Date of Award

Summer 8-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Counseling & Human Services

Program/Concentration

Counseling

Committee Director

Jeff Moe

Committee Member

Emily Goodman-Scott

Committee Member

Yonghee Suh

Abstract

The scope of practice for Licensed Professional Counselors (LPCs) and counseling residents (LPC-R) in integrated behavioral health (IBH) settings is grounded in accredited, theory-informed education and training. The benefits of IBH models are well-documented, however there is limited research that addresses how counselors develop professionally and clinically function, while navigating within pediatric inpatient environments. This qualitative dissertation used a focused ethnographic design to explore the lived experiences of ten purposively sampled counselors (n = 10) through demographic surveys, field observation, and semi-structured interviews. Reflexive journaling bracketed researcher bias, and thematic analysis, supported by NVivo and new member checking, guided interpretation.

Participants described navigating systemic and relational complexities, including fragmented supervision, shifting leadership, and marginalization within medical hierarchies. Simultaneously, they found meaning through peer consultation, collaborative teams, and witnessing patient and family system progress. Eight themes emerged: notable events, professional identity, conflict dynamics, collaboration, team cohesion, power imbalance, cultural relations, and continuous improvement.

Findings highlight how cultural dynamics, interdisciplinary relationships, and counselor voice shape clinical identity, therapeutic practice and ethical decision-making. This study emphasizes the need for experiential training, context-specific supervision, and mentorship within high-acuity counseling. Implications extend to counselor education, quality clinical supervision, and interdisciplinary workforce development to support the advancement of integrated care for vulnerable child and adolescent populations.

Rights

In Copyright. URI: http://rightsstatements.org/vocab/InC/1.0/ This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s).

DOI

10.25777/a98s-br03

ISBN

9798293843572

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