Service Learning in Human Development: Promoting Social Justice Perspectives in Counseling

Kristi A. Lee, Daniel J. Kelley-Petersen

The focus on human development is foundational to the field of counseling, with its importance codified in guiding documents and frameworks, such as the American Counseling Association’s Code of Ethics (2014). Many developmental theories have been established using single-gender or single-culture groups, yet they claim universal application to all humans. Although counseling students must learn these theories because of accreditation standards and licensure requirements, counselor educators need to prepare students for practice in a multicultural world. Counselors are now called to act as social justice advocates, and teaching strategies are needed to prepare students for this role. This study’s focus is on the use of service learning with community counseling students in a human development course. Results from a content analysis demonstrate how service learning enhances learning and broadens students’ perceptions of themselves, others, and social justice in counseling. Findings indicate a shift in participants’ perception of social justice in counseling.

Keywords: service learning, social justice, human development, developmental theories, content analysis


Distinct from the medical model that underlies psychology, the field of counseling has historically focused on developmental processes as the foundation to understanding what makes human life function well (Brady-Amoon, 2011; Kraus, 2008; Lewis, 2011; Stennbarger & LeClair, 1995). These processes of development are explained through theories about learning, normal personality development, and individual and family development, among others (Council for the Accreditation of Counseling & Related Educational Programs [CACREP], 2015). The American Counseling Association (ACA) identified “enhancing human development throughout the lifespan” as the first core value of the counseling profession (2014, p. 3). Further, human development has been established as one of eight knowledge areas by CACREP (2015), the national accrediting body for counselor education programs. Additionally, standardized tests, such as the National Counselor Examination for Licensure and Certification, require students to demonstrate mastery of studies that provide an understanding of the nature and needs of individuals at all developmental levels (National Board for Certified Counselors [NBCC], 2015).

Although understanding and promoting healthy human development across the lifespan are central themes in counselor education, there are critiques of the study of human development (Brady-Amoon, 2011). Many theories and models of human development reflect middle-class, Caucasian-American value systems and culture (Brady-Amoon, 2011; Broderick & Blewitt, 2015; Dixon, 2001; Henrich, Heine, & Norenzayan, 2010), and thus lack utility in developing both a robust and a nuanced understanding of groups who are outside of this demographic. Broderick and Blewitt (2015) stated that there is a “growing concern that traditional theories are insufficient to explain development because they are biased in favor of single-culture or single-gender models” (p. 351). The role of culture in human development is crucial to consider (Rogoff, 2003), yet many theories consider culture an extraneous variable. Systematic misapplication of theories designed for the dominant population may not adequately account for the accepted indicators of development for diverse cultural and societal contexts (Broderick & Blewitt, 2015;
Dixon, 2001; Kraus, 2008). Recognizing challenges in applying developmental theories to diverse populations is critical for counselors who promote social justice in counseling and in society (Kiselica & Robinson, 2001; MacLeod, 2013).


The Movement Toward a Social Justice Perspective in Counseling

Counselors have a unique position as frontline witnesses to how social inequities impact clients. Individual, couples, family, and group counseling are critical in helping clients in non-dominant groups navigate and survive systems of oppression and opportunity. However, these modalities of counseling may not be sufficient to prevent or meaningfully address mental health issues that have systemic causes (Toporek, Gerstein, Fouad, Roysircar, & Israel, 2006). The recognition for the need to adjust counseling approaches to work with issues of healthy human development in a pluralistic society has contributed to the growth of the social justice movement within the field of counseling (Ratts & Wood, 2011). At times identified as the “fifth force” (Ratts, 2009) in counseling, the social justice perspective not only addresses the individual needs of clients, but also seeks to change systems that inhibit human development for oppressed groups. Counselors are challenged to determine how to balance individual counseling interventions with advocacy interventions on local, state, or national levels. A social justice approach to counseling emphasizes the importance of healthy human development for individuals and social groups and necessitates a broader array of skills, knowledge, and perspectives, including advocacy skills (Bemak & Chung, 2011; Brady-Amoon, 2011; Lewis, 2011; Ratts, 2009).

Acceptance of the social justice counseling perspective is evidenced by its codification in important documents that guide many practitioners and educators in the field of counseling. In the preamble to the 2014 Code of Ethics, ACA identified “promoting social justice” (p. 3) as a core principle. Ethical counselors are called to “advocate at individual, group, institutional, and societal levels to address potential barriers and obstacles that inhibit access and/or the growth and development of clients” (2014, p. 5). In 2003, ACA endorsed the Advocacy Competencies (Lewis, Arnold, House, & Toporek, 2002), a document that describes skills and activities for counselor advocacy. Additionally, the 2016 CACREP standards call for preparation of counselors in “advocacy processes needed to address institutional and social barriers that impede access, equity, and success for clients” (2015, p. 10). These documents provide evidence that segments of the profession of counseling, particularly some counselor education programs, are embracing a social justice perspective that can be enacted through counselor advocacy.

Although many counselors may want to advocate for marginalized populations, they may not be comfortable doing so or they may not know how (West-Olatunji, 2010). Further, it is unclear whether counselor educators are adequately preparing students with the skills necessary to practice from a social justice perspective upon graduation (Bemak & Chung, 2011; Constantine, Hage, Kindaichi, & Bryant, 2007). Preparing counselors with effective and culturally relevant advocacy skills for work in today’s pluralistic society requires that counselor educators rethink historically used teaching methods (Brady-Amoon, Makhija, Dixit, & Dator, 2012; Burnett, Long, & Horne, 2005; Herlihy & Watson, 2007; Hoover & Morrow, 2016; Manis, 2012). Rethinking traditional teaching methods and curricula is particularly important for courses such as human development, which have traditionally focused on universalist theories established using single-gender or single-culture groups (Broderick & Blewitt, 2015). However, for the foreseeable future students will be required to demonstrate their mastery of these traditional theories on licensing exams (NBCC, 2015). To meet the dual challenge of preparing students for licensure and preparing them for practice in a pluralistic society, new teaching approaches are needed. The role of social justice advocacy has been conceptualized as central for counselors (Chang, Crethar, & Ratts, 2010; Lewis, Lewis, Daniels, & D’Andrea, 1998), yet few studies have demonstrated how to prepare students for this role.


Service Learning: A Pedagogy for Counselor Education

Defining Service Learning

Teaching that is active, experiential, and addresses real-world problems is needed to meet the call to prepare students as social justice advocates in the context of rapidly changing and diversifying demographics (Bemak, Chung, Talleyrand, Jones, & Daquin, 2011; Constantine et al., 2007; Manis, 2012). As an experiential teaching strategy that combines academic content learned in the classroom with activities in the community that address “human and community needs” (Jacoby, 2015, p. 6), service learning provides a potential avenue for more adequately preparing counseling students for work in today’s pluralistic society.

Although similar to experiential learning, service learning has a set of characteristics that make it distinct from internships and volunteerism (Furco, 2002). With an emphasis on collaboration with community partners (CPs) who represent historically marginalized communities, all participants enter the service-learning experience as learners and as contributors. Community members and students benefit from a collaborative learning partnership through which a solution to a community-articulated problem is developed (Warter & Grossman, 2002).

Service learning can take two forms: placement-based and project-based. Placement-based service learning usually involves a requirement for students to spend a set number of hours at a community organization where a student completes agreed-upon tasks (Parker-Gwin & Mabry, 1998). In project-based service learning, small student groups work with CP organizations on specific projects that help to meet a need or solve a community-articulated problem (Hugg & Wurdinger, 2007).


Service Learning in Counselor Education

A growing number of counselor educators have called for the use of service learning within counselor education to provide students with an avenue for understanding complex systemic social inequities (Bemak & Chung, 2011; Bemak et al., 2011; Constantine et al., 2007; Manis, 2012). Additionally, the use of service learning within counselor education has been the focus of a limited number of studies. A qualitative study by Jett and Delgado-Romero (2009) focused on the impact of using service learning with pre-practicum counseling students. Results showed that service learning “was perceived to facilitate student counselors’ professional development” (p. 116) through promoting a deeper understanding of counselors’ roles and contexts. Exposure to counseling environments promoted student counselors’ understanding of what counseling is, as opposed to what they imagined it to be (Jett & Delgado-Romero, 2009).

Service learning also has been found to increase multicultural competencies in counseling students. In utilizing service learning in a multicultural counseling class, Burnett, Hamel, and Long (2004) found that it provided “an opportunity to build community learning and cultural sensitivity” (p. 190). They found that service learning had merit in multicultural counseling competency training and in reducing a “missionary ideology” (p. 191) in students. These results suggest that service learning can be a useful strategy for helping students understand how to advocate with and on behalf of marginalized communities. In addition, service learning may give students the opportunity to practice advocacy skills in real-world contexts.

In order to explore the relationship between service learning and students’ understanding of the role of social justice advocacy in counseling, the present study documented and analyzed community counseling students’ experiences in project-based service learning in a human development course in a CACREP-accredited program. The study’s research question has four foci: In what ways does the use of service learning in a human development course impact students’ (a) understanding of course content; (b) understanding of development of people in non-dominant populations; (c) perceptions of themselves; and (d) understanding of a social justice perspective in counseling?



Description of Participants and Sampling Procedures

The study included data from 40 participants. Seventy-six percent of participants identified as female, 24% identified as male, and no participant identified as “other,” an option allowing for non-binary gender identities. Participants’ age range was 22 to 56 with an average age of 31, and they identified with the following race or ethnic categories: Black, 5%; Hispanic, 22%; Native American, 2%; Two or More Races, 10%; White, 49%; and No Response, 12%.

To gain a broad understanding of students’ experiences, data from nearly all community counseling students (hereafter called participants) who participated in the course over four academic terms were included in the study. The data for one student was left out of the study because of participation in the research process. Each participant was in the first of a three-year community counseling program while enrolled in the course with service learning. The program was in its final cycle of CACREP
re-accreditation as a community counseling program at the time the data were collected. This study was approved by its host institution’s Internal Review Board.


Class as Context

Service learning is grounded in a specific “academic house” (Lee & McAdams, 2017) that informs the type of service activities. The academic house for the current research project was a course designed to meet the CACREP human growth and development curriculum requirement. Entitled Counseling Across the Lifespan, it was positioned as the first course in a three-year community counseling program located in a private, urban, medium-sized university in the northwest region of the United States. Taught over a 10-week academic term, the course utilized a text that covered theories and models of human development across the lifespan (i.e., theories of learning, personality development, cognitive development, ecological models). Course elements included reading, class lectures, small and large group discussions, papers, and quizzes. Many theories of development included in the course to help students meet the requirements of licensure were developed using a single-gender, monocultural group. To incorporate a social justice perspective, the course instructor (first author) believed it was essential for students to understand how Euro-Western theories of development may or may not apply to populations for whom they were not developed. To provide context for critical analysis of class content, students engaged in a major class project, the Developmental Service-Learning Project (DSLP).

Developmental service-learning projects. In keeping with high-quality service-learning pedagogy with a social justice focus, the DSLPs were designed in collaboration with CP organizations working with marginalized populations. The primary instructor worked with a center on campus that supported faculty in developing service-learning courses to identify potential partners whose organizations serve people across the lifespan. Project examples included needs assessments, resource manual development, and socio-emotional lesson plan development. All project ideas were suggested by CPs and planned collaboratively with the course instructor. CPs visited class to introduce their organizations and projects to students during the second class session. Students then selected a project and met with their CPs during class time to launch the collaborative project work.

The DSLP had several requirements. For students to gain an understanding of the organization and the population with whom they were working, students visited the site under the supervision of the CP. Each project included the development of a product that could go into immediate use at the CP organizations and that would continue to benefit the site after the project ended. Students also were required to read, analyze, and report how relevant scholarly literature informed their project work. A project proposal detailing what would be accomplished during the DSLP was submitted for approval to the CP and the course instructor. Upon approval, students carried out their projects while remaining in contact with their CPs. During the study’s time period, there were a total of 24 completed DSLP projects. In collaboration with CPs, students completed projects on curriculum development, program evaluations, needs assessments through focus groups and interviews, and intake process development, among others. CP organizations served individuals across the lifespan and in historically marginalized communities ranging from a program on kindergarten readiness with refugee families, to developing resources for housing for an older African immigrant community.

CPs attended the final class session for DSLP group presentations. Partners asked questions, gave verbal feedback, and completed formal written evaluations of the projects. Project groups wrote a final report for their CP detailing their work and product. Digital and physical copies of all products were given to CPs for their continued use. The last class session served to celebrate partnerships and accomplishments. After the term ended, the course instructor met with each CP to discuss the experience, solicit feedback, and plan future collaborations; several CPs collaborated on projects over multiple academic terms.


Data Collection and Analysis

Data were collected from three sources, each a required class assignment. The first two sources were reflection papers—one written by participants at midterm, and one at the end of the term. The third assignment was a self-evaluation completed by participants at the end of the DSLP experience. Participants responded to specific prompts such as “Did your experience with the Developmental Service-Learning Project impact your comprehension of the material from the text and lectures? If so, how?” and “Through the Developmental Service-Learning Project, what did you learn about: Yourself? Your community? Working with people who may have had a different developmental trajectory than you?”

Content analysis is a qualitative methodology that can be used for analyzing and drawing meaning from large amounts of textual data. It allows for the “subjective interpretation of the content of text or data through the systematic classification process of coding and identifying themes or patterns” (Hsieh & Shannon, 2005, p. 1278). This methodology has been widely used in counselor education research (Avent, Wahesh, Purgason, Borders, & Mobley, 2015; Burkholder, Hall, & Burkholder, 2014; Cook, Hayden, Gracia, & Tyrrell, 2015).

Using content analysis of secondary data, researchers analyzed existing textual data collected from study participants enrolled in the course over four academic terms, for a total of 120 documents (N = 40 students with three documents each). To maintain participants’ confidentiality and to minimize possible researcher bias, all identifying information was removed from the data sources by the first author prior to analysis. Each participant was assigned a numerical identifier linking them to the course section in which they participated. These identifiers were kept in an Excel file that was password protected and was kept away from the rest of the data in order to reduce bias.

Data were analyzed in two phases to identify central themes associated with the participants’ experiences and perceptions with DSLP. First, data corresponding to each of the four foci of the research question were grouped into the following a priori categories: (a) understanding of course content,
(b) understanding of human development in non-dominant groups, (c) perception of self, and (d) a social justice perspective in counseling. During the second phase of analysis, data within each category were coded by meaning units, which was defined as a collection of words, sentences, or paragraphs that referred to a discrete idea. Closely related codes were collapsed into themes. Researchers used NVivo 10 (QSR International, 2012) for the coding process and to calculate interrater reliability statistics.



During the study, the researchers engaged in several strategies to ensure the study’s trustworthiness. The research team consisted of the course instructor and a graduate student research assistant who was trained in the research procedures. Prior to the study’s design and again before data analysis, researchers examined their potential biases. As recommended by Rossman and Rallis (2003), researchers engaged in reflexivity through writing, discussing, and revising researcher-as-instrument statements throughout the process. This process was done to bracket the researchers’ beliefs and opinions to ensure that the participants’ voices could be heard fairly and clearly.

Data were collected from documents that participants completed at two different points during the academic term (midterm and end of term), providing the basis of a longitudinal analysis. At the beginning of data analysis, researchers spent several hours coding data together to support shared meaning of codes and ensure credibility of the analysis. Additionally, researchers engaged in peer debriefing of codes and the coding process at weekly research meetings. Within each phase of coding, the researchers calculated interrater reliability statistics in NVivo 10 (QSR International, 2012) to determine the credibility of the analysis. After each coding session, researchers documented their reflections, questions, and ideas in a reflexive journal designed to document decision making related to the analysis. An audit trail was kept ensuring confirmability of the study’s findings.


Interrater Reliability

During each phase of coding, researchers conducted interrater reliability testing using NVivo 10 (QSR International, 2012) to ensure credibility of the coding process. In the first phase of grouping data into four a priori categories for further coding, an interrater reliability test resulted in a kappa coefficient of .68. This outcome is considered a “substantial” benchmark for kappa coefficients by Landis and Koch (1977). During the second phase of coding into emergent categories, the kappa coefficient for data that was coded by both researchers was .96. This is an “almost perfect” benchmark for kappa coefficients (Landis & Koch, 1977). These results demonstrated that raters consistently coded the data in a similar matter and increased the data’s credibility.



The study’s results indicated the level of impact the DSLP experience had on participants’ understanding of course content, understanding of people in non-dominant groups, perceptions of themselves, and what social justice in a counseling context meant to them. For participants, the DSLP experience became a lens to look at the world in a different way and was a primary frame of reference for the course. In this section, results for each of the four a priori categories is reported, including qualitative results from the content analysis, as well as a narrative description of the data’s emergent themes.


Understanding of Course Content

The first a priori category focused on the impact of the DSLP on participants’ understanding of content in the human development course. Content analysis resulted in 374 meaning units that coalesced into two themes: connecting class material and reflections on learning.

Participants articulated coming away with a more complex and nuanced understanding of seemingly straightforward developmental theories because of the DSLP experience. The messiness of lived experience became real in a way participants did not believe the theories always described. For example, one participant stated that the DSLP experience “muddied the overly clear waters of the text’s simplistic approach to the behavior of complex systems. The service-learning project was a much more realistic approach, introducing us to complex systems and their interactions.” The hands-on nature of the DSLP, as well as the real-world context it provided, facilitated learning that participants described as broader, deeper, and more relevant to their professional futures. Participants reported that the class content was more accessible, more understandable, and easier to absorb because of the DSLP experience. One participant stated that the service-learning experience “required me to broaden my scope of what we were learning in the class. The focus can often be narrow in the classroom setting, but we were able to consider the ‘big picture’ in a realistic way because of this project.”

Further, the context provided by the service-learning experience offered the opportunity for critical analysis of class content. Consistencies and inconsistencies between class content and the lives of the people at their DSLP sites became apparent to participants. Many times, students came away realizing the gaps between theoretical models and lived experiences, particularly for people in non-dominant groups. One participant stated that the experience “made me more critical of the dominant views of development presented in our text. . . . While I understand there are certain fundamental human needs, I really believe in thinking about context as much as content.”


Human Development in Non-Dominant Groups

The next a priori category focused on how the experience with the DSLP impacted participants’ understanding of development of people in non-dominant groups. As CP agencies worked with populations outside the dominant culture, the DSLP provided an opportunity for participants to learn about these groups. Data analysis resulted in 291 meaning units in five themes: access to resources, creating community, cultural awareness, cultural differences, and systems of oppression.

Because of the DSLP experience, participants noted better understanding of the challenges a person in a non-dominant group faces when creating or maintaining their identity. Several participants reported seeing community members’ struggles by incorporating a social construct or standard that did not fit with their own cultural experiences. One participant stated, “As an immigrant parent, the stress is likely increased because the ‘outside influences’ are coming from a culture that is at the very least unfamiliar, and at worst, in conflict with cultural values important to the parents.”

Participants observed a strong sense of resiliency in community members as they overcame obstacles to seek out support. Participants identified that engaging in wellness activities and having a sense of purpose and pride in their lives contributed to resiliency for community members. These wellness activities included groups offered at mental health agencies and informal gatherings where stories and experiences were shared. A participant stated that at her DSLP site she witnessed “strength and resiliency with which people can create meaning and community that is not based on dominant cultural values.”

Furthermore, participants witnessed that when faced with conflicts or challenges, community members found support by referring to their own cultural values and norms. A participant stated, “For an immigrant in a new country, believing that there are others around who not only speak the same language, but have the same values and interests can be powerful in promoting feelings of efficacy instead of helplessness.”


Perceptions of Self

The third a priori category focused on how the DSLP experience impacted participants’ perceptions of themselves. Content analysis resulted in 227 meaning units with three themes that focused on working with new populations, their personal role in social justice, and specific work-related skills.

As CP organizations worked with marginalized communities, such as the East African immigrant community and the youth of the Asian and Pacific Islander community, most participants interfaced with communities with whom they had not previously worked. These interactions spurred participant reflection on the similarities and differences between themselves and those with whom they were working. Participants expressed surprise in what they learned about communities new to them, expecting to find more similarities or more differences. One participant stated, “As a first-generation person, I assumed that I could relate to the issues that the families face. However, I learned that their experience here in (location) is much different than the one I had growing up.” Another participant stated, “Although the students that were in the (CP program) may have a different developmental trajectory than me, there were still many similarities between us. Their values and work ethic reflected the same as mine.”

The interaction with CPs and clients through the DSLP provided a lens for participants to see how structural inequities in society impact the health and development of people in marginalized groups. Because of this, participants were better able to see and understand their own privilege, whether that privilege was related to race, gender, socioeconomic status, or educational attainment. One participant stated, “To be able to briefly see through the eyes of another individual who does not have the same background or privilege as I do, I am better able to understand my own privilege.” Another participant stated, “We all have our own biases and stereotypes and maybe even racist ideologies that we need to get rid of.”

Many participants articulated their perspectives on what social justice meant to them personally and how to move social justice goals in society forward. These were general definitions of social justice not specific to how social justice related to counseling. One participant said, “I believe that being an advocate for social justice involves understanding that many factors in people’s lives influence their development, and that not everyone has equal opportunity to environments conducive to healthy development.” Another participant stated, “To me, social justice means recognizing human dignity across social categories and engaging in some way to distribute power more equitably among people.”


A Social Justice Perspective in Counseling

The final a priori category was focused on how engagement in the DSLP experience impacted participants’ understanding of a social justice perspective in counseling. Data analysis resulted in 416 meaning units with three themes: definitions of social justice in counseling, counselor social justice knowledge, and counselor action through advocacy.

Participants articulated what social justice in the counseling sphere meant to them. One participant stated, “In order to successfully incorporate a social justice approach to counseling, socioeconomic status, culture, academic proficiencies and group membership must be considered.” Empowerment was identified by multiple participants as key to social justice approaches to counseling. According to one participant, “Empowering individuals is at the heart of social justice.” Additionally, participants pointed to understanding each client as a whole individual, including their unique social location, as important in counseling from a social justice perspective.

Participants shared new knowledge of recognizing systems that impacted people in non-dominant groups and acknowledging that the external factors of barriers and injustices may play a role in the need for mental health services. One participant said, “A counselor can promote social justice by helping clients identify the foundation of their behavior and understand that their feelings of insecurity are valid.”

Participants identified that a social justice perspective in counseling included a call to advocate for clients. One participant defined advocacy as, “Part of being a therapist who believes in social justice is advocating for and empowering those individuals who feel they have no voice or feel their voice has been extinguished through societal or institutional oppression.” Participants stated that the goal of social justice counseling was, in fact, to strengthen and support the resiliency of their clients who experience challenges brought on by external factors. One person said, “Social justice advocacy seeks not only to fight oppression but to empower individuals and communities that have been historically oppressed to be self-determinant to live lives of meaning and hope through equitable redistribution of resources, power, and opportunities.”



The results of this study offer insight about how using service learning in a human development course impacted community counseling students. Because these findings document a shift in understanding the nature of human development in a pluralistic society, they may be useful for counselor educators who teach human development and who strive to prepare counseling students with a social justice perspective.


The Teaching and Learning of Human Development

As a core curricular area of accredited programs, coursework in human development is required for all counseling students (CACREP, 2015). Students who seek to become licensed counselors must demonstrate their mastery of this content area on national exams (NBCC, 2015). Therefore, counselor educators have an obligation to prepare students with this knowledge base. However, universalist theories of human development may not sufficiently explain development of all groups in a society (Broderick & Blewitt, 2015; Henrich et al., 2010). There is growing acknowledgement that often embedded in models are the worldviews of those who developed them (Rogoff, 2003). Counselor educators are called to teach human developmental theory in such a way that students will be able to responsibly apply (or not apply) theories to clients from whom and for whom they were not developed.

This study’s findings demonstrate that service learning provides participants with a deeper and more nuanced understanding of human development course content through its application in real settings. Participants witnessed how theories did not always match the lives of people at their service-learning sites. Further, participants articulated witnessing how systems of oppression negatively impacted the development of marginalized people. These results build on the evidence that the use of service learning can promote multicultural competence (Burnett et al., 2004) and help students be more prepared to move into the professional role of counselor with a more realistic perspective of what the role means (Jett & Delgado-Romero, 2009).


Preparing Counseling Students as Social Justice Advocates

According to the Code of Ethics (ACA, 2014), counselors should be ready to advocate for removing barriers to healthy growth and development, yet specific strategies for preparing students to do so are lacking. Participation in collaborative service learning focused on important issues for marginalized populations facilitates new awareness of what social justice counseling means. The need for counselors to be aware of their own privilege was stated clearly by participants. In addition, being a counselor for social justice also meant advocating for clients at multiple levels. Working with CPs provided opportunities to witness important work in the community and to practice enacting social justice advocacy. The results demonstrate that service learning can be used as a teaching strategy to meet CACREP requirements and to meet the call for using new “structures, requirements, and goals” (Constantine et al., 2007, p. 27) to prepare students as social justice advocates.


Limitations and Future Research

This study’s findings demonstrated that service learning can be used to teach academic content as well as promote students’ understanding of social justice and advocacy. However, limitations are important to note. First, the primary researcher was the course instructor and the co-researcher participated in the class as a student, although data for the co-researcher was not included in the analysis. Although steps were taken to ensure trustworthiness and authenticity, future studies should include an outside researcher to strengthen the methodology. Second, data for the study was drawn from written text. As such, there were no opportunities to ask participants follow-up or clarifying questions. Although content analysis was chosen to examine the participants’ experiences of the DSLP while they were occurring, future studies using interviews or focus groups could provide more sources of data. Third, the current study focused only on the student experience in the DSLP. Although CPs were involved in every aspect of project creation, execution, and evaluation, they were not included in the systematic study of outcomes. Future studies should examine the impact of service learning on CPs, clients, and communities.



The demographics of the United States are rapidly changing, and soon there will be no one majority group (Cárdenas, Ajinkya, & Gibbs Léger, 2011). Continuing to teach monocultural theories is no longer sufficient; it risks further marginalizing non-dominant groups in society. If we were to better understand how different groups and cultures experience development through their own lenses and a shared pluralistic lens, the problem of applying theories to those from whom and for whom they were not developed would be eliminated. Counselor educators should work with CPs and community members to develop, research, and apply culturally appropriate theories of human development. Until that time, counselor educators must use effective teaching strategies that prepare students to work responsibly and competently in a multicultural world. Service learning, as an educational tool for social justice in counselor education, can contribute to meeting this need.


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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Kristi A. Lee, NCC, is an associate professor at Seattle University. Daniel J. Kelley-Petersen, NCC, is an adjunct faculty member at Seattle University. Correspondence can be addressed to Kristi Lee, College of Education, 901 Twelfth Avenue, Seattle, WA 98122,

Human Sex Trafficking in America: What Counselors Need to Know

Stacey Diane A. Litam

The social justice issue of human sex trafficking is a global form of oppression that places men, women and children at risk for sexual exploitation. Although a body of research exists on the topics of human trafficking, literature specific to the mental health implications for counselors working with this population is limited. Counselors should increase their awareness of the vulnerabilities that place persons at risk of becoming trafficked. Additionally, obtaining a deeper understanding of the indicators and processes through which persons become trafficked is necessary in order to provide appropriate services. Counselors should learn how force, fraud and coercion influence the wellness of trafficked persons. The following article provides an overview of the relevant information pertinent to sex trafficking and addresses the counseling implications for working with sex trafficked survivors.


Keywords: human sex trafficking, sexual exploitation, social justice, trafficked survivors, oppression


The sexual exploitation of men, women and children through sex trafficking continues to occur in the United States and across the globe at an increasingly alarming rate. Despite misconceptions that sex trafficking requires transportation across state or country borders, the majority of victims are domestically trafficked within their own country by persons of the same nationality (Shelley, 2010; U.S. Department of State, 2009). Rates of forced labor are unknown and notoriously difficult to obtain due to methodological deficiencies (Fedina, 2015) and issues related to reporting and victim identification (Chesnay, 2013; Hyland, 2001; Laczko & Gramegna, 2003). However, the International Labour Organization (n.d.) estimates 27 million people become trafficked annually—4.5 million of whom are victims of forced sexual exploitation. Children and adolescents are exceptionally vulnerable to forced entry into the sex trade. The National Center for Missing and Exploited Children (2014) reported that 1 in 5 runaways are at risk for forced sexual exploitation. This represents an increase from an estimated 1 in 6 in 2014 (Polaris, 2016). Additionally, a study conducted by Estes and Weiner (2002) estimated that 326,000 youth are at risk for child trafficking. Counselors must become educated in recognizing the signs of trafficked persons, vulnerabilities to becoming trafficked, and the processes by which persons are forced into sexual exploitation in order to obtain a deeper understanding of the client’s worldview and provide appropriate support.


Existing literature addressing the mental health needs of sex trafficked survivors remains extremely limited (Hossain, Zimmerman, Abas, Light, & Watts, 2010; Tsutsumi, Izutsu, Poudyal, Kato, & Marui, 2008). Instead, the current body of research has focused on the sexual consequences of trafficking-related health issues such as sexually transmitted infections and rates of HIV among trafficked women in Asia (Beyrer, 2001; Beyrer & Stachowiak, 2003; Silverman et al., 2006; Silverman et al., 2007). The following article provides a brief overview of the definition, terms and processes associated with human trafficking. Next, the vulnerabilities and signs that a person has been or is currently being trafficked are presented. Finally, we address the clinical implications of working with trafficked survivors and identify trauma-sensitive interventions. Although female pronouns are used in this article, this detail is not intended to minimize the fact that many cisgender men, as well as lesbian, gay, bisexual and transgender persons, become victims of forced sexual exploitation (Martinez & Kelle, 2013; Oram, Stöckl, Busza, Howard, & Zimmerman, 2012).

Definition, Terms and Processes of Sex Trafficking


Despite the growing awareness of modern day slavery, the act of human trafficking is not a new phenomenon. In Imperial Rome, it has been estimated that between 30–40% of the Roman population was comprised of slaves trafficked from nearby countries such as Thrase, Gaul, Britain and Germany (Collingridge, 2006). In fact, during the height of the Roman Empire, wars were fought solely to procure more slaves (Cahill, 1995; Goldsworthy, 2006). Human trafficking was not limited to European countries. Beginning in 1619, both White and African slaves were taken from their countries and imported to Virginia to help construct the colonies (D. Davis, 2006; Jordan & Walsh, 2007). Human trafficking and modern day slavery are acts of social injustice that have historically exploited men, women and children.


According to the Trafficking Victims Protection Act (U.S. Department of State, 2000), the act of human trafficking refers to the recruitment, harboring, transportation, provision or obtaining of a person for commercial sex through force, fraud or coercion, or in which the person induced to perform a sex act is under 18 years of age. Despite common misconceptions, for an act to be considered sex trafficking, forced movement across the state is not required (U.S. Department of State, 2000). Sex trafficking includes a wide variety of traditionally accepted forms of labor, including commercial sex, exotic dancing and pornography (Logan, Walker, & Hunt, 2009). The following sections address the three components of control associated with human trafficking, namely force, fraud and coercion. Specific strategies used by traffickers to obtain and maintain control also are described.



As defined by the United States Department of Health and Human Services (2012), force pertains to the physical restraint or serious physical harm that traffickers use to obtain and maintain control. According to Chesnay (2013), methods of force are typically used to break down the victim’s spirit. Examples of force as a means of control include rape, physical violence, intimidation, physical confinement and restricted freedom (Williamson & Prior, 2009; Zimmerman et al., 2008). Traffickers may introduce an addiction to an illicit substance or use existing drug or alcohol addictions to force persons into exploitative circumstances (Raphael & Ashley, 2008; Raymond et al., 2002; Whitaker & Hinterlong, 2008; Williamson & Prior, 2009; Zimmerman, 2003). According to findings by Whitaker and Hinterlong (2008), victims’ resistance often leads to additional or more forceful control mechanisms used by traffickers. For example, traffickers may initially use physical or sexual violence and increase the severity (e.g., burning or torturing victims) when disobeyed. Additionally, Whitaker and Hinterlong discovered the presence of gendered patterns of control or the concept that different strategies are used when eliciting compliance from men and women (e.g., use of threats to community members and drug addiction in men, and threats to family relationships and references about the world being dangerous in women). It is important to note that not all trafficked persons experience physical suffering (Aradau, 2004; Belser, 2005).



     Fraud, or the use of false promises to lure persons into the human trafficking industry, is another method used by traffickers to control and exploit their victims (United States Department of Health and Human Services, 2012). Although fraud is typical in labor trafficking scenarios (e.g., women are offered appealing job opportunities overseas as a nanny or model and then forced into prostitution upon arrival), this tactic also is employed within sex trafficking scenarios (Belser, 2005; Whitaker & Hinterlong, 2008). Traffickers may recruit children from low-income families by promising parents that their children will be safer, better cared for and taught a useful skill or trade (Albanese, 2007; U.S. Department of State, 2009). Once recruited, victims enter into debt bondage and are promised freedom upon repayment to traffickers for their services (Williamson et al., 2010). Unfortunately, the result of debt bondage is a never-ending cycle from which victims cannot escape (Chesnay, 2013). Upon incurring a debt, persons in forced labor scenarios become trapped as traffickers enforce high interest rates, withhold payment, and charge for miscellaneous expenses such as the cost for food, transportation, condoms, and other supplies (International Labour Organization, 2005). Albanese (2007) described one case in which traffickers used fraud after recruiting two girls from Vancouver, British Columbia, and transporting them to Hawaii. In this scenario, the traffickers withheld the girl’s passports and threatened to circulate photographs of them engaging in sex acts in order to obtain their compliance. For many victims of forced labor, fraud is a strategy used by traffickers to exploit dreams or hope for a better life (U.S. Department of State, 2009).



     Coercion, or using threats of physical harm or physical restraint against a person, is another context of control associated with human trafficking (United States Department of Health and Human Services, 2012). Coercion can take the form of direct physical violence or be psychological in nature (Logan et al., 2009; U.S. Department of State, 2009). In many cases, traffickers coerce victims by threatening to harm their families if they do not comply with their demands (Whitaker & Hinterlong, 2008; Williamson & Prior, 2009). Coercive tactics can directly exploit cultural beliefs, such as the case described by Whitaker and Hinterlong (2008) in which a victim believed she had to obey a trafficker because he kept a lock of her hair. Homeless youth who lack resources (e.g., food, protection, drugs) become coerced by adults that provide shelter and later demand “payment” in the form of sex (Hagan & McCarthy, 1997, p. 48). Although some victims are controlled by traffickers, others are coerced into sexual exploitation by boyfriends, girlfriends and friends (Hagan & McCarthy, 1997; Widom & Kuhns, 1996). Traffickers may coerce their victim’s compliance through the use of a grooming process (Herman, 1992) in which a connection is forged between victims and their traffickers in order to produce intense loyalty (Priebe & Suhr, 2005). When threats, force or coercion is used for the purpose of exploitation, victim consent is not relevant (Logan, 2007).


     The grooming process. The seasoning, or grooming, process refers to the progression of power used by traffickers to control their victims and, in some cases, forge a trauma bond (Smith, Vardaman, & Snow, 2009). Similar to “Stockholm syndrome,” in which hostages relate to and defend their captors (Smith et al., 2009), trauma bonding is a form of coercive control in which traffickers instill a sense of fear as well as gratitude for being allowed to live (United States Department of Health and Human Services, 2012). As outlined by O’Connor and Healy (2006), the grooming process stages are ensnaring, creating dependence, taking control, and total dominance. During the ensnaring phase, traffickers begin to identify themselves as a trustworthy and valuable person in the victim’s life (O’Connor & Healy, 2006). Traffickers may provide favors, purchase expensive gifts, show affection and enter into a romantic relationship with the victim (Albanese, 2007). For many adolescents, this façade may represent the only affirming, reliable and secure relationship in their lives, and victims quickly find themselves emotionally invested. Next, traffickers create dependence. During this process, victims gradually become separated from their families and friends (O’Connor & Healy, 2006). Traffickers may convince victims that other persons in their lives are unreliable or untrustworthy. At the completion of this stage, victims begin to rely solely on their traffickers for support and become isolated from their previous lives (O’Connor & Healy, 2006). The taking control stage is characterized by a shift in the traffickers’ behavior from caring and supportive to controlling and possessive (O’Connor & Healy, 2006). The trafficker may begin to use threats, violence and drugs as methods of control and dictate whom the victim sees and where she goes (Whitaker & Hinterlong, 2008). At the end of this stage, traffickers may test the victims’ commitment to the relationship and demand that they begin selling commercial sex to prove their love (O’Connor & Healy, 2006). Once victims have become completely dependent on their traffickers and are convinced that the easiest way to earn money and maintain their relationships is through selling sex, total dominance has been achieved (O’Connor & Healy, 2006). Although the grooming process outlined by O’Connor and Healy is a helpful model that represents how many persons become trafficked, these series of stages may not occur in every case. Persons may enter the commercial sex trade through a variety of avenues, and their experiences of becoming trafficked may be consistent with, or distinct from, O’Connor and Healy’s model.


Contexts of Control

Just as variability exists within the stages of grooming, different factors influence whether the grooming process itself results in victim compliance. Traffickers use a variety of recruitment techniques and forms of exploitation to obtain and maintain control (Shelley, 2010). Contexts of control acknowledge the complex associations that influence the relationship between victim and trafficker (Whitaker & Hinterlong, 2008). These factors include the individual resiliencies of trafficked persons, the grooming process, and the methods of force, fraud and coercion used by traffickers (Whitaker & Hinterlong, 2008). According to Whitaker and Hinterlong (2008), the four contexts of control include control-seeking, control mechanisms, controllability and resistance. The context of control-seeking refers to the trafficker’s desire to limit the victims’ choices in order to increase the likelihood that their desires are met (Whitaker & Hinterlong, 2008). Traffickers with higher rates of control-seeking seek more power over victims’ behaviors, appearance and travel (Whitaker & Hinterlong, 2008). They may determine what victims wear, control how they interact with buyers, confine persons to specific locations, identify and enforce a mandatory amount of earnings per day, or withhold passports, money and identifying documents (Whitaker & Hinterlong, 2008; Zimmerman, 2003). Traffickers use control mechanisms (e.g., threats of violence, debt bondage, psychological intimidation and acute violence) to obtain and maintain control of victims, and they may vary depending on the victims’ level of controllability, or capacity to resist due to their social or financial context, cultural or personal beliefs, physical limitations, or other deficiencies (Shelley, 2010; Whitaker & Hinterlong, 2008). Thus, a trafficker may attempt to recruit a young woman by showering her with expensive gifts and affection, but if she demonstrates a low level of controllability (e.g., she has a strong support system, is financially stable, has high self-efficacy), the control mechanisms are less effective (Whitaker & Hinterlong, 2008). Controllability can be further delineated into six subdomains: social, financial, physical, cultural, psychological and institutional (Whitaker & Hinterlong, 2008). Persons with a strong combination across these six subdomains have lower controllability levels and are less likely to become trafficked through the grooming process (Whitaker & Hinterlong, 2008). Because trafficked people are unable to predict or manage events that influence their health and safety, the methods of control in human trafficking are parallel to the characteristics of abuse described in the literature on torture (Saporta & Van der Kolk, 1992).


Vulnerabilities and Risk Factors


     The market for commercial sex represents a diverse avenue that incorporates a wide spectrum of activities and transactions across many settings (Anderson & O’Connell Davidson, 2003). Although survivors of human trafficking are not limited to race, ethnicity, age, gender or socioeconomic status, vulnerabilities such as location, poverty, sexual minority status and childhood trauma history, among other factors, influence higher rates for potential sexual exploitation (Albanese, 2007;  Bales, 2007; Hyland, 2001; Kidd & Liborio, 2011; Martinez & Kelle, 2013). The following section outlines a variety of risk factors that have been linked to entrance into the sex trafficking trade.

Location as Risk Factor

Within the global human trafficking industry, there are origin and destination countries that influence the direction of movement and likelihood that persons become victims of forced sexual exploitation (Bales, 2007). Often, third world countries are origin countries characterized by locations with a large supply of available victims (Bales, 2007). The country may be in a state of conflict and social unrest or have high rates of poverty, government corruption and a lack of viable employment opportunities (Bales, 2007). Because trafficking is strongly linked to rates of poverty and minimal employment opportunities (Loff & Sanghera, 2004), many people willingly go with traffickers believing they will receive better opportunities abroad and can send money home to their families (Chung, 2009). Once recruited from origin countries, survivors are transported to destination countries, characterized by locations with high demand for commercial sex (Bales, 2007). Some locations, such as the United States, are bidirectional countries, in which victims are both recruited and put to work (Farr, 2005).


Although many persons become trafficked across international borders, the majority of victims in the United States are trafficked domestically (U.S. Department of State, 2009), with an increase of minors recruited from the Midwest (Williamson & Prior, 2009). In a study of 13 youth involved with forced sexual exploitation, respondents explained that recruitment occurred on the streets, while walking to friends’ houses, with peers, at corner stores, at malls, at their own homes, and waiting to meet with a probation officer outside the juvenile justice center (Williamson & Prior, 2009). In most cases, youth were approached by someone they knew, a mutual acquaintance, or people they recognized from their community (Williamson & Prior, 2009). Thus, counselors need to become familiar with recruitment cities, destination cities and bidirectional cities (Williamson & Prior, 2009). Recruitment and destination cities respectively refer to locations where persons are obtained and transported to meet the growing demand for commercial sex (K. Davis, 2006). Although victims may become recruited and forced into sexual exploitation in any city across the United States, smaller cities in the Midwest have been linked to increased rates of recruitment (K. Davis, 2006). Recruitment cities share similar characteristics, such as access to numerous highways that facilitate victim transportation to destination cities where demand for commercial sex is greatest (K. Davis, 2006). Once obtained, victims are transported to high-demand locations such as Chicago, Detroit and Las Vegas (Wilson & Dalton, 2007. Additional factors that seem to link location to sex trafficking exist. Previous studies have found increased rates of commercial sexual exploitation in areas with higher ratios of females to males (Rao & Presenti, 2012), in places with legalized prostitution (Cho, Dreher, & Neumayer, 2013), and within areas characterized by large populations of transient males such as military personnel, truckers, tourists, and conventioneers (Estes & Weiner, 2002; Farley & Kelly, 2000).


Interpersonal and Intrapersonal Risk Factors

     In addition to location, other vulnerabilities to becoming trafficked exist, including individual, family, peer-related and environmental factors (Williamson & Prior, 2009). Persons from any socioeconomic background, race or ethnicity may become trafficked (McClain & Garrity, 2010). A study exploring the shared characteristics of adolescent females in the commercial sex industry identified low IQ scores and multiple mental health disorders as common factors (Twill, Green, & Traylor, 2010). History of risky or deviant behavior exposes adolescents to increased risk for becoming trafficked. For example, adolescents selling, buying and using drugs all increase the likelihood of crossing paths with a trafficker (McClain & Garrity, 2010; Walsh & Donaldson, 2010). Additional risk factors such as poverty, unemployment, isolation, low self-efficacy, drug addiction and history of physical and sexual abuse have been linked with entrance into the sex trafficking industry (Bales, 2007; Kidd & Liborio, 2011). Although not all trafficked persons have histories of childhood abuse (Chudakov, Ilan, Belmaker, & Cwikel, 2002), persons forced into sexual exploitation have commonly experienced violence prior to becoming trafficked, which increases their vulnerability to entering the sex trafficking trade and influences the greater likelihood of developing future mental health concerns (Hossain et al., 2010).


Homelessness and Sexual Minority Status as Risk Factors

Runaway, homeless or throwaway children are recruited into trafficking rings and exposed to extreme forms of abuse (Estes & Weiner, 2002). Many are killed as a result of violence or from diseases incurred from their sexual victimization (Estes & Weiner, 2002; Mitchell, Finkelhor, & Wolak, 2010). Adolescents are typically approached by traffickers within 48 hours of living on the street (Jordan, Patel, & Rapp, 2013). Traffickers are predatory in nature and adept at identifying vulnerable persons in need of safety, security and protection (Albanese, 2007; Jordan et al., 2013). LGBT persons are especially at risk of forced sexual exploitation due to increased rates of high-risk behaviors and homelessness (Martinez & Keele, 2013). According to the National Coalition for the Homeless (2009), sexual minority youth are twice as likely to experience sexual abuse before the age of 12 and are 7.4 times more likely to become victims of sexual violence. Counselors working with LGBT adolescents must assess their clients’ histories and explore whether they have engaged in survival sex or substance abuse or have been homeless. Survival sex is characterized by the exchange of sexual acts for shelter, food, money, protection, favors or other resources (Estes & Weiner, 2002; Williams & Frederick, 2009). It is important to note that persons from stable families may become trafficked. Young women may go willingly with friends to parties and become enamored with charming men involved in the sex trafficking trade or become flattered by the attentions of predatory older men (Chesnay, 2013). According to a study conducted by Raphael and Myers-Powell (2010) that interviewed 25 ex-pimps in Chicago, the prime candidate for recruitment was a blonde runaway.


Social Media and Internet Use as Risk Factor

Free access and anonymity with the Internet has created greater opportunity for offenders to purchase sex online where a wider variety of options exist (Chung, 2009; McCarthy, 2010; Raphael & Myers-Powell, 2010). Social media Web sites such as Myspace, Twitter and Facebook have been identified as a frequent tool used by traffickers to recruit adolescents into the sex trafficking trade (Demir, 2010; Jordan et al., 2013; Raphael & Myers-Powell, 2010; Williamson & Prior, 2009). Offenders cited the use of social media Web sites to contact, groom and connect with their victims, whereas online advertisement Web sites such as Craigslist were used to sell their victims (Raphael & Myers-Powell, 2010).


Adolescents with low levels of self-efficacy may be at increased risk for victimization due to higher rates of social media use. According to the Pew Research Center (2013), 74% of adults online use social networking sites, with young adults ages 18 to 29 representing the vast majority of social media users. Research exploring the relationship between social media use and the well-being of young adults has yielded significant findings that promote a deeper understanding of how traffickers select and recruit victims online. A study conducted by Meier and Gray (2014) linked photo activity on Facebook with greater than ideal internalization and self-objectification. Michikyan, Subrahmanyam, and Dennis (2014) additionally discovered that young adults experiencing emotional instability were more strategic in their online self-presentation, presumably to seek reassurance. Social networking site use also has been found to increase levels of self-efficacy, satisfy a need for belonging and improve self-esteem in college-aged students (Gangadharbatla, 2008). Upon examination of these pre-existing vulnerabilities, counselors can acquire a deeper understanding of how the grooming process may result in trauma bonds and entrance into the sex trafficking trade. For at-risk adolescents that lack a strong support system, experience low levels of self-efficacy and seek affirmation through their social media presence, online connections with traffickers may satisfy their deep desires for validation. Because traffickers are predatory in nature and gravitate toward vulnerable persons with low self-efficacy and high rates of controllability, counselors working with adolescents and young adults should provide education on topics related to Internet safety and the consequences of promoting a sexually suggestive online presence.


Possible Signs of Trafficking


Counselors working with at-risk populations (e.g., clients with addictions, and a history of homelessness and trauma) must recognize the possible signs that clients are being trafficked. Because many victims remain invisible to law enforcement (Hyland, 2001) and counselors, the identification and treatment of victims represents one of the greatest challenges in working with this population (McClain & Garrity, 2010). According to Polaris (2015), a variety of indicators exist that may suggest forced exploitation.


Signs of Trafficking in Mental Health Settings

Counselors and other helping professionals should assess clients for signs of trafficking, including instances in which clients are under 18 and providing commercial sex acts, have a controlling older boyfriend, work excessively long or unusual hours, or have few personal possessions (Polaris, 2015). Within behavioral health settings, clients may present as fearful, anxious, depressed, submissive or tense with avoidant eye contact (Polaris, 2015). Trafficked persons rarely seek counseling independently and have likely endured intense, ongoing victimization and may present with depression, dissociative reactions, suicidal ideation, post-traumatic stress disorder, feelings of guilt,  shame and self-mutilation (Chesnay, 2013). Clients also may have histories of solicitation charges, substance use issues, or a need for safe and stable housing, lack a strong support system, and have visible bruises or branding (Chesnay, 2013; Hyland, 2001; Jordan et al., 2013). Branding refers to a method of identification used by traffickers to indicate ownership and may be tattoos or carvings (Jordan et al., 2013; Shared Hope International, 2016). It is the author’s experience that some clients that become addicted to opiates by their oppressors are forced to inject in locations on their bodies that will not detract from their overall marketability as a reusable commodity. In many cases, these locations include the inner thighs or between the fingers or toes. As one anonymous survivor (a client of the author) explained, “Nobody is going to buy someone with track marks.” A trend exists in which offenders trafficking drugs are beginning to traffic people (Shelley, 2010). Whereas drugs can be sold once, people can be sold repeatedly and thus represent a more profitable and less risky business venture (Neville & Martinez, 2004; Shelley, 2010).


Signs of Trafficking in Medical Settings

Trafficked persons may present in health care settings, although these instances occur at a low rate. Persons are only allowed to seek medical attention when traffickers believe their condition prevents monetary gain, at which point they can become disposable (Chesnay, 2013; Neville & Martinez, 2004). Medical issues associated with trafficked survivors within health care settings may include sexually transmitted infections, pregnancy, history of unsafe abortions, chronic pain, malnutrition, substance use issues, and sleep deprivation (Chesnay, 2013; Estes & Weiner, 2002). Counselors and medical professionals may additionally note that trafficked survivors struggle during a mental status exam (Chesnay, 2013). Due to a combination of working long hours, exhaustion, and frequent transportation to and from locations, trafficked persons may respond incorrectly to questions regarding time, place and person (Chesnay, 2013).


Signs of Trafficking in School Settings

School counselors need to be mindful of signs that students are being trafficked. Adolescents may be trafficked out of their own homes and transported to and from school by their oppressor (U.S. Department of Education, 2013). Possible signs that students are being trafficked within educational settings include references to frequent travel to other cities, signs of bruising, presence of depression, anxiety, or fear, coached or rehearsed responses to questions, and inappropriate dress based on weather conditions (U.S. Department of Education, 2013). Additionally, school counselors need to be mindful of children who have significantly older boyfriends or girlfriends, describe concern for the safety of family members if they disclose, or care for children that are not family members (U.S. Department of Education, 2013). When a child is being sex trafficked, they may be absent from school or miss periods of time while being sold to other communities (Williamson & Prior, 2009).


Challenges of Working With Trafficked Clients


Counselors may experience feelings of frustration and helplessness upon discovery that clients are rarely willing to leave their traffickers despite their dire situations. It is important to remember that many adolescents who become sex trafficked experience neurological effects from childhood physical, emotional and sexual trauma that inhibits their abilities to make pragmatic choices or escape their traffickers (Reid & Jones, 2011). The presence of chronic fear can inflict barriers to cognitive processing and decision making, which explains why some survivors do not escape when the opportunity arises (Loewenstein, Weber, Hsee, & Welch, 2001; Logan, Walker, Jordan, & Leukefelt, 2006). Due to the familiarity of unhealthy relationships and the lack of self-efficacy required to pursue change, childhood victims of sexual trauma are more likely to accept situations characterized by abuse (Reid & Jones, 2011). Counselors are encouraged to seek supervision, connect with colleagues and practice regular self-care routines in order to avoid experiencing burnout, secondary trauma, and compassion fatigue when working with this population.


Counselors working with trafficked clients are often faced with a series of challenges since an intervention modality specific to sex trafficked survivors has not yet been developed (Jordan et al., 2013). Although a small body of research exists on the health consequences associated with human trafficking, limited research has explored the mental health consequences of trafficking (Hossain et al., 2010; Tsutsumi et al., 2008). Current treatments are borrowed from evidence-based interventions originally developed for post-traumatic stress disorder and survivors of domestic violence, slavery and captivity (Jordan et al., 2013).


Assess Client’s Current State

Whether providing individual or group counseling to sex trafficked clients, several treatment considerations should be examined. First, counselors should assess whether the client is currently being trafficked or whether a sex trafficking history exists. Naturally, the counselor’s role will differ significantly depending on the client’s present situation. In the author’s experience, clients that are currently trafficked rarely seek mental health services independently. Instead, clients may present to counseling as the result of court mandates associated with drug or solicitation charges. Clients that are currently trafficked often resist help from mental health providers and avoid reporting due to well-founded fears of physical violence or threats of retribution if they disclose their situation (Flores, 2010). Therefore, building strong rapport with sex trafficked clients is critical (Chesnay, 2013). Because of the fraud and deception used by traffickers during the grooming process, many trafficked persons demonstrate marked difficulty with trusting others (Belser, 2005). It is essential that counselors build trust with the client by demonstrating unconditional positive regard, empathy and authenticity. Counselors may support clients by developing individualized safety plans and sharing valuable resources (e.g., The National Human Trafficking Hotline: 1-888-373-7888). Once a strong therapeutic relationship has been established, counselors may begin pursuing a variety of counseling goals, including psychoeducation, supporting clients through the stages of personal change, engaging in group counseling, medication management, addressing substance use issues, and promoting reintegration through education and job training.


Counselors working with sex trafficked survivors must assess whether the client has access to necessary resources, including housing, food, water, shelter and medicine. Ensuring that survivors are equipped with safe and stable homes minimizes the likelihood that they are simply returning to the same endangering conditions (Feingold, 2005). Counselors should work with sex trafficked clients to explore the circumstances that increased their risk for sexual exploitation. Once the situations are identified, counselors must work collaboratively with clients to create a sustainable maintenance promotion plan. Chesnay (2013) explained that once basic physiological needs and safe housing are obtained, mental health professionals can begin reframing the client’s worldview from “victim” to “survivor” to “thriving survivor.”


Asking Helpful Questions

In addition to taking the client’s trafficking situation into consideration, it is important to remain mindful of the language used when working with this population. Clients will rarely, if ever, identify with the term trafficked and also are likely to struggle with identifying their partner and protector as a pimp or trafficker (Chesnay, 2013). Trafficked clients may explain that they are working to help their boyfriends (Priebe & Suhr, 2005). Counselors and other mental health professionals are encouraged to accept the client’s identified terms and work within their individual framework (Chesnay, 2013).


Providing psychoeducation on the process, rates and prevalence of sex trafficking may be beneficial for clients to promote insight. Educational modalities that shift pertinent information from general to specific may be helpful in gradually exposing clients to difficult concepts. Counselors should work collaboratively with clients to identify salient issues and validate their experiences to promote recognition and exploration on the effects of trafficking. Counselors may use statements such as, “Many young adolescents living on the streets feel scared and find someone to protect and care for them. I wonder whether this is true for you?” Or, “Some people care so much about their partners that they feel obligated to prove their love and begin doing things they are not really comfortable with. I am curious whether this has been your experience as well?” Offering opportunities for clients to disclose information in a safe, nonjudgmental and accepting environment can increase client insight, promote counselor awareness of client history and facilitate therapeutic growth. Additionally, counselors should determine whether clients have access to safe and stable housing. If basic physiological needs are not met, clients may struggle to focus on higher order needs such as developing a safety plan or emotion regulation.


Assess Client’s Stage of Change

For clients that are currently trafficked, the stages of change outlined by Norcross, Krebs, and Prochaska (2011) may be a helpful tool for examining clients’ willingness to engage in counseling. Clients in the precontemplation stage may respond positively to counseling strategies aimed at increasing education and awareness. When clients present in the stage of contemplation, counselors may be most supportive by exploring client ambivalence. Counselors may facilitate costs and benefits analyses with the client regarding their current predicaments. Regardless of the client’s stage of change it is important that counselors do not force the client to leave their oppressor. This may put the client, their families and other loved ones at risk (Flores, 2010). Instead, counselors must listen, affirm and provide the client with resources such as the trafficking hotline and empower them to call when ready. It is important that counselors assess the severity and duration of trafficking-related abuse and recognize how these experiences influence recovery time (Hossain et al., 2010). In a sample of 204 trafficked girls and women, the presence of sexual violence during a trafficking experience had an independent effect on mental health symptoms (Hossain et al., 2010). Hossain and colleagues (2010) concluded that persons trafficked for longer periods of time have an increased likelihood of abusive episodes and prolonged feelings of entrapment, alienation, loss of control, humiliation and helplessness—all of which are associated with developing mental health disorders in the future. Counselors can better accommodate the needs of persons that have been trafficked for longer periods of time by providing longer duration post-trafficking care.


Assess Entrance Into Trafficking

Other treatment considerations pertain to the process through which clients became trafficked. Clients recruited and controlled through a grooming process may struggle to identify their captors as oppressors due to the presence of a trauma bond (United States Department of Health and Human Services, n.d.). Cases also exist in which clients have been trafficked by family members or sold to traffickers by their parents (Shelley, 2010). In some instances, adolescents and children are forced into sexual exploitation by their parents or siblings in order to support drug addictions or to avoid financial burdens (Estes & Weiner, 2002). One survivor, a client of the author, reported that a family member diagnosed with schizoaffective disorder trafficked her for a period of 2 months. The client described how the family member would hold a firearm to his neck and threaten to commit suicide if she did not provide him with heroin. The client explained how she felt forced to complete commercial sex acts with drug dealers, as this strategy was the quickest and easiest way to obtain illicit substances within her impoverished community. Counselors should work to identify their biases regarding how persons are trafficked, and by whom, in order to identify survivors and provide appropriate services.


Counseling Sex Trafficked Clients


     Counselors working with sex trafficked survivors should be prepared to employ a variety of trauma-sensitive interventions to support the individual needs of each client. Trauma-sensitive interventions identify safety as the foundation for working with persons to eliminate self-harm, develop trustworthy relationships, overcome challenges, promote wellness and remove themselves from dangerous situations (Najavits, 2002). Helping traumatized clients to regain a sense of control is critical (Goodman & Calderon, 2012). For example, counselors may use mindfulness-based activities such as body scans and body awareness exercises to help clients differentiate between current and past experiences (Rothschild, 2000). Counselors can use other mindfulness techniques, such as focusing on the present and emphasizing the mind-body connection, to help clients identify and reduce the somatic symptoms of arousal when no threats are present (Goodman & Calderon, 2012). Finally, counselors can help clients practice imagining, and returning attention to, comforting images to increase their sense of safety and decrease arousal (Goodman & Calderon, 2012). Ideally, counselors will empower their clients to redefine their lives not by their pasts, but by their futures (Chesnay, 2013).

Creative Interventions

     Creative-based interventions are especially powerful with sex trafficked clients because they provide opportunities for clients to make choices. For clients who have long been told what to do and have lived according to their trafficker’s demands, the presentation of choices and sense of control may represent an exciting and difficult challenge. Creative arts interventions have received a great deal of empirical support for clients presenting with trauma. Research that investigated resiliency has identified the importance of creativity, humor, flexibility, and movement as effective interventions to improve traumatized clients’ self-esteem, hope and prosocial behaviors (Johnson, Lahad, & Gray, 2009; Lahad, 2000; Raynor, 2002). Additionally, therapeutic art has been shown to be efficacious for work with clients presenting with emotional disturbances, grief and loss, low self-efficacy, depression, post-traumatic stress disorder, anxiety, and feelings of guilt and shame (Johnson et al., 2009; Slayton, D’Archer, & Kaplan, 2010). Creative interventions can be used to help clients reframe ideas, shift perspectives, externalize emotions and gain deeper understanding of events (Bradley, Whiting, Hendricks, Parr, & Jones, 2008). According to Lev-Weisel (1998), clients that struggle to find words to describe their traumatic experiences may prefer creative interventions as a means of expression. Counselors can integrate the use of creative and expressive interventions using mandalas or other art mediums to support clients in promoting openness while providing a sense of structure. Future areas of research are needed to determine the efficacy of creative interventions specific to clients with a history of sex trafficking.


Cognitive Behavioral Therapies

     Clients with a history of sex trafficking can benefit from cognitive behavioral therapies due to their internalization of derogatory labels (Hickle & Roe-Sepowitz, 2014). Counselors working with trafficked clients can identify and challenge these labels in order to decrease the presence of shame and other meta-emotions (e.g., anger at oneself for feeling shame). Additional evidence-based counseling interventions that may be useful for sex trafficked client populations include Eye Movement Desensitization and Reprocessing with adults (Maxfield, 2003; Shapiro, 1989) and trauma-focused cognitive behavioral therapy with children (Cohen, Berliner, & Mannarino, 2010; Cohen, Mannarino, Berliner, & Deblinger, 2000). The use of dialectical trauma-focused cognitive behavioral therapy is effective with both children (Racco & Vis, 2015) and adults with histories of trauma and post-traumatic stress disorder (Wagner, Rizvi, & Harned, 2007). Although trauma-focused cognitive behavioral therapy and dialectical trauma-focused cognitive behavioral therapy have not been tested specifically for sex trafficked populations, research indicates that these modalities are successful in helping children overcome histories of trauma and abuse (Classen, Koopman, Nevill-Manning, & Spiegel, 2001; Cohen & Mannarino, 1997). Future research studies should investigate the efficacy of cognitive behavioral therapies with sex trafficking survivors in order to standardize appropriate treatment methods for this unique population.


Group Counseling

     Providing survivors of forced sexual exploitation with an opportunity to participate in group counseling can empower persons to share similar experiences while creating a sense of community and support (Hickle & Roe-Sepowitz, 2014). Peer support is a crucial component for treatment since bearing witness to the similar lived experiences of other survivors provides a unique dimension of support and sense of universality (Chesnay, 2013). Counselors working with trafficked persons may focus on accomplishing a variety of treatment goals, including feeling identification, establishing safety, addressing substance use, countering internalized stigma and labels, providing psychoeducation and establishing healthy boundaries. Shame can be reduced by prompting discussions about taboo and stigmatizing topics within group settings (Hickle & Roe-Sepowitz, 2014). Many trafficked survivors have upheld the belief that they are the only ones who have been trafficked by parents, have engaged in survival sex, or who have been forced into sexual exploitation by boyfriends or girlfriends. According to Estes and Weiner (2002), boys that performed oral sex on adult males as a result of forced sexual exploitation experienced a profound sense of shame. Addressing these foci of shame can help clients recognize the universality of their experiences, build rapport with peers and facilitate trust in the group setting. Counselors should listen openly to the client’s stories of shame and receive them with empathy in order to dispel their negativistic beliefs. Psychoeducation within group settings can be used to explain how traffickers use coercion and other techniques to recruit young women (Hickle & Roe-Sepowitz, 2014).


Expressive techniques that allow group members to process trauma experiences without dissociating from the event are beneficial in promoting therapeutic growth (Hickle & Roe-Sepowitz, 2014). Clients can use markers, colored pencils and other artistic mediums to draw, color or write on an outlined body where they feel specific emotions such as pain, shame, anger, fear and guilt (Hickle & Roe-Sepowitz, 2014). Words and pictures from magazines also can be used to represent emotions or past and present states of mind and facilitate the healing process. The author has facilitated mask exercises within group settings to support trafficked clients in identifying and processing their ideal and actual selves. Once completed, the pictures and masks can be processed with other group members and similar or different experiences, emotions and challenges can be discussed.




Although social and cultural norms, poverty, gendered inequality and childhood history represent important vulnerability factors, the social injustice known as sex trafficking could not occur without the demand for sexual exploitation (Matheson & Finkel, 2013). A deeper understanding is needed to comprehend how persons become trafficked (Whitaker & Hinterlong, 2008). Additionally, a dearth of research remains that identifies specific evidence-based and trauma-sensitive modalities developed specifically for sex trafficked survivors (Chesnay, 2013; Jordan et al., 2013). The experiences, challenges and reflections of the author have been presented with the intention of providing education, support and guidance to other counselors serving this unique population. Regardless of which counseling tools are used, establishing and building a strong therapeutic alliance is a valuable tool that counselors can employ to support sex trafficked persons (Chesnay, 2013). Although challenging at times, establishing rapport requires a nonjudgmental attitude and a willingness to bear witness to clients’ experiences, without pointing out what survivors could have done differently (Chesnay, 2013).


It is important to remember that trafficked persons are often survivors of long-term childhood trauma characterized by instability within the home, childhood sexual trauma and community violence (Bales, 2007; Hossain et al., 2010; Kidd & Liborio, 2011; Williamson & Prior, 2009). Many adolescents were targeted, recruited and trafficked due to pre-existing vulnerabilities and high controllability factors (Whitaker & Hinterlong, 2008). Counselors are tasked with a unique position to provide corrective relational experiences characterized by the nonjudgmental acceptance, support and affirmation desperately needed by this population. Fewer resources and services exist for trafficked survivors than for victims of any other crime (Clawson, Dutch, & Cummings, 2006). Counselors should connect sex trafficked survivors to necessary social service supports, including case management services, safe and stable housing, and services aimed at supporting the successful reintegration of clients into the community through education and job training (Williamson & Prior, 2009). Future areas of research should explore the profiles of traffickers and standardize how mental health and medical providers can better identify, serve, protect, and support trafficked survivors (Bales, 2005). Finally, counselors are called to continue promoting awareness on the prevalence and signs of sex trafficked survivors. Increasing awareness and decreasing demand for sexually exploited persons are the fundamental steps necessary to end the human rights violation of sex trafficking (Chung, 2009; Kotrla, 2010).


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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Stacey Diane A. Litam is a doctoral candidate at Kent State University and a mental health counselor at Moore Counseling and Mediation Services Inc. Correspondence can be addressed to Stacey Litam, Moore Counseling and Mediation Services, 4600 Carnegie Avenue, Cleveland, Ohio 44103,

An Exploration of Career Counselors’ Perspectives on Advocacy

Melissa J. Fickling

Advocacy with and on behalf of clients is a major way in which counselors fulfill their core professional value of promoting social justice. Career counselors have a unique vantage point regarding social justice due to the economic and social nature of work and can offer useful insights. Q methodology is a mixed methodology that was used to capture the perspectives of 19 career counselors regarding the relative importance of advocacy interventions. A two-factor solution was reached that accounted for 60% of the variance in perspectives on advocacy behaviors. One factor, labeled focus on clients, emphasized the importance of empowering individual clients and teaching self-advocacy. Another factor, labeled focus on multiple roles, highlighted the variety of skills and interventions career counselors use in their work. Interview data revealed that participants desired additional conversations and counselor training concerning advocacy.

Keywords: social justice, advocacy, career counselors, Q methodology, counselor training


The terms advocacy and social justice often are used without clear distinction. Advocacy is the active component of a social justice paradigm. It is a direct intervention or action and is the primary expression of social justice work (Fickling & Gonzalez, 2016; Ratts, Lewis, & Toporek, 2010; Toporek, Lewis, & Crethar, 2009). Despite the fact that counselors have more tools than ever to help them develop advocacy and social justice competence, such as the ACA Advocacy Competencies (Lewis, Arnold, House, & Toporek, 2002) and the Multicultural and Social Justice Counseling Competencies (Ratts, Singh, Nassar-McMillan, Butler, & McCullough, 2015), little is known about practitioners’ perspectives on the use of advocacy interventions.

One life domain in which social inequity can be vividly observed is that of work. The economic recession that began in 2007 has had a lasting impact on the labor market in the United States. Long-term unemployment is still worse than before the recession (Bureau of Labor Statistics, U.S. Department of Labor, 2016a). Further, in the United States, racial bias appears to impact workers and job seekers, as evidenced in part by the fact that the unemployment rate for Black workers is consistently about double that of White workers (e.g., 4.1% White unemployment and 8.2% Black unemployment as of May 2016; Bureau of Labor Statistics, U.S. Department of Labor, 2016b). Recent meta-analyses indicate that unemployment has a direct and causal negative impact on mental health, leading to greater rates of depression and suicide (Milner, Page, & LaMontagne, 2013; Paul & Moser, 2009). Clearly, the worker role is one that carries significant meaning and consequences for people who work or want to work (Blustein, 2006).

The rate at which the work world continues to change has led some to argue that worker adaptability is a key 21st century skill (Niles, Amundson, & Neault, 2010; Savickas, 1997), but encouraging clients to adapt to unjust conditions without also acknowledging the role of unequal social structures is inconsistent with a social justice paradigm (Stead & Perry, 2012). Career counselors, particularly those who work with the long-term unemployed and underemployed, witness the economic and psychological impact of unfair social arrangements on individuals, families and communities. In turn, they have a unique vantage point when it comes to social justice and a significant platform from which to advocate (Chope, 2010; Herr & Niles, 1998; Pope, Briddick, & Wilson, 2013; Pope & Pangelinan, 2010; Prilleltensky & Stead, 2012).

It appears that although career counselors value social justice and are aware of the effects of injustice on clients’ lives, they are acting primarily at the individual rather than the systemic level (Cook, Heppner, & O’Brien, 2005; McMahon, Arthur, & Collins, 2008b; Prilleltensky & Stead, 2012; Sampson, Dozier, & Colvin, 2011). Some research has emerged that focuses on practitioners’ use of advocacy in counseling practice (Arthur, Collins, Marshall, & McMahon, 2013; Arthur, Collins, McMahon, & Marshall, 2009; McMahon et al., 2008b; Singh, Urbano, Haston, & McMahan, 2010). Overall, this research indicates that advocacy is challenging and multifaceted and is viewed as a central component of good counseling work; however, more research is needed if we are to fully understand how valuing social justice translates to use of advocacy interventions in career counseling practice. This study aims to fill this theory–practice gap by illuminating the perceptions of advocacy behaviors from career counselors as they reflect upon their own counseling work.



Through the use of Q methodology, insight into the decisions, motivations and thought processes of participants can be obtained by capturing their subjective points of view. When considering whether to undertake a Q study, Watts and Stenner (2012) encouraged researchers to consider whether revealing what a population thinks about an issue really matters and can make a real difference. Given the ongoing inequality in the labor market, increased attention and energy around matters of social justice in the counseling profession, the lack of knowledge regarding practitioners’ points of view on advocacy, and career counselors’ proximity to social and economic concerns of clients, the answer for the present study is most certainly yes.

Q methodology is fundamentally different from other quantitative research methodologies in the social sciences. It uses both quantitative and qualitative data to construct narratives of distinct perspectives. The term Q was coined to distinguish this methodology from R; Q measures correlations between persons, whereas R measures trait correlations (Brown, 1980). Rather than subjecting a sample of research participants to a collection of measures as in R methodology, Q methodology subjects a sample of items (i.e., the Q sample) to measurement by a collection of individuals through a ranking procedure known as the Q sort (see Figure 1; Watts & Stenner, 2012). Individuals are the variables in Q methodology, and factor analysis is used to reduce the number of points of view into a smaller number of shared perspectives. Then interviews are conducted to allow participants to provide additional data regarding their rankings of the Q sample items. In this study, career counselors were asked to sort a set of advocacy behaviors according to how important they were to their everyday practice of career counseling. Importance to practice was used as the measure of psychological significance since career counselors’ perspectives on advocacy interventions were of interest, rather than self-reported frequency or competence, for example.


Q Sample

The Q sample can be considered the instrumentation in Q methodology. The Q sample is a subset of statements drawn from the concourse of communication, which is defined as the entire population of statements about any given topic (McKeown & Thomas, 2013). The goal when creating the Q sample is to provide a comprehensive but manageable representation of the concourse from which it is taken. For this study, the concourse was that of counselor advocacy behaviors.

The Q sampling approach used for this study was indirect, naturalistic and structured-inductive. Researchers should draw their Q sample from a population of 100 to 300 statements (Webler, Danielson, & Tuler, 2009). For this study, I compiled a list of 180 counselor social justice and advocacy behaviors from a variety of sources including the ACA Advocacy Competencies (Lewis et al., 2002), the Social Justice Advocacy Scale (SJAS; Dean, 2009), the National Career Development Association (NCDA) Minimum Competencies (2009), the Council for Accreditation of Counseling and Related Educational Programs (CACREP) Standards (2009), and key articles in counseling scholarly and trade publications.

Consistent with a structured-inductive sampling strategy, these 180 statements were analyzed to identify categories representing different kinds of advocacy behaviors. By removing duplicates and those items that were more aligned with awareness, knowledge or skill rather than behavior, I was able to narrow the list from 180 to 43 statements. These statements were sorted into five domains that were aligned with the four scales of the SJAS (Dean, 2009) and a fifth added domain. The final domains were: Client Empowerment, Collaborative Action, Community Advocacy, Social/Political Advocacy, and Advocacy with Other Professionals. Aligning the Q sample with existing domains was appropriate since advocacy had been previously operationalized in the counseling literature.

Expert reviewers were used to check for researcher bias in the construction of the Q sample, including the addition of the fifth advocacy domain. Three expert reviewers who were faculty members and published on the topic of social justice in career counseling were asked to review the potential Q sample for breadth, coverage, omissions, clarity of phrasing and the appropriateness of the five domains of advocacy. Two agreed to participate and offered their feedback via a Qualtrics survey, leading to a refined Q sample of 25 counselor advocacy behaviors (see Table 1). Five statements were retained in each of the five domains. Finally, the Q sample and Q sorting procedure were piloted with two career counselors, leading to changes in instructions but not in the Q sample itself. Pilot data were not used in the final analysis.



In Q methodology, participant sampling should be theoretical and include the intentional selection of participants who are likely to have an opinion about the topic of interest (McKeown & Thomas, 2013; Watts & Stenner, 2012). It also is important to invite participants who represent a range of viewpoints and who are demographically diverse. For the current study, the following criteria were required for participant inclusion: (a) holds a master’s degree or higher in counseling and (b) has worked as a career counselor for at least one year full-time in the past two years. For this study, career counselor was defined as having career- or work-related issues as the primary focus of counseling in at least half of the counselor’s case load. Regarding the number of participants in a Q study, emphasis is placed on having enough participants to establish the existence of particular viewpoints, not simply having a large sample since generalizability is not a goal of Q methodology (Brown, 1980). In Q methodology, it also is important to have fewer participants than Q sample items (Watts & Stenner, 2012; Webler et al., 2009).

Participants were recruited by theoretical sampling of my professional network of practitioners, and one participant was recruited through snowball sampling. Nineteen career counselors participated in the present study from six states in the Southeast, West and Midwest regions of the United States. The participant sample was 68% female (n = 13) and 32% male (n = 6); the sample was 84% White and included two Black participants and one multi-racial participant. One participant was an immigrant to the United States and was a non-native English speaker. The participant sample was 95% heterosexual with one participant identifying as gay. Sixty-three percent of participants worked in four-year institutions of higher education and one worked in a community college. Thirty-two percent (n = 6) provided career counseling in non-profit agencies. The average age was 43 (SD = 12) and the average number of years of post-master’s counseling experience was eight (SD = 7); ages ranged from 28 to 66, and years of post-master’s experience ranged from one and a half to 31 years.


Q Sorting Procedure

The Q sort is a method of data collection in which participants rank the Q sample statements according to a condition of instruction along a forced quasi-normal distribution (see Figure 1). There is no time limit to the sorting task and participants are able to move the statements around the distribution until they are satisfied with their final configuration. The function of the forced distribution is to encourage active decision making and comparison of the Q sample items to one another (Brown, 1980).


Figure 1

Sample Q Sort Distribution

The condition of instruction for this study was, “Sort the following counselor advocacy behaviors according to how important or unimportant they are to your career counseling work.” The two poles of the distribution were most important and most unimportant. Poles range from most to most so that the ends of the distribution represent the areas that hold the greatest degree of psychological significance to the participant, and the middle of the distribution represents items that hold relatively little meaning or are more neutral in importance (Watts & Stenner, 2012).

The Q sorts for this study were conducted both in person and via phone or video chat (i.e., Google Hangouts, Skype). Once informed consent was obtained, I facilitated the Q sorting procedure by reading the condition of instruction, observing the sorting process, and conducting the post-sort interview. Once each participant felt satisfied with his or her sort, the distribution of statements was recorded onto a response sheet for later data entry.


Post-Sort Interview

Immediately following the Q sort, I conducted a semistructured interview with each participant in order to gain a greater understanding of the meaning of the items and their placement, as well as his or her broader understanding of the topic at hand (Watts & Stenner, 2012). The information gathered during the interview is used when interpreting the final emergent factors. Items in the middle of the distribution are not neglected and are specifically asked about during the post-sort interview so that the researcher can gain an understanding of the entire Q sort for each participant. Although the interview data are crucial to a complete and rigorous factor interpretation and should be conducted with every participant in every Q study, the data analysis process is guided by the quantitative criteria for factor analysis and factor extraction. The qualitative interview data, as well as the demographic data, are meant to help the researcher better understand the results of the quantitative analysis.


Data Analysis

Data were entered into the PQMethod program (Schmolck, 2014) and Pearson product moment correlations were calculated for each set of Q sorts. Inspection of the correlation matrix revealed that all sorts (i.e., all participants) were positively correlated with one another, some of them significantly so. This indicated a high degree of consensus among the participants regarding the role of advocacy in career counseling, which was further explored through factor analysis.

I used centroid factor analysis and Watts and Stenner’s (2012) recommendation of beginning by extracting one factor for every six Q sorts. Centroid factor analysis is the method of choice among Q methodologists because it allows for a fuller exploration of the data than a principal components analysis (McKeown & Thomas, 2013; Watts & Stenner, 2012). Next, I calculated the significance level at p < .01, which was .516 for this 25-item Q sample.

The unrotated factor matrix revealed two factors with Eigenvalues near or above the commonly accepted cutoff of 1 according to the Kaiser-Guttman rule (Kaiser, 1970). Brown (1978) argued that although Eigenvalues often indicate factor strength or importance, they should not solely guide factor extraction in Q methodology since “the significance of Q factors is not defined objectively (i.e., statistically), but theoretically in terms of the social-psychological situation to which the emergent factors are functionally related” (p. 118). Since there currently is little empirical evidence of differing perspectives on advocacy among career counselors, two factors were retained for rotation.

In order to gain another perspective on the data, I used the Varimax procedure. I flagged those sorts that loaded significantly (i.e., at or above 0.516) onto only one factor after rotation. Four participants (2, 8, 9 and 17) loaded significantly onto both rotated factors and were therefore dropped from the study and excluded from further analysis (Brown, 1980; Watts & Stenner, 2012). Two rotated factors were retained, which accounted for 60% of the variance in perspectives on advocacy behaviors. Fifteen of the original 19 participants were retained in this factor solution.

Q methodology uses only orthogonal rotation techniques, meaning that all factors are zero-correlated. Even so, it is possible for factors to be significantly correlated but still justify retaining separate factors (Watts & Stenner, 2012). The two factors in this study are correlated at 0.71. This correlation indicates that the perspectives expressed by the two factor arrays share a point of view but are still distinguishable and worthy of exploration as long as the general degree of consensus is kept in mind (Watts & Stenner, 2012).


Constructing Factor Arrays

After the two rotated factors were identified, factor arrays were constructed in PQMethod. A factor array is a composite Q sort and the best possible estimate of the factor’s viewpoint using the 25 Q sample items. First, a factor weight was calculated for each of the 15 Q sorts that loaded onto a factor. Next, normalized factor scores (z scores) were calculated for each statement on each factor, which were finally converted into factor arrays (see Table 1). In Q methodology, unlike traditional factor analysis, attention is focused more on factor scores than factor loadings. Since factor scores are based on weighted averages, Q sorts with higher factor loadings contribute proportionally more to the final factor score for each item in a factor than those with relatively low factor loadings. Finally, factors were named by examining the distinguishing statements and interview data of participants that loaded onto the respective factors. Factor one was labeled focus on clients and factor two was labeled focus on multiple roles.


Factor Characteristics

Factor one was labeled focus on clients and accounted for 32% of the variance in perspectives on advocacy behaviors. It included nine participants. The demographic breakdown on this factor was: six females, three males; eight White individuals and one person who identified as multi-racial. The average age on this factor was about 51 (SD = 10.33), ranging from 37 to 66. Persons on this factor had on average 11 years of post-master’s counseling experience (SD = 8.6), ranging from one and a half to 31 years. Fifty-six percent of participants on this factor worked in 4-year colleges or universities, 33% in non-profit agencies, and one person worked at a community college.

Factor two was labeled focus on multiple roles and accounted for 28% of the variance in career counselors’ perspectives on advocacy behaviors. It included six participants. Five participants on this factor identified as female and one identified as male. Five persons were White; one was Black. The average age of participants on this factor was almost 35 (SD = 6.79), ranging from 29 to 48, and they had an average of just over seven years of post-master’s experience (SD = 3.76), ranging from three and a half to 14 years. Four worked in higher education, and two worked in non-profit settings.


Factor Interpretation

In the factor interpretation phase of data analysis, the researcher constructs a narrative for each factor by incorporating post-sort interview data with the factor arrays to communicate the rich point of view of each factor (Watts & Stenner, 2012). Each participant’s interview was considered only in conjunction with the other participants on the factor on which they loaded. I read post-sort interview transcripts, looking for shared perspectives and meaning, in order to understand each factor array and enrich each factor beyond the statements of the Q sample. Thus, the results are reported below in narrative form, incorporating direct quotes and paraphrased summaries from interview data, but structured around the corresponding factor arrays.

Table 1

Q Sample Statements, Factor Scores and Q Sort Values



Factor 1

Factor 2

Factor Score


Factor Score


1 Question intervention practices that appear inappropriate.





2 Seek feedback regarding others’ perceptions of my advocacy efforts.





3 Serve as a mediator between clients and institutions.





4 Express views on proposed bills that will impact clients.





5 Maintain open dialogue to ensure that advocacy efforts are consistent with group goals.





6 Encourage clients to research the laws and policies that apply to them.





7 Collect data to show the need for change in institutions.





8 Educate other professionals about the unique needs of my clients.





9 Help clients develop needed skills.





10 Assist clients in carrying out action plans.





11 Help clients overcome internalized negative stereotypes.





12 Conduct assessments that are inclusive of community members’ perspectives.





13 With allies, prepare convincing rationales for social change.





14 Identify strengths and resources of clients.





15 Get out of the office to educate people about how and where to get help.





16 Teach colleagues to recognize sources of bias within institutions and agencies.





17 Deal with resistance to change at the community/system level.





18 Collaborate with other professionals who are involved in disseminating public information.





19 Help clients identify the external barriers that affect their development.





20 Use multiple sources of intervention, such as individual counseling, social advocacy and case management.





21 Train other counselors to develop multicultural knowledge and skills.





22 Work to ensure that clients have access to the resources necessary to meet their needs.





23 Work to change legislation and policy that negatively affects clients.





24 Ask other counselors to think about what social change is.





25 Communicate with my legislators regarding social issues that impact my clients.





Note. Q sort values are -4 to 4 to correspond with the Q distribution (Figure 1) where 4 is most important
and -4 is most unimportant; QSV = Q Sort Value.




Factor 1: Focus on Clients

For participants on the focus on clients factor, the most important advocacy behavior was to “identify client strengths and resources” (see Table 1). When speaking about this item, participants often discussed teaching clients self-advocacy skills, stating that this is a key way in which career counselors promote social justice. Identifying client strengths and resources was referred to as “the starting point,” “the bottom line” and even the very “definition of career counseling.” One participant said that counseling is about “empowering our clients or jobseekers, whatever we call them, to do advocacy on their own behalf and to tell their story.” In general, persons on this factor were most concerned with empowering individual clients; for example, “I would say, even when we’re doing group counseling and family counseling, ultimately it’s about helping the person in the one-to-one.” Similarly, one participant said, “Instead of fighting for the group in legislation or out in the community, I’m working with each individual to help them better advocate for themselves.” Interview data indicated that social justice was a strongly held value for persons on this factor, but they typically emphasized the need for balancing their views on social injustice with their clients’ objectives; they wanted to take care not to prioritize their own agendas over those of their clients.

Several participants on this factor perceived items related to legislation or policy change as among the least client-centered behaviors and therefore as the more unimportant advocacy behaviors in their career counseling work. Persons on this factor stated that advocacy at the systems level was neither a strength of theirs nor a preference. A few reported that there are other people in their offices or campuses whose job is to focus on policy or legislative change. There also was a level of skepticism about counselors’ power to influence social change. In regard to influencing legislative change in support of clients, one participant said, “I don’t think in my lifetime that is going to happen. Maybe someday it will. I’m just thinking about market change right now instead of legislative change.”

Interview data revealed that career counselors on this factor thought about advocacy in terms of leadership, both positively and negatively. One person felt that a lack of leadership was a barrier to career counselors doing more advocacy work. Another person indicated that leaders were the ones who publicly called for social change and that this was neither his personality nor approach to making change, preferring instead to act at the micro level. Finally, persons on this factor expressed that conversations about social change or social justice were seen as potentially divisive in their work settings. One White participant said the following:

There is a reluctance to do social justice work because—and it’s mostly White people—people really don’t understand what it means, or feel like they don’t have a right to do that, or feel like they might be overstepping. Talking about race or anything else, people are really nervous and they don’t want to offend or say something that might be wrong, so as a result they just don’t engage on that level or on that topic.


Factor 2: Focus on Multiple Roles

One distinguishing feature of the focus on multiple roles factor was the relatively high importance placed on using multiple sources of intervention (see Table 1). Participants described this as being all-encompassing of what a career counselor does and reflective of the multiple roles a career counselor may hold. One participant said, “You never know what the client is going to come in with,” arguing that career counselors have to be open to multiple sources of intervention by necessity. Another participant indicated that she wished she could rely more on multiple sources of intervention but that the specialized nature of her office constricted her ability to do so.

Participants on this factor cited a lack of awareness or skills as a barrier to their implementing more advocacy behaviors. They were quick to identify social justice as a natural concern of career counselors and one that career counselors are well qualified to address due to their ability to remain aware of personal, mental health and career-related concerns simultaneously. One participant said:

I don’t know if the profession of career counseling is really seen as being as great as it is in that most of us have counseling backgrounds and can really tackle the issues of career on a number of different levels.

In talking about the nature of career counseling, another participant said, “Social justice impacts work in so many ways. It would make sense for those external barriers to come into our conversations.”

Regarding collaborating with other professionals to prepare convincing rationales for social change, one participant stated that there are already enough rationales for social change; therefore, this advocacy behavior was seen as less important to her. Persons on this factor placed relatively higher importance on valuing feedback on advocacy efforts than did participants on factor one. One participant said she would like to seek feedback more often but had not thought of doing so in a while: “I did this more when I was in graduate school because you are thinking about your thinking all the time. As a practitioner, as long as social justice and advocacy are on my radar, that’s good.”



Neither setting nor gender appeared to differentiate the factors, but age and years of post-master’s experience may have been distinguishing variables. Younger individuals and those with fewer years of post-master’s experience tended to load onto factor two. Factor one had an average age of 51 compared to 35 for factor two, and the average age for all study participants was 43. It is interesting to note that the four participants who loaded onto both factors and were therefore dropped from analysis had an average of just over two years of post-master’s counseling experience versus 11 for factor one and seven for factor two. It is possible that their more recent training regarding advocacy may account for some differences in perspective from those of more experienced counselors.

Participants on factor one (focus on clients) who emphasized the importance of individual clients tended to perceive it as more difficult to have conversations about social justice with their peers or supervisors. In contrast, participants on factor two (focus on multiple roles) were more likely to cite a lack of knowledge or skills regarding their reasons for not engaging in more advocacy behaviors beyond the client level. Factor arrays indicated that factor one participants viewed engaging at the community level as more important, whereas participants on factor two viewed conversations with colleagues and clients about social justice as more important to their work.

The broader view of persons on factor two regarding the career counselor’s role and their openness to acknowledging their own lack of awareness or skills may reflect a different kind of socialization around advocacy compared to persons on factor one. Career counselors who graduated from counseling programs prior to the emphasis on multicultural competence in the early 1990s or before the inclusion of social justice in the literature and CACREP standards in the first decade of the 21st century may have had limited exposure to thinking about contextual or social factors that impact client wellness. Persons on both factors, however, expressed interest in social justice and felt that the vast majority of advocacy behaviors were important.

In post-sort interviews, participants from both factors described a gradual shift in emphasis from a focus on the individual on the right hand (most important) side of the Q sort distribution to an emphasis on legislation on the left hand (most unimportant) side. For example, the statement identify strengths and resources of clients was one of the most important behaviors for nearly every participant. Likewise, the statement work to change legislation and policy that negatively affects clients was ranked among the most unimportant advocacy behaviors for both factors. Interestingly, the statement encourage clients to research the laws and policies that apply to them was a consensus statement with a Q sort value of 0, or the very middle of the distribution. Since this advocacy behavior is both client focused and presumably would provide clients with important self-advocacy skills, it is interesting that it was ranked lower than other items related to client self-advocacy. Some participants indicated that they considered this item a “passive” counselor behavior in that they might encourage clients to research laws but could not or would not follow up with clients on this task. One participant said she would like to encourage clients to research laws that apply to them but shared that she would first need to learn more about the laws that impact her clients in order to feel effective in using this intervention.

Participants were asked directly about potential barriers to advocacy and potential strengths of career counselors in promoting social justice. Responses are discussed below. The questions about strengths and barriers in the post-sort interview did not reference Q sample items, so participant responses are reported together below.


Barriers to Promoting Social Justice

In the post-sort interviews, lack of time was mentioned by nearly every participant as a barrier to implementing more advocacy in career counseling, and it often came in the form of little institutional support for engaging in advocacy. For example, participants indicated that while their supervisors would not stop them from doing advocacy work, they would not provide material support (e.g., time off, reduced case load) to do so. This finding is consistent with other literature that suggests that career counselors report a lack of institutional support for engaging in advocacy (Arthur et al., 2009).

Another major barrier to advocacy was a lack of skill or confidence in one’s ability as an advocate. Advocacy at the social/political level requires a unique set of skills (M. A. Lee, Smith, & Henry, 2013), which practitioners in the present study may or may not have learned during their counseling training. Pieterse, Evans, Risner-Butner, Collins, and Mason (2009) reviewed 54 syllabi from required multicultural courses in American Psychological Association (APA)- and CACREP-accredited programs and found that awareness and knowledge tended to be emphasized more than skill building or application of social justice advocacy. This seems to have been reflected in the responses from many participants in the present study.

Participants on both factors indicated that they held some negative associations to advocacy work, calling it “flag waving” or “yelling and screaming” about inequality or social issues. They expressed some concern about how they might be perceived by their peers if they were to engage in advocacy; however, involvement in this study seemed to provide participants with a new understanding of advocacy as something that happens at the individual as well as at the social level. Participants appeared to finish the data collection sessions with a more positive understanding of what advocacy is and could be.


Strengths of Career Counselors in Promoting Social Justice

In addition to discussing barriers to advocacy, participants were asked directly about strengths of career counselors in promoting social justice and were able to identify many. First and foremost, participants saw the ability to develop one-on-one relationships with clients as a strength. One participant nicely captured the essence of all responses in this area by stating, “The key thing is our work one-on-one with an individual to say that even though you’re in a bad place, you have strengths, you have resources, and you have value.” Participants indicated that social change happens through a process of empowering clients, instilling hope and seeing diversity as a strength of a client’s career identity. The ability to develop strong counseling relationships was attributed partially to participants’ counseling training and identity, as well as to their exposure to a broad range of client concerns due to the inseparable nature of work from all other aspects of clients’ lives (Herr & Niles, 1998; Tang, 2003).

Career counselors in this study served diverse populations and highly valued doing so. These participants described multicultural counseling skills and experience as central to competent career counseling and to advocacy. They felt that they possessed and valued multicultural competence, which bodes well for their potential to engage in competent and ethical advocacy work with additional training, experience and supervision (Crook, Stenger, & Gesselman, 2015; Vespia, Fitzpatrick, Fouad, Kantamneni, & Chen, 2010).

Finally, participants felt that career counseling is seen as more accessible than mental health counseling to some clients, giving career counselors unique insight into clients’ social and personal worlds. Participants reported having a broad perspective on their clients’ lives and therefore unique opportunities to advocate for social justice. Relatedly, participants noted that the more concrete and tangible nature of career counseling and its outcomes (e.g., employment) may lead policymakers to be interested in hearing career counselors’ perspectives on social issues related to work. One participant noted that “there’s a huge conversation to be had around work and social justice” and that career counselors’ key strength “is empowering clients and the broader community to understand the role of work.”


Implications for Career Counselors, Counselor Educators, and Supervisors

Nearly all participants described the sorting process as thought provoking and indicated that social justice and advocacy were topics they appreciated the opportunity to think more about. There was a strong desire among some practitioners in this study to talk more openly with colleagues about social justice and its connection to career counseling, but a lingering hesitation as well. Therefore, one implication of the present study is that practitioners should begin to engage in discussions about this topic with colleagues and leaders in the profession. If there is a shared value for advocacy beyond the individual level, but time and skills are perceived as barriers, perhaps a larger conversation about the role of career counselors is timely. Career counselors may benefit from finding like-minded colleagues with whom to talk about social justice and advocacy. Support from peers may help practitioners strategize ways to question or challenge coworkers who may be practicing career counseling in ways that hinder social justice.

To move toward greater self-awareness and ethical advocacy, practitioners and career counseling leaders must ask themselves critical and self-reflexive questions about their roles and contributions in promoting social justice (McIlveen & Patton, 2006; Prilleltensky & Stead, 2012). Some authors have indicated there is an inherent tension in considering a social justice perspective and that starting such conversations can even lead to more questions than answers (Prilleltensky & Stead, 2012; Stead & Perry, 2012). Counselors should turn their communication skills and tolerance for ambiguity inward and toward one another in order to invite open and honest conversations about their role in promoting social justice for clients and communities. The participants in this study seem eager to do so, though leadership may be required to get the process started in a constructive and meaningful way.

Counselor educators and supervisors can provide counselors-in-training increased experience with systemic-level advocacy by integrating the ACA Advocacy Competencies and the Multicultural and Social Justice Counseling Competencies into all core coursework. Even though broaching issues of social justice has been reported as challenging and potentially risky, counselor educators should integrate such frameworks and competencies in active and experiential ways (Kiselica & Robinson, 2001; M. A. Lee et al., 2013; Lopez-Baez & Paylo, 2009; Manis, 2012). Singh and colleagues (2010) found that even self-identified social justice advocates struggled at times with initiating difficult conversations with colleagues; they argued that programs should do more to help counselors-in-training develop skills “to anticipate and address the inevitable interpersonal challenges inherent in advocacy work” (p. 141). Skills in leadership, teamwork and providing constructive feedback might be beneficial to prepare future counselors for addressing injustice. Furthermore, Crook and colleagues (2015) found that advocacy training via coursework or workshops is associated with higher levels of perceived advocacy competence among school counselors, lending more support in favor of multi-level training opportunities.



The current study is one initial step in a much-needed body of research regarding advocacy practice in career counseling. It did not measure actual counselor engagement in advocacy, which is important to fully understand the current state of advocacy practice; rather, it measured perceived relative importance of advocacy behaviors. Researcher subjectivity may be considered a limitation of this study, as researcher decisions influenced the construction of the Q sample, the factor analysis and the interpretation of the emergent factors. By integrating feedback from two expert reviewers during construction of the Q sample, I minimized the potential for bias at the design stage. Factor interpretation is open to the researcher’s unique lens and also may be considered a limitation, but if it is done well, interpretation in Q methodology should be constrained by the factor array and interview data. Although generalizability is not a goal of Q methodology, the sample size in this study is small and therefore limits the scope of the findings.


Suggestions for Future Research and Conclusion

Advocacy is central to career counseling’s relevance in the 21st century (Arthur et al., 2009; Blustein, McWhirter, & Perry, 2005; McMahon, Arthur, & Collins, 2008a), yet due to the complexity and personal nature of this work, more research is required if we are to engage in advocacy competently, ethically and effectively. There appears to be interest among career counselors in gaining additional skills and knowledge regarding advocacy, so future research could include analyzing the effects of a training curriculum on perceptions of and engagement with advocacy. Outcome research could also be beneficial to understand whether career counselors who engage in high levels of advocacy report different client outcomes than those who do not. Finally, research with directors of career counseling departments could be helpful to understand what, if any, changes to career counselors’ roles are possible if career counselors are interested in doing more advocacy work. Understanding the perspectives of these leaders could help further the conversation regarding the ideals of social justice and the reality of expectations and demands faced by career counseling offices and agencies.

This research study is among the first to capture U.S. career counselors’ perspectives on a range of advocacy behaviors rather than attitudes about social justice in general. It adds empirical support to the notion that additional conversations and training around advocacy are wanted and needed among practicing career counselors. Stead (2013) wrote that knowledge becomes accepted through discourse; it is hoped that the knowledge this study produces will add to the social justice discourse in career counseling and move the profession toward a more integrated understanding of how career counselors view the advocate role and how they can work toward making social justice a reality.



Conflict of Interest and Funding Disclosure

The author conducted this research with the assistance of grants awarded by the National Career Development Association, the North Carolina Career Development Association, and the Southern Association for Counselor Education and Supervision.



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Melissa J. Fickling, NCC, is an Assistant Professor at the University of Memphis. Correspondence can be addressed to Melissa J. Fickling, University of Memphis, Ball Hall 100, Memphis, TN 38152,