Tag Archives: immigration

Counseling survivors of human trafficking

By Lamerial McRae and Letitia Browne-James October 9, 2017

Millions of human trafficking victims exist across the globe. In the United States, hundreds of thousands of victims experience trafficking. As society expands and evolves, human trafficking perpetrators find new ways to recruit and victimize others. The evolution of perpetration ensues because of increases in accessing technology, shifting state and federal laws, and changing criminal investigation methods within communities. Human trafficking continues to evolve into a new way of enslaving human beings, stripping individuals of basic rights and freedoms, while skirting the legal issues of slavery and ownership.

Human traffickers often recruit individuals by offering the fantasy of increased happiness, stability, relationship success and financial freedom. Human traffickers, often referred to as “pimps” or “playboys,” may recruit a female or male victim with promises of a better quality of life, including, but not limited to money, security and safe shelter. These perpetrators often present as charming and recruit their victims using lies and manipulation. They prey on victims from vulnerable populations, including those with low socioeconomic status (SES), biological females, children and adolescents, immigrants and LGBTQ+ youth. The fact that these vulnerable populations often remain dependent on others or experience institutionalized marginalization allows for perpetrators to paint the picture of a better life, both in terms of finance and social support. Thus, counselors must understand the cycle of perpetration and victimization to pinpoint potential victims among clients.

As a starting point, counselors must understand the nature of the phenomenon and seek ways to identify potential risk and protective factors. Counselors must learn to assess and address possible victimization with effective rapport building and intervention. For example, youth may display delinquent behavior (e.g., truancy, sexual misconduct, drug use) as a symptom of coercion and threats by a perpetrator. Perpetrators often experience greater ease when recruiting teenagers because of their tendency to be influenced by others. Sadly, when teenagers fall victim to a human trafficker, they are subjected to the victim-blaming phenomenon.

Thus, to build therapeutic rapport from a nonjudgmental framework, counselors need to understand the true source of teenagers’ behavior rather than labeling them as inappropriate or delinquent. As counselors increase their understanding of risk and protective factors, the profession may be able to conceptualize human trafficking as a systemic problem from a broad perspective.

 

Risk and protective factors

Several risk and protective factors exist for those falling victim to human trafficking. Risk factors include the following demographics and experiences. Risk factors, which are not limited to the list provided, may change over time with the help of counselors.

  • Low SES
  • Previous or current substance abuse
  • Social vulnerability (e.g., children, females, LGBTQ+ individuals)
  • Limited education.

Protective factors, referred to as strengths in counseling, include the following demographics and experiences. Counselors must foster protective factors and strengths in clients to reduce the risk of falling victim to trafficking.

  • Education
  • Family stability
  • Strong social support networks
  • Mental and emotional health

Counselors should understand these risk and protective factors to assess potential risks for human trafficking and to focus on increasing protective factors in counseling. For example, counselors may use a family counseling approach when working with survivors to increase their connections to loved ones and family. Throughout the process of recruiting and selling human trafficking victims, counselors may notice several risk and protective factors playing a role in the process.

 

Human trafficking business model and counseling implications

Human trafficking remains a mysterious and misunderstood phenomenon. Because of a lack of understanding about the effects of human trafficking on our society, counselors are charged with educating themselves to best address and assess individuals for victimization.

Counselors should recognize that survivors of sex trafficking require additional techniques (to those used with other clients) to build rapport with them and to reduce the mistrust that they commonly have about people. To best serve survivors, treatment approaches need to remain centered on survivors, empower them, provide safety and involve a multidisciplinary approach. In addition, professional counselors working extensively with sex trafficking survivors hold legal and ethical responsibilities to provide appropriate services and identify strategies to overcome barriers to their treatment, including specialized and intensive training.

To begin, counselors must understand the human trafficking business model to conceptualize the systemic issue and the moving parts that contribute to the continuing cycle. To highlight some of the societal and professional impacts, consider the parallel of the human trafficking business model to the process of manufacturing goods. The human trafficking business model includes the following stages of grooming and distribution:

1) The supplier recruits the victim.

2) The manufacturer grooms the victim.

3) The retailer determines price and then markets the victim.

4) The retailer sells and the consumer purchases the victim.

The human trafficking business model is a sophisticated process, not always linear in nature, and it functions as a well-established industry. Thus, the need exists to explore each of the model to better understand how to help victims and break the cycle.

Stage 1: Supplying victims. The supplier, also known as the initial human trafficking perpetrator, displays high levels of mental health concerns (e.g., antisocial personality traits) and shows little concern for the basic human rights of others. When victims enter this stage, counselors may find that these individuals report troubles at home, low SES, depression, anxiety and truant behavior. These factors contribute to their need to survive. Unfortunately, this may result in a perpetrator using charm or manipulation to attract the victims. Perpetrators remove victims’ identification, passports and other valuables to trap them in the world of human trafficking.

Clinical assessment is vital at this stage and remains an ongoing process. Counselors may want to ease survivors into telling their stories, paying special attention to the therapeutic relationship. Thus, the most valuable interventions at this stage include active listening and reflection. When administering specific assessment instruments, counselors will want to measure attitudes about victimization and perpetration and prevalence rates of violence. Counselors must use both open- and closed-ended questions to directly address potential victimization. Nonverbally, counselors will want to avoid direct eye contact and limit their use of touch because of victims’ trauma and abuse history.

Stage 2: Grooming victims. This stage involves moving human trafficking victims from the supplier to the manufacturer. Perpetrators continue to display high levels of antisocial behaviors and major mental health concerns; survivors present with mental health concerns such as depression, anxiety and addiction. Substance abuse concerns usually present when perpetrators force their victims to engage in substance use to coerce and control their behaviors, often resulting in addiction.

Counselors must use clinical assessment and maintain that ongoing process. In addition, because survivors have been manufactured as a human trafficking product, their levels of abuse and mistrust often appear high when they present to counseling. Therefore, counselors must focus on the therapeutic relationship as victims provide information about their experiences in trafficking. Counselors should pay special attention to reducing the stigma of substance use and mental health concerns, especially considering that victims develop these concerns because of coercion and violence.

Stage 3: Marketing victims. This stage involves moving survivors from the manufacturer to the retailer. At this stage, human trafficking perpetrators focus on the marketing and sales aspect of their exploitation. For example, based on the quality of their goods (i.e., victim age, appearance) and market demand, perpetrators determine the price for selling each of their victims. At this stage, survivors present with major depressive, dissociative and addiction disorders.

At this stage, counselors again use clinical assessment to understand the survivor’s story while maintaining a trustworthy therapeutic relationship. As previously stated, severe mental health concerns present because of the violence and abuse that victims experience. Thus, counselors need to use evidenced-based practices to treat depression and dissociative symptoms. Some of the most helpful interventions to treat these mental health concerns include grounding and relaxation techniques.

When focusing on grounding, counselors must engage the client’s physical world to assist the person in becoming present in the moment. For example, counselors may ask clients to locate an object in the room and provide an in-depth description. Relaxation techniques to practice include deep breathing and mindfulness meditation. Both types of techniques allow clients to practice coping skills during sessions that can translate to their everyday life experiences.

Stage 4: Selling victims. As retailers push survivors toward the consumers, the perpetrators continue to focus on marketing strategies and targeting potential consumers. Perpetrators often target large events (e.g., the Super Bowl, national political conventions) to take advantage of the crowds and high demand for paid sexual services. Those paying for the sex services, the consumers, exhibit low levels of depression and anxiety. These consumers often report avoiding relationship concerns or other mental health concerns, resulting in a desire to seek out sexual activity.

Because survivors have been a part of ongoing abuse and a cycle of victimization that they cannot break, counselors must use a systemic approach to providing services. For example, counselors need to provide information on shelters and building connections with family. Counselors may incorporate the use of technology and location services, safety words and discussing location with loved ones at all times.

 

Case example         

Toney, an 18-year-old multiracial, cisgender male, moved away from his caregivers’ home about one year ago and currently lives with a friend. He moved because of safety issues in his home and within the nearby neighborhood. When Toney was 16, his father died during a gang-related shootout at their home. Thus, Toney often felt afraid of engaging in a similar lifestyle and enduring similar consequences. Toney’s mother suffered from a severe substance use disorder that led to eviction from their rental home because she could not afford the rent. Toney and his mother became homeless.

While Toney was homeless, Kevin, a childhood friend, suggested that Toney come live with him temporarily as long as Toney obtained a job and contributed to the rent and utility bills. One day, Toney answered the front door, and a young adult male appearing to be about Toney’s age attempted to sell him a magazine subscription. Toney disclosed to the salesman that he was financially strapped. The young man told Toney about the large sums of money he made while selling magazine subscriptions and offered to put him in contact with the owner. Toney was intrigued by the idea of alleviating his financial troubles, and the young male immediately scheduled a meeting with the owner for later that night.

That evening, Toney met with the young salesman and the business owner in an abandoned parking lot, bought their sales pitch and decided to go to work. The business owner told Toney that he would need to move six hours away to another state because there was a high demand for work there and he would not have to pay any rent or utility bills. The business owner promised Toney the opportunity to travel and see many areas of the country while working in the job.

Thus, Toney left a day later to live in a weekly hotel in a new city with his new manager and several others. Upon arriving, the manager took them to a warehouse to pick up the product. They all began working the next day.

After a few weeks, Toney began grasping the reality of his situation. The job of trying to sell magazine subscriptions was strenuous and exhausting. He often worked 10- to 12-hour days while receiving limited rest and food. When Toney voiced concerns about the number of work hours he put in each day, his manager threatened him. The threats later escalated to physical assault when Toney again voiced his concern and when the manager perceived him to be underperforming at the job.

No matter how hard Toney tried, he could not meet the daily sales goal that the manager set for employees. When Toney failed to meet the daily sales quota, the manager either denied him his nightly meal or forced him to sleep outside of the hotel on the streets. As a result, Toney rarely ate and often did not receive the money he had earned while working. He was told that he would receive the money once the team had completed its sales goals for the area and had moved on to another city.

One day, while trying to sell magazines to a homeowner who declined to buy anything, Toney became agitated and started crying. He told the homeowner that he was in trouble and begged her to help him get home, across state lines. The homeowner had recently watched a documentary on human trafficking and invited Toney to use her phone to call the authorities.

The police arrived and took Toney’s statement about his work experiences. Fortunately, the responding officer had recently attended a departmental training on human trafficking, and she took Toney to the police station for further questioning and support. The officer connected Toney with a local nonprofit organization that provided multidisciplinary services, including professional counseling, to survivors of human trafficking. The organization offered shelter and provided Toney with career development services to help him obtain legitimate work. The shelter’s ultimate goal was to move Toney back to his hometown.

In counseling sessions with Toney, the counselor focused on direct questions to assess the nature of the human trafficking Toney had experienced. For example, “Did anyone threaten you or your loved ones?” and “Did you have difficulty leaving the work that you did selling door-to-door merchandise?” While initially reluctant, Toney eventually responded with answers that indicated his victimization. For example, he reported that his manager used threats and power and control tactics (such as denying Toney food, money and shelter) to force him to work.

Following assessment, Toney received counseling services focused on recovering from the abuse he had endured. Toney felt validated because he was not alone while accepting that he had fallen victim to human trafficking. The counselor and Toney focused on crisis intervention and stabilization in the beginning, which included discussions about adjunct services and basic needs assessments (e.g., food and clothing, job obtainment). Next, the counselor and Toney addressed the trauma, focusing on decreasing anxiety-provoking cues and scaffolding into addressing more severe cues and triggers. All the while, Toney and the counselor developed several grounding and relaxation techniques to use both in their sessions and in Toney’s real-world experiences.

One of the most valuable grounding techniques made use of a rock that Toney could hold whenever he felt distressed. The counselor taught Toney how to become present, while holding the rock, through discussions about the texture, shape and weight of the rock. Discussing these tactile experiences allowed Toney to focus on the here-and-now rather than attempting to escape feelings and thoughts.

Toney and the counselor also used a breathing method in which Toney would take a deep breath through his nostrils for at least three seconds and exhale through his mouth for three seconds. They determined that he needed to take at least three deep breaths during the exercise so that he could calm down.

In the final stages of counseling, Toney and the counselor developed an action plan to help him avoid falling victim to trafficking. That does not mean, however, that Toney took responsibility for the actions of others. Toney and the counselor reviewed the different needs he may have and how to meet those needs in a helpful manner.

While focusing on the trauma from human trafficking victimization, the counselor worked with Toney on obtaining a job at a local fast food restaurant. They chose this restaurant so that he could easily transfer to another store in his hometown once he felt comfortable with the transition. After three months, Toney finally returned home and moved back in with his friend, Kevin. He remained employed as a fast food line cook and began seeking education at a local culinary institute.

 

 

****

Lamerial McRae is an assistant professor at Stetson University and a licensed mental health counselor in Florida. Her research and clinical interests include counselor identity development and gatekeeping; adult and child survivors of trauma, abuse and intimate partner violence; marriages, couples and families; LGBTQ issues in counseling and human trafficking. Contact her at ljacobso@stetson.edu.

Letitia Browne-James is a licensed mental health counselor, clinical supervisor and national certified counselor. She is a clinical manager at a large behavioral health agency in Central Florida and is in the final year of her doctoral program at Walden University, where she is pursuing a degree in counselor education and supervision with a specialization in counseling and social change. She has presented at professional counseling conferences nationally and internationally on various topics, including human trafficking.

 

****

 

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

Working with Latina/os in counseling

By Jacqueline Michelle Barthelemy June 20, 2017

According to the U.S. Census Bureau, as of July 1, 2015, Latina/os made up approximately 56.5 million of the total U.S. population, making them the largest ethnic or racial minority in the country. The Latina/o population is projected to grow to 120 million by the year 2060.

The question on many counselors’ minds is, how can we work better with our Latina/o clients? With the growing number of Latina/os in the U.S., it is likely we will work with these clients at some point as counselors, and it is our professional obligation to be prepared.

Working with clients in general can be a new learning experience, especially if their cultural background is different from our own. Many master’s programs require counseling students to take a multicultural course to prepare to work with clients of different backgrounds. But textbooks can provide only so much general knowledge. How are counselors supposed to learn how to work with different cultures if they are reduced to a mere chapter in a textbook for a one-semester course?

As someone whose background is Latina, my upbringing has prepared me to better serve people who share my cultural background. Nevertheless, my experiences have made me aware of further areas of growth in serving my clients (for instance, my lack of Spanish fluency is a hindrance).

In my current position, I work with clients and their families to get them more comfortable with the idea of counseling. It is sometimes difficult when working with Latina/o clients because there are so many challenges that bring them to counseling, or there is the stigma of counseling that turns them off to it altogether. If it is their first time going to counseling, their first impression of you, as the counselor, may color all future experiences with the counselors they may see. It is our duty to make clients feel comfortable and let them know that their concerns and goals are a part of the counseling process. Ultimately, clients set the tone for counseling.

 

Traditional Latina/o upbringings

In the Latina/o culture, family comes first (after God); the first relationship you have is the one with your family. Traditional Latina/o families are brought up being very close to their immediate and even extended family members, where everyone cares about everyone. Elders are highly regarded, and children, regardless of age, respect their parents.

Most families live in multigenerational households that include parents, siblings and grandparents. Sometimes extended family members may also reside in the home at one point or another. So when working with these clients, it is best to remember that family plays a vital role in their everyday lives.

When working with the whole family, it may appear that the family is unresponsive to the counseling process. Counselors should be as patient as possible, however, because family members may be waiting for their head of household (typically the male) to start and lead the conversation. The key is to treat and work with the family as a unit because that is how they might live their life traditionally. Family support is everything to Latina/os.

The Latina/o culture has many rich traditions that are passed down generationally. An example is the Mexican holiday of Dia de los Muertos (Day of the Dead, celebrated Nov. 1-2), during which families gather to pay respect for their loved ones. Often they build altars in their homes or at graves, where they place flowers, pan de muerto (bread of the dead, which is sweetened bread eaten the day of or the week leading up to the holiday as a sign of respect to the departed), pictures and the favorite food of their loved ones. Some say small prayers or retell stories of their dearly departed.

Knowing about this while counseling a family can be very beneficial, especially for those who are grieving. Understanding some of their traditions can help to build trust, connect with these clients and strengthen the counseling relationships. If you are counseling a Latina/o family or client who is grieving, talking about or suggesting the altar can help with the process. However, be sure to remember the origins of the family or client you are working with because different cultures in the Latina/o diaspora maintain different traditions.

Most Latina/os’ identities are strongly rooted in being members of specific groups. For example, if the client you are working with is from Guanajuato, Mexico, she or he will most likely take pride in being from that particular state in Mexico. As counselors, we should always ask clients where they are from to get a better understanding of who they are as individuals. Counselors should also be aware that having this sense of pride can cause conflicts in characterization of identity with other members of Latina/o groups.

Faith in one’s religion also plays a very important role in the lives of Latina/o clients. Religion can set the tone for the family as a whole — the tone being that God comes first, the family trusts in Him, they live their lives according to the Scriptures, and they are good and honest people. Many Latina/o clients have makeshift altars with religious artifacts in their homes where they pray the rosary daily (a rosary is a string of beads; some say a prayer per bead as a way to be closer to God or a saint). When counseling these clients, it is best to remember how important their faith is and how much of an impact it has on their lives and the decisions they make daily.

 

Stigmas of counseling in the Latina/o community

I grew up with the best of both worlds — a mixture of traditions blended with new possibilities. Sometimes those ideas conflicted with one another, however.

My grandparents stressed that if I had issues or problems, that I should share them only with my family and no one else. Our reputation and how the world perceived us was important. To share something too personal with strangers or people outside of the family could change people’s views of me, potentially leading to getting overlooked and judged. On the other hand, my mother told me that people would judge me regardless of what I shared, so I might as well be my most authentic self.

I had an amazing support system in my mother and grandparents. They listened to me and allowed me to feel what I felt, regardless of the situation. My family kept me grounded and later led me to my career path as a counselor. I realized that not everyone was as fortunate as I was to have this incredible family support team to believe in them unconditionally.

When I told my mother about my decision to become a counselor, she was supportive and understood what a counselor was. However, my grandparents had a hard time understanding my decision to go back for more schooling. The first thing they asked was, “¿Qué es un consejera?” (What’s a counselor?). I spent an hour trying to explain, but all they understood was that I was going back to school, so I was probably doing something with teaching (because my bachelor’s was in education).

My grandparents believed in getting an education, but they were confused about why I would want to go back to school again. Had I not done enough the first time around? Why was I delaying working full time? My grandparents, like many traditional Latina/os, did not fully understand what counseling was or why someone would utilize the service. They wondered why you would need to tell your problems to someone else when you have family or could pray about your problems.

I knew that as a counselor, I could be a part of a support system for others and help them reach their goals. When working with Latina/o clients, it is helpful to explain that our job as counselors is to be that support system for them, much like their own families. It is best to emphasize that you want to be able to assist them, offer resources and be another source for them to use in achieving their goals.

In the Latina/o culture, counseling is stigmatized. Many families are brought up not to “gossip” or talk about personal or family problems with strangers. Aside from that, most families do not have a clear understanding of what counseling is. Families stress not talking to others about their issues because they know that people can gossip. For some of these families and clients, their reputations are all that they have, and if they are talked about badly, they take it to heart.

It is our job as counselors to educate others about what counseling is and how the counseling process works. It is best to emphasize confidentiality and the rules that are in place to protect clients, as well as the only times when confidentiality needs to be broken. Having Latina/o clients understand the counseling process and what it entails can make all the difference in building good rapport.

The risk is high for any individual who is an undocumented immigrant. The resources available to these individuals are limited, and they have fewer opportunities to vocalize their needs for fear of being reported to Immigration and Customs Enforcement. Clients and potential clients who are Latina/o may be tight-lipped because they do not fully understand where information shared during counseling could end up. Again, I recommend carefully explaining what counseling and confidentiality are.

If the client or family members are working, their work environments may be less than ideal. They may be underpaid or get paid under the table (paid in cash only), and their superiors may subject them to harsh work conditions (for instance, overworking them). Latina/os who are undocumented immigrants live with the uncertainty of not knowing whether today is the day they are going to be deported. Because of this uncertainty, they sometimes do not feel comfortable sharing any personal information with people who are not family. These clients need to know that they can trust the counselor. Counselors need to reassure clients that their offices are safe spaces and what they share will remain confidential.

Some Latina/os choose not to share with family that they are seeking mental health counseling for fear of being judged negatively. When encountering clients who have no family support, it is best to address those concerns and explore other people (both outside and inside the family) they can count on for support.

As a school counselor, I have worked with Latina/o students, and to do so, one of the parents must give consent. The majority of the permission slips come back from the mothers, not the fathers. Typically, it is the mother who is more open to her child receiving counseling services, often on the condition that the father remains in the dark about the services the child receives. One time, I had to stop seeing a student when the father found out the student was receiving counseling services. The father came to the school livid. He gave his verbal and written consent to stop counseling services, and I had to oblige. It was a difficult situation because the student benefited from counseling, and I tried to get the father to see that. Ultimately, however, I had to honor the wishes of the parents and stop counseling services.

Another stigma of counseling with Latina/os is labeling in the educational setting. Many families worry about labels and how they can potentially negatively affect their child. Sometimes these labels can even lead parents to believe something is wrong with the child.

As counselors, it is our job to destigmatize labels and show that labeling is not always negative. When students are struggling academically in school, teachers, school counselors and other staff work together to figure out what is preventing them from succeeding academically. All the necessary avenues are taken (e.g., teacher works on modifying classwork and contacts parents for extra support) before determining a student needs an evaluation to determine if he or she has a learning disability.

When students need Individual Education Programs (IEPs), families are sometimes hesitant to support such plans. They worry what it might potentially mean for their child regarding being labeled. But in these cases, labels can help students receive the necessary services to achieve their academic goals. Remind parents that they are encouraged to be as involved as possible in the IEP process, the process can take a long time to complete (sometimes as long as six months) and that counselors can serve as advocates to assist them with the process.

 

Multigenerational conflicts

Even with what is taught in multicultural classes, not every family adheres to what you assume about Latina/os. As the years progress, younger generational Latina/os are abandoning some traditional norms. They are coming to be their own person and wanting to incorporate new traditions with the ones already established within the family.

An example of this is young Latinas not conforming to the expected gender norms of their culture. Most young Latinas who are raised in traditional families grow up learning that a wife’s place is in the home and taking care of the family, whereas a husband’s role is to provide for that family. Some Latinas are shattering these gender norms and wanting more for their life, such as going to college and putting off marriage and children. This can cause tension within the family unit.

For example, my mother broke barriers in her own family. When she was growing up, it was basically expected that she would be a good person and a future wife. My mother put off marriage and having a child and dedicated her time to figuring out her future. Her parents were not as supportive as she would have liked, and she left home (something that was not expected of young single Latinas).

My mother decided she wanted to go into the medical field, but she did not have her father’s support. Her mother would check on her and take her to night classes without her father knowing. The sneaking around her mother did went on for the duration of the time my mother was in school. It was because of the barriers my mother broke that I have been afforded the life I have now.

As a counselor, you might work with these clients and their families to try to get them to see eye to eye on what traditions they want to continue to uphold. The goals for counseling would be to hopefully reach a healthy and happy balance where everyone in the family is understanding of the others’ opinions.

 

Language barriers

Many Latina/os want and need counseling services, but the language barrier sometimes prevents them from receiving these services. Bilingual counselors are in high demand to reach these families. If counselors can speak Spanish, the family or client may feel more comfortable speaking with them, helping to build good rapport. If you are not fluent in Spanish, there are steps you can take to bridge this language gap, including using digital apps or going to someone who can help you learn the language.

I am not fluent in Spanish, but I have some conversational ability, and this has been a tremendous asset in reaching out and talking with Latina/o clients. If Spanish is your clients’ first language, they may feel more comfortable speaking in their native tongue and may talk more freely about their concerns or what brought them to counseling.

On another note, just because someone speaks a language doesn’t mean they read it well, so be sensitive to literacy levels in a language. Also, just because clients look like they Spanish might be their first language, don’t assume that it is. For example, some Latina/os such as Brazilians speak Portuguese.

 

Breaking down the stigmatization of counseling

How do we get Latina/o clients in our doors if they are hesitant to speak with someone outside of their families? The proactive actions counselors can engage in to break down these barriers include getting familiar with and volunteering in the community. Start small and get acquainted with the community you are targeting. What kind of resources and services does the community offer? Talk and research with other individuals to see how you can have a presence.

While working, see what potential clients are seeking help with (child care, employment, etc.) and figure out where the clients can go to receive those services. Often information is available to help people, but they do not know where to look for it. Knowing where and in what direction to point a client can make all the difference.

Normalize counseling and curtail the stigma; counseling does not equate to being “crazy.” People utilize counseling services for various reasons. Try and provide real-world examples of people taking care of themselves. For instance, you might say, “If you go to see a doctor for a checkup, why wouldn’t you see a counselor for a mental health checkup?” Let potential clients know it is normal to feel overwhelmed. After all, they are only human.

Educate potential clients about the counseling profession. Tell them that your job is not to judge but to listen and work with them to alleviate their stress. Explain that you are there to help them; they decide the counseling process and the direction of counseling. Self-disclose (within reason) about some of your own related experiences with the Latina/o client. Let them know they are not alone in their struggle. Inform them that it is normal to feel stressed and that talking about those stressors can be therapeutic.

Seek others in the community who are working with the Latina/o population, such as doctors, priests and schools. Explain who you are and what you are trying to achieve. Contact local public and private schools to ask about volunteering and working with the school’s counselors to help develop a counseling curriculum. Again, after being seen, you will become a trusted face in the eyes of potential clients. Underfunded schools in particular may not even have a school counselor on staff and would likely welcome the extra support for their students.

Finally, when trying to reach potential clients, think about the community you are working in. Is it in a low socioeconomic area? Is there an issue with trying to afford mental health services? Lack of financial income and insurance are among the reasons that some Latina/os do not seek mental health services. Think about offering pro bono counseling to make quality counseling available to all, regardless of insurance or income.

These clients may be working multiple jobs and face time constraints with raising a family. If they are without a vehicle, transportation to see a counselor may pose an obstacle as well. Counselors might think about being able to point these clients toward quality child care or offering bus passes to help with transportation to and from sessions.

 

Conclusion

Whatever brings Latina/os to counseling, it is important that we do our best to help in whatever way we can. Their first interaction with a counselor may lead them to form an assumption about all counselors moving forward. With the increase in population of Latina/os in the U.S., counselors have to be prepared to better serve these clients and break the stigma of counseling. Counselors must remember to be nonjudgmental and take an active interest in what their clients tell them about their backgrounds. Figure out how to work with others, and see how you can be a positive force in the community you are servicing.

Doing research about the client’s background can help strengthen the rapport between you and show the client that you are taking an interest in what she or he tells you. To work with this community, it would be best to take Spanish-language classes and read as much as you can about the Latina/o culture. Books and classes can certainly help, but the best way to truly serve these families and clients is through community engagement and becoming familiar with their cultural practices.

 

****

 

Jacqueline Michelle Barthelemy is a fourth-year school counselor. She received her master’s in counseling from Saint Xavier University and is currently a doctoral student in the counselor education and supervision program at the Chicago School of Professional Psychology. Contact her at jacqueline.m.barthelemy@gmail.com.

 

****

 

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Teaching counselor education curriculum in a ‘new reality’

By Suzanne A. Whitehead May 19, 2017

I love my job, my calling, as a counselor educator, and I take my role and passion as a graduate student advocate, public innovator and social justice change agent to heart every single day. As Mahatma Gandhi once said, “Be the change you wish to see in the world.”

His words are my mantra in life. Each one of us touches the hearts of so many others and, thus, the very future.

But teaching in these uncertain, turbulent times has been challenging to say the least. A powerful, yet almost silent and unspoken subtle change has occurred in my classrooms. It almost feels like a gray mist or cloud that is not seen but clearly felt.

I have never tried to be political with my students or to discuss politics in the classes that I teach. I don’t believe in it. Just because a professor has a “captive audience” in a class and CAN speak his or her mind doesn’t mean that one should. I don’t shy away from state, national or global issues because they are often pertinent to the material we discuss. Still, I don’t offer my own political opinion on these issues, mostly out of respect, but also because I feel it’s the right thing to do.

I care a great deal about my students. I can see the concern and worry in their eyes. They are more unsettled than normal, and the mood is palpable. Approximately 80 percent of my students are Hispanic and bilingual. They share an immense pride in their heritage, culture and family systems. I honor their commitment to their communities, their livelihoods and this country that they dearly love.

My students bring in reports of their own counselees in schools and agencies who share stories of intense fear, anxiety and pain at the idea that they, or their parents, could be deported. We have a lot of “Dreamer” students (children of undocumented immigrants) at my university and many of these children and families in our surrounding communities. Their understandable angst is powerful, heart-wrenching and compelling.

 

Teaching in these challenging times

And now we are asked to continue to teach our students as though nothing has changed in our world. No matter how one voted (or chose not to vote) in our nation’s most recent election, one thing is for certain: It has been an incredibly acrimonious, divisive and challenging time for our entire country. I have my opinions, but they are not for me to share them with my students. Yet they share theirs, every day. They have to because it affects their lives, their families and the clients they serve.

Other counselor educators who are struggling with these same issues may be wondering: How do we respond in a caring, empathic, yet ambiguous, way and not take sides?

The danger in “taking sides” is that even if I find great personal solace in doing so, I may also inadvertently destroy a student’s belief that each person has a right to free speech and to believe as he or she sees fit. In my bully pulpit ramblings, I could possibly (even if unintentionally) insult or even scar a student who may hold vastly different opinions from my own. That would be inexcusable. That serves no one except for my own selfish gain.

 

What we can do

It tugs at my heartstrings, but the only conclusion I can see is to treat this situation as a counselor would with any client. We must be confident, genuine, caring and willing to listen. We need to share that we understand students’ (and their clients’) fears and concerns. We express great empathy for what they are experiencing and model, summarize and validate their honest emotions, using an overall person-centered approach from Carl Rogers.

This isn’t always easy with a large number of students on one’s caseload. I never want to appear disingenuous. I just keep telling them, and myself, that their feelings, and those of their clients, are real, significant and truly matter. I will not judge; that is not my purpose as an educator. And I will not just gloss over everything with the proverbial, “It will all be just fine” message, to assuage their fears and my own discomfort.

All we can do is let them know how much we care and then use our own therapeutic orientations that we hold dear to help them and their clients. For example, in using a brief solution-focused therapeutic approach (Steve de Shazer), they can explore their options and what they believe IS within their power to influence, and develop effective ways to cope and move forward. These are all productive ways of handling and making sense of difficult times. The basic tenets of Viktor Frankl’s logotherapy seem useful here as well — finding purpose and meaning, even within one’s suffering and turmoil, and a reason to keep going.

 

Wellness for counselor educators

It is also more evident than ever that we as counselor educators need to take the time for wellness and coping strategies for our own mental well-being. It is one thing to conduct site visits and observations to see each of my students working with children, adolescents and adults. I too hear their stories firsthand and feel great empathy for their situations. But now, we also hear the same concerns from our students in our classes, and it is hard not to feel their pain intensely.

I reach out to my professional colleagues for feedback and interaction. I value the unwavering support of my family and friends and cherish their input now more than ever. And I have become intensely aware of where my own “head” is at — and my emotions — and utilize my coping strategies to the fullest. I consciously try to “check my ego and attitude” at the door before I step into the classroom and hold fast to the belief that I am here to instruct, teach, lead and inspire. The American Counseling Association’s values and code of ethical conduct are bedrocks of sanity to hold dear.

I am guessing that things will continue to be tricky for many of us in the coming months and years. As educators, we need to help each other through these very different times and circumstances. Knowing that the counseling profession is strong, and that our colleagues are always there for us, brings great comfort and resoluteness. My fervent hope is that it brings the same to each of you.

“Carpe diem,” dear colleagues.

 

 

****

 

Suzanne A. Whitehead is a licensed mental health counselor and assistant professor of counselor education at California State University, Stanislaus. Contact her at sawhitehead7@gmail.com or swhitehead1@csustan.edu.

 

****

 

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Mental health implications of undocumented immigrant status

By Laura M. Gonzalez and Nathaniel N. Ivers April 6, 2017

The phrase undocumented immigrant, or its less charitable counterpart, illegal alien, tends to cause a stir in the media. The focus is on the paperwork, the lack of permission or legal status to be in the United States. However, for counselors to work effectively with this population, it is helpful to spend some time considering the second part of that phrase: immigrant.

For a person to decide to leave all that is known, familiar and comforting behind, he or she is likely in a state of considerable duress. Among the stressors that push immigrants to leave their homes are grinding poverty and starvation, threatened or actual violence, extortion from gangs, ethnic or religious discrimination and lack of hope that their situation will improve. Whether their journey involves hiding in a container in a cargo ship, clinging to the top of a moving train or walking through difficult terrain, it is not a decision to be taken lightly. Such a journey can last for months and be extremely perilous.

A person who decides to undertake such a journey as the “best available option” is already living in a state of physical, mental and emotional deprivation. We encourage counselors to consider the challenges posed by the pervasive stressors present in the person’s home country, the possible trauma encountered on the journey and the difficulty of living in the shadows in a new land where so much is strange and unfamiliar.

We have several goals with this article. We wish to clarify terminology and definitions to generate an accurate understanding of this population, describe some of the challenges facing families with undocumented members in the United States, outline some commonly occurring mental health issues among undocumented immigrants and provide counselors with some resources and ideas about how to respond to these clients. In addition to building individual capacity to respond among counselors, we hope to inspire advocates in our profession to consider systems-level responses or ways we can promote more equitable access to the support systems that undocumented immigrants often need. We are focusing on the undocumented portion of the immigrant population because of the severity of their needs and the relative scarcity of resources to meet those needs.

In terms of definitions, immigrants are people who leave their home country to live (temporarily or permanently) in a host country. They differ from refugees, which are defined as individuals fleeing persecution, war or natural disaster. The United Nations classifies refugees as a protected group, and if a host country offers these individuals asylum, it comes with automatic legal status. Immigrants can apply to receive temporary legal status based on a special function (such as a work visa or student visa), or they may become eligible for residency through a qualified family member who is a U.S. citizen. However, there are caps on each category (i.e., not every person who wishes to come to the U.S. to work or study may do so). Deferred Action for Childhood Arrivals (more commonly known as DACA) is a temporary permission to work that does not provide true legal standing in the U.S., and it can potentially be revoked by executive action.

It is important to have a trusted source for accurate information about immigration, especially when so much inaccurate information abounds in other public sources. In particular, counselors may wish to become familiar with eligibility for health and human services for undocumented immigrants. A helpful source for this information is the National Immigration Law Center website (nilc.org), which provides details about eligibility for health care services, education, workers’ rights, driver’s licenses, economic support programs and so on.

It also is important for counselors to be aware that differences exist between federal and state immigration policies and practices. Some states have created restrictive laws to govern activities such as enrolling an undocumented child in school, presenting for services in an emergency room and applying for a driver’s license. Thus, it is incumbent upon counselors to understand the climate and laws within their states and local communities. The current policy climate is changing rapidly, so staying up to date is essential.

Common challenges

Each immigrant family with at least one undocumented member is unique, but some typical challenges do exist. For adult immigrants who are undocumented, there are daily concerns about detection by the authorities, potential deportation and separation from other family members. Even an act as simple as driving to the grocery store can be perilous without a driver’s license, so undocumented immigrants may adopt the mantra “trust no one” and try to live in the shadows, undetected. The newest guidelines from the Department of Homeland Security (dhs.gov/executive-orders-protecting-homeland) include a broader definition of priorities for deportation. This change has generated enormous fear in the immigrant community.

Many undocumented immigrants must work jobs in which they are paid as part of the underground economy. Thus, they are not able to speak out against unsafe workplace conditions or unfair or discriminatory practices for fear of retribution. These jobs often pay poverty-level wages and involve hard manual labor. Some undocumented immigrants work more than one job to make ends meet.

Adults who are undocumented are also unlikely to have access to needed services such as health, legal, educational and other social support services, so they have unmet needs in terms of physical and mental health. In addition, it is common for these adults to have experienced some form of trauma — physical or sexual assault, robbery, threats, extortion, bearing witness to murder — during their journey to the U.S., so there is an accumulation of stressors that can become quite profound.

Youth living in a family with at least one undocumented member experience some of the same stressors — concerns about deportation of a family member, poverty, lack of services, etc. But some of their concerns are different. In most cases, these youth will have access to basic K-12 education, so they often acculturate to U.S. language and culture norms more quickly than do their parents. This can be difficult in the early phases of adjustment, but it does bring some benefit in terms of language proficiency, educational opportunity and socialization.

However, when their friends start moving through rites of passage such as getting a driver’s license, landing a first job or applying to college, youth who are undocumented or who have an undocumented parent have a strikingly divergent experience. Some are already aware of their legal status, but other youth first learn about their lack of documentation when they ask their parents to assist with these normative tasks. At this point, some youth become disillusioned and depressed, believing that all of their dreams and aspirations are now beyond their reach. Without a socially sanctioned way to participate in society, these youth may become involved in maladaptive coping strategies (e.g., gang involvement, substance abuse). Other undocumented youth become more determined and start fighting to achieve their goals, even if they have to create new systems outside of the defined legal structures.

In both cases, it is unlikely that their parents will be able to provide much assistance, so undocumented youth will almost always need advocates or champions from outside of their group to assist them. It is risky to identify oneself as undocumented in today’s hostile political climate, so finding an advocate is not a straightforward process. Adults who are familiar with the signs and signals that a youth (or a youth’s family member) may be undocumented — for example, not driving, not applying to college even with a good academic record, having many absences from school that are not typical — may find ways to reach out and indirectly inquire about the youth’s circumstances or offer resources. Counselors might wish to review websites such as the Department of Education’s Resource Guide: Supporting Undocumented Youth (www2.ed.gov/about/overview/focus/supporting-undocumented-youth.pdf) and the UCLA clearinghouse of resources on undocumented youth (smhp.psych.ucla.edu/qf/undoc.html).

Using ecological systems theory 

It is important that counselors understand the singular environmental factors and societal barriers that have the potential to affect the development and mental health of undocumented youth and families. This understanding can prepare counselors to apply more effective strategies when working with undocumented clients or families.

Urie Bronfenbrenner’s ecological systems theory may be a particularly helpful tool for counselors in this regard. Bronfenbrenner’s theory describes human development in terms of interactions between individuals’ personal characteristics and their environmental systems. The five environmental systems are the microsystem, mesosystem, exosystem, macrosystem and chronosystem.

The microsystem is the most immediate environment in which an individual interacts. For children, microsystems commonly consist of a small group of people, such as parents, siblings, schoolteachers, friends and classmates. The mesosystem is the interaction between microsystems, such as the communications between parents and teachers.

The exosystem is outside of one’s direct interaction but still has the potential to impact one’s mental health and development because it directly influences members of one’s microsystem. This might include a parent’s relationship with his or her boss or co-workers, or a teacher’s relationship with his or her principal. A common example of the influence of the exosystem on someone is that of a parent who feels unappreciated and disrespected at work and then displaces that anger and frustration onto his or her children.

The macrosystem is the largest ecological system. It includes cultural values and beliefs, and political and economic systems. The chronosystem, which includes constancy and change, reflects the influence of time on one’s development.

Undocumented immigrant status can influence all aspects of a person’s ecological system. In the microsystem, immigration may affect the relationships among and between family members. The combination of fewer community and financial resources plus the need to stay obscure or in the shadows may reduce the number of microsystems that undocumented youth and families have. For example, documented youth may engage in more extracurricular activities than do undocumented youth. This expands the microsystems of documented youth to include additional people, such as teammates, music teachers and coaches.

Immigration, and particularly undocumented immigration, may also change traditionally microsystemic relationships into exosystemic relationships. For example, it is common for undocumented families to immigrate to the United States in waves, with a parent initially leaving children with extended family members. This can lead to parents becoming part of their children’s exosystem for a period of time. Later, when children are able to immigrate to the United States to reunite with their parents, the relationship rapidly shifts back to one that is microsystemic. These sudden shifts in interactions can require an adjustment period and strain the relationships between undocumented youth and their parents. Changes in microsystems can also occur as the result of other factors such as deportation.

Undocumented immigration may also influence the mesosystem, or interactions between microsystems, particularly in reference to the quality and frequency of such interactions. One example is the relationship between a child’s schoolteacher and parents. Language differences between parents and teachers can affect the strength of this relationship, which can in turn reduce the ability of undocumented parents to be fully involved in their child’s school. This can prove particularly challenging when difficult and complicated situations such as discrimination or bullying occur.

The indirect aspect of the exosystem may be particularly pronounced with undocumented youth and families. Parents who are trying to make ends meet but who are not legally allowed to work in the United States may work long hours at very low-paying jobs and experience exploitation, prejudice and discrimination. Parents who experience financial stress and fear of potential deportation may inadvertently displace their preoccupations onto their children in the form of irritation and frustration. This can negatively impact the mental health and development of these youth.

The macrosystem also may have a profound effect on mental health and development. In particular, marginalized groups such as undocumented youth and families are particularly vulnerable to economic and political trends. This is certainly true in reference to the legislation and execution of laws associated with undocumented immigration. As previously mentioned, undocumented youth who learn of their undocumented status and the barriers associated with that status in terms of securing education, employment, a driver’s license and so on may be particularly susceptible to feelings of despair, hopelessness, helplessness, anxiety and fear.

Unique factors associated with the chronosystem also may be in play with individuals and families who are undocumented. In particular, the possibility of change, such as deportation, may constantly be on the minds of undocumented youth or members of their microsystems. Changes (or a lack thereof) in immigration policies and laws may also affect the mental health of undocumented individuals. For example, in 2010, Dreamers anxiously awaited the prospect of gaining citizenship through federal legislation (known as the Dream Act). However, this legislation was met with barriers and did not pass Congress. This was a huge blow to many who were leaning on this legislation for the prospect of stability, opportunities for education and careers, and other privileges of full citizenship.

More recently, political rhetoric and actions associated with securing the U.S. border and enforcing immigration laws more strictly have created a great deal of uncertainty and fear in undocumented immigrant communities.

Strategies for working with undocumented clients 

Counselors can do a number of things to help undocumented individuals and their families. With respect to the microsystem, counselors can provide a space for undocumented youth and families to vent their frustrations, fears, mistrust and sadness associated with their experiences of discrimination, exploitation and barriers. Helping parents to express their frustrations may reduce the chances of them displacing anger and frustration onto other members of the family unit. Counselors can also help parents problem-solve and cope with challenging aspects of their lives, such as dealing with disrespectful co-workers or prejudicial bosses. In addition, counselors can help parents prepare for worst-case scenarios, such as steps they could take in the event that one or both parents were detained or deported.

Concerning the mesosystem, counselors can help youth and families develop their relationships with other microsystems, such as teachers and other school personnel. In particular, it is important for counselors to help undocumented youth and parents brainstorm ways to respond to school personnel about school issues such as academic struggles, behavioral challenges, discrimination and bullying. With clients’ permission, counselors working with undocumented youth and families may also consider taking on an advocacy role with school systems, particularly when discrimination and unresolved bullying are occurring.

With respect to the macrosystem, counselors may consider advocating for changes in the law regarding illegal immigration. This may include advocating for pathways to citizenship, better access to community resources and so on. It also may take the form of advocating against movements or legislation that would be harmful to undocumented youth and their families.

Counselors can also help youth and families draw upon and cultivate resilience. This may take the form of helping clients to remember the struggles and obstacles they have already been through and rediscover the strengths they possess that have helped them navigate these trials.

Case study

The following is a brief case study of a counseling experience that one of the article authors had with an undocumented family. Specific names and circumstances have been changed to protect the family’s identity. Many of the details of this case are common experiences that undocumented families face.

****

Marcus, an undocumented immigrant who is 14 and speaks Spanish, was referred to you by the school social worker. Marcus attends the first session with his 45-year-old mother, Elizabeth, who also speaks Spanish and is undocumented. Elizabeth shares with you that she immigrated alone to the United States 10 years ago. Because of financial difficulties, she had to leave Marcus with her parents in her country of origin. A few months before this first session, Marcus was able to join his mother in the U.S. Elizabeth shares that Marcus refuses to call her “mom” and acts very standoffish toward her.

Marcus shares that he doesn’t know why he had to come to the United States. He says that he was happy in his country of origin and misses his friends, grandparents and cousins. He also says that he doesn’t like school, that English is difficult for him to learn and that students at the school pick on him. He says he can understand the names the other kids call him and the mean things they say. He doesn’t have enough command of English to fight back with his words, however, so he uses his fists. Marcus has used his fists to fend off verbal attacks a number of times and, on each occasion, he has been suspended from school.

****

In this case example, Marcus’ microsystem changed suddenly. He was uprooted from the only life he had known, where he had friends and close connections to extended family. Using Bronfenbrenner’s model as a reference, we see that Marcus was separated from his ecological system — a system in which he knew the explicit and implicit cultural beliefs, values and rules and interacted with people who looked like him and shared his language. His microsystem changed from that of friends, grandparents, uncles, aunts and cousins to that of his mother and a schoolteacher.

Furthermore, Marcus’ mother, who for many years had been part of his exosystem — someone who influenced his life indirectly but didn’t interact with him outside of an occasional phone call and letter — became his primary microsystem. Elizabeth, who missed her son dearly and felt guilty for not being there to raise him, wanted desperately to pick up where they had left off before she immigrated to the United States. Marcus was not able to reciprocate her feelings, which hurt Elizabeth deeply.

Although Elizabeth had lived in the United States for a decade, she had interacted primarily with other Spanish speakers and largely remained in the shadows to avoid detection. Therefore, she struggled to communicate with school personnel at Marcus’ school and did not know how to help her son deal with the bullying that he experienced.

The counselor should take into account a number of factors when conceptualizing and treating this family. Systemically, it is important to recognize the changes (chronosystem) that have occurred in the lives of both Elizabeth and Marcus and how they are adjusting to those changes. The counselor might help Elizabeth recognize the adjustments that Marcus is experiencing and assist her in developing realistic expectations regarding their relationship. It also would be beneficial to further assess her relationship and interactions with Marcus’ school (mesosystem) and co-construct strategies to help her figure out what is going on in school and how to advocate for her son. The counselor also might consider ways that he or she can advocate appropriately on behalf of the family.

The counselor also might assess Marcus’ exosystem by understanding the stressors that Elizabeth faces in her daily life. These include working multiple jobs, experiencing pressure from family members in her country of origin to help out financially and dealing with ongoing fears of deportation. If Elizabeth is facing a great deal of stress and anxiety, the counselor could take care to validate Elizabeth’s emotions and provide her with stress-reduction tools.

The counselor can work with Marcus to develop healthy strategies for dealing with the verbal abuse he reports experiencing at school. The counselor also might work to broaden Marcus’ microsystem by looking into community programs in which Marcus might be interested, including sports programs, after-school programs or a mentorship program.

Conclusion and resources

Seemingly insurmountable barriers exist for undocumented children and families, but counselors can take a number of steps to facilitate the mental health of these clients. It can be particularly helpful to conceptualize undocumented families’ circumstances from a systemic perspective, such as Bronfenbrenner’s ecological systems theory. It also is helpful to validate clients’ experiences while drawing upon their resources, including the resilience and skills they have used to overcome past trials and struggles.

Finally, it is important for counselors to be aware of the resources that exist to help undocumented families. The following resources will get you started.

In addition, we recommend the following books for those who wish to deepen their personal understanding of the narratives of undocumented immigrants:

  • Enrique’s Journey: The Story of a Boy’s Dangerous Odyssey to Reunite With His Mother by Sonia Nazario
  • Underground America: Narratives of Undocumented Lives compiled and edited by Peter Orner

 

****

 

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Laura M. Gonzalez is an associate professor in the School of Education at the University of North Carolina at Greensboro, having received a Ph.D. in counselor education from North Carolina State University and an M.Ed. in college counseling from the University of Delaware. In addition, she has conducted research and outreach to the Latino immigrant community with the goal of enhancing educational access. Contact her at lmgonza2@uncg.edu.

Nathaniel N. Ivers is an assistant professor in the Department of Counseling at Wake Forest University. He received his master’s in counseling from Wake Forest University and a Ph.D. in counseling and counselor education from the University of North Carolina at Greensboro. He has published research and conceptual papers related to Latino immigrants and has provided counseling to the Spanish-speaking immigrant population in North Carolina. Contact him at iversnn@wfu.edu.

Letters to the editor: ct@counseling.org

 

****

 

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Counseling interns get firsthand exposure to immigrant experience

By Bethany Bray September 26, 2016

An innovative partnership in North Carolina is pairing counseling graduate students from the University of North Carolina at Charlotte with clients of a free medical clinic nearby. Many of these clients are recent immigrants.

According to those involved with the effort, the partnership provides the student interns with a chance to hone their counseling skills while also offering them a firsthand lesson in advocacy and social justice issues.

The Bethesda Health Center (BHC) provides free primary care, diabetes and hypertension management, and health education for low-income and uninsured residents of Charlotte and the surrounding county. The UNC Charlotte counseling interns offer mental health care alongside these physical health services.

The partnership provides much-needed care to minority populations who are, statistically, the least likely to seek or access mental health services, says Daniel Gutierrez, an assistant professor of counseling at UNC Charlotte, as well as a licensed professional counselor, licensed mental health counselor and member of the American Counseling Association.

It has also provided counseling students with some valuable learning that transcends the typical textbook lessons, says Katherine Wilkin, an ACA member and clinical mental health counseling student at UNC Charlotte. Wilkin, who was born in Venezuela, is able to offer counseling to BHC clients in Spanish and English.

The experience has opened Wilkin’s eyes to the cultural factors that often increase risks for mental health struggles, including the stress of navigating a language barrier and acculturation to a new location.

“My experience at Bethesda Health Clinic has enriched my training and has strengthened my passion for providing mental health services to the Hispanic population in their native language of Spanish,” Wilkin says. “… This program exposes counselors and students to a diverse population with unique issues. The [U.S.’s] growing Hispanic population calls for mental health professionals to be sensitive and aware of the cultural considerations when working with this population.”

UNC Charlotte’s work at BHC was highlighted recently by National Public Radio (NPR). CT Online reached out to Gutierrez for a Q+A to find out more.

 

CT: In your own words, how does this program meet a need?

DG: Latinos are the fastest-growing and largest minority in the U.S., and they experience mental health disorders at the same rate — some argue at higher rates — as the majority culture. Yet, when compared to the majority culture, they are the least likely to access mental health treatment. They, on average, receive a lower quality of care and end up presenting with more severe symptoms.

There is no doubt that there is a great need for effective and accessible mental health care for this population. However, there are numerous barriers that keep Latinos from accessing mental health treatment, such as language difficulties, a lack of appropriately trained mental health workers, stigma and an overall difficulty trusting providers.

On the other hand, counselor educators everywhere preach the importance of teaching our students to work with underserved and vulnerable populations, but we don’t always have the opportunity to give our students quality learning experiences doing this work. This program meets two needs: a) it creates access to appropriate mental health services for an underserved population; and b) it creates a diverse and dynamic learning experience for our students.

 

What have you learned from this program?

I don’t think you have enough room [in this article] to describe what I’ve learned. I learned how complicated it is to set up a program like this. I learned the importance of doing work with the I_learnedcommunity and not just in the community. This program has also reaffirmed my belief that understanding people is more important than understanding illness.

 

 

Talk about the logistics of how this program came together. What did it take to get started?

First off, the real credit goes to people like Wendy Mateo, the executive director of the Bethesda Health Center. Before all the publicity from NPR, and with limited resources and under some very challenging circumstances, Wendy was wholeheartedly serving the Latino community by providing medical care and chronic health management to the low-income and uninsured immigrant families in Charlotte. She does an amazing job and is an inspiration to helpers everywhere.

When we met with Wendy, she expressed that although they were making considerable strides in improving the physical health of Latinos in Charlotte, there was a great need for mental health services for their patients. We quickly realized that serving at a clinic that helps the underserved in Charlotte would be an amazing opportunity for our counseling students, and that our counseling students could provide the services that Bethesda truly needed. So, we brought together a team of faculty from different departments and began conversations about building counseling capacity at this free clinic.

We began by first evaluating the mental health needs for the current patients. We conducted chart reviews, spoke with staff at Bethesda and began to develop an understanding of what kind of mental health needs they were facing. We then had a series of meetings evaluating space needs; developing the right type of forms; discussing issues related to supervision, ethics, confidentiality, HIPPA compliance, how to manage interpreters; and examining the whole process for providing services.

I think we were all very aware that starting this program had many moving parts and that it wasn’t going to be as easy as just putting two chairs in a corner and assigning clients to students. It was a long and complex process, if we were going to do this right. These clients are already underserved by the community and are statistically more likely to receive substandard quality of care. It was important that we gave them the best care we could and that our students were going to have a positive experience.

After establishing a format and structure for the services, we recruited two doctoral-level counseling students who were licensed professional counselors to begin seeing clients. We called this our pilot study. We evaluated the progress of these initial students and used this data to inform the placement of master’s students. That following semester, we began placing master’s counseling students in their internships and practicums at the site. Thus far, the clients and the students both consider this program a great success.

 

Based on your experience, what advice would you give to counselors who might want to get involved in something similar in their local area?

One of the key members of our team, Mark DeHaven, is known for saying, “Collaboration is good, but partnership is better.” Too often we try to collaborate with community sites because they are great places to get data or place students, and that has merit. However, when you partner with a community agency, you begin to share responsibility and work together toward common goals, and that’s a whole other wonderfully beautiful thing.

I invite those who want to start these kinds of programs to begin by building strong community partnerships. It is complicated and sometimes cumbersome to partner with community agencies, but it has to be less about you and your agenda, and more about the needs of the people you are serving.

It’s also important that you develop a strong team of like-minded people [who are] willing to not just talk the talk but also walk the walk. I am lucky to work along some great and passionate people from different departments. Our team consists of Edward Wierzalis, a fellow Department of Counseling faculty member and the UNCC counseling program clinical coordinator; Mark DeHaven, a distinguished professor in public health science; Roger Suclupe, a lecturer from social work; Amy Peterman, an associate professor and director of clinical training in the Health Psychology Department; and a counseling Ph.D. student, Carolina Benitez.

This team made this project come together. So, my second piece of advice for future counselors is to build a good team.

 

The NPR piece says this came about because you were “looking to get more involved in the community.” Can you elaborate? Why is that important to you?

Well, I think this is probably a pretty personal question. I think everyone on our team serves in the community for different reasons. For me, I am driven by the spiritual ideas of welcoming the stranger, reaching out to those deemed the least and doing justice. I was also mentored by people who continually stated that in a world with so many health disparities, economic disparities and so much need, counselor educators should strive to go beyond mere talk and do impactful work.

After the NPR story went national, the first words from my mentor’s mouth were, “Some people got help — and that is the important thing.” I hang that email by my desk at work because it keeps me focused. Those of us with counseling training are equipped to do good in this world. Doing nothing seems like a mistake to me.

 

What type of nontextbook lessons have you seen your students learning?

Probably what I’ve enjoyed the most about this process is the surprising reactions I’ve seen from students. Our program has an emphasis on multiculturalism and diversity, so the students are well-versed in textbook knowledge. However, the internship experience [at BHC] offeredtears_in_eyes them a real quality experience working with a population that was culturally different from their own.

I have had students come to me during their experience and sit in my office with tears in their eyes, and say things like “I just didn’t know” and “I love working with these people.” I think it raised student awareness to some of the struggles Latino immigrants face, such as having to cope with the traumas they experienced before entering the U.S., the stress and anxiety of leaving loved ones behind, and trying to care for family with limited resources. They also expressed new levels of multicultural awareness and realized that there was much they had taken for granted, such as the ability to speak the same language as their clients.

At the end of the most recent semester, we had students describe their experiences, and most stated that what [they had] learned most form the program was “working with people who are culturally different from you,” “understanding that most Latinos are very different and come from different countries, even though they are all labeled as Latino” and “learning the challenges of working with translators and the importance of tuning into body language.” Students also stated that this site [BHC] provided them with experiences that many of the other sites could not.

 

What do you want counselors to know about this program and your experience with it?

I would want my colleagues across the country to know one thing: This is worth doing. Latinos and other racial ethnic minorities are not receiving services at the same rates as the majority population. There is a need for helping professionals willing to reach out to our communities.

This kind of work might be complicated to set up and require more energy than you want to expend, but it’s good work and it is worth doing. It’s a great experience for the students and the community. It’s not simple work; you will most likely make a lot of mistakes getting this kind of a program off the ground – I know we did – but it is so much better to dance and miss a few steps than to never dance at all.

 

****

 

From NPR: “Students Fill a Gap in Mental Health Care for Immigrants

Find out more about the Bethesda Health Center at caminocommunitycenter.org

 

Contact Daniel Gutierrez at DGutierrez@uncc.edu

 

****

 

Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

****

 

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.