, 2020b). See Table 1 for information regarding PND, Tau-U, and PI. Although the PI value is considered not clinically significant, it is important to contextualize this finding within visual inspection of Maryâs Hope scores in Figure 1. Because Mary had moderately high levels of Hope in the baseline phase, her room for improvement based on the ceiling effect as related to Hope was not high. In other words, in the context of Maryâs treatment and visual inspection of her scores, the SFBT intervention helped Mary move from good to better. In the context of Maryâs treatment and a visual representation of her scores on the DHS (see Figure 1), the SFBT intervention had some level of convincingness, which means that some amount of change in Hope occurred for Mary (Kendall et al., 1999; Lenz, 2021).
Table 1
Ratings for Hope by Participants
|
Age |
Ethnicity |
Gender |
Baseline Data |
Intervention Data |
PND |
ĎU (p) |
Â
PI |
|
M |
SD |
M |
SD |
| Mary |
31 |
Latina |
Female |
56.00 |
3.50 |
63.50 |
0.83 |
83% |
0.92 (.02) |
13.39% |
|
|
|
|
|
|
|
|
|
|
|
| Joel |
20 |
Latino |
Male |
27.75 |
2.87 |
34.90 |
5.26 |
60% |
0.70 (.05) |
25.75% |
Note. PND = Percentage of Non-overlapping Data.
Table 2
Ratings for OQ-45.2 Total Scale Score by Participants
|
Age |
Ethnicity |
Gender |
Baseline Data |
Intervention Data |
PND |
ĎU (p) |
Â
PI |
|
|
M |
SD |
M |
SD |
|
| Mary |
31 |
Latina |
Female |
45.25 |
16.25 |
17.67 |
7.44 |
100% |
â1.00 (.01) |
60.95% |
|
|
|
|
|
|
|
|
|
|
|
|
|
| Joel |
20 |
Latino |
Male |
84.00 |
6.00 |
47.10 |
10.74 |
 100% |
â1.00 (.004) |
43.93% |
|
Note. PND = Percentage of Non-overlapping Data.
Before treatment began, one of Maryâs baseline measurements was above the cut-score guideline on the OQ-45.2 of a total scale score of 63, which indicates symptoms of clinical significance. Comparison of level of clinical symptoms across baseline (M = 45.25) and intervention phases (M = 17.67) indicated notable changes in participant scores evidenced by a decrease in mental health symptom scale scores over time. Variation between scores in baseline (SD = 16.25) and intervention (SD = 7.44) indicated differential range in scores before and after the intervention. Data in the baseline phase trended upward toward a contra-therapeutic effect over time. Dissimilarly, data in the intervention phase trended downward toward a therapeutic effect over time. Comparison of baseline level and trend data with the first three observations in the intervention phase did suggest immediacy of treatment response for the participant. Data in the intervention phase moved into the desired range of effect for scores representing mental health symptoms.
Maryâs ratings on the OQ-45.2 illustrate that the treatment effect of SFBT was very effective for decreasing her total scale score measuring mental health symptoms. Evaluation of the PND statistic for the OQ-45.2 total scale score measure (1.00) indicated that all six scores were on the therapeutic side below the baseline (total scale score of 26). Mary successfully reduced clinical symptoms during treatment as evidenced by improved scores on items such as âI am a happy person,â âI feel loved and wanted,â and âI find my work/school satisfying.â This contention became most apparent after the first treatment session when Mary continuously scored lower on a majority of symptom dimensions such as Symptom Distress, Interpersonal Relations, and Social Role Performance. Scores below the PND line were within a 24-point range. Trend analysis depicted a consistent level of improvement following the first treatment measure. This finding is corroborated by the associated Tau-U value (ĎU = â1.0), which suggested a very large degree of change in which the null hypothesis about intervention efficacy for Mary could be rejected (p = .01). An analysis of statistical process control charting revealed that one data point in the treatment phase was beyond the realm of random occurrence with 99% confidence. This finding also corresponds with interpretation of the clinical significance estimate of PI that 60.95% improvement is clinically significant (Lenz, 2020a, 2020b). See Table 2 for information regarding PND, Tau-U, and PI. In the context of Maryâs treatment and a visual representation of Maryâs scores on the OQ-45.2 (see Figure 2), the SFBT intervention had a high level of convincingness, which means that a considerable amount of change in clinical symptoms occurred for Mary (Kendall et al., 1999; Lenz, 2021).
Participant 2
    Data for Joel is represented in Figures 1 and 2 as well as Tables 1 and 2. Comparison of level of Hope across baseline (M = 27.75) and intervention phases (M = 34.90) indicated notable changes in participant scores evidenced by an increase in mean DHS scores over time. Variation between scores in baseline (SD = 2.87) and intervention (SD = 5.26) indicated differential range in scores before and after the intervention. Data in the baseline phase trended downward toward a contra-therapeutic effect over time. Dissimilarly, data in the intervention phase trended upward toward a therapeutic effect over time. Comparison of baseline level and trend data with the first three observations in the intervention phase did suggest immediacy of treatment response for the participant. Data in the intervention phase moved into the desired range of effect for scores representing Hope.
Joelâs ratings on the DHS illustrate that the treatment effect of SFBT was debatably effective for improving his DHS score. Evaluation of the PND statistic for the DHS score measure (0.60) revealed that six out of ten scores were on the therapeutic side above the baseline (DHS score of 31). Joel successfully improved his Hope during treatment as evidenced by improved scores on items such as âI can think of many ways to get out of a jam,â âI can think of ways to get the things in life that are important to me,â and âI meet the goals that I set for myself.â Scores above the PND line were within an 18-point range. Trend analysis depicted a steady level of scores following the first treatment measure, with scores vacillating around the baseline score until the eighth treatment measure. This finding is corroborated by the associated Tau-U value (ĎU = 0.70), which suggested a large degree of change in which the null hypothesis about intervention efficacy for Joel could be rejected (p = .047). This finding also corresponds with interpretation of the clinical significance estimate of PI that 25.75% is slightly improved but not clinically significant (Lenz, 2020a, 2020b). One explanation for the lack of clinical significance and moderate effect size is the limited nature of the intervention. Based on results from visual depiction of Joelâs levels of Hope across treatment (see Figure 1), we suspect that this trend would have continued if he had received additional sessions of an SFBT intervention. His treatment was trending in a positive trajectory. In the context of Joelâs treatment and a visual representation of his scores on the DHS (see Figure 1), the SFBT intervention had a moderate level of convincingness, which means that a considerable amount of change in Hope occurred for Joel (Kendall et al., 1999; Lenz, 2021).
Before treatment began, all four of Joelâs baseline measurements were above the cut-score guideline on the OQ-45.2 of a total scale score of 63, which indicates symptoms of clinical significance. Comparison of level of clinical symptoms across baseline (M = 84.00) and intervention phases (M = 47.10) indicated notable changes in participant scores evidenced by a decrease in mental health symptom scale scores over time. Variation between scores in baseline (SD = 6.00) and intervention (SD = 10.74) indicated differential range in scores before and after intervention. Data in the baseline phase trended upward toward a contra-therapeutic effect over time. Dissimilarly, data in the intervention phase trended downward toward a therapeutic effect over time. Comparison of baseline level and trend data with the first three observations in the intervention phase did suggest immediacy of treatment response for the participant. Data in the intervention phase moved into the desired range of effect for scores representing mental health symptoms.
Joelâs ratings on the OQ-45.2 illustrate that the treatment effect of SFBT was very effective for decreasing his total scale score measuring clinical symptoms. Evaluation of the PND statistic for the total scale score measure (1.00) indicated that all 10 scores were on the therapeutic side below the baseline (total scale score of 77). Joel successfully reduced clinical symptoms during treatment as evidenced by improved scores on items such as âI am a happy person,â âI feel loved and wanted,â and âI find my work/school satisfying.â This contention became most apparent after the first treatment session when Joel continuously scored lower on a majority of symptom dimensions such as Symptom Distress, Interpersonal Relations, and Social Role Performance. Scores below the PND line were within a 41-point range. Trend analysis depicted a consistent level of improvement following the first treatment measure. This finding is corroborated by the associated Tau-U value (ĎU = â1.0), which suggested a very large degree of change in which the null hypothesis about intervention efficacy for Joel can be rejected (p = .004). An analysis of statistical process control charting revealed that eight data points in the treatment phase were beyond the realm of random occurrence with 99% confidence. This finding also corresponds with interpretation of the clinical significance estimate that 43.93% of improvement is slightly improved but not clinically significant (Lenz, 2020a, 2020b). Considering contextual evidence from the intervention as well as data visualization of Figure 2, it was clear that Joel experienced a downward trajectory in clinical symptoms. If he had received additional SFBT sessions, we suspect that he would have continued to experience a reduction in clinical symptoms. In the context of Joelâs treatment and a visual representation of his scores on the OQ-45.2 (see Figure 2), the SFBT intervention had a high level of convincingness, which means that a considerable amount of change in Hope occurred for Joel (Kendall et al., 1999; Lenz, 2021).
Discussion
The purpose of this exploratory study was to examine the impact of SFBT on clinical symptoms and hope among Latine clients. The results yield promising findings and preliminary evidence about the efficacy of SFBT as an intervention for promoting positive change across two Latine clientsâ clinical symptoms and hope. The scores varied for each outcome variable, and this is likely related to the length and duration of the intervention as well as each participantâs personal characteristics (Callender et al., 2021) and relationship to their counselor (Liu et al., 2020). Findings from the current study also lend further support regarding the efficacy among CITs who aim to impact clientsâ psychological functioning at a community counseling training clinic.
The findings for clinical symptoms showed a trend toward reduction in clinical symptoms across 8 weeks of SFBT. Both participants reported statistically significant improvements (p < .05) in reductions of clinical symptoms on the OQ-45.2. In both cases, the SFBT intervention was within the range of very large treatment effectiveness and clinical significance for improving symptoms of psychopathology. Results from the PND and PI confirmed that these participants experienced reduced clinical symptoms. It appears that there was a steady progression of improvement for these participants after their second treatment session. During this phase of treatment, Himmelberger used techniques such as exceptions to the problem and scaling questions to help participants recognize inner resources and personal strengths, analyze current levels of functioning, and visualize their preferred future (de Shazer, 1991).
In review of counseling session recordings and in supervision, Himmelberger commented that both Joel and Mary provided feedback throughout SFBT that they appreciated the opportunity to focus on small successes, personal strengths, and exceptions to their problems, and the use of scaling questions to assess and track their progress. They also commented that they appreciated how they were able to conceptualize family as a source of strength and element of resiliency (J. Cavazos et al., 2010; Oliver et al., 2011). Researchers have found that using SFBT techniques such as miracle and exceptions questions can help clients reduce negative affect (Brogan et al., 2020; Neipp et al., 2021). Our findings also are like those of Schmit et al. (2016), who found that SFBT may be effective for treating symptoms of internalizing disorders, and Oliver et al. (2011), who commented that SFBT can help Mexican Americans cultivate familismo.
The findings for Hope showed a visual trend toward increased levels of Hope across 8 weeks of SFBT. Both participants reported statistically significant improvements (p < .05) in Hope on the DHS. In both cases, the SFBT intervention was within the range of debatable effectiveness and slight improvement without clinical significance for improving symptoms of Hope. Maryâs rating on the DHS indicates the treatment was moderately effective and PI was not clinically significant. When visualizing Maryâs rating on the DHS, we see that Mary had high levels of Hope in the baseline phase, which means that she did not have much room to improve in the treatment phase. Contextualizing Maryâs treatment and using a visual representation of her scores on the DHS (see Figure 1), we infer that the SFBT intervention had some level of convincingness, which means that some amount of change in Hope occurred for Mary (Kendall, 1999; Lenz, 2021). Additionally, Joelâs rating on the DHS indicate that the treatment effect was debatably effective with a PI that is slightly improved but not clinically significant. When looking closely at Joelâs scores, we see that Joel experienced trends in a positive trajectory. In the context of his treatment and a visual representation of his scores on the DHS (see Figure 1), the SFBT intervention had a moderate level of convincingness, which means that a considerable amount of change in Hope occurred (Kendall, 1999; Lenz, 2021).
Suldo and Shaffer (2008) argued that using a dual-factor model of mental health with indicators of subjective well-being (e.g., hope) and illness (e.g., clinical symptoms) allows researchers and practitioners to measure and understand complete mental health. Although a clientâs psychopathology might decrease, subjective well-being might not improve with the same effect. Findings from SFBT treatment with Joel and Mary support a dual-factor model that suggests indicators of personal wellness and psychopathology are different parts of mental health and are important to consider in treatment (Vela, Lu, et al., 2016). For Joel and Mary, SFBT appeared to be efficacious for slightly increasing and maintaining scores on the DHS. Our findings support Joubert and Guse (2021), who recommended SFBT to facilitate hope and subjective well-being among clients. When clients can think about solutions, identify exceptions to their problems, and think about their preferred future, they might be more likely to develop hope for their future as well as improve subjective well-being (Joubert & Guse, 2021).
The findings from this study lend further support regarding the effectiveness of counseling services at a community counseling training clinic. Our findings are like Schuermann et al.âs (2018) findings that lend support for the efficacy of counseling services in a Hispanic-serving counselor training clinic and Dorais et al.âs (2020) findings of counseling studentsâ motivational interviewing techniques at a university addiction training clinic. Faculty supervision, group supervision, and live supervision have all been associated with increases in counseling internsâ self-efficacy to provide quality counseling services. Himmelberger received weekly supervision and consultation on SFBT principles as well as SCRD principles. It is possible that these forms of supervision helped her provide effective counseling services. Our findings also support the need to continue to design research studies to evaluate the impact of counseling services at community counseling training clinics with clients of different cultural backgrounds and different presenting symptoms.
Implications for Counselor Educators and Counselors-in-Training
    Based on our findings, we propose a few recommendations for counselor educators, CITs, and practitioners. First, our study provides evidence that CITs at community counseling centers can provide effective treatments with culturally diverse clients with moderate internalized symptoms such as depression and anxiety. As a result, SFBT can be taught and infused into counselor education curricula and can be delivered by future licensed professional counselors, school counselors, or counseling interns.
Community agencies working with this client population should also consider providing counselors with professional development and training related to SFBT. It is important to mention that when two of us were in graduate programs, we did not receive formal SFBT instruction. This might be due to greater emphasis on humanistic and cognitive behavioral therapies in counseling curricula or among some counselor education faculty. As a result, counselor educators must make a cogent effort to promote and discuss postmodern theories such as SFBT. This is important because SFBT can be effective at improving internalizing disorders among clients (Schmit et al., 2016) and Latine populations (Gonzalez & Franklin, 2016).
Another implication for counselor educators is to consider teaching CITs how to use SCRDs to monitor and assess treatment effectiveness. All counseling interns who work in a community counseling clinic need to demonstrate the effectiveness of their services with clients. Therefore, CITs can learn how to use SCRDs or a single-group pretest/posttest with clinical significance (Ikonomopoulos et al., 2021; Lenz, 2020b) to determine the impact of counseling on client outcomes. Finally, community counseling clinics can consider using the DHS and OQ-45.2 to measure indicators of subjective well-being and clinical symptoms. CITs can use these instruments, which have evidence of reliability and validity with culturally diverse populations, to document the impact of their counseling services on clientsâ hope and clinical symptoms.
Implications for Practitioners
    There also are implications for practitioners. First, counselors can use SFBT principles and techniques to work with Latine clients. By using a positive and future-oriented framework, counselors can build a positive therapeutic relationship and help Latine clients construct a positive future. Counselors can use SFBT to help Latine clients identify how familismo is a source of strength (Oliver et al., 2011) and draw on their inner resiliency (Vela et al., 2015) to create their preferred future outcome. Practitioners can use SFBT techniques, including looking for previous solutions, exceptions, the miracle question, scaling questions, compliments, and future-oriented questions. SFBT principles and techniques can be used to facilitate hope by helping Latine clients view mental health challenges as opportunities to cultivate strengths and explore solutions (Bannik, 2008; Joubert & Guse, 2021).
Practitioners also can use SCRDs to evaluate the impact of their work with clients. Although most practitioners collect pre- and post-counseling intervention data, they typically use a single data point at pre-counseling and a single data point at post-counseling. Using an SCRD in which a baseline phase and weekly treatment points are collected can help analyze trends over time and identify clinical significance. Lenz (2015) described how practitioners can use SCRDs to make inferencesâself as control, flexibility and responsiveness, small sample size, ease of data analysis, and type of data yielded from analyses. In other words, counseling practitioners can analyze data over time with a client and use the data collection and analysis methods in this study to evaluate the impact of their counseling services on client outcomes.
Implications and Limitations
    There are several implications for future research. First, researchers can evaluate the impact of SFBT on other indicators related to subjective well-being and clinical symptoms among culturally diverse populations, including subjective happiness, resilience, grit, meaning in life, anxiety, and depression (Karaman et al., 2019). More research needs to explore how SFBT might enhance indicators of subjective well-being and decrease clinical symptoms as well as the intersection between recovery and psychopathology. Although researchers have explored the impact of SFBT on internalizing symptoms (Schmit et al., 2016), more research needs to examine the impact on subjective well-being, particularly among Latine populations and Latine adolescents at a community counseling clinic.
Researchers also should consider using qualitative methods to discover which SFBT techniques are most effective. In-depth interviews and focus groups with SFBT participants would provide insight and perspectives with the miracle question, scaling questions, and other SFBT techniques. Counselors could also collect clientsâ journal entries to capture the impact of specific techniques on psychopathology or subjective well-being.
Additionally, using between-group designs to compare SFBT interventions with other evidence-based approaches such as cognitive behavior therapy could provide fruitful investigations. It is also possible to explore the impact of SFBT coupled with another approach such as positive psychology or cognitive behavior therapy with Latine populations. Finally, researchers can continue to explore the impact of CITs who work with clients in a community counseling clinic. Counseling interns can use SCRDs or single-group pretest/posttest designs to measure the impact of their counseling services.
The current study was exploratory in nature. Although both participants demonstrated improvement in measures related to subjective well-being and psychopathology, generalization to a larger Latine population is not appropriate. Because of the exploratory nature of this study, we cannot generate causal inferences regarding the relationship between SFBT and Hope as well as clinical symptoms. Second, we did not include withdrawal measures following completion of the treatment phase (Ikonomopoulos et al., 2016, 2017). Although some researchers use AB and ABA SCRDs to measure counseling effectiveness (Callender et al., 2021), we did not use an ABA design that would have provided stronger internal validity to evaluate changes of SFBT (Lenz et al., 2012). Because Himmelberger completed the academic semester and graduated from the clinical mental health counseling program, collecting withdrawal measures was not possible. Therefore, an AB SCRD was a more feasible approach.
Conclusion
    To the best of our knowledge, this is one of the first exploratory studies to examine the impact of the effectiveness of SFBT with Latine clients at a community counseling training clinic. This exploratory SCRD serves as a foundation for future data collection and evaluation of CITs who work with culturally diverse clients at community counseling training clinics. Results support the potential of SFBT as an intervention for promoting positive change for Latine clientsâ hope and clinical symptoms.
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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Krystle Himmelberger, MS, LPC, is a doctoral candidate at St. Maryâs University. James Ikonomopoulos, PhD, LPC-S, is an assistant professor at Texas A&M UniversityâCorpus Christi. Javier Cavazos Vela, PhD, LPC, is a professor at the University of Texas Rio Grande Valley. Correspondence may be addressed to James Ikonomopoulos, 6300 Ocean Drive, Unit 5834, Corpus Christi, TX 78412,
james.ikonomopoulos1@tamucc.edu.
