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Professional Issues

Practicing cultural humility

By Sidney Shaw December 27, 2016

Privilege is invisible to those who have it.” This pithy statement from sociologist Michael Kimmel reflects the state of research on privilege and also calls attention to the importance of counselors raising self-awareness about how privilege affects their work. A general consensus exists among counselors that they need to be aware of their own privilege and need to be multiculturally competent. These aims can be rendered inert, however, in the absence of a conceptual framework and process that guide counselors to embody cultural responsiveness within counseling sessions.

The Multicultural Counseling Competencies (MCCs), a ubiquitous model in counseling, address three main domains:

  • Counselor knowledge about different cultures and cultural perspectives
  • Counselor skills to utilize culturally appropriate approaches
  • Counselor awareness of their own and their clients’ cultural heritage and the influence of culture on attitudes, beliefs and experiences

This tripartite, developmental model, developed by Derald Wing Sue and colleagues, has for several decades provided a foundation in counseling for how cultural competence is conceptualized, pursued and evaluated. In this article, the acronym MCCs is used to refer to this model. (Note that the Association for Multicultural Counseling and Development endorsed the Multicultural and Social Justice Counseling Competencies in June 2015. These competencies, which were also endorsed by the American Counseling Association Governing Council, revise the MCCs.)

Although the value of the MCCs in terms of counselor development is evident from research and counselor support, they have limitations related to counseling outcomes and the interpersonal process that unfolds between the counselor and the client in sessions. Specifically, outcome research connected to the MCCs has been based largely on counselors’ self-reports of their own levels of multicultural competence. Such evaluations suffer from self-assessment bias and do not capture the client’s experience. The few studies that have examined counselor multicultural competence from both the counselor’s and the client’s perspective have found that counselors typically view their own multicultural counseling competence much higher than clients view the counselor’s multicultural counseling competence. In other words, counselors often have an inflated view of their own multicultural competence in comparison with the client’s view.

This gap in perceived competence is concerning, in part because counselors’ beliefs about their general level of multicultural competence influence their behavior. Specifically, when counselors think they are high in multicultural counseling competence, they are less likely to put effort toward growing in this domain. Likewise, they are less attuned to responses from clients that might indicate the counselors are not as multiculturally competent as they think. Although the MCCs are useful for counselor development and self-evaluation, a more process-oriented framework is needed to address in-session multicultural processes and counselor multicultural competence from the perspective of the client.

With this in mind, multicultural orientation (MCO) offers an empirically supported model for counselors to understand how individual clients experience the multicultural dimension of counseling in the sessions. This article describes a framework for counselors to increase their multicultural counseling effectiveness, privilege the voice of clients and make the counselor’s own invisible privilege a little more visible.

Multicultural orientation

MCO consists of two major domains: the client’s perception of the counselor’s level of cultural humility, and the degree to which the counselor addresses culture and cultural opportunities in the session.

In the words of Joshua Hook and colleagues, cultural humility refers to the counselor’s “ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the client.” Cultural humility contains intrapersonal and interpersonal dimensions. Intrapersonally, cultural humility encompasses counselors’ openness to accepting that their own cultural identities and experiences will limit their perspective and awareness in understanding the cultural experiences of others. The interpersonal dimension of cultural humility involves an “other-oriented” stance that includes openness, respect, consideration, humility and interest regarding the client’s cultural identity and experiences.

Cultural opportunities refer to moments in counseling sessions when counselors are presented with opportunities to address and focus on the client’s cultural identity. For example, a cultural opportunity may emerge in a session when a client of a marginalized racial group discusses depression that is linked to being treated unjustly in the workplace. This presents an opportunity for the counselor to explore potential discrimination and the client’s cultural identity.

An essential feature of MCO is that it is rooted in the client’s perspective. Specifically, counselors need to understand the degree to which the client perceives the counselor to be expressing cultural humility and the degree to which the client thinks the counselor seized on or missed cultural opportunities in the session.

Multicultural counseling outcomes

Despite several decades of calls for counselors to develop multicultural competence, scant research exists to demonstrate that counselors’ self-rated multicultural competence is related to counseling outcomes. This is partly because counselors’ self-evaluations of their multicultural competence, while important for self-reflection and understanding and guiding counselor development, do not address clients’ views of their counselors’ competence levels. Emerging research on MCO demonstrates that adopting an interpersonal stance that is focused on cultural opportunities and cultural humility has a positive effect on client outcomes and offers a practical framework for cultural engagement with clients in sessions.

Research in 2016 by Jesse Owen and colleagues found that cultural opportunities had a significant influence on client outcomes. Specifically, researchers examined the perspectives of racial and ethnic minority clients on “missed cultural opportunities” in sessions and the relationship of these missed opportunities to client outcome. Missed cultural opportunities were evaluated by client report on a scale to assess the degree to which the counselor missed opportunities to discuss important cultural factors in the session.

Findings revealed that client improvement and increased wellness at the end of counseling were strongly negatively correlated with missed cultural opportunities. That is to say, as missed cultural opportunities increased, client improvement decreased. Clients experienced better outcomes in counseling when they perceived that their counselor responded to in-session opportunities to address cultural factors. These opportunities are the moments in session when counselors either engage in a culturally responsive way with clients regarding their cultural identity or they miss the opportunity.

In addition, several studies have demonstrated the positive effects of cultural humility on the therapeutic alliance and client outcomes. Instead of assuming that they are high in multicultural competence based on their own self-evaluations, counselors who are high in cultural humility typically engage in collaborative, open exploration with clients regarding their cultural identity as a salient factor in treatment.

Indeed, two recent studies by Owen and colleagues found a strong positive correlation between the client’s perspective of the counselor’s level of cultural humility and client outcomes. Essentially, when clients viewed their counselors as high in cultural humility, those clients experienced much more improvement in counseling than did clients who viewed their counselors as lower in cultural humility.

Cultural humility also mitigates the impact of missed cultural opportunities. Put another way, when counselors miss important cultural opportunities in the session, the negative effects of these missed opportunities on client outcome are neutralized if clients see their counselors as being high in cultural humility.

Implications for counseling

Understanding the role of culture in counseling is a challenging and multifaceted endeavor. Despite the complexities, some distinct themes have emerged regarding the benefits of MCO when significant counselor-client cultural differences are present.

As already mentioned, client perspectives of the two domains of MCO (cultural humility and cultural opportunities) are good predictors of client outcomes. There are also several overlapping themes from this research that suggest why MCO influences client outcomes. These themes suggest that the MCO model can help counselors:

  • Reduce the frequency and impact of microaggressions committed in counseling sessions
  • Effectively utilize dynamic sizing in sessions
  • Create a culture of feedback with clients

Microaggressions in counseling

Overt forms of discrimination based on race, sex, age, sexual orientation and many other identities have a long history in the United States and still persist today, but a more subtle and pernicious form of prejudice manifests in microaggressions. According to Sue and colleagues, microaggressions can take at least three different forms:

  • Microassaults (e.g., purposeful actions of discrimination such as name-calling)
  • Microinsults (e.g., subtle communications that demean a person’s cultural identity)
  • Microinvalidations (e.g., subtle communications that negate a person’s cultural reality, such as displaying colorblind attitudes or telling a person of color that you don’t see color)

Microinsults and microinvalidations generally fall outside of the perpetrator’s conscious awareness. People of privilege frequently view these microaggressions as banal, trivial and not a source of harm for the recipient. However, in addition to promoting stereotypes, microaggressions often cause frustration, anger, low self-esteem and physical health problems for recipients. Although counselors take multicultural counseling courses in which they explore their own biases, research indicates that counselors commonly and unwittingly commit microaggressions toward minority clients.

At least four published empirical studies in the past 10 years have examined the role of microaggressions in counseling. Microaggressions have been found to be associated with weaker working alliances, fewer sessions attended and poorer counseling outcomes. The percentage of racial and ethnic minority clients who reported experiencing microaggressions in counseling in these studies ranged from 53 percent to 81 percent. The most common microaggressions committed by counselors included declarations of colorblindness, avoidance of discussion of cultural issues and denial of their own prejudices.

Mental health professionals commonly commit in-session microaggressions, despite generally having good intentions. Privileged counselors are unlikely to notice when they commit microaggressions in counseling and frequently lack awareness of the untoward effects of these subtle slights.

Several important research findings are instructive regarding in-session microaggressions. Namely, counselors who are viewed by clients as being culturally humble commit fewer microaggressions than do counselors who are viewed as lower in cultural humility. Additionally, when counselors who are high in cultural humility (as viewed by the client) do commit microaggressions, the negative impact of these microaggressions is lessened. A separate study found that the negative effects of microaggressions were mediated when the counselor addressed and discussed the microaggression that occurred. Thus, cultivating cultural humility can help counselors reduce the frequency and impact of inadvertently committing microaggressions and learn to recognize, discuss and attempt to repair microaggressions that they do commit.

Dynamic sizing

The concept of dynamic sizing, as articulated by Stanley Sue in 1998, refers to counselors’ adaptable skills regarding when to generalize cultural knowledge or norms about a client based on cultural identity versus when to individualize. For instance, in their training, counselors gain cultural knowledge about particular groups. For example, “Native people perceive direct eye contact as disrespectful” or “Asian people are collectivistic, not individualistic.”

Such statements may reflect cultural norms and general group characteristics, but dynamic sizing entails the counselor’s ability to know when and how to generalize cultural information about a client in a way that applies to the individual and is not simply stereotyping. My own experience working in Alaska Native health clinics was illuminating in this regard. Specifically, two Alaska Native clients independently pointed out to me that they believed the “direct eye contact is disrespectful” concept was a residual effect of their ancestors being taught to be submissive by white colonizers. Thus, they did not endorse avoidance of direct eye contact in sessions and explicitly preferred more maintained eye contact with me than did some other Alaska Native clients.

MCO provides a conceptual framework that promotes dynamic sizing because it takes an interpersonal stance that focuses on elements of cultural identity and cultural opportunities in the counseling session that are deemed salient by the client. Specifically, MCO guides counselors to understand cultural norms and characteristics but not to view these elements as fixed variables. Instead, this interpersonal stance promotes understanding how culture informs each client’s life from the client’s perspective.

Creating a culture of feedback

Counselors with privileged identities are often unaware of the impacts a lack of privilege can have on marginalized and oppressed populations. In counseling sessions, this privilege frequently manifests through unconscious biases. Well-meaning counselors frequently do not recognize when unconscious biases or microaggressions occur because these are, by definition, unconscious.

Given this reality, it is important that counselors create a culture of feedback. This involves providing space for clients to feel safe and open to explore topics such as discrimination, systemic inequality, microaggressions and their lived experiences of marginalization. More to the point, the MCO model pushes counselors to embrace the fact that these manifestations of inequality (discrimination, microaggressions, etc.) are not something that clients experience only “out there” in the world. These manifestations frequently occur in counseling sessions too. Even well-intended, thoughtful counselors can inadvertently commit microaggressions, engage in stereotyping or exhibit poor cultural awareness, thus setting back or severing the therapeutic bond with clients. MCO helps counselors create a climate of trust and safety in which they can engage clients in difficult dialogues to better understand their perspective.

Putting it into practice

The MCCs and MCO share some broad, overlapping aims of increasing culturally responsive counseling services, reducing disparities and their negative effects, increasing counselor awareness of their biases and reducing these biases. Both models point toward a few central (but certainly not exhaustive) steps to take outside of counseling sessions to increase counselors’ overall multicultural competence. In addition, MCO emphasizes what counselors can do within sessions to increase their overall multicultural competence.

Out-of-session recommendations

  • Assess your level of multicultural competence by honestly completing the Multicultural Competencies Self-Assessment Survey (MCSA) developed by Manivong Ratts.
  • Follow a four-step process toward increasing multicultural competence based on the MCSA. These steps involve assessing your areas of need, defining objectives based on what you learned from the MCSA, designing a plan to meet the objectives and evaluating your success.
  • Engage in intentional cultural self-exploration related to counselor development. For instance, address questions such as: How does my cultural identity and privilege limit my ability to see or understand lack of privilege and marginalization? What are my gut reactions to clients who have different cultural backgrounds than my own? How do I create space for or welcome clients to explore their cultural identities? How open am I to my clients’ feedback about my level of cultural competence and cultural responsiveness?
  • Educate yourself about microaggressions, including the types that counselors commonly commit. Because microaggressions are the behavioral manifestation of beliefs and attitudes, the process is not as simple as telling oneself not to commit microaggressions. However, when practiced in conjunction with evaluating your own privilege, learning about marginalized populations and taking a stance of cultural humility, you can improve your skills in noticing microaggressions and making the necessary repairs.
  • Don’t conflate biases or committing microaggressions with being a bad person or a bad counselor. Like everyone else, counselors absorb and internalize cultural messages and stereotypes communicated through the media and broader culture. Accepting your own imperfection around cultural biases is essential to maintaining a growth mindset, developing cultural humility and benefiting from a new awareness that emerges over time. Denying your own biases and microaggressions will cause them to persist.
  • Read some peer-reviewed articles and engage in ongoing professional development regarding MCO, the MCCs, cultural humility and microaggressions in sessions.


In-session recommendations

Although the MCCs and MCO share general aims, their paths to increasing multicultural competence are quite different. In many ways, they are complementary.

The MCCs guide counselors toward developing specific knowledge, skills and awareness through personal work done outside of counseling sessions. For example, the MCCs provide counselors a framework for examining their biases, exploring the influence of their own cultural identities, assessing their multicultural competence for areas of strength and weakness, and developing culturally responsive intervention skills.

However, the final word on the overall cultural competence of a counselor rests in the perspective of each specific client. In other words, “Does this client experience me as culturally competent?” As found repeatedly in the counseling research, the client’s perspective on a number of important elements of counseling is often more strongly associated with counseling outcomes than is the counselor’s perspective. This holds true for core predictors of outcome such as empathy, the therapeutic alliance and multicultural competence/responsiveness. Thus, putting MCO into practice involves establishing an interpersonal stance of cultural humility and a willingness to explore cultural opportunities that are relevant to the client.

With this in mind, some in-session recommendations follow.

  • Reconceptualize your multicultural competence to include an emphasis on privilege and power in relationships, especially regarding their effects in the therapeutic relationship. Counselors often think through the lenses of their theoretical orientations in sessions (existential, cognitive behavior therapy, Gestalt, etc.). Work toward adding culture and privilege to the lenses that you intentionally consider in sessions.
  • Begin by acknowledging, during the informed consent process, the cultural differences between you and the client that the client may (or may not) see as important. Do this by acknowledging, explicitly, your potential lack of awareness of the client’s cultural experiences. For example, “You shared at the beginning of our first session today that you identify as a transgender person, and I know that many transgender people experience discrimination. If this is your experience, then I really want to ensure that I am aware and sensitive to the effects of this. Even though I try to understand clients’ experiences, I may unintentionally miss something that is really important in this area. As a person who is not transgender, I may have blind spots about your experience, but I will work hard to overcome these. If at any point it seems that I am missing or misunderstanding something about your experience in this regard, then I really welcome your comments on this.”
  • Acknowledge your biases or the microaggressions you commit in session, either when you notice them yourself or when your clients point them out. Clients might point these out indirectly, so be sensitive to nonverbal or subtle verbal cues that indicate the client may feel devalued in some way. If you think you might have committed a microaggression in the session but are not sure, check with the client. Depending on the level of severity, this might involve a simple question to the client about your concern regarding something you said or did. In the case of more egregious microaggressions, you might need to discuss it with the client in more detail and apologize for your lack of awareness.
  • Develop a culture of feedback, beginning with the first session and continuing throughout. Although clients are not responsible for teaching counselors about their cultural identities, counselors cannot possibly have complete understanding of how culture influences a particular client. A general example of creating a culture of feedback is as follows: “It is really important for me to make sure that I understand your perspective in our sessions. For instance, although I know some things about your cultural background, I may not fully understand at times how this impacts your life and relates to challenges that have brought you to counseling. I welcome your thoughts about anything you think I may not be getting in our sessions about you, your values or your cultural experiences. I really welcome your feedback.”
  • Near the end of each session, check in with clients about the therapeutic alliance and the cultural dimension of counseling in that session. For example, “Before we end today, I want to ask about how things were for you in our session. How did you feel about our session today? Did I seem to understand things from your perspective? Were there certain things that I missed or misunderstood regarding how culture plays a role in what we discussed today?” Counselors can also ask scaling questions here. For instance, “How would you rate our session today on a scale from 1 to 10, specifically regarding how well I understood the influence of your cultural background in what we discussed today? I would really like your honest feedback about this. If you have feedback that seems negative in some way, I welcome that, and it won’t hurt my feelings.”


MCO cannot be scripted or manualized, but its central features include communicating respect, practicing humility, being receptive to acknowledging one’s own biases when they occur and practicing culturally inclusive engagement that resonates with clients. An essential element of cultural humility is nondefensiveness around one’s own lack of awareness or demonstrations of incompetence. Thus, before encouraging client feedback, counselors need to be clear about how willing and able they are to receive this feedback with humility.

Cultural competence is not adequately defined by counselors’ self-perceptions of competence. Rather, it is determined by how their clients — especially marginalized clients — view the counselors’ capacity and willingness to understand the cultural forces that influence clients’ lives. Comprehending clients’ subjective cultural experiences and acknowledging our own cultural blind spots in the process are central to cultural humility. This interpersonal stance can help counselors improve client outcomes, honor the cultural experiences of clients and clarify the effects of counselors’ own privilege.




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

Sidney Shaw is a core faculty member in the clinical mental health counseling program at Walden University, a certified trainer for the International Center for Clinical Excellence and a workshop presenter. Additional information on multicultural counseling and other counseling topics is available at sidneyleeshaw.wordpress.com. Contact him at sidneyleeshaw@gmail.com.

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.

Is it OK to have it all?

By Kathleen Smith December 21, 2016

As Lindsey Mitchell approached the end of her doctoral program in counseling at George Washington University, she wasn’t quite sure what was next. After a decade of intense focus on her education, she found her career options in the field both exciting and intimidating. When Mitchell began talking to other women in her program about career choices, she realized that questions about ambition, leadership and family were common among female counselors.

Energized by these discussions with her colleagues, Mitchell decided to take the conversation to the American Counseling Association’s 2016 Conference & Expo in Montréal. Her idea took shape as a panel session called “To Lean In or Not to Lean In: The Diverse Experiences of Women in the Counseling Field.” The title alone was enough to catch the attention of many women at the conference and set the stage for an engaging talk between four ambitious and thoughtful counselors.

The phrase “lean in,” made famous by Facebook Chief Operating Officer Sheryl Sandberg’s 2013 book, Lean In: Women, Work and the Will to Lead, is rife with connotations and criticisms. Sandberg encouraged women to take risks, not make sacrifices based on hypotheticals, and to pursue leadership by taking a seat at the table. A former chief of staff for the U.S. Treasury secretary and a leader in the tech industry, Sandberg draws from her years of experience in male-dominated fields.

But when Mitchell and others considered this philosophy of leaning in, they faced an important question: What does “sitting at the table” mean in the counseling profession when the majority of counselors and ACA members are already female? Weren’t they already at the table?

A colleague of Mitchell’s recommended that she recruit Desa Daniel, a doctoral counseling student at Kansas State University, as a compelling voice for the ACA Conference panel discussion. Daniel thinks that numbers alone aren’t enough to change leadership dynamics. Although ACA and the counseling profession as a whole may be filled with women, she notes that leadership positions within the profession don’t always mirror those numbers. “We still have a long way to go until women hold positions in universities and governance that reflect their presence,” says Daniel, adding that she’d like to serve as president of ACA in the future. She currently serves as the student representative for Counselors for Social Justice, a division of ACA, and as student liaison for Division 45 (the Society for the Psychological Study of Culture, Ethnicity and Race) of the American Psychological Association.

Jessica Jackson, a licensed mental health counselor and a doctoral candidate in counseling psychology at New Mexico State University, also joined the discussion. She points to the male-dominated foundational and theoretical influence in the field as a real challenge. “When you look in the texts, our foundational knowledge is coming from men of European descent, and the structure of the training is based on that,” she says. “No one deviates from the blueprint, so to me, that doesn’t feel like a field dominated by women.”

Jackson also points out that texts such as Sandberg’s, as well as feminist psychology and various waves of the feminist movement, typically failed to include black women in the conversation. Part of her role on the panel, she says, was to help remind counselors that women of color can still be forgotten or excluded in a space that is predominantly female.

Having it all

Comedian Tina Fey wrote that the rudest question someone can ask a woman is, “How do you juggle it all?” Fey suggested the question operates on the assumption that, for women at least, success in one arena of life (e.g., the workplace) implies failure in another (e.g., family life). The question is rarely posed to men. Members of the conference panel set out to consider what “having it all” looks like in the counseling profession and whether balance between multiple arenas of life is possible.

“Can women have it all? I think yes, but we may have to package what that looks like in a different and creative way,” Mitchell says. Currently serving as an Americans with Disabilities Act counselor at Houston Community College, Mitchell points to the male-dominated workplace models that create impediments to women who desire balance between work and family life. For instance, she observes, when their children are ill, some mothers in the workforce will hide that fact and instead claim a sick day for themselves because they don’t want their parenting responsibilities to hurt how they are perceived at work.

“You would think that in a female-dominated field like counseling, it would be better,” Mitchell says. “But we’re still using these male business models instead of thinking about how we can be greater leaders to women that maybe we didn’t have. Sometimes we don’t have a model for what that looks like, so we have to start creating our own.”

These sentiments reflect a common critique of Sandberg’s idea — namely that Lean In ignores systemic obstacles that are present and remain unchanged in the workplace, regardless of whether women make it to the top playing by the current rules. So what rules do counselors need to change to make the workplace and the classroom more flexible and empowering places for women?

Mitchell asked Megan Doughty Shaine, an assistant professor of psychology and counseling at Hood College in Maryland, to bring her voice to the panel as a professor and parent. Shaine shared how her desire to have a multifaceted career and also be a mother affected her path. “It does change the way you move through your education, from the internships you accept, to the jobs you consider, to how you prioritize things,” she says. For example, Shaine limited her search for doctoral programs to the East Coast because she wanted to be close to her family when she started one of her own.

Shaine recommends that women in counseling leadership model how conversations about “having it all” are OK and even encouraged at work. “You’re more likely to have a female supervisor than a male supervisor, at least in the clinical world,” she says. “We have to really evaluate how open we are with these issues of work-life balance.”

Jackson agrees, pointing out that real pressure still exists to choose between focusing primarily on career or family in academia. “People don’t feel comfortable choosing a middle ground because that looks like you don’t know what you want,” she says. “But I don’t think it’s impossible to integrate and have both. My idea of success is being able to acknowledge and appreciate the many roles that I have as a black professional woman without having to sacrifice what means the most to me.”

Finding balance

Members of the panel also considered how to model what good mental health looks like for women trying to balance multiple roles in life. “So many of the conversations that we have about self-care feel fake,” acknowledges Daniel, who does CrossFit every day as a self-care measure. “We have to show tangible examples of what it looks like and how people manage it over the course of their careers. We need to lead by example but also help people set objectives and deadlines for self-care.”

Mitchell suggests that establishing and maintaining boundaries is an important piece of achieving balance. “I feel the pressure to be everything to everyone, and I know that is not a realistic expectation,” she says. “There will be stages in my life where my professional career has to take priority and other times when it will take a step down in importance. I know I entered this profession because I care about people and want to help, so there can be a conflict when I have to put myself first and inadvertently disappoint somebody in another area of my life. So it is a bit of a Catch-22. But this conflict will have to be resolved by continuing to reevaluate my values, my stage of life and what my goals are at the time. It’s an ever-changing process.”

Rather than a detour from success, Jackson sees the pursuit of balance as integral to achieving her goals. “I’m a happier and better person when I can feed the many different parts of who I am,” she says. “By engaging in prayer, checking in and being honest with myself, and being present in the moment, I am better prepared to achieve my idea of success. Potential conflicts may arise due to this expectation that to be successful in your career, you must dedicate your entire life to your career. But I don’t believe in that. I don’t believe that I have to achieve burnout in order to be successful.”

An intersectional approach 

Another critique of the philosophy behind the “lean in” movement and second-wave feminism is the relative lack of examination of women’s intersecting identities. At the ACA Conference, panel members wanted a significant amount of the conversation to focus on the diverse roles and identities of women in the counseling field and the impact this reality has on what it means to lean in.

Jackson points out how traditional advice given in books such as Sandberg’s, including the call to be assertive, may not work for every woman. “As a black woman, being assertive comes across as being the angry black woman. So how do I navigate the need to be assertive without also coming across as angry, even when I’m not angry? Because as soon as I’m assertive, that’s what everyone assumes,” Jackson explains. “When people give you advice, it’s coming from their social identity: their privilege, their background, etc. So you have to figure out what you can take from that and what you can leave.”

Jackson also recommends that female counselors gather both mentors who share their identities and those who do not to help them better navigate the field. When her interest in pursuing a research career led her to apply to the National Research Mentoring Network, she decided to choose a white male as one of her mentors to give her a different perspective. “He gave some insight on how to approach challenges rather than simply focusing on why people don’t understand things the way I do,” Jackson says.

For Jackson, who aspires to improve pipelines for people of color into academia and the mental health field, leaning in also includes starting conversations about the changing landscape of counseling and the reality that counselors don’t provide services to just one population. “We have to expand our ability to provide therapy to people with multiple identities and make room for them at the table as well,” she says. “If the path to leadership was really so linear, there would be a more diverse group of people stepping into those roles.”

Shaine asserts that counseling programs also have to address intersecting identities for their students, particularly those who are considered nontraditional. She points to the young women in her classroom who also work full time and the middle-aged mothers who are returning to school after a long hiatus or a career change. “We have to support them and try to be creative in helping students navigate a program,” she says. “Otherwise, we’re going to lose their voice and we’re going to end up with this monolithic student body, which I don’t think any of us want. That feels very antithetical to the counseling profession, where we want a diversity of perspectives.”

Counseling education programs could also use creativity and a focus on intersectionality to prepare women for a variety of roles in the field. Daniel points out that these programs rarely focus on issues such as licensure, starting a business or management roles. “Counselor ed programs need to step up their game and talk to people about what’s possible on the ground,” she says. “It’s socially unjust to send women out into the field without the full resources of what it really means to have a clinical practice.”

Advice from the panel

When asked what advice they would give to women entering a counseling education program or their first job as a counselor, panel members provided a variety of suggestions.

Mitchell, who aspires to a major leadership role in university student services, says that surrounding herself with the type of women who prompted these conversations in the first place was her best resource. “Sometimes we’re afraid to do that because we don’t want to feel like the least intelligent person in the room,” she says. “But you have to put your insecurities aside and see what you can learn from these women because, someday, you’ll be the person in the room somebody else is looking up to.”

Jackson says that advocating for your interests can go a long way. “If other people have that interest, then maybe you have enough people to request a class on that subject,” she says. “To me, that’s how change starts — being vocal and advocating for yourself.”

Shaine says women in the counseling profession shouldn’t lose sight of the flexibility they possess. “You can make a choice and change your mind later. We have an incredibly flexible field that gives us many different options. Be gentle with yourself,” she advises, “and know that the choices you make now can always be adjusted if they don’t suit you in the future.”

Daniel, who aspires to be a faculty member in a counselor education program, says that supporting other women can be empowering in itself. “We need to be better about supporting all women in their journeys, even if it doesn’t look like [our] own,” she counsels. “At the end of the day, we are creating pipelines for little girls to be what they want to be.”




Kathleen Smith is a licensed professional counselor and writer in Washington, D.C. Her book, The Fangirl Life: A Guide to All the Feels and Learning How to Deal, was published earlier this year. Contact her at ak_smith@gwmail.gwu.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.

Nonprofit News: Surviving the loss of key members

By “Doc Warren” Corson III November 28, 2016

When counselors look to build a board of directors and fill key positions in their nonprofit programs, it is imperative to remember that there are many different types of leaders.

Some leaders are great thinkers and developers of new ideas and programs but lack the desire to maintain or reconfigure a program once it has taken root. Others are great maintainers but may lack the skills to start a program from scratch or reconfigure an existing program. Still others are best suited to take an existing but lagging program and make it stronger than they found it originally. All of these leaders can serve a program well so long as the timing is right.

When an existing program finds itself in transition naturally, it may discover that certain invaluable board members are less than fully equipped to handle the transition. As a result, the program, or the board member, may seek to open that board position to new blood. This often leads to angst at some level. It is important to note that we are all replaceable; change in and of itself need not be seen as a negative.

Transitions can bring great change. The loss of key board members may indeed bring about changes that are less than ideal. Perhaps the board member had a particular passion or key connections that made a program stand out. The loss of a particular board member may mean the loss of that program, or at least a great reduction to it. This in and of itself can have an impact, but it can also allow the program to find a new niche or direction that may bring about growth that was previously unforeseen. It may also allow the main program to redirect funds to a new program or at the very least allow for some experimentation.

Years ago, we faced the need to expand our offerings because we had outgrown our space. We looked at locations for a second office that would have allowed us to do many of the same things we had already been doing for years, but we ended up finding an 1860s farm for sale about 4 miles from our original location. This purchase allowed us to greatly increase the services we were already offering and also add new types of services.

While we lost the “homey” feel that was characteristic of our first (now secondary) office, we gained a “homey community” feel as part of our therapeutic farm-based program. Now folks feel cozy even though they are in a building that is nearly 8,000 square feet. This was made possible through the many innovations introduced by new board members and key staff changes. At the time there was a great deal of change and transition, but we viewed these as a natural extension of what we always had.

The second and third generation of a board can make or break a program. When change is massive, such as the case of multiple key members leaving at once, this can lead to full-scale dilution of the organization’s main goals or mission. It can even lead to the possible dissolution of the program as a whole. More often than not, however, the loss of board members comes in small doses, and careful replacements can help secure the future of the program with little interruption. Be sure to do a thorough assessment of the program’s needs before selecting potential candidates. The “ideal” candidate may become less than effective if his or her abilities are not in line with the program’s current and emerging needs.

Everyone can be replaced. Panic can set in for some companies upon announcing the impending loss of a founder. Founding board members choose to leave for many reasons, though perhaps the most common reason is their wish to retire. Good leadership on the part of other key players can reduce any major transitional issues, however. Case in point: Albert Ellis,Depositphotos_43929729_m-2015 who developed rational emotive behavior therapy, was removed from the board of directors of the Albert Ellis Institute despite the fact that he founded the institute and it was named after him. In fact, he lived in the building that housed it! Sure, there was some backlash from fans and supporters after he was removed (a New York state Supreme Court judge later reinstated Ellis to the board, saying he had been removed without proper notice). Regardless, since passing away, both Ellis’ institute and his legacy remain intact.

Not all losses are real losses. Every nonprofit program will eventually see the loss of key members. Some of these losses will come as an initial shock, but in many instances, these losses can actually lead to new possibilities, especially if the person had been suffering from burnout or otherwise grown lethargic. New blood can lead to new energy, ideas and improved services.

Stay true to your core mission. It is very important to make sure that new members not only are aware of the history, mission, beliefs and ideals of your nonprofit program, but also appreciate and respect them so that the “original recipe” remains intact (even if some changes are needed to grow with the times). The culture of your nonprofit is key, and it is important that potential new board members are aligned with that culture.

Pay attention to demographic shifts and adjust accordingly. New members or not, it is important to look at demographic shifts and adjust your nonprofit programming as needed. Replacing some key members may actually help you to do this because there may come a time when your leadership team lacks some key knowledge or ability to meet an emergent trend. No one wants to be the company that is caught figuratively stockpiling DVD players in an increasingly wireless world.

Periodic mission adjustments are healthy. Staying true to your mission is healthy, but remember to update that mission on occasion. Transition times may be the perfect opportunity to review and tweak as needed. Examples may include adding different types of programs and increasing the scope (or possibly narrowing the scope) of your operation to reflect current needs and successes.

Replacing key members of your nonprofit need not be a time for strife. Do your homework, remember some key points and move forward. After all, worrying about the loss will do nothing to prevent it, so wouldn’t it be better to simply act proactively?

I’m rooting for you.




Dr. Warren Corson III

Dr. Warren Corson III

“Doc Warren” Corson III is a counselor, educator, writer and the founder, developer, and clinical and executive director of Community Counseling Centers of Central CT Inc. (www.docwarren.org) and Pillwillop Therapeutic Farm (www.pillwillop.org). Contact him at docwarren@docwarren.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.

Widening the scope of counselor self-education

By Kevin Glenn November 7, 2016

Counseling is not a profession that has a knowledge ceiling. We are always working diligently to grow our knowledge so that we can be more efficacious for our clients. All too often, however, counselors may find themselves studying the same general areas: their chosen theoretical branding-images_self-educationorientations, research studies on their favorite evidence-based practices, literature handed out by supervisors and so on. As a result, a vast array of topics that could greatly enhance counseling in profoundly meaningful ways often gets overlooked.

No doubt most counselors are aware of this, but many may be unsure of where to start. The purpose of this article is to identify three areas of study that counselors can explore to widen the scope of their self-education: eclecticism, theoretical counseling and neuroscience.

An alternative form of eclecticism

Many counselors use eclectic practices. This can be advantageous to therapy because it enables counselors to implement a variety of evidence-based practices under the umbrella of science.

Regardless of how beneficial this approach is to counseling, however, it still comes with limitations of which many counselors, and even supervisors, are unaware. Does this mean that eclecticism is bad or ought to be avoided altogether? Absolutely not, but counselors can be engaged in efforts to improve their eclectic practices in much the same way that clients work to improve their lives.

In their chapter on eclecticism in the book Critical Issues in Psychotherapy: Translating New Ideas Into Practice (2001) Brent D. Slife and Jeffrey S. Reber point out some key limitations to eclecticism. For starters, eclecticism actually does not fully accomplish what it originally set out to achieve: escaping single theories. All too often, what occurs is a mashing of evidence-based practices into a single therapeutic brief case. This brief case creates a single theory, much like psychodynamics, cognitive behavior therapy (CBT) or existentialism. This is important for counselors to understand so that they do not become too comfortable with their carefully crafted eclectic brief case. Otherwise, they run the risk of not branching out and, instead, unintentionally maintaining a narrow practice.

The most common eclectic practice is a collection of evidence-based practices administered under the umbrella of CBT. Many counselors refer to this as “eclectic CBT.” Arnold Lazarus is most responsible for the advent of this approach with his BASIC ID model (behavior, affect, sensation, imagery, cognition, interpersonal factors and drug/biological considerations), which he referred to as technical eclecticism underpinned by a basic social cognitive theory.

This epitomizes the single theory of eclecticism referred to by Slife and Reber. That in and of itself is not a problem. What is important is that counselors continually remain mindful of not closing themselves off to other potential avenues for helping clients achieve healing transformations. After all, that kind of narrowness, or tunnel vision, is precisely what led counselors to escape from operating under only one chosen therapy.

Counselors who become aware of this do not need to feel that their eclectic practice is wrong or inadequate. Simply being mindful of the need to look for ways to continually improve their practice is all that counselors need to do. For example, counselors looking to grow their eclectic practice might encounter the solutions put forth by John Norcross and Larry Beutler in their chapter on eclecticism and integration in the book Current Psychotherapies (2013).

One alternative they explored was a form of eclectic-like practice known as assimilative integration, which could be thought of as technical eclecticism version 2.0 because it operates very similarly. The key difference is that counselors using this form of eclecticism first identify a comprehensive theory of therapy rather than a basic minimalistic one (as advocated for by Lazarus). From there, evidence-based techniques can be incorporated for use with a stronger philosophy of care. Assimilative integration gives counselors a more detailed instruction manual for evidence-based practice than does technical eclecticism.

The theoretical side of counseling

Many counselors may be hesitant to explore assimilative integration because it requires a grasp of theory and theoretical concepts of psychotherapy. I can sympathize with that hesitation because I have felt it myself. There is no doubt that our clients experience similar hesitations when we expose them to unfamiliar interventions and encourage them to explore uncomfortable aspects of who they are when working on goals and objectives. As counselors, we can set the example for them by exploring theoretical aspects that will improve our knowledge of psychotherapy, our use of interventions and how we meaningfully relate to our clients.

So, start simple. A significant amount of literature is available that critically examines what we do in psychotherapy. Identify one or two subareas of this critical thinking and explore it at your own pace. Critical thinking about eclecticism is an ideal place to start. Critical Issues in Psychotherapy by Slife, Richard N. Williams and Sally H. Barlow is one of the most comprehensive yet reader-friendly resources I have found. Counselors looking for more of a challenge could explore Re-Envisioning Psychology: Moral Dimensions of Theory and Practice (1999) by Frank C. Richardson, Blaine J. Fowers and Charles B. Guignon. Articles in the Journal of Theoretical and Philosophical Psychology would likewise provide some excellent starting points.

Counselors who explore the theoretical aspects of counseling will gain knowledge about how to overcome the disadvantages of psychotherapy’s extant nooks and crannies. In turn, this will aid counselors, especially new ones, in dealing with those all-too-familiar crossroads in therapy. Additionally, counselors will gain the tools they need to develop a more comprehensive theory of care, greatly enhancing their use of the interventions they have selected for their brief case. Of course, this is also advantageous to clients because it promotes new avenues for growth.

There is much to learn from the theoretical side of counseling that can help counselors enrich their therapeutic relationships while maintaining professionalism. Recall that evidence-based practices are not the primary curative factor in counseling. That honor belongs to the therapeutic relationship that the client has with the counselor. Interestingly, evidence-based practices, as valuable as they are, do not inform counselors on how to relate meaningfully to clients. Theoretical and philosophical concepts of relationships do (which is why I find it extremely peculiar that the American Counseling Association does not yet have a theoretical division).

Regardless, as counselors discover and learn about theoretical modalities of relating to clients, they will instinctively formulate their own comprehensive theories of healing that can be incorporated into an assimilative integration approach. Counselors will quickly appreciate the meaningful value that a philosophy of care based on relationships can bring to their eclectic practices. They will also enjoy the flexibility to incorporate other knowledge and techniques not afforded by other modalities.


Many counseling theories reject the psychodynamics concept of the unconscious, whereas affective neuroscience has been gathering evidence of the existence of an unconscious. Counselors who staunchly adhere to one of these other models may not find out about this evidence if they remain focused solely on cognitive-based avenues of practice. However, a theory based on how to relate to clients would be more open to all evidence of causes and amelioration of human suffering. Whether the cause revolves around faulty cognitions, wayward processing in the unconscious resulting from maladaptive past parent-child relationships, or emotionally minded impulses (see dialectical behavior therapy), it can be integrated into a comprehensive relationship-based approach to therapy because each of those elements can be explored within the therapeutic relationship.

The affective neurosciences have much to offer counselors about how to help clients process their emotions. In his book What Is Emotion? History, Measures and Meanings (2009), Jerome Kagan draws on neuroscience (affective and cognitive) to demonstrate that emotions promote a form of awareness in humans that comes before cognitive awareness. Kagan cites Antonio Damasio, most famous for his books The Feeling of What Happens: Body and Emotion in the Making of Consciousness (2000) and Self Comes to Mind: Constructing the Conscious Brain (2010), who uses patients with injuries to key areas of their brains, including cognitive regions, to demonstrate how emotion leads to consciousness and then thoughts.

Instead of cogito ergo sum (I think, therefore I am), Damasio is suggesting the truth is closer to I feel, therefore I am. It is our thoughts that actually make sense of the emotions we feel. Without cognition, our emotions would still exist but would be unintelligible to us. This is the case with children who suffer from hydranencephaly. These children are born without a neocortex for cognition but still feel emotions because their limbic systems remain intact.

Whether a counselor actually agrees with any of this is not the point here. The point is that the affective neurosciences offer key information that can aid clinical practice, provided that counselors are a) willing to widen their scope of self-education and b) use a philosophy of care that is amenable to synthesizing other scientific truths and knowledge that might be equally vital to therapy, even if they challenge our own worldviews.

When clients bring up unfamiliar material 

Another reason it is vitally important for counselors to widen their scope of self-education is so they will be prepared for clients who bring new and challenging information to the therapeutic setting. This applies equally, if not more so, to counselor supervisors so that they can aid budding clinicians in these experiences. Consider the following vignette.

An eye movement desensitization and reprocessing (EMDR) therapist attempted bilateral stimulation with a minor client (I’ll call her “Rose”) in a treatment placement. Rose, who had been asking the treatment facility’s group clinician questions about how emotions and memories work in the brain, told the therapist she no longer wanted to do EMDR or CBT. The eclectic therapist — who used Adlerian therapy, CBT, dialectical behavior therapy, trauma-focused CBT and EMDR — inquired about the refusal. Rose revealed information she had learned in the group clinician’s group therapy sessions. This information, which came from the affective neurosciences, challenged Rose’s prior understanding of how the brain worked. In light of this new information, Rose had become disillusioned with EMDR. When Rose’s mother learned of this, she became equally concerned and approached the treatment facility’s clinical manager.

Previously unaware of the information from the affective neurosciences, the EMDR therapist determined that Rose was being resistant to therapy and also accused the group clinician of undermining the EMDR therapist to Rose and her mother. Although the ACA Code of Ethics say counselors of differing theoretical views are to collaborate, the EMDR therapist was confused by the affective neurosciences information and sought the help of the treatment facility’s clinical manager and clinical director instead of approaching the group clinician.

The group clinician was called into the clinical manager’s office to discuss the situation. The clinical manager, a licensed therapist, asked if affective neuroscience was a therapy and, if so, did it conflict with other therapies. The group clinician attempted to explain that affective neuroscience is not a therapy but rather a scientific discipline that sheds light on how emotions work in the brain via brain scans.

Because neither the clinical manager nor the clinical director was aware of the knowledge from the affective neurosciences, they immediately issued a supervisory directive that neuroscience was not permitted as a therapy or topic of conversation at the treatment facility. Both deemed the discipline too advanced for the facility’s clientele. This bewildered the group clinician because Rose had demonstrated an accurate understanding of what she had been taught from the affective neurosciences in the group therapy sessions.

Meanwhile, the EMDR therapist worked ardently and drudgingly to rebuild Rose’s buy-in to EMDR, never collaborating with the group clinician or working from where Rose was at now. The therapist’s session notes reflected an ardent stance that the group clinician had been unethical and Rose’s treatment had been sabotaged. The therapist also noted that she was employing various interventions from her eclectic approach to break through this new “resistance.” Ultimately, the therapist was never successful in restoring Rose’s buy-in.

Turning challenges into opportunities

The foregoing vignette is an example of what can happen when counselors remain unaware of knowledge and science outside of their chosen worldview and philosophy of care, and also refuse to educate themselves. The same could be said of the clinical manager and clinical director who, in their ignorance of the discipline, chose to shoo the topic away instead of embracing it for the benefit of the client. As informed consent experts teach us, this can create a slippery slope with federal law, which mandates that it is illegal for medical or behavioral health professionals to knowingly withhold scientific information that can have a bearing on a client’s choice to start or continue with therapeutic services.

Instead, we can embrace opportunities such as the one presented above by widening the scope of our own self-education. Deepening the practice of eclecticism with a comprehensive philosophy of care that does not close the door to other scientific knowledge is an excellent place to start. Yes, this might include stepping a little outside of our comfort zones into theoretical aspects of counseling, but this wider scope of knowledge and the understanding that comes with it will better enable counselors to dialogue with clients who bring challenging knowledge and questions to therapy.

These opportunities for dialogue hold the potential to strengthen the relationship between counselor and client, set an example for the client of humility and willingness to change, and deepen the overall therapeutic experience for both client and counselor. Supervisors who remain unaware of many other aspects of scientific knowledge and theoretical understanding risk stunting their supervisees’ professional growth when they are unable to help these supervisees navigate challenging situations with clients.

If all else fails, counselors ought to have the humility to say to clients, “I was not aware of this information. Can you tell me more about it? I will look into it moving forward.” What a brilliant example of humility we can offer to our clients by validating them in this way while simultaneously opening up new pathways for therapeutic conversations and rapport building. Any counselor looking to widen the scope of his or her own self-education should wholeheartedly embrace these opportunities to learn new information from clients while enriching their therapeutic experiences.




Kevin Glenn is a licensed clinical mental health counselor and theoretical counselor. Contact him at klg65@gmx.com.

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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.



Fraudster targets counselor’s innate empathy

By Bethany Bray October 20, 2016

Picture this scenario: You’re a counselor in private practice and a potential client contacts you via the email address listed on your practice website. The emailer expresses interest in attending marriage counseling with his wife, then goes into detail about the specifics of his situation and the struggles he and his wife are facing.

He requests to set up a series of appointments over four weeks while he and his wife are in town visiting relatives. After a series of emails back and forth, you discuss pricing and schedule depositphotos_5439676_m-2015appointments for the couple at your practice.

No cause for concern or reason to put up your guard, right? Not so, asserts a licensed professional counselor (LPC) and American Counseling Association member in Colorado who says she fell victim to a scam that followed that exact series of events, resulting in her losing several thousand dollars.

She agreed to share her story publicly with CT Online (on the condition that her name be withheld) because she wants to make other counselors aware of a scheme that preys particularly on their desire to help others.

“Even though we [counselors] are helpers, we are not immune to fraud,” the LPC says. “It wasn’t even on my radar to be thinking someone might try this. … I would want other counselors to know that people could be wanting to scam us at any given point in time.”

The fraud occurred when the emailer sent the counselor a cashier’s check in advance to pay for his couples counseling sessions. He contacted her soon after and explained – in multiple convincing, well-written emails – that there had been a mix-up and that the cashier’s check had mistakenly been made out for more than he owed her. He asked the counselor to send back the extra funds, and she agreed. After she wired the extra money back to the “client,” her bank returned the cashier’s check as uncollectable.

Unbeknownst to the counselor, banks often will make funds available before they are fully clear, which can sometimes take months.

“I didn’t want to hold on to money that wasn’t rightfully mine. I was trying to be the professional and do the right thing for these people,” she says. “When I found out I had been scammed, I went into the worst panic attack I have ever had. I couldn’t even hold my phone. I couldn’t talk. I was shaking. I thought to myself, ‘How did I get scammed?’ It didn’t make any sense.”

The counselor, who has been in private practice in Colorado for six years, has contacted her bank and filed a police report, but says she has been told there is not much else she can do to recover her money.

The counselor says that throughout the process, she never suspected any fraudulent activity on the part of the “client.” Potential clients have often contacted her via email, she says, and clients have also prepaid for a series of sessions.

In addition, the fake client’s emails didn’t resemble the “Nigerian Prince” scams that have proliferated over email. The counselor says the person posing as the husband with a troubled marriage had an email address with a major Internet provider and that the messages were well-written and detailed. The prospective “client” and the counselor emailed back and forth for weeks.

The LPC says it seemed like this person was somewhat familiar with the counseling profession. He knew the right questions to ask about her services and what they would cover in sessions.

She believes counselors are particularly vulnerable to this type of fraud because they are hard-wired to be empathic helpers. In addition, they are also used to normalizing the abnormal, she says. Because counselors often interact with people who are facing significant life struggles or are mentally ill, they are less likely to question atypical actions such as a person not returning phone calls, sending messages out of the blue or writing an email that is hard to decipher, she explains.

But the experience of being scammed has left her feeling hurt and vulnerable, the counselor says.

“I go out of my way a lot for my clients and sacrifice my time a lot more than I probably should because I want to help somebody,” she says. “I think that’s part of counseling. In order to be empathetic and compassionate to people and promote healing and wellness, a lot of time our time gets sacrificed. … In order to have a business, your clients’ needs sometimes have to come first, if not in line with our own needs.”

The experience does have a silver-ish lining, however. After the reality of the scam settled in, the counselor took time for self-reflection and re-evaluated her business practices. Going forward, she says she will be cautious about screening potential clients and will request information such as an address, an emergency contact number, the name of the client’s primary care doctor and other details before scheduling appointments.

“I would like to try and speak to people on the phone, prior to setting anything up — do phone consultations to validate that they’re real people,” she says.

“I’ve always felt like [counselors are] people who are trying to make the world a better place,” she says. “Why would anyone want to defraud us?”





ACA members: Facing a dilemma about ethics, business practices or risk management? Contact the ACA Ethics and Professional Standards Department at (800) 347 6647, ext. 321 or email: ethics@counseling.org






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


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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.