Counseling Commons^™

Starting With Story, Not Symptom: Narrative Collapse And Cultural Repair In Appalachia, Wayne Coombs Ph.D.

Journal of Appalachian Health

Appalachia’s opioid crisis reflects uneven burdens, especially in distressed coalfield counties, and it cannot be solved by symptom tracking alone. This commentary argues for a narrative shift, starting with story and cultural repair alongside clinical care. Narrative collapse is defined here as the loss of shared, dependable public meaning across groups, not the absence of storytelling in families, churches, and recovery circles. Trauma science suggests that chronic threat reshapes nervous systems across generations, making safety a prerequisite for renewed trust. Drawing on narrative identity research, the piece proposes peer story work as infrastructure that can reduce shame, support treatment engagement, …

Unseen To Unstoppable: Critically Redefining Care For Rural Women With Alcohol Use Disorders, Nicole Gerace

DSW Capstone Projects

Research reveals that rural women with alcohol use disorders (AUDs) are up to 90% less likely to seek treatment than men or urban women. This Doctor of Social Work capstone project brings together a systematic literature review (SLR), a conceptual paper, and a practice application paper to examine the clinical social work practice problem of rural women with AUDs underutilizing treatment. Collectively, these products investigate factors contributing to these disparities, identify gaps in care, and propose more equitable and responsive approaches to treatment for these women. This project began with an SLR (2020–2025) that investigated clinical treatment interventions that demonstrated …

Navigating Mental Wellness: A Peer-Led Journey Into Adult Services, Kristin G. Haberek

DSW Capstone Projects

Students with severe emotional disturbances (SED) occupy one of the most underserved intersections in American education and mental health care. As they age out of children’s services, they face abrupt service discontinuation, disrupted therapeutic relationships, and adult systems ill-equipped to meet their needs. These vulnerabilities, including heightened risks of crisis, hospitalization, homelessness, and justice involvement, constitute a central practice problem. This capstone addresses these transitions across three scholarly products: a systematic literature review, a theoretical concept paper, and a practical application paper, tracing a unified arc from diagnosing structural failures to proposing an evidence-informed, equity-oriented clinical response. Synthesizing key findings …

The Impact Of Medicaid Policy Limitations On Access To Eating Disorder Treatment: Uncovering The Consequences Of A System Built To Fail, Meghan Frost

DSW Capstone Projects

Individuals who rely on Medicaid face major barriers when trying to access eating disorder (ED) treatment, reflecting broader patterns of structural disadvantage in publicly funded health care. Research shows delayed diagnosis, limited access to ED specialists, and frequent denials for recommended services. These gaps occur because Medicaid policies do not match the needs of evidence based ED care, resulting in delayed or incomplete care for many individuals with eating disorders.

This issue is highly relevant to social work practice because the policies shaping these barriers are complex and difficult for clients and ED providers to navigate. Social workers across clinics, …

Stigma And Isolation: The Lived Experiences Of Male Sexual Assault Survivors In College, Vanessa Vela

Theses and Dissertations--Family Sciences

Male sexual assault survivors on college campuses face barriers to disclosure, support, and recovery due to stigma, societal expectations of masculinity, and inadequate institutional resources. This hermeneutic phenomenological study explored the lived experiences of six male survivors of sexual assault enrolled in college, focusing on their perceptions of sexual violence before and after their assault, the psychological burden of disclosure, and their experiences with available support systems. Participants described challenges including rape myths, feelings of isolation, fear of emasculation, and limited access to gender-inclusive resources. While online communities provided some support, institutional services often failed to meet their needs due …

Parental Stress, Self-Compassion, And Meaning In Life Among Mothers Of Children With Autism Spectrum Disorder, Hyun-Ju Ju

Theses and Dissertations--Early Childhood, Special Education, and Counselor Education

Mothers of children with autism spectrum disorder (ASD) often experience higher levels of parenting stress than mothers of typically developing children or children with other developmental disabilities, which can undermine their psychological well-being. Additionally, parental stress among mothers of children with ASD is influenced by various demographic factors. This study primarily identified the relationship between parental stress and demographic factors. It also examined the correlations among parental stress, self-compassion, and meaning in life of mothers raising children with ASD within a positive psychology context. Finally, this study investigated whether self-compassion mediates the relationship between parenting stress and two distinct dimensions …

Therapist Perspective Of Therapeutic Alliance And Treatment Outcome In Systemic Psychotherapy, Benjamin Larkin Mize Patterson

Theses and Dissertations--Family Sciences

One of the most robust findings in psychotherapy outcome research has been the relationship of a strong therapeutic alliance with improvement in treatment. Most research, however, has measured therapeutic alliance from the client’s point of view, disregarding the therapist’s perspective of this phenomenon. In this naturalistic study of adults in systemic individual, couple, or family psychotherapy (N = 627), both client- and therapist-ratings of alliance were assessed for their associations with treatment outcomes. Multilevel modeling was employed to analyze data from the Marriage and Family Therapy Practice Research Network (MFT-PRN). Client-ratings of the therapeutic alliance and general functioning/relationship satisfaction …

Cbt And Me: A Beginning Therapist's Journey Utilizing Client Feedback, Haley Scruggs

Theses and Dissertations--Family Sciences

Cognitive behavioral couple therapy (CBCT) is a model of therapy targeting cognitions, emotional responses, and behavioral interactions between couples experiencing relationship distress. Routine outcome monitoring (ROM) is a tool that clinicians can use to track the progress of their clients in therapy from the perspective of the client. This study aimed to use MFT-PRN, a type of ROM, to gather client progress throughout CBCT treatment. Prototypical change trajectories were created in Microsoft Excel for examination of presenting problem progress, couple satisfaction, and overall relationship functioning. It was found that small data sensitivity affected the trajectories immensely, though ROM outcomes revealed …

Routine Outcome Monitoring In Emotionally Focused Therapy: A Clinical Perspective, Lillian Dunn

Theses and Dissertations--Family Sciences

The field of couple and family therapy has a foundation in systems theory and recognizes the intricate dynamics of relationships. Therapists often navigate complex webs of connection, aiming to enhance communication, foster healthy interaction patterns, and cultivate emotional well-being to strengthen relational bonds. This thesis focuses on the integration of routine outcome monitoring (ROM) within Emotionally Focused Therapy (EFT) and aims to shed light on its role in achieving therapeutic goals. ROM tools offer insights into the therapeutic process, facilitating tailored interventions to meet clients' needs. The findings suggest that integrating ROM into EFT benefits therapists and clients, enhancing our …

Exploring The Therapeutic Relationship In Mental Health Therapy With Queer And Disabled Adults, Rachel Womack

Theses and Dissertations--Social Work

Queerness and disability have been shown to be intimately connected, with members of the LGBTQIA+ community significantly more likely to identify as disabled compared to the general population. Though there are roughly 3-5 million queer and disabled individuals living in the United States, this remains a multiply marginalized and understudied population. Owing partially to stigma, minority stress, and discrimination, these individuals face an increased risk of a variety of mental health problems including depression, anxiety, self-harm, PTSD, and suicidality. Additionally, several barriers to mental health treatment exist, including inaccessible services, lack of provider knowledge, and outright discrimination from providers. Though …

What’S Harm Reduction Got To Do With It? A Study Of The Implementation Of Substance Use Management Practices Among A Sample Of U.S. Domestic Violence Programs, Stephanie H. Ratliff

Theses and Dissertations--Social Work

Domestic violence programs are essential resources for survivors of intimate partner violence (IPV). Programs offer services that go beyond providing safety and shelter. To improve outcomes, program staff have expanded services to meet the needs of survivors. One population of survivors that has gained attention in the peer-reviewed literature is survivors who use substances (SWUS). These survivors have unique needs and are at increased risk of IPV due to substance misuse. Research about the support available to SWUS after they access shelter is scarce. Using cross-sectional data from a national sample of 97 U.S. domestic violence programs, this study describes …

Maternal-Adolescent Communication About Sex And Risky Sexual Behaviors: A Cross-Cultural Comparison Of Czech, Spanish, And Taiwanese Youth, Mckinley Hall

Theses and Dissertations--Family Sciences

This present study aimed to test the relationship between perceived maternal-adolescent communication about sex and risky sexual behaviors, while also considering the links between perceived maternal-adolescent closeness and maternal-adolescent conflict with risky sexual behaviors, across three culturally distinct countries, namely the Czech Republic (N=878, mean age of 17.93), Spain (N =1024, mean age of 18.79), and Taiwan (N =1443, mean age of 16.48). Samples of adolescents from each country were used and statistical analyses were conducted to test the hypothesized relationships. Based on path analysis carried out on each sample, the results revealed that Czech adolescents reported the highest levels …

Links Between Perceived Mother-Adolescent And Father-Adolescent Conflict And Low Self-Control: A Cross-National Comparative Study, Tory Thomas

Theses and Dissertations--Family Sciences

The influence of parent-adolescent relationships and adolescent adjustment have been well-documented. Self-control has emerged as a key probabilistic construct in understanding adjustment, well-being, and life success. The present study tests the links between adolescent perceptions of maternal and paternal conflict and self-control. In addition, to understand the extent to which cultural developmental context impacts these associations, the study will employ a cross-cultural comparative lens to test whether cultural context moderates these links. Self-report data were collected from N = 4,924 adolescents (Mage = 16.97 years, 54.08% female) across four countries (China, Czech Republic, Turkey, and the United States). In by …

Disparities In Mental Health Technology Among African Americans: Breaking Cultural Inclusion Barriers, Nyoki Cosey-Brown

DSW Capstone Projects

Mental health technology is a healthcare delivery model of the future. The engagement in virtual healthcare was intensified when traditional healthcare methods were inaccessible during the federal restrictions implemented due to the COVID-19 pandemic. Utilizing digital apparatuses for healthcare improved the convenience, efficiency, and accessibility of various mental health services that were inoperable in past healthcare models. However, the historical constructs of stigma, discrimination, inequity, exclusion, and structural racism in mental healthcare were prevalent problems that remained present in virtual mental health platforms concerning the experiences of African-American patients and professionals who utilized the spaces.

This research explored mental health …

Internalized Homonegativity And The Mental Health Of Lesbian, Gay, And Bisexual Individuals: An Integrative Treatment Approach, David Kearby

DSW Capstone Projects

Lesbian, gay, and bisexual individuals (LGBI) have a higher rate of mental health disorders than the general population. The mental health disparities experienced by LGBI are positively correlated with higher internalized homonegativity (IH) levels, which impacts their functioning at the unconscious, cognitive, and interpersonal levels. Thus, effective interventions targeting the mental health of LGBI must consider IH's intrapsychic, cognitive, and interpersonal nature. An integrative psychotherapy approach addressing the mental health and IH of LGBI is needed to address the intrapsychic, cognitive, and interpersonal factors at play.

Product one of this capstone is a systematic literature review that identified psychotherapeutic interventions …

The Strong Black Woman Schema: A Proactive Approach To Conceptualizing And Providing Mental Health Treatment For Black Women Who Identify With The Strong Black Woman Schema, Kendra Mulder

DSW Capstone Projects

The Strong Black Woman Schema is the ideology that Black women should display mental and physical strength, stoicism, and nurturer traits. While Black women who identify with this schema typically associate this term with a positive identity, there are adverse outcomes that stem from this identification. Black women who identify with the Strong Black Woman schema experience higher rates of depression, anxiety, and psychological distress. No treatment modality has been determined to treat Black women who identify with the Strong Black Woman Schema. This capstone presentation will present a systematic literature review that discusses how the Strong Black Woman Schema …

Attitudes Of Therapists Surrounding Sand Tray Therapy With Adults, Madalyn Cooke

Theses and Dissertations--Family Sciences

Sand tray therapy provides a unique experience for adults and children to interact with their experiences and feelings from a distance. However, it is not used as frequently as talk therapy techniques in adult therapeutic treatment. The following thesis explores therapists’ attitudes about using sand trays with adults. A qualitative thematic analysis suggests that while some therapists deem sand trays as helpful with treatment, especially for clients who have a history of trauma, there are barriers for therapists to overcome in order to incorporate sand trays more frequently into practice with adult clientele.

Secondary Traumatic Stress Is An Occupational Hazard For Pet Hospice Support Staff: Psychoeducational Support Groups Provide The Cure, Kari Hayden

DSW Capstone Projects

There are three separate yet interrelated products presented in this final capstone product. The completed product is focused on pet hospice veterinary support staff and the need for an evidence-based social work intervention to combat secondary traumatic stress. This capstone uses the andragogical approach to adult learning theory as the foundation to construct a psychoeducational peer support group specific to this population. Implications for clinical social work in veterinary medicine are presented within this project.

The first scholarly product presented is the Systematic Literature Review (SLR). The SLR utilizes a scoping review process in an attempt to locate prior research …

Treatment Of Borderline Personality Disorder: Re-Envisioned To Mitigate Stigma And Enhance Treatment Effectiveness, Abigail Lorraine Steinkamp

DSW Capstone Projects

Borderline personality disorder (BPD) and the characteristics that define it are often viewed negatively by therapists and other mental health providers. Terms to describe these clients commonly include “manipulative”, “attention-seeking”, and “always in crisis.” Because of this jargon, there is a deep-set stigma that surrounds the disorder. Therapists and treating clinicians base their decisions and treatment protocol on hearsay of the disorder and already have an image of their prospective BPD client before the client enters their office. This capstone project seeks to inform clinicians about the present stigma and provides tools that are proposed to reduce stigmatizing beliefs within …

Black Men Need Love Too, Addressing Unaddressed Mental Health In African American Men, D'Quayvion Cloud

DSW Capstone Projects

The objective of this capstone is to analyze and demonstrate the importance of studies on unaddressed mental health among African American males. The major aim is to demonstrate why research, policy, and funding are vital to knowing how to work with this specific clinical group, allowing us to build effective and inclusive programs for these African American males and eliminate the stigma associated with members of this community. Due to unaddressed mental health and a lack of treatment options for our people, research has shown that African American men aged 20 to 24 had the highest suicide rate of any …

Role Expansion Of School Social Workers: An Educational Paradigm Shift, Sara Murrell

DSW Capstone Projects

This capstone product includes three written documents. The purpose of this work was to discover and justify the role expansion of school social workers into school leaders. The first, a systematic literature review examining the roles of school social workers. This document will review the current literature describing which school social work roles promote school social workers as school leaders, and which roles act as barriers for school social workers to become school leaders. The second document is a conceptual paper. This document identifies the need for a paradigm shift in education towards a whole child perspective. This document looks …

What's The Play? Using Social Learning Theory To Treat Men In Mental Health, Aaron Hemlepp

DSW Capstone Projects

Men have problems when it comes to mental health. Specifically, men are more likely to have a fatality of suicide than other genders and are more likely to have substance abuse problems than other genders. Combine this with societal problems such as the shrinking physical labor market and instability of family systems that have traditionally been seen as “men’s work.” The gender is not adapting to modern social functioning in the way that other genders have been, which means that therapy is not a useful tool for men and their problems. This means that therapy systems need an approach to …

Autonomous Self-Care: A Means To Mitigate Secondary Traumatic Stress Among Clinical Social Workers, Jessica Byrd

DSW Capstone Projects

Secondary traumatic stress (STS) negatively impacts the health of clinical social workers, thus, impairing their ability to provide quality services. The symptoms and consequences of STS have been discussed for decades and the conversation continues because STS is a prevalent and pervasive problem that effects social workers, clients, and organizations. For as long as STS has been recognized as a problem, self-care has been identified as a solution. Yet, clinical social workers underutilize self-care strategies to safeguard their mental, physical, and emotional well-being.

A systematic review of the literature review was conducted to explore, why self-care is underutilized among clinical …

Transforming Social Work Practice And Research: Examining Lived Experiences Of Black Male Veteran Students And Mental Health, Tay Robinson

DSW Capstone Projects

Mental health disparities amongst the African American/Black community are well documented in literature. Throughout history the African American/ Black community have dealt with unethical operating procedures and research studies. This capstone project looks at historical facts, the lack of Black male veteran specific research as it relates to mental health, lived experiences of Black male veteran students with mental health/treatment, and developing culturally appropriate approaches to increasing research and effective practices to better serve this community.

The second chapter and first product of this capstone project is a systematic literature review. This literature review focused on finding literature on African …

Transforming Hurt Boys Into Restored Men: The Lack Of Mental Health Treatment For Black Male Trauma Survivors, Shericka Danielle Smith

DSW Capstone Projects

Trauma affects individuals differently, but the prevalence of trauma and its impact on Black males is detrimental. Black males are at higher risk for posttraumatic stress disorder (PTSD), depression, substance abuse, and violent crimes when trauma is left untreated by a mental health professional. As the number of traumatic events experienced by Black males continues to rise, the number of these males who seek mental health treatment remains stagnant and painfully low. Many factors play into these behaviors, yet very little data exists on what is being done to change them.

Product one is a systematic literature review in which …

How To Live Life All The Way Up Learning Life Skills From Literary Characters, Sue N. Mize

Theses and Dissertations--English

In this essay, using the theories of psychiatrist, Eric Berne and his script theory; psychoanalyst, Carl Jung and his archetypes and mandalas; as well as the Native American Medicine Wheel; and the Hindu notion of the kundalini, I analyze the psychological development of Adele Quested of E.M. Forster’s A Passage to India (1924) and Anna Wulf of Doris Lessing’s The Golden Notebook (1962). Adela Quested goes to India seeking the real India and while engaging the archetype of the Lover discovers her real Self. While in India she metaphorically walks the Medicine Wheel and discovers that to be …

Children And High Conflict Divorce: Using Equine-Assisted Psychotherapy As Treatment, Ashley Berry

DSW Capstone Projects

The act of divorce has been commonplace throughout the world during the 20^th century, plateauing around the 1970s at around 50% of all marriages. While most divorces end peacefully, many contain ongoing conflict which can become detrimental to all involved, including the children. While historical treatment methods focus on changing the behavior of parents, there are instances where these methods may be ineffective, especially when the parents are unable or unwilling to change their conflictual behaviors. Equine-Assisted Psychotherapy (EAP), which has been used with individuals who have suffered from trauma, may be an option to use with this population …

Good Trouble: Disrupting The Disproportionality Of Black Boys In Special Education Due To Misdiagnosed And Unaddressed Trauma, Montrell Pryor

DSW Capstone Projects

Black boys experience a myriad of trauma as they navigate through society under the gaze of white patriarchy and archetypes. Whether engaging in trauma or witnessing it, it impacts Black boys tremendously, particularly in the educational setting. What typically looks like misbehavior in the classroom can be symptoms of unaddressed and untreated trauma that have been triggered and exacerbated in the school setting. As a result, this phenomenon contributes to the disproportionality of Black boys in special education and adds to the expansion of the school-to-prison pipeline.

This capstone provides a thorough examination of the literature in the form of …

Addressing The Mental Health Disparities Among Black Children During Natural Disasters: A Clinical Perspective And Response To The Covid-19 Pandemic., Brittany Reed

DSW Capstone Projects

The experiences of Black children resulting from the events surrounding the Covid-19 pandemic present a projection to create long-term mental health effects at higher rates than their peers of other races. While the long-term effects of this pandemic are still considered ongoing, the disparities within the Black community will subsequently develop into a trickle-down effect of secondary traumatic experiences faced by Black children. Then, where does that leave Black children and their mental health? This capstone project aims to examine how the Covid-19 pandemic will affect Black children, explore the mental health challenges and disparities faced by Black children resulting …

The Person Of The Therapist: Therapists’ Personal Characteristics As Predictors Of Working Alliance And Treatment Outcomes, Alyssa Laura Clements

Theses and Dissertations--Educational, School, and Counseling Psychology

Recent years has seen an increase in studies examining the unique contribution that the therapist has on treatment outcomes, which is commonly referred to as “therapist effects” (Barkham et al., 2017). Therapist effects on outcomes are believed to occur primarily via how the therapist’s interpersonal and intrapersonal qualities influence the therapeutic relationship, which in turn influences outcomes (Wampold et al., 2017). The current study focused on professional self-doubt, counseling self-efficacy, and humility because of previous writings about their potential to influence therapists’ interpersonal behaviors. Data was collected from Southwest Behavioral and Health Services (SBHS), a non-profit, comprehensive community behavioral health …