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Sara Al-Khedairy, PhD, is a 2025 graduate of the PhD program in Counselor Education & Supervision at Antioch University, Seattle.

Dissertation Committee:

Stephanie Thorson-Olesen, PhD, Committee Chair

Jennifer Kennett, PhD, Committee Member

Rasha Mohamed, PhD, Committee Member

Keywords

pre-licensed clinicians, mental health counseling, licensure, supervision, social-ecological theory, reality shock theory, systemic change

Document Type

Dissertation

Publication Date

2025

Abstract

The counseling profession is struggling to meet the rising demand for mental health care due to a growing workforce shortage driven by burnout, inadequate support, and low compensation—pressures that disproportionately impact pre-licensed clinicians. Despite their critical role in sustaining the field, pre-licensed counselors often face systemic barriers with little structural support. This qualitative study explored the lived experiences of pre-licensed clinical mental health clinicians through social-ecological and reality shock theories. Participants included 14 pre-licensed clinical mental health counselors who had graduated from CACREP-accredited programs within the last five years. Individual interviews were conducted to gain a deeper understanding of participants’ lived experiences, and data was analyzed utilizing a thematic analysis. Eight primary themes emerged: (1) Navigating personal and professional identities in the counseling field, (2) Areas of my life and my health are suffering, (3) Financial realities of pre-licensure are challenging, (4) Interpersonal and professional sources of support are impactful, (5) supervision has not been helpful and has not met my needs, (6) The pursuit of licensure is a confusing and difficult process, (7) Navigating systems in the counseling field can be complex and frustrating, and (8) Being a counselor is meaningful and rewarding. These findings highlight the significant challenges pre-licensed clinicians face while also emphasizing the crucial role of support and the enduring sense of meaning they find in their work. This dissertation is available in open access at AURA (https://aura.antioch.edu) and OhioLINK ETD Center (https://etd.ohiolink.edu).

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Sara Al-Khedairy, PhD, 2025

ORCID Scholar ID# 0009-0008-0572-5728

Dr. Sara A. Al-Khedairy (she/her), PhD, LPCC, NCC, is a practicing clinician and counselor educator based in California. She holds a PhD in Counselor Education and Supervision from Antioch University and an MA in Clinical Mental Health Counseling from the University of San Diego. Guided by a commitment to anti-oppressive and decolonial frameworks, Sara’s professional work spans clinical practice, teaching, and research. Her research interests include diversity, equity, and inclusion (DEI) in counselor education, the experiences of counselor trainees and pre-licensed clinicians, and the clinical and systemic dynamics of consensual non-monogamy. In her clinical practice, Sara specializes in working with consensually non-monogamous, neurodivergent, LGBTQ+, and BIPOC individuals, offering care grounded in relational depth and a liberation-centered approach.

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