Reflections on Power from Feminist Women Counselor Educators

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 “a professional relationship that empowers” (p. 20). Empowerment is a process that begins with awareness of power dynamics (McWhirter, 1994). Power is widely recognized in counseling’s 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 “powerful” 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 supervisors’ and supervisees’ 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 supervisor’s 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 participants’ 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 members’ lived experiences of power in the context of counselor education (Moustakas, 1994; Padilla-Díaz, 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 45–75 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 participants’ 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: “We 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.” 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 master’s 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 Graden’s 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)—or core theme—of the experience of power for the participants in this study is engagement in a near constant analysis of power—that 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 power—both observed and personally enacted—which 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, “I think of the ability to affect change and the ability to have a meaningful impact.” 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, “I don’t see power as a negative. I think it can be used negatively.” 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

                            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 educators’ 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 “the way things are done in institutions of higher learning.” 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 “power in academia comes with rank.” This contradiction highlights the tension inherent in power, at least among those who wish to use it for the “greater good” (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: “Now, 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.” 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 “feeling empowered” (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 “people using power to make others feel small.” For example, a professor or instructor minimizing students’ 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: “And then they’re [students] all coming to me crying, you know, surreptitiously coming to me in my office, like, ‘Can I talk to you?’ I’m like, ‘Yeah, shut the door. What’d he do now?’ I’m happy to be a safe person for them, it’s an honor, but this is ridiculous.” The irony of feeling powerless to stop another’s 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, “What is the impact? What is happening, what are the patterns?” 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 there’s an adverse impact. And a lot of time there is on marginalized or minoritized populations. So, what are we going to do about it? It’s 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:

I’ve never really been a power-focused person, and so I just don’t know that I saw it around me much before that. Which now I realize is a total construct of my privilege—that I’ve never had to see it. Then I started realizing that “Oh, there’s power all around me.” And people obsessed with power all around me. And then once I saw it, I kind of couldn’t 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 I’ll realize like, a lot of the people in positions of power around me are power-hungry or power-obsessed, and they’re using power in all the wrong ways. And maybe they don’t even have an awareness of it. You know, I don’t think everybody who’s obsessed with power knows that about themselves. It almost seems like a compulsion more than anything. And I think that’s 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 master’s 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 it’s 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, “I think overall I feel fairly powerful. But I don’t want a lot of power. I don’t like it.” One participant shared, “I 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 don’t take up as much space as I should,” 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: “Part 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. That’s where it’s at.” 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, “How do we get power to matter to people who are already in the positions where they hold power and aren’t interested in doing any self-examination or critical thinking about the subject?”

Finally, power was described as permeating every part of being an educator. To practice her use of power responsibly, one participant said, “I mean every decision I make has to, at some point, consider what my power is with them [the students].” 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 it’s 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 it’s something I don’t do alone. I make a point to consult a lot because I don’t want to misuse power, and I think gatekeeping—and, really, like any use of power I think—is stronger when it’s done with others.

     Again, this quote reflects the definition of power that emerged in this study as ideally being “done with others.” 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 “making waves” or being labeled a “troublemaker.” 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, “And so getting those voices . . . to the table seems like an uphill battle. I feel like I’m stuck in middle management, in a way.”

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 student–teacher and supervisee–supervisor relationships will almost certainly always be present. Power seemed to be described as an organizing principle in nearly all contexts—professionally, 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 Goodyear’s (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). Participants’ 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 associations—national, regional, and state—was 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 colleagues’ 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, participants’ 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.’s (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 profession’s 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 justice–oriented, 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 one’s actions and words demonstrate one’s 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.’s 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 here—namely, women of color and men faculty members—to 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, students’ 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 others’ 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 participants’ 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.

 

References

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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.

Mental Health Counselors’ Perceptions of Rural Women Clients

Lisbeth A. Leagjeld, Phillip L. Waalkes, Maribeth F. Jorgensen

Researchers have frequently described rural women as invisible, yet at 28 million, they represent over half of the rural population in the United States. We conducted a transcendental phenomenological study using semi-structured interviews and artifacts to explore 12 Midwestern rural-based mental health counselors’ experiences counseling rural women through a feminist lens. Overall, we found eight themes organized under two main categories: (a) perceptions of work with rural women (e.g., counselors’ sense of purpose, a rural heritage, a lack of training for work with rural women, and the need for additional research); and (b) perceptions of rural women and mental health (e.g., challenges, resiliency, protective factors, and barriers to mental health services for rural women). We offer specific implications for counselors to address the unique mental health needs of rural women, including hearing their stories through their personal lenses and offering them opportunities for empowerment at their own pace.

Keywords: rural women, mental health counselors, feminist, perceptions, phenomenological

 

More than 28 million women, ages 18 and older, live in rural America and represent over half of the rural population in the United States (Bennett et al., 2013; U.S. Census Bureau, 2010). Researchers have discussed women’s issues as a distinct category within counseling for over 50 years, yet few counseling programs offer training specific to counseling women (American Psychological Association [APA], 2018; Broverman et al., 1970; Enns, 2017). Rural women have garnered even less attention within counseling literature and training over time (Bennett et al., 2013; Fifield & Oliver, 2016). In addition, rural mental health researchers have focused on rural populations in general, encapsulating women under the entire family unit (U.S. Department of Agriculture, 2015). However, in all environments, women experience mental health needs in unique ways (Mulder & Lambert, 2006; Wong, 2017). Although government agencies have increased efforts to alleviate mental health disparities in rural areas, there is limited research available on rural women’s mental health to guide these efforts (Carlton & Simmons, 2011; Hill et al., 2016). Thus, more studies focused on rural women can assist in comprehensive data-based decision-making efforts of federal, state, and local policymakers (Van Montfoort & Glasser, 2020). Mental health counselors who work with rural women have a unique perspective in understanding the needs of rural women and the disparities they face.

The Invisibility of Rural Women’s Mental Health
Researchers have described rural women as invisible within the mental health literature. Specifically, they have used words such as “unnoticed,” “lack of recognition,” “overlooked,” and “no voice and no choice,” which may illuminate why rural women have less access to appropriate mental health services and may underlie the noticeable absence of rural women as participants within research (Mulder & Lambert, 2006; Weeks et al., 2016). Members of rural communities have traditionally seen women as an extension of their nuclear and extended families and as responsible for involvement in community and church activities (Mulder & Lambert, 2006). Rural women, as a population with unique mental health needs, may need help (i.e., representation in research) getting their voices heard on a more macro level to promote systemic changes (Van Montfoort & Glasser, 2020). A research approach based in feminist theory may amplify the voices of rural women (Schwarz, 2017).

Feminism is a theoretical approach that evolved following the women’s movement in the 1960s, and grew to effect change in social, political, and cultural beliefs about women’s roles (Evans et al., 2005). Many of the early feminist writers spoke of women as “oppressed” and “having no voice” (Evans et al., 2005). Those words have been similarly found throughout the literature on rural women (Weeks et al., 2016). Feminist theory has traditionally challenged the status quo of the patriarchy by working to reduce the invisibility of women’s experiences (Evans et al., 2005; Schwarz, 2017). Further, feminist theory has evolved to amplify voices of all oppressed and marginalized individuals and to promote recognition of the intersectionality of identity. The feminist perspective can facilitate insight into the context of rural women’s experiences (Wong, 2017).

Challenges Faced by Rural Women
The definition of rural areas has historically been based on population size (U.S. Census Bureau, 2010). Some consider rurality a more accurate term than rural, as it may include population density, economic concerns, travel distances to providers, religion, agricultural heritage, behavioral norms, a shared history, and geographical location (Smalley & Warren, 2014). Rural women face unique needs related to the intersection of gender with race, ethnicity, age, and sexual orientation (Barefoot et al., 2015). Rural women have less access to educational opportunities, are often the head of household, and are more likely to live in poverty than urban women (Watson, 2019). Lesbian and bisexual rural women face challenges of bias, lack of support, and increased victimization (Barefoot et al., 2015). Although urban women also experience mental health issues related to motherhood, rural women often must travel long distances to services and have limited access to postpartum care (Radunovich et al., 2017). Residents in many rural communities experience food insecurity and related disordered eating with less proximity to grocery stores and limited food choices (Doudna et al., 2015). Isolation also creates a greater risk for partner abuse that is complicated by long distances to shelters, lack of anonymity, and a widely held view of traditional gender roles (Weeks et al., 2016). The lack of research regarding rural women and mental health compromises the efforts of rural counselors to provide care that is culturally responsive and efficacious (Imig, 2014). In addition, the recognized barriers of accessibility, availability, and acceptability of mental health services in rural areas disproportionally affect rural women (Radunovich et al., 2017).

Barriers to Mental Health Services
A lack of professionals, limited training for work in rural areas, high rates of turnover of mental health professionals, and limited research about rural demographics can negatively impact the quality of services (Smalley & Warren, 2014). In addition, rural residents may experience barriers such as long distances to services, adverse weather conditions, affordability of services, and a lack of insurance coverage (Smalley & Warren, 2014). Rural women may also feel reluctant to seek out mental health services for fear of loss of anonymity and the stigma attached to seeking mental health services in rural areas (Snell-Rood et al., 2019). Approximately 40% of rural residents with mental health issues opt to seek treatment from primary care physicians (PCPs), as these professionals may represent the only health care provider in the area (Snell-Rood et al., 2017). However, these professionals often have limited expertise in diagnosing and treating mental health issues (Hill et al., 2016).

Currently, the Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2015) does not specify rurality or other cultural identities when referencing cultural competence within required curriculum. This omission may contribute to minimal specialized training, in addition to the limited research for mental health counselors to use as a guide for understanding the unique needs of rural women (Watson, 2019). Additionally, agencies have difficulty recruiting mental health counselors because of isolation from colleagues and supervisors, lower salaries, limited social and cultural opportunities, and few training opportunities specific to rural mental health (Fifield & Oliver, 2016).

Addressing Mental Health Needs of Rural Women
Given the limited research about rural women and their unique mental health needs, rural counselors are left with few evidence-based practices to utilize when working with this population (Imig, 2014). Historically, counseling researchers have equated “mentally healthy adults” with “mentally healthy adult males,” resulting in literature that is focused on best practices more appropriate for men (Broverman et al., 1970), and potentially upholding sex-role stereotypes within the fields of psychology, social work, medicine, and mental health counseling (APA, 2018; Schwarz, 2017). More recent researchers have demonstrated the efficacy of gender-specific counseling approaches (Enns, 2017). However, the approaches often do not consider the additional barriers to services that rural women may face, such as long distances to services, limited availability of mental health professionals, and the stigma of seeking services in a rural area (Hill et al., 2016).

In this transcendental phenomenological study, we sought to explore the lived experiences of licensed professional counselors (LPCs) who work with rural women in terms of their perceptions of rural Midwestern women’s mental health, and the academic training they received to prepare them for working with rural women. The study sought to answer the following research questions: (a) What are the lived experiences of LPCs who work with rural women?; (b) What are the challenges and benefits of working with rural women?; (c) How are mental health services perceived by those working with rural women?; and (d) What training, if any, did the participants receive that was specific to work with rural women?

Method

Qualitative research, by its very nature, validates individuals who may be disempowered (Morrow, 2007; Ponterotto, 2010). Phenomenology is a qualitative method that helps researchers describe the common meaning of participants’ lived experiences specific to a particular phenomenon (Creswell & Poth, 2018). In this study, the phenomenon was the lived experiences of LPCs who worked with rural women. Transcendental phenomenology (Moustakas, 1994) provided a framework for the study that began with epoché, a process of bracketing the researchers’ experiences and biases, and the collection of participant stories (Creswell & Poth, 2018). For this study, postpositivist elements of transcendental phenomenology (e.g., bracketing and data analysis) were utilized to reduce researcher biases (Moustakas, 1994). Specifically, we viewed bracketing as essential because participants might not share the feminist viewpoint of the researchers. The infusion of feminism into the study came from a constructivist/interpretivist standpoint as I (i.e., first author and lead researcher) believed—based on literature—the stories of rural women were not being heard and, thus, designed the study to help illuminate the experiences, mental health needs, and resiliency of rural women (Morrow, 2007).

Participants
For this study, participants were recruited using criterion and snowball sampling. Criterion sampling involved selecting individuals on the basis of their shared experiences and their abilities to articulate those experiences (Heppner et al., 2016). Snowball sampling allowed for selecting participants who previously had a demonstrated interest in this area of research based on their connection to other participants. Criteria for participation included a degree from a CACREP-accredited counseling program, licensure within their jurisdiction, current practice, and clinical work that included rural women. To recruit participants, we collected names and emails from a Midwestern state counseling association; however, this method produced only two responses. So, we utilized snowball sampling by asking participants to refer us to others who met our eligibility criteria (Creswell & Poth, 2018). We determined the number of LPCs needed to describe the phenomena by achieving saturation of the data collected (Heppner et al., 2016). This saturation was reflected by eventual redundancy in participant responses.

Following approval from the appropriate IRB, an invitation to participate was emailed to potential participants and included a link to a demographic form and informed consent for those who met the criteria and wished to participate. Rural areas were defined as those geographic areas containing counties with populations of less than 50,000, a definition that did not include population density but was appropriate for the Midwestern areas included in the study (Smalley & Warren, 2014). Twelve mental health counselors met the eligibility criteria for participation and enrolled in the study.

All participants had graduated from a CACREP-accredited counseling program, were licensed to practice within their jurisdiction, were currently practicing privately or in an agency, and had a clinical caseload that included rural women. The designation of LPC was used throughout the study and included all levels of licensure within the various jurisdictions. All of the LPCs reported working with a wide variety of mental health issues; three of the LPCs had addiction counseling credentials. Eleven participants self-identified as female and one self-identified as non-binary. Eleven participants self-identified as Caucasian, and one self-identified as Native American. Years of experience working as a mental health professional ranged from 4 years to 27 years, with an average of approximately 12 years. All participants reported working with both urban and rural clients, and one participant listed a reservation as the primary location for her work. LPCs’ clients included adult rural women from the upper Midwest. The rural women were single or married with children, working or unemployed, Caucasian or Native American. In addition, all the participants expressed a connection to rural areas, either through personal experience of growing up in a rural area or through connections with extended family. Each participant chose a pseudonym that is referred to throughout the manuscript.

Data Collection
We collected data through individual semi-structured interviews and participant artifacts. The semi-structured interview format allowed for more collaboration and interaction between interviewer and interviewee (Creswell & Poth, 2018). In this way, the interview format aligned with a feminist research approach and helped eliminate a power differential between researcher and participant (Heppner et al., 2016). There were 12 interview questions aimed at exploring participants’ work with rural women, participants’ perceptions of the unique mental health needs of rural women, the influence of participants’ rural heritage on their work with rural women, challenges and benefits of participants’ work with rural women, and participants’ training specific to work with rural women (see Appendix for all 12 interview questions). As lead researcher, I conducted all 12 interviews in order to maximize consistency in employing the interview protocol while allowing participants to elaborate on responses. Interviews ranged from 30–45 minutes. All research documents, such as informed consents, demographic questionnaires, and transcriptions, were securely stored on a password-protected device.

Participants were invited to share artifacts that represented their work with rural women. Artifacts could include personal letters, poems, artwork, and photos (Heppner et al., 2016). The artifacts in this study provided an opportunity for broader expression of the counselors’ experiences as well as understanding their connection to rural life. Seven artifacts were pictures of objects or individuals that inspired participants’ work with rural women, two were stories about experiences of rural women, and one was an original poem entitled “Rural Woman.”

Data Analysis
Brown and Gilligan’s (1992) research of young women and relationships utilized a Listener’s Guide for analyzing data. This guide is feminist and relational and allows researchers to pay attention to unheard voices. The Listening Guide is considered a psychological method that reflects the “social and cultural frameworks that affect what can and cannot be spoken or heard” (Gilligan & Eddy, 2017, p. 76). The method included three successive “listenings”—one for plot, one for “I” statements, and one for the individual in relationship to others (Brown & Gilligan, 1992). Throughout the listening process, I looked for and highlighted significant statements the participants made during the interview process that reflected the experiences of the phenomenon. I organized information via a phenomenological template under the heading “Essence of the Phenomenon” and included personal bracketing (epoché), significant statements, meaning units, and textural and structural descriptions (Creswell & Poth, 2018). Although a transcription service was utilized to transcribe the interviews, I read through the transcripts several times and coded data into categories or themes, which emerged organically from the transcripts. An independent peer reviewer then examined the transcriptions and helped to develop the codes and themes. We developed clusters of meaning from the significant statements into themes, followed by a textural and structural description that encompassed the significant statements and related themes. The rich and thick descriptions became the essence of the phenomenon enhanced by continual review of the interview tapes, journal notes, artifacts, and other data collected (Morrow, 2005).

Epoché
The epoché section was written from my perspective as the primary researcher and first author. I was responsible for designing the study, collecting and analyzing data, and writing the manuscript. My co-authors served as consultants in designing the study and helped to write and edit the manuscript. As the primary researcher, I sought to see the lived experiences of participants from a perspective that was free from my assumptions (Creswell & Poth, 2018). I grew up in a Midwestern rural area, steeped in traditional gender roles, while witnessing significant change for all women in expectations and opportunities. During the process of the study, it became apparent that my perceptions of rural women as stay-at-home farmwives have changed to reflect a population more diverse in ethnicity, family structure, and socioeconomic status; however, the traditional patriarchal expectations have not changed. My work as a mental health professional shaped my desire to explore the perceptions of other LPCs’ experiences of their work with rural women. Prior to the data analysis, I bracketed my personal and professional rural experiences about power differentials within rural areas.

Trustworthiness
To promote trustworthiness, I utilized self-reflective journaling, member checks, the achievement of data saturation, independent peer review, and an external audit. I kept a journal and made notes throughout the data collection process to facilitate an awareness of biases and/or assumptions that emerged during the process (Heppner et al., 2016; Morrow, 2005). I also conducted member checks, asking all participants to review and provide feedback via email on descriptions or themes (Creswell & Poth, 2018; Morrow, 2005). Frequently, participants would elaborate on themes by adding clarification to their responses to the interview questions. The “prolonged interaction” (Ponterotto, 2010, p. 583) with participants was significant for developing an egalitarian and unbiased relationship between researcher and participant. This strategy was congruent with feminist theory because it acknowledged the subjectivity of the researcher within the study and facilitated a collaborative relationship between researcher and participant (Morrow, 2007).

Coding the data into categories or themes helped arrange the large amount of data that was collected. The process was made easier by taking notes, or “memoing,” when reading through the information. The peer reviewer evaluated potential researcher bias by checking the coding against all transcripts, serving as a “mirror” that reflected my responses to the research process (Morrow, 2005, p. 254). Next, we discussed possible themes that emerged from the data (Heppner et al., 2016). I also utilized an external auditor to aid in establishing confirmability of the results rather than objectivity (Morrow, 2005). The auditor examined the entire process and determined whether the data supported my interpretations (Creswell & Poth, 2018). Both individuals had participated in phenomenological research and were not authors of this article.

Results

Analysis of the interview transcripts, the artifacts, and the journal reflections resulted in eight themes, organized into two categories. I further categorized each theme as: 1) textural, a subjective experience of the LPC’s experience with rural women; or 2) structural, the context of the experience. According to Moustakas (1994), the textural themes represent phenomenological reduction, a way of understanding that includes an external and internal experience; the structural themes represent imaginative variation, the context of the experience. One of the themes, counselor experience, fit the description of both textural and structural. The categories represented two distinct dimensions of the phenomenon: (a) LPCs’ perceptions of their work with rural women, and (b) LPCs’ perceptions of rural women and issues related to mental health.

Dimension 1: LPCs’ Perceptions of Their Work With Rural Women
Five textural themes emerged from the coding process; I took the names of three of these verbatim from the interviews. The textural themes included 20 codes that represented the subjective experiences of LPCs’ work with rural women. The participants’ pseudonyms were inserted into the direct quotes included in theme descriptions. Artifacts offered by participants were also included.

Bootstraps
Rooted in the familiar saying of “pull yourself up by your bootstraps,” this theme included codes of resilient, stoic, self-sufficient, and independent. According to LPCs’ perceptions of rural women, bootstraps described an acceptance of the current conditions of rural life and a reliance on past experiences for guidance. Many of the LPCs believed that rural women came to counseling with a skill set that, as Nancy said, “can teach us and others about how to be resilient.” Fave commented that working with rural women also required patience:

It’s this sense of “I can do this.” There are more demands with farming, and rural women still believe they should be able to do it all. When they come into counseling it can be difficult because they have worked hard to sort of protect this thing and keep it close to them because they’re pretty sure they can figure it out themselves.

Courtney shared a story about a ranch woman who was grieving the loss of her husband and was struggling with family issues. She remarked in one session, “Today I decided it was time to put on my red cowboy boots.” For Courtney, this represented her client’s resiliency and stoicism—“I’ve got this, and I’ve got my red boots on to prove it.”

Trailblazer
Trailblazer included pioneer, open-minded, resourceful, educated, and empowered; these words described LPCs’ perceptions of rural women’s abilities to move past accepting the realities of rural living and work toward change for improving themselves, their families, and their communities. According to the LPCs, this theme is distinct from bootstraps in that it is future-oriented rather than past-oriented. Elsie first referred to trailblazer when she told a story about a client who began recycling in the early 1980s: “She had bins and bins of recycling because she said, ‘I’m gonna leave this planet in a different shape than I found it.’ Rural women very much can be trailblazers.” The LPCs’ perceptions represented a new perspective that reflected resourceful change-makers, educated and empowered to challenge the status quo.

As one of her artifacts, Courtney offered a story about one woman’s determination to make Christmas special even though there were no resources for gifts and decorations. The woman found a large tumbleweed, covered it with lights and decorations, and declared it beautiful. Courtney said, “She was not just making do, but making things better.”

Challenges of Rural Women
LPCs observed multiple challenges for rural women including isolation, poverty/financial insecurity, role overload, grief, and generational trauma. Layla talked about the complex grief that was experienced by Native American women. She commented that “the death of a family member can mean losing someone from three or four generations. There is grief from loss of jobs, moving from the reservation, and loss of culture.” LPCs cited role overload as one of the most common experiences among rural women. Many rural women worked full-time jobs in addition to caring for family members while contributing to the farm/ranch operation. Jean observed that rural women “are responsible for everyone’s emotions in the family, sometimes leaving them isolated within the family.” LPCs believed that the isolation contributed to vulnerability. Rural women faced domestic violence, anxiety, depression, and addictions, exacerbated by having no one to talk with and long distances to services. Jean noted that resistance to change was perpetuated by the fear and control inherent in domestic abuse for many of her clients and led to complacency in reporting. The challenges of rural women described by participants defined the issues that LPCs faced when working in rural areas and increased their awareness of the critical needs of rural women.

Protective Factors
Protective factors included a sense of identity and the strong support systems of families and community that gave rural women “a lot of people that you can draw upon to help you through hard times,” according to Nancy. Her clients valued the easy access to nature and the opportunity to “immerse yourself in something bigger than yourself. It’s a way to build resilience and find meaning and joy spending time outside.” Layla found a strong sense of identity evident in rural Native women as central to the ability to teach their children cultural beliefs—a protective factor for future generations.

Nancy shared a picture of a family moving their 100-year-old home to a new location as her artifact. Her description of the house and rural heritage symbolized part of what she believed was important for rural women—the connection to family and heritage along with a sense of purpose in maintaining family culture. She said, “It’s a good way to pass down the family stories and even the family culture.”

Counselor Experience
Counselor experience (textural) included the reasons why participants chose to become LPCs. These included the motivations that sustained their work and advice for new counselors. Assumptions about diversity, a sense of purpose, listening, and connections to resources encapsulated this theme.

Layla became a counselor because she wanted “to give back to my Native people.” Nancy believed that the work with rural women helped her build a rural counselor identity. Woods’ early experience with rural women felt profound because of the chaos she observed in the lives of her clients, many of them impoverished single mothers struggling to survive. She was given a sense of purpose in her work saying, “These women are burned into my head.”

When asked about advice for new counselors who anticipate working with rural women, participants offered the following brief statements:

“Don’t make assumptions.” (Courtney)
“Ask to be taught.” (Marie)
“Hear their story without filtering through your own personal lens.” (Nancy)
“There is a difference in working in rural areas—a conservative mind-set, practicality—and you need to meet people where they are.” (Kay)
“Listen more than you talk.” (Suzie)
“Have respect for their culture.” (Layla)

LPCs’ Perceptions of Rural Women and Issues Related to Mental Health
Three structural themes represented what Moustakas (1994) termed imaginative variation, the acknowledgment of the context of multiple perspectives. The themes were derived from nine codes that provided a vital aspect of further describing the phenomenon. The theme descriptions included participants’ quotes and artifacts.

Perceptions of Rural Heritage
This theme represented LPCs’ view of rural life, including traditional values, heritage, and expectations/perfectionism. According to participants, many of the rural women embraced the traditional values of their rural heritage, and the roles of rural life; this theme honors that perspective. Fave talked about the expectations that rural women often have of themselves: “It’s a perfectionist perspective, meaning they can do it all.” Even in light of the increased demands on rural women’s time and energy, Marie found that rural women were often hesitant to seek outside professional mental health counseling, choosing instead to rely on family and community.

Barriers to Mental Health Services
The barriers included codes of lack of resources, stigma, and invisibility. All LPCs felt concerned about the lack of resources for rural women. Suzie talked about the dearth of women’s shelters on the reservation and resources for women who are victims of domestic violence. Suzie said, “They often stay because there are no resources for them to leave, and they can’t afford it.” Woods noted the lack of daycare providers and the fact that many rural women cannot afford these services and depend on family members for childcare. According to several LPCs, rural women do not prioritize their mental health needs, possibly because of the many demands on them.

Kay and Marie practiced in an urban area but saw many rural women who chose to travel long distances for mental health services because it gave them a sense of anonymity. Kay said, “They know if their car is parked at the counselor’s office, it won’t be recognized by everyone in town.” Rural women also feared exposing family secrets if they disclosed something to a counselor who lived in the same area.

Poignantly, LPCs acknowledged the invisibility and minimization of rural women’s mental health needs. The following comments by participants exemplified the rural woman’s experiences of being unnoticed or dismissed. Elsie stated, “Even if rural women are speaking, they don’t have the platform like urban women do, and they feel like nobody gets this life.” Kay stated, “Everything is fine, everything’s great and we’re not going to talk about the fact that Grandma is crying all the time and wearing sunglasses.”

The statements of the participants provided powerful examples of the ramifications of the silencing imposed on rural women through traditional or cultural norms. The stigma of accessing mental health services created a loss of connection between the rural women who needed the services and their community. In addition, rural women often felt selfish in seeking services just for themselves. The consensus among LPCs was that rural women suffer to a greater extent than other rural populations because their needs are minimized or not recognized. Elsie remarked that rural women do not often see their stories in mainstream media, leading them to believe “I’m living this experience that nobody else lives.”

The description of the artifact contributed for this theme may further elucidate the invisibility of rural women. Woods’ artifact was a picture of two locally designed sculptures of women. Woods said, “They are so rooted and earthy.” One sculpture had no arms or legs and, for Woods, that “speaks to the limited access to needed supports and the lack of voice.”

Counselor Experience
Counselor experience (structural) described how LPCs provide mental health services to rural women and included connection to rural life, distances and dual relationships, and lack of academic training/postgraduate training. Although not all the participants grew up in rural areas, many had rural ties through extended family. Marie’s upbringing on a ranch influenced her understanding of rural women: “There is a more intense work ethic; women are very strong and independent and hardworking.”

The LPCs seemed to feel a strong sense of purpose in their work; some of them chose to become counselors and returned to their home communities to work. They discovered that the connections of shared experiences fostered trust in the counseling relationship and process. Most felt that they were helping to make positive change. Although all participants believed the connection to a rural heritage was critical in their work with rural women, some LPCs did not live and work in the same location, saying it helped to reduce the possibility of multiple relationships. Nancy commuted almost an hour to her work “because you really want to have the counseling relationship be through your therapeutic lens and not through the community lens.”

None of the participants recalled receiving academic training specific to rural areas; however, all participants agreed on the need for academic training focused on rural areas and rural women. Elsie believed that textbooks should “include women’s voices and rural voices.” Jean expressed her concern that “We don’t necessarily address rural women or what they need from the communities around them or even what their typical experience is. I think that’s a disservice to our counseling students.”

Two artifacts aligned with this theme: Marie’s picture of a young girl, dressed in overalls, pitching hay, and Mae’s great-grandmother’s writing desk (see Figure 1). Marie’s artifact exemplified the family’s connection to rural life and the physical strength of rural women that she observed in her work. Mae now uses the writing desk in her practice and feels it gives her a strong connection to her rural heritage.

Figure 1

Mae’s Great-Grandmother’s Writing Desk


Note. Mae presented this picture of her great-grandma’s writing desk when asked to provide
an artifact that demonstrated her work with rural women.

 

Discussion

LPCs described rural women as strong, independent, resourceful, and resilient. However, this image of rural women was not corroborated within the research literature. An APA report on the behavioral health care needs of rural women (Mulder et al., 2000) did not mention resiliency as a coping strategy; however, in 2006, the report’s lead author recognized the need for additional research about resiliency in rural women, saying it would offer “significant potential benefit to rural women” (Mulder & Lambert, 2006, p. 15). In the present study, LPCs’ perceptions of rural women as resilient called attention to the innate strengths of rural women that developed out of necessity, cultivated by connections with family, community, and earth.

Rural heritage represented a dichotomy of rural tradition. From a positive perspective, participants believed the traditional roles of rural women provided a sense of identity and belonging. From a negative perspective, the traditional patriarchy evident in many rural areas dictated social and cultural norms, leaving rural women with the expectation that they should be able to “do it all.” Both perspectives defined a critical aspect of LPCs’ understanding of rural women. Even though many of the rural women participants described worked full-time to contribute to household income and health insurance (in addition to caretaker responsibilities), they faced gender inequities in income, employment, and educational opportunities (Watson, 2019). In addition, rural women have had little political power to effect needed policy changes for better access to care (Van Montfoort & Glasser, 2020).

LPCs highlighted multiple challenges that rural women experience: isolation, poverty, grief, role overload, and generational trauma. Barriers to obtaining services included stigma of mental health issues, loss of anonymity, a lack of resources, invisibility, and minimization of mental health issues. The general population also faces barriers of accessibility, acceptability, and availability of counseling services (Smalley & Warren, 2014); however, there were fewer references to the mental health barriers and challenges specific to rural women (Van Montfoort & Glasser, 2020). This is surprising given that the population of rural women exceeds that of any other population group in rural areas (Bennett et al., 2013). Rural women experience higher risks of depression, domestic violence, and poverty (Snell-Rood et al., 2019). The mental health services available in rural areas, often described as “loosely organized, of uneven quality, and low in resources” (Snell-Rood et al., 2019, p. 63), compound the challenges for rural women.

As evident in the themes of assumptions and diversity, rural women represent a unique population who deserve mental health services that reflect their specific needs. Rural communities and rural women are more diverse than once believed. LPCs’ observations are corroborated by research that acknowledged differences among rural women in socioeconomic status, family structure, age, sexual identity, ethnicity, education, and geographical location (Barefoot et al., 2015). In addition, there remains a misconception that the mental health needs of urban and rural women are the same; in fact, much of the literature about women and mental health is based on an urban context (Weaver & Gjesfjeld, 2014). The findings of the current study support the lack of recognition of the context of rural women’s issues and their status as an invisible population (Bender, 2016). Two LPCs’ observations of the isolation felt by rural women reinforced previous research of the invisibility of rural women. Elsie said, “Rural women don’t see their story a lot,” and Fave shared that “a lot of the women I work with don’t feel like they’re heard.”

None of the participants recalled academic training or postgraduate opportunities specific to work in rural areas or with rural women. Even though rural areas represent the largest population subgroup in the United States (Smalley & Warren, 2014), this study suggests that new counselors may not feel prepared to meet the needs of this underserved population. The shortage of mental health professionals working in rural areas and the lack of counselors who have training specific to rural mental health care suggest a need for rural-based training that might include an elective course in rural mental health and rural internships (Fifield & Oliver, 2016).

Implications

The recognition of the challenges and benefits of working with rural women may validate rural LPCs’ experiences, promote their professional identity as rural counselors, and potentially decrease the isolation felt when working in rural areas. Protective factors, including connections to family, community, and nature, may be critical for building resiliency in both rural women and rural LPCs. The increasing diversity of rural women is often contrary to the traditional stereotype of a stay-at-home farmwife (Carpenter-Song & Snell-Rood, 2017); diverse rural women may face unique barriers to accessing culturally relevant mental health services. In addition, many rural women experience role overload from working full-time and caring for families while contributing to the farm/ranch operation. Counselors should avoid interacting with rural women clients in ways that limit their identities based on stereotypes and work to make their services accessible for all women.

The study results also have implications for counselor educators. Rural-based counselors in this study did not report being taught how to work with rural women. A review of the 2016 CACREP programs found few gender-based counseling courses and none that addressed rural mental health. Programs could offer electives on counseling in rural areas, incorporate the context of gender and rural mental health into current curricula, and encourage rural internships. Collaborating with other rural health professionals may provide more informed approaches to working in rural areas. Rural residents may see their PCPs for mental health–related treatment, as PCPs may be the only health care provider in rural areas (Snell-Rood et al., 2017). Lloyd-Hazlett et al. (2020) suggested creating additional training for LPCs who choose to work in settings offering integrated care. Incorporating LPCs who have the appropriate training and skills into rural medical settings may offer mental health services in a familiar clinical context and one that does not broadcast engagement in mental health care. The collaboration may also provide more awareness of the mental health needs of rural women.

Limitations

The study has several limitations. Although I took measures to reduce any personal bias as a non-traditional rural woman, I do not believe it is possible to eliminate all biases. Many of the participants talked about empowering rural women and working toward making their clients’ voices heard, both tenets of feminist theory (Evans et al., 2005); however, participants rarely used the language of feminism. Several of the participants related personal stories of their connections with rurality and, often, their stories of rural women were from decades ago. Their stories may not have represented the current generation of rural women. Another limitation relates to the demographics of LPCs because a majority of participants self-identified as Caucasian and female and represented rural areas in the Midwest. LPCs working in other areas of the United States may encounter different demographics of rural women, mental health challenges specific to region, and unique intersections of their clients’ identities. Finally, the experiences of rural women were heard through LPCs and not from rural women clients themselves.

Directions for Future Research

This study included a sample of rural LPCs who were primarily Caucasian females from the Midwestern United States; future researchers may seek professional perspectives from participants who represent a blend of race, ethnicities, gender identities, and geographical locations. Research with rural women as participants themselves is also an important opportunity. Based on findings from this study, future researchers might also explore training needs related to work with rural women and rural populations. Studying counselor educators who teach in counseling programs based in rural areas could also offer unique insights. This may reveal information about ways educators currently infuse rural culture and work with rural women into the curriculum. Future researchers may study counselors, health care providers, and rural women in finding ways to integrate health care services in rural areas to provide better access to services and reduce the stigma often associated with mental health. Finally, additional studies about working with rural PCPs may highlight issues (e.g., intimate partner violence) that could benefit from early screening of symptoms.

Conclusion

Gilligan offers these words: “To have something to say is to be a person. But speaking depends on listening and being heard; it is an intensely relational act” (1982/1993, p. xvi). As indicated in our findings, rural women are too often invisible and unheard. This study represents a first step in amplifying the voices of rural women regarding their specific mental health needs. The experiences of the LPCs in this study have illuminated ways to connect with rural women, listen to their stories, and validate unique aspects of their cultural identities that seem to be well illustrated in one participant’s poem:

Rural Women
Resilient; stubborn; motivated
frightened; broken; courageous
Struggling; down-trodden; strong
Relentless in self-expectation
Armed with determination.
A common thread unites us
The heart gently calls, and the
soul asks only—please—listen to me.

 

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
Twelve Interview Questions

  1. Tell me about what comes to mind when you think about working with rural women.
  2. Tell me about where you grew up and how that has influenced your work with rural women.
  3. Tell me about how you began your work with rural women.
  4. What have you learned about rural women through your work with them?
  5. What are the unique mental health needs of rural women that you have seen in your work?
  6. Tell me about some of the benefits and rewards, if any, you have experienced working with rural women.
  7. Tell me about some of the challenges, if any, you have experienced working with rural women.
  8. How have your experiences working with rural women changed you as a mental health counselor?
  9. Tell me about any academic/classroom experiences in your graduate program that involved the mental health issues of rural women (e.g., class discussions, special projects, conversations with colleagues, internship experiences).
  10. Tell me about any training experience post-graduation that have involved the mental health issues of rural women (e.g., workshops, conference presentations, webinars, conversations with colleagues).
  11. What would you like other counselors to know about working with rural women?
  12. Please describe how the artifact that you have chosen relates to your work with rural women.

 

Lisbeth A. Leagjeld, PhD, NCC, LCPC, LPC-MH, is a program liaison and faculty member at South Dakota State University – Rapid City. Phillip L. Waalkes, PhD, NCC, ACS, is an assistant professor and doctoral program coordinator at the University of Missouri – St. Louis. Maribeth F. Jorgensen, PhD, NCC, LPC, LMHC, LIMHP, is an assistant professor at Central Washington University. Correspondence may be addressed to Lisbeth A. Leagjeld, 4300 Cheyenne Blvd., Rapid City, SD 57709, Lisbeth.leagjeld@sdstate.edu.