A “growing noble profession”, a “magician”, or an “emotional trash can”: an interview study of Bhutanese school counselors’ perceived challenges and resources

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However, little is known about school counseling services in the Kingdom of Bhutan. This study carried out 28 qualitative semi-structured interviews with school counselors, 19 online and 9 in-person, to investigate school counselors’ perceived challenges and resources. The data were analyzed using a phenomenological approach to inquiry and thematic analysis of interviews proposed by Braun and Clarke ( 2006 ). The identified challenges and resources were grouped for further analysis according to Martin et al. ( 2015 ) model of 11 factors affecting school counseling. The most often mentioned challenges were insufficient resources to cope with rising mental health needs (28; 100%) and cultural barriers to implementation of school counseling (26; 92.9%) such as stigma and role of corporal punishment. The most often mentioned resources were the importance of material resources such as having a separate counseling room within the school (n = 16; 57.1%) and the importance of support from external professionals such as clinical counselors (n = 11; 39.3%). In sum, the results revealed the needs for (1) more resources to cope with the various mental health needs of students across regions, (2) more awareness in the general population about school counseling, including overcoming stigma towards mental health, (3) to systemize stakeholder collaboration such that it make school counselor roles more clear, and (4) for more time for this profession to establish itself in the Kingdom. school counseling school-based mental health Bhutan interviews thematic analysis Figures Figure 1 Figure 2 Figure 3 Introduction The school counseling profession was introduced in Bhutan in 2011. Today, there are around 200 school counselors in Bhutan, serving about 600 schools (Ministry of Education and Skills Development, 2023 ). Bhutanese school counselors must reckon with numerous challenges threatening the mental health of children and youth. These include bullying in schools (UNICEF Bhutan, 2016 ), increasing school drop-out rates (Rapten, 2014), changing family structures as a result of globalization (Phuntsho, 2017 ), high youth unemployment (Harrison, 2021; Lester et al., 2020 ; Norbu, 2021 ) and rises in cases of substance abuse (Lorelle & Guth, 2013 ) and suicidal behaviors (Dema et al., 2019 ; The World Bank, 2024 ; World Health Organization, 2017 , 2022 ). As such, their work is crucial and timely, especially following the mental health toll of the COVID-19 pandemic as a result of strict nationwide lockdowns (Namgyel & Milbert, 2021 ; Tsheten et al., 2023 ) compounded with a lack of mental health facilities for children and youth (Nirola et al., 2015 ; Sacra, 2017 ; World Health Organization, 2022 ). However, very little information is available about their perceived challenges and resources that affect their work. School Counseling Research School counseling literature has highlighted different factors that affect school counseling services around the world. These may include how school counseling is organized, such as around a specific school counseling framework or program (Foss-Kelly et al., 2021 ; Goodman-Scott et al., 2022 ), how school counseling is directed, such as through specific policies (Camilleri-Zahra, 2021 ), or how school counseling is affected by cultural factors, such as the role of spirituality (Cobb, 2021 ; Stevens & Ritten, 2022 ). Investigating these factors is important as quantitative studies have shown that such factors can influence school counselors’ job satisfaction and job stress. In one study of 103 school counselors in the United States, it was found that job satisfaction was positively associated with the availability of school counseling programs, which provided administrative support, facilitated communication with stakeholders, and allowed sufficient time for program planning and evaluation (Pyne, 2011 ). In another study of 227 school counselors in the United States, it was found that job stress was positively associated with paperwork requirements, caseload size, and having to deal with activities described as inappropriate for school counselors by the American School Counseling Association (ASCA) (e.g., performing disciplinary actions, supervising common areas) (ASCA, 2019a ). Conversely, lower levels of job stress were associated with positive professional relationships and more adequate training (McCarthy et al., 2010 ). Understanding these factors is important as school counselors are prone to burnout (Moyer, 2011 ), that is, the experience of physical, behavioral, and emotional state of exhaustion as a result of their work conditions (Freudenberger, 1974 ). Burnout not only affects school counselors but can also spill over to the entire school and, in turn, impact students’ mental health if school counselors are unable to attend to students’ needs (Holman & Grubbs, 2018 ; Maslach & Leiter, 2017 ). Burnout can also increase the likelihood of school counselors quitting (Kim & Lambie, 2018; Mullen & Gutierrez, 2016). Qualitative studies, such as those employing interview methods, provide in depth and nuanced understanding of factors that affect school counseling services. This is evidenced in research such as on perceptions of supervision experiences in an interview of seven school counselors in the United States (Gillen et al., 2024 ), or to understand self-care practices in a study of 15 school counselors in Turkey (Şimşir Gökalp, 2022 ) or of perceived preparedness and efficacy in a study of 12 school counselors in Australia (Quigley & Hyde, 2023 ). In countries in East Asia, where school counseling has a much shorter history (Larran & Hein, 2024 ), interview studies have revealed for instance the need for a more systematic, collaborative model for working with other school staff, as was found in an interview study of 11 school counselors in Malaysia (Kok, 2013 ). Additional studies have found evidence for the need for role clarity including a common understanding and shared expectations of the role of the school counselor, such as clear definitions of confidentiality, as was found in a study of nine school counselors in Singapore (Lim & Wong, 2018 ), the need for more supervision as was found in a study of 14 school counselors in Singapore (Tan & Chou, 2018 ) and the issue of stigma around mental health as was found in a study of four school counselors in Sri Lanka (Jayawardena & Gamage, 2022 ). However, little research is available from many countries in the Global South, such as in Bhutan, where school counseling was recently implemented. School Counseling Research in Bhutan The Kingdom of Bhutan is a mountainous, Buddhist country located in the Himalayas with a population of just over 754,000 (United Nations, 2019). It is known for its unique economic and political philosophy of Gross National Happiness (GNH) used as a measurement of national sustainable development and well-being influenced by Buddhist philosophy instead of traditional metrics, such as the Gross Domestic Product (GDP) (Ura et al., 2012 ; Wangchhuk, 2008 ). Secluded from the world stage until 1961 (Wangchhuk, 2008 ), recent modernization has confronted the kingdom with economic, political, and social changes that are thought to have negative consequences for youth (Dema et al., 2019 ; Lester et al., 2020 ; Norbu, 2021 ; Phuntsho, 2017 ; World Health Organization, 2022 ). In response to these challenges, the Kingdom of Bhutan established the professions of clinical counseling, substance abuse counseling, and school guidance counseling (Dem & Busch, 2018 ). The first quantitative, online survey study of Bhutanese school counseling (source withheld for blinded peer review), reached 161 of the 174 school counselors active at the time, investigating their demographic characteristics, daily activities, roles and responsibilities and perceived challenges and resources. Results revealed the role of stigma around mental health as a significant barrier to help-seeking, school counselors need for various resources such as a counseling room, the need for more clearly defined roles and responsibilities, and the need for schools to make sure there is sufficient time and opportunities for students to go see the school counselor in confidence. In addition, results revealed the role of the COVID-19 pandemic as both a curse and a blessing for the school counseling profession. While moving counseling online in a country with sometimes insufficient infrastructure was a challenge, the pandemic also put the spotlight on the importance of mental health and the need for counseling services during times of crisis. To our knowledge, only two interview studies provide qualitative data on school counseling in the Kingdom. In their narrative interview study of four, first-generation Bhutanese school counselors, Dem and Busch ( 2018 ) were able to provide a first account of the challenges they face. These include role confusion, high workload, insufficient preparation, and lack of support mechanisms such as adequate supervision and the resulting threat of burnout. They further mentioned skepticism and a lack of support from school stakeholders, including schoolteachers and school principals, who view school counseling services as mere advice giving or a disciplinary measure while simultaneously having high expectations about counseling, such as providing immediate solutions to students. In addition, in an interview study by Jamtsho ( 2017 ), four of the participants, teachers with school counseling training, also reported that their school colleagues did not support them or understand the preventive value of school counseling services and merely saw school counseling as a disciplinary measure. In sum, what little information exists suggests that Bhutanese school counselors face a number of challenges that need to be further investigated. Qualitative data from a large, representative sample of school counselors would provide a more thorough and in-depth understanding of the different, perceived challenges they are facing and the resources that support them. The Martin et al. ( 2015 ) Model of Factors influencing School Counseling Services School counseling is implemented differently across different countries, and these differences can be due to various factors. To facilitate comparison across studies and between countries, Martin et al. ( 2015 ) developed a model of factors related to the development and practice of school counseling. To this end, literature from 25 different countries was analyzed, and a model of 11 contextual factors that shape school counseling was developed. These factors are: 1) “Cultural Factors”, 2) “National Needs”, 3) “Larger Societal Movements”, 4) “Models of School Counseling”, 5) “Laws and Educational Policy”, 6) “Characteristics of the Public Education System”, 7) “The Counseling Profession”, 8) “Research and Evaluation”, 9) “Related Professions”, 10) “Community Organizations or NGO Coalitions”, and 11) “Local Stakeholder Perceptions”. In one study of school counseling in Barbados (Griffin, 2019 ), all 11 factors were investigated in an ethnographic study of five school counselors. The themes that emerged from the analysis were found to align with the model namely, helped to provide a deeper understanding of school counseling and served to inform policy and practice (Griffin, 2019 ). Study Aims The first Bhutanese school counselors assumed their positions over ten years ago. However, how school counselors experience their work remains underexplored. Thus, this study sought to answer the question: what are Bhutanese school counselors’ perceived challenges and resources? To answer this question, the present study conducted semi-structured interviews with Bhutanese school counselors and analyzed the resulting data using Martin et al. ( 2015 ) 11-factor model of school counseling. Such data could inform school counseling policy in Bhutan and international research on school counseling. Methods Design In order to better understand school counselors’ challenges and resources from their perspective, the present study used qualitative research methods, namely semi-structured interviews, to allow for a nuanced understanding of school guidance counseling in Bhutan methods (Creswell & Creswell, 2017 ). Qualitative research refers to the collection and analysis of nonnumerical data and is especially appropriate to investigate research subjects that are underexplored (Creswell & Creswell, 2017 ; Ponterotto, 2010 ). The focus of qualitative research in this study is on counselors’ perceptions and experiences of school counseling and the way they make sense of their profession. Interview methods are believed to be especially suitable for studies that describe human experiences of a phenomenon (Morris, 2015) such as the experiences of psychotherapists and counselors (McLeod, 2000 ). This way, participants have the opportunity to voice their own opinions and thoughts regarding their perceived challenges and resources and allow for unanticipated ideas to emerge (Creswell & Creswell, 2017 ). Sample Twenty-eight school counselors were interviewed for this study, including 15 female and 13 male participants, of which 19 were from day schools and nine from boarding schools from across the country. Their level of counseling experience ranged from one year to ten years. Of these 28, 19 were interviewed online, and nine were interviewed in person. Criteria for participation in the study was being a certified school counselor in Bhutan registered at the Division for Youth and Sports (DYS) of the Ministry of Education and Skills Development (MoESD). Demographic information about the sample can be found in Table I, and a map of the distribution of interview participants throughout the Kingdom of Bhutan can be found in Figure I. Table I Summary of demographic data of participants (n = 28) n % Interview Participation Format in-person 9 32.1 online 19 67.9 Gender female male 15 53.6 13 46.4 School Type day school boarding school 19 67.9 9 32.1 School Level primary school lower secondary school middle secondary school higher secondary school central school 1 3.6 4 14.3 10 35.7 6 21.4 7 25.0 Work Experience ( M = 5 years) 1 year 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 2 7.1 1 2.6 10 35.7 0 0.0 4 14.3 0 0.0 4 14.3 2 7.1 2 7.1 1 2.6 Note: The Bhutanese education system is categorized into three stages after primary school: lower secondary school, middle secondary school, and higher secondary school. Central schools are schools established since 2014 that integrate all school levels and are located in in areas in need of education facilities ( Dukpa, 2021 ). Figure I Map of the distribution of school counselors who participated in the interview. (GISGeography, 2023 ) The provisional goal for this study was to interview at least 26 school counselors across Bhutan with an even distribution of male and female school counselors and school counselors from day schools and from boarding schools. Similar studies investigating school counseling also using qualitative methods have obtained relevant results such as Şimşir Gökalp ( 2022 ) who interviewed 15 school counselors in Turkey, Kok and Low ( 2017 ) who interviewed 12 school counselors in Malaysia, and Reupert et al. ( 2022 ) who interviewed 12 school psychologists in Australia. However, sample size recommendations, particularly for interview-based qualitative studies, vary between six (Morse, 1995 ) and 25 (Creswell & Creswell, 2017 ) participants to reach saturation, understood as the point at which a data set is considered complete, as indicated by data replication or redundancy (Marshall et al., 2013 ). That is why the final sample of 28 participants was deemed sufficient. Materials An individual, semi-structured interview format was used for data collection, namely, all interview questions were asked in the same order while allowing for a more open discussion than is possible with structured interviews. The interview was guided by an interview protocol designed according to recommendations by Creswell and Creswell ( 2017 ). The researcher designed the interview questions considering the cultural context of Bhutanese school counseling and, since school counseling is in an emerging phase in Bhutan, questions in the schedule were designed to be exploratory in nature and were developed according to a review of the literature on school counseling, in accordance with the research question and with Martin et al. ( 2015 ) model. The resulting interview protocol consisted of nine open-ended questions, including how adequately school counselors felt their training prepared them for their role as a school counselor, how they perceive the collaborative work with students, school staff, and parents, what barriers stop them from engaging in their role as a school counselor, what resources support them and what resources are lacking, how school counseling services fit or do not fit in Bhutanese culture and finally how they were affected by the COVID-19 pandemic. In addition, those with over five years of experience were also asked whether they felt the profession had changed over time and how the profession might further change in the next five years. Finally, all participants were asked at the end of the interview if there was anything else they would like to add that was not mentioned yet. A copy of the interview protocol can be found in the Appendices. Procedure This study was approved by the ethics committee of the University, supported by the MoESD, and performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki. Active or passive consent was sought from relevant school authorities, including the Dzongkha Education Officer of each of Bhutan’s 20 regions, or “Dzongkhas”, and the school principal of the counselor’s school. Before the interviews, the interview protocol was reviewed by the DYS to make sure that the questions were appropriate and understandable then piloted with one school counselor. Both gave their approval of the interview protocol and confirmed that the questions were understandable and appropriate, including their order and the way that they were formulated. The interviews took place in August and September 2022. Purposive sampling was used to recruit participants in that all school counselors were contacted by email to request their participation. School counselors who agreed to be contacted about the interview received an e-mail with date, time and location suggestions (online or in person) to conduct the interview. Once the meeting was determined, participants were asked to be interviewed in a quiet setting free of disturbances and to allow for about one hour of uninterrupted time. All participants were sent a copy of the consent form prior to their interview and were asked to sign it either before or after the interview. The consent form indicated informed consent, an understanding of confidentiality, and an understanding of the role of the primary investigator (PI). Participants were further informed of the voluntary nature of the study, that they could refuse to answer specific questions if they did not want to and were allowed to withdraw from the study at any time. Participants were not sent a copy of the interview questions prior to the interview to guarantee consistency in the interview procedure, namely that none of the school counselors knew of the questions before participating in the interview. Just before beginning the interview, participants were reminded again that they would be recorded and that the PI would be taking notes during the interview (Creswell & Creswell, 2017 ). It was anticipated that the interviews would last no longer than one hour but, in the end, ranged between 00:37 minutes and 1:36:00 hours ( M = 00:53) depending on the participant’s experience and willingness to share their experiences. At the end of the interview each participant was gifted with a book on school-based mental health. All interviews were audio-recorded using the recording and audio editing software Audacity then later transcribed using the transcription software Trint. Analysis This study was grounded in hermeneutic phenomenology as outlined by Moustakas ( 1994 ). This method focuses on a population’s common experience of a phenomenon, here the school counseling profession, to reduce individual experiences of the phenomenon and reach the “universal essence” (Creswell & Poth, 2016 , p. 76) of the experience of it for all individuals which the researcher can then describe. The researcher pays special attention to distancing themselves from their own experiences of the phenomenon, or bracketing, when analyzing and describing it. This approach to inquiry was chosen because it is suited for investigating the shared experience of a phenomenon shared by several individuals, ideally five to 25 (Polkinghorne, 1989 ), to understand their common experience to inform practice and policy (Creswell & Poth, 2016 , p. 76). Coding is the process of designating or categorizing text from interview data in order to help interpret the data and uncover themes (Gibbs, 2007 ). Because of the open-ended nature of the research question, thematic analysis (Braun and Clarke ( 2006 ) was used. Thematic analysis is a method used to identify themes in the data, namely similar responses, which form a pattern and capture meaning that is relevant to the research question in a consistent and systematic way. In keeping with this paradigm, the researchers’ roles and their lived experiences were acknowledged as playing an active role in the presentation and interpretation of data. That is why the research endeavored wherever possible to let the data speak for itself, namely allowing for the different perspectives of the participants to be compared and contrasted and for expected and unexpected yet relevant inferences to be uncovered (Nowell et al., 2017 ). After transcription of the interviews, the PI carried out the six phases of thematic analysis outlined by Braun and Clarke ( 2006 ) to analyze the resulting data namely (1) taking time to know the data well, during which the PI immersed themselves in the data, reviewing and rereading the interviews to become familiar with the data, making notes where necessary and actively looking for meanings and patterns relevant to the present study’s research question, (2) identifying codes during which initial codes are created, making sure to be inclusive and using broad initial definitions for these codes, (3) finding themes during which the codes found were organized into overarching themes, (4) reviewing the themes during which the themes are reviewed for coherence and correctness and make sure that they are distinct from each other, (5) labeling the themes during which definitions are developed for each theme, and (6) creating the report during which the themes are reported in narrative form, with interview extract examples in quotations to provide rich textual description. The Martin et al. ( 2015 ) model of 11 school counseling factors was used to guide the thematic analysis of the data using a deductive approach, where the data is analyzed according to theoretical or analytical interest. Any theme mentioned in the interviews was coded as per the model and all themes were categorized under one of the 11 factors of the model. To ensure that the counselors’ statements were fully captured and appreciated, the analysis also employed an inductive approach, where the data is analyzed without trying to integrate it into a pre-existing theoretical framework or any other previous assumptions. As such, themes not anticipated by the Martin et al. ( 2015 ) model that were repeatedly mentioned by different participants were noted and formed into specific themes which were then categorized under one of the 11 factors of the model until data saturation had been reached. Examples include the role of corporal punishment in Bhutanese schools which was categorized under 1) “Cultural Factors”, and the role of external professions, such as clinical counselors, which was categorized under 9) “Related Professions”. The qualitative analysis software program MAXQDA was used for the analysis of the interviews. It was used to code all interviews, distinguish patterns among codes, and draw conclusions about the coded excerpts, such as commonalities between the excerpts that suggest specific themes. This allowed for a list of themes to be developed, including the number of times each study mentioned each theme and an easy-to-access repertoire of the excerpts relevant to each theme. To assess coding reliability, a trained research assistant (RA) independently coded five (18%) interviews. They were trained by learning the code book and reading three interviews that were already coded, practicing coding another three interviews independently, going over the results with the PI, then coding another five interviews independently. Comparison with the coding of the same five interviews by the PI revealed an inter-rater reliability of 71.1% with 122 disagreements. All disagreements were analyzed, which revealed that 27 (22.1%) were coding errors in which the RA assigned the wrong code, 67 (54.9%) were codes that the PI had assigned to the interviews but not the RA because of the PI’s personal experience of school counseling in Bhutan (for instance the PI knew that the CECD was sometimes referred to as “the division”, “the ministry” or “our supervisors”), and 27 (22.1%) were codes which had been assigned by the RA but not the PI. The PI and RA agreed that the former two categories of disagreement could be resolved whereas the latter category was due to differences of perspectives around the themes, codes and their definitions. For instance, it was sometimes unclear when to assign the code “need for more initial training” and the code “need for more up-to-date training”. In the end, an inter-rater reliability of 85.9% was achieved which was deemed satisfactory. It was concluded that the coding procedure and the themes used for coding were effective, broad and sufficient. The RA moreover did not find or suggest additional codes or themes which might have been overlooked by the PI. Research Positionality Statement Because the background of the researcher matters in shaping qualitative research, it is important for researchers to declare their assumptions, biases, expectations and experiences in an effort to bracket the potential influence of their background on the research process (Keane et al., 2016 ). This increases their ability to remain focused on the participants’ experiences, stories, and voices while also allowing readers to assess their possible influences (Creswell & Creswell, 2017 ). The PI for this specific study identifies as a white, cisgender female of European descent (British and French nationality). They were born in France and grew up bilingual (French/English) in an atheist household and have been living in Germany since 2012. They had two years of experience working in schools as an educator and in a care home for youth as a psychologist but had not worked specifically as a school counselor or school psychologist. They have, over the last four years, investigated the Kingdom of Bhutan and the school counseling profession through communications, staying updated on several research fields in Bhutan, regularly reading all Bhutanese news outlets, reading about the history of Bhutan, and visiting the Kingdom twice to conduct field research. Because of initial contact with academics in Bhutan and because of their interest in school based mental health, they enquired about what services were available in Bhutanese schools and came across the recently implemented school counseling profession. Because of the lack of research, they resolved to investigate this profession further and came into contact with members of the MoESD who agreed to help them pursue this endeavor. Trustworthiness Trustworthiness defines specific criteria of qualitative research, such as credibility, transferability, dependability, and confirmability (Nowell et al., 2017 ). For the present study, two Euro-Western researchers from a Euro-Western university setting sought to carry out an investigation in a non-Euro-Western, non-university setting. Such circumstances, further underlined by the PI’s positionality statement above, have direct implications for this study’s trustworthiness which need to be considered. These considerations pertain specifically to decolonizing methods. Decolonization is a process of centering the concerns and worldviews of participants so that their own assumptions and perspectives are heard (Chilisa, 2019 ). Decolonizing methods seek to decolonize and indigenize Euro-Western research methodologies to effectively avoid academic imperialism. This is achieved by centering participants’ perspectives and values, where “Indigenous researchers are active participants, Indigenous perspectives are provided directly by Indigenous people, research questions are framed through Indigenous theories on knowledge and knowledge transfer, and the research conducted seeks to serve needs identified by Indigenous communities in meaningful ways” (Stoltz et al., 2022 , p. 120). The term “Indigenous” is understood here as persons native to a place whose cultural heritage differs from traditions that are associated with Euro-Western societies (Chilisa & Malunga, 2012 , p. 12) but who have not necessarily been subjugated to colonialization at some point in history. For the present study, decolonizing methods were employed where possible in order to raise questions on the influence of the investigator from the development of the research paradigm to the dissemination of results. This was in order to avoid any potential power imbalances by giving participants an equal position in the research process while simultaneously guaranteeing trustworthiness. To achieve this, qualitative measures were used to allow participants to be coresearchers in the investigation by providing room to articulate their own views and experiences. This creates a neutral, egalitarian, and collaborative space to break down previously held stereotypes and achieve mutual exchange, rather than for instance accidentally adopting a pathologizing approach (Mbah & Bailey, 2022 ; Thambinathan & Kinsella, 2021 ). Moreover, reflexive journaling, maintaining an audit trail, assuring reciprocity and respect for self-determination, and active listening were actively employed. Regular reflexive journaling was used by the PI to reveal, for instance, Western-centric assumptions (Creswell & Creswell, 2017 ). An audit trail was maintained, including timelines, informed consent, participant demographic questionnaires, interview protocols, transcriptions, memos kept during the coding process (in MAXQDA), notes that reflect changes in themes, and regularly updating the reflexivity journal (Creswell & Creswell, 2017 ; Nowell et al., 2017 ). Reciprocity and respect for self-determination were addressed by attempting to co-create the research design using piloting described above (Creswell & Creswell, 2017 ). Finally, during the interview process, active listening, namely intensely listening to and respecting their voice and interpretations of life events (Sciarra, 1999 ) was employed by the PI who also regularly summarized and reflected back key points raised by the participants to check that meaning was interpreted appropriately. All of the above was also important for bracketing, important in hermeneutic phenomenology, to allow the PI to take into account their own experiences when analyzing and describing the phenomenon of school counseling in Bhutan (Moustakas, 1994 ). Results Guided by Martin et al. ( 2015 ) model of factors influencing school counseling services, the analysis of interview data of 28 Bhutanese school counselors revealed 15 themes that were deemed specific and exhaustive enough to be final. Each specific theme is presented in Table II along with the number of interviews in which these were mentioned. Table II Themes revealed by the interviews and categorized according to Martin et al. ( 2015 ) model of factors. n = number of interviews in the respective theme was mentioned. Factor n % Theme n % Cultural Factors 26 92.9 Challenge of school counseling not being adapted to the local context and culture 26 92.9 Importance of similarities of school counseling with the local context and culture 23 82.1 National Needs 28 100 Need for more resources to cope with youth mental health needs 28 100 Challenge of differences of needs across the country 21 75 Larger Societal Movements 27 96.4 Challenge of the effects on the COVID-19 pandemic and lock-down measures on school counseling 27 96.4 Models of School Counseling 0 0 none 0 0 Laws and Educational Policy 24 85.7 Need for more clear school counseling roles and responsibilities 20 71.4 Need for more systematic organization such as a clear referral system 12 42.9 Characteristics of the Public Education System 13 46.4 Need for students to have more time to see the school counselor 13 46.4 The Counseling Profession 28 100 Importance of activities other than individual counseling 24 85.7 Importance of material resources 28 100 Importance of human resources such as school principal support 25 89.3 Need for more time for school counseling to establish itself in schools and be accepted 24 85.7 Research and Evaluation 0 0 none 0 0 Related Professions 16 57.1 Importance of support from external institutions 16 57.1 Community Organizations or NGO Coalition 0 0 none 0 0 Local Stakeholder Perceptions 27 96.4 Challenge of misconceptions about school counseling 24 85.7 Challenge of problems in communication/collaboration with stakeholders 18 64.3 Each theme is expressed either as a challenge (i.e. “challenge of” or “need of”), in that it is perceived as a barrier to school counselors carrying out their work that needs to be improved, or as a resource (i.e. “importance of”), in that it is already existing and perceived as an important factor which supports school counselors in their work and which should be nurtured. Themes were found to correspond to all factors of the Martin et al. ( 2015 ) model of 11 factors except for “Models of School Counseling,” “Research and Evaluation,” and “Community Organizations or NGO Coalition.” This categorization is visualized in Figure II. Figure II Categorization of themes mentioned in the survey according to each factor of the Martin, Lauterbach and Carey ( 2015 ) model of 11 factors into Challenges (in bold) or Resources (in italic) As such, this analysis revealed the following challenges and resources, which are presented in order of how often they were mentioned, along with direct quote examples from the interviews in order to ground the findings. The quotes are of a slightly different grammar to British or American English due to English being used as a secondary language in schools, government, and other administrative institutions. Rather than 'correcting' these quotes, they were kept intact to honor representation and voice. Challenges The most often mentioned challenges were found for the factors “National Needs” ( n = 28; 100%), for “Larger Societal Movements” ( n = 27; 96.4%), for “Cultural Factors” ( n = 26; 92.9%), for “Local Stakeholder Perceptions” ( n = 24; 85.7%), for “Laws and Educational Policy” ( n = 20; 71.4%), and for “Characteristics of the Public Education System” ( n = 13; 46.4%). National needs All 28 school counselors interviewed for this study mentioned the lack of resources to cope with youth mental health needs perceived to be rising ( n = 13; 46.4%) such as increases in cases of drug use ( n = 10; 35.7%): “I think every year we are seeing diverse issues. Issues are increasing in terms of as I said, […] for example substance use disorder was one of the common issues in school”. (Participant 25) Such resources perceived as lacking include the need for more specific, up-to-date training ( n = 22; 78.6%), with their current training being largely perceived as insufficient to address complex student mental health needs ( n = 25; 89.2%): “The training module that got us is not enough for us particularly to deal with the substance use issues and mental health and well-being of children. Because whenever we deal with students who are undergoing tremendous stress and disorder, any kind of mental issues, sometimes we feel that we are not competent enough to deal with such issues because the training is we have undergone, we feel that it's not adequate enough.” (Participant 03) Participants also mentioned the lack of awareness about school counseling among school stakeholders and the wider community ( n = 18; 64.3%), the lack of supervision ( n = 9; 32.1%) and the need for having one male and one female school counselor in each school ( n = 7; 25%): “A female and a male would be fair for students like for example, especially teen boys when they have issue they are very hesitant over the very fact that I am a female counselor they can’t really open up to me.” (Participant 16) Fundamental here is also the differences of these needs across the country (n = 21; 75%): “ It’s because of the setting. One is rural, this is urban setting, where kids are exposed to many things and that. They are just exposed to the rural setting, they are not exposed. […]. The availability and accessibility of substances and alcohol is more here”. (Participant 17) Larger Societal Movements Almost all participants mentioned at least once the challenge of the effects of the COVID-19 pandemic and lock-down measures ( n = 27; 96.4%). This includes the issue of having to switch to online counseling fast ( n = 16; 57,1%), sometimes with insufficient infrastructure ( n = 6; 21.4%), and new counselors who graduated during the lockdown not being able to gain valuable in-school experience necessary for their work, instead having to move straight into online counseling ( n = 7; 25%): “Then the lockdown happened and then I was like, it really affected me professionally because I did not have hands-on practice to take clients, directly we had to take online sessions with the students”. (Participant 09) Cultural Factors Most school counselors also mentioned the challenge of school counseling not being adapted to the local context and culture ( n = 26; 92.9%) because, for instance, of stigma towards mental health ( n = 15; 53.6%), the traditional role of corporal punishment in schools ( n = 15;53.6%), and school stakeholders not understanding the importance of confidentiality ( n = 9; 32.1%): “There are kids who want to reach out. These are staff who want to reach out, who want to talk about their issues, who want to be heard, and they want to discuss things with the counselor. But because of the stigma, they hold themselves back and this is what and because of this, they cannot seek help when they need it.” (Participant 17) “Sometimes they have a rigid mindset that our counseling won't help students. And they are in the belief of the old mindset, where it works through corporal punishment and all. So in that case is sometimes I get feedback from my friends and other teachers saying that -your counseling won’t work-”. (Participant 06) Local Stakeholder Perceptions Most school counselors also mentioned the challenge of misconceptions about school counseling ( n = 24; 85.7%), for instance, being told that counselors don’t do any work ( n = 13; 46.4%) or that school counselors are meant to provide immediate solutions to difficult problems ( n = 13; 46.4%): “All or some have misconception that counselors do not have much work compared to the teachers. And since counseling is taking place in a private room or in a closed or in a very safe room, many people do not know the work that we are doing”. (Participant 12) “As soon as they referred the child to the counseling, they want to see the immediate changes on the students where it takes some time. So, they don't understand that they think that as soon as the child is sent to the counseling, they want that child to come back as a perfect individual”. (Participant 23) Also mentioned often was the challenge of poor communication and collaboration with stakeholders ( n = 18; 64.3%): “Teachers, sometimes they do not always, but then sometimes they really go against the decision we make and the programs we do in school”. (Participant 09) Finally, they also mentioned the need for more time for school counseling to establish itself in schools and be accepted ( n = 24; 64.3%): “So people have started to accept that when you are not feeling well, especially when you're not feeling good here, it's ok to go to talk to someone, just like when you're having headache or stomachache, how you visit a doctor the same way. So now they have they have accepted that.” (Participant 16) Laws and Educational Policy An often-mentioned challenge was the need for more clear school counseling roles and responsibilities ( n = 20; 71.4%): “There's no clear, clarity of the roles and responsibilities of the school counselor, because sometimes school counselors are given the roles and responsibilities which directly come in conflict with their profession, like counselors are given those responsibilities of a teacher.” (Participant 05) Characteristics of the Public Education System Finally, participants also mentioned issues related to the public education system ( n = 13; 46.4%), such as that students need to have more time to see the school counselor ( n = 13; 46.4%) and the need for more systematic organization such as a clear referral system ( n = 12; 42.9%): “we don't have separate timing to take sessions. What we do is we take sessions during recess, during the break, which is just 10 minutes break, we try to adjust the time in that 10 minutes and we take sessions during lunch, And the third time that we have is after the school. After the school where they are eager to go home. Right. Because they are exhausted from the whole of being in the school.” (Participant 07) Resources The most often mentioned resources were found for the factors “The Counseling Profession” ( n = 28; 100%) and for “Related Professions” ( n = 16; 57.1%). „The Counseling Profession” All 28 school counselors in their interviews mentioned the importance of material resources ( n = 28; 100%), specifically the need for more of these ( n = 22; 78.6%), including a separate counseling room within the school ( n = 16; 57.1%), a printer ( n = 11; 39.3%), counseling books ( n = 10; 35.7%) or a computer ( n = 9; 32.1%): “To have a session we need a separate room. We cannot go everywhere and take a session. Luckily, I'm given a room here in this school.” (Participant 07) Beyond the help of material resources, most school counselors also mentioned the importance of human resources such as support from the CECD ( n = 21; 75%), from other school counselors ( n = 13; 46.4%), and from the school principal ( n = 12; 42.9%): “CECD really ensures that none of the counselors experience professional burnout. So time to time they make a point to check on us how we are doing, not just professionally but personally also. So we have a place to share our feelings when we are not well.” (Participant 16) Most school counselors also mentioned the importance of activities other than individual, one-on-one counseling which are useful for their work ( n = 24; 85.7%), such as carrying out orientation and awareness programs about school counseling (namely roles, tasks, and aims of school counseling services) with teachers, students, and parents ( n = 20; 71.4%), carrying out parenting education programs on topics such as parenting styles and children’s media use ( n = 12; 42.9%) and taking part in other training workshops such as about substance use ( n = 10; 35.7%): “So after having conducted some orientation program on counseling, awareness program to the student, parents and teachers, yes, some of this misconception has been cleared. And now, most of the teachers and school principals, they are more supportive of the counseling.” (Participant 12) „Related Professions” School counselors also mentioned the importance of support from external institutions ( n = 16; 57.1%) such as clinical counselors ( n = 11; 39.3%), hospitals and other medical centers ( n = 10; 35.1%) and psychiatrists ( n = 8; 28.6%) of which there are currently three in the Kingdom: “ Whenever we feel beyond our own capacity, we refer them to clinical counselor in hospital. And with regard to substance use and substance abuses, if it is a, you know, chronic user, then we send them to a (location withheld) regional referral hospital where we have a drop-in center as well as there is a team where they assess the addiction level of the client.” (Participant 19) Discussion Qualitative, semi-structured interviews analyzed using Martin et al. ( 2015 ) model of 11 factors influencing school counseling revealed a number of challenges and resources perceived by 28 Bhutanese school counselors. The study gathered different perspectives on school counseling services in Bhutan, ranging from the profession being described as a “growing noble profession” (Participant 12), school counselors being expected to be a “magician” (Participant 19), or feeling like the “emotional trash can” (Participant 11) of the school. More importantly, specific challenges and resources, some expected and some not, were revealed by the analysis guided by Martin et al. ( 2015 ) model of factors influencing school counseling services. Challenges and resources were found for “Cultural Factors,” “The Counseling Profession,” “Laws and Educational Policy” and “Characteristics of the Public Education System”. Challenges only were found for the factors “National Needs,” “Larger Societal Movements” and “Local Stakeholder Perceptions”. Resources only were found for “Related Professions”. No challenges or resources were found for “Models of School Counseling,” “Research and Evaluation,” “Community Organizations,” “NGO Coalition”. Reasons for this could be that there is already a model of school counseling available in Bhutan, namely the Guidance and Counseling Framework for Schools in Bhutan (Ministry of Education, 2010 ) albeit not mentioned in any of the interviews. This could be a sign that this model needs to be revised and updated. Moreover, there is no information available about research and evaluation currently being undertaken specifically for school counseling in Bhutan, which was also found to be the case for instance for school counseling services in Barbados (Griffin, 2019 ). This may be due to school counseling services in Bhutan being very new so that there has been insufficient time to implement research and evaluation. Finally, Community Organizations and NGO Coalition, such as UNICEF, were not mentioned by school counselors, perhaps because they currently don’t play a significant role supporting school counseling services. These results are depicted in Figure III below. Figure III Martin et al.’s ( 2015 ) model of factors organized as challenges and/or resources according to interview results These results suggest that, specifically in Bhutan, the school counseling profession needs more resources, more awareness, more organization, and more time. School counselors need (1) more resources to cope with complex mental health needs across schools and across regions, including more up-to-date training and more material resources. They need (2) more awareness in schools and the wider society about school counseling, including clearing misconceptions about school counseling and overcoming stigma towards mental health. School counselors also need (3) more organization, namely systemic changes to make school counselor roles more clear, to systemize stakeholder collaboration and referral systems, and to allow time for students in schools to go to the counselor. Finally, the school counseling profession also needs (4) more time to overcome the challenges of the COVID-19 pandemic and to allow for this profession to establish itself in the Kingdom as an important profession. The results of this investigation are consistent with previous research and provide new and unique contributions. These results corroborate a survey study carried out with 162 school counselors on their daily activities, perceived roles and responsibilities, and challenges and needs (reference withheld for blind peer review), namely that school counselors need more role clarity so that they are not being made to take on administrative duties, that they are impeded by lack of stakeholder understanding and support, by a lack of supervision and by stigma around counseling and mental health. The findings of the present study also support the survey results, namely, that school counselors benefit from receiving workshops and having time to carry out programs such as orientation and awareness to overcome the lack of stakeholder support and misconceptions about school counseling in the wider community. Moreover, these results further confirm the important role of material resources, such as having a counseling room and a computer, the ambiguous role of the COVID-19 pandemic, which was both a significant barrier to school counseling and a blessing as it initiated government initiatives to raise awareness about mental health and counseling, and the important role of time, more specifically that the profession needs more time to establish. The results of this interview study supplement the survey study and highlighted the important role of the support provided by the school principal (if they are supportive of school counseling), the support of the CECD, senior counselors and other school counselors, which can be described as social support and which is a type of support that is different for instance from material resources. The findings of the present study are also in line with Dem and Busch ( 2018 ) study of four school counselors in which they reported skepticism from their colleagues, role confusion insufficient preparation, insufficient supervision and stigma about counseling as significant challenges. The present study adds to this past research by also revealing the importance of orientation and awareness programs to reduce stigma and increase awareness, the importance of collaboration with stakeholders within the school and external institutions such as clinical counselors, the need specifically not just for more school counselors but for one male and one female school counselors in each school, and the heterogeneity of needs of schools across the country. More specifically, specific cross-country differences, such as differences between day schools and boarding schools or differences between schools in rural areas and schools in urban areas, need to be taken into account for each school and should be further investigated. School counseling research from other countries further supports these findings, specifically the benefit of having more organized school counseling services with clearer roles and responsibilities. In the United States for instance, schools that offer school counseling services can choose to implement these services within a Recognized ASCA Model Program (RAMP) (Mullen et al., 2019 ). As such, RAMP schools are understood as schools that offer school counseling within a comprehensive, data-driven program for which the roles and tasks of the school counselor are clearly defined, respected, and aligned with the ASCA National model (ASCA, 2012 ). In comparison to non-RAMP-schools, school counselors working in RAMP schools have been found to perform more school-counseling related duties (Randick et al., 2018 ) and RAMP schools had a positive effect on student achievement compared to non-RAMP schools (Akos et al., 2019 ; Jones et al., 2019 ). Other studies have investigated the benefits of specific types of resources, such as supervision. For instance, a sample of 24 school counselors in the United States who received supervision reported significantly better self-efficacy than a control group of 69 school counselors (Tang, 2020 ). Implications The results of this study first of all imply that Martin et al. ( 2015 ) model of factors influencing school counseling is a useful model for investigating school counseling services using qualitative methods. Specific themes could be identified that fit under one of the factors, except “Models of School Counseling,” “Research and Evaluation,” “Community Organizations,” and Organizations and “NGO coalitions.” Unlike what was expected, no new factors were created to accommodate for other themes relevant to the research questions that might have emerged from the data. This demonstrates the exhaustiveness of the model proposed by Martin et al. ( 2015 ). The results of this study further have various implications for policymakers seeking to improve school counseling services in Bhutan. These results not only draw attention to the necessity to provide school counselors with additional resources but also indicate what specific areas need to be supplemented. To address specific challenges and resources that may be hindering school counselors and contributing to burnout, policymakers could start by addressing the four needs revealed by the present study. To address (1) the need for more resources, Bhutanese school counselors’ initial training should be updated so that it is more efficient and relevant to the current needs of students; additional, continuous training should be provided depending on the specific needs of individual schools; and they should be provided with more material resources such as a counseling room and a computer with internet access. Policymakers should also consider implementing one male and one female in each school, or more, depending on the specific needs of that school. To address (2) the need for more awareness about mental health, country-wide advocacy, and awareness initiatives should be carried out to counteract stigma towards mental health and counseling, and more orientation and awareness programs should be provided in schools. To address (3) the need for more organization, school counselors’ specific roles need to be more clear and communicated to other school staff; a referral system should be established so that they can efficiently collaborate with external institutions to make referrals; within schools, school policies should allow students more time to go to the school counselor for counseling, for example by allowing students to go to the school counselor during class. Finally, to address (4) the need for more time to overcome challenges, patience is warranted. Namely, more time needs to pass in order to ensure school counseling services are implemented efficiently in Bhutan, and school counselors should not be expected to facilitate immediate, drastic changes. Strengths and Limitations A notable strength of this study is its sizeable sample. The researcher was able to carry out the interview with 28 school counselors which exceeded their expectation of reaching the provisional goal of 26 school counselors. Moreover, the interview protocol consisted of questions covering a wide array of themes relevant to school counseling. However, this study also presents a number of limitations. First of all, the closed setting of Bhutan definitely posed a challenge for qualitative investigation. Spending prolonged time in the field, which is desirable for qualitative research (Creswell & Creswell, 2017 ), was not possible because of administrative barriers. Second, while having an outsider carry out this study has potential advantages, such as providing an unbiased eye into this profession, the study was likely also impacted by cultural differences, such as the language barrier. The interviews were carried out in English which means that maybe some valuable information might have been missed. Future studies should consider carrying out the interview in the language of choice of the participants. Furthermore, although the researcher made every effort to consider their positionality, participants may nevertheless have been biased in their response because of the interviewer not being a Bhutanese national, which is why future studies may also want to consider having a researcher native to Bhutan carry out and analyze the interviews. Finally, as this study only focused on school counselors, the discussion may not be representative of the whole community. Future research should investigate the perspectives and views from other stakeholders such as schoolteachers, school principals, students and parents. Future directions Differences between day schools and boarding schools and between schools in rural areas and schools in urban areas should be investigated to better understand the issues affecting students and how these can be remediated efficiently, such as by implementing substance-prevention interventions in schools in areas where substances are easy to reach. Moreover, future interview studies should be repeated with school counselors in Bhutan in a few years in order to assess how these challenges and resources have evolved over time and why or how they may have changed because of changes to the school counseling system which address the four needs revealed by the study. Conclusions Using qualitative interviews carried out with 28 school counselors in Bhutan, the present study was able to uncover a number of challenges and resources with the help of Martin et al. ( 2015 ) model of factors influencing school counseling services. It was found that the profession in Bhutan needs more resources, more awareness, more organization, and more time to establish itself. It will be important to address these needs to buttress this nascent profession destined to play an ever-important role in the Kingdom of Bhutan, but one that can increase the risk of burnout. Declarations Author Contribution J.L. applied for the funding, carried out the data collection and wrote the main manuscript text.S.H. helped with the planning of the data collection, funding application and proof reading of the main mansucript text. All authors reviewed the manuscript. Acknowledgement The authors would like to thank Feline Ebert for their help in independently coding five of the interviews to assess inter-rater reliability.We are deeply indebted to our colleagues at the Ministry of Education, Dasho Tenzin Thinley, Reena Thappa, and Nidup Gyeltshen, to school counseling graduate Sangay Wangchuk for his help with the piloting of the data collection tools, and to all school counselors who so generously gave time to participate in this study. Data Availability The data are available from the corresponding author upon request. References Akos, P., Bastian, K. C., Domina, T., & de Luna, L. M. M. (2019). Recognized ASCA Model Program (RAMP) and student outcomes in elementary and middle schools. Professional school counseling , 22 (1). https://doi.org/http://dx.doi.org/10.1177/2156759X19869933 ASCA (2012). 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Tribal Collaborations and Indigenous Representation in Higher Education: Challenges, Successes, and Suggestions for Attaining the SDGs. In Indigenous Methodologies, Research and Practices for Sustainable Development (pp. 117–133). Springer. https://doi.org/http://dx.doi.org/10.1007/978-3-031-12326-9_7 Tan, S. Y., & Chou, C. C. (2018). Supervision effects on self-efficacy, competency, and job involvement of school counsellors. Journal of Psychologists and Counsellors in Schools , 28 (1), 18–32. https://doi.org/http://dx.doi.org/10.1017/jgc.2017.19 Tang, A. (2020). The impact of school counseling supervision on practicing school counselors’ self-efficacy in building a comprehensive school counseling program. Professional school counseling , 23 (1). https://doi.org/https://doi.org/10.1177/2156759X20947723 Thambinathan, V., & Kinsella, E. A. (2021). Decolonizing methodologies in qualitative research: Creating spaces for transformative praxis. International journal of qualitative methods , 20 , 16094069211014766. https://doi.org/https://doi.org/10.1177/16094069211014766 The World Bank (2024). Bhutan Labor Market Assessment Report . https://documents1.worldbank.org/curated/en/099020724131525893/pdf/P1756461b8f00f0571abfe13c21a8e5a6d5.pdf Tsheten, T., Chateau, D., Dorji, N., Pokhrel, H. P., Clements, A. C., Gray, D. J., & Wangdi, K. (2023). Impact of COVID-19 on mental health in Bhutan: a way forward for action. The Lancet Regional Health-Southeast Asia , 100179. https://doi.org/https://doi.org/10.1016/j.lansea.2023.100179 UNICEF Bhutan (2016). Research on Violence Against Children in Bhutan: a Report . https://www.unicef.org/bhutan/media/341/file Ura, K., Alkire, S., Zangmo, T., & Wangdi, K. (2012). A short guide to gross national happiness index . The Centre for Bhutan Studies. Wangchhuk, L. (2008). Facts about Bhutan: The Land of the Thunder Dragon;[commemoration of Coronation and Centenary Celebrations of the Kingdom of Bhutan, 2008] . Absolute Bhutan Books. World Health Organization (2017). Mental health status of adolescents in South-East Asia: Evidence for action . https://iris.who.int/handle/10665/254982 World Health Organization (2022). Addressing mental health in Bhutan (Ministerial Roundtable of the 75th Session of the WHO Regional Committee for South-East Asia, Issue. https://apps.who.int/iris/rest/bitstreams/1481718/retrieve Additional Declarations No competing interests reported. Supplementary Files Appendices.docx Cite Share Download PDF Status: Published Journal Publication published 04 Feb, 2025 Read the published version in International Journal for the Advancement of Counselling → Version 1 posted Editorial decision: Revision requested 11 Nov, 2024 Reviews received at journal 07 Oct, 2024 Reviews received at journal 01 Oct, 2024 Reviewers agreed at journal 09 Sep, 2024 Reviewers agreed at journal 08 Sep, 2024 Reviewers invited by journal 07 Sep, 2024 Editor assigned by journal 01 Aug, 2024 Submission checks completed at journal 31 Jul, 2024 First submitted to journal 30 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4829242","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":338341410,"identity":"1231c8c7-5c9b-4050-8e14-b857d3a28071","order_by":0,"name":"Julie Larran","email":"","orcid":"","institution":"Freie Universität Berlin","correspondingAuthor":false,"prefix":"","firstName":"Julie","middleName":"","lastName":"Larran","suffix":""},{"id":338341411,"identity":"ab6fef30-d15d-4c47-a88a-fb424ca7af45","order_by":1,"name":"Sascha Hein","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDElEQVRIie2QMUvDQBiG33CQLhddTwLmL6QEstQfk1vMUiRQkAxCT4ROpVnjv8g/6JWDugRdAy520cVBCTiq18biYK9dHe5ZPu74Ht57D7BY/iGBAIieXBA4TzmQ6LOQ3eVuQvmrkLDeKM4BBVsFcNlWwV6ld7dqsyvwouct88UEF8f+4lplGJwau0yHkV8uMb69OTpvtDI6mXGhSqSRMUYOXUJd8ErR+PF98sWr2hGKQq2fupuHl2dCP8HnWsl0Cp//KGOj0iQx8fRmRWiMtVLRTkmM9ZvXyPdmjJeKRkzeY8Q2KWHaN6UERbpq6ccZL4q6/yYv9Y9NiWppPgiM9TvYn/QDgsVisVj28g1MVFjZZEnqRAAAAABJRU5ErkJggg==","orcid":"","institution":"Freie Universität Berlin","correspondingAuthor":true,"prefix":"","firstName":"Sascha","middleName":"","lastName":"Hein","suffix":""}],"badges":[],"createdAt":"2024-07-30 13:43:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4829242/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4829242/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10447-025-09594-3","type":"published","date":"2025-02-04T15:56:52+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":63489539,"identity":"6d096983-c40e-4986-8afb-d0b295b69bac","added_by":"auto","created_at":"2024-08-28 17:07:33","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":78204,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eMap of the distribution of school counselors who participated in the interview. (GISGeography, 2023)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4829242/v1/e8c990ee01c95a92cb9c65b8.jpg"},{"id":63489540,"identity":"3a149430-1a4a-4267-b3fd-e464f7dc67ba","added_by":"auto","created_at":"2024-08-28 17:07:33","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":44079,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eCategorization of themes mentioned in the survey according to each factor of the Martin, Lauterbach and Carey (2015) model of 11 factors into Challenges (in bold) or Resources (in italic)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4829242/v1/8193d7c08c0d8dc87bae4b7c.jpg"},{"id":63489542,"identity":"d2943d50-986c-4532-90cd-94e783cc38ff","added_by":"auto","created_at":"2024-08-28 17:07:33","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":163869,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eMartin et al.’s (2015) model of factors organized as challenges and/or resources according to interview results\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4829242/v1/05aef4020b5065a4e4ade4f5.jpg"},{"id":75931344,"identity":"0c91dce9-b741-403c-b222-911745c780ab","added_by":"auto","created_at":"2025-02-10 16:14:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1257412,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4829242/v1/d7a187e6-4521-4bfa-94b1-be1819d3a3a5.pdf"},{"id":63489765,"identity":"c9dbb0d7-3842-4d3c-95a9-424cb6adb471","added_by":"auto","created_at":"2024-08-28 17:15:33","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":24765,"visible":true,"origin":"","legend":"","description":"","filename":"Appendices.docx","url":"https://assets-eu.researchsquare.com/files/rs-4829242/v1/2ae06cb18563af83baf3df0e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A “growing noble profession”, a “magician”, or an “emotional trash can”: an interview study of Bhutanese school counselors’ perceived challenges and resources","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe school counseling profession was introduced in Bhutan in 2011. Today, there are around 200 school counselors in Bhutan, serving about 600 schools (Ministry of Education and Skills Development, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Bhutanese school counselors must reckon with numerous challenges threatening the mental health of children and youth. These include bullying in schools (UNICEF Bhutan, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), increasing school drop-out rates (Rapten, 2014), changing family structures as a result of globalization (Phuntsho, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), high youth unemployment (Harrison, 2021; Lester et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Norbu, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and rises in cases of substance abuse (Lorelle \u0026amp; Guth, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) and suicidal behaviors (Dema et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; The World Bank, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; World Health Organization, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). As such, their work is crucial and timely, especially following the mental health toll of the COVID-19 pandemic as a result of strict nationwide lockdowns (Namgyel \u0026amp; Milbert, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Tsheten et al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) compounded with a lack of mental health facilities for children and youth (Nirola et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Sacra, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; World Health Organization, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). However, very little information is available about their perceived challenges and resources that affect their work.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eSchool Counseling Research\u003c/h2\u003e \u003cp\u003eSchool counseling literature has highlighted different factors that affect school counseling services around the world. These may include how school counseling is organized, such as around a specific school counseling framework or program (Foss-Kelly et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Goodman-Scott et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), how school counseling is directed, such as through specific policies (Camilleri-Zahra, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), or how school counseling is affected by cultural factors, such as the role of spirituality (Cobb, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Stevens \u0026amp; Ritten, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Investigating these factors is important as quantitative studies have shown that such factors can influence school counselors\u0026rsquo; job satisfaction and job stress. In one study of 103 school counselors in the United States, it was found that job satisfaction was positively associated with the availability of school counseling programs, which provided administrative support, facilitated communication with stakeholders, and allowed sufficient time for program planning and evaluation (Pyne, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). In another study of 227 school counselors in the United States, it was found that job stress was positively associated with paperwork requirements, caseload size, and having to deal with activities described as inappropriate for school counselors by the American School Counseling Association (ASCA) (e.g., performing disciplinary actions, supervising common areas) (ASCA, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2019a\u003c/span\u003e). Conversely, lower levels of job stress were associated with positive professional relationships and more adequate training (McCarthy et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Understanding these factors is important as school counselors are prone to burnout (Moyer, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), that is, the experience of physical, behavioral, and emotional state of exhaustion as a result of their work conditions (Freudenberger, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e1974\u003c/span\u003e). Burnout not only affects school counselors but can also spill over to the entire school and, in turn, impact students\u0026rsquo; mental health if school counselors are unable to attend to students\u0026rsquo; needs (Holman \u0026amp; Grubbs, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Maslach \u0026amp; Leiter, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Burnout can also increase the likelihood of school counselors quitting (Kim \u0026amp; Lambie, 2018; Mullen \u0026amp; Gutierrez, 2016).\u003c/p\u003e \u003cp\u003eQualitative studies, such as those employing interview methods, provide in depth and nuanced understanding of factors that affect school counseling services. This is evidenced in research such as on perceptions of supervision experiences in an interview of seven school counselors in the United States (Gillen et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), or to understand self-care practices in a study of 15 school counselors in Turkey (Şimşir G\u0026ouml;kalp, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) or of perceived preparedness and efficacy in a study of 12 school counselors in Australia (Quigley \u0026amp; Hyde, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In countries in East Asia, where school counseling has a much shorter history (Larran \u0026amp; Hein, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), interview studies have revealed for instance the need for a more systematic, collaborative model for working with other school staff, as was found in an interview study of 11 school counselors in Malaysia (Kok, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Additional studies have found evidence for the need for role clarity including a common understanding and shared expectations of the role of the school counselor, such as clear definitions of confidentiality, as was found in a study of nine school counselors in Singapore (Lim \u0026amp; Wong, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), the need for more supervision as was found in a study of 14 school counselors in Singapore (Tan \u0026amp; Chou, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and the issue of stigma around mental health as was found in a study of four school counselors in Sri Lanka (Jayawardena \u0026amp; Gamage, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). However, little research is available from many countries in the Global South, such as in Bhutan, where school counseling was recently implemented.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSchool Counseling Research in Bhutan\u003c/h2\u003e \u003cp\u003eThe Kingdom of Bhutan is a mountainous, Buddhist country located in the Himalayas with a population of just over 754,000 (United Nations, 2019). It is known for its unique economic and political philosophy of Gross National Happiness (GNH) used as a measurement of national sustainable development and well-being influenced by Buddhist philosophy instead of traditional metrics, such as the Gross Domestic Product (GDP) (Ura et al., \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Wangchhuk, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Secluded from the world stage until 1961 (Wangchhuk, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2008\u003c/span\u003e), recent modernization has confronted the kingdom with economic, political, and social changes that are thought to have negative consequences for youth (Dema et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Lester et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Norbu, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Phuntsho, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; World Health Organization, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). In response to these challenges, the Kingdom of Bhutan established the professions of clinical counseling, substance abuse counseling, and school guidance counseling (Dem \u0026amp; Busch, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe first quantitative, online survey study of Bhutanese school counseling (source withheld for blinded peer review), reached 161 of the 174 school counselors active at the time, investigating their demographic characteristics, daily activities, roles and responsibilities and perceived challenges and resources. Results revealed the role of stigma around mental health as a significant barrier to help-seeking, school counselors need for various resources such as a counseling room, the need for more clearly defined roles and responsibilities, and the need for schools to make sure there is sufficient time and opportunities for students to go see the school counselor in confidence. In addition, results revealed the role of the COVID-19 pandemic as both a curse and a blessing for the school counseling profession. While moving counseling online in a country with sometimes insufficient infrastructure was a challenge, the pandemic also put the spotlight on the importance of mental health and the need for counseling services during times of crisis.\u003c/p\u003e \u003cp\u003eTo our knowledge, only two interview studies provide qualitative data on school counseling in the Kingdom. In their narrative interview study of four, first-generation Bhutanese school counselors, Dem and Busch (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) were able to provide a first account of the challenges they face. These include role confusion, high workload, insufficient preparation, and lack of support mechanisms such as adequate supervision and the resulting threat of burnout. They further mentioned skepticism and a lack of support from school stakeholders, including schoolteachers and school principals, who view school counseling services as mere advice giving or a disciplinary measure while simultaneously having high expectations about counseling, such as providing immediate solutions to students. In addition, in an interview study by Jamtsho (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), four of the participants, teachers with school counseling training, also reported that their school colleagues did not support them or understand the preventive value of school counseling services and merely saw school counseling as a disciplinary measure.\u003c/p\u003e \u003cp\u003eIn sum, what little information exists suggests that Bhutanese school counselors face a number of challenges that need to be further investigated. Qualitative data from a large, representative sample of school counselors would provide a more thorough and in-depth understanding of the different, perceived challenges they are facing and the resources that support them.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eThe Martin et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) Model of Factors influencing School Counseling Services\u003c/h2\u003e \u003cp\u003eSchool counseling is implemented differently across different countries, and these differences can be due to various factors. To facilitate comparison across studies and between countries, Martin et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) developed a model of factors related to the development and practice of school counseling. To this end, literature from 25 different countries was analyzed, and a model of 11 contextual factors that shape school counseling was developed. These factors are: 1) \u0026ldquo;Cultural Factors\u0026rdquo;, 2) \u0026ldquo;National Needs\u0026rdquo;, 3) \u0026ldquo;Larger Societal Movements\u0026rdquo;, 4) \u0026ldquo;Models of School Counseling\u0026rdquo;, 5) \u0026ldquo;Laws and Educational Policy\u0026rdquo;, 6) \u0026ldquo;Characteristics of the Public Education System\u0026rdquo;, 7) \u0026ldquo;The Counseling Profession\u0026rdquo;, 8) \u0026ldquo;Research and Evaluation\u0026rdquo;, 9) \u0026ldquo;Related Professions\u0026rdquo;, 10) \u0026ldquo;Community Organizations or NGO Coalitions\u0026rdquo;, and 11) \u0026ldquo;Local Stakeholder Perceptions\u0026rdquo;. In one study of school counseling in Barbados (Griffin, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), all 11 factors were investigated in an ethnographic study of five school counselors. The themes that emerged from the analysis were found to align with the model namely, helped to provide a deeper understanding of school counseling and served to inform policy and practice (Griffin, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy Aims\u003c/h2\u003e \u003cp\u003eThe first Bhutanese school counselors assumed their positions over ten years ago. However, how school counselors experience their work remains underexplored. Thus, this study sought to answer the question: what are Bhutanese school counselors\u0026rsquo; perceived challenges and resources? To answer this question, the present study conducted semi-structured interviews with Bhutanese school counselors and analyzed the resulting data using Martin et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) 11-factor model of school counseling. Such data could inform school counseling policy in Bhutan and international research on school counseling.\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eDesign\u003c/h2\u003e\n \u003cp\u003eIn order to better understand school counselors\u0026rsquo; challenges and resources from their perspective, the present study used qualitative research methods, namely semi-structured interviews, to allow for a nuanced understanding of school guidance counseling in Bhutan methods (Creswell \u0026amp; Creswell, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). Qualitative research refers to the collection and analysis of nonnumerical data and is especially appropriate to investigate research subjects that are underexplored (Creswell \u0026amp; Creswell, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e; Ponterotto, \u003cspan class=\"CitationRef\"\u003e2010\u003c/span\u003e). The focus of qualitative research in this study is on counselors\u0026rsquo; perceptions and experiences of school counseling and the way they make sense of their profession. Interview methods are believed to be especially suitable for studies that describe human experiences of a phenomenon (Morris, 2015) such as the experiences of psychotherapists and counselors (McLeod, \u003cspan class=\"CitationRef\"\u003e2000\u003c/span\u003e). This way, participants have the opportunity to voice their own opinions and thoughts regarding their perceived challenges and resources and allow for unanticipated ideas to emerge (Creswell \u0026amp; Creswell, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eSample\u003c/h2\u003e\n \u003cp\u003eTwenty-eight school counselors were interviewed for this study, including 15 female and 13 male participants, of which 19 were from day schools and nine from boarding schools from across the country. Their level of counseling experience ranged from one year to ten years. Of these 28, 19 were interviewed online, and nine were interviewed in person. Criteria for participation in the study was being a certified school counselor in Bhutan registered at the Division for Youth and Sports (DYS) of the Ministry of Education and Skills Development (MoESD). Demographic information about the sample can be found in Table I, and a map of the distribution of interview participants throughout the Kingdom of Bhutan can be found in Figure I.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable I\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003cp\u003eSummary of demographic data of participants (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.07352941176471%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.941176470588236%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.985294117647059%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.07352941176471%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterview Participation Format\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.941176470588236%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.985294117647059%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.07352941176471%\" valign=\"top\"\u003e\n \u003cp\u003ein-person\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.941176470588236%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.985294117647059%\" valign=\"top\"\u003e\n \u003cp\u003e32.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.07352941176471%\" valign=\"top\"\u003e\n \u003cp\u003eonline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.941176470588236%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.985294117647059%\" valign=\"top\"\u003e\n \u003cp\u003e67.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.07352941176471%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.941176470588236%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.985294117647059%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.07352941176471%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003efemale\u0026nbsp;\u003c/p\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.941176470588236%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.985294117647059%\" valign=\"top\"\u003e\n \u003cp\u003e53.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e46.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.07352941176471%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.941176470588236%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.985294117647059%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.07352941176471%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eday school\u003c/p\u003e\n \u003cp\u003eboarding school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.941176470588236%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.985294117647059%\" valign=\"top\"\u003e\n \u003cp\u003e67.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e32.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.07352941176471%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool Level\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.941176470588236%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.985294117647059%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.07352941176471%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eprimary school\u003c/p\u003e\n \u003cp\u003elower secondary school\u003c/p\u003e\n \u003cp\u003emiddle secondary school\u003c/p\u003e\n \u003cp\u003ehigher secondary school\u003c/p\u003e\n \u003cp\u003ecentral school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.941176470588236%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.985294117647059%\" valign=\"top\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e35.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWork Experience (\u003cem\u003eM\u003c/em\u003e = 5 years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.07352941176471%\" rowspan=\"10\" valign=\"top\"\u003e\n \u003cp\u003e1 year\u003c/p\u003e\n \u003cp\u003e2 years\u003c/p\u003e\n \u003cp\u003e3 years\u003c/p\u003e\n \u003cp\u003e4 years\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 years\u003c/p\u003e\n \u003cp\u003e6 years\u003c/p\u003e\n \u003cp\u003e7 years\u003c/p\u003e\n \u003cp\u003e8 years\u003c/p\u003e\n \u003cp\u003e9 years\u003c/p\u003e\n \u003cp\u003e10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.941176470588236%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.985294117647059%\" valign=\"top\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e35.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"80%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cem\u003eNote: The Bhutanese education system is categorized into three stages after primary school: lower secondary school, middle secondary school, and higher secondary school. Central schools are schools established since 2014 that integrate all school levels and are located in in areas in need of education facilities (\u003c/em\u003eDukpa, \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFigure I\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eMap of the distribution of school counselors who participated in the interview. (GISGeography, \u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/h2\u003e\n \u003cp\u003eThe provisional goal for this study was to interview at least 26 school counselors across Bhutan with an even distribution of male and female school counselors and school counselors from day schools and from boarding schools. Similar studies investigating school counseling also using qualitative methods have obtained relevant results such as Şimşir G\u0026ouml;kalp (\u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e) who interviewed 15 school counselors in Turkey, Kok and Low (\u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e) who interviewed 12 school counselors in Malaysia, and Reupert et al. (\u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e) who interviewed 12 school psychologists in Australia. However, sample size recommendations, particularly for interview-based qualitative studies, vary between six (Morse, \u003cspan class=\"CitationRef\"\u003e1995\u003c/span\u003e) and 25 (Creswell \u0026amp; Creswell, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e) participants to reach saturation, understood as the point at which a data set is considered complete, as indicated by data replication or redundancy (Marshall et al., \u003cspan class=\"CitationRef\"\u003e2013\u003c/span\u003e). That is why the final sample of 28 participants was deemed sufficient.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eMaterials\u003c/h2\u003e\n \u003cp\u003eAn individual, semi-structured interview format was used for data collection, namely, all interview questions were asked in the same order while allowing for a more open discussion than is possible with structured interviews. The interview was guided by an interview protocol designed according to recommendations by Creswell and Creswell (\u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). The researcher designed the interview questions considering the cultural context of Bhutanese school counseling and, since school counseling is in an emerging phase in Bhutan, questions in the schedule were designed to be exploratory in nature and were developed according to a review of the literature on school counseling, in accordance with the research question and with Martin et al. (\u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e) model. The resulting interview protocol consisted of nine open-ended questions, including how adequately school counselors felt their training prepared them for their role as a school counselor, how they perceive the collaborative work with students, school staff, and parents, what barriers stop them from engaging in their role as a school counselor, what resources support them and what resources are lacking, how school counseling services fit or do not fit in Bhutanese culture and finally how they were affected by the COVID-19 pandemic. In addition, those with over five years of experience were also asked whether they felt the profession had changed over time and how the profession might further change in the next five years. Finally, all participants were asked at the end of the interview if there was anything else they would like to add that was not mentioned yet. A copy of the interview protocol can be found in the Appendices.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eProcedure\u003c/h2\u003e\n \u003cp\u003eThis study was approved by the ethics committee of the University, supported by the MoESD, and performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki. Active or passive consent was sought from relevant school authorities, including the Dzongkha Education Officer of each of Bhutan\u0026rsquo;s 20 regions, or \u0026ldquo;Dzongkhas\u0026rdquo;, and the school principal of the counselor\u0026rsquo;s school. Before the interviews, the interview protocol was reviewed by the DYS to make sure that the questions were appropriate and understandable then piloted with one school counselor. Both gave their approval of the interview protocol and confirmed that the questions were understandable and appropriate, including their order and the way that they were formulated.\u003c/p\u003e\n \u003cp\u003eThe interviews took place in August and September 2022. Purposive sampling was used to recruit participants in that all school counselors were contacted by email to request their participation. School counselors who agreed to be contacted about the interview received an e-mail with date, time and location suggestions (online or in person) to conduct the interview. Once the meeting was determined, participants were asked to be interviewed in a quiet setting free of disturbances and to allow for about one hour of uninterrupted time.\u003c/p\u003e\n \u003cp\u003eAll participants were sent a copy of the consent form prior to their interview and were asked to sign it either before or after the interview. The consent form indicated informed consent, an understanding of confidentiality, and an understanding of the role of the primary investigator (PI). Participants were further informed of the voluntary nature of the study, that they could refuse to answer specific questions if they did not want to and were allowed to withdraw from the study at any time. Participants were not sent a copy of the interview questions prior to the interview to guarantee consistency in the interview procedure, namely that none of the school counselors knew of the questions before participating in the interview. Just before beginning the interview, participants were reminded again that they would be recorded and that the PI would be taking notes during the interview (Creswell \u0026amp; Creswell, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). It was anticipated that the interviews would last no longer than one hour but, in the end, ranged between 00:37 minutes and 1:36:00 hours (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;00:53) depending on the participant\u0026rsquo;s experience and willingness to share their experiences. At the end of the interview each participant was gifted with a book on school-based mental health. All interviews were audio-recorded using the recording and audio editing software Audacity then later transcribed using the transcription software Trint.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eAnalysis\u003c/h2\u003e\n \u003cp\u003eThis study was grounded in hermeneutic phenomenology as outlined by Moustakas (\u003cspan class=\"CitationRef\"\u003e1994\u003c/span\u003e). This method focuses on a population\u0026rsquo;s common experience of a phenomenon, here the school counseling profession, to reduce individual experiences of the phenomenon and reach the \u0026ldquo;universal essence\u0026rdquo; (Creswell \u0026amp; Poth, \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e, p. 76) of the experience of it for all individuals which the researcher can then describe. The researcher pays special attention to distancing themselves from their own experiences of the phenomenon, or bracketing, when analyzing and describing it. This approach to inquiry was chosen because it is suited for investigating the shared experience of a phenomenon shared by several individuals, ideally five to 25 (Polkinghorne, \u003cspan class=\"CitationRef\"\u003e1989\u003c/span\u003e), to understand their common experience to inform practice and policy (Creswell \u0026amp; Poth, \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e, p. 76).\u003c/p\u003e\n \u003cp\u003eCoding is the process of designating or categorizing text from interview data in order to help interpret the data and uncover themes (Gibbs, \u003cspan class=\"CitationRef\"\u003e2007\u003c/span\u003e). Because of the open-ended nature of the research question, thematic analysis (Braun and Clarke (\u003cspan class=\"CitationRef\"\u003e2006\u003c/span\u003e) was used. Thematic analysis is a method used to identify themes in the data, namely similar responses, which form a pattern and capture meaning that is relevant to the research question in a consistent and systematic way. In keeping with this paradigm, the researchers\u0026rsquo; roles and their lived experiences were acknowledged as playing an active role in the presentation and interpretation of data. That is why the research endeavored wherever possible to let the data speak for itself, namely allowing for the different perspectives of the participants to be compared and contrasted and for expected and unexpected yet relevant inferences to be uncovered (Nowell et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eAfter transcription of the interviews, the PI carried out the six phases of thematic analysis outlined by Braun and Clarke (\u003cspan class=\"CitationRef\"\u003e2006\u003c/span\u003e) to analyze the resulting data namely (1) taking time to know the data well, during which the PI immersed themselves in the data, reviewing and rereading the interviews to become familiar with the data, making notes where necessary and actively looking for meanings and patterns relevant to the present study\u0026rsquo;s research question, (2) identifying codes during which initial codes are created, making sure to be inclusive and using broad initial definitions for these codes, (3) finding themes during which the codes found were organized into overarching themes, (4) reviewing the themes during which the themes are reviewed for coherence and correctness and make sure that they are distinct from each other, (5) labeling the themes during which definitions are developed for each theme, and (6) creating the report during which the themes are reported in narrative form, with interview extract examples in quotations to provide rich textual description.\u003c/p\u003e\n \u003cp\u003eThe Martin et al. (\u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e) model of 11 school counseling factors was used to guide the thematic analysis of the data using a deductive approach, where the data is analyzed according to theoretical or analytical interest. Any theme mentioned in the interviews was coded as per the model and all themes were categorized under one of the 11 factors of the model.\u003c/p\u003e\n \u003cp\u003eTo ensure that the counselors\u0026rsquo; statements were fully captured and appreciated, the analysis also employed an inductive approach, where the data is analyzed without trying to integrate it into a pre-existing theoretical framework or any other previous assumptions. As such, themes not anticipated by the Martin et al. (\u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e) model that were repeatedly mentioned by different participants were noted and formed into specific themes which were then categorized under one of the 11 factors of the model until data saturation had been reached. Examples include the role of corporal punishment in Bhutanese schools which was categorized under 1) \u0026ldquo;Cultural Factors\u0026rdquo;, and the role of external professions, such as clinical counselors, which was categorized under 9) \u0026ldquo;Related Professions\u0026rdquo;.\u003c/p\u003e\n \u003cp\u003eThe qualitative analysis software program MAXQDA was used for the analysis of the interviews. It was used to code all interviews, distinguish patterns among codes, and draw conclusions about the coded excerpts, such as commonalities between the excerpts that suggest specific themes. This allowed for a list of themes to be developed, including the number of times each study mentioned each theme and an easy-to-access repertoire of the excerpts relevant to each theme. To assess coding reliability, a trained research assistant (RA) independently coded five (18%) interviews. They were trained by learning the code book and reading three interviews that were already coded, practicing coding another three interviews independently, going over the results with the PI, then coding another five interviews independently. Comparison with the coding of the same five interviews by the PI revealed an inter-rater reliability of 71.1% with 122 disagreements. All disagreements were analyzed, which revealed that 27 (22.1%) were coding errors in which the RA assigned the wrong code, 67 (54.9%) were codes that the PI had assigned to the interviews but not the RA because of the PI\u0026rsquo;s personal experience of school counseling in Bhutan (for instance the PI knew that the CECD was sometimes referred to as \u0026ldquo;the division\u0026rdquo;, \u0026ldquo;the ministry\u0026rdquo; or \u0026ldquo;our supervisors\u0026rdquo;), and 27 (22.1%) were codes which had been assigned by the RA but not the PI. The PI and RA agreed that the former two categories of disagreement could be resolved whereas the latter category was due to differences of perspectives around the themes, codes and their definitions. For instance, it was sometimes unclear when to assign the code \u0026ldquo;need for more initial training\u0026rdquo; and the code \u0026ldquo;need for more up-to-date training\u0026rdquo;. In the end, an inter-rater reliability of 85.9% was achieved which was deemed satisfactory. It was concluded that the coding procedure and the themes used for coding were effective, broad and sufficient. The RA moreover did not find or suggest additional codes or themes which might have been overlooked by the PI.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eResearch Positionality Statement\u003c/h2\u003e\n \u003cp\u003eBecause the background of the researcher matters in shaping qualitative research, it is important for researchers to declare their assumptions, biases, expectations and experiences in an effort to bracket the potential influence of their background on the research process (Keane et al., \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e). This increases their ability to remain focused on the participants\u0026rsquo; experiences, stories, and voices while also allowing readers to assess their possible influences (Creswell \u0026amp; Creswell, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). The PI for this specific study identifies as a white, cisgender female of European descent (British and French nationality). They were born in France and grew up bilingual (French/English) in an atheist household and have been living in Germany since 2012. They had two years of experience working in schools as an educator and in a care home for youth as a psychologist but had not worked specifically as a school counselor or school psychologist. They have, over the last four years, investigated the Kingdom of Bhutan and the school counseling profession through communications, staying updated on several research fields in Bhutan, regularly reading all Bhutanese news outlets, reading about the history of Bhutan, and visiting the Kingdom twice to conduct field research. Because of initial contact with academics in Bhutan and because of their interest in school based mental health, they enquired about what services were available in Bhutanese schools and came across the recently implemented school counseling profession. Because of the lack of research, they resolved to investigate this profession further and came into contact with members of the MoESD who agreed to help them pursue this endeavor.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eTrustworthiness\u003c/h2\u003e\n \u003cp\u003eTrustworthiness defines specific criteria of qualitative research, such as credibility, transferability, dependability, and confirmability (Nowell et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). For the present study, two Euro-Western researchers from a Euro-Western university setting sought to carry out an investigation in a non-Euro-Western, non-university setting. Such circumstances, further underlined by the PI\u0026rsquo;s positionality statement above, have direct implications for this study\u0026rsquo;s trustworthiness which need to be considered. These considerations pertain specifically to decolonizing methods. Decolonization is a process of centering the concerns and worldviews of participants so that their own assumptions and perspectives are heard (Chilisa, \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e). Decolonizing methods seek to decolonize and indigenize Euro-Western research methodologies to effectively avoid academic imperialism. This is achieved by centering participants\u0026rsquo; perspectives and values, where \u0026ldquo;Indigenous researchers are active participants, Indigenous perspectives are provided directly by Indigenous people, research questions are framed through Indigenous theories on knowledge and knowledge transfer, and the research conducted seeks to serve needs identified by Indigenous communities in meaningful ways\u0026rdquo; (Stoltz et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e, p. 120). The term \u0026ldquo;Indigenous\u0026rdquo; is understood here as persons native to a place whose cultural heritage differs from traditions that are associated with Euro-Western societies (Chilisa \u0026amp; Malunga, \u003cspan class=\"CitationRef\"\u003e2012\u003c/span\u003e, p. 12) but who have not necessarily been subjugated to colonialization at some point in history. For the present study, decolonizing methods were employed where possible in order to raise questions on the influence of the investigator from the development of the research paradigm to the dissemination of results. This was in order to avoid any potential power imbalances by giving participants an equal position in the research process while simultaneously guaranteeing trustworthiness.\u003c/p\u003e\n \u003cp\u003eTo achieve this, qualitative measures were used to allow participants to be coresearchers in the investigation by providing room to articulate their own views and experiences. This creates a neutral, egalitarian, and collaborative space to break down previously held stereotypes and achieve mutual exchange, rather than for instance accidentally adopting a pathologizing approach (Mbah \u0026amp; Bailey, \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e; Thambinathan \u0026amp; Kinsella, \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eMoreover, reflexive journaling, maintaining an audit trail, assuring reciprocity and respect for self-determination, and active listening were actively employed. Regular reflexive journaling was used by the PI to reveal, for instance, Western-centric assumptions (Creswell \u0026amp; Creswell, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). An audit trail was maintained, including timelines, informed consent, participant demographic questionnaires, interview protocols, transcriptions, memos kept during the coding process (in MAXQDA), notes that reflect changes in themes, and regularly updating the reflexivity journal (Creswell \u0026amp; Creswell, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e; Nowell et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). Reciprocity and respect for self-determination were addressed by attempting to co-create the research design using piloting described above (Creswell \u0026amp; Creswell, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). Finally, during the interview process, active listening, namely intensely listening to and respecting their voice and interpretations of life events (Sciarra, \u003cspan class=\"CitationRef\"\u003e1999\u003c/span\u003e) was employed by the PI who also regularly summarized and reflected back key points raised by the participants to check that meaning was interpreted appropriately. All of the above was also important for bracketing, important in hermeneutic phenomenology, to allow the PI to take into account their own experiences when analyzing and describing the phenomenon of school counseling in Bhutan (Moustakas, \u003cspan class=\"CitationRef\"\u003e1994\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eGuided by Martin et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) model of factors influencing school counseling services, the analysis of interview data of 28 Bhutanese school counselors revealed 15 themes that were deemed specific and exhaustive enough to be final. Each specific theme is presented in Table II along with the number of interviews in which these were mentioned.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable II\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eThemes revealed by the interviews and categorized according to\u003c/em\u003e Martin et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) \u003cem\u003emodel of factors. n\u0026thinsp;=\u0026thinsp;number of interviews in the respective theme was mentioned.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCultural Factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e92.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChallenge of school counseling not being adapted to the local context and culture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e92.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImportance of similarities of school counseling with the local context and culture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNational Needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNeed for more resources to cope with youth mental health needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChallenge of differences of needs across the country\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLarger Societal Movements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChallenge of the effects on the COVID-19 pandemic and lock-down measures on school counseling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e96.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModels of School Counseling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLaws and Educational Policy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e85.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNeed for more clear school counseling roles and responsibilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e71.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNeed for more systematic organization such as a clear referral system\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics of the Public Education System\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNeed for students to have more time to see the school counselor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e46.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eThe Counseling Profession\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImportance of activities other than individual counseling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImportance of material resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImportance of human resources such as school principal support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e89.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNeed for more time for school counseling to establish itself in schools and be accepted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResearch and Evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelated Professions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImportance of support from external institutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity Organizations or NGO Coalition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLocal Stakeholder Perceptions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e96.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChallenge of misconceptions about school counseling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChallenge of problems in communication/collaboration with stakeholders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e64.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eEach theme is expressed either as a challenge (i.e. \u0026ldquo;challenge of\u0026rdquo; or \u0026ldquo;need of\u0026rdquo;), in that it is perceived as a barrier to school counselors carrying out their work that needs to be improved, or as a resource (i.e. \u0026ldquo;importance of\u0026rdquo;), in that it is already existing and perceived as an important factor which supports school counselors in their work and which should be nurtured. Themes were found to correspond to all factors of the Martin et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) model of 11 factors except for \u0026ldquo;Models of School Counseling,\u0026rdquo; \u0026ldquo;Research and Evaluation,\u0026rdquo; and \u0026ldquo;Community Organizations or NGO Coalition.\u0026rdquo;\u003c/p\u003e \u003cp\u003eThis categorization is visualized in Figure II.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure II\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eCategorization of themes mentioned in the survey according to each factor of the\u003c/em\u003e Martin, Lauterbach and Carey (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e\u003cem\u003e) model of 11 factors into Challenges (in bold) or Resources (in italic)\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAs such, this analysis revealed the following challenges and resources, which are presented in order of how often they were mentioned, along with direct quote examples from the interviews in order to ground the findings. The quotes are of a slightly different grammar to British or American English due to English being used as a secondary language in schools, government, and other administrative institutions. Rather than 'correcting' these quotes, they were kept intact to honor representation and voice.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eChallenges\u003c/h2\u003e \u003cp\u003eThe most often mentioned challenges were found for the factors \u0026ldquo;National Needs\u0026rdquo; (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;28; 100%), for \u0026ldquo;Larger Societal Movements\u0026rdquo; (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;27; 96.4%), for \u0026ldquo;Cultural Factors\u0026rdquo; (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;26; 92.9%), for \u0026ldquo;Local Stakeholder Perceptions\u0026rdquo; (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;24; 85.7%), for \u0026ldquo;Laws and Educational Policy\u0026rdquo; (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;20; 71.4%), and for \u0026ldquo;Characteristics of the Public Education System\u0026rdquo; (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;13; 46.4%).\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eNational needs\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAll 28 school counselors interviewed for this study mentioned the lack of resources to cope with youth mental health needs perceived to be rising (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;13; 46.4%) such as increases in cases of drug use (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10; 35.7%): \u003cem\u003e\u0026ldquo;I think every year we are seeing diverse issues. Issues are increasing in terms of as I said, [\u0026hellip;] for example substance use disorder was one of the common issues in school\u0026rdquo;.\u003c/em\u003e (Participant 25)\u003c/p\u003e \u003cp\u003eSuch resources perceived as lacking include the need for more specific, up-to-date training (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;22; 78.6%), with their current training being largely perceived as insufficient to address complex student mental health needs (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;25; 89.2%): \u003cem\u003e\u0026ldquo;The training module that got us is not enough for us particularly to deal with the substance use issues and mental health and well-being of children. Because whenever we deal with students who are undergoing tremendous stress and disorder, any kind of mental issues, sometimes we feel that we are not competent enough to deal with such issues because the training is we have undergone, we feel that it's not adequate enough.\u0026rdquo;\u003c/em\u003e (Participant 03)\u003c/p\u003e \u003cp\u003eParticipants also mentioned the lack of awareness about school counseling among school stakeholders and the wider community (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;18; 64.3%), the lack of supervision (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9; 32.1%) and the need for having one male and one female school counselor in each school (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7; 25%): \u003cem\u003e\u0026ldquo;A female and a male would be fair for students like for example, especially teen boys when they have issue they are very hesitant over the very fact that I am a female counselor they can\u0026rsquo;t really open up to me.\u0026rdquo;\u003c/em\u003e (Participant 16)\u003c/p\u003e \u003cp\u003eFundamental here is also the differences of these needs across the country (n\u0026thinsp;=\u0026thinsp;21; 75%): \u0026ldquo;\u003cem\u003eIt\u0026rsquo;s because of the setting. One is rural, this is urban setting, where kids are exposed to many things and that. They are just exposed to the rural setting, they are not exposed. [\u0026hellip;]. The availability and accessibility of substances and alcohol is more here\u0026rdquo;.\u003c/em\u003e (Participant 17)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eLarger Societal Movements\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAlmost all participants mentioned at least once the challenge of the effects of the COVID-19 pandemic and lock-down measures (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;27; 96.4%). This includes the issue of having to switch to online counseling fast (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16; 57,1%), sometimes with insufficient infrastructure (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6; 21.4%), and new counselors who graduated during the lockdown not being able to gain valuable in-school experience necessary for their work, instead having to move straight into online counseling (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7; 25%): \u003cem\u003e\u0026ldquo;Then the lockdown happened and then I was like, it really affected me professionally because I did not have hands-on practice to take clients, directly we had to take online sessions with the students\u0026rdquo;.\u003c/em\u003e (Participant 09)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eCultural Factors\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eMost school counselors also mentioned the challenge of school counseling not being adapted to the local context and culture (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;26; 92.9%) because, for instance, of stigma towards mental health (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15; 53.6%), the traditional role of corporal punishment in schools (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15;53.6%), and school stakeholders not understanding the importance of confidentiality (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9; 32.1%): \u003cem\u003e\u0026ldquo;There are kids who want to reach out. These are staff who want to reach out, who want to talk about their issues, who want to be heard, and they want to discuss things with the counselor. But because of the stigma, they hold themselves back and this is what and because of this, they cannot seek help when they need it.\u0026rdquo;\u003c/em\u003e (Participant 17)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Sometimes they have a rigid mindset that our counseling won't help students. And they are in the belief of the old mindset, where it works through corporal punishment and all. So in that case is sometimes I get feedback from my friends and other teachers saying that -your counseling won\u0026rsquo;t work-\u0026rdquo;.\u003c/em\u003e (Participant 06)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eLocal Stakeholder Perceptions\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eMost school counselors also mentioned the challenge of misconceptions about school counseling (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;24; 85.7%), for instance, being told that counselors don\u0026rsquo;t do any work (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;13; 46.4%) or that school counselors are meant to provide immediate solutions to difficult problems (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;13; 46.4%): \u003cem\u003e\u0026ldquo;All or some have misconception that counselors do not have much work compared to the teachers. And since counseling is taking place in a private room or in a closed or in a very safe room, many people do not know the work that we are doing\u0026rdquo;.\u003c/em\u003e (Participant 12)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;As soon as they referred the child to the counseling, they want to see the immediate changes on the students where it takes some time. So, they don't understand that they think that as soon as the child is sent to the counseling, they want that child to come back as a perfect individual\u0026rdquo;.\u003c/em\u003e (Participant 23)\u003c/p\u003e \u003cp\u003eAlso mentioned often was the challenge of poor communication and collaboration with stakeholders (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;18; 64.3%): \u003cem\u003e\u0026ldquo;Teachers, sometimes they do not always, but then sometimes they really go against the decision we make and the programs we do in school\u0026rdquo;.\u003c/em\u003e (Participant 09)\u003c/p\u003e \u003cp\u003eFinally, they also mentioned the need for more time for school counseling to establish itself in schools and be accepted (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;24; 64.3%): \u003cem\u003e\u0026ldquo;So people have started to accept that when you are not feeling well, especially when you're not feeling good here, it's ok to go to talk to someone, just like when you're having headache or stomachache, how you visit a doctor the same way. So now they have they have accepted that.\u0026rdquo;\u003c/em\u003e (Participant 16)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eLaws and Educational Policy\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAn often-mentioned challenge was the need for more clear school counseling roles and responsibilities (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;20; 71.4%): \u003cem\u003e\u0026ldquo;There's no clear, clarity of the roles and responsibilities of the school counselor, because sometimes school counselors are given the roles and responsibilities which directly come in conflict with their profession, like counselors are given those responsibilities of a teacher.\u0026rdquo;\u003c/em\u003e (Participant 05)\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eCharacteristics of the Public Education System\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFinally, participants also mentioned issues related to the public education system (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;13; 46.4%), such as that students need to have more time to see the school counselor (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;13; 46.4%) and the need for more systematic organization such as a clear referral system (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12; 42.9%): \u003cem\u003e\u0026ldquo;we don't have separate timing to take sessions. What we do is we take sessions during recess, during the break, which is just 10 minutes break, we try to adjust the time in that 10 minutes and we take sessions during lunch, And the third time that we have is after the school. After the school where they are eager to go home. Right. Because they are exhausted from the whole of being in the school.\u0026rdquo;\u003c/em\u003e (Participant 07)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eResources\u003c/h2\u003e \u003cp\u003eThe most often mentioned resources were found for the factors \u0026ldquo;The Counseling Profession\u0026rdquo; (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;28; 100%) and for \u0026ldquo;Related Professions\u0026rdquo; (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16; 57.1%).\u003c/p\u003e \u003cp\u003e \u003cb\u003e\u0026bdquo;The Counseling Profession\u0026rdquo;\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAll 28 school counselors in their interviews mentioned the importance of material resources (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;28; 100%), specifically the need for more of these (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;22; 78.6%), including a separate counseling room within the school (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16; 57.1%), a printer (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;11; 39.3%), counseling books (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10; 35.7%) or a computer (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9; 32.1%): \u003cem\u003e\u0026ldquo;To have a session we need a separate room. We cannot go everywhere and take a session. Luckily, I'm given a room here in this school.\u0026rdquo;\u003c/em\u003e (Participant 07)\u003c/p\u003e \u003cp\u003eBeyond the help of material resources, most school counselors also mentioned the importance of human resources such as support from the CECD (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;21; 75%), from other school counselors (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;13; 46.4%), and from the school principal (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12; 42.9%): \u003cem\u003e\u0026ldquo;CECD really ensures that none of the counselors experience professional burnout. So time to time they make a point to check on us how we are doing, not just professionally but personally also. So we have a place to share our feelings when we are not well.\u0026rdquo;\u003c/em\u003e (Participant 16)\u003c/p\u003e \u003cp\u003eMost school counselors also mentioned the importance of activities other than individual, one-on-one counseling which are useful for their work (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;24; 85.7%), such as carrying out orientation and awareness programs about school counseling (namely roles, tasks, and aims of school counseling services) with teachers, students, and parents (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;20; 71.4%), carrying out parenting education programs on topics such as parenting styles and children\u0026rsquo;s media use (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12; 42.9%) and taking part in other training workshops such as about substance use (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10; 35.7%): \u003cem\u003e\u0026ldquo;So after having conducted some orientation program on counseling, awareness program to the student, parents and teachers, yes, some of this misconception has been cleared. And now, most of the teachers and school principals, they are more supportive of the counseling.\u0026rdquo;\u003c/em\u003e (Participant 12)\u003c/p\u003e \u003cp\u003e \u003cb\u003e\u0026bdquo;Related Professions\u0026rdquo;\u003c/b\u003e \u003c/p\u003e \u003cp\u003eSchool counselors also mentioned the importance of support from external institutions (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16; 57.1%) such as clinical counselors (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;11; 39.3%), hospitals and other medical centers (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10; 35.1%) and psychiatrists (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8; 28.6%) of which there are currently three in the Kingdom: \u0026ldquo;\u003cem\u003eWhenever we feel beyond our own capacity, we refer them to clinical counselor in hospital. And with regard to substance use and substance abuses, if it is a, you know, chronic user, then we send them to a (location withheld) regional referral hospital where we have a drop-in center as well as there is a team where they assess the addiction level of the client.\u0026rdquo;\u003c/em\u003e (Participant 19)\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eQualitative, semi-structured interviews analyzed using Martin et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) model of 11 factors influencing school counseling revealed a number of challenges and resources perceived by 28 Bhutanese school counselors. The study gathered different perspectives on school counseling services in Bhutan, ranging from the profession being described as a \u0026ldquo;growing noble profession\u0026rdquo; (Participant 12), school counselors being expected to be a \u0026ldquo;magician\u0026rdquo; (Participant 19), or feeling like the \u0026ldquo;emotional trash can\u0026rdquo; (Participant 11) of the school. More importantly, specific challenges and resources, some expected and some not, were revealed by the analysis guided by Martin et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) model of factors influencing school counseling services. Challenges and resources were found for \u0026ldquo;Cultural Factors,\u0026rdquo; \u0026ldquo;The Counseling Profession,\u0026rdquo; \u0026ldquo;Laws and Educational Policy\u0026rdquo; and \u0026ldquo;Characteristics of the Public Education System\u0026rdquo;. Challenges only were found for the factors \u0026ldquo;National Needs,\u0026rdquo; \u0026ldquo;Larger Societal Movements\u0026rdquo; and \u0026ldquo;Local Stakeholder Perceptions\u0026rdquo;. Resources only were found for \u0026ldquo;Related Professions\u0026rdquo;.\u003c/p\u003e \u003cp\u003eNo challenges or resources were found for \u0026ldquo;Models of School Counseling,\u0026rdquo; \u0026ldquo;Research and Evaluation,\u0026rdquo; \u0026ldquo;Community Organizations,\u0026rdquo; \u0026ldquo;NGO Coalition\u0026rdquo;. Reasons for this could be that there is already a model of school counseling available in Bhutan, namely the Guidance and Counseling Framework for Schools in Bhutan (Ministry of Education, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) albeit not mentioned in any of the interviews. This could be a sign that this model needs to be revised and updated. Moreover, there is no information available about research and evaluation currently being undertaken specifically for school counseling in Bhutan, which was also found to be the case for instance for school counseling services in Barbados (Griffin, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). This may be due to school counseling services in Bhutan being very new so that there has been insufficient time to implement research and evaluation. Finally, Community Organizations and NGO Coalition, such as UNICEF, were not mentioned by school counselors, perhaps because they currently don\u0026rsquo;t play a significant role supporting school counseling services.\u003c/p\u003e \u003cp\u003eThese results are depicted in Figure III below.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure III\u003c/b\u003e \u003c/p\u003e \u003cp\u003eMartin et al.\u0026rsquo;s (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) \u003cem\u003emodel of factors organized as challenges and/or resources according to interview results\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThese results suggest that, specifically in Bhutan, the school counseling profession needs more resources, more awareness, more organization, and more time. School counselors need (1) more resources to cope with complex mental health needs across schools and across regions, including more up-to-date training and more material resources. They need (2) more awareness in schools and the wider society about school counseling, including clearing misconceptions about school counseling and overcoming stigma towards mental health. School counselors also need (3) more organization, namely systemic changes to make school counselor roles more clear, to systemize stakeholder collaboration and referral systems, and to allow time for students in schools to go to the counselor. Finally, the school counseling profession also needs (4) more time to overcome the challenges of the COVID-19 pandemic and to allow for this profession to establish itself in the Kingdom as an important profession.\u003c/p\u003e \u003cp\u003eThe results of this investigation are consistent with previous research and provide new and unique contributions. These results corroborate a survey study carried out with 162 school counselors on their daily activities, perceived roles and responsibilities, and challenges and needs (reference withheld for blind peer review), namely that school counselors need more role clarity so that they are not being made to take on administrative duties, that they are impeded by lack of stakeholder understanding and support, by a lack of supervision and by stigma around counseling and mental health. The findings of the present study also support the survey results, namely, that school counselors benefit from receiving workshops and having time to carry out programs such as orientation and awareness to overcome the lack of stakeholder support and misconceptions about school counseling in the wider community. Moreover, these results further confirm the important role of material resources, such as having a counseling room and a computer, the ambiguous role of the COVID-19 pandemic, which was both a significant barrier to school counseling and a blessing as it initiated government initiatives to raise awareness about mental health and counseling, and the important role of time, more specifically that the profession needs more time to establish. The results of this interview study supplement the survey study and highlighted the important role of the support provided by the school principal (if they are supportive of school counseling), the support of the CECD, senior counselors and other school counselors, which can be described as social support and which is a type of support that is different for instance from material resources.\u003c/p\u003e \u003cp\u003eThe findings of the present study are also in line with Dem and Busch (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) study of four school counselors in which they reported skepticism from their colleagues, role confusion insufficient preparation, insufficient supervision and stigma about counseling as significant challenges. The present study adds to this past research by also revealing the importance of orientation and awareness programs to reduce stigma and increase awareness, the importance of collaboration with stakeholders within the school and external institutions such as clinical counselors, the need specifically not just for more school counselors but for one male and one female school counselors in each school, and the heterogeneity of needs of schools across the country. More specifically, specific cross-country differences, such as differences between day schools and boarding schools or differences between schools in rural areas and schools in urban areas, need to be taken into account for each school and should be further investigated.\u003c/p\u003e \u003cp\u003eSchool counseling research from other countries further supports these findings, specifically the benefit of having more organized school counseling services with clearer roles and responsibilities. In the United States for instance, schools that offer school counseling services can choose to implement these services within a Recognized ASCA Model Program (RAMP) (Mullen et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). As such, RAMP schools are understood as schools that offer school counseling within a comprehensive, data-driven program for which the roles and tasks of the school counselor are clearly defined, respected, and aligned with the ASCA National model (ASCA, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). In comparison to non-RAMP-schools, school counselors working in RAMP schools have been found to perform more school-counseling related duties (Randick et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and RAMP schools had a positive effect on student achievement compared to non-RAMP schools (Akos et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Jones et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOther studies have investigated the benefits of specific types of resources, such as supervision. For instance, a sample of 24 school counselors in the United States who received supervision reported significantly better self-efficacy than a control group of 69 school counselors (Tang, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eImplications\u003c/h2\u003e \u003cp\u003eThe results of this study first of all imply that Martin et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) model of factors influencing school counseling is a useful model for investigating school counseling services using qualitative methods. Specific themes could be identified that fit under one of the factors, except \u0026ldquo;Models of School Counseling,\u0026rdquo; \u0026ldquo;Research and Evaluation,\u0026rdquo; \u0026ldquo;Community Organizations,\u0026rdquo; and Organizations and \u0026ldquo;NGO coalitions.\u0026rdquo; Unlike what was expected, no new factors were created to accommodate for other themes relevant to the research questions that might have emerged from the data. This demonstrates the exhaustiveness of the model proposed by Martin et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe results of this study further have various implications for policymakers seeking to improve school counseling services in Bhutan. These results not only draw attention to the necessity to provide school counselors with additional resources but also indicate what specific areas need to be supplemented. To address specific challenges and resources that may be hindering school counselors and contributing to burnout, policymakers could start by addressing the four needs revealed by the present study. To address (1) the need for more resources, Bhutanese school counselors\u0026rsquo; initial training should be updated so that it is more efficient and relevant to the current needs of students; additional, continuous training should be provided depending on the specific needs of individual schools; and they should be provided with more material resources such as a counseling room and a computer with internet access. Policymakers should also consider implementing one male and one female in each school, or more, depending on the specific needs of that school. To address (2) the need for more awareness about mental health, country-wide advocacy, and awareness initiatives should be carried out to counteract stigma towards mental health and counseling, and more orientation and awareness programs should be provided in schools. To address (3) the need for more organization, school counselors\u0026rsquo; specific roles need to be more clear and communicated to other school staff; a referral system should be established so that they can efficiently collaborate with external institutions to make referrals; within schools, school policies should allow students more time to go to the school counselor for counseling, for example by allowing students to go to the school counselor during class. Finally, to address (4) the need for more time to overcome challenges, patience is warranted. Namely, more time needs to pass in order to ensure school counseling services are implemented efficiently in Bhutan, and school counselors should not be expected to facilitate immediate, drastic changes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eA notable strength of this study is its sizeable sample. The researcher was able to carry out the interview with 28 school counselors which exceeded their expectation of reaching the provisional goal of 26 school counselors. Moreover, the interview protocol consisted of questions covering a wide array of themes relevant to school counseling. However, this study also presents a number of limitations. First of all, the closed setting of Bhutan definitely posed a challenge for qualitative investigation. Spending prolonged time in the field, which is desirable for qualitative research (Creswell \u0026amp; Creswell, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), was not possible because of administrative barriers. Second, while having an outsider carry out this study has potential advantages, such as providing an unbiased eye into this profession, the study was likely also impacted by cultural differences, such as the language barrier. The interviews were carried out in English which means that maybe some valuable information might have been missed. Future studies should consider carrying out the interview in the language of choice of the participants. Furthermore, although the researcher made every effort to consider their positionality, participants may nevertheless have been biased in their response because of the interviewer not being a Bhutanese national, which is why future studies may also want to consider having a researcher native to Bhutan carry out and analyze the interviews. Finally, as this study only focused on school counselors, the discussion may not be representative of the whole community. Future research should investigate the perspectives and views from other stakeholders such as schoolteachers, school principals, students and parents.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eFuture directions\u003c/h2\u003e \u003cp\u003eDifferences between day schools and boarding schools and between schools in rural areas and schools in urban areas should be investigated to better understand the issues affecting students and how these can be remediated efficiently, such as by implementing substance-prevention interventions in schools in areas where substances are easy to reach. Moreover, future interview studies should be repeated with school counselors in Bhutan in a few years in order to assess how these challenges and resources have evolved over time and why or how they may have changed because of changes to the school counseling system which address the four needs revealed by the study.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eUsing qualitative interviews carried out with 28 school counselors in Bhutan, the present study was able to uncover a number of challenges and resources with the help of Martin et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) model of factors influencing school counseling services. It was found that the profession in Bhutan needs more resources, more awareness, more organization, and more time to establish itself. It will be important to address these needs to buttress this nascent profession destined to play an ever-important role in the Kingdom of Bhutan, but one that can increase the risk of burnout.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJ.L. applied for the funding, carried out the data collection and wrote the main manuscript text.S.H. helped with the planning of the data collection, funding application and proof reading of the main mansucript text. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank Feline Ebert for their help in independently coding five of the interviews to assess inter-rater reliability.We are deeply indebted to our colleagues at the Ministry of Education, Dasho Tenzin Thinley, Reena Thappa, and Nidup Gyeltshen, to school counseling graduate Sangay Wangchuk for his help with the piloting of the data collection tools, and to all school counselors who so generously gave time to participate in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data are available from the corresponding author upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAkos, P., Bastian, K. C., Domina, T., \u0026amp; de Luna, L. M. M. (2019). 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However, little is known about school counseling services in the Kingdom of Bhutan. This study carried out 28 qualitative semi-structured interviews with school counselors, 19 online and 9 in-person, to investigate school counselors\u0026rsquo; perceived challenges and resources. The data were analyzed using a phenomenological approach to inquiry and thematic analysis of interviews proposed by Braun and Clarke (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). The identified challenges and resources were grouped for further analysis according to Martin et al. (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) model of 11 factors affecting school counseling. The most often mentioned challenges were insufficient resources to cope with rising mental health needs (28; 100%) and cultural barriers to implementation of school counseling (26; 92.9%) such as stigma and role of corporal punishment. The most often mentioned resources were the importance of material resources such as having a separate counseling room within the school (n\u0026thinsp;=\u0026thinsp;16; 57.1%) and the importance of support from external professionals such as clinical counselors (n\u0026thinsp;=\u0026thinsp;11; 39.3%). In sum, the results revealed the needs for (1) more resources to cope with the various mental health needs of students across regions, (2) more awareness in the general population about school counseling, including overcoming stigma towards mental health, (3) to systemize stakeholder collaboration such that it make school counselor roles more clear, and (4) for more time for this profession to establish itself in the Kingdom.\u003c/p\u003e","manuscriptTitle":"A “growing noble profession”, a “magician”, or an “emotional trash can”: an interview study of Bhutanese school counselors’ perceived challenges and resources","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-28 17:07:28","doi":"10.21203/rs.3.rs-4829242/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-11T16:35:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-07T18:24:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-01T17:45:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"133087099521569474179158027783812253008","date":"2024-09-09T20:14:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50468171862920599852079512143402999458","date":"2024-09-08T18:09:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-07T20:10:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-01T23:21:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-31T22:46:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal for the Advancement of Counselling","date":"2024-07-30T13:42:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-for-the-advancement-of-counselling","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"adco","sideBox":"Learn more about [International Journal for the Advancement of Counselling](http://link.springer.com/journal/10447)","snPcode":"10447","submissionUrl":"https://submission.nature.com/new-submission/10447/3","title":"International Journal for the Advancement of Counselling","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"18b68e52-a17d-4ec4-9398-8b7ce1b16b3a","owner":[],"postedDate":"August 28th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-10T16:11:03+00:00","versionOfRecord":{"articleIdentity":"rs-4829242","link":"https://doi.org/10.1007/s10447-025-09594-3","journal":{"identity":"international-journal-for-the-advancement-of-counselling","isVorOnly":false,"title":"International Journal for the Advancement of Counselling"},"publishedOn":"2025-02-04 15:56:52","publishedOnDateReadable":"February 4th, 2025"},"versionCreatedAt":"2024-08-28 17:07:28","video":"","vorDoi":"10.1007/s10447-025-09594-3","vorDoiUrl":"https://doi.org/10.1007/s10447-025-09594-3","workflowStages":[]},"version":"v1","identity":"rs-4829242","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4829242","identity":"rs-4829242","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}