PREVENTION IN

COUNSELING PSYCHOLOGY:
THEORY, RESEARCH, PRACTICE AND TRAINING
A Publication of Prevention Section in Division 17 of American Psychological Association
Volume 5 Issue 1 Fall 2012

Photo by Erin Sadler, http://www.erinsadler.com

Prevention in Counseling Psychology: Theory, Research, Practice and Training is a publication of the Preven-
tion Section of the Society for Counseling Psychology. The publication is dedicated to the dissemination of information on
prevention theory, research, practice and training in counseling psychology, stimulating prevention scholarship, promoting
collaboration between counseling psychologists engaged in prevention, and encourages student scholars. The publication
focuses on prevention in specific domains (e.g., college campuses) employing specific modalities (e.g., group work), and
reports summaries of epidemiological and preventive intervention research. All submissions to the publication undergo
blind review by an editorial board jury, and those selected for publication are distributed nationally through electronic and
hard copies.

Editorial Board Chair

Michael Waldo
New Mexico State University

Managing Editor
Julie M. Koch
Oklahoma State University

Production Editor
Jonathan P. Schwartz
New Mexico State University

Associate Editor
Cynthia A. Unger
New Mexico State University

Members of the Editorial Board

Aimee Arikian, University of Minnesota
Kimberly Burdine, Oklahoma State University
Stephanie Chapman, Baylor College of Medicine
Simon Chung, University at Albany
Michael Gale, University at Albany
Michelle Murray, University at Albany

Submission Guidelines

The Prevention Section of the Society of Counseling Psychology publishes Prevention in Counseling Psychology: Theory, Re-
search, Practice and Training. This is a blind peer-reviewed publication presenting scholarly work in the field of prevention
that is distributed nationally. Contributions can focus on prevention theory, research, practice or training, or a combina-
tion of these topics. We welcome student submissions. As a publication of the Prevention Section of Division 17, presenta-
tions and awards sponsored by the section will be highlighted in these issues. We will also publish condensed reviews of
research or theoretical work pertaining to the field of prevention. All submissions need to clearly articulate the prevention
nature of the work. Submissions to this publication need to conform to APA style. All submissions must be electronically
submitted. Please send your documents prepared for blind review with a cover letter including all identifying information
for our records. Submissions should be emailed to Julie Koch, Managing Editor, at julie.koch@okstate.edu.

2 Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 5, No. 1
Volume 5 Fall
Issue 1
PREVENTION IN 2012
COUNSELING PSYCHOLOGY
Section News
Message from the Chair 4
LeRoy Reese

Greetings from the Editorial Board 5

Editorial Board

Message from Your Graduate Student Representative 6

Erin Ring

Theory, Research, Practice and Training

Social Responsibility and Prevention in the APA Ethical Principles of
Psychologists: Where Did They Go? 7
Jonathan Kodet

Tools for prevention: Utilizing tele-behavioral health services in a rural Native

American community 10
Julie Clark, Maria Aleksandrova-Howell, Ashleigh Coser, Lahoma Schultz, Jake Roberts

Self-compassion, health and wellness in women 16

Julie Swagerty and Julie Koch

Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 5, No. 1 3
Section News

Message from the Chair

LeRoy Reese
Morehouse School of Medicine

Prevention Section Update and Welcome

Recently I became Chair of the Prevention Section and in that role I have both the opportunity and responsibility of
building upon the exemplary leadership of previous Chairs as we continue to define and refine the scope and role of
prevention within the Society of Counseling Psychology and how we contribute to efforts to improve the health of the
nations citizenry. I want to thank previous Chairs Sally Hage and Jonathan Schwartz for their support and assistance
helping me transition to the role of Chair.

The Prevention Section is at an important cross roads, as this year represents an unique opportunity for the Section.
Current Society President Andy Horne has made prevention the theme of his presidency and in that role he will be able
to infuse prevention initiatives throughout the important work of the various Sections of the Society. With prevention
as the theme of his Presidency, there will be multiple opportunities for leadership and making contributions by mem-
bers of the Prevention Section and I want encourage active participation by our members. Andys leadership also repre-
sents an opportunity to grow the membership of the Section.

Another important way to support the work of the Section is by contributing to our publication, Prevention in Counsel-
ing Psychology: Theory, Research, Practice and Training published twice a year in February and July. As my prede-
cessors have done, I invite you to contribute your brief research reports, theory based literature reviews as well as novel
and innovative ideas that may advance the work of prevention practitioners and researchers.

I am pleased to share that the Prevention Guidelines for Psychologists have undergone final revisions and will soon be
published and may be available by the time the next issue is published. I want to thank our colleagues for their commit-
ted stewardship in seeing the production of this document through a long and arduous process.

Finally, I want to encourage each of you as colleagues and citizens committed to the advancement of prevention to the
well-being and health of our communities to review the proposed budget for fiscal year 2013 http://www.hhs.gov/
budget/hhs-general-budget-justification-fy2013.pdf. While this is not light reading, it speaks directly to the important
role of prevention advocates within the Society, the APA and though APAs Office of Government Relations to inform
the Congress and others about the obstinate health problems facing our citizens and the need for prevention resources to
attend to these problems and meet the Healthy People 2020 goals which lays out the nations public health goals.

Thanks to all of you including my colleagues putting this publication together who continue to make pursuit of healthy
people and healthy communities a priority. Continued peace!

4 Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 5, No. 1
 Section News

Greetings from the Editorial Board

Welcome to the Fall 2012 issue of Prevention in Counseling Psychology: Theory, Research, Practice and
Training, the publication of the Prevention Section of the Society of Counseling Psychology. The goal of this
publication is to promote prevention theory and research. Within these pages, you will find new contributions
that highlight recent efforts in prevention.

First, we offer a brief piece by doctoral student Jonathan Kodet, who shared his ideas with us at the student
poster session at APA in August. He expanded this work into a conceptual piece that reminds us of our social
responsibility as counseling psychologists. We encourage members of the Prevention Section to respond with
brief opinion pieces in our next issue.

We are pleased to showcase the work of Clark, Aleksandrova-Howell, Coser, Schultz, and Roberts who de-
scribe their substance abuse prevention via group telehealth to Native American adolescents. In this example
of prevention in action, the authors provide a narrative about the methods they used to begin and maintain this
group, the curriculum they used, and the limitations they encountered in providing telehealth services to Native
teens scattered throughout rural areas. This work partners cutting-edge technology with traditional Native be-
liefs and healing practices.

We also present a literature review by Swagerty and Koch that introduces the importance of self-compassion
as a construct related to womens physical and mental health and well-being. Implications for counseling psy-
chologists are discussed.

Next issue, we would like to publish a description of your prevention work. We accept manuscripts addressing
prevention theory, research, practice and training. We believe this is an excellent forum for sharing your work
with prevention oriented colleagues. We especially would like to see more submissions that are the product of
student-faculty collaboration. We encourage you to submit your own work for our next issue to Julie Koch,
Managing Editor, at Julie.koch@okstate.edu. The deadline for our Winter 2012 issue is December 15th, 2012.

Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 5, No. 1 5
 Section News

Message from Your Graduate Student Representative

Erin Ring
University at Albany

Welcome to another semester! I am the graduate student representative of Division 17s Prevention Section, and am
writing to let you know a bit about our section and tell you about some of the student opportunities we have to become
involved.
When telling others about my involvement in the Prevention Section, people often pause and respond, Prevention of
what? The section is great in that our members have very diverse interests, yet share the common goals of ending
problem behaviors, delaying their onset, and reducing their negative impacts. We foster the psychological well-being
of others and simultaneously work to prevent negative consequences on a personal, organizational, and community-
wide level. Hence, areas of interest often include the prevention of risk-taking behaviors, violence and bullying, and
the development of mental disorders, among others.
To students who are interested in prevention, we strongly encourage you to join our section (its free!). There are sev-
eral ways to become involved, including opportunities to present and publish research, join listserv discussions, meet
with other professionals in the field, and serve on the Editorial Board of this peer-reviewed publication. We also have
potential leadership opportunities for those interested in serving as an officer of the section.
To those who continue as members: Thank you! This years APA Convention went extremely well, and wed like to
thank all of the students who helped make it happen. Several students presented their work at the Division 17 Social
Hour, which was well attended. We also had a student poster session at our annual awards ceremony with some great
research and theoretical pieces relevant to Prevention. Students traveled from several different states and programs to
present their work, and the contributions were very well received by students and professionals alike. Finally, wed like
to congratulate those who received our sections annual research and achievement awards. Their work is invaluable to
our field and we look forward to seeing future accomplishments by our students, ECPs, and experienced professionals.
As we proceed through another academic year, there are several reasons to become excited. We are thrilled to have Dr.
Andy Horne as SCP president this year, particularly due to his presidential initiatives in obesity and violence preven-
tion. He has been an invaluable member of the Section for quite some time, and we look forward to collaborating with
him throughout the next year to continue to address the importance of prevention in our field. Please keep an eye out
for APA 2013 Convention updates--we hope to combine our own interests in prevention with Dr. Hornes initiatives to
create some exciting programs. Stay tuned for updates over the next several months, as Im sure there will be ways to
become involved!
Lastly, if you would like to join the section, hold an interest in any of the above opportunities, or have additional ideas
for your involvement, please dont hesitate to contact me at ering@albany.edu. I can provide you with some more in-
formation at that time. Best of luck with the rest of the academic year, and I look forward to hearing from you!

6 Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 5, No. 1

Social Responsibility and Prevention in the APA Ethical Principles
of Psychologists: Where Did They Go?
Jonathan Kodet
University of Kentucky
The ethics of social responsibility, prevention, and social jus-
tice within the field of psychology are being given greater atten-
tion as more researchers, academics, and clinicians examine the
influence of sociocultural contexts on individual well-being and
human development (Bronfenbrenner, 2005; Evans, 2004; Green-
leaf & Williams, 2009; Goodman et al., 2004; Hage & Kenny,
2009; Kitchener & Anderson, 2011; Prilleltensky, 2008; Romano
& Hage, 2000; Sue & Sue, 2013; Vera & Speight, 2003). A myr-
iad of voices are actively critiquing the status quo of psycholo-
gys individualistic and intrapsychic framework of intervention
and formulating ways to meet the challenges of systemic and en-
vironmental barriers to mental health and wellbeing (Albee,
2000; Aldarondo, 2007; Chung & Bemak, 2012; Conyne &
Cook, 2004; Ellis & Carlson, 2009; Fox, Prilleltensky, & Austin,
2009; Hage et al., 2007; Montero & Sonn, 2009; Prilleltensky &
Nelson, 2002; Ratts, 2009; Toporek, 2006; Worell & Remer,
2003). One shared goal in this movement, to use an ecological
metaphor, is to stop what or who is poisoning the river at its
headwaters, instead of only helping people access and cope with
drinking from it further downstream. With this image in mind,
prevention work can be recognized as one of the most integral
ways for psychologists to demonstrate social responsibility and
work to bring about social justice (Romano & Hage, 2000).
In 2002, a contrasting development occurred within the
American Psychological Associations (APA) Ethical Principles
of Psychologists and Code of Conduct, hereafter referred to as
the APA Ethics Code. The previous General Principles
(competence, integrity, professional and scientific responsibility,
respect for peoples rights and dignity, concern for others wel-
fare, and social responsibility) (APA, 1992) were replaced with
the current framework of five principles: beneficence and nonma-
leficence, fidelity and responsibility, integrity, justice, and re-
spect for peoples rights and dignity (APA, 2002). Through this
Correspondence concerning this article should be
directed to:
Jonathan Kodet, M.S., University of Kentucky, Coun-
seling Psychology Doctoral Student,
j.kodet@uky.edu
Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 5, No. 1
Theory, Research, Practice and Training
revision, one rarely discussed or recognized casualty was the con-
cept of social responsibility (Knapp & VandeCreek, 2003; Wise,
2005) and specific language supporting prevention.
What is social responsibility? While psychologists have
been writing about social responsibility for decades, it is rarely
defined explicitly. Based on Charles R. Clarks discussion of so-
cial responsibility ethics (1993), social responsibility is defined
here as the duty to reduce human suffering and further human
rights by improving society at large, extending beyond ethical ob-
ligations owed to individuals who are participants in professional
relationships. With this definitional model of social responsibil-
ity in mind, Clark (1993) asserts that [A]ll other ethical obliga-
tions are subordinate to it. As used here, social responsibility
ethics is the delineation of psychologys broadest overarching
ethical imperative, and it involves the subordination of private
and personal goals to the greater consideration of human wel-
fare (p. 313).
The most significant references of social responsibility ex-
cluded from the 2002 revision were (a) mitigate the causes of
human suffering (APA, 1992, p. 1600) and (b) encourage the
development of law and social policy that serve the interests of
their patients and clients and the public (APA, 1992, p. 1600).
In excluding language of mitigating causes, the 2002 revision ef-
fectively removed the only proactive reference supporting prima-
ry prevention from the General Principles. Likewise, the most
explicit message encouraging psychologists to be involved with
shaping the social policies is no longer communicated in the cur-
rent APA Ethics Code.
Three contextual considerations highlight the importance of
the above exclusions of social responsibility and prevention from
the APA Ethics Code. First, as the authoritative document for
psychologists in the United States, the APA Ethics Code remains
the single most utilized ethics training document for the next gen-
eration of American psychologists and therefore has a normative
function in influencing the identity of the profession of psycholo-
gy. Second, professional codes of ethics are influenced by the
cultural values of their creators (De Las Fuentes, Willmuth, &
Yarrow, 2005; Kitchener & Anderson, 2011). Finally, the APA
General Principles are aspirational in nature and are specifically
meant to encourage psychologists toward optimal professional
action (Knapp & VandeCreek, 2003). In comparison, within the
United States, the National Organization for Human Services and
the National Association of Social Workers both present a code
7
Social Responsibility and Prevention in the APA

of ethics document with an undisputedly strong social responsi-
bility ethic. Likewise, both the American Counseling Associa-
tions ethics code and the American Psychiatric Associations Ellis, C., & Carlson, J. (2009). Cross cultural awareness and so-
ethics code present political advocacy as part of the professional
identity of practitioners. Internationally, the Code of Ethics for
Psychologists Working in Aotearoa/New Zealand devotes two
pages addressing practice implications and extensive commentary
about social responsibility. Perhaps most exhaustively, the
Canadian Code of Ethics for Psychologists dedicates over four Fox, D., Prilleltensky, I., & Austin, S. (Eds.). (2009). Critical
pages to the principle of social responsibility.
In conclusion, the current General Principles within the
APAs Ethics Code do not carry the same explicit emphasis on
the systemic sphere of influence and use of social epidemiologi-
cal language as did Principle F: Social Responsibility (APA,
1992). When these exclusions are contrasted with the increasing
number of voices from counseling psychology and other special-
ties calling for psychologists involvement in prevention and so-
cial justice advocacy, it is imperative that this incongruity be con-
sidered in future revisions of the APA Ethics Code. Social re-
sponsibility requires attention to prevention strategies and calls
for psychologists to be involved in mitigating the causes of hu-
man suffering and shaping social policies for the public good.
Given the normative role and aspirational nature of the APA
General Principles in training future psychologists, these princi-
ples would better reflect a prevention approach by reintegrating
and expanding upon these concepts lost from the previous Princi-
ple F: Social Responsibility.
References
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psychological change: Psychotherapy processes & practices
for the 21st century (pp. 689-706). New York, NY: Wiley.
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Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 5, No. 1 9
Theory, Research, Practice and Training

Tools for prevention: Utilizing tele-behavioral health services in a

rural Native American community
Julie Clark
Lahoma Schultz
Maria Aleksandrova-Howell
Jake Roberts
Ashleigh Coser White Eagle Health Center
Oklahoma State University

This article illustrates the collaborative relationship between a major university and a tribal nation. Polycom capabilities were
used to reach a rural Native American (NA) population for the purpose of conducting a tele-behavioral mental health group. The
group was designed to provide psycho education on the prevention of substance misuse and suicide. The treatment team included
two Native American psychologists, two Native American masters students and one Russian doctoral student. Based on the
teams personal and professional experiences as Native people and their collective knowledge of the unique socio-cultural history
of Native Americans, the team wanted to provide culturally infused and holistic prevention education for Native American ado-
lescents that integrated openness to traditional healing, spirituality, and aspects of cultural connectedness. This article provides an
outline, as well as a discussion of the limitations and future direction, of this exploratory project. This information can be used for
future collaborations and expansion of such prevention focused programs.

It is well documented that Native Americans (NA) have a
higher rate of marijuana, cocaine, and hallucinogen abuse com-
pared to other minority groups (2010 NSDUH: Summary of Na-
tional Findings, SAMHSA, CBHSQ). Native American adoles-
cents report the highest rates of use compared to any other racial
group and inhalant use among NA youth is consistently increas-
ing (Johnston, OMalley, Bachman, & Schulenberg, 2012). It is
also common for Native communities to be located in geograph-
ically rural locations. Kast (2001) noted rural communities have
advantages as well as disadvantages. A lack of employment op-
portunities that provide adequate income, as well as health care
benefits, may be one disadvantage for those living in rural areas.
Advantages may include a stronger sense of a cohesiveness that
supports community members and their families. Oftentimes ru-
ral, as well as ethnic minority populations will seek help among
themselves or the clergy. Many rural communities also have
strong foundations built upon self-sufficiency. These values may
limit seeking help from outsiders, especially if the type of help
sought, such as mental health services, could be stigmatized by
others in the community. Lack of privacy and lack of access to
resources were also noted as impediments to help seeking among
rural, non-reservation Native American adolescents in a south-
west state (Gray & Winterowd, 2002).
Research has shown that aside from cultural and ethnic char-
acteristics, adolescents with substance use and misuse issues gen-
Correspondence concerning this article should be
directed to:
Julie Clark, Oklahoma State University, 434 Willard
Hall, Stillwater, OK, 74078. Email:
julz.dorton@okstate.edu
erally benefit from prevention interventions (Catalano, Hawkins,
Berglund, Pollard, & Arthur, 2002). Native American popula-
tions may generally be more receptive to holistic culturally
grounded prevention measures as opposed to remediation
measures based on the medical model (Baldwin, Johnson, & Be-
nally, 2009). Generally speaking, from the Native world view-
point, wellness means balance and harmony with the environ-
ment and in relationships with oneself, other individuals, fami-
lies, and communities (Wright, Nebelkopf, King, Maas, Patel, &
Samuel, 2011). Currently, for many tribes, prevention is part of
contemporary tribal wellness programs and may fit well with the
holistic paradigms that are interwoven throughout many Native
American populations.
In attempts to prevent substance use and misuse in rural Na-
tive American communities, an element of creativity may be nec-
essary in order to bridge the gap in services available. Given the
geographical challenges faced by rural communities, including
access to economic resources and transportation, a relatively new
and growing concept to reach rural populations is tele-mental or
tele-behavioral health models used to provide mental health ser-
vices from a distance (Evidence-Based Practice for Telemental
Health, 2009). Telemental health services have been used in a va-
riety of ways (Simms, Gibson, & ODonnell, 2011). Each tele-
mental health experience has helped inform the use of tele-
behavioral health as a means of reaching groups who may not
otherwise have access to behavioral health services. It has been
successfully used in group therapy (Morland, Pierce, & Wong,
2004; Frueh, Monnier, Yim, Grubaugh, Hamner, & Knapp, 2007)
and there is some evidence that tele-behavioral health has been
effective with Native American youth (Savin, Garry, Zuccaro, &
Novins, 2006).
As noted earlier, rural populations often face challenges in

10 Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 5, No. 1

accessing health and education services due to limited personal
and community resources which are influenced by geographical
location (Gray & Winterowd, 2002; Kast, 2001). Therefore, ap-
proaching this project from a collaborative model was key in or-
der to reach this rural population (Thomas, Donovan, Sigo, Aus-
tin, & Marlatt, 2009). The endeavor discussed in this article was
unique in that it was a collaborative project between a tribe and a
major university, utilizing each organizations telecommunication
resources to reach a rural population.
According to the Indian Health Service (IHS) data, (n.d.)
methamphetamine use and abuse has continued to increase both
on and off reservations to the point of reaching epidemic propor-
tions. This is a major problem that is detrimental to a population
already ravaged by the effects of alcohol and other drugs and its
related effects on communities, families, and tribal groups creat-
ing major socio-economic and health problems. Recently, IHS
determined a strong impact could be made on these problems
through well planned prevention and education efforts of individ-
ual tribes. Initial funds for this effort were authorized by Con-
gress with P.L. 110-161, the Consolidated Appropriations Act of
2008. The enactment of P.L. 111-8, the Omnibus Appropriations
Act of 2009, targeted additional funds for Native American com-
munities to further combat issues related to methamphetamine
use and suicide (IHS, n.d.).
Collaboratively the authors of this article were able to com-
bine the resources of a small federally recognized tribe and a ma-
jor university in the mid-central area of the United States to pro-
vide tele-behavioral health services to a small group of Native
American adolescents living in a rural community. This article
outlines the process, challenges and future direction of this col-
laborative effort at preventing substance misuse and suicide
among Native teens.
In 2009, the tribe was informed that they were one of 23
tribes in an area served by IHS to be awarded funding for the de-
velopment of a three-year Methamphetamine and Suicide Preven-
tion Initiative (MSPI) project. Currently, the number of enrolled
members of this tribe is less than 3,600 and according to the U.S.
Census (2008) about 2,300 members reside on tribal land. The
county in which this tribe is located is reported to have a popula-
tion of approximately 46,000 with 74% living in an urban setting
and 26% living in a rural setting; Native Americans make up
8.3% of that population. Within this county 18.4% of the resi-
dents report living at or below the poverty line and, among those
46.3% are reported to be Native American, representing the high-
est percent of poverty across all ethnic minority groups in that
county.
Upon receiving notification of funding, the tribe hired a Psy-
chologist/Behavioral Health Director (PBHD). The first six
months of the three-year project were devoted to hiring a coordi-
nator, planning activities, and meeting with other intra-tribal pro-
grams and outside agencies to formulate the implementation
phase. Honoring specific cultural prevention, intervention or
treatment programs that promote the healing of communities,
families and victims was a key component of publicizing the edu-
cational aspects of the project to the community. In order to plan
and strategize the best methodology for implementing a tele-
behavioral health system the PBHD met with the tribes health
Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 5, No. 1
Tools for Prevention
center staff. Aside from ensuring the chosen poly-com system
would be compatible with the health centers technological sys-
tem, it was important that the tribal community was made aware
of the plan to implement a tele-behavioral health system. This
was accomplished via a newsletter and the tribes website.
During this time the PBHD agreed to supervise the clinical
work of two masters level community counseling students and
one counseling psychology doctoral student. These students, all
enrolled at the same university, were completing the practicum
and internship requirements for their degree programs. Placement
at the tribal behavioral health unit was an appropriate fit, as it met
the supervision and client contact hours required by their aca-
demic programs. The PBHD contacted the first author, a faculty
member within the students academic programs, about collabo-
rating with the tribes tele-behavioral health program endeavor
utilizing the universitys poly-com system. Use of the universi-
tys polycom system would allow the students and faculty mem-
ber to provide telemental health services from two different cam-
pus locations. In order to address the needs of the community and
utilize the MSPI funding, a group focusing on adolescent sub-
stance use prevention was formed.
One of the first challenges faced by the therapeutic team was
selecting a curriculum that was culturally and developmentally
appropriate for teens. The majority of existing culturally focused
substance abuse related treatment options for Native American
adults and adolescents target those with severe alcohol and drug
issues. For Native youth with mild to moderate drug related is-
sues the area of effective prevention models is under-developed
(Winters, Dewolfe, & Graham, 2006).
When selecting the curriculum and planning the focus of the
tele-behavioral health group the team wanted to encourage pre-
vention through education about the historical, societal and cul-
tural factors that have influenced substance use across both older
and contemporary generations. The cultural competence of the
therapeutic team, now made up of two Native American psy-
chologists, two Native American masters students and one Rus-
sian doctoral student, is an important factor when doing research
and providing health services in Native communities (Baldwin,
1999; Whitbeck, 2011). Whitbecks (2011) study showed that
Euro-American centered prevention programs often ignore cul-
turally specific protective components valuable to ethnic minority
groups thereby losing the opportunity to utilize participants cul-
tural strengths, values and ownership of moving towards well-
ness. The most effective prevention model needs to be tailored to
the culture, age and gender of the population at risk (Baldwin et
al., 2009) and research affirms that making prevention models
culturally sensitive increases their effectiveness (Botvin, Baker,
Dusenbury, Tortu, & Botvin, 1990).
Utilizing a group therapy format the team wanted to provide
holistic education on preventing substance misuse for Native
American adolescents that integrated openness to traditional heal-
ing practices, spirituality, along with cultural awareness and con-
nectedness. Some of the goals of the team were to raise group
members motivation to be substance free, provide education
about risks associated with using, and enhance the effectiveness
of protective factors that may be available at the individual, fami-
ly, peer, school, community, and societal levels (Hawkins, Cata-
11
Tools for Prevention
lano, & Miller, 1992).
A holistic focus was desired given some of the historical at-
tempts at assimilation such as education via the Indian boarding
school system. Many who attended not only lost their families,
culture, language, and spiritual ceremonies, they were not given
the essential tools for parenting and healthy relationships. The
methods of coping with these losses, and the associated unre-
solved grief, have typically not been healthy ones as is seen in the
high rates of substance use, obesity and domestic violence in
many Native communities (Clark & Winterowd, 2012; Omidy &
Clark, 2012). In order to raise awareness about these historical
influences in conjunction with peer pressure, reasons for use,
consequences of use on academic performance and long term
goals, the team wanted to utilize a culturally specific curriculum
that addressed some of the unique socio-cultural challenges faced
by many Native Americans.
In designing their treatment goals, the team wanted group
members to holistically examine factors that may influence, or in-
hibit, substance use. They also wanted to encourage discussions
related to group members positive sense of self-worth, ability to
make good decisions, personal responsibility, and the ability to
act independently of others (Beauvais & Trimble, 2003). Identi-
fied goals were to initiate conversations and activities related to
communication skills, cultural identity, tribal affiliation, open-
ness to diversity, and knowledge of personal cultural heritage.
Assessing knowledge about the dangers of substance use, own
experiences of substance use, and understanding family history of
substance use was important as was identifying family resiliency
factors. Individual strengths and personal and career aspirations
were deemed important to identify. Finally, the team wanted to
take into account any Native American cultural characteristics,
expectations, beliefs, or culturally rooted skepticism about west-
ernized interventions.
Curricula
The initial curriculum selected for use with this group was,
Through the Diamond Threshold: Promoting Cultural Compe-
tency in Understanding Native American Substance Mis-
use (Robbins, Asetoyer, Nelson, Stilen, & Tall Bear, 2011), a
curriculum written by Native American health care providers that
makes use of stories, music, and experiential exercises that reflect
some of the historical and cultural contexts of the Native Ameri-
can community. This curriculum addresses familial use of sub-
stances, experiences of discrimination, and shame inducing stere-
otypes that may perpetuate various forms of oppression. It takes
into account a cultural revitalization of the Native American pop-
ulation and its transition to healing, which may help redefine the
foundation and nature of alcohol and drug problems. This curric-
ulum addresses broad concepts that are unique to Native Ameri-
cans specifically, but group facilitators observed the need to nar-
row these complex ideas to be more developmentally appropriate
for teens. Thereby the team agreed to add a second curriculum,
Substance Abuse Prevention Activities: Just for the Health of
It, specifically developed for children and adolescents (Rizzo
Toner, 1993). The team agreed that before addressing how the
historical influences of assimilation practices may influence sub-
stance use among Native Americans, basic education needed to
12 Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 5, No. 1
take place about substance use in general. Worksheets were uti-
lized from the second curriculum in order to help illustrate and
narrow the broader concepts of the initial curriculum. Worksheets
utilized to encourage insight, education and discussion covered
general knowledge about substances, factors that influence addic-
tion and abuse, myths about use, and abstaining from use. In or-
der to begin exploring the broader concepts of racism, discrimi-
nation and micro aggressions, the group discussed some of the
stereotypes about Native Americans.
The Group
Participants were accepted via referrals from their therapist
(25%), parents (42%), or were court ordered by the local Munici-
pal Court System Juvenile Division (33%). The group consisted
of 10 females and 2 males, ranging in age between 10 and 23
years old. Seven participants were from single parent homes and
three participants were from homes with a mother or father who
were in a partnered relationship but not married. Participants in-
dicated they held 12 different tribal affiliations. While all partici-
pants were affected by alcohol abuse of family members, only six
participants were personally involved in substance use and abuse.
The 23 year old group member attended two sessions. As part of
her therapeutic work with her psychologist she volunteered to
serve as a mentor to the younger group members based upon her
history of substance misuse. The therapeutic team agreed to allow
this young adult to participate in keeping with the cultural norms
and values of the community. Culturally speaking, elders typical-
ly serve in this type of role; however, this particular community
recently experienced the death of a tribal member who was con-
sidered to be the last living elder. Elders are considered those
who carry the knowledge, wisdom and stories of a tribe. More of-
ten than not, with each death, transmission of the culture dies as
well. Therefore, it is sometimes prudent to utilize those who are
willing to serve in that role even though they may not meet the
true historical cultural meaning of the term or role of elder.
The group met weekly for 15 weeks at the tribal health clinic
and the first author was located at a satellite campus of the uni-
versity. The typical format was that the first author would intro-
duce the topic to the group and the other four members of the
therapeutic team would facilitate the group by handing out and
explaining worksheet instructions and terms and sometimes illus-
trating concepts on the dry erase board. Each member of the ther-
apeutic team would offer reflections, observations and summaries
about the content, or behaviors observed, as well as engage the
group and other facilitators in process questions.
From their observations, the therapeutic team noticed that
during the first few weeks, group members did not seem highly
motivated to take an active stance and were often either silent or
constrained in their overall emotional and verbal input in to the
group. However, during the last five sessions of the group, most
group members exhibited behaviors indicating more investment
in group activities as demonstrated by sharing their experiences
and plans for the future more openly.
Pre-and post-surveys
The collaborative effort to provide prevention education uti-
lizing technology to Native American adolescents living in a ru-

ral community may be one of the first of its kind in this area of
the United States. Since this was not designed as a formal re-
search project, but rather an exploratory endeavor to assess the
needs of the community, only basic demographic information
was collected along with pre- and post- assessment on knowledge
of the topic, and finally a brief survey with questions assessing
the group experience. The pre-and post-group surveys utilized
questions from the initial curriculum, Through the Diamond
Threshold: Promoting Cultural Competency in Understanding
Native American Substance Misuse (Robbins et al., 2011).
Three participants out of the group of 12 (25%) submitted an-
swers to the pre-test, and eight participants out of this group
(67%) responded to the post-test.
Answering the first pre and post-test question, What names
or labels are sometimes given to persons with drug and alcohol
problems that are hurtful to their healing? all participants
(100%) demonstrated broad knowledge of such names and labels.
Responses to the second question, What are the four dimensions
of life where one strives to feel comfort and a sense of exist-
ence? demonstrated that when the group started there were no
participants (0%) who had any knowledge of these four main di-
mensions of life. However, by the end of the group, five out of
eight participants (63%) responded with all four dimensions, one
participant (12%) responded with three of the dimensions, and
two (25%) responded with two of the four dimensions. Answer-
ing the pre-test question, What are some of the prevailing stere-
otypes we hear about Native Americans? only two out of three
who responded had good insight to the stereotypes heard about
Native Americans. The results of the post-test show that by the
end of the group sessions all participants (100%) had good
knowledge about stereotypes related to Native Americans. Com-
parison of the pre and post-test answers to the question, What
are the benefits or problems of respecting, accepting, and honor-
ing diversity?, demonstrated that at the beginning of the group,
only two participants had good insight to the benefits of respect-
ing, accepting, and honoring diversity, but by the end of the ses-
sions four out of eight participants (50%) responded with stated
benefits, two (25%) responded with stated problems, and one
(12%) participant responded, I dont know. Furthermore, alt-
hough all participants had personal insight to the question, Why
might Native American people create distance and remain alien-
ated from Euro-American and the dominant culture? when they
entered the group, by the end of the group sessions their answers
changed. According to the pre-test, they responded with such an-
swers as anger, fear of being made fun of, and cultural dif- sons for attending the group. One of the main intentions of the
ferences, as reasons to avoid the dominant culture. By the end of
the therapy sessions, two participants responded with references
to racism, and two responded, just being different. Others re-
sponded, There may still be anger or bitterness, referring to
cultural differences, or, personal differences, and explained bers of the community may have initially expressed interest dur-
the distance by such statements as, Because they make up stere-
otypes about us, and fear of death. Finally, only one partici-
pant answered the pre-test question, What is it about Native
American ceremonies that help someone heal? This person stat-
ed, They feel the spiritual magic working and they feel better.
By the end of the fifteen sessions, answering the same question,
four participants (50%) responded that the spiritual aspects and
Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 5, No. 1
Tools for Prevention
prayers help us to heal. Among other single responses there
were such statements as not sure (12%), they dont
help (12%), and makes them happy (12%).
Evaluation Surveys
The last group session was used to discuss group members
experiences and to administer post group evaluation surveys.
Eight participants out of 12 (67%) submitted their responses to
the evaluation survey. In response to the statement, I learned a
lot in group, six participants (75%) said yes, and two partici-
pants (25%) said no. Seven participants (88%) enjoyed the top-
ics discussed in the group, and one participant (12%) reported not
enjoying the topics discussed. Seven participants (88%) reported
that talking about reasons for using substances was helpful, while
one participant (12%) denied its usefulness. Moreover, although
goal setting procedures were helpful for six participants (75%),
two participants (25%) reported that goal setting procedures were
not helpful.
When responding to the statement, I would like to have
talked more about three participants (38%) would like to have
talked more about drugs or substance abuse, two participants
(25%) would like to have talked more about Native American
culture, two participants (25%) responded, I dont know, and
one participant (12%) responded, problems in life other than
drugs or alcohol.
Responses to the statement, The thing I liked most about the
group varied as each participant came up with a different re-
sponse (12%). Participants reported that they liked talking
about stereotypes, communicating, how people were com-
fortable around each other, worksheets, everyone was friend-
ly, it was easy to express myself, and I like to come here be-
cause when I think about doing drugs then I come here and the
thought goes away.
Responses to the statement, The thing I liked least about the
group included such responses as I dont dislike any-
thing (three participants, 38%), participating, and
attending (two participants, 25%). There were also such single
responses as I dont know, It starts at 3:30 PM, and
storytelling (one participant, 12% per each of these responses).
Limitations
Over the course of the 15 weeks, the team discovered some
challenges and limitations to providing tele-behavioral health ser-
vices to Native teens with varying backgrounds of use and rea-
group was prevention of adolescent substance misuse. In order to
garner community participation the student group facilitators ad-
vertised counseling services to the community through health
fairs, pow-wows, and tribal youth programs. While some mem-
ing recruitment, the resulting group was made up of adolescents
that were court-ordered or referred by their parent or therapist.
Consequently, group members commitment and motivation to
participate at the outset of the group may have been lacking. Mo-
tivation, as defined by Battjes, Gordon, O'Grady, Kinlock, and
Carswell, (2003), is a construct that contributes to participants
engagement in the group activities and towards the overall group
13
Tools for Prevention
therapy outcome. The teams observations of the group demon-
strated that although participants motivation to participate in
group activities fluctuated from session to session, it appeared to
be much higher by the end of the 15 weeks. Once the group
members began to actively engage in discussion with fellow
group members and facilitators, commitment and motivation to
participate appeared to increase.
Another challenge was the use of a curriculum that, while
culturally appropriate, was designed more for adults. While key
cultural aspects of the curriculum were related to loss of cultural
practices and knowledge, and effects of intergenerational trauma,
it was discovered that these concepts needed to be restructured
for use with adolescents. Although group members enjoyed talk-
ing about some of the topics stimulated by the initial curriculum,
such as stereotypes of Native Americans, many of the terms and
concepts had to be explained in a more developmentally appro-
priate manner. During post-group discussions, the therapeutic
team realized that Through the Diamond Threshold presents
broad concepts that may require more in-depth understanding and
knowledge of the historical events and traumas experienced by
Native American tribes and how these events affected tribal
groups across generations. The second curriculum seemed to
narrow these broader concepts into smaller more understandable
and developmentally appropriate concepts. Group members were
given more age appropriate activities that allowed them to dis-
cuss unhealthy substance related behaviors, the consequences of
such behaviors and explore healthy alternatives to such behav-
iors. The material presented in the second curriculum seemed to
be easier for group members to comprehend and follow. Almost
all group members later commented that they enjoyed games,
worksheets, and skits from the second curriculum. By utilizing
the worksheets, group facilitators were able to infuse the broader
culturally specific elements introduced by the first curriculum as
well as incorporate personal and professional knowledge and ex-
periences.
Differences in group members ages and relationship to one
another, either familial or outside of the group, also affected
group dynamics, cohesion, rapport, and level of participation. Fa-
cilitators observed what appeared to be hesitation or resistance
towards authentic sharing given the familial, social or community
nature of some group members.Another limitation seemed to be
whether or not the group member was attending due to anothers
substance misuse or personal misuse. Those who had misused
shared different experiences than those whose family members
were users. Time constraints on the group were imposed due to
the acquired group meeting space being within the tribal health
clinic once a week after school. Halfway through the fifteen
weeks an agreement was reached with the clinic director to hold
the group after clinic hours. As a result, the group was able to
meet longer which enhanced development of group cohesion and
rapport.
Additionally, a majority of parents were uncooperative in
terms of intake procedures and screening. Even though parents
had been contacted by phone and home visits from the youth pro-
gram director, intake and screening forms were returned unan-
swered or with questions on intake forms and screeners left unan-
swered. Many parents were unresponsive when contacted for fur-
14 Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 5, No. 1
ther information. According to Walls, Johnson, Whitbeck, &
Hoyt (2006), parents and caretakers of Native American adoles-
cents may prefer to see their children receiving informal and tra-
ditional help. It is possible that if parents knew that the curricu-
lum was designed for Native Americans by Native Americans
and that group facilitators were either Native American them-
selves or were highly sensitive to cultural expectations and needs
of Native American adolescents, they would be more cooperative
and might welcome the possibility for their children to get profes-
sional help. The court-ordered group members seemed to be ab-
sent more often or arrived late to group even though they may
have been also been suspended from school at the time.
Future directions
Currently the team is working on modifying or creating a
curriculum that is more developmentally appropriate in vocabu-
lary and concepts for Native American teens. Some of the key
components of a culturally appropriate curriculum are to address
concerns of both users and non-users as well as the socio-cultural
and historical factors that may influence family members use
across multiple generations. The authors believe that by provid-
ing a historical context to Native American adolescents growing
up in communities or situations where substance misuse has af-
fected them and/or their family functioning, a level of under-
standing and awareness will be created that may prevent the mis-
use of substances and thereby the resultant negative outcomes for
future generations.
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Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 5, No. 1 15
Theory, Research, Practice and Training

Self-compassion, health and wellness in women

Julie Swagerty and Julie Koch

Oklahoma State University

Self-compassion, or maintaining an attitude of self-kindness and self-care in spite of failures, inadequacies, and painful experi-
ences in life, may be linked with positive health choices and healthy living. Rather than setting and pursuing health goals to meet
external standards or to fit an ideal, women who are self-compassionate may be more likely to make positive lifestyle choices out
of a sense of caring for oneself. A self-compassionate woman may also be more resilient when facing barriers to wellness, such
as setbacks, challenges or failures. Since self-compassion seems to improve with practice, self-compassion may be an effective
intervention to consider in addressing both physical and psychological difficulties in women. This review provides an overview
of the established correlates with self-compassion and the literature relevant to this exciting prospective tool in health promotion
and disease prevention for women.

Introduction
Despite advances in the research illuminating the enormous
impact of diet and exercise among other health behaviors on
wellness, it seems that Americans are becoming increasingly less
healthy and many peoples unhealthy choices contribute to their
own morbidity and premature death. In 1995, no state had an
obesity rate of over 20%; by 2010 every state had an obesity rate
of at least 20%, with a national average of 33.8% (Centers for
Disease Control and Prevention, 2011b). Statistics show about 20
million American women are currently obese or overweight
(Setse et al., 2008). Additionally, research demonstrates a strong
link between obesity and depression, especially among women
(Ma & Xiao, 2010; Simon et al., 2008; Simon et al., 2006). Not
only have health status and physical activity levels been shown to
vary based on gender, with women shown to be less active than
men (Center for Disease Control, 2007a), but also to vary among
women, based on factors such as socioeconomic status and race
(UCLA Center for Health Policy Research, 2008), health behav-
ior, psychosocial stress (Dishman, Sallis, & Orenstein, 1985;
Eyler, Brownson, King, Brown, & Donatelle, 1997; United States
Department of Health and Human Services, 1996); acculturation,
and perceived health status (Pender, Murdaugh, & Parsons,
2002). Overall, populations with lower income, lower education,
or of a minority status show consistently lower engagement in
healthy behaviors and increased engagement in risky behaviors
(American Cancer Society, 2008; Crespo, Smit, Andersen, Carter
-Pokras, & Ainsworth, 2000; U.S. Department of Health and Hu-
man Services, 1996, 2001). Socioeconomic variables can often
impact womens access to important health-related resources
such as fitness facilities, childcare, and fresh produce. Women
Correspondence concerning this article should be
directed to:
from lower SES backgrounds often cite cost as a major perceived
barrier to healthy eating (Buchholz, Huffman, & McKenna,
2012). These findings reflect an overall negative trend in healthy
lifestyle behaviors and associated wellness issues, demonstrating
the relevance of such health issues for women and the importance
of cultural variables in womens health.
When considering womens health and lifestyles, especially
issues related to fitness and weight, women seem to bear a
double burden as the female body tends to be the object of
much greater scrutiny, with femininity characterized by bodily
appearance, mainly, thinness (Lupton, 1996; Malson, 1998;
Markula, Burns, & Riley, 2008; Orbach, 2006). Todays women
are inundated with pressures to attain this ideal of female thinness
(Stice, Maxfield, & Wells, 2003). Such cultural messages about
beauty and fitness uphold an unrealistic standard of thinness and
lifestyle behaviors that starkly contrast with the realities of aver-
age everyday living in the US. In fact, when women do engage
in healthy lifestyle behaviors such as exercise, many attribute
their motivation to a desire to be thin (Markland & Hardy, 1993;
McDonald & Thompson, 1992). To further illustrate important
gender differences related to lifestyle, wellness, and societal pres-
sure, women are often viewed as responsible not only for their
own health, but also for the health of their children and spouses
(Tischner & Malson, 2011). Finally, women have been shown to
identify self-esteem as significantly more important than men as
a major barrier in implementing healthy lifestyle changes
(Mosca, McGillen, & Rubenfire, 1998). Pressures to meet socie-
tal standards for women often impact a womans view of herself
and contribute to the many obstacles she may face in making
healthy choices that promote well-being. The prevalence of criti-
cal health issues that impact women today, such as obesity and
depression, and the impact of a womans view of her self on her
health behaviors and well-being, reveal a need to further consider
the relationship among these factors.

Julie Swagerty, M.S., Oklahoma State University, Self-Compassion

434 Willard Hall, Stillwater, OK, 74078. Ju- An alternative self-construct. In exploring womens view
lie.swagerty@okstate.edu of self, the construct of self-compassion currently offers an alter-

16 Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 5, No. 1

native way to conceptualize a healthy way of relating to ones
self. This newer construct emerging out of the recent focus on
mindfulness has already been applied to health and wellness on a
theoretical level (Terry & Leary, 2011). Self-compassion is the
opposite of self-criticism; rather, it is characterized by self-
acceptance. Self-criticism, on the other hand, breeds negative
feelings that may prevent a positive or adaptive view of self
(Blatt, Quinlan, Chevron, McDonald, & Zuroff, 1982). Self-
compassion, as described by Neff (2003a), involves being open
to and moved by ones own suffering, experiencing feelings of
caring and kindness toward oneself, taking an understanding,
nonjudgmental attitude toward ones inadequacies and failures,
and recognizing that ones experience is part of the common hu-
man experience (p. 224). Neff identifies three interrelated facets
of self-compassion that are expressed in moments of perceived
disappointment or pain. Each facet consists of a component and
its counterpart: self-kindness, or a stance of understanding toward
oneself as opposed to self-criticism; common humanity, viewing
ones imperfect and at times, painful, existence as related to the
human experience in general versus as in isolation; and mindful-
ness, or maintaining a balanced awareness of thoughts and feel-
ings rather than getting carried away with ones emotions or eval-
uations.
Framework for conceptualizing the self: Self-compassion
versus self-esteem. An adaptive attitude towards oneself proves
potentially relevant in examining contributing factors toward par-
ticipation in healthy lifestyle behaviors. While self-esteem has
already been identified as significant in engagement in healthy
behaviors (Mosca, McGillen, & Rubenfire, 1998), self-
compassion has also been positively linked to engagement in
healthy behaviors, such as exercise (Magnus, Kowalski, McHugh
2010). Various reasons explain why self-compassion might be
advantageous over self-esteem as a construct capturing ones
view of self. High self-esteem has been linked to negative out-
comes such as narcissism and self-centeredness (Baumeister,
Bushman, & Campbell, 2000; Neff 2003a; Neff 2003b). Self-
compassion, on the other hand, appears to relate to many of the
same psychological benefits of self-esteem, but proves a bit har-
dier as a construct. Self-compassion does not hinge on perfor-
mance evaluations or social comparisons and so does not relate to
the need to maintain an unrealistically positive view of self. The-
oretically, self-compassion should be easier to improve than self-
esteem because it does not involve the need to maintain an unre-
alistic view of self (Neff, 2003a). The very appeal of self-esteem
lies in its capacity to motivate actions aimed to reduce dissonance
among a persons ideal and actual self (Rosenberg, 1979) and the
fact that it is not unconditional (Kaplan, 1995). Yet, self-
compassion essentially defies this need to hold oneself in a high
regard based on merit, success, or even mastery; it prescribes self
-acceptance based on an inherent sense of ones worth as a living
being. The idea is that when one can promote a stance of self-
kindness and self-acceptance, one becomes free to strive less to
meet arbitrary standards, imposed by self, others, or society.
Therefore, it may be high self-compassion that can more fully
and securely allow the gap to decrease between the ideal and the
actual self.
The distinctions Neff has drawn in differentiating the con-
Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 5, No. 1
Self-Compassion, Health, and Wellness in Women
struct of self-compassion from self-esteem can be seen as sifting
out many of the aspects of self-esteem that can be negative or
maladaptive: self-comparison, self-evaluation, and a need to ex-
ceed or measure up to standards imposed by self, others, or socie-
tal values. Self-compassion, alternatively, reflects an acceptance
of flaws and an attitude of kindness toward self while connecting
with the common experiences of humankind. In exploring the re-
lationship among womens view of self and healthy lifestyle be-
haviors, it makes intuitive sense to utilize a self-related construct
that captures a sense of acceptance in spite of inadequacies and
failures versus a positive evaluation of self that may be more con-
tingent on social comparison and situational factors.
Correlates and outcomes related to self-compassion.
Though in its early stages as an operationalized construct in the
social sciences, the area of self-compassion has already generated
numerous studies since the Self-Compassion Scale was devel-
oped (Neff, 2003a). In a recently published overview of studies
related to self-compassion, Barnard and Curry (2011) identified
correlates to self-compassion in the following domains: affect,
cognitive patterns, and social factors. For example, in the affect
domain, self-compassion has been shown to be related to well-
being (Neely, Schallert, Mohammed, Roberts, & Chen, 2009),
being positively associated with psychological traits such as opti-
mism and happiness (Neff, Rude, & Kirkpatrick, 2007), and neg-
atively associated with depression and anxiety (Mills, Gilbert,
Bellew, McEwan, & Gale, 2007; Neff, 2003a; Ying, 2009), and
negative affect (Neff et al., 2007). Related to emotional regula-
tion, self-compassion has been linked to emotional intelligence
(Neff 2003a), approach coping strategies (Neff, Hsieh, & Dejitte-
rat, 2005), and decreased reactivity to imagined distress and neg-
ative feedback (Leary, Tate, Adams, Allen, & Hancock, 2007).
Self-compassion has been found to negatively correlate with ru-
mination, thought suppression, and avoidance; and positively to
mindfulness (Neff et al., 2005; Neff, Rude, & Kirkpatrick, 2007;
Neff & Vonk, 2009; Raes, 2010; Thompson & Waltz, 2008).
Additionally, self-compassion has been shown to relate to self-
acceptance (Neff, 2003b), self-perceived competence (Leary et
al., 2007; Neff et al., 2005), and social connectedness (Neff,
2003a; Neff et al., 2007).
As more studies demonstrate the significance of self-
compassion in relation to many relevant domains of functioning,
the question of whether self-compassion can be raised among in-
dividuals in a measurable and practical way has naturally
emerged as a next step. Research on self-compassion has already
extended to the intervention and experimental stage. Indeed, it
has been shown that self-compassion can be increased with prac-
tice through implementation of self-compassion training pro-
grams (Gilbert & Proctor, 2003; Shapiro, Brown, & Biegel,
2007) and researchers are showing interest in exploring self-
compassion from an experimental perspective (e.g., Leary, Tate,
Adams, Allen, & Hancock, 2007). Other more established thera-
peutic interventions such as Dialectical Behavioral Therapy
(Linehan, 1993), Acceptance Commitment Therapy (Hayes,
Strosahl, & Wilson, 2003), and more recently, Mindfulness-
Based Stress Reduction (Kabat-Zinn, 2003), share the common
emphasis on components related to self-compassion.
17
Self-Compassion, Health, and Wellness in Women
Self-Compassion and Health
While few studies related to self-compassion and health have
been published to date, researchers have recently identified a the-
oretical rationale for exploring a link between self-compassion
and health behaviors. Ironically, initial reactions to the construct
of self-compassion include a concern that too much self-
compassion might lead to over-indulgence, apathy, or laziness
(Neff, 2003b). Yet, researchers in the area of self-compassion
suggest just the opposite: Self-compassion involves the pursuit of
ones own health and well-being and is associated with higher
levels of motivation to make needed changes in ones life (Neff,
Rude, & Kirkpatrick, 2007). Self-compassion may engender
healthier choices and lifestyles by helping people to observe and
track their health goals with greater focus and less defensiveness,
remain balanced when facing setbacks, pursue goals that are in
their best interests, seek medical attention when needed, adhere
to prescribed treatments, and regulate negative affect (Terry &
Leary, 2011).
Self-compassion may have a key role in enabling women to
manage the intense pressures to be thin and meet societal stand-
ards of ideal beauty and fitness, while still promoting healthy
choices (Neff, 2009). Magnus, McHugh and Kowalski (2010)
emphasize the promotion of healthy perspectives of the self as es-
sential in improving womens exercise experience and psycho-
logical well-being. Self-compassion fits well as a construct to
utilize in this process of investigating womens attitudes toward
self in relation to their health behaviors. Overall health and well-
being is most fully pursued and achieved by individuals who en-
gage in healthy behaviors out of a sense of kindness and compas-
sion toward self that has to do simply with being human, not out
of a desire to obtain a particular state of fitness or an externally-
reinforced outcome (Neff, 2004). Magnus et al. (2003) put it this
way: self-compassion [gives] rise to proactive behaviors
aimed at promoting or enhancing well-being (p. 366). Chang
(2010) reinforces this intuitive connection between healthful life-
style behaviors and self-compassion: Adopting health-
promoting behaviours as a lifestyle component is an expression
of the human tendency to actualize and is directed at elevating in-
dividual well-being, self-actualisation and personal fulfill-
ment (p. 191). In looking at what may impact womens lifestyle
behaviors and the benefits of healthy behaviors, the attribute of
self-compassion provides an appropriate and useful lens to exam-
ine womens view of self.
Though much of the work to date representing the intersec-
tion of self-compassion and health is largely theoretical, two
studies have been published related to self-compassion and wom-
ens health. Both studies look at specific health behaviors, exer-
cise and eating, among women. The first study investigated
whether inducing a self-compassionate state would reduce the
likelihood of college women engaging in overeating after eating
unhealthy food (Adams & Leary, 2007). The induction of self-
compassion did moderate effects of food consumption levels after
the initial serving of unhealthy food and reduced negative affect.
These findings highlight the role of self-compassion in contrib-
uting to more healthful behaviors among young women and have
direct implications for women who are restrictive eaters. The self
-criticism and negative affect associated both with being a highly
18 Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 5, No. 1
restrictive eater and with eating as a means to cope with and reg-
ulate emotions can be targeted and decreased by fostering self-
compassion. Authors of the study suggest that helping people
make dietary choices in a less rigid way and react in more adap-
tive ways to diet failure may promote healthier eating behaviors.
These findings also support the idea that self-compassion may
enable people to think and react more clearly after a disappoint-
ment or mistake.
Magnus, McHugh, and Kowalski (2010) provide further sup-
port for uncovering the relationship between womens view of
self and health behaviors, specifically exercise. Neff (2009) ad-
dresses this very topic in a straightforward manner: Because
people with self-compassion care about themselves, they want to
engage in healthy behavior. They do not need to motivate them-
selves by fear of self-punishment or the judgments of others; their
motivation stems from the intrinsic desire for well-being (p.
564). Magnus et al. hypothesized that self-compassion would be
positively related to more autonomous motivation for exercise
and mastery-oriented goal styles and that self-compassion would
predict autonomous motivation to exercise and lower social phy-
sique anxiety over and above self-esteem. Findings supported
this hypothesis: In many areas, self-compassion explained a sig-
nificant amount of variance over and above self-esteem (goal ori-
entation, self-determination, and social physique anxiety). Re-
searchers concluded that self-compassion appears to be strongly
linked to well-being for women exercisers. Findings confirmed
previous research linking self-compassion to more adaptive self-
regulation and goal orientations.
Framework for conceptualizing health: Positive versus
medical model. The emergence of self-compassion as an alter-
native to self-esteem in considering womens health was dis-
cussed earlier. In further exploring theory related to womens
health, it becomes important to explore the positive health model
as a workable framework. Health behavior has been defined as
an action taken by a person to maintain, attain, or regain good
health and to prevent illness (Anderson, Keith, & Novak, 2002,
p. 784). In Penders Health Promotion Model (1987), Pender de-
fines health-promoting behavior as an expression of the human
actualizing tendency and directed toward sustaining or increas-
ing the individuals level of well-being, self-actualization, and
personal fulfillment (Walker, Sechrist, & Pender, p. 76). She
distinguishes this from health-protecting behavior, which reflects
the human tendency to preserve homeostasis and decrease ones
risk of illness. This distinction reflects the paradigm shift from
the medical model, where health is viewed as absence of disease,
to a more expansive one of positive health, where health is
viewed as an optimal state (Gill et al., 2010). The definition of
health by the World Health Organization reaffirms this positive
and integrated conceptualization of health: Health is a state of
complete physical, mental, and social well-being, and not merely
the absence of disease or infirmity (1946, p. 1). In Penders re-
vised version of the Health Promotion Model (2002), she empha-
sizes the trend away from a curative and biomedical model to a
multidimensional phenomenon with biopsychosocial, spiritual,
environmental, and cultural dimensions, and stresses that health
promotion should focus on available resources, potentials, and
capabilities as well as dysfunction and potential risks (p. 29).
 Self-Compassion, Health, and Wellness in Women

Advantages to a positive health framework over a medical activity by itself has demonstrated positive benefits across many
model in exploring womens health are many. The focus on dis- facets of wellness including physical health, disease risk reduc-
ease and pathology fosters a narrow and impersonal quality of tion, life satisfaction, cognitive functioning, and psychological
health care. A positive health perspective entails a more integra- well-being (Carek, Laibstain, & Carek, 2011). By exploring the
tive and holistic approach in all aspects of health ranging from connection among womens view of self and participation in
prevention and promotion to treatment. In taking a negativistic healthy behaviors, mechanisms factoring into maintaining
approach to health more representative of the medical model, healthy lifestyles among women may be more closely considered
health-related prevention efforts are prohibitive in nature and and understood.
consist of identifying poor health behaviors that should be avoid-
ed. Alternatively, a positive health orientation involves the pro- Gaps in the Literature
motion of behaviors and lifestyles that enhance wellness. A posi- While many researchers have identified the potential value
tive health framework is empowering, collaborative, holistic, and of the construct of self-compassion in relation to health, only two
strengths-based. empirical studies have been published to date directly exploring
Penders Health Promotion Model (Pender et al., 2006) the relationship between self-compassion and health behavior.
makes apparent the connection between a womans self- While Magnus et al. (2010) examined the relationship between
compassion, or attitude of self-kindness and non-judgment in self-compassion, exercise, and self-determined motivation among
light of her inadequacies and failures, and her engagement in women, there is a need to further consider the relationship be-
healthy lifestyle behaviors. Self-compassion could provide one tween self-compassion and broader constructs related to health
the ability to experience failure or setbacks related to health goalssuch as lifestyle behaviors across other domains as well as physi-
with resilience; to remain content even in the face of challenges cal activity. Terry and Leary (2011) suggest a need to consider
or difficulties related to health behaviors; and to place increased self-compassion in relation to self-regulation and health as a
value on health behaviors based on the pursuit of enhancing ones broader construct, but at this time, no studies have been published
wellness rather than avoiding illness. Self-compassion could incorporating such variables.
lessen and negate the pressures from external sources, such as When current health disparities and unequal societal pres-
messages from the media about what it means to be beautiful or sures related to womens health are taken into account, the need
feminine, or criticism from partners, physicians, and friends. to consider demographic and cultural variables among women
Overall, the consideration of the relationship between womens and the potential impact on their health behaviors is further high-
view of self and engagement in healthy lifestyle behaviors, the lighted. Women have been identified as less active than men,
framework of positive health, and the construct of self- with minority women designated to be the least active population
compassion enables a focus on enhancement rather than reduc- (Center for Disease Control, 2007). These discrepancies cannot
tion; mind and body versus disease; and pursuit of health for be ignored. With such a host of barriers that women, and espe-
healths sake rather than prescriptions or prohibitions. cially minority women and women of lower socioeconomic back-
grounds may face, it is important to seize the opportunity to dis-
Healthy Lifestyle Behaviors cover a potential source of resilience and hope that the construct
Another area where further exploration is warranted is the in- of self-compassion offers in womens capacity to overcome ob-
tersection of self-compassion and wellness. Understanding why stacles to wellness.
or how a woman is able to engage in healthy lifestyle behaviors is
of paramount importance in a society where women often en- Implications
counter pressures to stay thin and to balance career, family, and Self-compassion, a new and exciting construct in the social
home, while national and global statistics reflect that overall sciences correlated with increased optimal functioning and well-
health appears to be worsening and health disparities increasing. ness, proves a promising area for future research and practice in
As mentioned earlier, the importance of lifestyle behaviors in the field of promotion and prevention in womens health. In a
promoting overall health has been well established. Across a va- time when health care costs are skyrocketing, preventable health
riety of health and psychological problems, lifestyle interventions problems such as obesity and diabetes are also on the rise, espe-
appear to be at least as effective as drug treatment (Blumenthal et cially among women. Empirical research and theoretical litera-
al., 2007; Dunn, Trivedi, Kampert, Clark, & Chambliss, 2005; ture support the notion that self-compassion may lead to positive
Gillies et al., 2008; Mather et al., 2002; Walsh, 2011). Exercise, health practices and increased wellness. More self-compassionate
diet, social support, recreation, stress management, and religious/ women are expected to be more motivated to engage in practices
spiritual involvement exemplify some of the domains that have that promote their own wellness, to bounce back more easily
been shown to contribute to ones physical and psychological from setbacks, to more effectively monitor and regulate their own
health (Walsh, 2011). Especially pertinent for women, physical health choices, to seek treatment and support when needed, and
exercise has been shown to significantly improve health problems to sustain a more accepting and appreciative attitude towards
and physical transitions related to hormonal changes, including their own bodies.
perceived ratings of pain and quality of life (Moriyama et al., Preliminary experimental findings, as mentioned earlier,
2008). Across cultures, research has demonstrated that healthy show that self-compassion can be improved. Such results warrant
lifestyles earlier in life can prevent and/or delay many chronic further research to investigate the intersection of self-compassion
health conditions in later life (Cicconetti et al., 2002). Physical and health in women, uncover the mechanisms of raising self-

Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 5, No. 1 19
Self-Compassion, Health, and Wellness in Women
compassion, and develop programs to support the utilization of
such training in health promotion and prevention for women.
Empirical studies may continue to illuminate strong relationships
between self-compassion and positive health practices, beliefs,
and attitudes. Further research is needed to demonstrate whether
this relationship might be causal, or whether raising self-
compassion will improve a womans ability to make better health
choices that will lead to increased wellness. As such experi-
mental studies continue to shed light on these and other effects of
self-compassion, self-compassion training may be incorporated
into counseling and health interventions for women.
Research also is needed to highlight specifics about how self
-compassion may be effectively improved in women long-term.
For example, how many training sessions of what length may re-
sult in long-lasting improved levels of self-compassion? Would
self-compassion training be more effective delivered in groups or
individually? What kind of training should be required for facili-
tators? These and many other questions need to be answered be-
fore self-compassion can be fully utilized as an effective and
trusted means to promote health and prevent disease among
women.
The existing research does suggest that self-compassion
training could be a cost-effective and brief intervention with little
to no risk for the women participating. An attractive characteris-
tic of self-compassion training would be the ease of delivery to
underserved and often overlooked populations in the community.
Self-compassion training could be easily provided to populations
of women who are at-risk or in greater need such as incarcerated,
impoverished, and homeless women, through services offered in
prisons or through community agencies such as the YWCA, chil-
drens and family services, or domestic violence agencies.
If self-compassion proves instrumental in choosing healthy
lifestyle behaviors, self-compassion training could potentially be
beneficial for any issue impacted by lifestyle. The possibilities
then are endless, and self-compassion training could positively
impact women experiencing a wide variety of obstacles to well-
ness, such as anxiety, depression, substance abuse, obesity, cardi-
ac disease, diabetes, parenting issues, gambling, and smoking ad-
diction, among others. Self-compassion could be integrated into
programs aimed at broader preventive efforts in womens health,
such as programs designed to improve inter-conception health for
women or even more general health initiatives designed to pre-
vent obesity or cardiac disease in women.
Mindfulness techniques and interventions have been empiri-
cally supported as effective in the treatment of many mental
health issues such as depression and anxiety. It is possible that
practicing counseling psychologists could incorporate self-
compassion training into their work with clients, similar to how
they may currently incorporate relaxation training, mindfulness
interventions, or other psychoeducation in therapy. Other possi-
ble applications of self-compassion training include populations
of women who are impacted by problems with body image and/or
disordered eating behaviors. Self-compassion training could en-
hance womens ability to accept their bodies, view their mistakes
with patience and gentleness, and have the clarity and motivation
to identify values and future goals. Additionally, self-
compassion training appears promising in the training and prac-
20 Prevention in Counseling Psychology: Theory, Research, Practice and Training, 2012, Vol. 5, No. 1
tice of counseling psychologists and other practitioners in the
helping professions for preventing burnout and improving self-
care.
Since initially being addressed in the field of counseling psy-
chology by Neff over ten years ago, the construct of self-
compassion has garnered a lot of attention and has been linked
across social, cognitive, and affective domains of functioning.
Maybe one reason self-compassion has captured the focus of
many researchers and practitioners alike in the field of counseling
psychology is its intuitive application to mental health and over-
all wellness. The characteristics of self-compassion involve a
forgiving and accepting stance toward oneself, a balanced experi-
ence of painful emotions, and a sense of connection to others
amidst difficult situations. When a woman holds a realistic and
adaptive view of self that is not dependent on social comparison
or situational success, she can be more resilient in the face of
hardships. When she appreciates and accepts her physical, psy-
chological, and emotional being as a whole, she is more inclined
to pursue activities and make choices that lead to wellness.
While more research is needed to fully examine the construct of
self-compassion and its implications for practice in counseling
psychology and health care in general, it appears to have great
potential to positively and meaningfully affect many aspects of
womens lives.
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