PREVENTION IN COUNSELING PSYCHOLOGY: - ResearchGate

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 Prevention 

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 


Associate Editor 

Cynthia A. Unger 


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, Research, 

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 combination 

of these topics. We welcome student submissions. As a publication of the Prevention Section of Division 17, presentations 

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 

Issue 1 

Section News 

PREVENTION IN 

COUNSELING PSYCHOLOGY 

Fall 

2012 

Message from the Chair 4 

Le’Roy 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 

Le’Roy 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 

nation’s 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 members 

of the Prevention Section and I want encourage active participation by our members. Andy’s leadership also represents 

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 Counseling 

Psychology: Theory, Research, Practice and Training published twice a year in February and July. As my predecessors 

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 committed 

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 APA’s 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! 


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 describe 

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 beliefs 

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 women’s physical and mental health and well-being. Implications for counseling psychologists 

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 15 th , 2012. 


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 17’s 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 communitywide 

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 (it’s free!). There are several 

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 year’s APA Convention went extremely well, and we’d 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, we’d like 

to congratulate those who received our section’s 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 prevention. 

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. Horne’s initiatives to 

create some exciting programs. Stay tuned for updates over the next several months, as I’m 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 don’t hesitate to contact me at ering@albany.edu. I can provide you with some more information 

at that time. Best of luck with the rest of the academic year, and I look forward to hearing from you! 



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 justice 

within the field of psychology are being given greater attention 

as more researchers, academics, and clinicians examine the 

influence of sociocultural contexts on individual well-being and 

human development (Bronfenbrenner, 2005; Evans, 2004; Greenleaf 

& Williams, 2009; Goodman et al., 2004; Hage & Kenny, 

2009; Kitchener & Anderson, 2011; Prilleltensky, 2008; Romano 

& Hage, 2000; Sue & Sue, 2013; Vera & Speight, 2003). A myriad 

of voices are actively critiquing the status quo of psychology’s 

individualistic and intrapsychic framework of intervention 

and formulating ways to meet the challenges of systemic and environmental 

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 Association’s (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 people’s rights and dignity, concern for other’s welfare, 

and social responsibility) (APA, 1992) were replaced with 

the current framework of five principles: beneficence and nonmaleficence, 

fidelity and responsibility, integrity, justice, and respect 

for people’s rights and dignity (APA, 2002). Through this 

Correspondence concerning this article should be 

directed to: 

Jonathan Kodet, M.S., University of Kentucky, Counseling 

Psychology Doctoral Student, 

j.kodet@uky.edu 

revision, one rarely discussed or recognized casualty was the concept 

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. Clark’s discussion of social 

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 obligations 

owed to individuals who are participants in professional 

relationships. With this definitional model of social responsibility 

in mind, Clark (1993) asserts that “[A]ll other ethical obligations 

are subordinate to it. As used here, social responsibility 

ethics is the delineation of psychology’s broadest overarching 

ethical imperative, and it involves the subordination of private 

and personal goals to the greater consideration of human welfare” 

(p. 313). 

The most significant references of social responsibility excluded 

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 effectively 

removed the only proactive reference supporting primary 

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 current 

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 generation 

of American psychologists and therefore has a normative 

function in influencing the identity of the profession of psychology. 

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 


Social Responsibility and Prevention in the APA 

of ethics document with an undisputedly strong social responsibility 

ethic. Likewise, both the American Counseling Association’s 

ethics code and the American Psychiatric Association’s 

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 

pages to the principle of social responsibility. 

In conclusion, the current General Principles within the 

APA’s Ethics Code do not carry the same explicit emphasis on 

the systemic sphere of influence and use of social epidemiological 

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 specialties 

calling for psychologists’ involvement in prevention and social 

justice advocacy, it is imperative that this incongruity be considered 

in future revisions of the APA Ethics Code. Social responsibility 

requires attention to prevention strategies and calls 

for psychologists to be involved in mitigating the causes of human 

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 principles 

would better reflect a prevention approach by reintegrating 

and expanding upon these concepts lost from the previous Principle 

F: Social Responsibility. 

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doi:10.1207/s15327019eb0303&4_6 

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Sage. 

Goodman, L. A., Liang, B., Helms, J. E., Latta, R. E., Sparks, E., 

& Weintraub, S. R. (2004). Training counseling psychologists 

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

rural Native American community 

Julie Clark 

Maria Aleksandrova-Howell 

Ashleigh Coser 


Lahoma Schultz 

Jake Roberts 

White Eagle Health Center 

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 master’s students and one Russian doctoral student. Based on the 

team’s 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 adolescents 

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. 


directed to: 

Julie Clark, Oklahoma State University, 434 Willard 

Hall, Stillwater, OK, 74078. Email: 

julz.dorton@okstate.edu 

It is well documented that Native Americans (NA) have a 

higher rate of marijuana, cocaine, and hallucinogen abuse compared 

to other minority groups (2010 NSDUH: Summary of National 

Findings, SAMHSA, CBHSQ). Native American adolescents 

report the highest rates of use compared to any other racial 

group and inhalant use among NA youth is consistently increasing 

(Johnston, O’Malley, Bachman, & Schulenberg, 2012). It is 

also common for Native communities to be located in geographically 

rural locations. Kast (2001) noted rural communities have 

advantages as well as disadvantages. A lack of employment opportunities 

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 rural, 

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 southwest 

state (Gray & Winterowd, 2002). 

Research has shown that aside from cultural and ethnic characteristics, 

adolescents with substance use and misuse issues generally 

benefit from prevention interventions (Catalano, Hawkins, 

Berglund, Pollard, & Arthur, 2002). Native American populations 

may generally be more receptive to holistic culturally 

grounded prevention measures as opposed to remediation 

measures based on the medical model (Baldwin, Johnson, & Benally, 

2009). Generally speaking, from the Native world viewpoint, 

wellness means balance and harmony with the environment 

and in relationships with oneself, other individuals, families, 

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 Native 

American communities, an element of creativity may be necessary 

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 services 

from a distance (Evidence-Based Practice for Telemental 

Health, 2009). Telemental health services have been used in a variety 

of ways (Simms, Gibson, & O’Donnell, 2011). Each telemental 

health experience has helped inform the use of telebehavioral 

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 


Tools for Prevention 

accessing health and education services due to limited personal 

and community resources which are influenced by geographical 

location (Gray & Winterowd, 2002; Kast, 2001). Therefore, approaching 

this project from a collaborative model was key in order 

to reach this rural population (Thomas, Donovan, Sigo, Austin, 

& 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 organization’s 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 proportions. 

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 creating 

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 individual 

tribes. Initial funds for this effort were authorized by Congress 

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 communities 

to further combat issues related to methamphetamine 

use and suicide (IHS, n.d.). 

Collaboratively the authors of this article were able to combine 

the resources of a small federally recognized tribe and a major 

university in the mid-central area of the United States to provide 

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 collaborative 

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 development 

of a three-year Methamphetamine and Suicide Prevention 

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 population 

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 residents 

report living at or below the poverty line and, among those 

46.3% are reported to be Native American, representing the highest 

percent of poverty across all ethnic minority groups in that 

county. 

Upon receiving notification of funding, the tribe hired a Psychologist/Behavioral 

Health Director (PBHD). The first six 

months of the three-year project were devoted to hiring a coordinator, 

planning activities, and meeting with other intra-tribal programs 

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 educational 

aspects of the project to the community. In order to plan 

and strategize the best methodology for implementing a telebehavioral 

health system the PBHD met with the tribe’s health 

center staff. Aside from ensuring the chosen poly-com system 

would be compatible with the health center’s technological system, 

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 tribe’s website. 

During this time the PBHD agreed to supervise the clinical 

work of two master’s 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 academic 

programs. The PBHD contacted the first author, a faculty 

member within the students’ academic programs, about collaborating 

with the tribe’s tele-behavioral health program endeavor 

utilizing the university’s poly-com system. Use of the university’s 

polycom system would allow the students and faculty member 

to provide telemental health services from two different campus 

locations. In order to address the needs of the community and 

utilize the MSPI funding, a group focusing on adolescent substance 

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 issues 

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 prevention 

through education about the historical, societal and cultural 

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 psychologists, 

two Native American master’s students and one Russian 

doctoral student, is an important factor when doing research 

and providing health services in Native communities (Baldwin, 

1999; Whitbeck, 2011). Whitbeck’s (2011) study showed that 

Euro-American centered prevention programs often ignore culturally 

specific protective components valuable to ethnic minority 

groups thereby losing the opportunity to utilize participants’ cultural 

strengths, values and ownership of moving towards wellness. 

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 healing 

practices, spirituality, along with cultural awareness and connectedness. 

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, family, 

peer, school, community, and societal levels (Hawkins, Cata- 



lano, & Miller, 1992). 

A holistic focus was desired given some of the historical attempts 

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 unresolved 

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 inhibit, 

substance use. They also wanted to encourage discussions 

related to group member’s positive sense of self-worth, ability to 

make good decisions, personal responsibility, and the ability to 

act independently of others (Beauvais & Trimble, 2003). Identified 

goals were to initiate conversations and activities related to 

communication skills, cultural identity, tribal affiliation, openness 

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 westernized 

interventions. 

Curricula 

The initial curriculum selected for use with this group was, 

“Through the Diamond Threshold: Promoting Cultural Competency 

in Understanding Native American Substance Misuse” 

(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 American 

community. This curriculum addresses familial use of substances, 

experiences of discrimination, and shame inducing stereotypes 

that may perpetuate various forms of oppression. It takes 

into account a cultural revitalization of the Native American population 

and its transition to healing, which may help redefine the 

foundation and nature of alcohol and drug problems. This curriculum 

addresses broad concepts that are unique to Native Americans 

specifically, but group facilitators observed the need to narrow 

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 substance 

use among Native Americans, basic education needed to 

take place about substance use in general. Worksheets were utilized 

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 addiction 

and abuse, myths about use, and abstaining from use. In order 

to begin exploring the broader concepts of racism, discrimination 

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 Municipal 

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 indicated 

they held 12 different tribal affiliations. While all participants 

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 typically 

serve in this type of role; however, this particular community 

recently experienced the death of a tribal member who was considered 

to be the last living elder. Elders are considered those 

who carry the knowledge, wisdom and stories of a tribe. More often 

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 university. 

The typical format was that the first author would introduce 

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 illustrating 

concepts on the dry erase board. Each member of the therapeutic 

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 utilizing 

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 research 

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 answers 

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 existence?” 

demonstrated that when the group started there were no 

participants (0%) who had any knowledge of these four main dimensions 

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. Answering 

the pre-test question, “What are some of the prevailing stereotypes 

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. Comparison 

of the pre and post-test answers to the question, “What 

are the benefits or problems of respecting, accepting, and honoring 

diversity?,” demonstrated that at the beginning of the group, 

only two participants had good insight to the benefits of respecting, 

accepting, and honoring diversity, but by the end of the sessions 

four out of eight participants (50%) responded with stated 

benefits, two (25%) responded with stated problems, and one 

(12%) participant responded, “I don’t know.” Furthermore, although 

all participants had personal insight to the question, “Why 

might Native American people create distance and remain alienated 

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 answers 

as “anger,” “fear of being made fun of,” and “cultural differences,” 

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 responded, 

“There may still be anger or bitterness,” referring to 

“cultural differences,” or, “personal differences,” and explained 

the distance by such statements as, “Because they make up stereotypes 

about us,” and “fear of death.” Finally, only one participant 

answered the pre-test question, “What is it about Native 

American ceremonies that help someone heal?” This person stated, 

“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 

prayers help us to heal.” Among other single responses there 

were such statements as “not sure” (12%), “they don’t 

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 participants 

(25%) said “no.” Seven participants (88%) enjoyed the topics 

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 don’t 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 response 

(12%). Participants reported that they liked “talking 

about stereotypes,” “communicating,” “how people were comfortable 

around each other,” “worksheets,” “everyone was friendly”, 

“it was easy to express myself,” and “I like to come here because 

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 don’t dislike anything” 

(three participants, 38%), “participating,” and 

“attending” (two participants, 25%). There were also such single 

responses as “I don’t 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 services 

to Native teens with varying backgrounds of use and reasons 

for attending the group. One of the main intentions of the 

group was prevention of adolescent substance misuse. In order to 

garner community participation the student group facilitators advertised 

counseling services to the community through health 

fairs, pow-wows, and tribal youth programs. While some members 

of the community may have initially expressed interest during 

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. Motivation, 

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 



therapy outcome. The team’s observations of the group demonstrated 

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 talking 

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 appropriate 

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 discuss 

unhealthy substance related behaviors, the consequences of 

such behaviors and explore healthy alternatives to such behaviors. 

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 experiences. 

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. Facilitators 

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 another’s 

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 program 

director, intake and screening forms were returned unanswered 

or with questions on intake forms and screeners left unanswered. 

Many parents were unresponsive when contacted for further 

information. According to Walls, Johnson, Whitbeck, & 

Hoyt (2006), parents and caretakers of Native American adolescents 

may prefer to see their children receiving informal and traditional 

help. It is possible that if parents knew that the curriculum 

was designed for Native Americans by Native Americans 

and that group facilitators were either Native American themselves 

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 professional 

help. The court-ordered group members seemed to be absent 

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 vocabulary 

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 providing 

a historical context to Native American adolescents growing 

up in communities or situations where substance misuse has affected 

them and/or their family functioning, a level of understanding 

and awareness will be created that may prevent the misuse 

of substances and thereby the resultant negative outcomes for 

future generations. 

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DOI:10.3109/10826084.2011.592438 



Self-compassion, health and wellness in women 

Julie Swagerty and Julie Koch 


Self-compassion, or maintaining an attitude of self-kindness and self-care in spite of failures, inadequacies, and painful experiences 

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 people’s 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 behavior, 

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 Human 

Services, 1996, 2001). Socioeconomic variables can often 

impact women’s access to important health-related resources 

such as fitness facilities, childcare, and fresh produce. Women 


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 women’s health. 

When considering women’s 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). Today’s 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 average 

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 pressure, 

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 societal 

standards for women often impact a woman’s view of herself 

and contribute to the many obstacles she may face in making 

healthy choices that promote well-being. The prevalence of critical 

health issues that impact women today, such as obesity and 

depression, and the impact of a woman’s 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, 

434 Willard Hall, Stillwater, OK, 74078. Julie.swagerty@okstate.edu 

Self-Compassion 

An alternative self-construct. In exploring women’s view 

of self, the construct of self-compassion currently offers an alter- 


Self-Compassion, Health, and Wellness in Women 

native way to conceptualize a healthy way of relating to one’s 

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 selfacceptance. 

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). Selfcompassion, 

as described by Neff (2003a), involves “being open 

to and moved by one’s own suffering, experiencing feelings of 

caring and kindness toward oneself, taking an understanding, 

nonjudgmental attitude toward one’s inadequacies and failures, 

and recognizing that one’s experience is part of the common human 

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 

one’s imperfect and at times, painful, existence as related to the 

human experience in general versus as in isolation; and mindfulness, 

or maintaining a balanced awareness of thoughts and feelings 

rather than getting carried away with one’s emotions or evaluations. 

Framework for conceptualizing the self: Self-compassion 

versus self-esteem. An adaptive attitude towards oneself proves 

potentially relevant in examining contributing factors toward participation 

in healthy lifestyle behaviors. While self-esteem has 

already been identified as significant in engagement in healthy 

behaviors (Mosca, McGillen, & Rubenfire, 1998), selfcompassion 

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 one’s 

view of self. High self-esteem has been linked to negative outcomes 

such as narcissism and self-centeredness (Baumeister, 

Bushman, & Campbell, 2000; Neff 2003a; Neff 2003b). Selfcompassion, 

on the other hand, appears to relate to many of the 

same psychological benefits of self-esteem, but proves a bit hardier 

as a construct. Self-compassion does not hinge on performance 

evaluations or social comparisons and so does not relate to 

the need to maintain an unrealistically positive view of self. Theoretically, 

self-compassion should be easier to improve than selfesteem 

because it does not involve the need to maintain an unrealistic 

view of self (Neff, 2003a). The very appeal of self-esteem 

lies in its capacity to motivate actions aimed to reduce dissonance 

among a person’s ideal and actual self (Rosenberg, 1979) and the 

fact that it is “not unconditional” (Kaplan, 1995). Yet, selfcompassion 

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 one’s worth as a living 

being. The idea is that when one can promote a stance of selfkindness 

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 construct 

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 exceed 

or measure up to standards imposed by self, others, or societal 

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 relationship 

among women’s view of self and healthy lifestyle behaviors, 

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 contingent 

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 developed 

(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 wellbeing 

(Neely, Schallert, Mohammed, Roberts, & Chen, 2009), 

being positively associated with psychological traits such as optimism 

and happiness (Neff, Rude, & Kirkpatrick, 2007), and negatively 

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 regulation, 

self-compassion has been linked to emotional intelligence 

(Neff 2003a), approach coping strategies (Neff, Hsieh, & Dejitterat, 

2005), and decreased reactivity to imagined distress and negative 

feedback (Leary, Tate, Adams, Allen, & Hancock, 2007). 

Self-compassion has been found to negatively correlate with rumination, 

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 selfacceptance 

(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 selfcompassion 

in relation to many relevant domains of functioning, 

the question of whether self-compassion can be raised among individuals 

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 practice 

through implementation of self-compassion training programs 

(Gilbert & Proctor, 2003; Shapiro, Brown, & Biegel, 

2007) and researchers are showing interest in exploring selfcompassion 

from an experimental perspective (e.g., Leary, Tate, 

Adams, Allen, & Hancock, 2007). Other more established therapeutic 

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. 



Self-Compassion and Health 

While few studies related to self-compassion and health have 

been published to date, researchers have recently identified a theoretical 

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 selfcompassion 

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 

one’s own health and well-being and is associated with higher 

levels of motivation to make needed changes in one’s 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 standards 

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 essential 

in improving women’s exercise experience and psychological 

well-being. Self-compassion fits well as a construct to 

utilize in this process of investigating women’s attitudes toward 

self in relation to their health behaviors. Overall health and wellbeing 

is most fully pursued and achieved by individuals who engage 

in healthy behaviors out of a sense of kindness and compassion 

toward self that has to do simply with being human, not out 

of a desire to obtain a particular state of fitness or an externallyreinforced 

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 lifestyle 

behaviors and self-compassion: “Adopting healthpromoting 

behaviours as a lifestyle component is an expression 

of the human tendency to actualize and is directed at elevating individual 

well-being, self-actualisation and personal fulfillment” 

(p. 191). In looking at what may impact women’s lifestyle 

behaviors and the benefits of healthy behaviors, the attribute of 

self-compassion provides an appropriate and useful lens to examine 

women’s view of self. 

Though much of the work to date representing the intersection 

of self-compassion and health is largely theoretical, two 

studies have been published related to self-compassion and women’s 

health. Both studies look at specific health behaviors, exercise 

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 selfcompassion 

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 contributing 

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 

restrictive eater and with eating as a means to cope with and regulate 

emotions can be targeted and decreased by fostering selfcompassion. 

Authors of the study suggest that helping people 

make dietary choices in a less rigid way and react in more adaptive 

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 disappointment 

or mistake. 

Magnus, McHugh, and Kowalski (2010) provide further support 

for uncovering the relationship between women’s view of 

self and health behaviors, specifically exercise. Neff (2009) addresses 

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 themselves 

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 physique 

anxiety over and above self-esteem. Findings supported 

this hypothesis: In many areas, self-compassion explained a significant 

amount of variance over and above self-esteem (goal orientation, 

self-determination, and social physique anxiety). Researchers 

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 selfregulation 

and goal orientations. 

Framework for conceptualizing health: Positive versus 

medical model. The emergence of self-compassion as an alternative 

to self-esteem in considering women’s health was discussed 

earlier. In further exploring theory related to women’s 

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 Pender’s Health Promotion Model (1987), Pender defines 

health-promoting behavior as “an expression of the human 

actualizing tendency” and “directed toward sustaining or increasing 

the individual’s 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 one’s 

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 Pender’s revised 

version of the Health Promotion Model (2002), she emphasizes 

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). 



Advantages to a positive health framework over a medical 

model in exploring women’s health are many. The focus on disease 

and pathology fosters a narrow and impersonal quality of 

health care. A positive health perspective entails a more integrative 

and holistic approach in all aspects of health ranging from 

prevention and promotion to treatment. In taking a negativistic 

approach to health more representative of the medical model, 

health-related prevention efforts are prohibitive in nature and 

consist of identifying poor health behaviors that should be avoided. 

Alternatively, a positive health orientation involves the promotion 

of behaviors and lifestyles that enhance wellness. A positive 

health framework is empowering, collaborative, holistic, and 

strengths-based. 

Pender’s Health Promotion Model (Pender et al., 2006) 

makes apparent the connection between a woman’s selfcompassion, 

or attitude of self-kindness and non-judgment in 

light of her inadequacies and failures, and her engagement in 

healthy lifestyle behaviors. Self-compassion could provide one 

the ability to experience failure or setbacks related to health goals 

with resilience; to remain content even in the face of challenges 

or difficulties related to health behaviors; and to place increased 

value on health behaviors based on the pursuit of enhancing one’s 

wellness rather than avoiding illness. Self-compassion could 

lessen and negate the pressures from external sources, such as 

messages from the media about what it means to be beautiful or 

feminine, or criticism from partners, physicians, and friends. 

Overall, the consideration of the relationship between women’s 

view of self and engagement in healthy lifestyle behaviors, the 

framework of positive health, and the construct of selfcompassion 

enables a focus on enhancement rather than reduction; 

mind and body versus disease; and pursuit of health for 

health’s sake rather than prescriptions or prohibitions. 

Healthy Lifestyle Behaviors 

Another area where further exploration is warranted is the intersection 

of self-compassion and wellness. Understanding why 

or how a woman is able to engage in healthy lifestyle behaviors is 

of paramount importance in a society where women often encounter 

pressures to stay thin and to balance career, family, and 

home, while national and global statistics reflect that overall 

health appears to be worsening and health disparities increasing. 

As mentioned earlier, the importance of lifestyle behaviors in 

promoting overall health has been well established. Across a variety 

of health and psychological problems, lifestyle interventions 

appear to be at least as effective as drug treatment (Blumenthal et 

al., 2007; Dunn, Trivedi, Kampert, Clark, & Chambliss, 2005; 

Gillies et al., 2008; Mather et al., 2002; Walsh, 2011). Exercise, 

diet, social support, recreation, stress management, and religious/ 

spiritual involvement exemplify some of the domains that have 

been shown to contribute to one’s physical and psychological 

health (Walsh, 2011). Especially pertinent for women, physical 

exercise has been shown to significantly improve health problems 

and physical transitions related to hormonal changes, including 

perceived ratings of pain and quality of life (Moriyama et al., 

2008). Across cultures, research has demonstrated that healthy 

lifestyles earlier in life can prevent and/or delay many chronic 

health conditions in later life (Cicconetti et al., 2002). Physical 

activity by itself has demonstrated positive benefits across many 

facets of wellness including physical health, disease risk reduction, 

life satisfaction, cognitive functioning, and psychological 

well-being (Carek, Laibstain, & Carek, 2011). By exploring the 

connection among women’s view of self and participation in 

healthy behaviors, mechanisms factoring into maintaining 

healthy lifestyles among women may be more closely considered 

and understood. 

Gaps in the Literature 

While many researchers have identified the potential value 

of the construct of self-compassion in relation to health, only two 

empirical studies have been published to date directly exploring 

the relationship between self-compassion and health behavior. 

While Magnus et al. (2010) examined the relationship between 

self-compassion, exercise, and self-determined motivation among 

women, there is a need to further consider the relationship between 

self-compassion and broader constructs related to health 

such as lifestyle behaviors across other domains as well as physical 

activity. Terry and Leary (2011) suggest a need to consider 

self-compassion in relation to self-regulation and health as a 

broader construct, but at this time, no studies have been published 

incorporating such variables. 

When current health disparities and unequal societal pressures 

related to women’s health are taken into account, the need 

to consider demographic and cultural variables among women 

and the potential impact on their health behaviors is further highlighted. 

Women have been identified as less active than men, 

with minority women designated to be the least active population 

(Center for Disease Control, 2007). These discrepancies cannot 

be ignored. With such a host of barriers that women, and especially 

minority women and women of lower socioeconomic backgrounds 

may face, it is important to seize the opportunity to discover 

a potential source of resilience and hope that the construct 

of self-compassion offers in women’s capacity to overcome obstacles 

to wellness. 

Implications 

Self-compassion, a new and exciting construct in the social 

sciences correlated with increased optimal functioning and wellness, 

proves a promising area for future research and practice in 

the field of promotion and prevention in women’s health. In a 

time when health care costs are skyrocketing, preventable health 

problems such as obesity and diabetes are also on the rise, especially 

among women. Empirical research and theoretical literature 

support the notion that self-compassion may lead to positive 

health practices and increased wellness. More self-compassionate 

women are expected to be more motivated to engage in practices 

that promote their own wellness, to bounce back more easily 

from setbacks, to more effectively monitor and regulate their own 

health choices, to seek treatment and support when needed, and 

to sustain a more accepting and appreciative attitude towards 

their own bodies. 

Preliminary experimental findings, as mentioned earlier, 

show that self-compassion can be improved. Such results warrant 

further research to investigate the intersection of self-compassion 

and health in women, uncover the mechanisms of raising self- 



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 selfcompassion 

will improve a woman’s ability to make better health 

choices that will lead to increased wellness. As such experimental 

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 result 

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 facilitators? 

These and many other questions need to be answered before 

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 characteristic 

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, children’s 

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 wellness, 

such as anxiety, depression, substance abuse, obesity, cardiac 

disease, diabetes, parenting issues, gambling, and smoking addiction, 

among others. Self-compassion could be integrated into 

programs aimed at broader preventive efforts in women’s health, 

such as programs designed to improve inter-conception health for 

women or even more general health initiatives designed to prevent 

obesity or cardiac disease in women. 

Mindfulness techniques and interventions have been empirically 

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 selfcompassion 

training into their work with clients, similar to how 

they may currently incorporate relaxation training, mindfulness 

interventions, or other psychoeducation in therapy. Other possible 

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 enhance 

women’s 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, selfcompassion 

training appears promising in the training and practice 

of counseling psychologists and other practitioners in the 

helping professions for preventing burnout and improving selfcare. 

Since initially being addressed in the field of counseling psychology 

by Neff over ten years ago, the construct of selfcompassion 

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 overall 

wellness. The characteristics of self-compassion involve a 

forgiving and accepting stance toward oneself, a balanced experience 

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, psychological, 

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 

women’s lives. 

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