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Practicum Students' Anticipatory Thoughts about Challenging Client Situations

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Title: Practicum Students' Anticipatory Thoughts about Challenging Client Situations
Language: English
Authors: L. DiAnne Borders (ORCID 0000-0001-8713-245X), Alexis Arzuaga, Emily N. Spain
Source: Counselor Education and Supervision. 2025 64(3):288-299.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 12
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Practicums, Counselor Training, Self Efficacy, Stress Variables, Student Attitudes, Student Reaction, Counselor Client Relationship, Well Being
DOI: 10.1002/ceas.12341
ISSN: 0011-0035
1556-6978
Abstract: Practicum students' anxiety as they envision seeing "real" clients can impede their self-efficacy and in-session functioning. To explore how anticipatory stress and coping theory might help better support them, we used CQR-M to code students' (n = 42) immediate thoughts and reactions to three challenging client situations before and after practicum. Students' responses reflected key tenets of the theory, pointing to pre-practicum approaches that may lessen students' anticipatory stress and enhance their well-being.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1483619
Database: ERIC
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  Value: <anid>AN0187978646;cev01sep.25;2025Sep17.06:45;v2.2.500</anid> <title id="AN0187978646-1">Practicum Students' Anticipatory Thoughts About Challenging Client Situations </title> <p>Practicum students' anxiety as they envision seeing "real" clients can impede their self‐efficacy and in‐session functioning. To explore how anticipatory stress and coping theory might help better support them, we used CQR‐M to code students' (n = 42) immediate thoughts and reactions to three challenging client situations before and after practicum. Students' responses reflected key tenets of the theory, pointing to pre‐practicum approaches that may lessen students' anticipatory stress and enhance their well‐being.</p> <p>Keywords: anticipatory stress and coping; challenging clients; clinical supervision; CQR‐M; practicum students</p> <hd id="AN0187978646-2">Introduction</hd> <p>Regardless of setting, practicum is a challenging experience for counseling students. Even pre‐practicum, they report high anxiety, low self‐efficacy, and elevated levels of stress (Clarke and Hartley [<reflink idref="bib14" id="ref1">14</reflink>]) about seeing their first "real" clients. During practicum, they struggle with feelings of frustration, confusion, anger, and/or disappointment about their performance yet fear trying new skills (Melton et al. [<reflink idref="bib42" id="ref2">42</reflink>]). Cognitively, they tend to be preoccupied with their own thoughts, including self‐doubt and self‐critical cognitions (Kannan and Levitt [<reflink idref="bib33" id="ref3">33</reflink>]). Novices' reactions may be exacerbated when clients disclose challenging situations, such as suicidal ideation (Elston et al. [<reflink idref="bib20" id="ref4">20</reflink>]) and trauma exposure (Borders et al. [<reflink idref="bib8" id="ref5">8</reflink>]; Cartwright et al. [<reflink idref="bib12" id="ref6">12</reflink>]), and when clients have different cultural identities (Jacquart et al. [<reflink idref="bib30" id="ref7">30</reflink>]). Importantly, current evidence suggests novices <emph>will</emph> encounter these client situations early on, likely during their practicum experience (e.g., Elston et al. [<reflink idref="bib20" id="ref8">20</reflink>]; Jacquart et al. [<reflink idref="bib30" id="ref9">30</reflink>]; Webber et al. [<reflink idref="bib55" id="ref10">55</reflink>]).</p> <p>This conundrum suggests specific attention should be given to students' anxiety and stress <emph>before</emph> they start practicum rather than "once signs of interpersonal stress are observed" (Moore, Stubbs‐Brown, et al. [<reflink idref="bib46" id="ref11">46</reflink>], 26). Such an approach would be in line with anticipatory stress and coping, the first stage of the Transactional Model of Stress and Coping (TMSC) process model (Lazarus and Folkman [<reflink idref="bib37" id="ref12">37</reflink>]). To date, however, the TMSC anticipatory stage has not been applied in counseling research. Thus, we conducted an initial investigation of students' anticipatory thoughts and reactions about challenging client situations they likely will encounter during their practicum experience. Our broad aim was to explore the potential contribution the first TMSC stage might offer toward better helping students to cope with their pre‐practicum stress.</p> <hd id="AN0187978646-3">Challenging Client Situations</hd> <p>First, working with suicidal clients is simply a "professional reality" (Sherba et al. [<reflink idref="bib50" id="ref13">50</reflink>], 279). Elston et al. ([<reflink idref="bib20" id="ref14">20</reflink>]), for example, reported over 50% of their counseling practicum students, across settings, had worked with suicidal clients. Of concern, few counseling programs offer in‐depth training in suicide intervention skills (Wachter Morris and Barrio Minton [<reflink idref="bib54" id="ref15">54</reflink>]). As a result, students report feeling anxious and underprepared, even fearful of bringing up the subject of suicide directly (Binkley and Leibert [<reflink idref="bib5" id="ref16">5</reflink>]; Elston et al. [<reflink idref="bib20" id="ref17">20</reflink>]).</p> <p>Second, while the counseling field remains primarily White and female, the US population is increasingly diverse in terms of race, ethnicity, gender, and sexual orientation (Day‐Vines et al. [<reflink idref="bib17" id="ref18">17</reflink>]). Counseling students, however, may be underprepared to address differences in client‐counselor identities, as multicultural counseling coursework is more successful in increasing knowledge than enhancing multicultural attitudes and skills (Benuto et al. [<reflink idref="bib4" id="ref19">4</reflink>]; Dunn et al. [<reflink idref="bib19" id="ref20">19</reflink>]). Broaching, inviting explicit conversations around the relevance of clients' culture to their lived experiences (e.g., discrimination, oppression) into the counseling context (Day‐Vines et al. [<reflink idref="bib18" id="ref21">18</reflink>]; Jones and Welfare [<reflink idref="bib32" id="ref22">32</reflink>]), is considered a foundational skill. The "norm of silence" (Jones and Welfare [<reflink idref="bib32" id="ref23">32</reflink>], 50) is powerful, however, for counselors of all identities (Bayne and Branco [<reflink idref="bib2" id="ref24">2</reflink>]). Counselors report avoiding broaching due to fear of seeming biased, offending clients, damaging or rupturing the relationship, or causing the client to leave counseling (Jacquart et al. [<reflink idref="bib30" id="ref25">30</reflink>]; Sue et al. [<reflink idref="bib52" id="ref26">52</reflink>]), along with uncertainty about how to broach (King [<reflink idref="bib34" id="ref27">34</reflink>]).</p> <p>Third, data indicate that 70% of individuals worldwide experience a traumatic event during their lifetime (Benjet et al. [<reflink idref="bib3" id="ref28">3</reflink>]), with some indications that incidences of trauma in the US have increased due to the pandemic and socio‐cultural–political climate (Felter et al. [<reflink idref="bib22" id="ref29">22</reflink>]; Moh and Sperandio [<reflink idref="bib43" id="ref30">43</reflink>]). Thus, counselors in all settings—including trainees in practicum and internship—will work with trauma‐exposed clients (Borders et al. [<reflink idref="bib8" id="ref31">8</reflink>]; Henning et al. [<reflink idref="bib28" id="ref32">28</reflink>]; Webber et al. [<reflink idref="bib55" id="ref33">55</reflink>]). Although required by CACREP since 2016 (Council for Accreditation of Counseling and Related Professions [<reflink idref="bib16" id="ref34">16</reflink>]), trauma training remains inconsistent rather than integrated across counseling curricula (Felter et al. [<reflink idref="bib22" id="ref35">22</reflink>]; Moh and Sperandio [<reflink idref="bib43" id="ref36">43</reflink>]). Students without training report intense emotional (e.g., shock, overwhelm, panic) and cognitive (e.g., uncertainty, self‐doubt, unfocused thinking) reactions to their clients with trauma exposure (Borders et al. [<reflink idref="bib8" id="ref37">8</reflink>], [<reflink idref="bib7" id="ref38">7</reflink>]; Lu et al. [<reflink idref="bib39" id="ref39">39</reflink>]). As a result, they are at higher risk for burnout, vicarious trauma, and secondary traumatic stress (Henning et al. [<reflink idref="bib28" id="ref40">28</reflink>]; Knight [<reflink idref="bib35" id="ref41">35</reflink>]), especially trainees of color (Butler et al. [<reflink idref="bib10" id="ref42">10</reflink>]) and trainees with a trauma history (Henning et al. [<reflink idref="bib28" id="ref43">28</reflink>]; Parker et al. [<reflink idref="bib48" id="ref44">48</reflink>]).</p> <hd id="AN0187978646-4">Anticipatory Stress and Coping</hd> <p>The TMSC model (Lazarus and Folkman [<reflink idref="bib37" id="ref45">37</reflink>]) indicates that an individual's experience of stress is based on their assessment of the level of difficulty in a situation paired with perceptions of their ability to effectively manage (cope with) the situation. Thus, stress responses may vary by person (individual) and by situation (context), requiring that coping actions reflect a person–environment fit. TMSC flows along three stages. The initial anticipatory stage represents a person's concerns or worries about stressful consequences from an upcoming event that is likely, or certain, to happen as well as their efforts to find ways to reduce the anticipated impact (Aspinwall and Taylor [<reflink idref="bib1" id="ref46">1</reflink>]; Feldman and Hayes [<reflink idref="bib21" id="ref47">21</reflink>]; Folkman and Lazarus [<reflink idref="bib23" id="ref48">23</reflink>]). The second TMSC stage involves the actual encounter with the stressful situation and efforts to cope as the event unfolds, followed by the third post‐encounter stage, wherein the individual assesses the immediate and future impact and meaning of the event and determines next steps (Lazarus and Folkman [<reflink idref="bib37" id="ref49">37</reflink>]). Two cognitive processes characterize each stage: primary appraisal involves assessing the significance of the situation as irrelevant, benign, a threat, or a challenge (e.g., what is at stake?), while secondary appraisal involves evaluation of the effectiveness of one's available coping strategies to manage the stress response to the situation.</p> <p>In contrast to an abundance of supportive research on the TMSC stressful encounter stage, study of anticipatory stress and coping has been neglected until recently (Casper and Sonnentag [<reflink idref="bib13" id="ref50">13</reflink>]; Feldman and Hayes [<reflink idref="bib21" id="ref51">21</reflink>]), including within counseling research. For example, Moore et al. ([<reflink idref="bib44" id="ref52">44</reflink>]) reported practicing counselors commonly experience high stress when they encounter challenging clients, often resulting in cognitive and emotional overload. In fact, a high percentage of their counselors fit distressed, anguished, and paralyzed versus relaxed stress profiles (Moore, Crawford, et al. [<reflink idref="bib45" id="ref53">45</reflink>]). Further testing the TMSC encounter stage, Moore, Stubbs‐Brown, et al. ([<reflink idref="bib46" id="ref54">46</reflink>]) concluded counselors' perceptions (appraisals) of their established coping resources indirectly influenced (mediated) whether their interpersonal stress contributed to burnout. To our knowledge, however, no researchers have explored anticipatory stress and coping with counselors or counseling students. Recent research in other contexts (e.g., job demands, aging; Casper and Sonnentag [<reflink idref="bib13" id="ref55">13</reflink>]; Scott et al. [<reflink idref="bib49" id="ref56">49</reflink>]) suggests addressing practicum counselors' anticipatory stress could be vital to their well‐being. Findings indicate anticipating stress can have the same immediate and ongoing deleterious physiological, cognitive, and affective impacts as the actual experience of (encounter with) a stressful event (e.g., Casper and Sonnentag [<reflink idref="bib13" id="ref57">13</reflink>]; Kramer et al. [<reflink idref="bib36" id="ref58">36</reflink>]), such as those reported by Moore et al. [<reflink idref="bib44" id="ref59">44</reflink>].</p> <p>Our aim, then, was to conduct an initial exploration of the relevance of TMSC's (Lazarus and Folkman [<reflink idref="bib37" id="ref60">37</reflink>]) anticipatory stage of stress and coping within the counseling context. We reasoned it could be particularly fruitful to focus on practicum students, as they have both high stakes investment in the stressful situation of practicum (i.e., determining whether they are capable of being a counselor) but have not yet developed "established coping strategies" (Moore, Stubbs‐Brown, et al. [<reflink idref="bib46" id="ref61">46</reflink>], 25) to effectively manage the stressful situation. Lazarus and Folkman ([<reflink idref="bib37" id="ref62">37</reflink>]) noted this combination—high stakes and deficit resources—often engenders feelings of vulnerability.</p> <p>As an initial test of the theory, we sought to identify novice counselors' anticipatory thoughts and reactions regarding three challenging client situations via a thought‐listing procedure. Counseling researchers have employed the thought‐listing technique (Cacioppo et al. [<reflink idref="bib11" id="ref63">11</reflink>]) for several decades, studying novice counselors' in‐session thoughts (e.g., Morran et al. [<reflink idref="bib47" id="ref64">47</reflink>]), cognitive complexity of their client descriptions (Welfare and Borders [<reflink idref="bib56" id="ref65">56</reflink>]), and considerations about their use of self‐disclosure (Grossman [<reflink idref="bib26" id="ref66">26</reflink>]). Cacioppo et al. ([<reflink idref="bib11" id="ref67">11</reflink>]) indicated that thought‐listing can be particularly useful to elicit thoughts in anticipation of a situation. We were guided by the following research questions: (<reflink idref="bib1" id="ref68">1</reflink>) How do practicum students' pre‐practicum anticipatory thoughts and reactions differ based on the specific challenging client situation? (<reflink idref="bib2" id="ref69">2</reflink>) How do the students' pre‐ and post‐practicum anticipatory thoughts differ by challenging client situation? (<reflink idref="bib3" id="ref70">3</reflink>) What do students' pre‐ and post‐practicum anticipatory thoughts reveal about their specific, individual concerns and needs for each challenging client situation? Following data analysis, our intention was to explore how anticipatory stress and coping theory and research might explain practicum counselors' responses and inform effective approaches to better support them.</p> <hd id="AN0187978646-5">Method</hd> <p>We modeled the format of Morran et al.'s ([<reflink idref="bib47" id="ref71">47</reflink>]) thought‐listing procedure to obtain practicum students' immediate thoughts about three challenging client situations (i.e., suicidal ideation, different identities, trauma history) they likely would encounter during practicum. We identified Consensual Qualitative Research‐Modified (CQR‐M; Spangler et al. [<reflink idref="bib51" id="ref72">51</reflink>]) as an appropriate discovery‐oriented, exploratory method to analyze students' responses to the three thought‐listing prompts. CQR‐M was designed for large datasets of brief, simple qualitative responses while retaining the original CQR emphasis on rater consensus. CQR‐M is particularly appropriate for new or unexplored phenomena (Spangler et al. [<reflink idref="bib51" id="ref73">51</reflink>]) when the goals are to broaden current knowledge that can inform further research and describe rather than interpret open‐ended yet specific prompts (Hill and Knox [<reflink idref="bib29" id="ref74">29</reflink>]). Such a discovery‐oriented approach seemed more appropriate than either content analysis, which is preferable for deductive coding of more concrete data (e.g., content of journals or syllabi, specific counseling skills used; McKibben et al. [<reflink idref="bib41" id="ref75">41</reflink>]), or other phenomenological approaches (e.g., thematic analysis; Braun and Clarke [<reflink idref="bib9" id="ref76">9</reflink>]) designed to identify both explicit and implicit (latent) meanings in more expansive data (e.g., participant interviews).</p> <p>The thought‐listing assessment was added to a large quantitative survey on coping and emotion regulation to provide a contextual qualitative perspective of students' experiences. The categorical nature of the thought‐listing data (three responses per prompt coded separately into non‐ordered categories; see below) did not lend itself to direct statistical comparisons with quantitative score; thus, the qualitative data were intended as a stand‐alone study.</p> <hd id="AN0187978646-6">Participants</hd> <p>Given the exploratory nature of the study, we recruited a convenience sample of students enrolled in practicum during spring 2022 and 2023 in a CACREP‐approved full‐time, in person master's counseling program in the Southeast. Students volunteered for the study following informed consent procedures that had been approved by the University Institutional Review Board. Of the eligible students (<emph>n</emph> = 67), only the 42 who completed both pre‐ and posttest thought‐listing procedures were included in this study. Across the 2 years, students' mean age was 25.6 (<emph>SD</emph> = 6.3), with 22 specializing in clinical mental health counseling, 7 in couple and family counseling, and 13 in school counseling. Students self‐identified as nonbinary, <emph>n</emph> = 1; transgender man, <emph>n</emph> = 1; man, <emph>n</emph> = 2; or woman, <emph>n</emph> = 38. In addition, one person self‐identified as African American/White, African American/White/Multiracial, Arab American, Asian American, Multiracial, White/Asian/Multiracial, White/Hispanic/Multiracial, or White/Middle Eastern/North African; two identified as Hispanic; three identified as African American; and 28 (66%) identified as Caucasian/White (one did not report). One student identified as Bisexual/Queer, Hetero/Queer/Asexual, or Queer; two as Lesbian; two as Questioning; six as Bisexual; and 29 (69%) as Straight/Heterosexual.</p> <hd id="AN0187978646-7">Thought‐Listing Procedure</hd> <p>We wrote three identical thought‐listing prompts to elicit practicum students' anticipatory stress reactions to three challenging client situations students realistically could anticipate they would encounter during practicum and likely felt at least somewhat unprepared to address effectively. Each prompt stated the following:</p> <p>You are assigned a new client in practicum. In preparation for meeting with the client, you preview their intake paperwork. You read/see that the client reports <emph>past suicidal ideation</emph>.</p> <p>What are your immediate thoughts/reactions as you anticipate meeting with this client?</p> <p>Write your first three immediate thoughts/reactions below.</p> <p>A second prompt identified the client as reporting "<emph>a history of trauma</emph>,<emph>"</emph> while a third prompt stated the client "reports <emph>different cultural identities from your own</emph>." Students recorded their responses (immediate thoughts/reactions) on three blank lines directly below each prompt. The prompts were presented in random order within the larger survey.</p> <p>We intentionally worded the prompts to elicit students' immediate responses specific to the challenging situation (context), void of details about the client (e.g., race, gender) or the situation (e.g., when the client experienced suicidal ideation, type of trauma event). The open‐ended wording thus invited students' unique individual anticipatory reactions and allowed them to respond spontaneously, based on their own assumptions, identities, mental health histories, relevant trainings, and/or life experiences.</p> <hd id="AN0187978646-8">Procedures and Context</hd> <p>Students were recruited to the larger study during a class meeting (spring 2022) or practicum orientation (spring 2023). They completed the assessments in randomized order via Qualtrics and received a $25 gift card for completing the full survey at both pre‐ and posttests.</p> <p>All students completed practicum in the counseling program's in‐house training clinic. Their clients were primarily undergraduate student volunteers, some of whom received optional class credit for attending at least four counseling sessions. Both undergraduate and master's students were attending a medium‐size, minority‐serving university in the Southeast, with 50% of undergraduates self‐identifying as persons of color (e.g., African American/Black, Hispanic/Latin, Asian) and/or first‐generation. Before practicum, master's students had completed coursework in multicultural counseling, helping skills, counseling theories, and professional issues, including legal and ethical considerations. Relevant to the three client prompts, they had learned and practiced SIMPLE STEPS (McGlothlin [<reflink idref="bib40" id="ref77">40</reflink>]) to assess suicidal ideation and received introductory lectures on broaching as well as trauma‐informed care. Practicum students were supervised by doctoral students who had completed a supervision content course and were supervised by the first author. Practicum students received weekly individual/triadic and group supervision in accordance with the 2016 CACREP standards.</p> <hd id="AN0187978646-9">Data Analysis</hd> <p>The first author, with extensive CQR and CQR‐M experience, trained the second and third authors through discussion of readings (e.g., Spangler et al. [<reflink idref="bib51" id="ref78">51</reflink>]) and practice coding responses to the same thought‐listing responses of students who completed only the pre‐ or posttest measure. Two domains and initial categories emerged in research team discussions of these data. We used the practice responses to test and expand the list of categories and create a codebook. We coded responses based on their content, regardless of whether they were phrased as statements or questions.</p> <p>Before coding the main study dataset, the third author scrambled the pre–post thoughts by participant and by prompt; thus, team members were not aware which were pre‐ or post‐responses. Then, we followed the prescribed CQR‐M steps (Spangler et al. [<reflink idref="bib51" id="ref79">51</reflink>]): (<reflink idref="bib1" id="ref80">1</reflink>) all research team members independently read a group of responses to a specific prompt, assigning each response to one domain and one category within that domain; (<reflink idref="bib2" id="ref81">2</reflink>) team members met to share and discuss their coding and reach consensus; (<reflink idref="bib3" id="ref82">3</reflink>) team members repeated this process for a new group of responses until all responses were coded. We completed coding responses for one client prompt at a time and revised the codebook as needed. The third author maintained a table of consensus codes throughout this process. Given the brevity of responses and ongoing discussion to reach consensus, CQR‐M does not include auditing, and responses are reported via percentages (vs. CQR labels of general, typical, etc.) (Spangler et al. [<reflink idref="bib51" id="ref83">51</reflink>]).</p> <hd id="AN0187978646-10">Coding Team and Trustworthiness</hd> <p>The three‐member team collectively conducted the coding process across 1 academic year (2023–2024). The first author is a White, cisgender woman and counselor educator who has supervised doctoral students working with master's students in counseling practicum and internship for some years. The second author is a first‐year doctoral student who identifies as an Ibero‐Caribbean man from Puerto Rico. He is an experienced clinician working primarily with trauma exposure and suicidal ideation clients. The third author, who identifies as a White, lesbian cisgender woman with Korean heritage, is a first‐year master's student with experience in a residential eating disorders clinic as well as several years of work as a research assistant. Neither were enrolled in the counseling program at the time of data collection.</p> <p>In initial discussions of the perspectives we brought to the project, we named our curiosities about participants' thought‐listings, based on our own identities and previous experiences relevant to the three client prompts. We were curious about students' emotional responses to encountering such challenging situations during practicum. We anticipated developmental concerns (e.g., self‐doubt), high self‐expectations, potential countertransference, and concerns about negatively impacting the client. We wondered how responses might reflect participants' pre‐practicum course content. We expected to see changes pre–post while agreeing the three client situations might still be challenging at posttest. We revisited these perspectives as needed throughout the coding process.</p> <p>In CQR, trustworthiness (credibility) is at the heart of the consensus approach (Hill and Knox [<reflink idref="bib29" id="ref84">29</reflink>]), as multiple coders' different perspectives inform the interpretations of the data. The consensus process also serves as a form of triangulation, given that multiple coders independently examine the data and then reach an agreement via team discussion (dependability, transferability, confirmability) (Hays and Singh [<reflink idref="bib27" id="ref85">27</reflink>]; Hill and Knox [<reflink idref="bib29" id="ref86">29</reflink>]). In addition, the first author maintained an audit trail of team meeting discussions, noting patterns of disagreement and challenges in reaching consensus (credibility) (Hays and Singh [<reflink idref="bib27" id="ref87">27</reflink>]). For example, she noted one coder sometimes seemed to read past the brief phrases in speculating about underlying rationales for participant responses; as needed, the team revisited the need for objectivity in staying close to participants' words. Finally, example participant quotes are reported below to illustrate the domains and categories, further addressing confirmability (Hays and Singh [<reflink idref="bib27" id="ref88">27</reflink>]).</p> <hd id="AN0187978646-11">Results</hd> <p>The CQR‐M process yielded two domains containing eight categories describing participants' pre–post responses to the three thought‐listing prompts about challenging client situations (i.e., suicidal ideation, trauma history, different identities). Across the 42 participants, a total of 756 responses were possible (i.e., three responses per prompt at both pre‐ and posttest), with 126 responses per prompt possible at pretest and at posttest. For the suicidal ideation prompt, one pretest and three posttest responses were missing. Also, four pretest and one posttest responses to the different identities prompt were too brief or vague to code (e.g., "cool," "interesting"). We coded the remaining 747 responses into one of the eight categories within two domains. Before addressing our RQs, we describe the CQR domains and categories and percentages of students' responses overall (see Table 1).</p> <p>1 TABLE Overall n's and percentages for three thought‐listing prompts of challenging client situation before and after practicum.</p> <p> <ephtml> <table><thead><tr><th align="center">Thought‐listing prompts</th></tr><tr><th /><th>Suicidal ideation</th><th>Different identities</th><th>Trauma history</th><th /></tr><tr><th>Domains and categories</th><th>Pretest</th><th>Posttest</th><th>Pretest</th><th>Posttest</th><th>Pretest</th><th>Posttest</th><th>Total <italic>n</italic> and %</th></tr></thead><tbody><tr><td>Counseling/client‐focused</td></tr><tr><td>Competence</td></tr><tr><td>n</td><td>10</td><td>1</td><td>18</td><td>6</td><td>22</td><td>15</td><td>72</td></tr><tr><td>%</td><td>8.00</td><td>0.81</td><td>14.75</td><td>4.80</td><td>17.46</td><td>11.90</td><td>9.64</td></tr><tr><td>Ethics</td></tr><tr><td>n</td><td>0</td><td>0</td><td>1</td><td>0</td><td>0</td><td>0</td><td>1</td></tr><tr><td>%</td><td>00.00</td><td>00.00</td><td>00.82</td><td>00.00</td><td>00.00</td><td>00.00</td><td>00.13</td></tr><tr><td>Preparation</td></tr><tr><td>n</td><td>19</td><td>10</td><td>16</td><td>12</td><td>14</td><td>13</td><td>84</td></tr><tr><td>%</td><td>15.20</td><td>8.13</td><td>13.11</td><td>9.60</td><td>11.11</td><td>10.32</td><td>11.25</td></tr><tr><td>Plans</td></tr><tr><td>n</td><td>49</td><td>70</td><td>35</td><td>56</td><td>39</td><td>46</td><td>295</td></tr><tr><td>%</td><td>39.20</td><td>56.91</td><td>28.70</td><td>44.80</td><td>30.95</td><td>36.51</td><td>39.49</td></tr><tr><td>Case conceptualization</td></tr><tr><td>n</td><td>16</td><td>23</td><td>16</td><td>22</td><td>26</td><td>28</td><td>131</td></tr><tr><td>%</td><td>12.80</td><td>18.70</td><td>13.11</td><td>17.60</td><td>20.64</td><td>22.22</td><td>17.54</td></tr><tr><td>Totals</td></tr><tr><td>n</td><td>94</td><td>104</td><td>86</td><td>96</td><td>101</td><td>102</td><td>583</td></tr><tr><td>%</td><td>75.20</td><td>84.55</td><td>70.49</td><td>76.80</td><td>80.16</td><td>80.95</td><td>78.05</td></tr><tr><td>Counselor‐focused</td></tr><tr><td>Emotions</td></tr><tr><td>n</td><td>11</td><td>10</td><td>13</td><td>12</td><td>14</td><td>11</td><td>71</td></tr><tr><td>%</td><td>8.80</td><td>8.13</td><td>10.66</td><td>9.60</td><td>11.11</td><td>8.73</td><td>9.50</td></tr><tr><td>Self‐talk</td></tr><tr><td>n</td><td>12</td><td>4</td><td>5</td><td>2</td><td>1</td><td>3</td><td>27</td></tr><tr><td>%</td><td>9.60</td><td>3.25</td><td>4.10</td><td>1.60</td><td>00.79</td><td>2.38</td><td>3.61</td></tr><tr><td>Self‐descriptive</td></tr><tr><td>n</td><td>8</td><td>5</td><td>18</td><td>15</td><td>10</td><td>10</td><td>66</td></tr><tr><td>%</td><td>6.40</td><td>4.07</td><td>14.75</td><td>12.00</td><td>7.94</td><td>7.94</td><td>8.84</td></tr><tr><td>Totals</td></tr><tr><td>n</td><td>31</td><td>19</td><td>36</td><td>29</td><td>25</td><td>24</td><td>164</td></tr><tr><td>%</td><td>24.80</td><td>15.45</td><td>29.51</td><td>23.20</td><td>19.84</td><td>19.05</td><td>21.95</td></tr><tr><td>Total N</td><td>125</td><td>123</td><td>122</td><td>125</td><td>126</td><td>126</td><td>747</td></tr><tr><td>Total %</td><td>100</td><td>100</td><td>100</td><td>100</td><td>100</td><td>100</td><td>100</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note</emph>: Column data calculated by total number of coded responses for each pre–post prompt. Percentages in last column calculated by total number of coded responses.</p> <p>The first domain, counseling/client‐focused responses (<emph>n</emph> = 583, 78%) (situation focus) included five categories. C<emph>ompetence</emph> responses specifically stated participants' concerns about their counseling skills or performance in the upcoming counseling session (e.g., fear of doing something wrong, lack of relevant skills). <emph>Ethics</emph> included specific mention of an ethical concern or issue (e.g., informed consent to share information with supervisor). <emph>Preparation</emph> responses indicated participants' intention to gather information or take action before the upcoming counseling session (e.g., consult with supervisor, practice skills). In contrast, responses in the <emph>plans</emph> category pointed to participants' intentions or considerations of employing a skill or approach during the upcoming counseling session (e.g., being open‐minded and curious, reflecting emotions). <emph>Case conceptualization</emph> responses indicated participants' desire to better understand the client and/or the client's situation (e.g., gather details about the trauma event).</p> <p>The second domain, counselor‐focused responses (<emph>n</emph> = 164, 22%) (self‐focus), included three categories. In <emph>emotions</emph> responses, participants specifically named their feelings in reaction to the thought‐listing prompt (e.g., sad, eager, nervous). <emph>Self‐talk</emph> included statements and directives to self, such as self‐validations and self‐affirmations (e.g., reference to having relevant skills). Finally, in <emph>self‐descriptive</emph> responses, participants revealed information about themselves that involved self‐disclosure (e.g., their own trauma history), self‐awareness (e.g., their potential biases), or self‐reflection (e.g., their potential personal reactions to the client situation).</p> <p>Across domains and categories, most participants' responses were coded as <emph>plans</emph> (<emph>n</emph> = 295, 39.50%) at both pre‐ and posttest for all three challenging client situations, ranging from 28.70% (pretest, different identities) to 56.91% (posttest, suicidal ideation). The second most frequent category overall was <emph>case conceptualization</emph> (<emph>n</emph> = 131, 17.60%). Four other categories had similar overall frequencies: <emph>preparation</emph> (<emph>n</emph> = 84, 11.30%), <emph>competence</emph> (<emph>n</emph> = 72, 9.60), <emph>emotions</emph> (<emph>n</emph> = 71, 9.50%), and <emph>self‐descriptive</emph> (<emph>n</emph> = 66, 8.90%). Participants listed relatively few <emph>self‐talk</emph> (<emph>n</emph> = 27, 3.60%) statements overall; suicidal ideation had the highest percentage (<emph>n</emph> = 12, 9.60%) across the prompts. Finally, only one response (pretest, different identities) specifically addressed <emph>ethics</emph> (0.13%). In general, these results suggested students were primarily focused on action plans (i.e., what to do) with the three clients and obtaining additional information that could inform those plans.</p> <hd id="AN0187978646-12">Practicum Students' Pretest Anticipatory Thoughts by Client Prompt (RQ1)</hd> <p>For the <emph>suicidal ideation</emph> prompt, students' pre‐practicum anticipatory thoughts by domain primarily were counseling/client‐focused (<emph>n</emph> = 94, 75.20%) rather than counselor‐focused (<emph>n</emph> = 31, 24.80%). Students' immediate thoughts focused mostly on their <emph>plans</emph> (<emph>n</emph> = 49, 39.20%) for the session. Their other pretest responses clustered somewhat in <emph>preparation</emph> (<emph>n</emph> = 19, 15.20%), <emph>case conceptualization</emph> (<emph>n</emph> = 16, 12.80%), <emph>self‐talk</emph> (<emph>n</emph> = 12, 9.60%), <emph>emotions</emph> (<emph>n</emph> = 11, 8.80%), <emph>competence</emph> (<emph>n</emph> = 10, 8.00%), and <emph>self‐descriptive</emph> (<emph>n</emph> = 8, 6.40%). Across the three prompts, students listed the most pre‐practicum thoughts and reactions about their <emph>preparation</emph> and <emph>plans</emph> for this client, as well as the highest number of <emph>self‐talk</emph> statements.</p> <p>For the <emph>different identities</emph> client prompt, students reported more counseling/client‐focused (<emph>n</emph> = 86, 70.49%) than counselor‐focused thoughts (<emph>n</emph> = 36, 29.51%) before practicum. The largest percentage were coded <emph>plans</emph> (<emph>n</emph> = 35, 28.70%). In addition, around 14% of pretest thoughts were coded <emph>competence</emph> (<emph>n</emph> = 18, 14.75%), <emph>self‐descriptive</emph> (<emph>n</emph> = 18, 14.74%), <emph>preparation</emph> (<emph>n</emph> = 16, 13.11%), or <emph>case conceptualization</emph> (<emph>n</emph> = 16, 13.11%). Few responses were coded <emph>self‐talk</emph> (<emph>n</emph> = 5, 4.10%); only the <emph>ethics</emph> response (0.82%) was coded here. Across the three client prompts, students listed the fewest pre‐practicum plans and the most self‐descriptive responses for the different identities prompt.</p> <p>For the <emph>trauma history</emph> client prompt, students listed the most pretest counseling/client‐focused responses (<emph>n</emph> = 101, 80.16%) and the fewest counselor‐focused responses (<emph>n</emph> = 25, 19.84%). Their anticipatory thoughts primarily were about <emph>plans</emph> for the session (<emph>n</emph> = 39, 30.95%), along with <emph>case conceptualization</emph> (<emph>n</emph> = 26, 20.64%) and their <emph>competence</emph> (<emph>n</emph> = 22, 17.46%). The smallest categories were <emph>self‐descriptive</emph> (<emph>n</emph> = 10, 7.94%) and <emph>self‐talk</emph> (<emph>n</emph> = 1, 0.79%). Across the three clients, students voiced the highest percentages of pre‐practicum thoughts and reactions about their <emph>competence</emph> and a desire to learn more details (<emph>case conceptualization</emph>) for the trauma history prompt. In addition, there was less variation in responses by category (i.e., category percentages were more similar for this client prompt).</p> <hd id="AN0187978646-13">Practicum Students Pre‐ vs. Posttest Anticipatory Thoughts by Client Prompt (RQ2)</hd> <p>To address the second research question, we compared percentages of students' pre‐ and posttest responses by category and client prompt (see Table 1). Participants' <emph>plans</emph> responses increased pre–post for each client prompt, by 16% for different identities and 17% for suicidal ideation, with the smallest increase (6%) for the trauma history prompt. Participants' <emph>case conceptualization</emph> responses also increased pre–post for all client prompts, although by only 2%–6% points, again with the smallest change for the trauma history prompt. In contrast, participants' <emph>competence</emph> responses decreased pre–post 6%–10% across all three prompts, although <emph>competence</emph> concerns around the trauma history client were highest both before and after practicum and had the smallest decrease. Similarly, participants reported fewer <emph>preparation</emph> statements and questions pre–post by 1%–7% points, with the smallest change for the trauma history prompt. The number of <emph>emotions</emph> statements were fairly consistent pre–post, with similar percentages across the three clients; trauma history prompts had the largest decrease but only 2.4%. Participants' <emph>self‐descriptive</emph> statements also showed minimal changes (different identities 2.75%; suicidal ideation 2.33%) to no change (trauma history). <emph>Self‐talk</emph> responses for the suicidal ideation prompt decreased pre–post by 6%, decreased by 2.5% for the different identities prompt, and increased slightly (1.6%) for the trauma history prompt. This profile suggests that overall, by the end of their practicum experience, students were even more focused on specific <emph>plans</emph> for working with all three clients, had more questions about each client situation (<emph>case conceptualization</emph>), and were somewhat less concerned about their <emph>competence</emph>. Across the three client prompts, however, they voiced the fewest changes about a client with a trauma history, still voicing the most <emph>competence</emph> concerns, <emph>preparation</emph> needs, and desire for further details about this client situation (<emph>case conceptualization</emph>).</p> <hd id="AN0187978646-14">Practicum Students' Pre‐ and Posttest Anticipatory Thoughts by Client Prompt—Their Specific C...</hd> <p></p> <hd id="AN0187978646-15">Suicidal Ideation</hd> <p>For the suicidal ideation client prompt, many students named SIMPLE STEPS (McGlothlin [<reflink idref="bib40" id="ref89">40</reflink>]), an assessment tool they had learned and practiced the previous semester. Although there was some sense of concern about responding appropriately and effectively both before and after practicum (<emph>competence</emph>), students named <emph>preparing</emph> for or actual <emph>plans</emph> to implement specific actions much more often here than other client prompts. For example, one student initially named "fear and on learning edge for sure," but at posttest, stated, "simple steps, essential to directly address." Similarly, another initially focused on <emph>preparation</emph>, "I should look back at the training and find the SIMPLE STEPS and the safety protocol papers," but at posttest seemed clear about the steps (<emph>plans</emph>), "simple steps, safety plan, consult." (<emph>Note</emph>: Practicum students were required to consult with the on‐call doctoral student or faculty member when a client voiced any history of suicidal ideation.) Similarly, at pretest, one wondered, "If confidentiality needs to be broken, who do we contact first?" (<emph>preparation</emph>), while at posttest named clear <emph>plans</emph> to "assess to identify reasoning for prior suicidal ideation and if there is any current suicidal ideation." <emph>Self‐talk</emph> reassurance thoughts at pretest were more frequent for this client prompt, especially positive self‐talk such as "Okay, I think I'm prepared for this" and "I can handle this," as well as self‐reminders to "be open, no judgement." One student who felt "prepared from training" at pretest affirmed at posttest, "feeling more ready because of training and past experiences with clients who have reported this" as well as "maybe some trepidation."</p> <p>Some students listed desired information (c<emph>ase conceptualization</emph>), including "How long ago? What are the triggers?" "Was there an attempt?" Fairly typical <emph>emotions</emph> were stated at pre‐ and posttest, often by the same student, including "anxious" and "nervous," along with <emph>self‐descriptive</emph> statements such as "need to regulate." Others had stronger reactions. One student stated at pretest, "I am freaking out internally" and wondered, "Will it be like a bad experience I had before?"; at posttest, this student still felt "nervous" and "panic." Only one student referred to personal experience (<emph>self‐description</emph>) at pretest, stating, "I have experienced that before too...what will this mean when working?"; at posttest this student seemed less concerned, instead naming SIMPLE STEPS and consultation and stating, "Be present for the client."</p> <hd id="AN0187978646-16">Different Identities</hd> <p>In response to the different identities prompt, students often named broaching (Day‐Vines et al. [<reflink idref="bib18" id="ref90">18</reflink>]), a foundational culturally responsive concept and skill introduced during their previous semester coursework. A number of these statements, especially at pretest, implied students felt broaching was an imperative they were worried about—essentially, something I must do, but I'm not sure how and fear I may do it wrong. For example, the one student who pointed to <emph>ethics</emph> stated, "Do no harm," as well as "I will need to broach."</p> <p>Students specified some of their worries in pretest <emph>competence</emph> statements: "What if they think I don't care because I can't relate?" "Are they gonna be okay that I'm White?" "Hopefully I can give them a good experience with a White person," and "I don't want to potentially hurt them because of our differences." They stated posttest worries in more counseling language, such as "I am nervous about my ability to truly connect and build strong rapport with a client with identities different from my own."</p> <p>Students named related concerns in their initial <emph>preparation</emph> thoughts: "I need to research working with this population because I don't want to make things worse for them," "I need to prepare to broach really well," and "I need to figure out what is and is not appropriate/broaching is super important with this client due to these differences." Students' <emph>plans</emph> often reflected similar anxieties: "Broaching disclaimers to be said," "Listen to what they care to share/only bring up what is necessary," and "Need to broach carefully." <emph>Plans</emph> often were stated as questions: "How will I broach?" "What should I ask/How should I ask?" and "How do I navigate different cultural identities and life experiences?" <emph>Case conceptualization</emph> responses included concerns about potential impact on the relationship, such as "These different identities may create a boundary in our relationship." There were fewer specific mentions of other related concepts, such as cultural humility and power, although these often seemed implied: "I will need to acknowledge any privileges/power differentials I hold." A few pretest responses (across categories) may have suggested a distancing or denial stance: "cool, this is a great opportunity to broach," "I'm gonna get to learn about a new culture!" One student wrote, "This doesn't really make me nervous" before practicum, but at posttest, stated, "Nervous that I am not familiar with their culture and that they will not think I am competent."</p> <p>After practicum, most students' distress seemed to have dissipated, at least somewhat, as the tone of their responses was less imperative and fearful. For example, their <emph>plans</emph> were more contextual and perhaps reflected their practicum experiences and/or supervisors' feedback: "Explore client experiences with curiosity," "Hold space for my client to openly discuss any thoughts, concerns, or emotions around our different identities," "What is the best way to introduce broaching so that it feels natural?" and explaining to the client "what broaching is and why it is important." Their <emph>plans</emph> also suggested more focus on client impact: "How do I make them feel understood?" "I hope I notice identity‐related concerns in the moment without the client having to point them out to me," and "I need to find the right time to broach identities without interrupting the conversation." One student worried at pretest, "Does their culture reject LGBT+ people?" (<emph>case conceptualization)</emph> but wondered at posttest, "How do I make them feel understood?" (<emph>plans</emph>). Post‐practicum <emph>case conceptualization</emph> statements reflected similar differences: "Client is the expert of their own lives," "I must understand that this client may have apprehensions or struggles about working with me due to our different identities," and "Awareness of how this impacts their presenting concerns." Similarly, there also was some movement away from pretest sentiments of "what can I learn from them" to posttest thoughts such as "It will be important to invite client expertise without making them 'the teacher'" and "I need to respect and learn more to understand what their cultural values are related to their presenting concern."</p> <p>The few <emph>emotion</emph> responses named few feelings. Students equally stated "nervous" and "excited," sometimes simultaneously. Few students listed anxiety or fear. These emotion words did not seem to reflect the level of concerns stated about their <emph>competence</emph> impact on clients.</p> <p>In <emph>self‐descriptive</emph> statements, most students were considering their potential biases, both before, "Addressing my own biases around this," and after practicum, "Assessing my own reactions," and "I immediately envisioned someone of a different racial identity." A few students focused on differing values; one stated, "What if they have different morals than me? Or conservative views? That might be difficult to work with as a progressive individual." Several pretest <emph>self‐talk</emph> statements pointed to managing biases: "I am good at not being biased, we are all humans," "Remember to keep their identities in your mind as you talk to the client in order to accurately see their perspective," and "be open‐minded."</p> <p>Some students of color expressed concerns similar to those of the whole group. For example, one Hispanic student wrote, "nerves to make sure I don't say something offensive." The three African American students seemed somewhat less emotional in their responses, with one stating pre‐practicum, "Ask about the identities they feel will come up in session." Another wrote, "I expect that my clients will have different identities from my own" (pretest), perhaps suggesting this was not a new situation to navigate.</p> <hd id="AN0187978646-17">Trauma History</hd> <p>For the trauma history prompt, students' responses stood out in several ways. For example, in pre‐ and posttest thoughts, students focused on facts and details, such as what kind of trauma, "how severe," when it occurred, and "are they still dealing with that trauma?" (<emph>case conceptualization</emph>). Others stated more nuanced conceptualization thoughts, such as "I am curious how that trauma relates to their presenting concerns" and "The way trauma can affect body, mind, and emotions."</p> <p>Students' pretest <emph>competence</emph> responses pointed to concerns that their lack of training might harm the client: "Oh no, am I equipped to help them because I am still a student?" "What if I say something triggering/unhelpful?" "What if I say the wrong thing and it makes their concerns worse?" and "I feel a lot of responsibility for what happens next." Some posttest <emph>competence</emph> statements were similar: "We aren't trained for trauma yet." "I hope that I don't trigger them." Others seemed to have learned a way to manage their concerns by the end of practicum, such as "reminding them this space is for them but we have to get through intake paperwork." Another student seemed to have achieved an important distinction, saying, "I feel confident in talking about trauma experiences, but know I am not trained to do trauma work." In a contrasting example, one student at pretest thought, "I'm not sure what interventions I would do but I could help them explore the trauma deeper" and "We will actually have deep meaningful stuff to talk about in session." At posttest, however, this student reported, "I don't know how to treat trauma" and "I will only be able to help this person talk through it but I don't know effective interventions."</p> <p>Some students expressed <emph>self‐descriptive</emph> concerns about their reactions at pretest, such as "I'm walking on eggshells," "I can't relate," and "Will I be able to restrict my emotional reactions while conveying empathy?" Another student voiced a different reaction, saying this prompt was a "reminder of why I am doing this job." The few who indicated a trauma history themselves were concerned about how their own trauma history might come up, such as "I hope I can stay calm if I have had a similar experience," and "I feel connected to them already as a kindred trauma soul." At posttest, the latter student wrote, "Meee too." Another stated, "I'm gonna feel a lot of guilt and take that with me" at the end of the semester.</p> <p>In contrast to the other prompts, trauma history <emph>preparation</emph> statements often focused on readying the self versus finding out "what steps to take in order to discuss with the client" (pretest). For example, one student indicated at pretest that, after reviewing intake paperwork, "...I would want to sit with what the client went through and see if any emotions or behaviors are coming up for me in response, before I see my client in person" and "I will need to maintain the mindset of remaining balanced and grounded with my client." Other responses included, "I need to practice my reactions to hearing about trauma so I do not seem judgmental" and "I need to take care of myself before session – ground myself" (posttest). Students also mentioned their supervisor more frequently in <emph>preparation</emph> responses to this prompt, both at pretest (e.g., "Consult with supervisor on next steps" and "I will want to consult with my supervisor before seeing them") as well as posttest (e.g., "Consult prior to session AND during session if needed" and "I will probably need to seek extra support when working with this client").</p> <p>In contrast to "nervous" and "anxious" responses to other client prompts, students' <emph>emotion</emph> responses to the trauma history prompt reflected rather disheartened feelings, including "sorrow," "sad," "heaviness," and "compassion," "I feel bad for them," and "helpless – how can I help this person?" Some of their <emph>plans</emph> had a more empathic (vs. sympathetic) undertone, particularly at posttest: "I need to be patient and empathetic," "It will be important to get more information while exercising care."</p> <p>Students more often mentioned <emph>plans</emph> to use foundational skills for this prompt, primarily at posttest: "unconditional positive regard," "reflection of feelings," "helping skills to make client feel safe/comfortable," and "soft, low, and slow," along with "Focus on therapeutic relationship." Other posttest plans included "validate, validate, validate" and "Be trauma‐informed?" as well as some contextual thoughts, such as "I want to create an environment in which my client feels comfortable to share or not share about their trauma experiences," "Allow the client to open up on their terms," and "I will let the client speak about it when they feel comfortable to do so." In addition, a few responses suggested attunement to avoiding retraumatization, both at pretest (e.g., "I don't want to push them further into their trauma," "How do we talk about it without reexperiencing it?") and at posttest (e.g., "Thinking about how to ask about it without retraumatizing," "I am cautious not to re‐traumatize the client.").</p> <hd id="AN0187978646-18">Discussion</hd> <p>As an initial exploration of the relevance of anticipatory stress and coping theory (Lazarus and Folkman [<reflink idref="bib37" id="ref91">37</reflink>]) to practicum students' experiences, we gathered students' anticipatory thoughts and reactions about three specific challenging client situations they were likely to encounter during practicum. Overall, most students seemed clearest about how to work with the suicidal ideation client, uneasy about broaching with the client with different identities, and uncertain, worried, yet empathic about the client with a trauma history. Within the two counseling/client (situation) focused and self‐focused domains, they prioritized plans and preparation for meeting with the clients in both their pre‐ and post‐practicum thoughts. After practicum, they seemed somewhat more settled and confident overall, with some clear exceptions. Results reflected previous literature in several ways. For the suicidal ideation prompt, our findings suggested that, even with minimal instruction and practice, students can begin practicum feeling somewhat prepared for working with client suicidal ideation (e.g., Binkley and Leibert [<reflink idref="bib5" id="ref92">5</reflink>]; Elston et al. [<reflink idref="bib20" id="ref93">20</reflink>]). For different identities, they seemed to be aware of the need to break the "culture of silence" (Jones and Welfare [<reflink idref="bib32" id="ref94">32</reflink>], 50) but were stymied by their new self‐awareness around potential biases and lack of clarity about how to implement what they had learned (cf. Benuto et al. [<reflink idref="bib4" id="ref95">4</reflink>]; Dunn et al. [<reflink idref="bib19" id="ref96">19</reflink>]; King [<reflink idref="bib34" id="ref97">34</reflink>]), fearing detrimental consequences (Melton et al. [<reflink idref="bib42" id="ref98">42</reflink>]). Few statements suggested resistance to broaching; the overriding concern was how to address differing identities that avoided sounding judgmental, again in line with prior research (Jacquart et al. [<reflink idref="bib30" id="ref99">30</reflink>]; Sue et al. [<reflink idref="bib52" id="ref100">52</reflink>]). For the trauma history client, they expressed unique emotions, including sadness and helplessness, and voiced concerns that their lack of trauma‐specific training would negatively impact the client (Lu et al. [<reflink idref="bib39" id="ref101">39</reflink>]).</p> <p>Across prompts, we observed patterns and themes in some students' responses, often in line with previous reports. Not surprisingly, self‐efficacy was a common theme (Clarke and Hartley [<reflink idref="bib14" id="ref102">14</reflink>]; Kannan and Levitt [<reflink idref="bib33" id="ref103">33</reflink>]). For example, one student wrote, "I am scared that I won't help and only make the situation worse" (suicidal ideation), "Concern that I will react (by feeling I'm doing bad) to potential disconnection" (different identities), and "Will I be enough?" (trauma history). Some seemed to state self‐efficacy concerns indirectly, via potential client reactions (e.g., "Are they going to come to session resistant to me because of stereotypes they have about my identities?"), or questioning their ability to respond appropriately (e.g., "Do I know enough information about their culture to help them?" "Can I make an effective safety plan with them?"). Some consistently highlighted resourceful actions they could take themselves, such as seeking more information via intake paperwork or researching each client topic. In contrast, others consistently intended to consult or meet with their supervisor (Lu et al. [<reflink idref="bib39" id="ref104">39</reflink>]). Students sometimes emphasized creating a safe space or building a strong relationship with each client. In terms of the influence of student characteristics, and as noted earlier, some students of color seemed less emotional about the different identities client, and students with a trauma history worried about how that might come up with the trauma client. Finally, it was not unusual for students to express conflicting feelings (curious, excited, nervous; confidence and doubt) within the same client response sequence (Folkman and Lazarus [<reflink idref="bib23" id="ref105">23</reflink>]).</p> <hd id="AN0187978646-19">Anticipatory Stress and Coping Theory</hd> <p>Our broader aim was to explore TMCS (Folkman and Lazarus [<reflink idref="bib23" id="ref106">23</reflink>]; Lazarus and Folkman [<reflink idref="bib37" id="ref107">37</reflink>]) as a framework for understanding practicum students' presession reactions to three challenging client situations they likely would encounter during practicum. Students' thought‐listings aligned with several tenets of TMCS at the anticipatory stress and coping stage.</p> <p>First, their thought‐listings seemed to represent their immediate primary and/or secondary appraisals of each client situation, although we did not ask specifically for such appraisals. In other words, their responses indirectly suggested their initial assessment of the significance and level of risk in the situation (what is at stake?) and evaluation of their ability to manage their resulting stress responses. Of the four types of primary stress appraisals, the content and tone of many students' responses suggested a threat appraisal, which denotes concern over some harm or loss—to the client or themselves—in an encounter with the clients. For example, they feared being seen as incompetent, negatively impacting the counseling relationship, and causing further harm to the client. In terms of secondary coping appraisals, students prioritized active efforts to better understand and manage the client situations. They named specific <emph>plans</emph> and skills to implement in‐session with the clients, sought additional information to inform their <emph>case conceptualizations</emph>, and intended to spend time <emph>preparing</emph> for the client sessions. Such problem‐focused coping (vs. emotion‐focused coping; Lazarus and Folkman [<reflink idref="bib37" id="ref108">37</reflink>]) is viewed as more productive at the anticipatory stage of the coping process (Feldman and Hayes [<reflink idref="bib21" id="ref109">21</reflink>]).</p> <p>Second, students' thought‐listings somewhat illustrated the TMSC person–environment fit tenet that effective coping strategies are dependent on the interplay of characteristics of the individual and demands of the specific situation, as appraised by the individual (Folkman and Lazarus [<reflink idref="bib23" id="ref110">23</reflink>]; Folkman and Moskowitz [<reflink idref="bib25" id="ref111">25</reflink>]; Lazarus and Folkman [<reflink idref="bib37" id="ref112">37</reflink>]). The client prompts gave focus to the environmental aspect of the principle, and results highlighted students' different reactions across the three situations. Differences <emph>within</emph> each situation were also apparent, such as variations in students' degree of worry (from concern to almost panic) and source of concern (competence, ability to self‐regulate). Potential individual factors driving such differences included students' race/ethnicity and trauma history. Response patterns and themes (see above) perhaps also suggested some individualized tendencies (e.g., worries about "am I enough" vs. "do I know enough"). The client prompts, however, did not directly elicit the individual characteristics side of the person–environment fit TMSC principle.</p> <p>Lazarus and Folkman ([<reflink idref="bib37" id="ref113">37</reflink>]) suggested a wide range of possible person‐based factors (e.g., personality dynamics, sense of control over a stressful situation, fear of failure, concurrent stressors), which might include the impact of students' trauma histories. Lazarus and Folkman ([<reflink idref="bib37" id="ref114">37</reflink>]) also speculated cultural values and beliefs would inform what facet of a situation a person consciously attends to, what feelings and behaviors they consider appropriate to the situation, as well as determinations of "what is at stake and the consequences for violating" (p. 165) cultural norms. Such factors potentially suggest that the "culture of silence" (Jones and Welfare [<reflink idref="bib32" id="ref115">32</reflink>], 50) influenced students' hesitations and fears around broaching different identities. Direct investigations of individual factors within the counseling context could be informative.</p> <p>Third, it is clear that anticipatory worries and fears <emph>are</emph> stressful, as evident in many of the students' thoughts and reactions. Of concern, high stress is a contributor to low counseling self‐efficacy and a precursor to burnout for both counseling students and practitioners (e.g., Clarke and Hartley [<reflink idref="bib14" id="ref116">14</reflink>]; Moore, Stubbs‐Brown, et al. [<reflink idref="bib46" id="ref117">46</reflink>]; Um and Bardhoshi [<reflink idref="bib53" id="ref118">53</reflink>]), and anticipatory stress could be a factor in these negative outcomes. Growing evidence indicates anticipation of stressful situations can have both immediate and long‐term health consequences on one's physiological, cognitive, and affective health—that can be as impactful as actual stress encounters (e.g., Kramer et al. [<reflink idref="bib36" id="ref119">36</reflink>]). Of note, emerging research suggests anticipatory coping may counteract the deleterious effects of anticipatory stress (e.g., Johnson and Neupert [<reflink idref="bib31" id="ref120">31</reflink>]). Thus, helping students develop coping strategies <emph>before</emph> they encounter stressful client situations could be beneficial both for their clinical performance (e.g., ability to stay present with client) as well as their overall well‐being.</p> <hd id="AN0187978646-20">Strengths and Limitations</hd> <p>Our methodology was appropriate to our aim to explore a new theoretical perspective on student stress and allowed us to gather brief qualitative indications of students' individual worries within a long quantitative survey (cf. Spangler et al. [<reflink idref="bib51" id="ref121">51</reflink>]). Our dataset was large; however, our student sample size was moderate. Approximately one‐third of participants were students of color, suggesting our sample reflected Council for Accreditation of Counseling and Related Educational Programs ([<reflink idref="bib15" id="ref122">15</reflink>]) 2023 statistics (59% White vs. 66% in our sample) for master's students. Recruiting participants from one program was a limitation yet also avoided multiple program confounds (e.g., different pre‐practicum curricula or practicum sites). The brevity of the thought‐listing prompts and student's responses, however, limits the depth of our results. Thus, we are unable to offer, for example, more comprehensive explanations underlying students' concerns or determine what contributed to pre–post changes in participants' thought‐listings. We detected hints of supervisory input in students' post‐practicum responses, but students also could have been influenced by peers in group supervision, their own counselors, and/or other sources of social support, or even their own trial‐and‐error efforts to manage their distress. We took steps to manage our potential biases, yet other researchers may have identified different coding domains and categories. The larger study included several measures of emotion (dys)regulation that could have influenced students' engagement with the thought‐listing prompts.</p> <hd id="AN0187978646-21">Implications for Clinical Supervisors and Researchers</hd> <p>Moore, Stubbs‐Brown, et al. ([<reflink idref="bib46" id="ref123">46</reflink>]) emphasized the critical role of practicing counselors' "pre‐established coping strategies" (p. 25) in countering the impact of stressful client situations and potential burnout. Practicum counselors, however, have not yet had the opportunity to identify, practice, and hone their counseling‐specific coping strategies, leaving them in the potentially vulnerable position of high stakes and deficit resources (Lazarus and Folkman [<reflink idref="bib37" id="ref124">37</reflink>]). In light of our exploratory and limited data, we offer a few tentative yet theory‐based suggestions for practicum supervisors. Of note, clinical supervision is frequently recommended for helping counselors deal with stressful clinical work (e.g., Henning et al. [<reflink idref="bib28" id="ref125">28</reflink>]; Moore et al. [<reflink idref="bib44" id="ref126">44</reflink>]), and there is some empirical support for its positive impact on practitioners' burnout (Yang and Hayes [<reflink idref="bib57" id="ref127">57</reflink>]).</p> <p>Individual supervision seems a particularly promising avenue for addressing practicum students' anticipatory stress, given the modality's focus on supervisees' specific needs. Thus, in early practicum supervision sessions, supervisors might first help each student delineate their anticipatory stress—both their general worries about seeing "real clients" as well as which client situations engender what specific fears and concerns (primary appraisal) for that student. Next, supervisors could engage students in reviewing their currently available coping options (secondary appraisal), explore how their existing coping strategies might be adapted to the counseling context as well as specific client situations of concern, and then identify additional coping strategies where needed. Supervisors might prioritize active problem‐solving, preparation, and planning as suggested for the anticipatory stage (Feldman and Hayes [<reflink idref="bib21" id="ref128">21</reflink>]) and named by our participants. They also can keep in mind that, within TMSC, there are "no <emph>a priori</emph> assumptions about what constitutes good or bad coping" (Folkman et al. [<reflink idref="bib24" id="ref129">24</reflink>], 993); rather, effective coping is what works for the individual in the specific situation. In addition, persons typically use multiple strategies simultaneously in any given situation (Folkman and Lazarus [<reflink idref="bib23" id="ref130">23</reflink>]). Importantly, supervisors would want to incorporate coping skill practice (e.g., role plays) and instructive feedback to maximize students' effective use of the skills (Aspinwall and Taylor [<reflink idref="bib1" id="ref131">1</reflink>]; Feldman and Hayes [<reflink idref="bib21" id="ref132">21</reflink>]). Even such limited training might help students feel better prepared (cf. Elston et al. [<reflink idref="bib20" id="ref133">20</reflink>]) and better able to stay present with clients through managing their physiological, cognitive, and emotional anticipatory stress reactions (cf. Kramer et al. [<reflink idref="bib36" id="ref134">36</reflink>]). These supervision actions could be repeated as needed throughout the practicum semester as new challenging situations arise.</p> <p>Although preliminary, our results indicate further research on the TMSC anticipatory stage could be fruitful. One particular focus stemming from our results is charting how supervisors help students develop workable and effective anticipatory coping strategies, as measured by outcomes of students' ratings of effectiveness (see Folkman et al. [<reflink idref="bib24" id="ref135">24</reflink>]) as well as indicators of their clinical performance. Counseling researchers also might investigate whether students' anticipatory coping decreases their burnout and increases their self‐efficacy (see Moore, Stubbs‐Brown, et al. [<reflink idref="bib46" id="ref136">46</reflink>]). A challenge for researchers could be TMSC's emphasis on individualized coping strategies rather than a prescribed intervention for all. Case study designs may be needed to explore individual students' use of their coping strategies in anticipation of specific stressful encounters, both in the short‐term (pre–post counseling session) and longitudinally (e.g., across practicum and internship).</p> <p>Researchers could extend our methodology by constructing more descriptive prompts to better reflect the complexity of clients' presenting concerns. They also might explore other situations students find distressing (e.g., client aggression, complicated diagnoses, client manipulation; Lent et al. [<reflink idref="bib38" id="ref137">38</reflink>]) as well as potential individual factors influencing students' anticipatory thoughts and reactions (e.g., cultural beliefs, mental health history).</p> <hd id="AN0187978646-22">Conclusion</hd> <p>To our knowledge, this is the first study of novice counselors' anticipatory stress and coping. Our results are in line with tenets of TMSC (Lazarus and Folkman [<reflink idref="bib37" id="ref138">37</reflink>]) that emphasize practicum students' need for individualized coping strategies specific to the counseling context, even the particular challenging client situation. Attention to TMSC's anticipatory stage broadens supervisors' options for supporting students to include a deliberate focus on coping <emph>before</emph> the stressful encounter. Researchers' attention to the first stage of TMSC could provide a more complete understanding of how to lessen the debilitating impact of practicum students' stress as well as promote their overall well‐being.</p> <hd id="AN0187978646-23">Conflicts of Interest</hd> <p>The authors declare no conflicts of interest.</p> <ref id="AN0187978646-24"> <title> References </title> <blist> <bibl id="bib1" idref="ref46" type="bt">1</bibl> <bibtext> Aspinwall, L. G., and S. E. Taylor. 1997. " A Stitch in Time: Self‐Regulation and Proactive Coping." 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Header DbId: eric
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An: EJ1483619
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Practicum Students' Anticipatory Thoughts about Challenging Client Situations
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22L%2E+DiAnne+Borders%22">L. DiAnne Borders</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-8713-245X">0000-0001-8713-245X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Alexis+Arzuaga%22">Alexis Arzuaga</searchLink><br /><searchLink fieldCode="AR" term="%22Emily+N%2E+Spain%22">Emily N. Spain</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Counselor+Education+and+Supervision%22"><i>Counselor Education and Supervision</i></searchLink>. 2025 64(3):288-299.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 12
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Practicums%22">Practicums</searchLink><br /><searchLink fieldCode="DE" term="%22Counselor+Training%22">Counselor Training</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Efficacy%22">Self Efficacy</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Variables%22">Stress Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Attitudes%22">Student Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Reaction%22">Student Reaction</searchLink><br /><searchLink fieldCode="DE" term="%22Counselor+Client+Relationship%22">Counselor Client Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Well+Being%22">Well Being</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1002/ceas.12341
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0011-0035<br />1556-6978
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Practicum students' anxiety as they envision seeing "real" clients can impede their self-efficacy and in-session functioning. To explore how anticipatory stress and coping theory might help better support them, we used CQR-M to code students' (n = 42) immediate thoughts and reactions to three challenging client situations before and after practicum. Students' responses reflected key tenets of the theory, pointing to pre-practicum approaches that may lessen students' anticipatory stress and enhance their well-being.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1483619
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1483619
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1002/ceas.12341
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 12
        StartPage: 288
    Subjects:
      – SubjectFull: Practicums
        Type: general
      – SubjectFull: Counselor Training
        Type: general
      – SubjectFull: Self Efficacy
        Type: general
      – SubjectFull: Stress Variables
        Type: general
      – SubjectFull: Student Attitudes
        Type: general
      – SubjectFull: Student Reaction
        Type: general
      – SubjectFull: Counselor Client Relationship
        Type: general
      – SubjectFull: Well Being
        Type: general
    Titles:
      – TitleFull: Practicum Students' Anticipatory Thoughts about Challenging Client Situations
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: L. DiAnne Borders
      – PersonEntity:
          Name:
            NameFull: Alexis Arzuaga
      – PersonEntity:
          Name:
            NameFull: Emily N. Spain
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 09
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 0011-0035
            – Type: issn-electronic
              Value: 1556-6978
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              Value: 64
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              Value: 3
          Titles:
            – TitleFull: Counselor Education and Supervision
              Type: main
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