Tag Archives: women

Speaking to the needs of women in counseling

By Bethany Bray January 8, 2018

Rosemarie Scotti Hughes, dean emerita of the School of Psychology and Counseling at Regent University in Virginia, believes that counselor education needs to update the curriculum on the developmental cycle of women and family structure as currently taught in entry-level counseling courses. People are far more diverse in their lifestyle choices than in decades past, she says, but the curriculum hasn’t kept pace.

American women today are getting married and having children much later, on average, than did previous generations. Others are choosing to remain single or raise children on their own or with an unmarried partner. For the first time ever, single adult women outnumber married adult women in the United States.

“The traditional teaching we used to do about life cycles in Counseling 101 or 102 isn’t happening anymore,” Hughes says. “We need to present to students ‘this is what families look like now.’ We need to present a variety of models of what a family can be: same-sex couples, [young adults] living at home after graduating college, couples living together sometimes long years before getting married, having children from multiple partners … single moms who have no intention of marrying.”

Regardless of her life choices, today’s woman is not living in the same world that her mother and grandmothers lived in. In 1960, the median age for a first marriage was 20.3 for women and 22.8 for men in the United States. In 2016, the medians were 27.4 for women and 29.5 for men — roughly a seven-year difference for both genders. In addition, according to the U.S. Centers for Disease Control and Prevention, in recent years, the overall birthrate for American women in their 20s has decreased slightly, whereas the birthrate for women in their 30s has increased.

The social and cultural shifts that Hughes acknowledges are, to use an appropriate pun, married to the issues that female clients bring into the counseling office, from relationships
and family dynamics to career planning and parenting.

These shifts have brought progress in many ways. More and more women are attending college and joining the workforce. At the same time, women continue to struggle with challenges that have plagued the generations before them, such as balancing career and home life and struggling for professional advancement in male-dominated atmospheres.

This reality raises two interrelated questions: What do today’s women need from professional counseling? And how can today’s counselors strive to hit this ever-moving target?



Diving in

A first step is getting to know the context, culture and full story of the client who is sitting in front of the counselor. Most likely, her experience won’t mirror exactly the U.S. averages for marriage, childbirth, education and other issues.

Recent statistical shifts also differ greatly for women from different backgrounds, especially women of color, notes aretha marbley, an American Counseling Association member and professor of counselor education at Texas Tech University. Women shouldn’t be lumped into one monolithic group, she says, pointing out that the label includes those who are economically disadvantaged, disabled, transgender or otherwise marginalized.

“We need to do a better job of having the voices of all women heard and not just [middle-class female] voices. We’re probably better at that than men, but we’re still not good,” marbley says. “Especially in counseling, don’t make assumptions. Don’t let our voices overshadow those who are marginalized. We really, as counselors, need to do a better job and check our biases at the door — because they’re there.”

Lisa Forbes, an assistant clinical professor in the counseling program at the University of Colorado Denver who also works with clients at an inpatient psychiatric unit at a nearby medical facility, agrees that it is important that counselors not make assumptions. “You can read all the literature on this topic and know everything about women’s rights and equality, but it might not be that way for the woman who is in the room with you. Take each client as their own person,” says Forbes, an ACA member. “First and foremost, take a look at your own beliefs and your own values of stereotypical gender roles. If you’re not constantly trying to challenge those things, you will bring it into the room. … Don’t make assumptions, across the board. Just like any form of multicultural counseling, know the literature, know your personal biases, but get to know your client for who they are and what they need.”

Supporting women clients

Forbes co-presented a session titled “Identity Development of Working Mothers: How to Support Their Mental Health Needs” at ACA’s 2017 Conference & Expo in San Francisco with Margaret Lamar, an assistant professor in the counseling program at Palo Alto University. Women’s issues, especially in the realm of working mothers, is a professional and personal area of interest for Forbes and Lamar, both of who work full time while raising children.

Women frequently can find themselves bumping up against a lose-lose situation, Lamar says. She explains that a woman who works often gets judged as being a bad mother because she doesn’t see her children as much as stay-at-home moms see their kids. At the same time, her workplace supervisors or co-workers might feel she is a liability because she still has to manage the pull of children and family distractions. Pew Research Center data indicate that mothers now spend more hours per week engaged in child care than women did in 1965, Lamar notes.

“There is an expectation that moms should be more present as mothers, but at the same time we’re seeing more and more women in the workforce,” says Lamar, a licensed professional counselor (LPC) and ACA member. “We see women having more anxiety, more depression and feeling overwhelmed. When women are trying to juggle all of these things, the first thing to go is self-care and a focus on relationships. They go into survival mode.”

“These are things that are showing up in our counseling sessions,” she continues, “and we need to be mindful of the language we’re using [and] how we’re pathologizing women. Be aware of that oppressive social context so we are not blaming women. Talk with your clients about [how] they are living in a climate where these expectations are commonplace and it affects mental health.”

Hughes, a recently retired LPC and licensed marriage and family therapist (LMFT) in Virginia, says she often saw female clients who had children later in life and struggled with perfectionism. They often kept their children involved in an endless string of activities, from dance classes and sports to music lessons and Scouts, and then planned extravagant birthday parties and other social activities, Hughes observes.

“They’re adding so much stress to their lives, all of this on top of working,” says Hughes, who wrote the chapter on feminist theory in the ACA Encyclopedia of Counseling. “They keep the kids involved in so many things because they think the kids need all these things for them to be a good mother. I don’t see that they can accept the concept of being a ‘good enough’ mother. … Thinking they can put all of these things into a 24-hour day is fairly unrealistic. You can work and raise your family, but you can’t be supermom. We were never meant to be supermom.”

Hughes says counselors can work with these clients to challenge the irrational thinking that spurs perfectionism and help them focus on what matters most: their relationship with their children.

This “intensive mothering expectation” can lead to self-esteem and identity issues, anxiety, depression and other mental health struggles, Forbes says. The concept, coined in the mid-1990s in the book The Cultural Contradictions of Motherhood by Sharon Hays, an assistant professor of sociology and women’s studies at the University of Virginia, originates with the stereotypical ideal of the 1950s housewife: The woman keeps the household running while bearing responsibility for the majority of household chores and child-rearing tasks.

Decades later, that expectation — whether stated overtly or in more subtle ways — is still going strong, Forbes says. “It puts women in a tough spot, and that’s all wrapped up in our identity development. It’s the idea of a mom who is always involved, takes the kids to their activities and makes kale smoothies every day — being everything for everyone — and it’s really an impossible feat. That’s kind of what we judge women by, and I think it’s unfortunate that we can’t bend a little bit on that.”

Women can even project these expectations onto other women, intentionally or unintentionally, through social media posts and in-person comments, further perpetuating the problem. Forbes has seen this play out in her own life. She is the mother to a 4-year-old and a 2-year-old, and her husband travels often for work.

“I personally struggle a lot with balancing all of these roles and the expectations that moms are put under,” she says. “If I spend an hour away from my kids, I am judged, but if my partner spends an extra hour with the kids, he is patted on the back.”

“If we [practitioners] don’t challenge our own beliefs on this, we will inadvertently bring this into the counseling session,” she adds.

The importance of language

Most of all, counselors must be mindful of the language they use with female clients and check their own assumptions, Lamar says. For example, a counselor working with a female client who is feeling anxious and overwhelmed may initially assume that the woman simply needs to take on less, delegate responsibilities to a partner or ask for help. Although well-meaning, these suggestions carry the implication that the woman is responsible for everything and should be the one to give the responsibility away, Lamar says.

Instead, the counselor might coach the client to negotiate responsibilities with a partner and make a plan, from arranging for childcare to doing the grocery shopping. “It’s really a … shift in our thinking of how to approach that [with a client]. It needs to be both partners coming at this together and negotiating on equal footing,” Lamar says. “It may not be as simple as having trouble setting boundaries. She is under pressure to take on all these pieces in order to feel like she’s a good mom or a good employee. Pay attention to how we acknowledge that instead of placing the responsibility on the woman.”

Similarly, a counselor working with a new mother who is getting ready to return to work should think twice about asking her whether she is ready or if she can handle it, Forbes says. Those kinds of questions assume that it is all up to her. The underlying message is, “You’re the mom. You should stay home,” Forbes observes. Likewise, questions such as, “How are you going to balance everything?” send the message that the client has to balance everything, she
adds. Instead, Forbes suggests that counselors turn their questions to focus on how the mother can advocate for herself to find support and equality at home and at work.

Cassie Owens, an LPC in private practice in Dunwoody, Georgia, cautions that counselors shouldn’t lump their female clients into specific categories — new mother, working professional, single mother — and make related assumptions. “There’s so many different chapters to a woman’s life, and most women wear more than one hat. Be really mindful when asking questions and doing assessments, and don’t make assumptions … based on that first, initial impression or intake session,” says Owens, who specializes in maternal mental health and works exclusively with female clients.

Forbes also focuses on the importance of getting to know the client and her situation. “Listen to a client’s language. Is she wanting help, or is she not sure how to ask? … What changes in her life does she want to make, and what can she advocate for?” counsels Forbes. “Always check in to brainstorm ideas. … Have them make a list and pick one [area to focus on]. What’s the worst-case scenario of an outcome, and what’s the best-case scenario? She knows better than you how things might turn out.”

The same wisdom applies when counseling clients about issues in the workplace, Lamar says. A counselor should not coach a female client to speak up when she is being overlooked professionally without considering her circumstances and professional context. “You should stand up for yourself” is often impractical advice for a number of reasons, including the risk of repercussions, Lamar explains.

“People still underestimate the pressures that women feel in the workplace. I work in academia and mental health, two [professions] that are supposed to be more ‘aware,’ and I have had people take credit for ideas that I’ve had or talk over me in meetings,” Lamar says. “I had a male student explain to me why some [of my] research was wrong. It kind of baffles me. There’s just so many women who experience these kinds of things — microaggressions, victim blaming and, recently, sexual harassment. These are things that women experience all the time to varying degrees.”

The widespread nature of these experiences has made headlines recently as more women have begun coming forward to report cases of sexual harassment involving major figures in
the worlds of politics, entertainment, news media and other professions. We have also repeatedly witnessed examples of why women often choose not to report wrongdoing out of a fear of making waves and the victim blaming that can follow.

Identity and resetting the narrative

It may be useful for counselors to weigh protective factors in female clients’ lives against their risk factors, Forbes says. For instance, counselors might look for areas of life where these clients can strengthen their network of support socially, professionally or therapeutically, such as through local women’s or mothers’ groups, social clubs, nonprofit organizations or church groups.

Finding a “tribe” of people a client can relate to is helpful in combating the feelings of isolation that often accompany many of the issues with which women struggle, especially postpartum depression, Owens says. Online groups can also be a source of support for new mothers or women in different stages of life, says Owens, the vice president of the Georgia chapter of Postpartum Support International. Owens had one client who was a member of a Facebook group for local moms. She invited others to join her for a walk, posting the date, time and location of where to meet. Several women came, allowing her to meet some new people with the shared experience of motherhood.

“That takes a lot of courage, but she really wanted to meet people in her neighborhood,” Owens says. “Also know of support groups that other therapists are running, and know and work with other practitioners in your area. A counselor can help a client navigate them and just [let them] know that these kinds of things exist.”

Counselors can also help support female clients by exploring issues of identity. Often, a woman’s identity is tied to expectations that she has internalized, Forbes says. Counselors can help clients dismantle unhealthy expectations — for example, the mother who does it all — and become aware of how unrealistic they are.

Identity can also be central for women facing transitions, such as a client having a baby in her late 30s after a decade of building a career. This can be a “shock to the system,” Forbes says, because it upsets the equilibrium the client previously felt in her identity.

“Talk the client through her new identity. Being a mother is such a strong identity for a woman, but how can we add that to your existing identity [rather than replacing it]?” asks Forbes. The counselor needs to meet the client where she is. Instead of saying, “This will change everything,” help her to make a plan and rely on a support system, Forbes says.

Owens agrees. “If they’ve had a career and decide to stay home with a baby, it’s a huge change in identity, a loss of self and [can be] a loss of self-worth. Or, it’s the juggling act of going back to work and balancing life. ‘How am I going to be a good mother and employee and [still] take care of myself?’”

In addition to focusing on protective factors, Forbes finds that narrative, feminist and relational-cultural therapies are often helpful when working with female clients. Bibliotherapy can also be used to normalize the expectations and pressures that female clients may be feeling. Forbes recommends anthropologist Solveig Brown’s book All on One Plate: Cultural Expectations on American Mothers to learn more about the intensive mothering concept and its unrealistic expectations.

Helping clients recognize the unrealistic expectations that society often places on women is important, regardless of the theory or method a counselor uses. “There’s so much value in externalizing the problem from the woman. Patterns can be so ingrained that you don’t challenge them, but if you can name them and externalize them, it can be liberating,” Forbes says. “It’s really empowering for women to get to that place that ‘I am not my symptoms; my symptoms are the result of my experience.’”

For example, a female client may be struggling with the decision to take a promotion at work because she feels her children need her more. “Go deeper. Ask the client, ‘What does that mean for you when you have that thought?’ Is it about guilt? If she feels she should be at home with her children, that guilt could turn into low self-worth and feelings of ‘I’m not a good mom,’” Forbes says.

“I would externalize that guilt that she has,” Forbes continues. “She feels like it’s her fault that she has two different roles — mother and employee — and that guilt comes from within. Talk about where that guilt [actually] comes from: greater society. Challenging those societal expectations can help.”

Similarly, Forbes suggests, feelings can be externalized through a version of the empty chair technique typically associated with Gestalt therapy. The client is invited to put her guilt in an empty chair so that she can visualize it, feel it and talk to it. That takes the blame away from the client and helps her realize that “this is not you; it’s your experience of expectations and unfair stereotypes,” Forbes explains.

“Tell [the client], ‘You are not a failure. You live within a context of a culture, within a family, and all of those things affect your self-image and your mental health,’” she says. “They can rewrite their own story on how it works for them, not the way they’ve been told it should be.”

The long road to progress

Although cultural shifts mean that more women are advancing in their careers and living independently, the struggle for progress is far from over. The counselors interviewed for this article agreed that the conversation needs to be ongoing.

Women still shoulder the burden of unpaid maternity leave, child care costs that can be staggering and a pervasive wage gap between them and their male counterparts that is even more pronounced for women of color. There is substantial potential, Lamar notes, for counselors to strengthen their role as client advocates, especially when it comes to policy changes surrounding family leave, child care and other social issues.

“We’re not in a place, as a group of women, to say we’re all done [making progress] now,” says marbley, an LPC supervisor and leader of the ACA Women’s Interest Network. “We need to continue to advocate for those who don’t have the power or ability to do so. We’re not free yet. We’re not ready to say it’s all equal. We can still do better, and if we [women] empower each other, we can help. At the end of the day, it’s not bad. We just have more work to do.”

Hughes was the first female academic dean at Regent before she retired from counselor education in 2009. She notes that throughout her tenure, most of her colleagues and subordinates were male. Likewise, marbley says that in her experience, promotion and tenure remain a struggle for women in counselor education. She also notes that many of the conferences and professional events that young women counselors attend are led by males.

Counseling is a relatively young profession. Perhaps, Hughes says, the work of recognizing the subtleties and needs of women in counseling can be attributed to the profession’s growing pains. “This is all part of counseling’s struggle with identity,” she says. “I’m still not sure if counselors know who we are.”




Statistics snapshot: Women in America

  • On average, women make 80 cents for every dollar earned by a man, a gender wage gap of 20 percent (full-time, year-round employees, as of 2015).

Source: Institute for Women’s Policy Research bit.ly/2leGr6t

  • This past fall, the majority of U.S. college and university students were female — an estimated 11.5 million women compared with 8.9 million men.

Source: National Center for Education Statistics bit.ly/1DLO7Ux

  • Women who are single or living with a nonmarital partner account for 4 out of 10 U.S. births. Less than half of children (46 percent) are living in what has previously been considered a “traditional” household: a family with two married parents in their first marriage.

Source: Pew Research Center pewrsr.ch/1OypOcD

  • It was reported this past year that the mean age at which American women have their first child is 28 years old. In 2014, the mean was 26 years old; in 2000, it was 24; and in 1970, it was 21.

Source: Centers for Disease Control and Prevention bit.ly/2AbMUJQ

  • Between 2007 and 2017, the share of U.S. adults living without a spouse or partner increased from 39 percent to 42 percent.

Source: Pew Research Center pewrsr.ch/2jsZuu5

  • In 2012, 42 million Americans, or 1 out of 5 adults ages 25 and older, had never been married. In 1960, this statistic was roughly 1 in 10.

Source: Pew Research Center pewrsr.ch/1qu8b10




To contact the counselors interviewed in this article, email:




Bethany Bray is a staff writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

Letters to the editor: ct@counseling.org




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Counseling survivors of human trafficking

By Lamerial McRae and Letitia Browne-James October 9, 2017

Millions of human trafficking victims exist across the globe. In the United States, hundreds of thousands of victims experience trafficking. As society expands and evolves, human trafficking perpetrators find new ways to recruit and victimize others. The evolution of perpetration ensues because of increases in accessing technology, shifting state and federal laws, and changing criminal investigation methods within communities. Human trafficking continues to evolve into a new way of enslaving human beings, stripping individuals of basic rights and freedoms, while skirting the legal issues of slavery and ownership.

Human traffickers often recruit individuals by offering the fantasy of increased happiness, stability, relationship success and financial freedom. Human traffickers, often referred to as “pimps” or “playboys,” may recruit a female or male victim with promises of a better quality of life, including, but not limited to money, security and safe shelter. These perpetrators often present as charming and recruit their victims using lies and manipulation. They prey on victims from vulnerable populations, including those with low socioeconomic status (SES), biological females, children and adolescents, immigrants and LGBTQ+ youth. The fact that these vulnerable populations often remain dependent on others or experience institutionalized marginalization allows for perpetrators to paint the picture of a better life, both in terms of finance and social support. Thus, counselors must understand the cycle of perpetration and victimization to pinpoint potential victims among clients.

As a starting point, counselors must understand the nature of the phenomenon and seek ways to identify potential risk and protective factors. Counselors must learn to assess and address possible victimization with effective rapport building and intervention. For example, youth may display delinquent behavior (e.g., truancy, sexual misconduct, drug use) as a symptom of coercion and threats by a perpetrator. Perpetrators often experience greater ease when recruiting teenagers because of their tendency to be influenced by others. Sadly, when teenagers fall victim to a human trafficker, they are subjected to the victim-blaming phenomenon.

Thus, to build therapeutic rapport from a nonjudgmental framework, counselors need to understand the true source of teenagers’ behavior rather than labeling them as inappropriate or delinquent. As counselors increase their understanding of risk and protective factors, the profession may be able to conceptualize human trafficking as a systemic problem from a broad perspective.


Risk and protective factors

Several risk and protective factors exist for those falling victim to human trafficking. Risk factors include the following demographics and experiences. Risk factors, which are not limited to the list provided, may change over time with the help of counselors.

  • Low SES
  • Previous or current substance abuse
  • Social vulnerability (e.g., children, females, LGBTQ+ individuals)
  • Limited education.

Protective factors, referred to as strengths in counseling, include the following demographics and experiences. Counselors must foster protective factors and strengths in clients to reduce the risk of falling victim to trafficking.

  • Education
  • Family stability
  • Strong social support networks
  • Mental and emotional health

Counselors should understand these risk and protective factors to assess potential risks for human trafficking and to focus on increasing protective factors in counseling. For example, counselors may use a family counseling approach when working with survivors to increase their connections to loved ones and family. Throughout the process of recruiting and selling human trafficking victims, counselors may notice several risk and protective factors playing a role in the process.


Human trafficking business model and counseling implications

Human trafficking remains a mysterious and misunderstood phenomenon. Because of a lack of understanding about the effects of human trafficking on our society, counselors are charged with educating themselves to best address and assess individuals for victimization.

Counselors should recognize that survivors of sex trafficking require additional techniques (to those used with other clients) to build rapport with them and to reduce the mistrust that they commonly have about people. To best serve survivors, treatment approaches need to remain centered on survivors, empower them, provide safety and involve a multidisciplinary approach. In addition, professional counselors working extensively with sex trafficking survivors hold legal and ethical responsibilities to provide appropriate services and identify strategies to overcome barriers to their treatment, including specialized and intensive training.

To begin, counselors must understand the human trafficking business model to conceptualize the systemic issue and the moving parts that contribute to the continuing cycle. To highlight some of the societal and professional impacts, consider the parallel of the human trafficking business model to the process of manufacturing goods. The human trafficking business model includes the following stages of grooming and distribution:

1) The supplier recruits the victim.

2) The manufacturer grooms the victim.

3) The retailer determines price and then markets the victim.

4) The retailer sells and the consumer purchases the victim.

The human trafficking business model is a sophisticated process, not always linear in nature, and it functions as a well-established industry. Thus, the need exists to explore each of the model to better understand how to help victims and break the cycle.

Stage 1: Supplying victims. The supplier, also known as the initial human trafficking perpetrator, displays high levels of mental health concerns (e.g., antisocial personality traits) and shows little concern for the basic human rights of others. When victims enter this stage, counselors may find that these individuals report troubles at home, low SES, depression, anxiety and truant behavior. These factors contribute to their need to survive. Unfortunately, this may result in a perpetrator using charm or manipulation to attract the victims. Perpetrators remove victims’ identification, passports and other valuables to trap them in the world of human trafficking.

Clinical assessment is vital at this stage and remains an ongoing process. Counselors may want to ease survivors into telling their stories, paying special attention to the therapeutic relationship. Thus, the most valuable interventions at this stage include active listening and reflection. When administering specific assessment instruments, counselors will want to measure attitudes about victimization and perpetration and prevalence rates of violence. Counselors must use both open- and closed-ended questions to directly address potential victimization. Nonverbally, counselors will want to avoid direct eye contact and limit their use of touch because of victims’ trauma and abuse history.

Stage 2: Grooming victims. This stage involves moving human trafficking victims from the supplier to the manufacturer. Perpetrators continue to display high levels of antisocial behaviors and major mental health concerns; survivors present with mental health concerns such as depression, anxiety and addiction. Substance abuse concerns usually present when perpetrators force their victims to engage in substance use to coerce and control their behaviors, often resulting in addiction.

Counselors must use clinical assessment and maintain that ongoing process. In addition, because survivors have been manufactured as a human trafficking product, their levels of abuse and mistrust often appear high when they present to counseling. Therefore, counselors must focus on the therapeutic relationship as victims provide information about their experiences in trafficking. Counselors should pay special attention to reducing the stigma of substance use and mental health concerns, especially considering that victims develop these concerns because of coercion and violence.

Stage 3: Marketing victims. This stage involves moving survivors from the manufacturer to the retailer. At this stage, human trafficking perpetrators focus on the marketing and sales aspect of their exploitation. For example, based on the quality of their goods (i.e., victim age, appearance) and market demand, perpetrators determine the price for selling each of their victims. At this stage, survivors present with major depressive, dissociative and addiction disorders.

At this stage, counselors again use clinical assessment to understand the survivor’s story while maintaining a trustworthy therapeutic relationship. As previously stated, severe mental health concerns present because of the violence and abuse that victims experience. Thus, counselors need to use evidenced-based practices to treat depression and dissociative symptoms. Some of the most helpful interventions to treat these mental health concerns include grounding and relaxation techniques.

When focusing on grounding, counselors must engage the client’s physical world to assist the person in becoming present in the moment. For example, counselors may ask clients to locate an object in the room and provide an in-depth description. Relaxation techniques to practice include deep breathing and mindfulness meditation. Both types of techniques allow clients to practice coping skills during sessions that can translate to their everyday life experiences.

Stage 4: Selling victims. As retailers push survivors toward the consumers, the perpetrators continue to focus on marketing strategies and targeting potential consumers. Perpetrators often target large events (e.g., the Super Bowl, national political conventions) to take advantage of the crowds and high demand for paid sexual services. Those paying for the sex services, the consumers, exhibit low levels of depression and anxiety. These consumers often report avoiding relationship concerns or other mental health concerns, resulting in a desire to seek out sexual activity.

Because survivors have been a part of ongoing abuse and a cycle of victimization that they cannot break, counselors must use a systemic approach to providing services. For example, counselors need to provide information on shelters and building connections with family. Counselors may incorporate the use of technology and location services, safety words and discussing location with loved ones at all times.


Case example         

Toney, an 18-year-old multiracial, cisgender male, moved away from his caregivers’ home about one year ago and currently lives with a friend. He moved because of safety issues in his home and within the nearby neighborhood. When Toney was 16, his father died during a gang-related shootout at their home. Thus, Toney often felt afraid of engaging in a similar lifestyle and enduring similar consequences. Toney’s mother suffered from a severe substance use disorder that led to eviction from their rental home because she could not afford the rent. Toney and his mother became homeless.

While Toney was homeless, Kevin, a childhood friend, suggested that Toney come live with him temporarily as long as Toney obtained a job and contributed to the rent and utility bills. One day, Toney answered the front door, and a young adult male appearing to be about Toney’s age attempted to sell him a magazine subscription. Toney disclosed to the salesman that he was financially strapped. The young man told Toney about the large sums of money he made while selling magazine subscriptions and offered to put him in contact with the owner. Toney was intrigued by the idea of alleviating his financial troubles, and the young male immediately scheduled a meeting with the owner for later that night.

That evening, Toney met with the young salesman and the business owner in an abandoned parking lot, bought their sales pitch and decided to go to work. The business owner told Toney that he would need to move six hours away to another state because there was a high demand for work there and he would not have to pay any rent or utility bills. The business owner promised Toney the opportunity to travel and see many areas of the country while working in the job.

Thus, Toney left a day later to live in a weekly hotel in a new city with his new manager and several others. Upon arriving, the manager took them to a warehouse to pick up the product. They all began working the next day.

After a few weeks, Toney began grasping the reality of his situation. The job of trying to sell magazine subscriptions was strenuous and exhausting. He often worked 10- to 12-hour days while receiving limited rest and food. When Toney voiced concerns about the number of work hours he put in each day, his manager threatened him. The threats later escalated to physical assault when Toney again voiced his concern and when the manager perceived him to be underperforming at the job.

No matter how hard Toney tried, he could not meet the daily sales goal that the manager set for employees. When Toney failed to meet the daily sales quota, the manager either denied him his nightly meal or forced him to sleep outside of the hotel on the streets. As a result, Toney rarely ate and often did not receive the money he had earned while working. He was told that he would receive the money once the team had completed its sales goals for the area and had moved on to another city.

One day, while trying to sell magazines to a homeowner who declined to buy anything, Toney became agitated and started crying. He told the homeowner that he was in trouble and begged her to help him get home, across state lines. The homeowner had recently watched a documentary on human trafficking and invited Toney to use her phone to call the authorities.

The police arrived and took Toney’s statement about his work experiences. Fortunately, the responding officer had recently attended a departmental training on human trafficking, and she took Toney to the police station for further questioning and support. The officer connected Toney with a local nonprofit organization that provided multidisciplinary services, including professional counseling, to survivors of human trafficking. The organization offered shelter and provided Toney with career development services to help him obtain legitimate work. The shelter’s ultimate goal was to move Toney back to his hometown.

In counseling sessions with Toney, the counselor focused on direct questions to assess the nature of the human trafficking Toney had experienced. For example, “Did anyone threaten you or your loved ones?” and “Did you have difficulty leaving the work that you did selling door-to-door merchandise?” While initially reluctant, Toney eventually responded with answers that indicated his victimization. For example, he reported that his manager used threats and power and control tactics (such as denying Toney food, money and shelter) to force him to work.

Following assessment, Toney received counseling services focused on recovering from the abuse he had endured. Toney felt validated because he was not alone while accepting that he had fallen victim to human trafficking. The counselor and Toney focused on crisis intervention and stabilization in the beginning, which included discussions about adjunct services and basic needs assessments (e.g., food and clothing, job obtainment). Next, the counselor and Toney addressed the trauma, focusing on decreasing anxiety-provoking cues and scaffolding into addressing more severe cues and triggers. All the while, Toney and the counselor developed several grounding and relaxation techniques to use both in their sessions and in Toney’s real-world experiences.

One of the most valuable grounding techniques made use of a rock that Toney could hold whenever he felt distressed. The counselor taught Toney how to become present, while holding the rock, through discussions about the texture, shape and weight of the rock. Discussing these tactile experiences allowed Toney to focus on the here-and-now rather than attempting to escape feelings and thoughts.

Toney and the counselor also used a breathing method in which Toney would take a deep breath through his nostrils for at least three seconds and exhale through his mouth for three seconds. They determined that he needed to take at least three deep breaths during the exercise so that he could calm down.

In the final stages of counseling, Toney and the counselor developed an action plan to help him avoid falling victim to trafficking. That does not mean, however, that Toney took responsibility for the actions of others. Toney and the counselor reviewed the different needs he may have and how to meet those needs in a helpful manner.

While focusing on the trauma from human trafficking victimization, the counselor worked with Toney on obtaining a job at a local fast food restaurant. They chose this restaurant so that he could easily transfer to another store in his hometown once he felt comfortable with the transition. After three months, Toney finally returned home and moved back in with his friend, Kevin. He remained employed as a fast food line cook and began seeking education at a local culinary institute.




Lamerial McRae is an assistant professor at Stetson University and a licensed mental health counselor in Florida. Her research and clinical interests include counselor identity development and gatekeeping; adult and child survivors of trauma, abuse and intimate partner violence; marriages, couples and families; LGBTQ issues in counseling and human trafficking. Contact her at ljacobso@stetson.edu.

Letitia Browne-James is a licensed mental health counselor, clinical supervisor and national certified counselor. She is a clinical manager at a large behavioral health agency in Central Florida and is in the final year of her doctoral program at Walden University, where she is pursuing a degree in counselor education and supervision with a specialization in counseling and social change. She has presented at professional counseling conferences nationally and internationally on various topics, including human trafficking.




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.


Helping female clients reclaim sexual desire

By Alicia Muñoz October 2, 2017

If you see women in your counseling practice, it will be hard to ignore the issue of female sexual desire in your work together, even if the focus of treatment is something that appears unrelated to sexuality. In fact, a woman’s relationship with her own experience of sexual desire is often inextricably linked to her sense of identity, self-esteem, personal agency, energy levels, self-care habits and interpersonal relationships. Her desire issues and how she feels about them will weave their way, often implicitly, into your sessions.

The more that counselors can increase their awareness of the nuanced issues related to female sexual desire, the easier it will be to create a space in which clients can explore these issues safely and productively. Working with women more explicitly on understanding, experiencing and sustaining sexual desire can empower them to proactively regulate their moods, reduce stress levels and decrease symptoms of anxiety and depression. Furthermore, reconnecting with the motivation to feel sexual desire has the potential to help transition trauma survivors from “survival to revival” (in the words of couples therapist Esther Perel) as they access the enlivening energy of their own erotic life force.

In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), female sexual interest/arousal disorder is characterized by a lack of sexual interest or sexual arousal for at least six months. Whether a woman is upset or distressed by her lack of interest or arousal is a crucial criterion for the diagnosis. The disturbance can be moderate, mild or severe, lifelong or acquired, generalized or situational. Furthermore, according to the DSM-5, “Women in relationships of longer duration are more likely to report engaging in sex despite no obvious feelings of sexual desire at the outset of a sexual encounter compared with women in shorter-duration relationships.”

Rosemary Basson, director of the University of British Columbia’s sexual medicine program, has noted that other than in the early stages of a new relationship, women’s arousal doesn’t always follow the traditional model of spontaneous sexual desire. Rather, women’s desire tends to be more responsive, with a deliberate choice to experience sexual stimulation required before an actual experience of arousal.

Estimates on how many women suffer from female sexual interest/arousal disorder vary widely, in part because there is so much complexity, variability and subjectivity to how sexual desire issues and arousal problems are measured and experienced. According to an article by Sharon J. Parish and Steven R. Hahn in the April 2016 issue of Sexual Medicine Reviews, issues with sexual desire or arousal are present in 8.9 percent of women ages 18 to 44, 12.3 percent of women ages 45 to 64 and 7.4 percent of women 65 and older. These percentages translate into a significant portion of the female population. It is hard not to wonder what sociocultural circumstances are contributing to making problems with desire so pervasive and systemic for women.

In Standard E.5.c. of the 2014 ACA Code of Ethics, counselors are reminded to “recognize historical and social prejudices in the misdiagnosis and pathologizing of certain individuals and groups and strive to become aware of and address such biases in themselves or others.” This ethical consideration comes into play when counselors treat women with desire issues.

With the work of Helen Singer Kaplan’s triphasic sexual response cycle and an ever-expanding body of nuanced research on women’s sexuality, studies have come a long way from the male-centric, Freudian view of women’s sexual and psychological functioning and even from Masters and Johnson’s linear model of spontaneous sexual response. Researchers today strive to be more objective and aware of the physiological and psychological reality of women.

Even so, systemic prejudices related to gender and gender identity continue to saturate every area of girls’ and women’s lives, creating unique challenges in female clients in the areas of desire and sex. Fostering the safety and trust necessary to explore your clients’ desire issues can move issues of female sexuality and desire from an implicit undercurrent in your work to an explicit focus of therapy. This can help clients separate the wheat of their erotic potential from the chaff of limiting, destructive or shame-based gender and sexual conditioning.

Take Louisa, a 30-year-old client who has been married for two years. (Note: Louisa isn’t an actual client; however, her situation illustrates common sexual desire issues experienced by clients who seek counseling.) Although Louisa initially seeks treatment for depression and anxiety, a few sessions into treatment she begins referring in passing to life stressors that are “TMI” (too much information). Following these TMI comments, Louisa deflects the conversation to other topics with a shrug and a laugh.

Counselors can be attuned to these “throwaway” comments and to dismissive humor, gently inviting clients to elaborate by expressing interest in the information the client is editing out. When the counselor gently points out Louisa’s “TMI” reference and explores what she thinks might be too much information for the therapist, the issue of Louisa’s sex life begins to surface. Counselors may need to reassure clients who experience shame around sexual desire and sexuality that it can be of great benefit to focus on and explore heretofore off-limit topics and the memories, beliefs, thoughts and feelings connected to those topics.


The following interventions may provide springboards for exploring desire issues in counseling sessions with female clients.

1) Provide psychoeducation on the connection between relaxation and sexual arousal, and work with your client to identify ways she can relax. Maureen Ryan, a sexual health coach in Amherst, New York, says, “The first step to a great sexual experience is to relax. Pleasurable touch helps facilitate this process. The body becomes aroused, and then the desire follows. For most women, sexual intimacy precedes desire.”

Explore the thoughts, fears and behavioral patterns that inhibit relaxation. Work on helping your client identify how she might create an external environment that would facilitate her transition into a sexually receptive or erotically engaged state. This might include activities that allow her to feel present or “in the flow” or connect more with pleasurable sensory input (tastes, sounds, smells, visual stimuli, touch).

2) Invite your client to create a body map. Sex therapist Aline Zoldbrod suggests using this technique with couples to facilitate a dialogue about current preferences. However, it can also be used one-on-one with female clients who may struggle with shame issues related to their bodies and their experiences of sexual desire.

Your client draws a body shape, back and front, and then uses red, yellow and green crayons to color the shapes in. Green means “I like to be touched here always,” yellow means “I like to be touched here sometimes,” and red means “I never like to be touched here.” This map can serve as one starting point for a deeper exploration of a client’s relationship to her body and her history with touch.

3) Introduce the “prop” of a velvet vulva into your arsenal of psychoeducational tools and use it to help clients understand the anatomy of the vulva, the clitoris and what movements and sensations typically stimulate arousal. This prop can also be used to instruct women on arousal as counselors model a clear, sex-positive language for expressing needs and preferences to a partner.

4) Introduce your client to the concept of “sexual blueprints.” You may want to provide a client with a handout summarizing sexologist Jaiya’s five erotic blueprints: energetic, sensual, sexual, kinky and shapeshifter. Reading about and discussing these blueprints can reduce shame, normalize a client’s experience of her own sexual predilections and help her consider new possibilities. Jaiya’s website (missjaiya.com) has a quiz to help women and men identify their blueprints.

5) Explore the meaning of pleasure for your client. What turns her on? What charges her up and connects her to her own sense of flow or aliveness? A counselor can coach a client to say, “I feed my own desire when …” and then complete the sentence with different activities, thoughts and behaviors that enliven her. Encourage your client to begin developing a running list of whatever it is she can proactively do to power herself up, delight herself and revitalize herself.

Also be sure to have an extensive list of your own desire-feeding activities. This will help you menu ideas for your clients.

6) Help clients develop awareness about the sex-negative and body-negative influences that have shaped how they see and experience themselves and their bodies. Encourage them to limit the sex- and body-negative influences in their lives. This may mean avoiding certain magazines, being mindful about television shows and choosing not to watch certain movies or videos. It may mean setting clearer boundaries with select people in their lives.

Also help clients explore ways that they can take in more sex- and body-positive messages, either through reading different magazines, limiting their exposure to narrow standards of beauty, increasing their vigilance of the kinds of advertising or body imagery they expose themselves to, or regularly and intentionally appreciating their own bodies through pleasurable body rituals and experiences.

A shift in attitude

Over time, Louisa begins to understand that the lack of sex in her marriage underlies her anxiety and depressive symptoms. She fears it means that she and her husband are on their way to divorce and that it’s “all her fault.” Here, the counselor helps Louisa increase her awareness of this critical inner voice and develop greater self-compassion.

Louisa’s husband has become more vocal about their sexual problems and grown increasingly more irritable and withdrawn in their day-to-day life. As a result, Louisa is no longer able to continue pretending the problem is just situational, temporary or unimportant.

In therapy, she examines her sexual misconceptions and beliefs and the influence of her family’s cultural and gender-based expectations of her. To her surprise, she realizes she has limited awareness of her actual bodily sensations. She often “lives in her head” and ignores the signals her body sends her. As a result, she has never really tuned in to what she feels leading up a to sexual encounter. Her low sexual desire is just the tip of an iceberg of denial related to sensations and emotions.

Part of Louisa’s work in therapy becomes learning how to “listen” to her body. She practices doing this in session and also sets aside time outside of sessions to sit quietly and observe her own sensory experience.

In the past, when Louisa lost her motivation to have sex with one of her boyfriends and couldn’t recreate the feeling of strong, active arousal with him, she would interpret it as “falling out of love” or the boyfriend “not being right for her.” It wasn’t until Louisa married her husband that she was faced with the stark truth of her own sexual experience: She had a hard time experiencing spontaneous, robust arousal once the novelty of a relationship wore off. Mostly, later in a relationship, she simply responded to her partner’s desire for her.

This insight signaled a shift in Louisa’s attitude toward sex and herself. She started to mourn her lack of erotic engagement with her past partners and current husband and to commit to cultivating a relationship with her own erotic experience. She began recognizing her own inhibitions, her lack of erotic accountability and the expectation she had always carried that her partner should know what pleased her without her assistance, guidance or willingness to explore the ways that their needs and desires met or diverged.

Because Louisa loved her partner and wanted to make their marriage work, she committed to learning how to experience her own desire and arousal more regularly. Her motivation to feel desire for her own pleasure and sense of wholeness shifted her approach to the sexual disconnection in her marriage from that of a burdensome problem to an adventure.

Untapped potential

When it comes to working effectively with female sexuality and desire, remaining neutral about larger cultural biases can stall your work as a counselor. In a culture saturated with narrow and distorted models and templates of beauty, it is nearly impossible for human beings who emerge from their mothers as female babies to grow up free of misconceptions about their core selves, their bodies, their sensuality and their eroticism.

Some women may manage to stay intuitively connected to their erotic core throughout childhood and adolescence despite the social, relational and societal risks involved, perhaps even making it into adulthood relishing the full range of their sexual experiences on their own terms. A great number of women, however, wouldn’t have survived physically, much less psychically, without shutting off their sexual circuit boards.

Usually, this shutdown isn’t a conscious choice. It is something that girls learn to do within the context of their relationships as a way of maintaining caregivers’ and others’ love and approval. Even for girls growing up in progressive, supportive families, fitting in with peer groups or feeling socially rooted can sometimes cost them some important piece of connection to their core sexual selves. Girls may grow up lacking erotically vibrant, powerful female role models. Sometimes their families and circumstances don’t allow them the luxury of maintaining a strong, healthy, intact relationship with their bodies.

When girls suppress aspects of their deepest erotic impulses and experiences, layers of judgment and shame encase not only what and how they feel, but also who they are. Like a seed trapped in amber, a woman’s erotic potential can remain untapped even as she develops and grows in other areas. It waits for the right conditions to emerge.

Counselors can provide those conditions in therapy. Here are some key ways that counselors can help women reclaim their erotic selves.

1) Take continuing education courses on sexuality.

2) Read progressive, inclusive books on women’s sexuality and women’s sexual empowerment, such as Getting the Sex You Want by Tammy Nelson, She Comes First by Ian Kerner, Mating in Captivity by Esther Perel, Woman on Fire by Amy Jo Goddard, Pussy: A Reclamation by Regena Thomashauer, Come as You Are by Emily Nagoski and Women’s Anatomy of Arousal by Sheri Winston.

3) Familiarize yourself with the facts regarding the unique challenges that women continue to face today locally, nationally and globally, particularly as they relate to physical safety, fiscal equality, political representation and reproductive issues and rights.

4) Learn to talk about all of the parts of women’s bodies with ease. Practice with your children, spouses, colleagues and friends. Learn the exact locations of women’s body parts, study how they interact and learn to identify a woman’s body parts by their correct names (e.g., distinguishing between a woman’s visible genitals — her vulva — and the internal, muscular tube that leads from her vaginal opening to her cervix — her vagina). Learn to discuss sex, sexuality and sexual acts correctly and comfortably.

5) When you pick up on a client’s reactivity, defensiveness, shame or self-consciousness related to a sexual topic, bring warmth and compassion to the moment through attuned interventions. For example: “I noticed that you covered your eyes just now as you mentioned having sex with your boyfriend. Can we be curious about what just came up for you?”

It is important to keep in mind that low desire and lack of sexual interest are issues that many women won’t openly admit to, even when these experiences are their daily reality. There is a lot at stake. Just as a man’s sexual identity and sense of competence can get tied up with his ability to pleasure his partner to orgasm or to maintain an erection, a woman’s sense of sexual self-worth can be intricately connected with her ability to both stimulate and quench her partner’s sexual desire.

When the impetus or the drive to engage in sex with her partner or spouse wanes, a woman’s sense of sexual self-confidence can waver. It can feel as if she is failing at an essential aspect of her being: loving and being loved sexually. It can also inspire terror. Will she lose connection to this person she depends on and loves? How will this affect her family relationships? Is this a prelude to something worse? What changes lie around the corner as a result of her inability to match her partner’s sexual needs with her own authentic responses and initiatives?

Counselors are in a privileged and important position with their female clients at this particular historical juncture. Women are feeling pulled to take up leadership positions and exert influence in spheres of power previously dominated by men, from political offices to corporate headquarters to influencing the ecological trajectory of the planet. To experience the fullness of their emotional range, the force of their uniquely feminine values, priorities and principles, and the vitality of their full aliveness, many women need help developing a healthier relationship with their erotic selves. Because many women have adapted and suppressed aspects of themselves to function in a world that prioritizes the more traditionally masculine values of strength, dominance, competition and self-protection, they need to find ways to access the more traditionally feminine priorities of sustainability, vulnerability, connection and empathy to feel truly like themselves again.

Counselors can safely, warmly and sincerely support the exploration of women’s low sexual desire or inhibited arousal by first prioritizing a woman’s desire as an essential energy source in her life. They can help their female clients navigate the unique, nuanced challenges of low desire and the ways it manifests in a woman’s relationship to her own self, her body and those she loves. Once this issue is prioritized in treatment, it can be made explicit and explored. From there, it becomes easier to disentangle the negative beliefs that women harbor about their bodies and themselves from their inalienable, noncontingent worth as women.

Because many women have come to experience their own desire as beyond their control, they may fear that they are the problem — outliers on the graph of normative human sexual desire doomed to disappoint and frustrate the people they love and need most. Helping women take control of their own experience of sexual desire through explicit counseling interventions has the potential to shift clients’ views of what’s possible for them erotically and, in so doing, what’s possible for them as vibrant, entitled human beings with desires that matter. This shift is seismic and can transform all aspects of women’s lives.




Alicia Muñoz is a licensed marriage counselor and desire expert in private practice in Falls Church, Virginia. She is also a speaker, author, blogger and frequent contributor to various print and online publications. Visit marriedtodesire.com for more of her writing on desire, or sign up for her weekly Relational Growth Challenge at aliciamunoz.com.

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Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Is it OK to have it all?

By Kathleen Smith December 21, 2016

As Lindsey Mitchell approached the end of her doctoral program in counseling at George Washington University, she wasn’t quite sure what was next. After a decade of intense focus on her education, she found her career options in the field both exciting and intimidating. When Mitchell began talking to other women in her program about career choices, she realized that questions about ambition, leadership and family were common among female counselors.

Energized by these discussions with her colleagues, Mitchell decided to take the conversation to the American Counseling Association’s 2016 Conference & Expo in Montréal. Her idea took shape as a panel session called “To Lean In or Not to Lean In: The Diverse Experiences of Women in the Counseling Field.” The title alone was enough to catch the attention of many women at the conference and set the stage for an engaging talk between four ambitious and thoughtful counselors.

The phrase “lean in,” made famous by Facebook Chief Operating Officer Sheryl Sandberg’s 2013 book, Lean In: Women, Work and the Will to Lead, is rife with connotations and criticisms. Sandberg encouraged women to take risks, not make sacrifices based on hypotheticals, and to pursue leadership by taking a seat at the table. A former chief of staff for the U.S. Treasury secretary and a leader in the tech industry, Sandberg draws from her years of experience in male-dominated fields.

But when Mitchell and others considered this philosophy of leaning in, they faced an important question: What does “sitting at the table” mean in the counseling profession when the majority of counselors and ACA members are already female? Weren’t they already at the table?

A colleague of Mitchell’s recommended that she recruit Desa Daniel, a doctoral counseling student at Kansas State University, as a compelling voice for the ACA Conference panel discussion. Daniel thinks that numbers alone aren’t enough to change leadership dynamics. Although ACA and the counseling profession as a whole may be filled with women, she notes that leadership positions within the profession don’t always mirror those numbers. “We still have a long way to go until women hold positions in universities and governance that reflect their presence,” says Daniel, adding that she’d like to serve as president of ACA in the future. She currently serves as the student representative for Counselors for Social Justice, a division of ACA, and as student liaison for Division 45 (the Society for the Psychological Study of Culture, Ethnicity and Race) of the American Psychological Association.

Jessica Jackson, a licensed mental health counselor and a doctoral candidate in counseling psychology at New Mexico State University, also joined the discussion. She points to the male-dominated foundational and theoretical influence in the field as a real challenge. “When you look in the texts, our foundational knowledge is coming from men of European descent, and the structure of the training is based on that,” she says. “No one deviates from the blueprint, so to me, that doesn’t feel like a field dominated by women.”

Jackson also points out that texts such as Sandberg’s, as well as feminist psychology and various waves of the feminist movement, typically failed to include black women in the conversation. Part of her role on the panel, she says, was to help remind counselors that women of color can still be forgotten or excluded in a space that is predominantly female.

Having it all

Comedian Tina Fey wrote that the rudest question someone can ask a woman is, “How do you juggle it all?” Fey suggested the question operates on the assumption that, for women at least, success in one arena of life (e.g., the workplace) implies failure in another (e.g., family life). The question is rarely posed to men. Members of the conference panel set out to consider what “having it all” looks like in the counseling profession and whether balance between multiple arenas of life is possible.

“Can women have it all? I think yes, but we may have to package what that looks like in a different and creative way,” Mitchell says. Currently serving as an Americans with Disabilities Act counselor at Houston Community College, Mitchell points to the male-dominated workplace models that create impediments to women who desire balance between work and family life. For instance, she observes, when their children are ill, some mothers in the workforce will hide that fact and instead claim a sick day for themselves because they don’t want their parenting responsibilities to hurt how they are perceived at work.

“You would think that in a female-dominated field like counseling, it would be better,” Mitchell says. “But we’re still using these male business models instead of thinking about how we can be greater leaders to women that maybe we didn’t have. Sometimes we don’t have a model for what that looks like, so we have to start creating our own.”

These sentiments reflect a common critique of Sandberg’s idea — namely that Lean In ignores systemic obstacles that are present and remain unchanged in the workplace, regardless of whether women make it to the top playing by the current rules. So what rules do counselors need to change to make the workplace and the classroom more flexible and empowering places for women?

Mitchell asked Megan Doughty Shaine, an assistant professor of psychology and counseling at Hood College in Maryland, to bring her voice to the panel as a professor and parent. Shaine shared how her desire to have a multifaceted career and also be a mother affected her path. “It does change the way you move through your education, from the internships you accept, to the jobs you consider, to how you prioritize things,” she says. For example, Shaine limited her search for doctoral programs to the East Coast because she wanted to be close to her family when she started one of her own.

Shaine recommends that women in counseling leadership model how conversations about “having it all” are OK and even encouraged at work. “You’re more likely to have a female supervisor than a male supervisor, at least in the clinical world,” she says. “We have to really evaluate how open we are with these issues of work-life balance.”

Jackson agrees, pointing out that real pressure still exists to choose between focusing primarily on career or family in academia. “People don’t feel comfortable choosing a middle ground because that looks like you don’t know what you want,” she says. “But I don’t think it’s impossible to integrate and have both. My idea of success is being able to acknowledge and appreciate the many roles that I have as a black professional woman without having to sacrifice what means the most to me.”

Finding balance

Members of the panel also considered how to model what good mental health looks like for women trying to balance multiple roles in life. “So many of the conversations that we have about self-care feel fake,” acknowledges Daniel, who does CrossFit every day as a self-care measure. “We have to show tangible examples of what it looks like and how people manage it over the course of their careers. We need to lead by example but also help people set objectives and deadlines for self-care.”

Mitchell suggests that establishing and maintaining boundaries is an important piece of achieving balance. “I feel the pressure to be everything to everyone, and I know that is not a realistic expectation,” she says. “There will be stages in my life where my professional career has to take priority and other times when it will take a step down in importance. I know I entered this profession because I care about people and want to help, so there can be a conflict when I have to put myself first and inadvertently disappoint somebody in another area of my life. So it is a bit of a Catch-22. But this conflict will have to be resolved by continuing to reevaluate my values, my stage of life and what my goals are at the time. It’s an ever-changing process.”

Rather than a detour from success, Jackson sees the pursuit of balance as integral to achieving her goals. “I’m a happier and better person when I can feed the many different parts of who I am,” she says. “By engaging in prayer, checking in and being honest with myself, and being present in the moment, I am better prepared to achieve my idea of success. Potential conflicts may arise due to this expectation that to be successful in your career, you must dedicate your entire life to your career. But I don’t believe in that. I don’t believe that I have to achieve burnout in order to be successful.”

An intersectional approach 

Another critique of the philosophy behind the “lean in” movement and second-wave feminism is the relative lack of examination of women’s intersecting identities. At the ACA Conference, panel members wanted a significant amount of the conversation to focus on the diverse roles and identities of women in the counseling field and the impact this reality has on what it means to lean in.

Jackson points out how traditional advice given in books such as Sandberg’s, including the call to be assertive, may not work for every woman. “As a black woman, being assertive comes across as being the angry black woman. So how do I navigate the need to be assertive without also coming across as angry, even when I’m not angry? Because as soon as I’m assertive, that’s what everyone assumes,” Jackson explains. “When people give you advice, it’s coming from their social identity: their privilege, their background, etc. So you have to figure out what you can take from that and what you can leave.”

Jackson also recommends that female counselors gather both mentors who share their identities and those who do not to help them better navigate the field. When her interest in pursuing a research career led her to apply to the National Research Mentoring Network, she decided to choose a white male as one of her mentors to give her a different perspective. “He gave some insight on how to approach challenges rather than simply focusing on why people don’t understand things the way I do,” Jackson says.

For Jackson, who aspires to improve pipelines for people of color into academia and the mental health field, leaning in also includes starting conversations about the changing landscape of counseling and the reality that counselors don’t provide services to just one population. “We have to expand our ability to provide therapy to people with multiple identities and make room for them at the table as well,” she says. “If the path to leadership was really so linear, there would be a more diverse group of people stepping into those roles.”

Shaine asserts that counseling programs also have to address intersecting identities for their students, particularly those who are considered nontraditional. She points to the young women in her classroom who also work full time and the middle-aged mothers who are returning to school after a long hiatus or a career change. “We have to support them and try to be creative in helping students navigate a program,” she says. “Otherwise, we’re going to lose their voice and we’re going to end up with this monolithic student body, which I don’t think any of us want. That feels very antithetical to the counseling profession, where we want a diversity of perspectives.”

Counseling education programs could also use creativity and a focus on intersectionality to prepare women for a variety of roles in the field. Daniel points out that these programs rarely focus on issues such as licensure, starting a business or management roles. “Counselor ed programs need to step up their game and talk to people about what’s possible on the ground,” she says. “It’s socially unjust to send women out into the field without the full resources of what it really means to have a clinical practice.”

Advice from the panel

When asked what advice they would give to women entering a counseling education program or their first job as a counselor, panel members provided a variety of suggestions.

Mitchell, who aspires to a major leadership role in university student services, says that surrounding herself with the type of women who prompted these conversations in the first place was her best resource. “Sometimes we’re afraid to do that because we don’t want to feel like the least intelligent person in the room,” she says. “But you have to put your insecurities aside and see what you can learn from these women because, someday, you’ll be the person in the room somebody else is looking up to.”

Jackson says that advocating for your interests can go a long way. “If other people have that interest, then maybe you have enough people to request a class on that subject,” she says. “To me, that’s how change starts — being vocal and advocating for yourself.”

Shaine says women in the counseling profession shouldn’t lose sight of the flexibility they possess. “You can make a choice and change your mind later. We have an incredibly flexible field that gives us many different options. Be gentle with yourself,” she advises, “and know that the choices you make now can always be adjusted if they don’t suit you in the future.”

Daniel, who aspires to be a faculty member in a counselor education program, says that supporting other women can be empowering in itself. “We need to be better about supporting all women in their journeys, even if it doesn’t look like [our] own,” she counsels. “At the end of the day, we are creating pipelines for little girls to be what they want to be.”




Kathleen Smith is a licensed professional counselor and writer in Washington, D.C. Her book, The Fangirl Life: A Guide to All the Feels and Learning How to Deal, was published earlier this year. Contact her at ak_smith@gwmail.gwu.edu.

Letters to the editor: ct@counseling.org.




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Girls feeling pressure to be ‘sexy, famous and perfect’

By Laurie Meyers April 5, 2016

In our culture, women receive many messages that can eat away at their self-esteem. For example, self-worth equals youth and beauty. Perfection in all areas of life — professional and personal — is not only achievable, but expected. Women begin to learn these “lessons” as girls, say counseling experts.

American Counseling Association member Laura Hensley Choate says girls are taught that their value is connected solely to what she calls the “three A’s” — appearance, attention and Vgu1RUfKT3WN1ZYxSWaR_14672519443_13d8873062_kaccomplishments. The expectation they take away is that not only must they look their best, but they must also be noticed and popular, all while achieving high grades and earning recognition and awards in sports or other extracurricular activities, Choate explains. In addition, these messages are trickling down to girls at younger and younger ages, so that now even the youngest girls feel the pressure to be, as Choate puts it, “sexy, famous and perfect.”

This pressure has harmful effects on girls’ social and academic development, says Michelle Bruno, a counseling professor at Indiana University of Pennsylvania whose research interests include trauma and resiliency in adolescent girls. Bruno had the opportunity to work with girls on these issues through her involvement in an empowerment program designed by the nonprofit organization Ruling Our eXperiences (ROX), which began as a research study by counselor educator Lisa Hinkelman at Ohio State University.

ROX programs are designed for elementary, middle and high school girls. The programs target areas such as confidence, self-esteem and body image, healthy relationships, effective communication, social media, cyberbullying, sexual violence prevention, stress and coping, academic and career development, and leadership. Bruno, an ACA member, helped bring ROX to several schools in western Pennsylvania, coordinating with school counselors and serving as one of the onsite supervisors.

“Girls [as young as 9] are navigating peer relationships and beginning to be able to choose more independently their participation in classes and activities in school,” she says. “How they perceive and feel about themselves plays an important role in such tasks. Younger children often display higher levels of confidence than what we see in adolescents. We see younger children believing they can do anything, believing that they are the best at whatever fun activity they are trying out. During the preteen and teen years, many girls experience comprised levels of optimism and decreased healthy risk taking. They value acceptance by others and work hard to achieve it among their peer groups. Girls may not want to try new things for fear of failure or standing out.”

Bruno, like Choate, decries the tremendous pressure placed on girls regarding appearance. “The prominent messages about female beauty depict unrealistic and even unhealthy images,” Bruno explains. “Body image struggles are exacerbated by the sexualization of girls in the media, which teaches girls that their value stems from sexual appeal, to the exclusion of other traits. Young girls may end up engaging in self-objectification to achieve attention from others. How one looks becomes a significant focus for young girls, who of course are also in the midst of physical changes.”

Girls are also constrained by what they learn about “acceptable” female behavior, Bruno continues.

“Girls may be oversocialized with regard to expectations around relationships, with a need to please others being paramount over other behaviors,” she says. “This may lead to a perceived need to regulate emotions such as anger, which can result in relational aggression. This is often a result of when girls experience anger or other difficult emotions but mask it because of negative consequences seen as ‘unladylike.’ This creates incongruence and the message that being authentic is not always OK. Taken together, girls in their preteen years are forming all of these ideas around self-worth, how to define it and how to be worthy.”

ROX is a 20-week program that aims to help girls “unlearn” — or not learn in the first place — these “lessons,” Bruno notes. During the course, school counselors or other facilitators work with small groups of girls in what Bruno describes as “interactive psychoeducation” that focuses on building skills such as communication through practice and role-play. The girls also receive homework to work on in between sessions.

Bruno’s involvement with ROX was brief — her role was simply to help introduce the program into Pennsylvania schools — but she remains a big proponent.

“I saw the ROX program as unique and empowering because it is built upon a framework that examines the interrelatedness of all of these factors [appearance, appropriate behavior, etc.] and creates a safe space for girls to examine these topics while building concrete skills,” she says. “The program is highly successful because it addresses the very issues that many women can continue to struggle with throughout their adult lives. Learning these skills at 11 or 12 years old provides opportunities to support girls in defining themselves by internal standards, to help them exercise the ability to communicate feelings in an appropriate manner and to recognize the impact that outside factors can have on them.”

One of the predominant outside factors influencing today’s girls is social media, and Choate is very concerned about its effect. Although she does not view social media as the root of all negative messaging, she is concerned about certain aspects of it.

“Social media is … a new and constant pressure for girls as they feel they must be ‘on’ and perform at all times in order to get noticed and not to miss out on anything,” says Choate, whose book on cultural influences and young girls, Swimming Upstream: Parenting Girls for Resilience in a Toxic Culture, was recently published by Oxford University Press. “They tend to measure their worth on their numbers — their number of friends, followers and likes for each picture. This leads to the development of an inauthentic self that is focused on pleasing others instead of what is authentic to her.”

“We have not yet seen the long-term effects of these pressures on girls because they are so new,” she continues. “It will be interesting to see today’s young girls, who have grown up on social media and who experience a lack of face-to-face communication, in terms of their mental health. What we do know is that rates of depression, anxiety, substance use problems, eating disorders and self-injury are all on the rise for adolescent girls and young women. So I am concerned about these trends and how they will affect girls’ future development and mental health.”

Because of these concerns, Choate, a professor of counselor education at Louisiana State University, also wrote a book for mental health professionals, Adolescent Girls in Distress: A Guide for Mental Health Treatment and Prevention, in 2013. In it, she recommends that counselors focus on the following areas when helping adolescent girls navigate cultural pressures:

  • Parenting: Working with parents to improve communication and family support.
  • Authenticity and self-awareness: Encouraging girls to take time for self-reflection to gain a strong understanding of who they are and what they value. Possessing this level of self-awareness can encourage adolescent girls to stand up for who they are and what they believe in rather than giving in to the pressure of meeting cultural expectations.
  • Wellness, spirituality and gratitude: Encouraging girls to maintain balance in all life dimensions, not just the ones valued by culture (such as the physical). In addition, recognizing meaning and purpose in their lives and being grateful for what they have rather than focusing on what they do not have.
  • Problem-solving and decision-making skills: Promoting problem solving versus ruminating about problems and learning to have the confidence that they can take action to solve their own problems.
  • Coping skills for emotional resolution: Teaching girls how to manage intense emotions without harming themselves or others.
  • Social skills for communication, assertiveness and conflict resolution: Teaching girls how to develop healthy relationships first with peers and then with romantic partners.
  • Cognitive skills for cognitive restructuring and self-regulation: Helping adolescent girls learn to delay gratification and think through the consequences of actions.
  • Body acceptance and positive physical self-concept: Teaching girls to love the changes in their developing bodies and to appreciate their bodies for what they can do, not just for how they look.
  • Media literacy skills: Teaching girls how to critique the cultural messages they receive through the media and to recognize and resist the intent of the messages.
  • Goal-setting skills and perseverance: Encouraging girls to develop goals and a positive outlook for the future.




Related reading: For more on women, body issues and societal pressure, see “Falling short of perfect” in the April issue of Counseling Today




Laurie Meyers is senior writer at Counseling Today. Contact her at LMeyers@counseling.org