Ethical Practice in a Diverse World:
The Challenges of Working with Differences in the Psychological
Treatment of College Student-Athletes
Mary Jo Loughran
Edward F. Etzel
West Virginia University
Edward F. Etzel
Collegiate student-athletes are a unique population when compared to both college nonathletes and athletes of other ages and levels of competition. Psychologists who work in this milieu must be thoroughly familiar with the developmental, academic and lifestyle issues that these young people generally face and must be prepared to intervene appropriately and ethically. Although attending to the factors that unify college athletes is important, it is equally critical for psychologists to be knowledgeable about potential differences among and between collegiate athletes. These differences may be visible (e.g., ethnicity, gender) or less visible (e.g., socioeconomic status, disability status, religion/spirituality, and sexual orientation). Ethical challenges that may arise in treatment when considering the differences between athletes are explored. Recommendations are made regarding resolution of potential dilemmas. Most notable among these are education and consultation.
Ethical challenges and dilemmas are facts of life in any helping profession and sport psychology is certainly no exception. Etzel and Watson (2007) argued that ethical decision making in sport psychology can be especially challenging due to several factors, including the varied background of practitioners in this area (psychology vs. kinesiology/movement science), as well as the sometimes nontraditional format of sport psychology consulting (location, time, and duration of sessions).
Several published reports have explored various aspects of ethical decision making in sport psychology practice. Brown and Cogan (2006) identified confidentiality, diagnosis and third-party billing, maintenance of boundaries, and competence as four areas of potential ethical dilemmas specific to work with athletes. Moore (2003) also included informed consent and termination issues as topics for consideration in the discussion of sport psychology ethics. These investigations have relevance and applicability across settings ranging from youth sport programs to the Olympic and professional ranks. The collegiate athletic setting, however, is unique in several ways and thus warrants a discussion of ethical issues particular to that milieu. Although certainly similarities exist between both student-athletes and athletes outside the academic realm, as well as between student-athletes and non-athlete students, this discussion will be limited to the challenges occurring within the collegiate athletic venue.
In addition to the above-mentioned consulting and psychotherapeutic issues that pose potential ethical dilemmas for sport consultants, there are several other areas of professional practice that may challenge the consultant’s ethical practice of applied sport psychology with college athletes. Multicultural competence is one such area that has not been frequently discussed in this context. Collegiate athletics is a world in which participants hail from every conceivable ethnic and demographic background. Student-athletes may represent the most diverse student group on campus, at least in terms of racial composition. For example, African-American students comprise 12.7 percent of the national student body (Journal of Blacks in Higher Education, 2007), but make up 20.6 percent, 18.1 percent, and 7.3 percent of Division I, II, and III athletes, respectively (Lapchick, 2006). Consequently, effective ethical intervention with collegiate athlete clients requires a thorough understanding of the potential interplay between cultural background and psychological variables. Knapp and VandeCreek (2007) explored the need to incorporate the client’s cultural context when attempting to resolve ethical dilemmas. They argued in favor of an approach called “soft universalism.” This approach to ethical decision making advocates an overall adherence to universal values while at the same time respecting culture-specific expressions of norms. In other words, practitioners should attempt to uphold the universal ethical principles of autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity (Meara, Schmidt, & Day, 1996), while at the same time being cognizant of variations among cultural standards that may alter the appropriate course of action for a given client.
Loughran (in press) suggested that the world of collegiate athletics functions as a cultural entity, complete with its own language, norms, and values. Similar to the professional arena, team uniforms and other university-identified apparel worn by athletes are one example of the outward expression of an athletic department’s culture. Likewise, team members are expected to conform to norms of behavior established and enforced by the coaches and administrators. It is incumbent upon the practitioner who works within the culture of collegiate athletics to become familiar with these norms and their idiosyncratic expression in order to maximize ethical practice and decision making.
To date, investigations of ethical issues specific to work with the collegiate athlete have been sparse (Watson & Etzel, 2004). Although the sport psychology literature has numerous treatments of ethical decision making, the application of the ethical principles specifically within the collegiate athletic environment have been far less prevalent. Further, the issue of diversity as it relates to professional ethics is a topic that has received even less exploration in the literature. This paper attempts to fill this gap in the literature and explores the potential ethical dilemmas that arise in work with collegiate athletes with a particular emphasis on issues of diversity. Differences that are readily identifiable such as race and gender are explored, as well as those differences that are less visible such as socioeconomic status, disability status, religious/spiritual affiliation, and sexual orientation. Ethical decision making is explored within the context of the university athletic culture. For the sake of consistency, the term consultant will be used throughout the paper in reference to any professional providing psychological or mental health services to the collegiate athlete.
Consultants who provide treatment to college student athletes must be knowledgeable about the stressors unique to this population, as well as those facing all young people in this age range. Student athletes tend to underutilize available counseling resources (Watson, 2006) despite data suggesting that the levels of psychological distress they may experience approximates the levels found in the non-athlete population (Broughton, 2001). Researchers have explored the barriers to help-seeking behavior faced by the student athlete (Watson, 2006) and have identified internal factors, such as a need to be “strong” and “self-sufficient” (Ferrante, Etzel, & Lantz, 1996), as well as external factors, such as the lack of available counselors knowledgeable about student-athletes, time limitations, and some discouragement from seeking help outside the athletics system (Brooks, Etzel, & Ostrow, 1987). The past several years have seen recent progress in removing some of the stigma associated with seeking psychological services. One positive development recently is that several university athletic departments have hired psychologists to work strictly with their student-athletes to provide both performance enhancement and personal counseling services (Winerman, 2005). The presence of a psychologist on the athletic department staff certainly sends the message to the student-athlete that the university supports their psychological and emotional, as well as their physical, health. It is fair to say, however, that despite these recent gains, more work remains to be done to remove the stigma of receiving psychological care.
College and university students, athlete or not, seek psychological services for a variety of issues ranging from homesickness and career indecision to serious psychological disturbances. Benton, Robertson, Tseng, Newton, and Benton (2003) documented what has long been suspected among providers of psychological services to college students; namely, that the presenting concerns of this population have become more complex and more severe in recent years. Their data indicated relative constancy over a thirteen year period in the frequency of less severe presenting concerns (e.g., developmental issues, situational emotional concerns, and academic skill difficulties). However, during the same time period, frequency rates of more serious concerns (e.g., relationships, stress/anxiety, family issues, physical problems, personality disorders, suicidal thoughts, and sexual assault) significantly increased by approximately twofold (Benton, et. al., 2003; Kadison & DiGeronimo, 2004). In addition to these problem areas, other health concerns that are commonly experienced by college athletes may include eating disorders, substance abuse, and training underrecovery (Etzel, Watson, Visek, & Maniar, 2006). The NCAA has recently recognized the pervasiveness of these problems in student-athletes and has begun to take some action (Hosick, 2005).
Collegiate athletes appear to confront the same developmental tasks and situational stressors encountered by non-athlete students. Therefore it can be assumed that they are not immune from the psychological risks typical of this phase of life. However, collegiate athletes do carry the added burden of sport participation, and consequently face unique risk factors not shared by their non-athlete peers. Pinkerton, Hinz, and Barrow (1989) reviewed the literature and identified common presenting concerns of collegiate student-athletes, including fear of success, identity conflict, social isolation, poor athletic performance, academic problems, and career/vocational concerns. Additionally, Selby, Weinstein, and Bird (1990) observed that sport-related injuries, alcohol abuse, and body image issues are significant concerns for collegiate athletes. While this literature is somewhat dated, these issues continue to be significant in the lives of today’s student-athletes.
Another factor that renders the collegiate athlete a unique consumer of psychological services is the atypical manner by which he or she may come into treatment. Similar to their non-athlete peers, self-referrals are quite common, as well as referrals by parents, friends, intimates, and faculty members. On the other hand, student athletes may also be referred to a consultant by coaches, athletic trainers, sports medicine physicians, athletic department administrators, and other professionals involved in the athlete’s life linked to their sport participation; all or many of these persons may be aware of the referral. This illustrates the often public nature of the student athlete’s life and the lack of or limited privacy afforded to those who participate in intercollegiate athletics. The potentially ensuing compromises to the student-athlete’s private life raises the prospect of the common ethical dilemma of confidentiality violation. The consultant engaged in providing services to college athletes must be aware of this risk and other ethical issues that often arise in treating this population.
Ethical issues confronting the consultants working with college athletes take on added importance when paired with the demands of practicing with individuals from diverse backgrounds and the issues they often face (Berg-Cross & Pak, 2006). LaRoche and Maxie (2003) argued that counseling professionals need to equip themselves with the proper tools to deal effectively with the changing composition of the U.S. population. As an example of the need for broad understanding of multicultural issues, they cited the 2000 Census statistic indicating that 25% of the U.S. population is classified as “minority” and that this percentage appears to be growing exponentially (LaRoche & Maxie, 2003).
The challenges of working with college students from differing backgrounds are well-documented (Berg-Cross & Pak, 2006). Besides the differences that are visible such as ethnicity and gender, consultants must also be able to sensitively and effectively address differences that are not readily observable, such as socioeconomic status, religious/spiritual affiliation, sexual orientation, and disability status. The remainder of this paper will address the ethical challenges that may arise when psychologists work with collegiate athletes around any or all of these differences.
Visible Differences: Ethnicity and Gender
Ethnicity. Student-athletes may represent the most diverse population on some campuses. In 2004-2005, the NCAA reported the following distribution of racial/ethnic make-up of all Division I, II, and III intercollegiate athletes: African-American males (17.2%), African-American females (10.2%); Hispanic males (3.3%), Hispanic females (2.7%); Asian males (1.3%), Asian females (1.7%); and Caucasian males (70.4%), Caucasian females (77%) (Vicente, 2006). These data indicate that 29.6% of male athletes and 23% of female athletes are non-White, non-European-American. Membership in an ethnic minority group is a factor that may contribute to the student athlete’s decision not to seek psychological services. Indeed, African-American individuals tend to underutilize mental health services (Diala, Muntaner, Walrath, Nickerson, LaVeist, & Leaf, 2000) and to terminate from using those services prematurely (Watkins & Terrell, 1988). Similarly, individuals from Asian cultures as well as Latino/Latina backgrounds tend to use alternative sources for psychological/mental health support and are far less likely than European Americans to seek formal counseling (Kimerling & Baumrind, 2005; Paris, Anez, Bedregal, Andres-Hyman, & Davidson, 2005; Wynaden, Chapman, Orb, McGowan, Zeeman, & Yeak, 2005). Several reasons have been cited in the literature for the disparities in utilization of counseling resources for ethnic minorities. These include the lack of ethnically similar counselors (Atkinson & Lowe, 1995; Pope-Davis & Coleman, 1997), failures in cultural sensitivity on the part of the practitioners (Diala et. al., 2000), and cultural values that encourage suspicion of “other” (Bailey, 1987; Ho, 1992).
For the consultant practicing in a collegiate athletic setting, the disparities along ethnic lines in the utilization (and underutilization) of counseling services bring to light an ethical issue regarding competence. A large scale survey of its members conducted by the American Psychological Association revealed that the majority of psychologists, sport psychologists not excluded, rated themselves as most competent to treat European Americans, despite the concurrent finding that many respondents reported having a caseload with diverse ethnic composition (Allison, Crawford, Echemendia, Robinson, & Knepp, 1994). Given the aforementioned incidence of minority group participation in college athletics, it is incumbent upon the ethical consultant to take steps toward remediating any knowledge and counseling skill deficits that may hinder competent service delivery to members of any member of an ethnic minority group.
Within the cultural context of collegiate athletics, where the values of conformity and subjugation of individual differences are prominent, the challenge for the consultant working with athletes with ethnic minority membership may come in the form of engendering a reputation for trustworthiness that is gained through a knowledge of the struggles of non-dominant culture members. This is of particular importance when the consultant is a member of the dominant ethnic culture. Similarly, when working with dominant culture members, the consultant must be sensitive to the athlete’s underlying attitudes and beliefs about race and ethnicity that may be the result of his or her prior experiences (or lack thereof in many cases) with teammates from other ethnic backgrounds.
The American Psychological Association has published a set of therapeutic recommendations for psychologists working with ethnic minority clients (Association of Black Psychologists, 2003). This document was jointly prepared by four ethnic minority professional psychological associations, including the Asian American Psychological Association (AAPA), the Association of Black Psychologists (ABPsi), the National Latina/o Psychological Association (NLPA), and the Society of Indian Psychologists (SIP). The authors of this booklet caution its readers against the belief that reading it will provide sufficient background to work effectively with all ethnic minority clients. At the same time, however, the information presented in that document contains a thorough introduction to the awareness, knowledge, and skills that are necessary for psychologists to begin to understand the context of their ethnic minority clients.
Gender. Another area of focus for consultants providing care to college athletes is gender. APA Division 17 has provided guidelines on how to best work with female clients (Fitzgerald & Nutt, 1986). The advent of Title IX has seen increasing numbers of women participating in intercollegiate athletics over the past 30 years. Nonetheless, disparities remain, both in the numbers of female athletes as well as in the resources devoted to women’s athletic programs by colleges and universities. Although they comprise 52% of the general population, women comprise only 44% of NCAA Division I athletes. Rather recent data indicate that at Division I institutions, the average number of male athletes surpass the number of female athletes by 266 to 210 (NCAA, 2003). However, between 1981 and 2004 there was a 29% overall increase in men and a remarkable 150% increase in women NCAA-affiliated student-athletes (NCAA, 2006). Despite the gains made in the number of female athletes involved in collegiate athletics, there continue to be stressors faced by women competitors that do not burden their male counterparts (e.g., sexism, risk of sexual assault, pregnancy). Adams, Schmitke, and Franklin (2005) argued that the world of athletics in the U.S. continues to be the most male identified and male dominated dominion of any institution with the possible exception of the military. Further, an examination of the NCAA’s Gender Equity Report suggests that women athletes do not usually have a female role model in the position of head coach (NCAA, 2006). Although women coaches are more plentiful today than ever, there continues to be a significant gender gap in the collegiate coaching ranks. The most recent data available indicate that in 2002-03, 543 women’s teams were coached by men compared to only 318 women’s teams coached by women (NCAA, 2003).
One ethical issue confronting consultants working with male and female student athletes is the mandate that practitioners be knowledgeable about gender oppression issues and their impact upon the work they do with their clients. It is safe to say that this may be challenging to the consultant in light of the athletic culture’s strong valuing of stereotypically male-identified characteristics of strength and domination over more female stereotypes of emotionality and caretaking. Further, consultants have a responsibility to identify overt as well as covert gender oppression and to work as best they can toward empowering the student athletes in their care.
Gender oppression manifests differently for males and females. Unlike men, women athletes face a major challenge in reconciling the potentially conflicting role demands of athleticism and femininity. Progress in this struggle often involves female athletes resolving gender role conflict by assuming and prizing more masculine aspects of their identity. Young and Bursik (2000) reported that female athletes were more likely to experience a more masculine self-concept, which not surprisingly was related to higher levels of self-esteem and identity achievement. Further evidence of progress was reported by Miller and Levy (1996) who compared female athletes with non-athletes and found no difference in the degree of gender role conflict between those two groups.
For male student athletes, gender oppression may take the form of hesitance to seek needed psychological assistance for fear of being seen as weak by self and significant others. Martin (2005) reported that a sample of male high school and college athletes expressed a more prominent stigma than their female counterparts toward seeking the services of a sport psychologist. The ethical responsibility of the consultant is to work toward removing the stigma of help seeking via education of referring sources, including coaches, training staff, and athletes themselves. Unfortunately, this is not an easy task to undertake in a milieu that does not readily change, particularly in light of the athletic cultures’ espoused values of self-reliance, physical and mental toughness, and avoidance of help seeking outside of the athletic system.
Less Visible Differences: Socioeconomic Status, Disability Status, Religion/Spirituality, and Sexual Orientation
In addition to the considerable challenges associated with providing competent and ethical psychological treatment to student athletes who vary in ethnic origin and gender, there also are pertinent issues resulting from differences between individuals that are not readily visible. Among the more salient issues with the potential to have an impact on psychological functioning are socioeconomic status, disability status, religion/spirituality, and sexual orientation.
Socioeconomic Status. The NCAA does not collect data on the socioeconomic status of its participating collegiate athletes. Although related, socioeconomic status and ethnicity are separate complex factors that require independent examination, particularly when applied to the area of psychological treatment issues in collegiate athletics. For example, Humara (1999) cited the literature to support his conclusion that socioeconomic status is a stronger predictor of aggression than is ethnicity.
The collegiate athlete hailing from the lower socioeconomic strata may face increased stress associated with the financial burdens related to college attendance in comparison to his or her teammates from middle and upper class backgrounds. For example, travel costs may prohibit the athlete from visiting home during breaks and likewise may preclude the athlete’s family members from traveling to competitions.
The culture of collegiate athletics may inadvertently contribute to the difficulties endured by the athlete from a lower socioeconomic background. Requirements such as dress codes for travel and public relations activities may place an undue financial burden on the athlete and his/her family. The consultant needs to be aware of these stressors and may intervene by providing feedback to the coaches and administrators about possibly providing affordable alternatives to the athlete.
Disability Status. Similar to socioeconomic status, no data are available concerning the prevalence of disabilities among collegiate student-athletes. However, there is substantial evidence in the literature to document the existence of learning disabilities (Clark & Parette, 2002), psychiatric disabilities (Storch, Storch, Killiany, & Roberti, 2005) and other possible physical limitations (e.g., hearing impairment; post injury mobility) in this population.
Issues of confidentiality may come into conflict with coordination of care, resulting in an ethical dilemma for the consultant providing care to the student-athlete with a disability. For example, if the student-athlete does not wish the disability to be disclosed to coaches, athletic trainers, or team physicians, the consultant may be hampered in her or his effort to refer the student-athlete for medication or ancillary academic support services (e.g., testing) or disability services.
Another common issue that arises in the examination of disabilities in collegiate athletes is the impact of multiple mild traumatic brain injuries (MTBI, aka “concussions”) on psychological and academic functioning. Collins and his colleagues (Collins, et. al., 1999) documented the relationship between learning disabilities, repeated MTBIs, and subsequent neuropsychological impairment in a sample of collegiate athletes. Understandably, the student athlete may be hesitant to disclose a concussive episode for fear of reduced playing time or potential removal from the team. If the consultant becomes aware of a potential head injury via disclosure from the athlete, there is a resultant ethical dilemma engendered in the competing demands between the paramount consideration given to the student’s safety and the client’s right to confidentiality in the treatment relationship. In these cases, the consultant should be encouraged to educate the client about the potential health risks of keeping a medical condition from the coaching and athletic training staff. Of course, in these cases, the consultant must also take care to ensure that the student-athlete is receiving the appropriate medical care and should make medical and neuropsychological referrals accordingly. If the practitioner becomes convinced that the student’s safety is at risk with continued athletic participation, disclosure of the condition against the wishes of the client may be warranted. Prior consultation with a trusted colleague would be recommended in this case to ensure that all other alternatives have been sufficiently explored.
Psychiatric disabilities are another area of concern for the ethical consultant. Psychologists, counselors and other non-prescribers must work together with physicians and other medical professionals toward the best interest of the growing number of student-athletes who are taking some type(s) of psychotropic medication (Schwartz, 2006). APA’s ethical code directs psychologists to cooperate with other professionals for this purpose (American Psychological Association, 2008).
Most notably, the athlete may disclose that he or she is taking psychotropic medications, but does not wish this information to be shared with the coaching staff or sports medicine professionals. Such information may be vital to the trainers and others involved in the athlete’s medical care. In cases like these, the consultant will need to respect the confidentiality of the athlete, while at the same time encouraging him or her to disclose this information to selected individuals.
Similarly, there may arise in the course of providing treatment to an athlete the need to refer him or her for psychiatric evaluation to assess the potential benefits of medication. Some psychotropic medications have side effects that can potentially interfere with athletic performance (e.g., weight gain, fatigue, concentration difficulties, etc.). Discussing psychotropic medication use may put the consultant into direct conflict with the athletic culture’s strong emphasis on performance at all costs. It may also be at odds with other personal factors linked to a reluctance to the notion that medication can be useful to an athlete client (Kamm, 2000). Again, the consultant’s ethical mandate in this circumstance is to make treatment decisions with the best interest of the client in mind. Education of the athletic staff about psychiatric disabilities may be a helpful aid in this regard.
Religion/Spirituality. Although anecdotal evidence suggests that numerous student-athletes are quite religious and or spiritual, the NCAA keeps no statistics regarding collegiate athletes’ religious or spiritual affiliation or practices. Storch, Kolsky, Silvestri, and Storch (2001) recently conducted a pilot study in an attempt to ascertain the religious participation of college athletes in comparison to their non-athlete peers. Religiosity in their study was defined as a function of participation in public and private religious observances as well as their perception of the role played by their religious beliefs in their lives. The results of their survey suggest that the athletes surveyed were mildly to moderately “religious,” (i.e., defined by the authors as occasional attendance at religious services and as a modest role for intrinsic religious beliefs in one’s life). They also reported that athletes were more religious in comparison to their nonathlete counterparts.
Displays of religiosity, Christianity in particular, are fairly pervasive in the athletic environment. Even non-religious and/or non-Christian athletes may feel significant pressure to conform to the perceived norm promoted by an athletics program or their particular team. The relative popularity of several national organizations devoted to ministry in collegiate athletics provides further evidence of the need for awareness by psychologists about this issue. On its website, the organization known as “Athletes in Action” claims a presence on 125 college campuses across the U.S. (Athletes in Action, 2006). Similarly, the Fellowship of Christian Athletes reports having over 495 collegiate affiliations (Fellowship of Christian Athletes, 2007).
DeBerg (2002) cautioned that athlete participation in religious-centered activities may appear on the surface to be voluntary, but can be perceived by the athlete to be mandatory, particularly if a pro-religion coach is in attendance at the activity. If an athlete’s religion or spirituality is at odds with the predominant affiliation of one’s teammates and coaches, the athlete may feel compelled to hide his or her beliefs or to feign agreement with the dominant culture. For example, a non-Christian athlete may be offended or feel alienated or at least uncomfortable when a Christian pre-game or pre-banquet team prayer is required.
The consultant working with a student-athlete who is experiencing pressure or alienation as a result of his or her religious/spiritual affiliation or practices faces several ethical dilemmas. Encouraging the athlete to defy an implicit or explicit directive from the coach may be in the client’s best interest in terms of psychological health. However, encouragement of such may also result in the diminishment of the athlete’s status on the part of the team or in the eyes of the coach. It is the consultant’s responsibility to be attuned to the cultural milieu of the athletic department and to avoid placing the athlete into a situation in which his or her best interests are not being served. Of course, the consultant also has the responsibility to examine if and how her/his own religious/spiritual beliefs factor into such situations and to ensure that she/he exerts no undue influence in treatment decisions.
Sexual Orientation. In general, college age clients appear to be more inclined today than in the past to address issues associated with sexual identity with psychologists/consultants (Cohen, 2006). However, perhaps more so than any other demographic or descriptive characteristic, accurate data regarding the percentage of individuals with sexual minority status in collegiate athletics is very difficult to obtain. Homophobia in the athletic world is well documented (Jacobson, 2002; Muska, 2000) and most likely serves as a deterrent to the collegiate athlete who may wish to disclose a gay, lesbian, bisexual, or questioning identity. Wolf-Wendel, Toma and Morphew (2001) conducted a series of on-campus focus groups in which they explored the perceptions of gay men and lesbians in college athletics. The results of their inquiry revealed that sexual orientation remains a controversial issue that is sometimes regarded with open hostility among some athletes, coaches, and administrators.
Homophobia also may inhibit the gay, lesbian, bisexual, or questioning athlete from seeking needed psychological consultation, particularly if the treatment provider is allied with the university’s athletic department. The ethical dilemma inherent in treating the gay, lesbian, bisexual, or questioning student athlete lies in the possible conflicting demands between promoting the client’s identity exploration and possible disclosing (i.e., “coming out”), and recognizing that doing so may put the client’s status on the team at risk. On the one hand, the consultant may wish to support an inclination for disclosure to facilitate the development of a healthy adjustment as well as a social support network. On the other hand, the consultant treating student athletes must be aware of the risks associated with such a disclosure in an environment that is often openly hostile to members of the sexual minority community and should proceed with care. Of course, the practitioner also must explore what internal biases he or she brings to the consultation and must take care not to operate from a position of prejudice or ignorance.
Sensitivity to differences, both visible and invisible, is a prerequisite to competent practice for consultants engaged in the provision of care to today’s college student athletes. Ethical dilemmas that arise in the treatment of this population can be resolved for the most part by the practitioner who is aware of the numerous ethical challenges that are typical of this milieu. Dilemmas that unfortunately do arise in the treatment of this population can be resolved if the practitioner takes care to abide by the ethical codes of conduct put forth by the American Psychological Association (APA) and the Association for Applied Sport Psychology (AASP). This process also should include self-evaluation to explore personal beliefs and potential prejudices held by the practitioner toward members of non-dominant culture. It is recommended that consultants regularly seek continued education, consultation, and peer supervision with seasoned colleagues to ensure that personal attitudes do not interfere with professional conduct. Nevertheless, practitioners who work with college student-athletes, especially those closely aligned with athletic departments, may often face ethical challenges in their practice. It is incumbent upon these professionals to anticipate potential dilemmas and to be proactive in seeking optimal resolutions.
The above-mentioned remedies of education, consultation, and self-evaluation are only a partial solution to the problem of disparities in care among student-athletes from differing backgrounds. Additionally, systematic research needs to be conducted to more fully understand the scope of the problems facing student-athletes from all avenues of non-dominant culture as well as to identify and evaluate the efficacy of interventions geared toward all members of the student-athlete population, regardless of background characteristics. Ideally, this research would address the fundamental conflict facing consultants between adhering to ethical behavior and bowing to external demands for performance from the student-athlete.
Adams, N., Schmitke, A., & Franklin, A. (2005). Tomboys, dykes, and girly girls: interrogating the subjectivities of adolescent female athletes. Women’s Studies Quarterly, 33(1/2), 17-34.
Allison, K., Crawford, I., Echemendia, R., Robinson, L., & Knepp, D. (1994). Human diversity and professional competence. American Psychologist, 49, 792-796.
American Psychological Association (2008). Ethical principles of psychologists and code of conduct. Retrieved February, 2008 from http://www.apa.org/ethics/code2002.html#3_09
Association of Black Psychologists (2003). Psychological treatment of ethnic minority populations. Retrieved September, 2007 from http://www.apa.org/pi/oema/programs/empa_ptemp.pdf.
Athletes in Action (2006). Vision & Direction for the Future: Annual Report 2006. Retrieved September 26, 2007 from the Athletes in Action website: http://www.aia.com/about/Annual%20Report%202006.pdf
Atkinson, D. & Lowe, S. (1995). The role of ethnicity, cultural knowledge, and conventional techniques in counseling and psychotherapy. In J. Ponterotto, J. Casas, L. Suzuki, & C. Alexander (Eds.), Handbook of multicultural counseling. Thousand Oaks, CA: Sage.
Bailey, E. J. (1987). Sociocultural factors and health care seeking behaviors among Black Americans. Journal of the American Medical Association, 79, 389-392.
Benton, S. A., Robertson, J. M., Tseng, W.-C., Newton, F. B., Benton, S. L. (2003). Changes in Counseling Center Client Problems Across 13 Years. Professional Psychology: Research and Practice, 34(1), 66-72.
Berg-Cross, L., & Pak, V. (2006). Diversity issues. In P. Grayson & P. Meilman, (Eds.), College mental health practice (153-172). New York: Routledge.
Brooks, D. D., Etzel, E. F., & Ostrow, A. C. (1987). Job responsibilities and backgrounds of NCAA Division I athletic advisors and counselors. The Sport Psychologist, 1, 201-207.
Broughton, E. (2001). Counseling and support services for college student athletes. Paper presented at the Annual Conference of the American College Personnel Association, Boston, MA March 3-7, 2001.
Brown, J., & Cogan, K. (2006). Ethical clinical practice and sport psychology: When two worlds collide. Ethics and Behavior, 16, 15-24.
Clark, M. & Parette, P. (2002). Student athletes with learning disabilities: A model for effective supports. College Student Journal, 36(1), 47-62.
Cohen, K. (2006). Sexual concerns. In P. Grayson & P. Meilman, (Eds.), College mental health practice, (pp. 215-237). New York: Routledge.
Collins, M. W. PhD; Grindel, S. H. MD; Lovell, M. R., Dede, D. E. , Moser, D. J. Phalin, B. R., Nogle, S., Wasik, M., Cordry, D., Daugherty, M. K., Sears, S. F., Nicolette, G., Indelicato, P., & McKeag, D. B. (1999). Relationship between concussion and neuropsychological performance in college football players. Journal of the American Medical Association, 282(10), 964-970.
DeBerg, B. A. (2002). Athletes and religion on campus. Peer Review, 4(4), 10-12.
Diala, C. Muntaner, C., Walrath, C., Nickerson, K. J., LaVeist, T. A. & Leaf, P. J. (2000) Racial differences in attitudes toward professional mental health care and in the use of services. American Journal of Orthopsychiatry, 70(4), 455-464.
Etzel, E. F., & Watson, J. C. (2006). Ethics in sport and exercise psychology. Ethics & Behavior, 16, 1-3.
Etzel, E., & Watson, J. (2007) Ethical challenges for psychological consultations in intercollegiate athletics. Journal of Clinical Sport Psychology, 1, 304-317.
Etzel, E., Watson, J. Visek, A., & Maniar, S. (2006). Understanding and promoting college student-athlete health: Essential issues for student affairs professionals. National Association of Student Personnel Administrators (NASPA) Journal, 43(3), Art. 9. Retrieved February 25, 2008 from http://publications.naspa.org/naspajournal/vol43/8ss3/art9.
Fellowship of Christian Athletes (2007). Organization website: http://www.fca.org/ Retrieved September 26, 2007.
Ferrante, A., Etzel, E. F., & Lantz, C. (1996). Counseling college student-athletes: The problem, the need. In E. F Etzel, A. Ferrante, & J. Pinkney. (Eds.), Counseling college student-athletes: Issues and interventions (2nd ed.), (pp. 3-26). Morgantown, WV: Fitness Information Technology.
Fitzgerald, L.F., & Nutt, R. (1986). The Division 17 principles concerning the counseling/psychotherapy of women: Rationale and implementation. The Counseling Psychologist, 14, 180-216.
Ho, M. K. (1992). Differential application of treatment modalities with Asian- American youth. In L. A. Vargas & J. D. Koss-Chroniro, (Eds.), Working with Culture. San Francisco: Jossey-Bass.
Hosick, M.B. (February, 2005). Forum places psychological focus on mental health issues. The NCAA News, Retrieved May 16, 2007 from http://www1.ncaa.org/membership/ed_outreach/health- safety/forummentalhealthpdf.pdf
Humara, M. (1999). The relationship between athletics, Hispanics, and aggression. Athletic Insight, 1(1). Retrieved February 25, 2008 from http://www.athleticinsight.com/Vol1Iss1/Hispanic_Aggression.htm
Jacobson, J. (2002). The loneliest athletes. Chronicle of Higher Education, 49(10), 33- 34.
Journal of Blacks in Higher Education (2007). States with the most African-American college students. Weekly Bulletin, Retrieved June 27, 2008 from http://www.jbhe.com/latest/index082307.html
Kadison, R., & DiGeronimo, T. (2004). College of the overwhelmed. San Francisco: Jossey-Bass.
Kamm, R. L. (2000). The sport psychiatry examination. In D. Begel & R. Burton (Eds.), Sport psychiatry, (pp. 159-190). New York: W.W. Norton.
Kimerling, R. & Baumrind, N. (2005) Access to specialty mental health services among women in California. Psychiatric Services. 56(6), 729-734.
Knapp, S. & VandeCreek, L. (2007). When values of different cultures conflict: Ethical Decision making in a multicultural context. Professional Psychology: Research and Practice, 38, 660-666.
Lapchick, R. (2006). The 2005 racial and gender report card: College sports. Retrieved June 27, 2008 from http://www.tidesport.org/RGRC/2005/2005_Racial_Gener_Report_Card_college.pdf.
LaRoche, M. J. & Maxie, A. (2003). Ten considerations in addressing cultural differences in psychotherapy. Professional Psychology: Research and Practice, 34(2), 180-186.
Loughran, M.J. (in press). Counseling the Gay, Lesbian, Bisexual, Transgendered, and Questioning (GLBTQ) student athlete: Issues and intervention strategies. In Etzel, E. F. (in press), Counseling College Student Athletes: Issues and Interventions (3rd Edition), Morgantown, WV: Fitness Information Technologies, Inc.
Martin, S. B. (2005). High school and college athletes' attitudes toward sport psychology consulting. Journal of Applied Sport Psychology; 17(2), 127-139.
Meara, N. M., Schmidt, L. D., & Day, J. D. (1996). Principles and virtues: A foundation for ethical decisions, policies, and character. The Counseling Psychologist, 24, 4-77.
Miller, J. L., & Levy, G. D. (1996). Gender role conflict, gender-typed characteristics, self-concepts, and sport socialization in female athletes and nonathletes. Sex Roles, 35 (1/2), 111-122.
Moore, Z. (2003). Ethical dilemmas in sport psychology: Discussion and recommendations for practice. Professional Psychology: Research and Practice, 34(6), 601 – 610.
Muska (2000). Fighting homophobia in college athletics. Chronicle of Higher Education, 47, 10-12.
NCAA (2006). 2003-2004 NCAA Gender Equity Report. Retrieved November 6, 2007 from the NCAA website http://www.ncaa.org.
NCAA (2003). 2001-2002 NCAA Gender Equity Report. Retrieved November 6, 2007 from the NCAA website http://www.ncaa.org.
Paris, M., Anez, L. M., Bedregal, L. E., Andres-Hyman, R. C., & Davidson, L. (2005). Help seeking and satisfaction among Latinas: The role of setting, ethnic identity, and therapeutic alliance. Journal of Community Psychology, 33(3), 219-312.
Pinkerton, R. S., Hinz, L. D., & Barrow, J. C. (1989). The college student-athlete: Psychological considerations and interventions. Journal of American College Health, 37(5), 218 – 226.
Pope-Davis, D. B., & Coleman, H. L. K. (1997). Multicultural counseling competencies: Assessment, education and training, and supervision. Thousand Oaks, CA: Sage Publishing.
Schwartz, A. J. (2006). Are college students more disturbed today? Stability in the acuity and qualitative character of psychopathology of college counseling center clients: 1992-1993 through 2001-2002. Journal of American College Health, 54(6), 327-337.
Selby, R., Weinstein, H. M., & Bird, T. S. (1990). The health of university athletes: Attitudes, behaviors, and stressors. Journal of American College Health, 39(1), 11-18.
Storch, E. A., Kolsky, A. R., Silvestri, S. M., & Storch, J. B. (2001). Religiosity of elite collegiate athletes. The Sport Psychologist, 15, 346-351.
Storch, E. A., Storch, J. B., Killiany, E. M., & Roberti, J. W. (2005). Self-reported psychopathology in athletes: A comparison of intercollegiate student-athletes and non-athletes. Journal of Sport Behavior, 28(1), 86-98.
Vicente, R. (2006). Race & Ethnicity: 1999 – 00 – 2004-05 NCAA Student-Athlete Race and Ethnicity Report. Retrieved October 8, 2007 from http://www.ncaa.org/library/research/ethnicity_report/2004-05/2004-05_race_ethnicity_report.pdf .
Watkins, C. E., & Terrell, F. (1988). Mistrust level and its effects on counseling expectations in black-white counselor relationships: An analogue study. Journal of Counseling Psychology, 35(2), 194-197.
Watson, J. C. (2006). Student-athletes and counseling: Factors influencing the decision to seek counseling services. College Student Journal, 40(1), 35-42.
Watson, J.C., & Etzel, E.F. (2004). Ethical issues affecting psychologists’, counselors’ and sport psychology consultants’ work with collegiate student-athletes. Professional Studies Review,1, 49-60.
Winerman, L. (2005). Psychology in the stadium. APA Monitor, 36(4), 50.
Wolf-Wendel, L. E., Toma, J. D., & Morphew, C. C. (2001). How much difference is too much difference? Perceptions of gay men and lesbians in intercollegiate athletics. Journal of College Student Development, 42(5), 465-479.
Wynaden, D., Chapman, R., Orb, A., McGowan, S., Zeeman, Z., Yeak, S. (2005). Factors that influence Asian communities' access to mental health care. International Journal of Mental Health Nursing. 14(2), 88-95.
Young, J., & Bursik, K. (2000). Identity development and life plan maturity: A comparison of women athletes and nonathletes. Sex Roles. 43(3-4), 241-254.